What is a gut twist, causes
Inversion (otherwise called invagination) is a form of obstruction, which is acute. Its development occurs with an incorrect arrangement of intestinal loops. As a result, this leads to problems of free movement of intestinal contents: over time, because of this, it changes, stretches, a person suffers from severe dehydration and intoxication.
If treatment is not started in time, intestinal torsion can cause peritonitis, inflammation, and even bowel infarction. Therefore, when the first symptoms appear, you should immediately consult a doctor for advice and further treatment. The main causes of intestinal obstruction include:
too sharp body turns
severe abdominal trauma
This pathology can have either mechanical or dynamic etiology. For example, if the movement of feces is impaired, an inversion of the intestines can occur. When this organ is squeezed, blood vessels are clamped, which leads to impaired blood circulation, perforation appears, which provokes peritonitis.
This poses a serious danger - the development of intestinal necrosis, and peritonitis without emergency medical care can cause death. That is why it is so important to know what signs can tell you about the presence of such a problem as intestinal invagination. Until now, this pathology often leads to death and only for one reason - too late to see a doctor.
The main causes of intestinal invagination are as follows:
Mechanical. In this case, the problem is due to the fact that some foreign body has entered the intestine and has closed the passage. Or the problem is caused by squeezing the intestines from the outside.
Strangulation. The main symptom is squeezing of blood vessels, and those of them, through which blood enters the injured area, suffer. This can cause gangrene.
A muscle spasm can cause obstruction. Usually a change in muscle tone is caused by any disease of the internal organs. Also, such violations are often found after the operation, serious poisoning or with diseases of the central nervous system.
Such a pathology usually leads to an inflammatory process that changes the mesentery - it changes shape, scars may appear on the surface, the two parts of the intestine come closer together, which provokes an inversion. In addition, prolonged hunger and a sedentary lifestyle can affect the development of inversion.
This type of obstruction is very rare. When it appears, the patient suffers from constipation, severe bloating, pain in the lower body. If you do not seek medical help in time, the condition will worsen, serious complications may appear.
When the departments of the small intestine are overfilled, an inversion occurs. It is considered the most common. For example, infants are often affected. The most prominent symptoms include:
digestive tract disorder
Moreover, intussusception begins to manifest itself very rapidly. Some initially believe that discomfort is associated with overeating, physical labor, and the use of laxatives. The stomach starts to hurt a little, after a certain period the pain becomes chronic, and it is felt not only in the stomach, but also in the back and lower back. In addition, vomiting is a clear sign.
Reasons for the appearance in children
Most often, in small patients, intestinal torsion appears for almost the same reasons as in adults: prolonged constipation, trauma, the formation of adhesions or neoplasms. Also, the problem may be the presence of a large number of helminths that block the passage in the intestine.
Full or partial inversion may occur, and the first case is usually encountered if the internal organs of the child do not correspond to his age norm. Given the location of the inversion can be:
high and low
thick and thin.
In the first year of life, children often suffer from pathology. The most common cause is a hernia of the food hole. Having noticed the first signs of intussusception, it is urgent to consult a doctor for prescribing treatment.
The main symptoms and signs
The main symptoms of inversion are customary to include:
Cramping abdominal pains, moreover, pain over time increases, becoming permanent.
Lack of flatulence and stool.
Nausea and vomiting.
Seal of the abdominal wall.
How to treat this pathology
In the diagnosis of inversion of the intestines of the patient, it is urgently necessary to hospitalize. During the examination, the doctor will find out in which section of the intestine obstruction occurred. It is worth noting that in 90% of cases, surgical intervention is required, and the faster the operation takes place, the more likely it is to complete successfully.
But treatment is also possible with a conservative method, which is aimed at rectifying the intestine.
For example, if the problem is caused by severe constipation, then an enema will help. The main thing is not to start doing anything yourself, but to be examined by your doctor.
You can also use folk methods:
Sedge with Hypericum. Take 100 g of plants, pour 300 ml of boiling water. Place everything in a thermos and leave for 8 hours. After this, strain the mixture and divide it into 4 parts - they need to be drunk during the day. If the condition has not improved the next day, consult a doctor immediately.
Beet. To prepare this recipe, you will need 0.5 kg of fresh beets, 1 teaspoon of yeast and 150 g of sugar. Cut the beets into large cubes, put in a pan and pour boiling water, leave for three hours. Then add sugar and yeast to the mixture. Folk remedy for inversion will be ready the next day, it can be taken in unlimited quantities.
The first signs of the disease are abdominal pain, characterized by instability. That is, a person experiences sharp pain attacks, after which relief comes. When there is an infringement of the intestinal walls, then the pain is constant, sometimes intensifying.
Due to the accumulation of gases, the stomach swells (the increase is asymmetric). At the same time, the intestine enlarged in volumes closely adjoins the walls of the abdominal cavity, which makes its contractions visually noticeable. A little later, vomiting develops. Vomit gradually changes its smell and contents. In advanced cases, dissemination of feces in the vomit is not excluded. Chair and gas are missing. Bloating can be accompanied by intestinal sounds, which disappear over time. Replaces the sound remotely resembling bursts of water.
The danger of obstruction lies in the fact that at the initial stage of the disease it is almost impossible to identify its signs with a standard examination. Palpation does not bring severe discomfort, the temperature does not rise. A sharp deterioration occurs at the moment when the death of intestinal tissue begins. Symptoms of peritonitis are manifested - acute abdominal pain, dry mouth, the appearance of brown plaque in the oral cavity, fever, chills, rapid weak pulse. A blood test can show a sharp jump in white blood cell count.
There are three stages of the development of the disease - early (up to 12 hours), intermediate (12-24 hours) and late (more than 24 hours). If the patient is taken to the hospital at the last stage of bowel obstruction, he has already developed intoxication of the body, pus accumulates in the abdominal cavity, which can cause sepsis - a critical condition, it will be difficult to save life.
