Diseases

Intestinal perforation

Intestinal perforation


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A Intestinal breakthrough (or Intestinal perforation) denotes a local breakthrough of the intestinal wall in the form of a hole or tear, whereby the contents of the intestine can penetrate into the abdominal cavity of the person concerned. Accordingly, it is an extremely serious clinical picture, since a life-threatening situation can arise very quickly.

Definition

In medicine, an intestinal breakthrough is understood to mean a local breakthrough in the intestinal wall, as a result of which the contents of the intestine flow freely into the patient's abdominal cavity. Although the perforation in the form of a hole or tear is relatively small even in most cases, the intestinal wall is completely broken through in the event of a breakthrough. Since there is a large number of germs in the faeces, severe inflammation of the peritoneum (peritonitis) quickly develops - if not recognized early - which can be fatal if therapy is started too late. From a medical point of view, a breakthrough of the intestine differentiates between a "free intestinal breakthrough" and a "covered intestinal breakthrough". The latter is the much less dangerous form, because here an adjacent organ at the point of breakage prevents the contents of the intestine from being distributed throughout the abdominal cavity. This "only" leads to local inflammation with abscess formation.

Intestinal breakthrough: symptoms

The symptoms can be very different and depend on the cause of the perforation. For example, appendicitis causes increased pain in the right lower abdomen, which often subsides at the moment of the breakthrough, but then worsens massively as the peritonitis increases. The underlying illnesses can of course cause pain even before the breakthrough - but the greatest pain is caused by the stool or chyme suddenly emerging when the breakthrough occurs. This contains substances such as stomach acid, which irritate the peritoneum, which lines the abdominal cavity and thus surrounds most of the internal organs below the diaphragm up to the entrance to the small pelvis. As a result, the pain is passed on from the nerves of the peritoneum, which may even lead to a state of shock.

In addition to pain, there are other signs of inflammation such as fever and increasing paralysis of the intestine with vomiting. Blood tests show an increase in inflammation at this time. If no therapeutic measures have been taken by then, a general sepsis (also "blood poisoning") usually develops, ie a serious infection that affects the entire body. If this is the case, immediate intensive medical treatment is necessary, since sepsis can otherwise be fatal and can quickly become very dangerous, especially for older patients or those weakened by other diseases.

Intestinal breakthrough: causes

Various causes can be considered for an intestinal breakthrough, which entail pathological changes to the intestinal mucosa or the intestinal wall. Usually, an inflammation of the intestine that is not recognized or not adequately treated triggers an intestinal breakthrough: Since the blood flow to the mucous membrane and intestinal wall is restricted as a result of the inflammatory reaction in the intestine, tissue damage quickly occurs, which can lead to intestinal perforation in the further course.

Inflammatory bowel disease

A common cause in this connection is the chronic intestinal inflammation Crohn's disease and ulcerative colitis, which are summarized under the collective term "chronic inflammatory bowel diseases" (IBD). Both are autoimmune diseases, in which the immune system "fights" the body's own tissue for a previously unknown reason, which leads to severe inflammatory reactions. Characteristic of these two diseases, which often occur between the ages of 20 and 40, are years of abdominal pain and diarrhea, which are usually accompanied by constant fatigue. Both diseases usually develop in batches, but in ulcerative colitis only the colon is affected, Crohn's disease can in principle occur in the entire gastrointestinal tract - however, the small and upper colon are most often affected. Another difference is in the prospects of healing: While Crohn's disease has not yet been curable, ulcerative colitis has a good chance of healing after the entire colon has been surgically removed.

Intestinal perforation can occur in both cases as part of complications. In ulcerative colitis and (less often) in Crohn's disease, the inflammation of the intestinal wall can be so weakened that intestinal paralysis (ileus) occurs. As a result, the intestinal contents are no longer passed on to the rectum, instead the intestine expands massively - what is known as a "toxic megacolon". The overstretching of the intestinal wall causes very severe pain, in addition there are symptoms such as an extremely bloated stomach, chills, high fever, rapid heart rate (tachycardia), anemia (anemia) and disorders in the water electrolyte balance. If surgery is not performed immediately in this situation, a life-threatening intestinal breakthrough can quickly occur.

In addition to the chronic inflammatory bowel diseases ulcerative colitis and Crohn's disease, other diseases such as Chagas disease, Hirschsprung's disease and pseudomembranous colitis can also be considered as the cause of a toxic megacolon, which in turn can lead to an intestinal breakthrough as a result of complications.

