Colon perforation suture, cecal fistula

Treating diseases: colon fistula Indication Perforation of the colon and cecal fistula are suitable for perforation of the cecum and ascending colon, and the abdominal cavity is not seriously polluted. Contraindications The perforation is large and the abdominal cavity is seriously polluted. Preoperative preparation 1. Anti-shock: 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: At present, it is recommended to use a combination of drugs, such as gentamicin and clindamycin, to start the drug before surgery, and continue to use 7 to 8 days after surgery. 3. Gastrointestinal decompression: can prevent postoperative flatulence. Surgical procedure 1. Intra-abdominal exploration through the mid-abdominal incision or right rectus abdominis incision, if the rupture is small, the surrounding intestinal wall is normal, the necrotic tissue at the edge of the rupture is cut off, and the full-layer intermittent suture is performed with the 1-0 non-absorbent line. The muscle layer of the sarcoplasmic layer was sutured again and further strengthened by the use of nearby fat sag and omental covering. 2. For abdominal penetrating injury, the posterior peritoneum of the ascending colon should be opened, the cecum and ascending colon should be freed, and the posterior wall should be perforated. In order to ensure that the suture is well healed, a cecal stoma decompression can be performed at the same time. 3. Use the non-absorbent line to make two concentric purse stitches at the anterior colon of the cecum, 1 cm apart. Make a small incision in the center of the purse. 4. Insert a double catheter suction tube from the incision and aspirate the contents of the intestine. 5. Remove the suction tube, insert a braided catheter, ligature the first purse string, and cut the tail. 6. Ligation of the second purse string to invert the wall of the cecum. The tail is then passed through the peritoneum and knotted to fix the wall of the cecum to the peritoneum. The stoma is taken from the abdominal wall incision or another puncture in the lower right abdomen. 7. Suture the abdominal wall incision layer by layer and fix the stoma tube to the skin. complication 1, anastomotic If the suture technique is perfect, it is caused by excessive flatulence or mesenteric vascular ligation. The former and intestinal paralysis exist simultaneously, not easy to detect; the latter clinical manifestations are clear, mainly for the performance of advanced peritonitis. If the abdominal inflammation is obvious and the scope is wide, open drainage should be performed; if the inflammation is limited, a few needles can be removed from the incision suture, placed in the drainage, and treated with non-surgical treatment. 2, anastomotic stricture Mild stenosis, no special treatment, due to the expansion of feces, most of them can be relieved. Severe stenosis requires surgery. 3, abdominal wall incision infection Due to leakage of the intestinal lumen, it should be handled with care, especially the sutured cecum should be careful. 4, the feces overflow along the rubber tube Most occur 4 to 8 days after surgery, the catheter can be pulled out or the catheter can be cut in the skin plane, and the tip can be discharged from the anus. After extubation, the stoma can heal itself. If the wall of the cecum has been sutured to the skin during surgery, additional surgery is required to close the stoma.

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