Intestinal perforation (intestinal perforation)

A so-called "intestinal breakthrough" (or intestinal perforation) refers to a local breakthrough of the intestinal wall in the form of a hole or a crack, whereby the intestinal contents can penetrate into the abdominal cavity of the person concerned. Correspondingly, a bowel perforation is usually an extremely serious condition, as a life-threatening situation can very quickly arise.

contents

• definition
• symptoms
• causes
• Chronic inflammatory bowel disease
• Appendicitis (appendicitis)
• diverticula
• Colon cancer / colon cancer
• Other causes
• diagnosis
• therapy
• Naturopathy

definition

Intestinal penetration is understood in modern medicine as a local breakthrough in the intestinal wall, whereby the contents of the intestine or faeces (feces) flows freely into the abdominal cavity of the patient. Although the perforation in the form of a hole or crack is itself relatively small in most cases, the intestinal wall is completely broken in a breakthrough. As the feces contain a large number of germs, the result of the disease - if not detected early - is that the peritoneal inflammation (rapid development of the peritoneum) develops rapidly, which can be fatal if the therapy starts too late. In a breakthrough of the intestine is distinguished from a medical point of view between a "free intestinal perforation" and a "covered intestinal perforation". The latter is a far less dangerous form, as it prevents an adjacent organ at the fracture site from spreading the contents of the intestine throughout the abdominal cavity. This causes "only" local inflammation with abscess formation in this case.

Intestinal perforation can occur in different parts of the intestine. Image: www.fotolia.com © bilderzwerg

symptoms

The symptoms can vary widely and are related to the cause of the perforation. For example, appendicitis causes increased pain in the right lower abdomen, which often initially subsides at the moment of the breakthrough, but then massively worsens again in the course of increased peritonitis. Of course, the underlying diseases can also cause pain even before the breakthrough - yet the strongest pain is caused by the suddenly escaping stool or chyme during the breakthrough. This contains substances such as stomach acid, which irritate the peritoneum, which lines the abdomen and thus encloses most of the internal organs below the diaphragm to the entrance of the small pelvis. As a result, the pain is transmitted from the nerves of the peritoneum, which may even lead to shock.

In addition to pain, other signs of inflammation such as fever and increased intestinal paralysis with vomiting occur, in blood tests at this time shows an increase in inflammatory levels. Unless therapeutic measures have been taken until then, usually a general sepsis develops (also "blood poisoning"), ie a severe infection that affects the entire body. If this is the case, an immediate intensive care treatment is necessary because a sepsis otherwise fatal and especially for older or weakened by other diseases patients can quickly become very dangerous.

causes

For a gut breakdown, various causes or diseases come into consideration, which bring about a pathological change in the intestinal mucosa or the intestinal wall. In most cases, an unrecognized or insufficiently treated inflammation of the intestine is the trigger for an intestinal breakthrough: Since the blood flow to the mucous membrane and intestinal wall is limited as a result of the inflammatory reaction in the intestine, it quickly leads to tissue damage, which can subsequently lead to intestinal perforation.

Chronic inflammatory bowel disease

A common cause in this context, the chronic intestinal inflammation Crohn's disease and ulcerative colitis, which are summarized under the collective term "chronic inflammatory bowel disease" (CED). Both are autoimmune diseases in which the immune system "fights" the body's own tissue for unknown reasons, causing severe inflammatory reactions. Characteristic of these two diseases, which occur frequently between the age of 20 and 40, are years of abdominal pain and diarrhea, which are usually accompanied by constant fatigue. Both diseases usually progress in bouts, whereas ulcerative colitis affects only the large intestine, but Crohn's disease can, in principle, occur throughout the entire gastrointestinal tract, but most commonly the small and large intestines are affected. Another difference is in the prospects of cure: While Crohn's disease is not curable so far, there is good chance of recovery from ulcerative colitis after surgical removal of the entire colon.

A bowel perforation can occur in both cases in the context of complications. It can happen in ulcerative colitis and (more rarely) in Crohn's disease, too, that the intestinal wall is so severely weakened by the inflammation that intestinal paralysis (ileus) occurs. As a result, the intestinal content is no longer forwarded towards the rectum, instead, the intestine expands massively - which is referred to as "toxic megacolon". The overstretching of the intestinal wall causes very severe pain in this complication, in addition to symptoms such as an extremely inflated abdomen, chills, high fever, palpitations (tachycardia), anemia (anemia) and disturbances in the water-electrolyte balance. If surgery is not performed immediately in this situation, it can quickly lead to a life-threatening intestinal breakthrough.