Appendicitis (appendicitis)

Appendicitis (appendicitis) is often the cause of the intestinal breakthrough, although in spite of the usual name it is not an inflammation of the appendix, but the so-called “appendix”. This represents a particularly sensitive part of the appendix, which consists of lymphatic tissue, is on average ten centimeters long and has a diameter of 0.5 to two centimeters. The first symptoms of appendicitis are usually abdominal pain in the stomach area or around the navel, which typically migrate into the right lower abdomen, where the abdominal wall is then usually extremely strained and extremely sensitive to touch. In addition, there are other symptoms such as nausea and vomiting, loss of appetite and fever, and there is often also a restricted bowel movement. Appendicitis is caused by various causes, which can usually only be clarified by examining the surgically removed inflamed worm process. In many cases, however, constipation of the appendage of the worm due to hardened, heavily thickened stool (“excrement stones”) is the trigger, which can cause the colon bacteria to multiply and ultimately cause inflammation. A kinking of the worm process due to an unfavorable position in the abdominal cavity can lead to accumulation of secretions and inflammation; in rare cases, fruit seeds, worms or adhesions of the intestinal wall can also be identified as causes. In addition, inflammatory bowel diseases such as Crohn's disease can trigger appendicitis.

Colon diverticulum (diverticulosis)

So-called “large intestine diverticula” can be considered as the cause of one. These are bottle-shaped protuberances of the intestinal wall, which are commonly referred to as "colon diverticulosis". In principle, the protuberances can occur in the entire gastrointestinal tract, but nevertheless occur most frequently in the left section of the large intestine. Colon intestines are not a congenital change, but are considered a so-called "civilization disease", which is mainly caused by modern living conditions (low-fiber diet, lack of exercise, smoking, etc.). While diverticula are harmless in over 80 percent of cases and do not require treatment, inflammation of one or more diverticula can also occur, which can arise from faecal residues that stick to the protuberances. In the case of such a “diverticulitis”, severe abdominal pain (especially in the left lower abdomen) usually occurs, which often intensifies when eating. In addition, symptoms such as loss of appetite, malaise, vomiting and - depending on the extent of the inflammation - constipation or diarrhea and severe flatulence (bloated stomach) can occur. As a complication in the context of diverticulitis, intestinal breakthrough occurs in about ten percent of cases, whereby this is often covered by abdominal fat (“covered intestinal breakthrough”) and leads to an abscess. In rare cases, however, a free perforation can occur, with the result of a severe clinical picture with peritonitis up to severe inflammatory shock.

Colon cancer / colon cancer

A breakthrough can be caused by colon cancer (colon cancer), which is one of the most common malignant tumors in humans. In most cases, colon cancer develops from a benign intestinal tumor (adenoma), with the risk of cancer increasing with the size of the adenoma. General risk factors for colorectal cancer include obesity and unfavorable eating habits due to too much animal fat and too little fiber. Smoking, alcohol, inflammatory bowel diseases, but also genetic factors can also favor colon cancer - in many cases, however, no clear cause for the dishonor of the disease can be found. A particular problem with colon tumors is that they are often only recognized relatively late, since typical symptoms such as tiredness, abdominal pain, constipation, diarrhea or flatulence only appear in the advanced stage of the disease.

As a result, with late detection, an intestinal obstruction (ileus) may have developed due to the tumor, which is life-threatening and must be treated immediately. In addition, there is a risk that the tumor will colonize and attack surrounding organs and structures, which can lead to a breakthrough and the resulting life-threatening peritonitis. As with all malignant tumors, colon cancer also has the risk of “metastasis” in other parts of the body, which means the spread of spatially separated, similar daughter tumors. Nevertheless, the chances of recovery from colorectal cancer are on average fifty percent. The chance increases with early detection, but also decreases steadily as the disease progresses.

Other causes

In addition to the causes mentioned, various sexual practices such as anal sex with large objects can also trigger intestinal perforation. In addition, a dangerous intestinal breakthrough often occurs after acute constipation, since the volume within the intestine has increased due to the accumulated feces, but the thin intestinal wall usually cannot counteract this pressure. In addition, a so-called “abdominal trauma” can also be the cause, which denotes the injury to the abdominal organs due to external violence. A distinction is made between blunt trauma in which the creek remains closed (for example, in the event of a blow or an impact in a traffic accident) and penetrating trauma, such as a knife stab or a gunshot wound.

Diagnosis

If there is suspicion, the abdomen is usually scanned as part of a first examination. In most cases, this results in a hardened abdominal wall as a result of an increased “defense tension” of the body. In addition, those affected find the examination very painful. In addition to this, imaging methods such as ultrasound or X-ray are generally used for diagnosis. If the X-ray is used, the patient must stand during the images, as this is the only way to correctly diagnose any air in the area of ​​the diaphragm - this, in turn, is a clear sign of an intestinal breakthrough.

