1 Causes of the occurrence of
There are a number of common reasons why the organs are perforated:
- destruction of the wall by inflammation or necrosis, neoplasm( perforation perforation is often perforated by ulcers);
- introduction of a foreign body from the outside( gunshot or knife wound);
- introduction of a foreign body from the inside of the organ( bone entering the stomach);
- careless medical manipulation( scraping of the uterus);
- rupture of the thinned wall due to increasing tension( congestion of fecal masses).
From the general list for each organ it is possible to single out the reasons most typical for it:
- gallbladder - the stones formed in the organ stretch the wall, the blood supply to which is broken in this place, and gangrene develops with subsequent tissue rupture, but perforation without stones, for exampleat acalculous cholecystitis, burdened with diabetes;
- pulmonary pleura - abscess of lung, rupture of cavity;
- fallopian tubes - purulent inflammatory process, ectopic pregnancy;
- uterus - difficult delivery, trauma with a surgical instrument, pathological neoplasm, purulent inflammatory process;
- esophagus is a pathological tumor or a swallowed acute bone type object;
- stomach - ulcer, swallowed sharp object or chemically aggressive fluid, pathological neoplasm;
- intestine - pathological neoplasm, ulcerative process( in this case, ruptures in the small intestine are rare, but if they do, the clinical course is extremely difficult);
- duodenum - ulcer;
- heart valve - ulcerative endocarditis;
- vascular wall - the formation of an aneurysm, the prolonged occurrence of a series of solid drainage, as a result of which a decubitus is formed on the wall of the vessel;
- heart - ruptured aortic aneurysm( more commonly called heart rupture);
- appendix is a gangrenous condition that led to the disintegration of the wall.
2 Symptoms of the disease
Symptom is complicated by severe soreness, and the accuracy of the diagnosis depends on the skill of the specialist. Most often, after perforation, there is diffuse peritonitis with severe pain in the abdomen, while the patients take a characteristic posture - the knees are pulled up to the stomach. Often in the field of perforation, the most severe pain. There may also be the following symptoms:
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- vomiting in the development of functional intestinal obstruction;
- bloating, weak pulse, tachycardia and fever in case of bacterial complication;
- severe soreness occurs suddenly in the epigastric region and right hypochondrium at the time of perforation of the ulcer of the duodenum or stomach, patients note pain comparable to a knife strike;there is also shortness of breath, pallor, dryness of the tongue, the abdominal wall strains, the stomach becomes "like a board";
- slowly growing with inflammation soreness temporarily subside when perforating the appendix;
- fever, leukocytosis and soreness in the right upper quadrant of the stomach during the perforation of the gallbladder;
- discomfort in the lower abdomen, minor pain and absence of urine( anuria) in case of bladder perforation;
- soreness in the lower abdomen, weakness, fever, spotting from the vagina during perforation of the uterus.
-
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- What is peritonitis
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- Effective agent for gastritis and stomach ulcer
If organ perforation is accompanied by internal bleeding, the following signs of anemia develop:
- weak and frequent pulse;
- increasing pallor;
- decreasing pressure;
- vomiting.
3 Possible consequences
The main problem with each perforation is the inflow of the contents of the perforated organ into its environment.
Consequences of perforation can be varied and depend on the organ in which it appeared, for example, if the aorta is perforated, the consequence is the rapid onset of death due to rapid and large blood loss. Often in the cavity, where foreign substances enter, inflammation begins( purulent peritonitis or purulent pleurisy).Exceptions are cases where, prior to the formation of perforation, there has been a adhesion of connective tissues, which can prevent the outflow of contents into the neighboring region. There are examples of the consequences of common perforations:
- Stomach and 12 duodenum - due to the effects of pepsin and acidic stomach contents, chemical peritonitis develops within 6-8 hours. The perforation of the front walls leads more often to the entry of the contents into the free abdominal cavity, and the rear ones to the stuffing box with the formation of an abscess. The posterior wall of the duodenum can also perforate into the pancreas, thereby developing pancreatitis.
- Gallbladder - chemical peritonitis
- Perforation of the intestine( most often in the large intestine) - fecal peritonitis.
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4 Medical measures
In perforation of hollow organs, the main danger is the infection of the abdominal cavity with their contents and the development of peritonitis, so the faster the operation is after the rupture, the less the risk of purulent inflammation in the abdominal cavity. The patient's organ is sutured or resected, the necrotic tissue is removed, and the neighboring structures are inspected in parallel.
Independently you can not get rid of perforation, and some time you will not be able to suffer: the place of perforation still does not grow, and death can come literally on the third day.
Every suspicion of organ perforation requires an emergency diagnosis, because delay can lead to the death of the patient. A balanced electrolyte solution should be carried out plasma replacement therapy, constantly monitor the pulse and pressure. If there was a significant loss of blood, blood transfusion is necessary, and even if the diagnosis is still presumable, it is required to begin the introduction of intravenous antibiotics of a wide spectrum of action.
After the installation of a specific diagnosis, treatment depends on a number of factors:
- directly diagnosis;
- of the patient's age;
- of the patient;
- degree of blood loss and blood properties( coagulability);
- degree of development of peritonitis;
- recommendations of an anesthesiologist-rheumatologist.
An alternative to surgery is the Taylor technique, but it is highly unreliable in terms of improvement indicators. The patient is injected into the perforation area with a probe, the process being controlled by an X-ray machine. Every 15 minutes, the body content is sucked off, and intensive antibiotic therapy is performed to stop peritonitis. The degree of failure is too great, therefore it can be said that there is no alternative to surgical intervention.
If there is a suspicion of perforation, do not delay contacting the doctor, because in this case, procrastination is literally like death.
- We recommend that you read
- 1 Causes of the onset of the disease
- 2 Characteristic symptoms of the disease
- 3 Possible consequences
- 4 Treatment measures
The perforation that has arisen in the internal organ is an emergency situation that requires diagnosis and immediate treatment. It can happen with any hollow organ, but most often perforation occurs in the 12 duodenum, stomach and intestines. The closest in medicine synonym for perforation is perforation, and the definition from the medical dictionary explains that this means the emergence of an end-to-end defect in the organ wall, resulting in a direct communication between its internal contents and the surrounding environment.
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