Colonic fecal perforation

　　The main pathogenic factor for colonic fecal perforation is chronic constipation. The possible pathogenesis may be:
　　1. The dry and hard fecal mass in the colon directly compresses the colonic mucosa, causing ischemic necrosis of the mucosa, which then leads to ulcers and even perforation.
　　2. Large amounts of feces accumulate in the colon, causing the intestinal tract to become highly dilated, increasing the intraintestinal pressure and exceeding the capillary diffusion pressure of the intestinal wall, especially the intestinal wall on the contralateral side of the mesentery, leading to ischemia and necrosis of the intestinal wall.
　　

　　Due to the rupture of the intestinal tract, colonic fecal perforation can cause the outflow of intestinal contents, which can directly浸润the peritoneum, causing secondary peritonitis, and may have clinical manifestations such as abdominal tenderness, rebound pain, and muscle tension. Since infection can directly enter the blood circulation to form sepsis, toxic shock may occur in clinical practice.

　　Colonic fecal perforation is more common in the elderly. Abdominal pain usually starts in the lower left abdomen, gradually involving the entire abdomen, and defecation often causes the sudden intensification of abdominal pain. When seeking medical attention, all have the signs of peritonitis, about 1/3 of the patients can palpate a mass in the lower abdomen due to a large amount of feces in the intestines. Half of the patients have free gas under the diaphragm on abdominal X-ray films, and sometimes fecal mass shadows and calcified fecal mass shadows can also be seen.

　　To prevent colonic fecal perforation, it is necessary to actively treat the primary disease. The main pathogenic factor of this disease is chronic constipation. Therefore, patients with constipation should improve their condition in advance by adjusting their diet and defecation habits.

　　Half of the diagnoses of colonic fecal perforation depend not only on clinical manifestations but also on essential auxiliary examinations. Patients may have free gas under the diaphragm on abdominal X-ray films, and sometimes fecal mass shadows and calcified fecal mass shadows can also be seen. Colonoscopy can help confirm the diagnosis.

　　In addition to conventional surgical treatment for colonic fecal perforation, dietary adjustments are also needed. During the surgical treatment process, fasting is required; after surgery, fluid foods should be eaten to avoid foods that increase the burden on the gastrointestinal tract.

　　Once colonic fecal perforation occurs, it must be operated on in time. The treatment method for perforated colon should be based on the degree of abdominal contamination, patient condition, and other factors. The main surgical methods are mainly three: resection of the affected segment of the colon plus stoma of the proximal colon; colostomy of the perforated segment of the colon; repair of colonic perforation plus stoma of the proximal colon.