In addition to the chronic inflammatory bowel disease ulcerative colitis and Crohn's disease, other diseases such as Chagas disease, Hirschsprung's disease and pseudomembranous colitis come as a cause of toxic megacolon into consideration, which in turn can lead to intestinal perforation in the context of complications.

Appendicitis (appendicitis)

Appendicitis is often the cause of the intestinal perforation, although it is not an inflammation of the cecum, but the so-called "appendix" (appendix) despite the usual name. This is a particularly sensitive part of the cecum, which consists of lymphatic tissue, is on average 10cm long and has a diameter of 0.5 to 2 cm. First symptoms of appendicitis are usually abdominal pain in the stomach or around the navel, which typically migrate further into the right lower abdomen, where the abdominal wall is then usually noticeably tight and extremely sensitive to touch. In addition, there are other symptoms such as nausea and vomiting, loss of appetite and fever, also often shows a limited intestinal activity. Appendicitis is caused by various causes, which can usually be clarified only by examining the surgically removed inflamed appendix. In many cases, however, blockage of the appendix by hardened, heavily thickened stool ("feces") is the trigger, which can multiply the colon bacteria and eventually cause inflammation. A kinking of the appendix due to an unfavorable position in the abdominal cavity can also lead to septic congestion and inflammation, in rarer cases also fruit cores, worms or adhesions of the intestinal wall can be identified as causes. In addition, inflammatory bowel diseases such as Crohn's disease can trigger an appendicitis.

diverticula

So-called "large intestine diverticula" come as a cause for one into consideration. These are bottle-shaped protuberances of the intestinal wall, which are called in heaped form as "Dickdertivertikulose". The protuberances can in principle occur in the entire gastrointestinal tract, but most often occur in the left part of the colon. Colon diabetics are not an innate change, but are considered as a so-called "civilization disease", which is mainly caused by the modern living conditions (low-fiber diet, lack of exercise, smoking, etc.). While diverticula are harmless in more than 80 percent of the cases and need no treatment, it can also cause inflammation of single or multiple diverticula, which can be caused by feces that stick in the protuberances. In the case of such "diverticulitis" there are usually severe abdominal pains (especially in the left lower abdomen), which often increase with food intake. In addition, there are often loss of appetite, malaise, vomiting and - depending on the extent of inflammation - constipation or diarrhea and severe bloating (distended belly). As a complication in the context of diverticulitis it comes in about 10% of cases to a bowel through, which is often covered by belly fat occurs ("covered intestinal perforation") and leads to an abscess. In rare cases, however, it can also lead to a free perforation, with the result of a serious clinical picture with peritonitis (peritonitis) to severe inflammatory shock.

Colon cancer / colon cancer

A breakthrough can be caused by colon cancer (colon carcinoma), which is one of the most common malignant tumors in humans. In most cases, colon cancer develops from a benign intestinal tumor (adenoma), increasing the risk of cancer as the size of the adenoma increases. General risk factors for colon cancer include overweight and unfavorable dietary habits as a result of too much animal fat and too little fiber. Smoking, alcohol, inflammatory bowel disease, as well as genetic factors can also contribute to bowel cancer, but in many cases no clear cause for the disease can be identified. It is particularly problematic in colon tumors that they are often detected relatively late, since typical symptoms such as fatigue, abdominal pain, constipation, diarrhea or flatulence occur only in the advanced stage of the disease.

As a result, for example, an intestinal obstruction (ileus) may have already developed through the tumor during later detection, which is life-threatening and must be treated immediately. In addition, there is a risk that the tumor populates and attacks surrounding organs and structures, which can lead to a breakthrough and a resulting perilous peritonitis. As with all malignant tumors, there is also the risk of so-called "metastasis" in other areas of the body, which means the spread of spatially separated, similar secondary tumors. Nevertheless, the chances of recovery in colorectal cancer are on average fifty percent. This increases the chance of early detection, but also decreases steadily as the disease progresses.

