Inversion of intestines: symptoms, causes, treatment,operation

Update: November 2018

Inversion of intestines is not terrible with its pain. This condition is deadly
dangerous because of the very strong poisoning of the body, dehydration and
electrolyte disorders. The only way to survive is
своевременно удалить погибшие и гибнущие участки intestine. Highly
редко и только у детей хирурги справляются с этой intestinal
obstruction without surgery. This is only possible with early
diagnostics.

What is volvulus

So called intestinal loop twist around the axis of the mesentery. what
it means?

The mesentery is such a serous membrane in which they pass.
the vessels supplying the intestines, as well as nerves and lymphatic
vessels She is представляет собой два листка брюшины (оболочки,
which in the form of a thin film envelops the guts from above), between
which laid the fatty tissue and passes a lot of vessels.

The mesentery is not only a feeding, but also a fixing organ. it
the part of the peritoneum that passed to the intestine enveloped it from all sides
и вернулась на заднюю стенку брюшной cavities. AT итоге кишка как
as if hanging on such a bundle.

The mesentery that fits the intestinal loops has a different length.
So, the small intestine keeps on a fairly long stretch that
allows the whole mass of guts to move. Mesentery thick
the intestine is short, so the colon seems to be soldered to
задней стенке брюшной cavities.

Inversion of intestines in adults is when the intestinal loop
rotates around its axis. AT результате такого скручивания
передавливаются и находящиеся в брыжейке vessels Gut without getting
food, dying off, and the products of her death poison the whole
an organism.

Inversion of the intestine can be:

  • partial: if the mesentery is turned up to 270 °;
  • complete: if twisting occurred at 270-360 °;
  • double or triple full (shown in the figure).

Pure inversion of intestines in children is rare. AT основном, этим
the word is called the state when one intestine is “inserted” into another
or this one loop penetrates into itself the same as rubber finger
gloves when you take it off. Medically called
инвагинацией intestine.

Why does bloat develop?

Causes of intestinal twisting is a combination of one of
predisposing and one of the producing factors.

Predisposing factors are:

  • abnormal development of the diaphragm or abdominal wall, due to which
    intestinal loop is easily inserted there, which forms
    hernia;
  • mesentery too long due to intestinal loops
    move freely and can “spin”;
  • enlarged large intestine (megacolon);
  • incomplete rotation of the intestine when the latter is already twisted, and
    it remains only to give a provoking factor to develop bloat
    (“Bowel turn” means that in the prenatal period
    the intestine rotates);
  • �”Pockets” of the peritoneum, into which intestines may fall and not have
    opportunities to turn around;
  • Hirschsprung disease.

it все врожденные факторы. They can cause
turning-up is not necessarily in childhood, but also cause
adults – it all depends on when it will produce
factor of the necessary force.

Additional predisposing factors that are characteristic
More for adults are:

  • abdominal adhesions;
  • scars on the internal organs;
  • pregnancy, most often – 3 trimester, when the uterus displaces
    the intestine, especially the sigmoid colon;
  • intestinal infection, which increases as a result
    lymph nodes that are under the mucous membrane of the thin
    guts;
  • cystic intestinal fibrosis;
  • intestinal prolapse;
  • Meckel’s diverticulum.

Inversion of the intestines often accompanies the pathology of the nervous system:
multiple sclerosis, mental illness, senile
dementia.

Now about the generating factors. They are:

  • eating a lot of vegetables or fruits, which is why
    bowel activity increases dramatically or develops
    flatulence;
  • starvation, after which a person began to eat coarse food immediately
    or its large volumes;
  • taking peristalsis (laxatives,
    psychotropic);
  • heavy physical exertion that increased intra-abdominal
    pressure;
  • intestinal inflammation caused, for example, by ingestion
    bacteria (for example, salmonella or dysenteric bacilli);
  • prolonged constipation;
  • acute appendicitis.

The main thing that causes intestinal torsion in infants is
introduction of complementary foods. AT этом случае острое состояние может развиться
even without predisposing factors, especially if the child was given
A large number of complementary foods or have taken too rough food for
of this. AT некоторых случаях ребенок заболевает, когда к прикорму
вернулись, не подождав 4-5 недель после intestinal инфекции (в том
числе, ротавирусной). AT этом случае лимфоузлы еще не
have time to decrease, and coarse food already makes the intestines actively
work, and in some cases the loop begins to wrap.

Statistics

More often всего перекручивается сигмовидная кишка (80% от всех
intestinal torsion), then – thin (in 15% of cases), less than 5%
falls on the colon, which is located near the spleen.

Torsion of the intestine itself is only 4-6% of the entire intestinal
obstruction. The remaining cases occur in the overlap of the lumen.
intestinal adhesions or tumor. Most often people over 60 get sick
years old.

При всех видах intestinal непроходимости смертность составляет
3-10%. After surgery, unfortunately, a third of people die
the world.