Torsion of intestines - mechanical intestinal obstruction, developing as a result of rotation of the intestinal loop around the mesenteric axis. The greatest prevalence is among elderly patients (the predominant age of patients is 60 years and older). In the vast majority of cases, inversion is localized in the large intestine: in 80% of cases there is a twisting of the sigmoid colon, 15% of the cecum, less than 5% of the transverse colon part of the intestine, splenic angle. Inversion of the intestines is about 5% of all cases of intestinal obstruction, 10-15% of all episodes of colonic obstruction.
For children, a twist in the small intestine is more characteristic, one way or another associated with congenital pathology. In pregnant women, this form of bowel obstruction usually occurs in the third trimester, when an enlarged uterus displaces the sigmoid colon, causing its torsion. A significant part of patients with intestinal torsion is represented by a contingent of nursing homes and psychiatric clinics.
Diagnosis of intestinal obstruction is a comprehensive examination of the patient, which includes the following measures:
- examination - palpation of the abdomen, determination of skin color, control of body temperature and blood pressure,
- X-ray of the large intestine - if there is a suspicion of an intermediate or late stage, the study is carried out immediately
- blood test - general and biochemical,
- Ultrasound or CT scan of the abdominal cavity - methods to visualize a possible cause of obstruction.
In some cases, there are indications for laparoscopy. Most often, they resort to this measure when external signs confirm the diagnosis, and the critical condition of the patient does not allow for a complete diagnosis. With laparoscopy, the doctor not only reveals a pathological area of the intestine, but can also directly begin treatment.
If the patient is delivered at an early stage of the disease and the above methods do not make it possible to establish a diagnosis, a contrast x-ray of the passage of barium through the intestines is shown with a scan every two hours. Until the circumstances are fully clarified, the patient remains in the hospital.
Most often, the inversion of the sigmoid and small intestine occurs. According to the degree of torsion, the inversion is divided into partial (up to 270 °), full (270-360 °), as well as repeated. The occurrence of pathology is usually associated with congenital features of the mesentery of the intestine and anomalies of its attachment, adhesive disease, in which adhesions bring together individual loops of the intestine, causing stagnation of the contents and stretching of the intestine, fixation of loops and mesentery.
In this situation, prerequisites arise for the torsion of the intestinal loops around the axis of the too long mesentery - from a 90 ° turn to two to three complete twisting, as a result of which the blood vessels and nerves are infringed in the mesentery, there is a mechanical obstacle to the advancement of food masses. The following factors predispose to the development of the disease: a sharp increase in intra-abdominal pressure during physical exertion, weight lifting, a sudden increase in intestinal motility after forced starvation, significant overeating, eating unusual food, and long-term persistent constipation.
With inversion of the small intestine, the cause in most cases is an abnormality in the development of the mesentery, less often, adhesions of the abdominal cavity. Usually, bowel loops rotate in a clockwise direction; the entire small intestine can be fully involved in the process. The causes of large intestine inversion are adhesions, large tumors and cysts of the abdominal cavity, pregnancy, the postoperative period during interventions on the abdominal organs, and the prescription of drugs that enhance intestinal motility. Most often, inversion occurs in the sigmoid region, since it has the longest mesentery. Less commonly, pathology occurs in the right half of the colon, in the splenic angle.
Torsion of the intestines can complicate the course of diseases such as acute appendicitis, Hirschsprung's disease, cystic intestinal fibrosis, megacolon, gastrointestinal carcinoma, enteroptosis, senile dementia, various mental disorders, multiple sclerosis. Often this pathology develops against the background of taking psychotropic drugs, saline and osmotic laxatives, after colonoscopy.
How to cure intestinal torsion
In the event of negative symptoms, you should immediately consult a doctor and undergo a diagnosis. At the initial examination, the gastroenterologist conducts a visual examination and palpation of the abdomen. For an accurate diagnosis, radiography with contrast is performed. If there is a twist in the image, a loop, accumulation of liquid and air will be visible. Radiography allows you to determine the exact location of the pathology.
If you postpone a visit to the doctor, the prognosis of the disease will not be favorable and may even lead to death. The danger is due to the rapid development of gangrene due to circulatory disorders in a particular area. As a treatment, surgery is used, which involves the elimination of inversion. In particularly difficult cases (with the development of necrosis), a resection of a part of the intestine is performed, followed by the application of an anastomosis.
The operation is performed under general anesthesia. As a rule, laparoscopy is used - several small incisions are made in the abdomen, through which a camera and surgical instruments are inserted into the abdominal cavity.
You can fix the inversion of the sigmoid colon with a colonoscope. If the tube passes through the twisted section, then the problem is eliminated, the gas escapes, an act of defecation occurs and relief comes.
After surgery, the patient expects a long recovery period. During rehabilitation, he is obliged to observe complete physical and emotional rest, as well as to eat properly (it is worth giving up foods rich in fiber, heavy, rough and solid foods). To prevent infection of the wound, it should be regularly treated with antiseptic solutions and dressings.
In order to accelerate recovery and recovery, it is recommended to use physiotherapeutic procedures: laser therapy, electrophoresis and magnetotherapy. Favorably, the patient's condition is affected by breathing exercises. Its implementation helps to avoid complications from the respiratory system, which can be caused by prolonged bed rest.
To maintain normal health and improve the condition, painkillers and analgesics are prescribed (Analgin, No-shpa). With severe pain that persists after surgery, Morphine can be used (only as directed by a doctor and with strict adherence to the recommended dosage).
Inversion of the intestines is a dangerous condition that requires immediate medical attention and surgical intervention. Timely contacting specialists guarantees a favorable outcome, a quick recovery and the ability to lead a full life.
At the beginning of the diagnostic search, the patient may be in the department of gastroenterology, however, after diagnosis, he should be transferred to the department of abdominal surgery.Conservative therapy and preparation for surgery begin with the introduction of a nasogastric tube for unloading the intestines, removing stagnant contents and gases. The goal of infusion therapy is to restore fluid balance, water-electrolyte balance of blood, and protein levels. Antibacterial therapy is required if peritonitis or sepsis is suspected - it begins immediately after the patient is hospitalized, if these complications are excluded - two hours before surgery.
