Terminal ileal and right colectomy in Crohn's disease

End ileum and right colectomy for Crohn's disease are used for surgical treatment of inflammatory bowel disorders. The infectious intestinal disorders discussed here mainly include localized enteritis (Crohn's disease) and ulcerative colitis. The former is an idiopathic chronic non-specific inflammation of unknown cause. Its pathological features are mainly segmental lesions, which invade the various layers of the intestinal wall and form non-caseal granuloma. About 80% of the lesions occur at the end of the ileum, but also involve the cecum, ascending colon, and sigmoid colon, and can even affect various parts of the digestive tract. In the acute phase of the disease, abdominal pain, diarrhea, and blood in the stool may occur. In some cases, perforation may occur; in the chronic phase, intestinal stenosis, intestinal adhesion and internal hemorrhoids may be formed, or fistulas may be formed with adjacent organs. The disease should be treated with active medical treatment before the occurrence of complications, because the surgical treatment is very poor, about half of them may recur within 4 to 5 years after surgery, so the surgery should strictly control the indications. Ulcerative colitis is an unexplained inflammatory lesion of the colon that mainly affects the mucosal and submucosal tissues of the colon and, in severe cases, the entire layer of the colon. The symptoms are particularly severe in children with this disease. The disease often occurs in the rectum and then spreads to the proximal colon, and can even affect the entire colon. Early colonic mucosal congestion, edema, microscopic mononuclear and multinucleated leukocyte infiltration. The lesion develops further and gradually forms a small ulcer. After fusion, it expands into a wide range of irregular large ulcers. After the ulcer is healed, the pseudopolyps in the intestine can be left behind. Intestinal wall fibrous tissue hyperplasia causes thickening and narrowing of the intestinal wall. A few serious cases can spread to the muscular layer, causing severe intestinal blockage, and even cause toxic megacolon, intestinal perforation and massive bleeding, and cancer can occur in some cases. The treatment of this disease is mainly based on internal medicine, and surgery is only required if strict medical treatment cannot be controlled or complications occur. Treatment of diseases: ulcerative colitis Indication End ileum and right colectomy for Crohn's disease apply to: 1. Localized enteritis (Crohn's disease) is suitable for surgical treatment under the following conditions: 1 combined with massive bleeding or perforation; 2 severe poisoning symptoms; 3 acute abdominal pain, excluding surgical acute abdomen; 4 long-term medical treatment with intestinal obstruction , internal hemorrhoid formation and severe perianal lesions as well as extraintestinal fistula and abdominal cavity infectious mass. If the sick child is slow-growing due to the disease, it is recommended to perform surgery as early as possible in childhood. 2. Ulcerative colitis is suitable for surgical treatment in the following cases: 1 systemic medical treatment is still invalid for more than 1 year; 2 combined with massive hemorrhage, intestinal perforation or toxic megacolon; 3 intestinal obstruction, can not be relieved by non-surgical treatment; 4 The course of disease is longer, suspected of malignant transformation; 5 cases of arthritis, pyoderma, iritis and other systemic complications; 6 children with this disease growth and development pause. According to the characteristics of the lesions before surgery, according to the characteristics of the lesions, according to the following principles, choose a reasonable surgical method: 1 for localized enteritis, such as bleeding, perforation spreads a small range, does not belong to multiple lesions, and sick children Good condition, feasible one-stage intestinal resection and intestinal anastomosis; if the lesion is in the ileocecal or right colon, in order to prevent postoperative anastomotic leakage, it is recommended to remove the right colon and do the ileum and transverse colostomy. Total colectomy or subtotal colectomy and ileostomy are only available for a wide range of colonic lesions. 2 For ulcerative colitis, if the disease is generally not good, can not tolerate major surgery, first ileostomy, until the symptoms are relieved, the condition is improved and then enteral resection. Subtotal colectomy and ileostomy were performed in infants and young children. Preoperative preparation 1. Infectious intestinal diseases After systematic medical treatment or complications, in addition to emergency surgery, generally perform necessary digestive examinations (such as barium meal, barium enema, fiber enteroscopy, etc.) before surgery to understand the lesions. Nature and scope of violations in order to rationally choose the surgical approach. 2. Actively improve the general condition of sick children such as correcting anemia, hypoproteinemia, water-electrolyte balance disorders or severe poisoning symptoms, including blood transfusion, infusion, infusion of plasma and albumin. 3. Apply antibiotics to prevent infection, and apply intestinal antibacterial agents to prepare for adequate bowel preparation. Surgical procedure 1. A transverse incision on the right side of the incision or a rectus abdominis incision in the right lower quadrant. 2. Explore the small intestine and colon, to understand the extent of the affected intestine (the most common part of the disease is the terminal ileum), the diseased intestinal tube hypertrophy, with or without fistula formation. 3. Cut the ileum from the proximal end of the lesion 5 cm, free the ascending colon, cut the peritoneum of the ascending colon, and reach the right curvature. The blood vessels were ligated with silk, the ascending mesenteric membrane was cut, the right colonic artery and the ileal artery were ligated, and the colon was cut by clamping in the vicinity of the right curvature, and then the affected intestine, ascending colon and terminal ileum were removed. 4. The end small intestine and the colon were end-to-end anastomosis, sutured with a 2-0 silk suture, and the muscle layer was sutured. The mesangial holes are then sutured intermittently with silk. complication 1. When the sick child is generally in poor condition, total colon resection and partial small bowel resection may be difficult to tolerate, traumatic shock and hemorrhagic shock may occur, or the incision may be healed poorly and the incision may be cracked. 2. Cases of localized enteritis should be completely removed, otherwise it may cause the formation of anastomotic leakage, or recurrence or even cancer in a short period of time, bringing new problems to treatment. 3. Postoperative abdominal or incisional infection, infectious intestinal disease with internal hemorrhoids, perforation, has seriously contaminated the abdominal cavity, and even formed diffuse, localized peritonitis and abdominal abscess, so in addition to the removal of the diseased intestine segment, should Clear other lesions in the abdominal cavity and drain the abdominal cavity, and actively fight infection treatment. 4. If the lesion recurs, non-surgical therapy should be used in time, and surgery should be performed in case of complications.