Colonic rupture

　　Colonic rupture usually occurs in upper abdominal or bilateral abdominal trauma, and the causes of colonic rupture are generally due to external force, most of which are open wounds, and very few are closed wounds. To prevent the occurrence of this disease, it is recommended that everyone pay attention to production safety in daily life.

　　Colonic rupture is prone to complications such as intestinal fistula after surgery. The so-called intestinal fistula (fistula of intestine) refers to pathological channels between intestinal tracts, between intestinal tracts and other organs, or between the body and the outside world, causing the excretion of intestinal contents out of the intestinal cavity, leading to a series of pathophysiological changes such as infection, fluid loss, malnutrition, and organ dysfunction. Intestinal fistulas can be divided into internal fistulas (internal fistula) and external fistulas (external fistula).

　　External trauma is an important cause of colonic rupture. The clinical manifestations of colonic rupture generally include the following points:

　　1. Abdominal pain, distension, and fever;

　　2. Abdominal muscle tension, diffuse abdominal tenderness, rebound tenderness, positive shifting dullness, and weakened or absent bowel sounds;

　　3. It may be accompanied by shock symptoms.

　　Prevention is an important measure to reduce the occurrence of diseases. The following methods of preventing colonic rupture are introduced now:

　　1. Collect the medical history and systemic examination as detailed as possible, including the mechanism of injury, the size and direction of the violence, and the site of injury. If it is a lower abdominal trauma and pelvic fracture, it should be considered that there may be a colonic injury.

　　2. When diagnosing diseases, start from the whole, consider comprehensively, and do not be satisfied with the diagnosis of a single disease.

　　3. For patients with severe illness and complex clinical manifestations, the possibility of injury to other organs should be considered.

　　4. Comprehensive improvement and strengthening the technical level and responsibility of endoscopic physicians to reduce the incidence of iatrogenic injury.

　　5. Pay attention to colon obstruction due to the presence of the ileocecal valve. Once the colon is completely obstructed, it generates a闭袢性 obstruction, and the intraluminal pressure rapidly increases. In addition, the colon wall is relatively thin, and the blood circulation is poor, so it is easy to rupture.

　　6. A positive abdominal puncture result does not necessarily confirm colon injury, but it can provide a basis for laparotomy exploration and争取 operation time.

　　Colon rupture is caused by the action of external force, called colonic perforation. The abdominal puncture of this disease is positive, and abdominal X-ray examination shows gas-filled abdomen, which can be diagnosed as colon rupture through the above two examination methods.

　　Patients with this disease should pay attention to eating low-fat, low-fiber, low-irritant, easy-to-digest, moderately warm and nutritious food. In daily diet, it is appropriate to choose more easily digestible high-quality protein foods such as fish, eggs, dairy products, and tender green vegetables rich in vitamins, fresh fruit juices and vegetable juices, etc., to supplement the nutritional consumption caused by long-term diarrhea. At the same time, pay attention to eating less food with high oil content and too much fat, cold, and spicy food. Foods rich in fiber, such as leeks, celery, soybean sprouts, onions, etc., should be avoided. Eat less gas-producing foods and sweets. When flatulence and intestinal rumbling are strong, it is advisable to eat less sucrose and easily gas-producing fermented foods such as soybeans, sweet potatoes, radishes, pumpkins, and soybeans.

　　There are many methods for the suture of colon surgery. If the time from injury to surgery is within 8 hours, and the abdominal contamination is not severe, the blood loss is less than 20% of the normal blood volume, the patient's overall condition is good, the age is young, the resistance is strong, the colon rupture is simple, and the preoperative shock is not severe, then primary suture can be performed, such as simple suture repair, and colorectal resection and anastomosis. If the operation time is after 8 hours from the injury, the abdominal contamination is severe, the patient is older, the overall condition is poor, or there are multiple abdominal organ injuries, then staged surgery should be adopted, including colostomy and ostomy.