Inversion of the small intestine is treated exclusively by surgery. During the operation, the surgeon should try to straighten the torsion of the loops; in the presence of intestinal necrosis, a segmental resection of the small intestine is performed, and anastomosis of the small intestine is applied to the small or large intestine. If peritonitis is detected during the operation, an ileostomy is applied, after three months a reconstructive operation is performed. The operation for the inversion of the cecum aims to conduct a hemicolectomy with the application of an inter-intestinal anastomosis or ileostomy (in the presence of inflammatory exudate in the abdominal cavity). In debilitated patients, percutaneous typhlostomy can be performed - it will improve the intestine and stabilize the patient.
The treatment of sigmoid colon inversion is preferably begun with sigmoidoscopy or colonoscopy, during which a flexible tube is inserted into the sigmoid colon to relieve intestinal tract. If necessary, after decompression, a radical operation is performed, the indications for which are acute inversion of the sigmoid colon, the absence of the effect of conservative therapy. After the operation, it is necessary to continue massive antibacterial and infusion therapy, to monitor the patient for early detection of complications: infection, failure of sutures on the intestine, the formation of intestinal abscesses and fistulas, the development of generalized infection.
Forecast and Prevention
Since the inversion of the intestines in the vast majority of cases develops in elderly patients, the prognosis for this disease is quite serious, due to poor initial health status, the presence of severe concomitant pathology. Mortality in the late detection of pathology (more than three days from the onset of the disease) reaches 40%, and postoperative mortality - 30%. After endoscopic treatment, half of the patients have relapses of the disease.
For prevention, control of the appointment and administration of psychotropic and laxatives, drugs that enhance or slow intestinal motility is required. The amount of coarse dietary fiber in the diet should be sufficient, but not excessive. After surgical interventions, prevention of adhesion formation must be carried out without fail.
Only a specialist can decide how to treat bowel obstruction. An indication for immediate surgery is peritonitis, since there is a great threat to the patient's life. In other cases, resort to conservative treatment.
In this case, the patient is prescribed special procedures (for example, enemas and gastric lavage), as well as taking medications:
- antispasmodics that stop pain,
- drugs that stimulate intestinal motility,
- saline solutions, glucose for intravenous administration.
Each remedy is part of a comprehensive treatment. But, unfortunately, such therapy does not always help. If conservative methods cannot cure bowel obstruction and there is no positive dynamics within 12 hours, then surgical intervention cannot be avoided.
The operation is also indicated if bowel obstruction has arisen due to the formation of an obstruction in the way of feces and if peritonitis has developed. Surgical intervention is aimed at:
- Elimination of the reason, because of which the movement of feces is difficult.
- Removal of dead intestinal tissue.
With obstruction of the small intestine, its resection is performed.
Upon invagination, the surgeon unravels the wrapped bowel loops. If obstruction is a consequence of the presence of adhesions, then they are excised. In the event that the cause was the presence of a tumor, then hemicolonectomy is performed, that is, its removal. The surgeon has many options for action, because the causes of bowel obstruction are very diverse. Together with the operation, antibiotic therapy is carried out to prevent the growth of pathogenic bacteria in the body and possible blood poisoning.
After the operation, a long recovery period is required. It consists in the normalization of intestinal motility, the adjustment of water and protein balance. Exercise is strictly forbidden to the patient; strict adherence to the prescribed diet will be required from him. All these measures are carried out in order to prevent the reappearance of bowel obstruction and to establish the work of this body.
Treatment with folk remedies
In some cases, with chronic intestinal obstruction or in case of slight difficulties with the release of feces, which are not accompanied by severe pain, treatment with folk remedies is possible. But we must remember that this is permissible only when there is no threat to health and life!
Traditional medicine recommends effective natural remedies for constipation for the elderly and children:
- Common beetroot To make a medicine out of it, you should cut 0.5 kg of root vegetables into small pieces, put them in a saucepan and pour boiling water (5 l). After this, the container must be closed with a lid for 3 hours. Then the pieces of beets must be removed, and in the resulting infusion add 1 teaspoon of dried yeast and 150 g of sugar. Leave for a day. Now the drink is ready to drink! You need to drink it regularly throughout the day - about 5 times a day.
- Enema of butter and milk. This procedure is done at night, 2 hours before bedtime for 3 days. Take half a glass of milk, heat and dilute 20 g of butter in it. The enema solution is ready!
- Effective infusion of St. John's wort and sand sedge. You need to take 1.5 tablespoons of these plants, pour the raw materials 600 ml of boiling water and leave for 8 - 12 hours. Use infusion, filtered through a fine sieve, 4 times a day.
Before using all folk remedies, you should consult a doctor. Only he can assess the severity of the disease and, if necessary, prescribe conservative treatment. In some cases, initiative can lead to disastrous results.
Bowel obstruction is an ailment that occurs in people of all ages, including children. This is a very serious condition, but you should not be scared. With timely access to medical help, the prognosis is usually favorable. In order to prevent such problems with the intestines, it is necessary to treat chronic diseases in a timely manner and monitor your diet. Then many troubles will pass by.
Small intestine twist
In this case, the symptoms will be similar to torsion of the cecum. Signs of pathology will manifest themselves in the following:
- severe pain syndrome. An unpleasant feeling will have a constant and cutting character. Most often occurs in the upper abdomen. May intensify and become intolerable,
- increased peristalsis,
- overexcitation of the patient. The patient may scream from severe pain. To relieve pain, a person lies on his side and presses his knees to his stomach,
- nausea and vomiting. As soon as a bowel torsion occurred, the patient begins to tear with feces. Moreover, this symptom has a multiple character,
- asymmetry of the abdomen,
- gas and stool retention,
- dizziness, headache, impaired consciousness,
- temperature increase up to 40 degrees,
- pain in muscle and joint structures,
- blanching of the skin,
- excessive sweating
- overdrying of the mucous membranes.
