Colonic injury

　　What are the causes of colonic injury

　　Medicine indicates that the causes of colonic injury can be roughly divided into three aspects.

　　1. Penetrating injury

　　The most common, seen both in peacetime and in wartime, such as lacerations caused by knives, scissors, and sharp objects, as well as blast and gunshot wounds, can cause varying degrees of colonic injury.

　　2. Blunt instrument injury

　　In cases of abdominal closed injuries caused by traffic accidents, earthquakes, and house collapses, the force may directly affect the spine, leading to transverse colon rupture injury; or due to the thin wall and high tension of the colon, the intestinal tract may rupture; or damage to the blood vessels of the colon mesentery may lead to colon necrosis, etc.

　　3. Iatrogenic injury

　　During sigmoidoscopy or colonoscopy, colonic perforation and rupture may occur due to improper operation; or colonic perforation and rupture may be caused by electrocautery of polyps, during the reduction of intestinal intussusception with barium enema or air-barium double-pressure contrast, colonic rupture may occur; or colonic injury may also be caused by surgical damage to the intestinal wall and mesentery.

　　Colonic injury accounts for 10% to 20% of abdominal injuries in peacetime, and more in wartime. There are many complications after colonic injury surgery, and the mortality rate is also relatively high.

　　During colonic injury, there are rupture of serous layer, rupture of serous muscle layer, and complete rupture of the intestinal wall, even fracture; intestinal wall contusion has subserous hematoma and intramural hematoma; if there is mesenteric injury, there are arterial and venous rupture, or thrombosis causing delayed intestinal necrosis.

　　When the colonic wall is completely ruptured or necrotic, the contents of the colon (faeces) overflow into the peritoneal cavity, causing diffuse peritonitis. If there is adhesion, it can form localized peritonitis. Occasionally, due to small perforations, faeces may block and heal. The contents of the colon are neutral and have a small stimulus to the peritoneum, and the early peritonitis is not obvious, which is easy to misdiagnose. In the later stage, local contamination is severe (the most bacteria are in the faeces), and in addition, the colon has a ileocecal valve and an anal sphincter at both ends, which " seals " the two ends, causing increased intraluminal pressure, a large amount of extravasation of intestinal contents, resulting in severe peritoneal infection and serious systemic toxic symptoms, even death. The colonic wall is thin, the blood circulation is poor, so the healing ability after colonic wall rupture is also poor, and it is easy to form an intestinal fistula, which is a common complication of this disease. Therefore, we should pay more attention and stay away from diseases.

　　Colonic injury can cause bowel sounds, nausea, abdominal tenderness, and peritoneal irritation. In addition to its clinical manifestations, it can also cause other diseases. This disease can cause anemia and secondary infection, which should be highly emphasized by clinical doctors and patients.

　　What are the typical symptoms of colonic injury

　　The symptoms of colonic injury can generally be summarized into the following aspects;

　　Bowel sounds, nausea, abdominal tenderness, peritoneal irritation, peritonitis, abdominal pain, tension, abdominal aortic pulsation.

　　If there is a history of abdominal trauma, there is usually a history of abdominal pain, often accompanied by nausea, vomiting, and hematochezia. In cases of extraperitoneal colonic injury, rupture, and delayed intestinal necrosis, symptoms appear later. If there are associated injuries, local symptoms can be masked due to severe injury.

　　The most prominent sign is generalized abdominal tenderness, rebound tenderness, and muscle tension, which are most obvious at the site of the lesion. The severity of peritoneal irritation can vary due to the size of the colonic rupture or the amount of extravasated material during transection, the type of bacteria, and the time of visit, and can be positive for mobile dullness and the disappearance of bowel sounds.

　　Reminders: If you have the above symptoms, it is recommended that you discover and treat them early. Thank you for your attention to the Feihua Health Network.

　　What measures can prevent colonic injury

　　Measures for preventing colonic injury include the following; let's get to know them together. Colonic injury is more common in young and middle-aged adults and has a clear history of abdominal trauma. The prognosis depends on the location, extent, range of colonic injury, and abdominal contamination, and is closely related to the timeliness and appropriateness of rescue and treatment. There are many complications such as primary repair or anastomosis, formation of intestinal fistula, and residual abdominal infection.

　　It is mainly to avoid injury factors. In order to avoid infection.

　　What laboratory tests are needed for colon injury

　　1. X-ray examination

　　Abdominal X-ray or fluoroscopy shows free gas under the diaphragm or gas accumulation behind the peritoneum, and the abdominal intestines are generally distended or there is a liquid-gas plane, to determine whether there is a hollow organ injury. According to the location, determine whether there is a colon rupture injury. Abdominal X-ray can also detect fractures and metal foreign bodies, etc.

