Colorectal injury

Introduction to colorectal injury Intestinal injury (injuryofthecolonandrectum) is the fourth most common abdominal injury in abdominal trauma. Colonic injury has the following characteristics: 1 thin colon wall, poor blood circulation, weak healing ability; 2 colon filled with feces, containing a large number Bacteria, once the intestinal rupture, abdominal cavity is serious, easy to cause infection; 3 high pressure in the colon cavity, postoperative intestinal flatulence often causes suture or anastomotic rupture; 4 liters, descending colon is more fixed, the posterior wall is located in the peritoneum, Postpartum injury is easy to miss and cause serious retroperitoneal infection; 5 combined injury and penetrating injury of colon injury. Colonic damage is not immediately life-threatening, but the late mortality rate due to infection is higher. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: septic shock colon injury

Causes of colorectal injury

Blunt injury (20%):

The abdomen is hit by heavy objects, such as work-related injuries, car accidents, falling, falling, fighting, boxing and other blunt violent blows. The large intestine is located between the posterior abdominal wall and the anterior abdominal impact force, causing injury to the intestinal wall, perforation or breakage. The disease.

Iatrogenic injury (20%):

It is not uncommon for sigmoidoscopy and fiberoptic colonoscopy to cause colon perforation. In the 468 cases of abdominal injuries, 3 cases of colonic injury caused by fiberoptic colonoscopy. Therefore, iatrogenic injury can cause the disease.

Knife stab wound (15%):

In the war, he was seen in a bayonet wound. He was often seen in public security accidents such as fighting, murder, and robbery.

Firearm injuries (15%):

Wartime shrapnel, gunshot wounds, often combined with small intestine or abdominal cavity, other organs damage.

Colorectal injury prevention

Prevent infection and avoid trauma.

Colorectal injury complications Complications , septic shock, colon injury

Abdominal infections and septic shock are major complications of colonic injury.

Symptoms of colorectal injury Common symptoms Abdominal pain Peritonitis Side abdominal wall or posterior lumbar region tenderness Intestinal perforation Pelvic injury Blood in the stool Subcutaneous emphysema Squeezing injury Nausea bleeding

symptom

(1) Abdominal pain and vomiting: knots, rectal perforations or large pieces of damage, abdominal pain and vomiting after the feces in the intestines overflow into the abdominal cavity. The pain is first confined to the perforation, which spreads to the entire abdomen and becomes diffuse peritonitis with full abdominal pain.

(2) peritoneal irritation: abdominal tenderness, muscle tension and rebound tenderness. Pain at the perforation or rupture site is most pronounced.

(3) The bowel sounds weaken or even disappear.

(4) digital rectal examination: low rectal injury can touch the injury site with a hollow feeling, the finger is covered with blood, and only a few blood lesions in the colon injury.

Colonic injury is a hollow organ injury. After the colon rupture, the intestinal contents overflow and stimulate the peritoneum to cause peritonitis. This is consistent with the clinical manifestations of other hollow organ ruptures, but the colon contents are less irritating to the peritoneum, so the clinical diagnosis of colon injury Symptoms and signs develop slowly, and often do not get timely diagnosis and treatment. It is worthy of caution. The clinical manifestations of colon injury mainly depend on the degree of injury, the location, the time of treatment after injury and whether there are other organ injuries at the same time.

Penetrating colonic injury mainly manifests as abdominal pain after injury, with peritonitis, or effusion of fecal-like intestinal contents from open wounds, non-penetrating colonic injury, complicated clinical manifestations, abdominal pain is a common symptom, and a small number of patients with colonic injury There is no abdominal pain in the injury, more common in the left half of the colon injury, because the left colon content is dry and solid, the intestinal contents are not easy to enter the abdominal cavity after rupture, the peritoneal stimulation is small, the delayed colonic rupture of the patient, the abdominal pain symptoms once improved Later, recurring, combined with other organ injury, early shock, early epidural colon injury, abdominal pain and peritonitis symptoms are not obvious, when the retroperitoneal space infection is obvious, there is tenderness in the lateral abdominal wall or the back waist, sometimes can touch the subcutaneous Emphysema, nausea, vomiting are also common symptoms. Low colon injury can be blood in the stool or jam-like stool. Increased body temperature is a late manifestation of peritonitis.

Colonic injury caused by colonoscopy is during the examination, the patient suddenly has severe abdominal pain, followed by peritonitis. The colonic perforation caused by barium enema is not good except for abdominal pain. The patient is generally in poor condition and sees the expectorant entering the abdominal cavity under fluoroscopy.

Type

1. According to whether there are wounds on the body surface, it is divided into open injury and closed injury.

(1) Open injury: There are wounds in the abdomen or lower back, which are more common in knife stab wounds and gunshot wounds.