Twisting the sigmoid colon
The inversion of the sigmoid colon is similar to the twisting of the small intestine. But it has its own characteristics.
The disease in children and adults is characterized by:
- pain syndrome. It manifests itself sharply in the lower abdomen. Pain can be given to the lower areas of the spine,
- nausea and vomiting. First, the patient vomits the contents of the stomach and bile. After a few hours, feces appear in the masses,
- lack of stool
- labored breathing. This symptom is explained by the accumulation of gases in the sigmoid colon, as a result of which the intestinal walls are stretched. The digestive tract presses on the internal organs, as a result of which the volume of the chest is reduced,
- disturbance of the heartbeat. Because of this, pain in the sternum, arrhythmia and tachycardia develop.
If bowel obstruction is suspected, symptoms should be determined as soon as possible. Then urgently need to contact a doctor.
This method of treatment only helps relieve symptoms. The true cause of the disease, he can not eliminate.
The patient may be assigned:
- antispasmodics in the form of No-shpa, Drotaverin, Papaverine. They will relieve spasm and lower intestinal motility,
- painkillers and antipyretics. They are taken at temperatures above 38 degrees. Analgesics will help relieve severe pain. Such medicines include Aspirin, Paracetamol, Ketanol, Ibuprofen.
If there is a twist of the sigmoid colon, then it is enough for a specialist to straighten the intestines with the fingers. The thing is that this site is located near the anus. But you should not carry out such a procedure yourself.
If no complications are observed, the patient stays at home and performs outpatient treatment. With intoxication of the body, it is possible to clean the intestinal tract with a special probe.
To eliminate the cause of the disease, surgical intervention must be performed. The technique for performing the operation for each patient is selected individually. The whole process depends on the location of the organ twist, the viability of the tissue structures and the age of the patient.
The plan for the implementation of surgical procedures is as follows.
- The patient is anesthetized. Generally applied common.
- After the patient falls asleep, the surgeon makes access to the affected area. This implies a laparotomy incision.
- The doctor enters the abdominal region and detours the loops.
- When the intestines are straightened, the cavity is washed with antiseptic and disinfectant solutions. Drainage and suturing of wounds are also carried out.
After surgery, the patient is prescribed drug therapy, which involves:
- taking antibacterial agents. This will avoid complications and eliminate infectious agents,
- staging droppers with magnesia and glucose. Such a process will help cleanse the blood fluid and provide the body with useful components,
- treatment of seams with antiseptic agents,
- the appointment of painkillers to muffle pain.
In stationary conditions, under the supervision of doctors, the patient is for seven to fourteen days.
Compliance with diet and other recommendations
After surgery, the patient should not eat for two days. At this time, a strict drinking regimen is observed. With an improvement in well-being, liquid dishes are gradually brought into the diet in the form of broths and soups. Further, the menu expands to the use of cereals, boiled vegetables, baked fruits, compotes and fruit drinks.
It is necessary to take food up to five to six times a day and a little.
After the patient is prescribed a diet should be observed in the same mode for at least one month.
You should also adhere to other, equally important recommendations in the form of:
- performing physiotherapeutic procedures. The doctor may prescribe electrophoresis with the use of analgesics, magnetotherapy,
- strict bed rest,
- complete lack of physical activity. You can periodically walk, but not more than 20 minutes,
- conducting breathing exercises.
Subject to all recommendations, the outcome of the disease is favorable.
First Aid Treatment
Inversion of the intestine is a serious process, which with untimely help can lead to death. If you suspect this pathology, you must urgently call an ambulance.
While the ambulance is traveling, you need to adhere to some rules.
- The patient should ensure complete peace. He must remain in a supine position.
- No medicines should be given without a doctor’s permission.
- Do not feed and drink the patient. This can lead to the development of peritonitis, the spread of infection throughout the body and a significant deterioration.
- In no case should you take laxatives or put enemas. Also, no need to rinse the stomach.
After the ambulance arrives, the doctor assesses the condition of the person and, if necessary, takes him to the hospital.
To prevent the development of this disease, you must adhere to some rules.
- Watch your diet. The diet should be right. Do not overload the intestines with overeating.
- Train the muscle structures that hold the abdominal cavity.
- Timely detect and treat intestinal diseases. Avoid relapses of chronic diseases. Prevent constipation.
- Do not carry heavy objects and avoid serious physical exertion.
- If you suspect the development of pathology in children, you need to contact a pediatrician in a timely manner.
The main rule for any person is the lack of self-medication. Only an experienced doctor should provide assistance and prescribe treatment after a detailed examination.
The characteristic of the disease
Torsion of the intestines is a pathology in which looping of the intestine around the mesenteric axis occurs. This problem can occur in various parts of the intestine. Most often, the area of the colon is damaged. This situation is observed mainly among representatives of the older generation. In children, on the contrary, the small intestine is the most vulnerable, but pathology in childhood is rarely diagnosed (the disease develops against the background of a congenital anomaly in the structure of the organ).
The degree of looping of the intestinal loops can be different. Depending on this, such forms of pathology are distinguished as partial (less than 270 degrees), full (270-360 degrees), multiple inversion (when the loops are twisted in several places).
Regardless of the degree of twisting, an inflammatory process develops in the intestine (on its affected area), the structure of the walls of the organ is disrupted, which leads to the development of the clinical picture.
What it is?
Torsion of the intestines - acute intestinal obstruction, which begins to progress due to the rotation of the intestine around the mesenteric axis. This can also occur due to twisting of a certain section of the intestine along with the mesentery around the axis (the process is accompanied by a pronounced circulatory disturbance).
More often this pathology is diagnosed in children under one year of age. This is due to the fact that their peristalsis has not yet fully normalized, so some part of the small intestine can enter the colon.