What is dangerous volvulus

Normally, a large amount of fluid is excreted into the lumen of the gastrointestinal tract. Have
adults are:

  • about 1.5 liters of saliva;
  • 2 liters of gastric juice;
  • 1.5-2.5 liters of pancreatic secretion;
  • 3 l of intestinal juice;
  • up to 1.5 liters of bile.

90% of this mixture of fluids must be absorbed into the blood.

When the gut twists around its axis, it ceases and
form and new intestinal juice, and suck everything in it already
was at this point. The fluid contained in the gut causes
swelling of its wall, and the blood from the vessels begins to sweat into the lumen
intestine. Haveже в первые сутки болезни в кишечнике может остаться
5-6 liters of fluid, and some of the fluid will be in the abdominal
cavities. This means that for this to happen, it must come out of the vessels and
tissues.

When dehydrating tissues and reducing the amount of fluid in
vessels to the adrenal glands is the team to develop aldosterone and ADH.
These hormones make it so much sodium remains in the body, and
its antagonist, potassium, should be released accordingly – with urine and
vomit. This imbalance of sodium and potassium changes the pH of the blood.
и tissues. Because of this, the cells are damaged. As they grow
death increases the amount of potassium in the blood and it blocks
the spread of the pulse from the nerve to the muscles, and also greatly impairs
heart function (with an increase in potassium above 6 mmol / l, the risk of
cardiac arrest).

In the lumen of the twisted gut, not just water, but
fluid rich in protein (from cell disruption).  She is
becomes an excellent breeding ground for microorganisms,
dwelling there. As a result:

  • more aggressive ones are activated;
  • part of them is shifted to other parts of the intestines, which for this
    not adapted.

As a result of their vital activity, microbes secrete an increased
the amount of substances that, together with inflammatory
molecules are massively absorbed into the blood. Intoxication
is growing.

After another time, microorganisms overcome the intestinal barrier and
fall into the abdominal cavity. Purulent peritonitis develops
(inflammation of the peritoneum), further enhancing intoxication and
leading to serious disruption of all vital
organs.

Circulatory disorders of the twisted bowel and its overdistension
liquid leads to the fact that in the intestinal wall appears
hole. The contents of the gut exits through this opening, reinforcing
phenomena of peritonitis.

Symptoms

The first sign of bowel movement is abdominal pain. She is
occurs suddenly, without prior discomfort or nausea.
If before that there was fasting or a heavy meal, then this pain
сразу должна натолкнуть на мысль о intestinal obstruction.

Pain:

  • felt “under the spoon” or near the navel. Inversion
    sigmoid colon – in the left abdomen;
  • it is paroxysmal (this is due to intestinal motility),
    periodically increases;
  • while the abdomen is soft, his palpation (probing hands) is not
    causes increased pain.

The pain gradually increases and soon takes hold of the entire abdomen.

In addition to pain, at the beginning of the disease such a symptom of bloat occurs.
intestines like vomiting. Tears at the beginning of the food eaten the day before, then
bile Vomiting does not bring relief and gradually increases. Through
time vomit acquire the smell of feces, and this is very bad
prognostic sign (indicates a high risk of mortality).

With pain and vomiting, another symptom appears –
нарушение перистальтики, то есть движения intestine. First she
intensifies: stomach growls, iridescent can even be heard
sounds, while feces and gases do not depart. Short period of time
only gases can escape – if the inversion occurred in a thin
intestine, or only feces – if torsion occurred in the area
connections of small and caecum.

With the development of invagination in a child at the very beginning
diseases can go a little gas, and also stand out “feces” in
the form of blood-stained mucus. This is not a mandatory symptom, but it
appearance often becomes the cause of an error in diagnosis when
the child is suspected to have dysentery and is hospitalized for infectious
hospital

When the body “understands” that pushing the contents through
twisted loop does not work, peristalsis begins to decrease.
The abdomen is increasingly swollen (feeling that the belly is full,
�“Blowing”), becoming noticeably asymmetrical. For example, if inversion
occurred in the sigmoid colon, then there will be bloating on the right
below, and on the left below, on the contrary, retraction of the abdomen.

If you try to listen with your ear how the intestines work, nothing
heard In the later stages of the disease when applying the ear to
swollen stomach, you can hear the sound of the heart and breath.

The most dangerous thing in the intestines is that over time (sometimes quite
short) intestinal symptoms are reduced:

  • stomach ache, but not so much and not cramping;
  • abdominal distention grows at a slower rate;
  • vomiting becomes not so frequent;
  • feces and gases do not depart at all.

But signs of intoxication are growing: increased heart rate, weakness,
drowsiness. Due to loss of fluid, the tongue becomes dry, coated
dirty gray bloom. As a result of imbalance of sodium and potassium
there are interruptions in the work of the heart. Body temperature drops to
35 ° C or lower.

