Lesions of the small intestine: what is it, symptoms, causes, methods of treatment, species classification, diagnosis

Most often, damage to the small intestine occurs as a result of a direct, hard blow to the abdomen. The main symptoms are shock and internal bleeding. The person needs urgent medical attention. The forecast depends on the timeliness of the request.

Species classification of damage

The small intestine is up to 5 meters long. This organ is more likely to be damaged than other parts of the gastrointestinal tract - 35% of all abdominal injuries. This is due to its anatomical features, length and lack of adequate protection.

An injury that occurs in an extreme situation or in everyday life is characterized by a violation of the integrity of the walls and dysfunction of the small intestine. Moreover, isolated injuries account for 20% of all cases. The rest are combined with damage to other organs of the peritoneum, cranium and spine, sternum, and small pelvis. All injuries are divided into three types - crushing, bursting and separation.

The crush comes from a strong perpendicular blow to the abdomen. Or the person is caught between two planes. In this case, the abdominal wall moves with the small intestine to the spine, ribs or ilium. Depending on the strength of the impact, necrosis of the compressed area develops or the tube ruptures.

It can also burst in the place where there is a closed loop filled with intestinal contents or gas. In addition to trauma, the cause is an anatomical feature or pathological abnormalities. These are adhesions, kinks, hernias.

Full separation is possible with a side impact, when the loops go to the side in the vertical direction. The small intestine is torn off from the mesentery or with a fold from the place of fixation.

In a confined space, the contents of the hollow organ do not have time to move after it, so the rupture occurs far from the place of impact. Simultaneous damage to the small intestine and mesentery is diagnosed in 70% of cases.

Clinic and diagnostics

Small bowel defects can be open or closed. The first happens as a result of a bullet or knife wound. Closed damage results from:

• disasters;
• falling from a height;
• compression between two planes;
• punch in the stomach.

The main symptom is acute pain at the time of injury and a rapid pulse.

Further, attention is drawn to the tension of the abdominal muscles during examination. The presence of gas in the abdominal cavity leads to the disappearance of hepatic dullness on palpation. O bleeding, the formation of free liquid says dullness of the percussion sound. The outpouring of intestinal contents, after a while, leads to peritonitis with all its manifestations:

• tongue dry, coated;
• vomiting, possibly mixed with blood;
• decrease in pressure;
• intestinal paresis;
• bloating, gas does not go away;
• stool retention;
• peristalsis is not audible on auscultation.

In the future, the temperature rises, leukocytosis is observed in the blood.

The pain may subside for some time after the injury. Such a "bright" interval after anti-shock measures is misleading. This happens with a partial tear of the small intestine. Apparent well-being can last for several days.

The deterioration of the condition begins abruptly, the strength of the pain increases. It is associated with necrosis or organ perforation.

Since concomitant abdominal trauma occurs more often, diagnosis is difficult. With craniocerebral disorders, bone fractures, damage to the chest, a person is in a state of shock. At the same time, it is difficult to determine the detachment of the small intestine without violating its integrity.

X-rays are taken for differential diagnosis. This allows free gas to be detected in the abdominal cavity, which indicates organ damage. An ultrasound will show an accumulation of blood and exudate. For combined injuries, laparoscopy is a preoperative diagnostic method.

Treatment methods

If the small intestine is damaged, the only treatment is timely surgery. Most of the patients are admitted to the surgical department in a state of shock. Before surgery, anti-shock therapy is performed, then diagnostics.

The best method is mid-midline laparotomy. The intervention is performed under endotracheal anesthesia, drugs are injected to relax the muscles of the peritoneum. The operation involves the following tasks:

• removal of blood, draining the site of injury;
• stopping the source of bleeding;
• extraction of intestinal contents by electric suction;
• inspection of parts of the organ to detect damage;
• suturing the wound;
• restoration of patency;
• sanitation of the abdominal cavity;
• installation of drains.

Separate small tears, less than half the diameter of the small intestine, are sutured, preliminarily removing the damaged tissue. With a complete transverse rupture and multiple wounds located close to each other, apply deletion parts of the organ.

The outcome of the operation depends on how quickly it is performed after the injury.

You should consult a doctor at the slightest suspicion of damage to the small intestine. The prognosis of recovery depends on this. Complications develop due to late treatment, due to the failure of the seams at the junction of individual elements, damage to other organs of the abdominal cavity.

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Small intestine anatomy.

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Links to sources:

• http://pishchevarenie.ru/tonkaja-kishka/povrezhdeniya-tonkoj-kishki.html
• https://ilive-com-ua.turbopages.org/ilive.com.ua/s/health/travmy-kishechnika-prichiny-simptomy-diagnostika-lechenie_76375i15938.html
• https://medbe.ru/materials/khirurgiya-kishechnika/abdominalnaya-travma-povrezhdeniya-tonkoy-kishki
• https://www.eurolab.ua/digestive-disorders/3502/3503/29261
• https://studfile.net/preview/2705060/page: 9