Characteristic signs of intestinal torsion
The main signs of the development of the disease include:
- Nausea and vomiting.In the early stages of the development of the problem, this symptom is weakly expressed, the patient has a small amount of vomit. Over time, the situation worsens,
- Lower abdominal pain. Often, pain is common: the patient feels discomfort not only in the abdomen, but also in the sacral spine,
- Irregular shape of the abdomen. Often bursting and bloating is observed only on one side, as a result of which the stomach acquires an asymmetric shape,
- Lack of gas formation and bowel movements,
- Pain in the sternum, impaired heart rate. With inversion of the intestines, pressure in the chest area increases, which has a negative effect on the work of the heart,
- Choking, difficulty breathing. The delay of feces in the intestine contributes to a pathological increase in the size of the organ, which leads to compression of other areas, including the organs of the respiratory system.
These signs indicate the development of the most common form of pathology: inversion of the intestines in the large intestine. If the problem is localized in the small intestine, the patient has a slightly different clinical picture, including such manifestations as:
- Anxiety, irritability, associated with the development of severe pain, when the patient can not tolerate pain,
- Acute pain in the lower abdomen
- The appearance of protrusions in the navel,
- Profuse vomiting. Elements of bile and then feces are found in the vomit
- Signs of intoxication (vomiting, general well-being, symptoms of dehydration, weakness),
- Lack of bowel movement (this symptom does not occur immediately, as in the case of a lesion of the large intestine, but a few hours after the problem occurs).
Stages and manifestations of intestinal wrapping
Inversion of the intestine, most often, is characterized by rapid development, however, 2 stages are still distinguished. This is the beginning and climax.
|Development stage||Characteristic manifestations|
What is dangerous pathology
It is important to understand that intestinal inversion is a condition that does not go away on its own. So, the patient needs emergency medical care. Otherwise, there is a high risk of developing life-threatening complications, such as:
- Fecal peritonitis. Fecal masses cannot be excreted from the body, they accumulate in the intestines. This leads to the development of inflammation and perforation of the walls of the organ. Through the formed openings, feces leave the intestinal cavity, spread in nearby areas, causing their toxic damage,
- A significant violation of the heart (up to the development of a heart attack) occurs as a result of the fact that the intestine, which has increased in size, compresses the heart muscle, interfering with its normal contraction,
- Complete intestinal obstruction.
To make a diagnosis, it is necessary to evaluate the totality of symptoms and conduct a series of additional studies. During a patient survey, the doctor specifies the following points:
- The duration of the development of symptoms,
- Localization and nature of pain
- The presence of vomiting, their number, abundance and nature of the allocated vomit,
- Stool frequency and stool consistency,
- The patient’s eating habits, foods he ate before the symptoms appeared,
- The presence or absence of surgery on the digestive tract,
- Features of a person’s lifestyle, his physical activity.
In addition to assessing existing complaints, the doctor conducts such studies as:
- Examination of the patient to detect asymmetry of the abdomen, focal swelling, assessment of the skin,
- Palpation to detect densified areas and increased intestinal motility,
- Percussion of the intestinal region (with the development of pathology, a characteristic popping sound is heard when tapping),
- Listening to peristalsis. During the procedure, increased peristalsis, or its absence, is detected, the doctor can also hear various bursts,
- X-ray to determine the localization of pathology,
When the characteristic symptoms of intestinal torsion appear, it is necessary to call an ambulance team as soon as possible and deliver the patient to a medical facility. However, special measures must also be taken before the doctors arrive. This will prevent the development of dangerous complications and, possibly, save a person’s life.
Before the ambulance arrives, you must:
- To provide the patient with complete rest, put him in the most comfortable position,
- Exclude the use of food or liquid,
- Ensure the flow of fresh air, free the patient from items of clothing that constrain movement,
- Do not take kaike or medicine,
- Do not do cleansing enemas, as this will only exacerbate the situation.
It is important to properly prepare the patient, preparation includes such moments as:
- Conducting UAC and OAM,
- Restoring the fluid balance of the body,
- Drug therapy
- Cleansing the stomach through an enema or using a special probe that is inserted through the nose.
The operation is also carried out in several stages:
- An incision of the skin, subcutaneous layer and muscle tissue to ensure full access to the lesion,
- Unwinding damaged loops
- Bowel cleansing using a probe,
- Antiseptic tissue treatment,
- Installation of a special drainage tube, one end of which is located in the intestine, the other is brought out,
- Wound closure.
In some cases, if necrotic (dead) areas are observed in the affected area, it is necessary to remove them, and only then carry out antiseptic treatment, drainage and suturing.
The operation is very complex and traumatic, so the patient needs a long recovery period, which includes the following points:
- Drug therapy with painkillers,
- Lack of motor activity,
- Antiseptic treatment of surgical sutures,
- Compliance with strict dietary restrictions,
- Breathing exercises.
To eliminate the pain syndrome both in the preoperative period and at the recovery stage after surgery, the following groups of anesthetics are used:
|Morphine||It belongs to the category of narcotic anesthetics with a strong effect. It weakens the transmission of nerve signals from the affected area to the brain, and has a relaxing effect on the patient.||10 MG intramuscularly 5-6 times a day. Duration - no more than 3 days.||40 rub for 1 ampoule|
For successful recovery after intestinal wrapping, the patient must follow a special diet. It is important to limit the consumption of products that enhance intestinal motility, to activate the processes of fermentation, gas formation. In order not to overload the intestines, it is necessary to take food in small portions, but quite often (at least 5 times).
How to treat intestinal torsion?
As a rule, treatment of intestinal torsion begins with conservative therapy. But this is possible only if there is no peritonitis and if the patient's condition allows slight delay. Therefore, all people who have experienced acute abdominal pain and have not defecated for a long time should consult a doctor as soon as possible.
As part of conservative therapy, it is prescribed:
- taking painkillers,
- siphon enema
- intestinal cleansing due to the introduction of a gastrointestinal probe,
- taking medications that help restore the water-salt balance in the body.
Important: conservative treatment usually gives better results in eliminating sigmoid inversion.
Nevertheless, despite all the efforts of doctors and patients, it is not always possible to overcome intestinal obstruction with the help of conservative therapy. In such cases, it is removed surgically.