(2) Closed injury: There is no wound on the body surface, mostly caused by blunt violence, such as crush injury.

2. According to whether the wound is connected to the abdominal cavity, it is divided into intraperitoneal injury and extraperitoneal injury.

(1) Intra-abdominal injury: The colon wound is connected to the abdominal cavity, and the contents of the intestine enter the abdominal cavity. There is peritonitis, which is more common in the cecal, transverse colon, sigmoid colon rupture and partial injury in the abdominal cavity of the ascending and descending colon.

(2) extraperitoneal injury: the ascending and descending colon is located outside the peritoneum. After the injury, the intestinal contents enter the loose connective tissue of the retroperitoneal space. Once the infection is easily spread, there is no obvious peritonitis. More common in the back and back knife stab wounds.

Patients with open injuries can easily make a diagnosis based on the location of the open wound, the direction of the ballistic or stab wound and the peritonitis. Most of the open abdominal injuries are penetrating injuries, almost all of which have intra-abdominal organ damage. Most of these wounded patients need to have a laparotomy. If the back waist is stabbed, the wound has a fecal sample of intestinal content, which can make a diagnosis of colon damage. Closed colonic injury is difficult to diagnose, and is often associated with other organ damage. If there is rapid progression of diffuse peritonitis with toxic shock, or indirect violence, the lower abdominal pain progresses to peritonitis and there is a colonic injury with underarm free gas. The diagnosis of iatrogenic colon injury is easier. During the colonoscopy, the patient has abdominal pain and peritonitis, which can make a diagnosis of colon injury.

Judging whether there is colonic injury is a clinical problem. If there is obvious peritoneal irritation and rectal bleeding, it should be explored as soon as possible. Free gas can be seen on the plain film of the abdomen, gas accumulation after the retroperitoneum, disappearance of the unilateral psoas muscle image, and paralytic ileus. Pelvic and lumbar fractures suggest a possibility of large bowel injury. Abdominal lavage is a useful diagnostic method. It should be irrigated after the abdominal plain film is taken to prevent gas from entering the abdominal cavity and affecting the X-ray diagnosis. The extracted lavage fluid should be examined for blood cells, bacteria or amylase, and one or more abnormalities may be considered for surgical exploration.

Extraperitoneal rectal injury is more difficult to diagnose. More severe pelvic injuries usually involve a large number of soft tissue injuries and rectal injuries. It is very important to perform anal digital examination. If necessary, a proctoscope or sigmoidoscopy can be used to detect bloody fluid outflow and Damage site.

Examination of colorectal injury

The lavage fluid is taken out for examination of white blood cells, bacteria or amylase, and more than one abnormality may be considered for surgical exploration.

1. Diagnostic abdominal puncture: simple and easy, if there is organ injury, the positive rate is generally above 90%. According to the nature of the puncture, it can be judged whether there is a rupture of the hollow organ, but no specificity for the diagnosis of colon injury. And the peritoneal perforation is negative, and the intra-abdominal organ damage cannot be ruled out.

2. Diagnostic peritoneal lavage: It has a high diagnostic value for closed abdominal trauma, and its diagnostic rate is as high as 95%. As with diagnostic abdominal puncture, it is still not specific for judging whether there is a colon injury.

3. Abdominal X-ray examination: Some patients can find free gas under the armpit, which is helpful for diagnosing colon injury, and can help locate cases with foreign bodies.

4. Laparoscopy: can directly detect the damage of intra-abdominal organs, can find the location of the colon injury, the degree and the relationship with the surrounding organs, the accuracy rate of more than 90%, valuable for early diagnosis.

Diagnosis and diagnosis of colorectal injury

diagnosis

History of trauma

There is a history of trauma or a history of colonoscopy in the abdomen or other nearby areas, and abdominal pain or other discomfort after the injury.

2. Clinical manifestations

(1) Abdominal pain and vomiting: knots, rectal perforations or large pieces of damage, abdominal pain and vomiting after the feces in the intestines overflow into the abdominal cavity. The pain is first confined to the perforation, which spreads to the entire abdomen and becomes diffuse peritonitis with full abdominal pain.

(2) peritoneal irritation: abdominal tenderness, muscle tension and rebound tenderness. Pain at the perforation or rupture site is most pronounced.

(3) The bowel sounds weaken or even disappear.

(4) digital rectal examination: low rectal injury can touch the injury site with a hollow feeling, the finger is covered with blood, and only a few blood lesions in the colon injury.

3. Blood routine examination

White blood cell count and neutrophilia.

4. X-ray photos

For closed injury, when the patient's condition allows standing photos, most of the free gas under the armpit can be found.

5.B ultrasound, CT, MRI

If the above examination is not clear, you can use any one of the two tests to help diagnose.

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