Violation of the integrity of the large intestine: rupture

The intestine is an essential organ in the digestive system that originates from the stomach and ends at the anus. In the intestines, food is digested from which useful substances are extracted, and the processed product is excreted naturally along with waste and toxins. Sometimes patients turn to a proctologist with organ problems; one of the serious pathologies is rupture of the colon.

The nature of the violation of the integrity of the organ can be of a closed or open type with intra-abdominal and extra-abdominal localization. A rupture inside the colon can be common and may involve nearby organs or the sphincter. The depth of the rupture is noted to the depth of the mucous tissues of the organ, hematomas in the submucosal tissues, and rupture of all layers of the intestinal walls.

Causes

Factors that provoke colon rupture include:

• chronic constipation;
• diseases of the large intestine;
• frequent use of laxatives;
• mechanical injuries;
• a sharp increase in pressure inside the intestines.

The cause of a closed form of injury can be car accidents or a fall from a height. In this case, there may be several gaps. Fractures of the pelvic bones can lead to rupture of the colon. With strong compression, the colon can completely rupture in the transverse direction. In rare cases, the large intestine may come off completely. The reasons for this phenomenon: a strong direct blow or oblique compression of the abdomen.

Open damage to the large intestine can result from a wound to the abdomen or certain medical procedures. The integrity of the colon may be compromised during surgery with a sharp object.

The anal area can be injured by blunt objects, such as falling on a pen, umbrella or mop. Such injuries lead to sphincter rupture and anal fissures. The integrity of the colon can be compromised by a foreign body in the stool.

Colon rupture can occur spontaneously when lifting a heavy object or when there is high pressure within the peritoneum, such as during urination, childbirth, or a blow to the abdomen.

Mechanical damage to the large intestine can include anal sex, intestinal lavage, or careless use of technical means. An enema based on a chemical solution can provoke a crack or rupture of the intestine.

Colon injuries

Anatomy of the large intestine
Injury to the rectal organ can occur due to a strong blow to the abdominal cavity. Such phenomena are possible in the event of an accident, explosion, high pressure on a person, or a fall from a high point.

Injury can be different. Starting from strong compression to the occurrence of ruptures in the organ. If a perpendicular blow is applied to the human peritoneum, then most often this leads to a complete separation of the rectum. This is a dangerous injury that can have serious consequences.

Such injuries are difficult to diagnose, since there are many injuries inside. Ruptures near the rectum occur from a gunshot, as well as after application to the stomach with a cutting or stabbing object. Any injury to the rectal organ can only be treated surgically.

How does it manifest?

1. The first signs of colon disease are pain. The patient feels a sharp and burning pain in the perineum and anus. In some cases, pain may be felt in the intestinal area. Intestinal rupture may be accompanied by bloody discharge.
2. During defecation, the pain worsens and does not go away for several hours. Depending on the extent of the damage, the pain can intensify and be absolutely unbearable. With severe intestinal injuries, bleeding can be profuse. In such cases, the patient experiences a painful shock and may lose consciousness.
3. Symptoms of damage worsen with severe injuries, and with minor injuries the patient may only feel a spasm of the anal sphincter. In addition to the above signs of the disease, the patient experiences nervousness and irritability.
4. If the root cause of the rupture is chronic constipation, then nausea, dizziness and weakness may be added to the symptoms.
5. Sometimes there is a lot of moisture on the skin around the anus and the patient may complain of itching and burning in this area.
6. When the large intestine is severely ruptured, the abdominal cavity fills with air and the abdomen becomes swollen and hard. The patient experiences difficulty breathing and a rapid pulse. In this case, feces penetrate from the large intestine into the abdominal cavity.
7. With severe intestinal injuries, intestinal loops may prolapse beyond the anal ring, which is accompanied by high temperature.

Illness in children

Oddly enough, colon disease is more common in children than in adults. Even children under 3 years old can experience such serious injuries. This is due to the fact that the organs of the digestive system have not yet formed, so children have problems with bowel movements. With persistent constipation, the lining of the large intestine is damaged by feces.