As a rule, they try to straighten the gut with the help of air supplied to it by a special apparatus.
If this does not happen, an operation is performed, during which doctors remove irreversibly damaged sections of the intestine and make maximum efforts to restore only slightly damaged ones.
In the future, products enhancing intestinal peristatics are excluded or limited from the patient’s menu:
- wholemeal porridge with peel,
- dairy products,
- cold drinks,
- peeled vegetables and fruits, especially when raw,
- apricots, prunes,
- all kinds of greenery
- vegetable oil.
Still exclude some products that have a negative effect on the entire digestive tract:
Inversion of the intestines does not pass on its own. Untimely seeking help is fraught with dire consequences:
- Peritonitis is an inflammation of the abdominal cavity, as a result of fecal mass entering it. It arises as a result of thinning and the formation of holes in the walls of the intestine.
- Cardiovascular pathologies result from vasoconstriction and circulatory disorders. May lead to heart attacks.
- Intestinal obstruction - impaired movement of feces through the lumen of the small or large intestine.
For each meal, you must select 1 of the proposed options:
- Breakfast: Protein omelet, milk porridge,
- Lunch: Curd casserole, yogurt,
- Lunch: Meat puree, vegetable soup, boiled fish,
- Snack: Liquid yogurt, baked fruit,
- Dinner: Steamed fish, stewed vegetables.
A full-fledged treatment of intestinal torsion includes all the necessary steps. Only with an integrated approach can the patient recover completely and prevent the risk of developing dangerous consequences.
The disease in question can develop against the background of the following factors:
- Abnormal changes in the parameters of the sigmoid colon, which are diagnosed in newborns or in people of advanced age.
- The presence of additional pockets of the peritoneum.
- Hernias (external / internal) that are localized in the abdominal cavity.
- Adhesive disease, which can occur due to trauma to the intestine, after various surgical procedures are performed on it, with infection of the peritoneum.
- Bowel obstruction by gallstones / feces, foreign bodies, worms, malignant / benign formations. The cause of this pathology can also be tumors of neighboring organs, which squeeze the intestinal tube.
- Hirschsprung's disease. It occurs in newborns and is a deficit of nerve cells, which negatively affects the intestinal motor function.
- Takayasu syndrome, during which the abdominal aorta is affected. Young women often suffer from such an ailment.
- Failures in the central nervous system.
- Pathologies associated with metabolic disorders (potassium / sodium deficiency, diabetic ketoacidosis).
- Intoxication of the body as a result of zinc poisoning.
- Inversion of the intestine. A similar defect can be triggered by several factors:
- Abundant food after prolonged fasting.
- Mental disorders.
- Incorrect fixation of the cecum (congenital anomaly).
- Sedentary lifestyle.
Mechanical obstruction is eliminated exclusively by surgery. The type of operation depends on the causes of the pathology. For example, if the cause of an obstruction of the intestine is the ingestion of a foreign body and the formation of a large fecal stone, surgical opening of the intestine is indicated. Gut twisting can be corrected by twisting the loop. To avoid relapse, the problem area is fixed or shortened. If intestinal tissue death is noted, atrophied areas are excised with subsequent intestinal stitching.
Dynamic obstruction allows the use of conservative therapy. In this case, the patient must always be under continuous medical supervision, since there is a high risk of sepsis.
Patients with suspected acute intestinal obstruction are immediately delivered to the surgical department. The complex of diagnostic measures depends on the patient’s indicators - if the condition is critical, an emergency operation is performed, during which the diagnosis is first confirmed, and then the cause of the pathology is eliminated.
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Specialty: infectious disease specialist, gastroenterologist, pulmonologist.
Total length of service: 35 years .
Education: 1975-1982, 1MI, San Gig, highest qualification, infectious diseases doctor.
Science degree: doctor of the highest category, candidate of medical sciences.
- Infectious diseases.
- Parasitic diseases.
- Emergency conditions.
Before the arrival of specialists, you can carry out the following activities:
- Measure blood pressure and body temperature.
- Test your pulse regularly and monitor your heartbeat.
- Provide complete physical peace.
- Give the patient water in small quantities.
- Give the patient medications that promote bowel movements. This will only intensify the pain.
- Install cleansing enemas.
Emergency care and treatment of bowel obstruction in adults and children
- Intramuscularly administered drugs that help eliminate spasm (papaverine, platifillin), as well as anti-allergic drugs (suprastin).
- A probe is inserted into the stomach to ensure a constant discharge of vomit.
- Transportation is carried out on a stretcher.
- With the development of shock syndrome, the patient is given an injection with a plasma-replacement solution.
- Installation of siphon enemas, thanks to which you can cleanse the colon.
- Infusion therapy, the main task of which is to prevent dehydration and stimulate intestinal motility. This manipulation is carried out with simultaneous catheterization of the bladder and regular replenishment of the level of potassium in the blood.
- Prevention of circulatory disorders through the introduction of rheologically active substances (reopoliglyukin).
- Replenishment of the amount of proteins (albumin, protein, amino acids). In severe conditions, plasma can be used.
- Relieving pain by antispasmodics (atropine, no-spa).
- Prescribing antimicrobials to prevent sepsis.
Based on the location of the defect, the following manipulations can be performed:
- Small bowel resection with small bowel obstruction with the further creation of anastomosis between the small and large intestines.
- Double-barreled colostomy with colonic obstruction, which arose as a result of a pathological neoplasm. If the tumor is not operable, the surgeon solves this problem by applying a bypass anastomosis.
- Intestinal Surgery to eliminate foreign bodies.
- Separation of adhesions. In modern medicine, a laser, an electric knife, can be used for such manipulations.
- Elimination of intestinal twisting by untwisting a loop. Before this procedure, the intestine is thoroughly cleaned of the contents. Necrotic sites (if any) are removed. Surgical treatment of a twist of the sigmoid colon can be carried out in two ways: with further fixation of the intestine or with its initial shortening using resection.