This is a period of imaginary well-being, coming in 2-12 hours.
from the beginning of the first symptoms. He can deceive himself
a person (he will stay at home and not go to the hospital) and doctors
non-surgical profile. In fact, it is this stage that is
last opportunity to save lives through surgery.

The next period of development of the disease is called terminal (
is finite). It occurs in 12-36 hours from the appearance of the first
symptoms. His symptoms are:

  • human consciousness is depressed as a result of intoxication;
  • the stomach is swollen and the asymmetry of distention is almost not visible;
  • no intestinal noise can be heard;
  • pulse weak, frequent and arrhythmic;
  • low blood pressure;
  • tongue dry and furred;
  • vomiting attacks develop periodically: vomit wears
    fecal appearance and odor;
  • body temperature is high due to inflammation of the peritoneum.

Have детей симптомы заворота кишок почти такие же. This and pain in
stomach, because of which small children are pressing their legs to the stomach, and
lack of stool and gas, and symptoms of intoxication. The difference is
that the baby quickly becomes sluggish, any attempt to feed him
or let the water end up vomiting. Swelling builds up very quickly
stomach, and symptoms of intoxication. The pulse of the baby quickens,
the skin turns pale, and then acquires a grayish tint.
Putting a heater on the stomach or enema does not improve the condition.
If this is an invagination of the intestine, then at the onset of the disease from the direct
the intestine can stand out a little scarlet mucus.

Have детей нельзя ждать появления каловой рвоты или угнетения
consciousness: peritonitis in an infant develops many times faster,
than an adult. In addition, they have a higher number of toxins, which
absorbed into the blood. Therefore, at the slightest suspicion of inversion
intestines need to contact the children’s hospital, where there is a surgical
department.

Diagnostics

At the present stage, the diagnosis is made fairly quickly. Still on
The surgeon probes and listens to the abdomen. He further
conducting a digital rectal examination, after which he prescribes
X-ray intestine without contrast. This is usually a study and
defines signs specific to bloat.

Иногда прибегают к HaveЗИ живота – чтобы увидеть перистальтику.
Also, be sure to pass urine to determine diastase in it:
if this enzyme is elevated, the person is most likely not
torsion of intestines, and intestinal paresis associated with inflammation
pancreas.

If the situation is ambiguous, that when turning intestines happens
extremely rarely, surgeons resort to x-ray contrast study
intestine. To do this, they enter into the digestive tract barium and make a series
radiographs. Barium can be injected through the mouth or into the rectum:
it all depends on what level (large or small intestine)
there was an obstruction.

Also in difficult cases can be performed
multispiral computed tomography of the abdomen (MS-CT). This method
very informative and often avoids the contrast
research, but the appropriate equipment is not in every
the hospital.

How is inversion treated

The treatment of intestinal bloat in adults is only surgical. Doctors
make a big cut, through it take out and inspect the bloated
guts. They quickly find a place for turning, and then their task is not
unleash the intestines, and evaluate its viability and remove that
part of the gut that died. If it is a sigmoid colon, then its
removed, and the overlying intestinal tract is brought to the front
abdominal wall in the form of a stoma – so that feces and gases are emitted from there.
If the inversion was in the small intestine, then after removal
the remaining gut the remaining parts sew (impose
anastomosis).

When peritonitis is detected, a stoma can lead to the cecum.
Then, after treating the peritoneal inflammation, after 3 months you can
perform reconstructive surgery – reconnect derived
intestine with colon remaining in the abdomen.

Have маленьких детей operation проводится не всегда сразу. AT
In some cases, surgeons try to “straighten” the intestine from the intestine with
using air introduced in the form of such a specific procedure
like an enema. If this fails, resort to surgery.

After surgery, a probe is carried out through the entire intestine.
output through the nose. By detachable from the probe look like
восстановилась перистальтика intestine. Also in the postoperative
period must be prescribed antibiotics, droppers with the introduction
salt solutions and glucose. The abdominal cavity is washed through
drainage installed during the intervention.

It must be said that the less time has passed since
disease before surgery, the greater the chance of a favorable prognosis.
Why? Because there will be fewer violations of water, electrolyte
and acid-base balances, and this means that the operation can
will be proceed as soon as possible without a long preliminary
preparation. That is – quickly stop the death of even more
участка intestine.

Forecast

Inversion of the intestine has a very serious prognosis and mortality to
40%. Forecast усугубляется, если:

  1. there was a late appeal (more than a day from the start
    diseases);
  2. humans have chronic or congenital diseases.

Relapse prevention

Unfortunately, inversion can recur. More often
повторяется именно не заворот, а другой вид intestinal
непроходимости, связанный с образованием спаек в брюшной cavities.
To prevent this, after discharge from the hospital you need to keep
connection with the doctors of the clinic or hospital: they must appoint
procedures and drugs that prevent the formation of adhesions. ATажно
also in the postoperative period, follow the diet prescribed
doctor, and avoid constipation.

Автор: Кривега Мария Салаватовна врач-реаниматолог

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