Frequent diarrhea in childhood is also dangerous, as is constipation. They irritate the walls of the colon and cause swelling. Any changes in the gastrointestinal tract in a child’s body can lead to the formation of cracks. As a rule, cracks heal quickly, however, they cause discomfort to the baby.

Sometimes colon diseases can be caused by parasites that are in the baby's intestines. The most common cause of colon injury is the presence of worms.

Signs of intestinal damage in children are similar to those in adults. The process of defecation becomes unpleasant for the child and in most cases is accompanied by pain in the anus. Bloody discharge may appear in the stool. With severe pain, the process of defecation may become impossible. In this case, feces accumulate and become compacted in the intestines. Helping a child in this situation is quite difficult. Therefore, when the first symptoms of colon disease appear, you should seek help from a doctor.

Symptoms

An existing injury to the rectal organ is recognized by the following symptoms:

Pain in the lower abdomen

• severe pain in the lower peritoneum and anorectal canal - pain similar to contractions, turning into aching symptoms;
• gag reflex with nausea;
• internal blood loss;
• weakening of the general condition;
• fever with chills;
• bloody traces in the stool (a similar symptom occurs from a fistula);
• painful bowel movements;
• frequent passing of gas;
• there is stool discharge from the vagina;

If there is at least one sign indicating damage to the rectal organ, medical attention is necessary.

Diagnostics

As a rule, anal fissures are diagnosed without much effort. During the examination, the doctor palpates the colon mucosa and detects sphincter spasms. If there is a crack, palpation is accompanied by pain. To obtain a complete clinical picture, the doctor conducts a patient interview, sigmoidoscopy and anoscopy.

1. Sigmoidoscopy allows you to determine the condition of the rectum. The examination is carried out using a special tube, at the end of which there are lenses and a light source.
2. Anoscopy allows you to examine the colon to a depth of 12 cm using a special instrument - an anoscope, which is inserted into the anus.

To identify closed injuries of the large intestine, gunshot or stab wounds of the abdominal cavity, a wide laparotomy is performed. In the early stages of damage, symptoms are mild, so laparoscopy can reveal ruptures and cracks in the walls of the colon.

When diagnosing rectal injuries, the doctor first takes into account the patient’s complaints and pain.

Classification

Colon trauma is divided according to degree of complexity:

• simple break;
• complicated injury with disruption of the sphincter;
• Complicated injury with disruption of the functionality of other organs inside the peritoneum.

Complex injuries are recognized by the number of ruptures and classified by location (inside or outside the peritoneal cavity).

The classification of injuries for the selection of medical care is determined by the following stages:

• Lighter trauma - anal fissures with small tears in the mucous tissue of the rectal organ. Therapy is carried out over 3-7 days using local medications.
• Moderate injuries - dissection of the rectum and extra-abdominal cavities, varying degrees of ruptures with impaired integrity of the abdominal muscles.
• Severe injuries – compromised integrity of the abdominal cavity and other organs with complications and the formation of an infectious process.

Treatment

As a rule, treatment for violation of the integrity of the large intestine is carried out surgically, which consists not only of surgery, but also of rehabilitation therapy. The extent of the operation directly depends on the degree and severity of the damage and the severity of the patient’s symptoms.

For open injuries, surgical treatment of the wound is first performed. Ruptures and cracks of the intestine are sutured only with cut or puncture wounds and in the absence of purulent inflammation.

If the lesions are inside the abdominal cavity, the surgeon makes an incision in the anterior abdominal wall and examines the intestines, stomach and liver. Such an examination is carried out in order to identify concomitant injuries to the abdominal organs.

In case of a minor rupture, the intestine is simply sutured, but in case of more serious damage, the surgeon removes the injured section of the intestine and sutures the junction in several layers.

