Partial resection of cecum and ascending colon injury, primary anastomosis, proximal ostomy

Partial resection of the cecum and ascending colon, one-stage anastomosis, and proximal ostomy for treatment. Colon injury is one of the more common intra-abdominal organ injuries, second only to small bowel injuries. Almost all colon injuries are secondary injuries to abdominal penetrating injuries. The blunt trauma of the colon only accounts for 3% to 5%, and the rectal injury accounts for less than 20% of the colorectal injury. Characteristics of colorectal injury: 1 Colon and rectum are the most common intra-abdominal organs. According to the measurement, each gram of feces contains about 1011~12 anaerobic bacteria. Escherichia coli 108, anaerobic bacteria have developed resistance to most antibiotics. Medicinal. Therefore, once damaged, it is highly susceptible to infection. 2 The colon wall is thin, especially the right colon, the blood circulation is poor, and the healing ability after injury is far less than that of the small intestine. Due to its physiological and biochemical characteristics, intestinal flatulence often occurs after colon surgery, resulting in anastomotic leakage, causing severe intra-abdominal infection. 3 There are many interstitial spaces around the lower end of the rectum, and there are more loose fat connective tissues filled in the lower part of the rectum. The blood supply is poor, and the infection easily spreads to the surrounding tissues after the injury. The ascending and descending colons are relatively fixed, and the posterior wall is located in the retroperitoneum. It is easily missed after injury and causes severe peritoneal infection. 4 colorectal injury is often accompanied by other tissue and organ damage, causing difficulties in diagnosis and treatment. 5 colorectal blunt trauma is easy to miss or misdiagnosis, treatment is not timely, easy to cause adverse consequences. It has been reported that the infection rate after colon rectal injury is as high as 25% or more, and infection is considered to be the main cause of postoperative death and complications. Therefore, early diagnosis, timely and effective treatment of colorectal injury is very important. Treatment of diseases: cecal torsion Indication 1. A wide range of cecal and ascending colon injury or mesangial vascular injury, affecting intestinal blood circulation. 2. The ideal one-stage resection and anastomosis: 1 The patient is generally in good condition and has no signs of shock. 2 surgical treatment was performed within 6-8 hours after injury. 3 no serious combined injuries. 4 abdominal cavity pollution is not serious. Contraindications The general condition is poor, and the abdominal cavity is seriously polluted. Preoperative preparation 1. Anti-shock with a colonic injury with shock, the mortality rate can be as high as 80%. Therefore, active and effective anti-shock in preoperative is of great significance in the treatment of colonic injuries. 2. The application of antibiotics currently advocates a combination of drugs, such as the combination of gentamicin and clindamycin, starting the drug before surgery, and continuing to use 7-8 days after surgery. 3. Gastrointestinal decompression can prevent postoperative flatulence. Surgical procedure 1. Use the intestinal tissue clamp to clamp the intestinal wall of the lesion, and wrap it with a gauze pad to reduce the contamination of the abdominal cavity during surgery. Absorb the peritoneal exudate, feces and blood clots. After washing the abdominal cavity with a large amount of warm isotonic saline, the operation was performed. 2. The peritoneum is cut in the lateral aspect of the ascending colon, and the cecum and ascending colon are bluntly separated and lifted out of the incision. The extent of the resection is determined according to the location and extent of the injury. Generally, the right cecum and ascending colon injuries are treated with right hemicolectomy and ileum transverse colon end-to-end anastomosis. complication 1. Anastomotic fistula, if the suture technique is perfect, it is caused by excessive flatulence or mesenteric vascular ligation. The former and the intestinal paralysis exist at the same time and are not easy to detect. The latter has a clear clinical manifestation, mainly for the performance of advanced peritonitis. If the abdominal inflammation is obvious and the scope is wide, the laparoscopic drainage should be performed. If the inflammation is limited, a few needles can be removed from the incision suture, and the drainage can be placed and treated with non-surgical treatment. 2. Anastomotic stenosis: mild stenosis, no special treatment, due to the expansion of feces, most of them can be relieved. Severe stenosis requires surgery.