Material checked: Boris Sergeyevich Kravchenko, surgeon - 12/24/2019 Gangrene is a process of necrosis and further death of whole organs or individual parts of the body resulting from diseases or damage to tissues of a living organism of various etiologies. →
Rehabilitation and Prevention
Subsequently, certain measures must be taken to accelerate recovery and prevent the development of complications or re-inversion. First of all, the patient needs to provide bed rest and anesthesia for the healing period. Sudden movements are unacceptable during this period. It is necessary to take care of restoring the water-salt balance.
From food in the first few weeks you need to eat cereals, mashed potatoes and liquid soups. Any solid food is prohibited so far. It is not recommended to use products that promote gas formation. You need to drink plenty of water and fruit drinks. In the future, you can gradually return to your usual diet.
To prevent intestinal torsion, it is very important to lead an active lifestyle. Eat correctly: the body needs proteins, you can not be zealous with the intake of fiber-rich foods. Ideally, food should be taken 4-6 times a day in small portions. After a meal, you need to sit alone for a while. In no case should you play sports right after eating!
Gut inversion - symptoms in adults and children, causes and treatment
Volvulus - under this English term in the WHO registry of diseases registered inversion of the intestines is one of the varieties of strangulation obstruction in the gastrointestinal tract.
What it is? Torsion of the intestines is a disease manifested by a violation of the passage of the gastrointestinal tract due to overlapping or partial narrowing of the intestinal lumen caused by twisting of the intestinal loops, or due to intestinal invagination (when one section of the intestine is introduced into the section of the other intestine).
Under normal conditions of normal functioning, intestinal loops can make turns quite natural for the body, reaching 120 °. In the case when the turns of the intestinal loops reach or exceed 180 °, their lumen sharply narrows or completely overlaps. Infringement of the abdominal duplicate (mesentery) occurs, most often triggered by the circulation of the colon.
In the process of development of intestinal torsion, several loops of the intestine in its various departments can participate.
At the same time, vascular infringement of the mesentery occurs, intestinal ischemia develops (violation of blood supply) and, as a result, a violation of the absorption mechanism and the formation of stagnant processes of chyme or feces in the digestive tract. The gastrointestinal tract is subjected to overflow and stretching, its functions are violated.
In case of intestinal inversion in adults or children, without urgent medical intervention, intestinal necrosis, perforation of the intestinal walls, development of dehydration, intoxication of the body, peritonitis and inflammatory reactions in the peritoneum can develop.
Intestinal inversion can be complete or partial, acquired or congenital.
The disease is susceptible to any age category of patients, but it is mainly observed in adult elderly patients (60 years and older). Surprisingly, the main contingent of patients with inversion of intestines are adherents of vegetarian food.
Signs and symptoms of intestinal torsion in adults
1)Localization of torsion in the small intestine - The most frequent and more severe form of the disease. It is characterized by various processes of loop twisting - full or partial. But the most dangerous condition is due to a change in position in all parts of the small intestine with signs of partial high torsion.
It is manifested by a sharp start. Severe paroxysmal pains come from the depths of the peritoneum, quickly spreading to the epigastric, lumbar and umbilical zones. There is intoxication symptomatology in the form of repeated vomiting.
- Characteristic is the penetration and mixing of feces with food and bile chyme (intestinal contents).
2)Sigmoid Inversion It is noted more often in the elderly category of patients, mainly in men, in the form of signs of gastritis with a previous 3-day malaise and paroxysmal pain.
The main distinguishing feature of this localization of the disease is the rapid development of bloating (flatulence).
The formation of gases occurs in the anterolateral zone of the peritoneum (in the iliac region), but their distribution is possible throughout the abdominal interior.
- A characteristic feature is the asymmetry of the abdomen, when the bulge is more pronounced on its right side.
It is on this basis that one can determine the inversion of the intestines in the sigmoid section of the gastrointestinal tract. Patients rarely immediately consult a doctor, since pain starting on the left side and gradually spreading throughout the abdomen is tolerable, and vomiting of the bile mass appears only at a late stage of development.
3)Inversion of the colon (blind) - a rare pathology. It can manifest itself with various pathological processes:
- with simultaneous torsion of the iliac region around the abdominal duplicate,
- with twists in different directions of movement "clockwise",
- transverse kink, provoking a shift of the lesion site up.
Common symptoms of intestinal torsion in adults, wherever its localization is noted, is manifested:
- Abdominal pain symptoms
- Bloating without signs of gas discharge, or a slight exit,
- Signs of constipation and possible diarrhea preceding it,
- Intoxication symptoms, manifested by nausea and reflex vomiting,
- Xerostomia and fever
- Bad breath
- Asymmetric belly
- Hypotension and pallor of the skin.
With poor excretion of feces, blood impurities may be present in them. The presence of hemorrhagic processes can be noted and bloody impurities in the vomit. Such signs are evidence of a critical condition requiring urgent medical attention.
The most common cause of intestinal torsion in children is not the readiness of the child's digestive system to accept new food, which is often noted in babies who are abruptly transferred from breastfeeding to artificial mixtures.
This fact leads not only to a disorder in the stool of the child, but also to functional disorders of the gastrointestinal tract.
In particular, peristalsis disorders and the development of intussusception (entry of one intestine into another), which is the main reason for the development of inversion in children.
Both in newborn babies and in infants, the rest of the genesis is due to anatomical congenital anomalies. The characteristic localization of congenital inversion of the intestines in children is the region of the small intestine. The causes of the occurrence are due to:
- Excessive mobility of the abdominal duplicate, or its long dimensions,
- The failure of the natural shutter system between the intestinal regions,
- Inconsistency of the anatomical forms of the various sections of the gastrointestinal tract.
- The development of various neoplasms and many other congenital factors.
In a child up to one year of age, intestinal inversion can occur as a result of a hernia of the esophagus, which provokes a violation of food transport through the esophagus and the development of looping of intestinal loops.
In older children, intestinal obstruction can provoke worm colonies and normal overeating. The main symptoms of intestinal inversion in children are manifested:
- high temperature
- acute soreness in the abdomen
- frequent gagging and vomiting
- bowel movements with mucous and blood inclusions.