The integrity of the large intestine is restored after 3-4 months. A rupture in the large intestine can cause damage to the sphincter, in which case the surgeon applies a discharge colostomy, treats the wound and the intestinal walls. The colostomy can later be removed.

Treatment of damage to the large intestine in children is aimed at eliminating worms and softening stool. Therefore, the doctor may prescribe drugs such as Duphalac, Lactusan and Prelaxan. In addition, the doctor prescribes probiotics Linex or Lactobacterin. As a local treatment, ointments and suppositories containing methyluracil and benzocaine are very effective. Glycerin suppositories have a healing effect, they facilitate the process of defecation and promote rapid healing of anal fissures.

Treatment of minor damage to the wall of the colon is carried out only with medication. If treatment is ineffective, surgery may be performed. Breaks or cracks can be repaired using radio waves.

Doctor's comment

The prescribed operation - resection of the sigmoid colon - raises many questions in you, which is understandable: the quality of life in the future depends on the experience of surgeons and the techniques used in treatment. In our clinic, we always strive to perform low-traumatic operations, after which there are no noticeable marks left, and recovery takes a minimum of time. Moreover, in 90% of patients we manage to do without an ileostomy, preserving the function of natural movement of intestinal contents. If, for a number of reasons, it is necessary to temporarily remove the end of the intestine to the abdominal wall, then after a couple of months we carry out reconstruction—restoring the passage of feces through the intestines. Of course, to choose the most effective treatment method, you need to undergo a high-quality examination. All necessary studies can be done in our clinic, equipped with the most modern expert-class equipment. To receive more complete information regarding your specific case, make an appointment at a time convenient for you, and together we will discuss all the possibilities for solving your problem.

Head of the surgical service at SwissClinic Konstantin Viktorovich Puchkov

Rehabilitation period

Treatment of damage to the large intestine will be effective if you adhere to a special diet in the period after surgery. A proper diet contributes to a rapid recovery process. The doctor recommends drinking only liquids for the first 2 days after surgery so that the sutures on the intestines can heal. During the rehabilitation period, the diet can be divided into 3 stages:

1. For the first 3-5 days after surgery, it is advisable to eat small portions 7-8 times a day. One serving should not exceed 200 g. Food should not be solid. During this period, you are allowed to drink tea, jelly and juice. It is not recommended to drink tea that is too hot.
2. At the next stage, the meal can be divided into 6 times and the portion slightly increased - up to 400 g. In addition to liquid, you can eat ground porridge, chopped fish, and you can include chicken broth, milk, and butter in your diet.
3. The final stage lasts about 2 weeks. You can eat food 4-5 times a day. The range of dishes can be increased. Steamed dishes, low-fat soups, boiled meat or fish, and baked apples are allowed.

During the rehabilitation period, it is very important that the stool is regular and soft. Traditional recipes can help with this. You can prepare laxative decoctions based on buckthorn bark or rhubarb root.

For minor anal fissures, treatment can be carried out using homemade suppositories. Wax candles quickly relieve inflammation and heal wounds. Dissolve 100-120 g of wax in a water bath and add chopped plantain, chamomile and motherwort. Mix the resulting mixture thoroughly and form into candle shapes. It is best to store such candles in the refrigerator.

Aloe juice has an excellent healing effect. 1 tbsp. l. Mix aloe with fish oil and egg. Moisten a cotton swab and apply it to the anus.

For preventive purposes, children and adults can drink oatmeal jelly. It eliminates constipation, normalizes intestinal flora and improves intestinal tone. To prepare it, you need to pour oatmeal into a container and fill it with boiled water and kefir. Place the container in a warm place for 2 days. Then drain the liquid and add cold water to the thick sediment. Cook the jelly until it thickens.

You can strengthen the muscle layer, relieve spasms and pain, and speed up the healing process with an infusion of medicinal fume. This will require 2 tbsp. l. dry herbs, pour 500 ml of boiling water and leave to brew overnight. Take the infusion before meals.