Therapy

In the case of an intestinal perforation, quick treatment is essential, since the person concerned has a life-threatening situation. Accordingly, an operative intervention must be carried out in which the open position is closed. If intestinal contents have already entered the abdominal cavity, the patients are also treated with an antibiotic to kill dangerous germs and thus prevent life-threatening inflammation. In addition, intensive medical surveillance is usually carried out for about 10 days. If the acute breakthrough of the intestine was caused by cancer, part of the intestine is usually surgically removed, since this is the only way to counteract the formation of metastases in other regions of the body. In this case, an artificial intestinal exit is often made.

Naturopathy

If an intestinal breakthrough has occurred, surgery is the only life-saving option. In addition, there are a number of procedures and measures in the field of naturopathy to preventively reduce the risk. However, the emergency call 112 should be made immediately in the acute case. Because only life-saving measures in emergency medicine can save lives.

As a precautionary measure, it is generally advisable to promote intestinal health on a regular basis and to carry out an “intestinal cleansing” at the latest in the case of persistent or worsening symptoms such as indigestion (diarrhea and / or constipation), headache, constant fatigue, heavy weight gain or rheumatic complaints. At the center of the intestinal restoration is the rebuilding or normalization of the intestinal flora, in which there is a balance between the bacteria living in the intestine. Before the intestine can be rehabilitated, however, the intestine is cleaned first, during which toxic substances, harmful intestinal bacteria and other “ballast” are removed. There are a number of methods and agents for this colon cleansing, such as herbal remedies or the so-called "colon hydrotherapy". The same applies to the subsequent intestinal cleansing - here too, depending on the individual case, very different procedures are used, such as the ingestion of coli bacteria or lactic acid-producing germs.

In addition, it is generally important for a healthy intestine to pay attention to a healthy intestine. This should contain as little meat, fat and sweets as possible and instead consist primarily of high-fiber and fiber-rich food (whole grains, linseed, fruits and vegetables), which ensures that food residues do not remain in the intestine for too long. It is equally important to largely avoid fermenting foods such as cabbage, sauerkraut, onions and garlic in order to avoid fermentation processes, bloated stomach and flatulence in the intestine. In addition, you should definitely drink enough (at least 1.5 to 2 liters a day), as a lack of fluids can quickly lead to hard stools that are difficult to excrete.

So-called “stool softeners” such as Indian psyllium (psyllium husks) are also suitable for constipation. These swell very strongly, causing the stool in the intestine to increase in volume. This in turn creates a higher pressure, which causes the intestinal contents to be transported further. In addition, the psyllium, due to its large amount of mucus, increases the lubricity of the intestinal contents and thus counteracts digestive problems. In addition to the psyllium, naturopathy also offers a number of other proven home remedies for constipation, including, for example, dead tree bark or wormwood and horned herb. As with all herbal remedies, however, any use should be discussed with a doctor or naturopath to avoid risks or harmful side effects.

In addition to the reconstruction of healthy intestinal flora and a change in diet, other therapeutic measures to strengthen intestinal health have proven themselves in naturopathy, such as autologous blood therapy. Since many people react to stress with gastrointestinal complaints, techniques that regulate emotions are also highly recommended (“stress relief”). In addition, there are relaxation procedures that can have a very positive effect on intestinal health, since these methods can indirectly influence the functions of the gastrointestinal tract. Autogenous training, progressive muscle relaxation or yoga are particularly suitable here. (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese

Swell:

  • German Society for Gastroenterology, Digestive and Metabolic Diseases e.V. (DGVS), German Society for General and Visceral Surgery e.V. (DGAV): S2k guideline on diverticular disease / diverticulitis, as of December 2013, detailed view of guidelines
  • Dr. Johan Friso Lock, Professor Dr. Christoph-Thomas Germer: First German guideline on diverticular disease, Bayerisches Ärzteblatt, December 2017, bayerisches-aerzteblatt.de
  • Institute for Quality and Efficiency in Health Care (IQWiG): Diverticular disease and diverticulitis (retrieval: 06.09.2019), gesundheitsinformation.de
  • ONKO internet portal of the German Cancer Society: Colon cancer (accessed: September 6, 2019), krebsgesellschaft.de
  • Saarland University Hospital and Saarland University Medical Faculty: Acute Abdomen - Visceral Surgical Emergencies (accessed: September 6, 2019), uniklinikum-saarland.de
  • Parswa Ansari: Digestive Perforation, MSD Manual, Merck and Co., Inc. November 2017, msdmanuals.com
  • Professional Association of Pediatricians e. V .: Appendicitis (retrieval: 06.09.2019), kinderaerzte-im-netz.de

ICD codes for this disease: K57, K63ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: PERFORATION REPAIR INTESTINAL PERFORATION REPAIR BOWEL PERFORATION REPAIR (July 2022).


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