Small Intestine Mesentery Injury

　　Blunt injury is caused by violent compression of the small intestine between the lumbar vertebrae, causing the contents of the intestine to move abruptly up and down. The upper part reaches the Treitz ligament, and the lower part reaches the ileocecal valve, forming a high-pressure closed loop segment. Perforation often occurs within 70 cm of the upper and lower ends of the small intestine. Occasionally, due to indirect violence (such as a fall from a height or sudden stop during rapid movement), due to inertia, the intestine is violently shaken in the abdominal cavity, and the gases and fluids inside the intestine are suddenly transmitted to a segment of the intestinal loop, causing an abrupt increase in intraluminal pressure, leading to intestinal rupture. A few cases are caused by excessive contraction of the abdominal muscles or iatrogenic reasons.

　　Complications such as peritonitis, shock, and poisoning may occur.

　　Contusion or hematoma of the intestinal wall may have mild or localized peritoneal irritation symptoms in the early stage of injury, and the patient's overall condition is not significantly changed. With the absorption of hematoma or the repair of contusion inflammation, abdominal signs may disappear, but they may also cause intestinal wall necrosis and perforation due to pathologic changes, leading to peritoneal inflammation.

　　When the intestine ruptures or perforates, the contents of the intestine overflow, stimulating the peritoneum with digestive juices, causing the patient to experience severe abdominal pain, accompanied by nausea and vomiting. Physical examination may show pale complexion, cold skin, weak pulse, rapid breathing, and blood pressure drop. There may be generalized abdominal tenderness, rebound pain, abdominal muscle tension, positive mobile dullness, and disappearance of bowel sounds. With the passage of time from the injury, the symptoms of infection and poisoning become more severe.

　　After the small intestine ruptures, only a portion of patients have pneumoperitoneum. If there is no pneumoperitoneum, the diagnosis of small intestinal perforation cannot be negated. Some patients may not show clear peritoneal inflammation for several hours or even a dozen hours after the injury due to a small incision or blockage by food residue, fibrinogen, or protruding mucosa, which is called the latent period of symptoms. It is necessary to observe the changes in abdominal signs.

　　The clinical manifestations of small intestinal injury mainly depend on the degree of injury and the presence of organ injury, mainly manifested as peritonitis. The symptoms of shock and poisoning may not be obvious, and some patients may present with internal hemorrhage, especially when the mesenteric vessels are ruptured, hemorrhagic shock may occur.

　　Mainly pay attention to diet control, do not overeat or eat high-fat foods to prevent thrombosis. Participate in physical exercise regularly, as exercise can dilate blood vessels, increase vascular elasticity, promote blood circulation, and prevent vascular occlusion.

　　Abdominal X-ray examination has limited value, and only a few cases show free gas under the diaphragm. Abdominal puncture can provide strong evidence. CT and MRI examinations are helpful for diagnosis.
　　Percutaneous abdominal puncture can obtain digestive fluid or bloody fluid, and diagnosis is usually not difficult. Abdominal X-ray examination has limited value, and only a few cases show free gas under the diaphragm. Some small intestinal blunt injuries often have no obvious symptoms and signs in the early stage (within 6 hours after injury), making diagnosis difficult. Close observation should be made, and abdominal puncture can provide strong evidence.

　　Firstly, what kind of food is good for the small intestine

　　Noodles, noodle slices, wontons, tender greens, fish, shrimp, eggs, and bean products, so that the intestines can rest. Regular and balanced diet, a variety of food types, and the method of eating slowly and chewing thoroughly can help patients eat well, eat scientifically, and eat healthily. However, it is necessary to pay attention to controlling weight appropriately to maintain a normal weight and prevent excessive thinness and obesity. Do not seek excessive nutrition but reasonable intake. Choosing a variety of vegetables or fruits is better than choosing a single one.

　　Secondly, to protect the small intestine, it is best not to eat spicy and stimulating foods

　　1. Strong alcohol, spicy, hot, and stimulating foods, which have a stimulating effect on the anus, should never be eaten.

　　2. High-fat diet and low-fiber foods.

　　3. Try to eat less fried, smoked, and pickled foods.

　　Immediate surgery should be performed after diagnosis. If intra-abdominal bleeding is found, the substance organs and mesenteric blood vessels should be first explored to find the bleeding focus, and appropriate treatment should be given. Then, the intestine should be explored, starting from the Treitz ligament and checking segment by segment. Small perforations at the mesenteric margin are sometimes difficult to find, and the beginning and end of the small intestine, adherent intestinal segments, and loops entering the hernia sac are prone to injury, so special attention should be paid. The perforation site can be first gently clamped to prevent the continued extrusion of intestinal contents, and then appropriate treatment can be given after the entire small intestine has been explored.