Fecal perforation of colon

Introduction Colonic fecal perforation (SP) is a rare and lethal acute abdomen. Chronic constipation is the main cause of fecal ulcer. SP occurs in the elderly, abdominal pain generally begins in the left lower abdomen, gradually involving the entire abdomen, defecation activities often cause abdominal pain suddenly increased, there are peritonitis manifestations at the time of treatment. About one-third of patients can reach the mass in the abdomen due to a large amount of fecal mass in the intestine. Once the SP occurs, it is necessary to have an early operation. The prognosis of this disease is poor, and most of the early postoperative patients die from severe infectious toxic shock.

Cause

Chronic constipation is the main cause of fecal ulcers. Its pathogenesis may be:

1 The dry fecal mass in the colon directly compresses the intestinal mucosa, causing pressure-induced ischemic necrosis of the mucosa, which in turn forms ulcers and even perforations.

2 A large amount of fecal mass is deposited in the colon to make the intestines highly expand, and the intestinal pressure rises and exceeds the capillary diffusion pressure of the intestinal wall, especially the intestinal wall on the opposite side of the mesangial margin, leading to ischemia and necrosis of the intestinal wall.

3 mechanical intestinal obstruction caused by fecal block, direct perforation caused by increased intestinal pressure, especially when there is a lesion in the intestinal wall. The action of the fecal mass dilates the lumen of the intestine. When the internal pressure is higher than the capillary perfusion pressure of the intestinal wall, especially on the edge of the mesentery, ulceration occurs first, followed by perforation.

an examination

1. Abdominal X-ray film: usually in the vertical position of the abdomen, you can see the free gas under the armpit. The appearance of such signs proves that perforation has occurred.

2. CT: This examination is the same as the abdominal X-ray film, but the definition is higher and more targeted.

3. Clinical physical examination: The patient has abdominal pain and abdominal muscle tension. We call it platy abdomen, tenderness and rebound tenderness are very obvious.

Differential diagnosis

1. Acute peritonitis: Acute peritonitis can be classified from the following different perspectives: (1) According to the cause, it can be divided into bacterial peritonitis and non-bacterial peritonitis. Non-bacterial peritonitis is common in the stomach, duodenal acute perforation, acute pancreatitis and other gastric juice, intestinal fluid, pancreatic juice and other leakage into the abdominal cavity to stimulate the peritoneum. However, if the lesion continues to heal, there will be multiple bacterial infections after 2 to 3 days, which is no different from bacterial peritonitis. (2) According to the clinical process can be divided into acute, subacute and chronic three categories (3) according to the scope of inflammation can be divided into diffuse peritonitis and localized peritonitis. (4) According to the pathogenesis, it can be divided into secondary peritonitis and primary peritonitis. The vast majority of peritonitis is secondary peritonitis. Primary peritonitis is rare, and there is no pathological lesion in the abdominal cavity. The pathogen is infected by the bloodstream or lymphatic dissemination of the peritoneum, which is more common in cirrhosis, nephrotic syndrome and infant cases with low immune function.

2. Small intestine rupture: abdominal pain, bloating, fever. Abdominal muscle tension, total abdominal tenderness, rebound tenderness, mobile dullness (+), bowel sounds weakened or disappeared. Severe cases can be accompanied by shock performance.

3. Colonic injury: The onset is acute and heavy, and shock often occurs. Peritonitis appears in a short time after injury; delayed bowel rupture or necrosis does not appear acute abdomen after a period of injury, can occur in a few days or more than 10 days after the onset of peritonitis, began to light, gradually worse.

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