　　2. Diagnostic abdominal puncture (shortened as abdominal puncture)

　　Determined according to the extracted fluid, if it is fecal matter, it is intestinal injury, and if there is unclotted blood, it may be injury to solid organs. Diagnostic puncture and lavage: use a catheter needle for abdominal puncture, pull out the needle core, insert a catheter, and test the extracted fluid. If the fluid cannot be extracted, lactate Ringer's solution or isotonic saline (10-20ml/kg) can be injected into the abdominal cavity through the catheter. The lavage fluid is collected, and according to visual observation and laboratory examination, if any of the following is met, it is considered positive: ① The lavage fluid contains visible blood, bile, gastrointestinal contents, or urine; ② The red blood cell count in the microscope is greater than 0.12×10^12/L; ③ Amylase exceeds 1000u/L (Sorensen method); ④ A large amount of bacteria is found in the lavage fluid under the microscope. This method is more reliable than diagnostic puncture, with a diagnostic accuracy rate of 98.1% and very few complications.

　　The false positive rate of diagnostic abdominal puncture or lavage is about 2% to 3%, and it is more common in: ① Fracture of the pelvis or spine, the peritoneum is pierced by bone尖, blood flows into the peritoneal cavity; ② Large retroperitoneal hematoma in the lower abdomen, causing mispuncture into the hematoma area, and drawing lessons from it, obtaining unclotted blood, the relative contraindications are: ① Severe abdominal distension or intestinal paralysis; ② A history of widespread intestinal adhesions or multiple abdominal surgeries; ③ In the second half of pregnancy, patients.

　　3. Laparoscopic examination

　　In recent years, fiberoptic laparoscopy has been widely used, continuously improving the early diagnostic rate of abdominal injuries.

　　4. CT examination and B-ultrasound examination

　　It has a high diagnostic rate for injuries to solid organs and can provide reference for injuries to hollow organs, especially for the diagnosis of abdominal effusion and abscess, which is relatively accurate.

　　Dietary taboos for colon injury patients

　　The following content should be paid attention to in terms of diet for colon injury;

　　Practical experience has proven that a high-fat diet (especially polyunsaturated fatty acids) can promote the occurrence of intestinal tumors.

　　Although cholesterol itself is not carcinogenic, it can produce a promoting effect on cancer after reacting with bile acids. Therefore, colon tumor patients should not consume too much fat, and the calories provided by fat each day should account for less than 30% of the total calories. In addition, the proportion of animal to vegetable oil should be appropriate. In a day's diet, the amount of fat in the food itself, plus the amount of oil used in cooking, should be controlled below 50 grams. Some people control animal fat very strictly, often using vegetable oil as the main source, and even not consuming animal oil.

　　Conventional methods of Western medicine for treating colon injury

　　Medicine shows that after diagnosing colon injury, surgery is the fundamental principle of treatment, but the surgical method should be determined according to the local injury condition, because surgery is an aggressive attack on the colon with poor blood circulation and more bacterial proliferation, and the high pressure inside the colon makes it easy to form complications such as colonic fistula or residual abdominal infection after repair or intestinal anastomosis surgery. Therefore, improve surgical skills and apply a large amount of antibiotics. The specific treatment methods are as follows:

　　I. Treatment of colon wall contusion

　　When a patient undergoes laparotomy for abdominal injury, local seromuscular layer injury of the colon is found, which can be sutured and repaired transversely; for intestinal wall hematoma and mesenteric hematoma, incise and remove the hematoma, stop bleeding, and then perform repair surgery if there is no intestinal wall blood flow obstruction; for extensive seromuscular layer injury of a segment or multiple segments of the intestinal wall, mesenteric hematoma or vascular injury affecting the blood flow of the corresponding intestinal segment, perform corresponding intestinal segment resection and anastomosis surgery; if the patient's condition is critical or local contamination is severe, perform proximal stoma at the site of colon injury, distal closure or double-end stoma.

　　II. Colonic rupture and transverse injury of colon

　　1. Primary suture repair for light contamination, or for colon rupture within 12 hours with severe contamination but thorough flushing, we advocate for the full effort to perform primary suture repair surgery or intestinal resection and anastomosis surgery, and thoroughly flush the abdominal cavity and necessary abdominal drainage surgery during the operation with normal saline.

　　2. Double-end stoma for ileum or colon, delayed closure of stoma For patients with multiple organ injuries, unstable recovery from shock, overall condition not allowed, or severe local contamination exceeding 12h, double-end stoma can be performed; or local intestinal repair or resection and anastomosis, proximal stoma, distal closure, and delayed closure of stoma after 3 months.

　　温馨提示: The above treatments are based on the needs of the disease. Please treat according to your own condition under the guidance of a doctor. Thank you for your attention to Feihua Health Net.