Other causes

In addition to the above causes, however, various sexual practices such as anal intercourse with large objects can be a trigger for intestinal perforation. In addition, it often comes after an acute constipation to a dangerous intestinal perforation, since the volume has increased within the intestine by the pent-up feces, the thin wall of the intestine can usually counteract this pressure but not. In addition, a so-called "abdominal trauma" may be the cause, whereby the injury of the abdominal organs is called by external violence. Here, a distinction is made between a blunt trauma, in which the brook ceiling remains closed (for example, a shock or the impact of a traffic accident) and a penetrating trauma, such as a knife stab or a gunshot wound.

diagnosis

If suspected, a scan of the abdomen is usually carried out as part of a first examination. In most cases, this results in a hardened abdominal wall as a result of an increased "defensive tension" of the body, in addition, the affected feel the investigation as very painful. In addition to the diagnosis generally imaging techniques such as ultrasound or X-ray are used. If the X-ray is consulted, the patient must stand during the recording, however, because only in this way any existing air in the region of the diaphragm can be diagnosed properly - because this is again a clear indication of a bowel opening.

therapy

In the case of intestinal perforation, rapid treatment is indispensable because of a life-threatening situation for the person affected. Accordingly, in each case an operative intervention must be made, in which the vacancy is closed. If intestinal contents have already reached the abdominal area, the patients are also treated with an antibiotic to kill dangerous germs and thus prevent life-threatening inflammation. In addition, in the normal case intensive care monitoring takes place for a period of about 10 days. If the acute intestinal breakthrough is caused by a cancer, usually a part of the intestine is removed surgically, because only in this way the formation of metastases in other body regions can be counteracted. In this case, an artificial bowel outlet is often placed in the sequence.

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 natural medicine to reduce the risk beforehand. However, the emergency call 112 should be discontinued immediately in the acute case. Because only life-saving measures of emergency medicine can save lives.

As a general precaution, it is generally advisable to regularly promote intestinal health and to carry out a so-called "intestinal cleansing" at the latest on persistent or intensifying symptoms such as indigestion (diarrhea and / or constipation) headaches, constant tiredness, heavy weight gain or even rheumatic complaints. At the center of the intestinal rehabilitation is the rebuilding or normalization of the intestinal flora, in which there is a balance between the intestinal bacteria. Before the colon can be rehabilitated, however, first finds a colon cleansing, in which toxic substances, harmful intestinal bacteria and other "ballast" is eliminated. For this colon cleansing, there are a number of methods and remedies such as herbal remedies or the so-called "colon hydro-therapy". The same applies to the subsequent intestinal rehabilitation - again, depending on the individual case very different procedures are used, such as the ingestion of coli bacteria or lactic acid-forming germs.

In addition, it is generally important for a healthy bowel to pay attention to a gut-healthy diet. It should contain as little meat, fat and sweets as possible and instead consist primarily of high-fiber and fiber-rich foods (whole grains, flax seeds, fruits and vegetables), which ensures that leftover food does not remain in the intestines for too long. It is equally important to largely abstain from fermenting foods such as cabbage, sauerkraut, onions and garlic in order to avoid fermentation processes, bloating and flatulence in the intestine. In addition, it is important to drink enough (at least 1.5 to 2 liters a day), as dehydration can quickly lead to severe stool, which is difficult to eliminate.

When constipations are also suitable as "Stuhlaufweicher" such as Indian psyllium or psyllium husks. These swell greatly, causing the stool in the intestine to increase in volume. This in turn creates a higher pressure, which causes a further transport of the intestinal contents. In addition, due to its large amount of mucus, the psyllium can increase the lubricity of the intestinal contents and thus counteract digestive problems. In addition to the psyllium, naturopathy offers a number of other proven home remedies for constipation, such as buckthorn bark or wormwood and centaury. As with all herbal remedies, however, any use should be discussed with a physician or alternative practitioner to avoid risks or harmful side effects.

In addition to the rebuilding of a healthy intestinal flora and a dietary change, other therapeutic measures for strengthening intestinal health have proven useful in natural medicine, such as the self-blood therapy or homeopathy. Since many people respond to stress with gastrointestinal discomfort, techniques are also highly recommended that serve the emotion regulation ("stress management"). In addition, there are relaxation procedures that can have a very positive effect on the intestinal health, as these functions can indirectly influence the functions of the gastrointestinal tract. For example, autogenic training, progressive muscle relaxation or yoga is particularly well suited here. (No)

Image: Dieter Schütz