Perforation and gangrene of the colon with amoebiasis
Helminthiases / / August 12, 2017
Complications of amoebiasis
gangrene and perforation of the colon are the most serious complications of all amoebic invasion.They occur in 2-6% of hospitalized patients with amebiasis and 20-45% of deaths from it.Bowel perforation occurs as a result of the destruction of all its layers of deep ulcers.The walls of the intestine around the perforated ulcer necrobiotic undergo changes that often makes it impossible to suturing during surgery.
In some cases, bowel necrosis occurs without visible perforation, and then talk about amoebic bowel gangrene.Gangrenous change may be subject to very extensive areas of the colon, sometimes extends to the terminal ileum.In contrast to the gangrene of the vascular wall origin affected amebiasis intestinal loops usually have a black color, and are dull, moderate swelling of tissues doughy consistency, matte shade, easily disintegrating in attempts to isolate it even from fragile loose adhesions.The mucous membrane of the intestine sometimes peeled in places destroy
ability of amoebae themselves caught in the abdominal cavity, cause inflammation of the peritoneum is not certain, but some features of the pathological and clinical manifestations of peritonitis arose when amebiasis indirectly point to the peculiar influence of amoebas and their toxins on the development and course of inflammation of the peritoneum.
complication in most cases develops in acute intestinal amebiasis flow, often in the midst of illness.In children, it seems, it is less common than in adults.Mortality in it is very high, averaging 67% among operated.In the group of persons who did not receive surgery and specific treatment, mortality is 100%.
forerunners perforation amoebic ulcers and gangrene of the intestine are stubborn for acute amoebic colitis, are often not amenable to specific treatment, his aggravation with an increase in liquid with blood and mucus, or frothy stools, increased abdominal pain such as intestinal colic, deterioration of general condition.Moment of the perforation of ulcer in most cases remains unclear: a sign of "a dagger of pain", so characteristic of the perforation of hollow organs of the abdominal cavity, there is no vomiting, delayed flatus and sharp bloating occur infrequently.the patient's general condition is severe: the face haggard, sharp-featured, waxy skin color, look indifferent, drowsy state is replaced by delusions.The temperature is usually low-grade, in severe cases, normal or below normal, pulse small filling with relative bradycardia, blood pressure is reduced.The skin of the anterior abdominal wall of the dough-like consistency.Abdomen moderately swollen, painful on palpation, there is rumbling in the gut.Muscle tension anterior abdominal wall and Shchetkina symptoms are mild or absent.Percussion dullness is defined in the sloping part of the abdomen and the disappearance of hepatic dullness.In blood moderate hypochromic anemia, white blood cell count often slightly elevated or normal.The study reveals signs of intoxication urine kidney damage.Irregular radiological sign is the presence of gas under the right dome of the diaphragm;horizontal levels are sometimes observed in the intestines.The chair is usually a liquid, with blood and mucus, or foam.The feces sometimes contain scraps ottorgsheysya colonic mucosa.
Such atypical for peritonitis caused by a number of factors.Peritonitis with amoebiasis develops gradually, often occurs before bowel perforation due to leakage of intestinal contents through the colon wall changed.The body of the patient is weakened, and the defensive reactions of his repressed preceding acute amebic colitis.Certain value also has a specific, apparently amoebae analgesic effects of toxins on the peritoneum.A case where the patient amebic colitis, is not accompanied by perforation of the intestine, amoebae were found in ascites fluid.In strong young subjects with a short previous intestinal amebiasis can take place and the typical pattern of perforation peritonitis with clear symptoms.
Diagnostics perforations amoebic ulcers and gangrene of the colon is based on the following data: dysentery and other intestinal disorders in history, symptoms of colitis in the onset of the disease or at the stationary observation (cramping abdominal pain, loose stools with mucus and blood, rumblingin the gut), the detection of fragments of the colon mucosa in the stool or tissue-dissolving mobile forms of Entamoeba in svezhevzyatom native smear, some local signs of peritonitis.
presence of growth dysentery bacteria at sowing feces does not give reason to deny the origin of intestinal amebic lesions as perforation and peritonitis is most often develop when mixed amoebic and bacterial dysentery.Similarly, the absence of amoebas in the stool is not evidence of absence amebiasis, as these simply do not always show up even after repeated and qualified study.
- Amebiaz symptoms
- Appendicitis with amoebiasis
Treatment perforations amoebic ulceration of the colon, as well as any perforation peritonitis, surgical.The success of surgery depends on the timing of surgery, as well as the complex of conservative therapy before and after surgery.