Colon obstruction
Introduction
Introduction Colonic obstruction can occur anywhere in the colon, but in the left colon. Cancerous obstruction often has typical chronic colonic obstruction, such as constipation, diarrhea, pus and bloody stool, bowel habits and shape changes; abdominal pain in right colon obstruction in the right and middle abdomen, left abdominal obstruction and abdominal pain in the left lower abdomen . Chronic obstruction can develop gradually or suddenly into acute obstruction. Beal suggested that progressive bloating and constipation in the elderly are typical colon cancer obstructions. Normal people have 10% to 20% ileocecal valve insufficiency, part of the colon content can return to the intestine to cause small intestine dilatation, gas accumulation, fluid, easily misdiagnosed as low intestinal obstruction. If the ileocecal valve function is good, a closed bowel segment is formed between the ileocecal part and the obstruction part; at this time, the gas and liquid in the ileum continuously enter the colon, causing the colon to swell, the abdominal distension is obvious, and the exhaust and defecation are completely stopped, but still No vomiting. In addition to abdominal distension during the examination, intestinal type or sputum and lump can be seen, and digital rectal examination and X-ray examination should be performed. In the abdominal fluoroscopy or abdominal plain film, the proximal intestinal fistula showed obvious expansion, and the distal intestinal fistula showed no gas. The standing position showed fluid level in the colon. Barium enema helps to identify, and at the same time it can play an important role in establishing the site of obstruction and the cause. Buechter reported a diagnosis rate of 97% and 94% for abdominal X-ray and barium enema, respectively.
Cause
Cause
The main causes of colonic obstruction are as follows:
(a) cancerous obstruction
The primary cause of colonic obstruction. Buechtor reported that colon cancer obstruction accounted for 78% of colonic obstruction, and the literature reported that the cancerous obstruction below splenic flexion was 72% to 88%. Tumor location: 39% of the left colon is more common, followed by 27% of the transverse colon, 19% of the right colon, and 15% of the rectum. The common sites of colonic obstruction were: sigmoid colon 38%, spleen 14%, descending colon 10%, transverse colon 9%, rectum 9%, cecal 6%, ascending colon 5%, anal curvature 3%.
(two) colonic torsion
The second common cause can occur in the cecum, transverse colon and sigmoid colon, but is most common in the sigmoid colon. According to statistics from the United States and Western Europe: 1% to 7% of colonic obstruction is caused by colonic torsion, of which the sigmoid colon accounts for 65% to 80%, and the right colon is 15% to 30%. The transverse colon and spleen are rare.
The sigmoid colon has the following three conditions. 1 sigmoid colon length; 2 sigmoid mesenteric base contraction; 3 weight gain in the intestinal segment (such as constipation, overeating) and external force (strong bowel movement).
(3) Colonic schistosomiasis
In the epidemic area of schistosomiasis in China, schistosomiasis granuloma or colon cancer is still seen; because a large number of schistosomiasis eggs are deposited in the intestinal wall, repeated inflammation, destruction and repair, so that the intestinal wall tissue hyperplasia thickens, forming polyps, causing intestinal The cavity is narrow and obstructed.
(D) acute pseudo-colon obstruction (Ogilvie syndrome)
The disease was proposed by Ogilvie in the United Kingdom in 1948. There have been many reports since, and the disease has increased in recent years. The exact cause of the disease is unknown. According to the literature from 1948 to 1980, 88% were caused by causes other than colon, such as surgery, trauma, heart failure, uremia, diabetes, ischemic enteritis, metastatic tumors, hypoxia and hypotension. Etc. 12% of the reasons are unknown. The mortality rate of non-perforated patients was 25% to 31%, and those with perforations were 43% to 46%. Fariano believes that the disease is associated with parasympathetic dysfunction of the ankle. Matsui reported that some of the nerve conduction dysfunction caused the disease, and under the microscope, the number of ganglion cells in the intestinal wall was reduced, and the nerve cells were degenerative. Bode reported 22 cases of the main cause of surgery.
