Parasigmoid inguinal hernia
Introduction
Introduction to sigmoid colostomy Colostomy is a treatment for colorectal malignant tumors, trauma and neonatal anorectal and rectal malformations. After abdominal abdominal resection (Mile), two pores can be formed in the abdominal cavity: stoma tube and left The gap between the lateral abdominal wall and the pelvic floor peritoneal suture or the bulge caused by the pelvic floor peritoneal splitting gap, the small intestine sliding into the two pores to form the sigmoid colostomy sulcus (postsigmoidostomichernia). Sigmoid colostomy is a complication of colostomy and can occur early in the postoperative period or several years later. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: acute diffuse peritonitis shock
Cause
Etiology of sigmoid colostomy
(1) Causes of the disease
After the sigmoid colostomy, the normal anatomical relationship changes, and the formation of pores between the sigmoid colon and the lateral abdominal wall is the potential basis of the disease, and the increase of intra-abdominal pressure caused by various reasons is the cause of the disease.
(two) pathogenesis
In the sigmoid colostomy, a hole is formed between the colon that is towed to the abdominal wall stoma and the left abdominal wall. The inner boundary of the pore is the sigmoid colon, the outside is the lateral abdominal wall, and the posterior side is the iliopsoas muscle (Fig. 1), which is like a ring. The suture or suture occlusion is not sutured during surgery. If there is significant bloating or peristalsis dysfunction after operation, it may cause the small intestine intestinal tube to enter the pelvic cavity through this abnormal passage to form internal hemorrhoids, causing mechanical obstruction of the small intestine. Even if the needle is narrowed, the sigmoid colon fistula of the stoma can also be obstructed by compression of the small intestine fistula through the ankle ring.
In acute intestinal obstruction, intestinal swell, gas accumulation, increased intestinal pressure, can cause blood circulation disorder caused by intestinal wall, leading to intestinal narrowing and necrosis, water and electrolyte metabolism disorder; chronic intestinal obstruction above the intestinal wall of small intestine A chronic hypertrophic inflammatory change.
Prevention
Sigmoid colostomy
Sigmoid colostomy is the pathological basis of sigmoid colostomy. Therefore, eliminating and reducing the sulcus during sigmoid colostomy is the key to prevent this disease.
1. During the operation, the sigmoid mesentery and the left wall peritoneum should be fixed by suture, and the left side of the colon can be closed to prevent the small intestine from entering the pelvic cavity by the left colon.
2. As far as possible through the extraperitoneal route sigmoid colostomy, completely eliminate the left side of the colon, so that no gap can be formed between the sigmoid colon and the left abdominal wall.
3. Before the sigmoid colon was raised, the peritoneum of the colon was cut open, the sigmoid colon was partially free and part of the descending colon was free, and then the sigmoid colon was externally placed outside the abdominal wall. The sigmoid mesentery was sutured intermittently with the cut outer peritoneum. The distance between each needle is about 1cm. The number of suture needles should be determined according to the length of the lateral peritoneum. After the suture is completed, check with your fingers. The index finger should not be used to prevent the collaterals in the colostomy. The colostomy can be retracted to the abdominal cavity. The occurrence of internal complications.
4. Postoperative recovery of intestinal peristalsis, avoid the use of Xinsi's Ming class to enhance intestinal peristalsis drugs.
In addition, some people in China believe that the small intestine is arranged in the colon frame before the abdomen, and the omentum is covered to reduce the tendency of the small intestine to drill to the left side of the colon. Some foreign scholars advocate the use of transabdominal or midline colon. The mouth replaces the left lower abdomen colostomy, and the small intestine is placed in the colon frame before closing the abdomen, while the left colonic side groove is ignored and closed.
Complication
Sigmoid colostomy Complications acute diffuse peritonitis shock
A large number of intestinal intrusion and compression through the ankle ring, incarceration, intestinal blood supply disorders and strangulation, necrosis, clinical manifestations of diffuse peritonitis and toxic shock, abdominal puncture may have bloody fluid extraction.
Symptom
Symptoms of sigmoid colostomy sputum common symptoms huge colon abdominal discomfort bowel abdomen tenderness nausea abdominal muscle tension
Most of the disease (about 70%) occurs during the recovery period of bowel movement after colostomy surgery or before discharge, and can also occur in several years after surgery. The clinical manifestations are acute intestinal obstruction or chronic intestinal obstruction.
1. Acute intestinal obstruction
Sudden onset of paroxysmal abdomen pain, bloating, vomiting, cessation of bowel movements and venting, and bowel sounds in the patient's umbilical cord and left lower abdomen, can be heard and gas.
2. Chronic intestinal obstruction
Some patients have long-term abdominal pain after sigmoid ostomy surgery, abdominal discomfort, this situation is mostly larger than the sigmoid colon, the contents of the small intestine into the pelvic cavity are caused by poor passage, once a large number of intestinal intrusion and compression through the ankle ring, incarceration , on the basis of chronic intestinal obstruction, the appearance of acute obstruction.
Examine
Examination of sigmoid colostomy
Abdominal fluoroscopy or abdominal plain film shows intestinal gas accumulation, and there are signs of intestinal obstruction such as step liquid level.
Diagnosis
Diagnosis and differentiation of sigmoid colostomy
diagnosis
Preoperative diagnosis of mechanical small bowel obstruction is relatively easy, but it is more difficult to diagnose the disease. Most cases are diagnosed as sigmoid colostomy by performing surgical exploration after conservative treatment failure. Considering the following points, the possibility of the disease may be considered. .
History
For patients with sigmoid colostomy due to rectal cancer and rectal trauma, acute intestinal obstruction occurs suddenly during the recovery period of postoperative bowel movement or before discharge. It is characterized by sudden umbilical and left lower abdominal cramps, accompanied by nausea and vomiting. Defecation, the disease develops faster; or there is chronic intestinal obstruction after surgery, such as progressive abdominal distension, abdominal pain, slow development of the disease and other symptoms.
2. Signs
Abdominal tenderness, the lower abdomen is most obvious, the bowel sounds are hyperthyroidism, and the abdominal muscles are tense in the later stage, and the bowel sounds weaken or even disappear.
3. X-ray inspection
Abdominal fluoroscopy or plain film shows signs of intestinal obstruction in the small intestine, liquid level and the like.
Differential diagnosis
It must be differentiated from pelvic floor perforation and adhesion intestinal obstruction after Miles surgery in low rectal cancer patients. Some authors pointed out that early postoperative intestinal obstruction, suspected pelvic floor peritoneal hiatus, can be inserted into the perineal wound by colonoscopy. If you see the bowel that is taken out, you can diagnose it.
