Symptoms of colon perforation

Colon perforation often occurs in many elderly people. Generally, when the symptoms occur, the first symptom is abdominal pain, which will gradually circulate downward and eventually spread, affecting the patient's bowel movements and gas discharge. It may even cause accumulation of stool and inability to digest normally. In addition, many patients will have peritonitis, which will eventually lead to colon perforation, which will not only aggravate the abdominal pain, but also cause many complications.

Clinical manifestations

SP is common in the elderly. The abdominal pain usually starts in the left lower abdomen and gradually affects the entire abdomen. Bowel movements often cause sudden aggravation of abdominal pain. Symptoms of peritonitis are already present when seeking medical treatment. Patients may feel a mass in the abdomen due to large amounts of stool in the intestines.

examine

1. Half of the patients have free gas under the diaphragm on abdominal X-ray films, and sometimes fecal shadows and calcified fecal shadows can also be seen. Diagnostic abdominal puncture helps to understand the nature of peritonitis.

2. SP lacks specific clinical manifestations and the preoperative diagnosis rate is low. The key to improving the preoperative diagnosis rate lies in having a full understanding of the disease. When an elderly patient with peritonitis has a history of chronic constipation, a mass can be felt in the abdomen, and there is free gas and fecal shadows below the diaphragm, colonic fecal perforation should be highly considered.

diagnosis

The diagnosis can be confirmed based on medical history, clinical manifestations and laboratory tests.

treat

Once SP occurs, surgery must be performed as soon as possible. There are three main methods for treating perforated colon, depending on the degree of abdominal contamination and the patient's condition: ① resection of the diseased segment of colon plus proximal colostomy; ② external colostomy of the perforated segment of colon; ③ repair and closure of the perforation plus proximal colostomy.

Once it occurs, surgery must be performed as soon as possible. There are three main treatment methods for perforated colon, depending on the degree of abdominal contamination and the patient's condition:

① Colon resection of the diseased segment plus proximal colostomy;

② External stoma of the perforated colon;

③Perforation repair and closure plus proximal colostomy.

Most scholars advocate early external colostomy of the perforated segment of the colon because the procedure is simple and safe, especially when the patient is in poor condition and the operation time is limited, and when the perforation is too low to make external colostomy difficult, the perforation can be repaired and closed with a proximal colostomy.

Since the 1980s, with the deepening of understanding of this disease, the preferred treatment has been resection of the diseased intestinal segment plus proximal colostomy, followed by external colostomy. Serpell and Guyton compared the results of several surgical methods and found that both the postoperative mortality rate and the incidence of complications were lowest with diseased colon resection plus proximal colostomy.

Serpell believes that colonic fecal ulcers are often multiple, and sometimes the inflammation and necrotic lesions involve a section of the intestine. In addition, the proximal colon is often filled with fecal masses and highly dilated. Therefore, by comparison, resection of the diseased segment of the colon plus proximal ostomy can reduce the incidence of re-perforation and intestinal fistula. In addition, removing a highly dilated colon is also helpful in improving constipation.

Guyton emphasized that during surgery, all the serosal surfaces of the colon should be carefully checked to see if they are intact. He found that there were often fecal ulcers underneath the lacerations of the colonic serosal surface. Once a laceration was found on the serosal surface, that section of the intestine should be removed.