(5) pelvic adhesion after colonic obstruction
The characteristics of this disease are:
More than 1 occurred in middle-aged women after pelvic surgery;
2 intermittent bloating, chronic abdominal pain and constipation;
3 enema has no special lesions;
4 fiber colonoscopy showed sigmoid colon angle, also stenosis, to prevent colonoscopy.
(6) Obstruction caused by compression or invasion of extratumoral tumors
For example, pancreatic cancer or gastric cancer invades the transverse colon and causes obstruction; it is not uncommon for female pelvic tumors, especially ovarian tumors, to cause obstruction caused by sigmoid colon.
(7) Gallstone obstruction
Colonic obstruction accounts for 1% to 3% of all intestinal obstruction, and the preoperative diagnosis rate is only 15% (13% to 48%). Gallstone enters the digestive tract.
1 gallbladder - twelve intestinal fistula (more common);
2 gallbladder - colon fistula;
3 gallbladder - stomach cramps;
4 common bile duct, duodenal fistula. In some cases, gallstones can enter the duodenum directly through the dilated ampulla.
Examine
an examination
Related inspection
Fiberoptic colonoscopy, digital examination of the gastrointestinal tract CT examination of abdominal plain film enzyme tumor markers
1, colonic obstruction can occur in any part of the colon, but the left colon is more. Cancerous obstruction often has typical chronic colonic obstruction, such as constipation, diarrhea, pus and bloody stool, bowel habits and shape changes; abdominal pain in right colon obstruction in the right and middle abdomen, left abdominal obstruction and abdominal pain in the left lower abdomen . Chronic obstruction can develop gradually or suddenly into acute obstruction. Beal suggested that progressive bloating and constipation in the elderly are typical colon cancer obstructions. Normal people have 10% to 20% ileocecal valve insufficiency, part of the colon content can return to the intestine to cause small intestine dilatation, gas accumulation, fluid, easily misdiagnosed as low intestinal obstruction. If the ileocecal valve function is good, a closed bowel segment is formed between the ileocecal part and the obstruction part; at this time, the gas and liquid in the ileum continuously enter the colon, causing the colon to swell, the abdominal distension is obvious, and the exhaust and defecation are completely stopped, but still No vomiting. In addition to abdominal distension during the examination, intestinal type or sputum and lump can be seen, and digital rectal examination and X-ray examination should be performed. In the abdominal fluoroscopy or abdominal plain film, the proximal intestinal fistula showed obvious expansion, and the distal intestinal fistula showed no gas. The standing position showed fluid level in the colon. Barium enema helps to identify, and at the same time it can play an important role in establishing the site of obstruction and the cause. Buechter reported a diagnosis rate of 97% and 94% for abdominal X-ray and barium enema, respectively.
2, sigmoid colon torsion often has a history of constipation or multiple abdominal pain episodes in the past, after defecation, exhaust symptoms after relief. In addition to abdominal cramps, there is significant abdominal distension, and vomiting is generally not obvious. Abdominal X-ray plain film can be seen as "an abnormally flattened double-twisted bowel, which is horseshoe-shaped and almost fills the entire abdominal cavity." When in doubt, it can be used as a sputum enema, and it is "bird's beak" in the obstruction.
3, the clinical manifestations of colonic obstruction are basically similar to the general small bowel obstruction, the clinical manifestations have the following characteristics:
1 All patients have abdominal pain, the right colonic obstruction is mostly in the right upper abdomen, the left half is mostly in the left lower abdomen, the chronic obstruction is slightly abdominal pain, the acute obstruction is severely abdominal pain, but not as severe as the volvulus and intussusception;
2 nausea and vomiting appear later, even absent. Later, the vomit was yellow fecal-like content with a foul smell;
3 abdominal distension is obvious, small intestinal obstruction, both sides of the abdomen protruding, sometimes horseshoe shape;
4 anus stops defecation and deflation, but most patients can still have a small amount of gas in the early stage of obstruction;
5 physical examination showed obvious abdominal distension, can be horseshoe-shaped, percussion is drum sound, auscultation can smell the sound of water. X-ray plain film examination showed obvious colonic effusion, gas accumulation, and a liquid level.