Attacks of anxiety in a child are manifested by crying, legs tightening and refusal to eat. They start suddenly and stop abruptly. Immediately rolls an attack of double vomiting, provoked by the closure of the intestinal lumen. Parents should monitor the passage of the stool of the child.
If the child has severe constipation, and when palpating, a condensed accumulation of gases is detected - this is clear evidence of intestinal obstruction.
Very soon, after the start of the process, the excretion of feces and gases will completely stop. The process of toxic poisoning of the body and dehydration will begin. With treatment, you should hurry, since mortality can occur literally after a day.
Gut inversion: causes, symptoms in adults and children, first aid, treatment
Inversion is a variant of mechanical intestinal obstruction. It develops as a result of a local torsion of the intestinal tract along with the mesentery, on which it is attached. The twist angle and direction may be different. As a result, complaints and clinical manifestations of the problem change.
They are due to the duration and volume of the delayed food lump, compression of blood vessels and nerves. These changes lead to the death of cells and tissues of the affected gastrointestinal tract. Death of the walls can cause their stratification, which causes the food lump to enter the abdominal cavity and causes severe complications - fecal peritonitis.
Inversion is an urgent surgical condition that requires immediate care.
Predispose to the development of pathology:
- lengthening of the intestine for various reasons (or its individual parts),
- excessive proliferation of the mesentery, cicatricial defects of its root with narrowing,
- congenital pathology, leading to the straightening of the line of fixation of the mesentery to the parts of the digestive tract,
- adhesive processes
- post-surgical and post-inflammatory adhesions,
- the activity of parasites,
- excessive and rapid weight loss, leading to hypermobility of intestinal loops,
- dysentery, inflammatory processes, frequent constipation.
Reasons that give impetus to the process (producing factors):
- a sharp and sudden increase in abdominal pressure,
- increased motility (peristalsis) of the digestive tract,
- taking excessive amounts of food at long intervals (overeating). Especially if the food is rough. Unification causes lumen overflow, increased gas formation, and displacement of intestinal loops,
- traumatic damage to the abdomen.
Torsions of 180-360 ° and more become dangerous.
Types of inversion
Depending on the site in which pathology can develop, a pathological process is distinguished in:
- sigmoid colon.
This most common classification includes the main clinical types of pathology. Diagnosis is important for choosing the tactics of the upcoming treatment.
Small intestine inversion
Practical observations by abdominal surgeons (dealing with diseases of the abdominal cavity organs) indicate that this form of obstruction has become much less common than before.
The process develops in the clockwise direction and is always difficult. It is due to the length of the involved department and large angles (quantity) of rotation.
Sometimes the entire small intestine enters the inversion.
Patients complain of:
discomfort with heaviness in the abdomen, loss of appetite, diarrhea (in the prodromal period - the initial phase),
- sudden sharp pain attacks that are much easier, or completely go away with conservative methods of care,
- forced position. The patient most often lies on his back, or on his side, anxious. The legs are pulled to the stomach. Sometimes a person takes a knee-elbow pose. In these poses, the pain is less intense
- reflex vomiting of food taken, the frequency and intensity of which is increasing. With a long delay in going to the doctor, it takes on a fecal character,
- delayed stool, lack of feces,
- severe weakness, headache, palpitations, high body temperature caused by intoxication - poisoning.
On examination, the doctor discovers a swollen abdomen, the absence of normal peristalsis. With percussion (tapping the abdominal wall), the specialist determines the abdominal effusion. Against this background, auscultatory noise in the abdomen gives way to "silence."
After the diagnosis is established and before the operation, it is necessary to try to help the patient.
- infusion solutions are prescribed to relieve intoxication and restore the volume of circulating blood,
- adequate pain relief is performed with potent drugs, if necessary with narcotic analgesics,
- in case of possible effectiveness, the stomach is washed and an enema is placed.
Features of surgical interventions
In connection with the serious condition of the patient and the volume of exposure, the patient must be entered into anesthesia (general anesthesia).
Surgical access to eliminate intestinal obstruction is carried out using a wide laparotomy incision from the xiphoid process, with the navel around the left, to the pubic area. To the cecum and sigmoid colon, lower middle access is sufficient.
The nature of the operation depends on the anatomical lesions. In the period of early changes, the usual straightening of torsions is enough. Against this background, normal blood circulation and peristalsis are quickly restored. In the eyes of the operating doctor, the intestine turns pink, begins to actively contract. Detection of the adhesive process requires its dissection.
Necrotic tissue changes (blackening), dullness, the presence of a bloody effusion require removal (resection) of the affected area.
In case of inversion of the cecum, it is fixed by a flap of the visceral peritoneum (cecopexy) with a shortened mesentery. Another way - corrugated cecoplication offers reinforcing ligaments with sutures. Retroperitoneal immobilization is recommended for some patients. In this case, the cecum and the ascending intestinal section are sutured to the parietal peritoneum.
With gangrene and peritonitis, the affected area is excised, and the ends of the intestine are displayed on the surface of the abdominal wall in the form of a “double-barreled shotgun”. This technique is called an ileostomy. After therapeutic measures, the second stage of the operation is prescribed with the restoration of intestinal integrity.
Due to the severe surgical impact, patients quite a long time away from the operation.
- special diet
- bed and half bed mode,
- medical and breathing exercises
- physiotherapeutic help.
The implementation of simple recommendations will significantly reduce the risk of developing an acute ailment.
To prevent the disease requires:
- compliance with a balanced diet. Overeating should be avoided, eat balanced
- treat constipation diseases
- observe an active motor regime to eliminate stagnation in the abdominal cavity,
- to undergo periodic examinations and treatment by specialists in gastroenterologists with pathologies of the gastrointestinal tract.
Inversion of the intestine is a serious surgical pathology and requires the mandatory participation of a specialist. In the case of timely assistance, the chances of recovery without consequences for the body are much higher.