In short, except for colonic torsion, the clinical manifestations of colonic obstruction are not as typical and severe as small bowel obstruction.
Diagnosis
Differential diagnosis
Colonic obstruction should be distinguished from small bowel obstruction.
Intestinal obstruction: After pathologically obstructing the intestinal lumen of the small intestine, the contents pass through the obstruction, and the small intestine lumen above the obstruction plane expands and the intestinal lumen below the obstruction plane collapses. The expansion or/and enlargement of the intestinal lumen begins with a proximal segment near the obstruction, and becomes lighter as it expands toward the upper end. As intestinal contents (mainly gases and liquids) are blocked, they accumulate in the dilated intestinal lumen above the obstruction. Therefore, there are more gas and liquid in the dilated abdominal cavity above the obstruction. Severe obstruction or long obstruction time, large pressure in the intestinal lumen and obvious expansion of the intestinal lumen, it is easy to cause blood vessels in the intestinal wall to be compressed and cause blood supply disorders and formation of necrotic perforation of the intestinal wall.
1, colonic obstruction can occur in any part of the colon, but the left colon is more. Cancerous obstruction often has typical chronic colonic obstruction, such as constipation, diarrhea, pus and bloody stool, bowel habits and shape changes; abdominal pain in right colon obstruction in the right and middle abdomen, left abdominal obstruction and abdominal pain in the left lower abdomen . Chronic obstruction can develop gradually or suddenly into acute obstruction. Beal suggested that progressive bloating and constipation in the elderly are typical colon cancer obstructions. Normal people have 10% to 20% ileocecal valve insufficiency, part of the colon content can return to the intestine to cause small intestine dilatation, gas accumulation, fluid, easily misdiagnosed as low intestinal obstruction. If the ileocecal valve function is good, a closed bowel segment is formed between the ileocecal part and the obstruction part; at this time, the gas and liquid in the ileum continuously enter the colon, causing the colon to swell, the abdominal distension is obvious, and the exhaust and defecation are completely stopped, but still No vomiting. In addition to abdominal distension during the examination, intestinal type or sputum and lump can be seen, and digital rectal examination and X-ray examination should be performed. In the abdominal fluoroscopy or abdominal plain film, the proximal intestinal fistula showed obvious expansion, and the distal intestinal fistula showed no gas. The standing position showed fluid level in the colon. Barium enema helps to identify, and at the same time it can play an important role in establishing the site of obstruction and the cause. Buechter reported a diagnosis rate of 97% and 94% for abdominal X-ray and barium enema, respectively.
2, sigmoid colon torsion often has a history of constipation or multiple abdominal pain episodes in the past, after defecation, exhaust symptoms after relief. In addition to abdominal cramps, there is significant abdominal distension, and vomiting is generally not obvious. Abdominal X-ray plain film can be seen as "an abnormally flattened double-twisted bowel, which is horseshoe-shaped and almost fills the entire abdominal cavity." When in doubt, it can be used as a sputum enema, and it is "bird's beak" in the obstruction.
3, the clinical manifestations of colonic obstruction are basically similar to the general small bowel obstruction, the clinical manifestations have the following characteristics:
1 All patients have abdominal pain, the right colonic obstruction is mostly in the right upper abdomen, the left half is mostly in the left lower abdomen, the chronic obstruction is slightly abdominal pain, the acute obstruction is severely abdominal pain, but not as severe as the volvulus and intussusception;
2 nausea and vomiting appear later, even absent. Later, the vomit was yellow fecal-like content with a foul smell;
3 abdominal distension is obvious, small intestinal obstruction, both sides of the abdomen protruding, sometimes horseshoe shape;
4 anus stops defecation and deflation, but most patients can still have a small amount of gas in the early stage of obstruction;
5 physical examination showed obvious abdominal distension, can be horseshoe-shaped, percussion is drum sound, auscultation can smell the sound of water. X-ray plain film examination showed obvious colonic effusion, gas accumulation, and a liquid level. In short, except for colonic torsion, the clinical manifestations of colonic obstruction are not as typical and severe as small bowel obstruction.
