Stomach injury
Stomach tube belonging to the abdominal cavity. In general, the abdominal organs, especially the gastrointestinal incurred as acupuncture to be less chance of injury. This is because the thick abdominal muscle, subcutaneous fat, muscle, etc. The gastrointestinal and other muscular organ itself has a certain ability to contract, when the delicate mm needle into the abdominal cavity. Organs are stimulated, will take the initiative to shrink by peristalsis and concessions, combined with a smooth surface, easy to stab, stab even smaller, but also because of muscle contraction bridge, so as to show clinical symptoms.
However, acupuncture can also cause stomach improper serious injury, and even lead to gastric perforation peritonitis. Therefore, must not be blindly according to the ancients “belly as well,” saying that blindly deep puncture, so as to avoid adverse consequences. Domestic accidental needle injury and stomach on the first report found in the early fifties of last century, when the Nanjing Huadong Military District Hospital Surgery, from June 1949 to October 1950, a total of 40 cases of abdominal puncture wounds treated cases, in which acupuncture because there are four cases of damage [1]. After another there are some clinical reports. These cases, mostly confirmed by surgery. If two cases of abdominal pain, were confirmed by abdominal acupuncture points (Point name unknown) sicker after treatment. It was found, including one case due to inadvertent needle perforation peritonitis helmet, found in the stomach during surgery has four perforations; another one cases of pyloric obstruction peritonitis, surgical saw exudation, edema, anterior and large omental adhesions, pyloric obstruction, etc., that are related to needlestick injuries related [2].
It is worth mentioning that there are clinical reports of acupuncture cause indirect gastric perforation. This often occurs in the upper stomach ulcers and other diseases of the patients, are indirectly acupuncture accident. Although the report is not much, the exact cause is not very clear, but it should pay attention to.
[Injury]
An acupoint reason: As each person’s shape and position of the stomach varies in different physiological or pathological conditions, such as satiation or ptosis of the stomach, there is a greater change, so it is difficult to fix the projection surface.
Likely to result in injury points: Shangwan, Zhongwan, built in the lower abdominal; left of the Order of the full beam gate, closed and so on.
As in the abdominal cavity, may be due to the deep abdominal muscles from the white line into the peritoneal cavity, is on the lesser curvature Central.
In addition, improper Zusanli acupuncture can cause indirect damage.
Second, the pathological causes: When dilatation of the stomach, the stomach and duodenum volume increased significantly, stomach thinning, increased pressure, then abdominal acupuncture points, improper operation, gastric perforation have occurred, the risk of rupture. In chronic gastritis, ulcers or tumors of the case, because the organizational structure of pathological changes, acupuncture is also easy to damage. At the same time, can also cause indirect damage.
Third, the reason for the action:
(A), the needle body is too thick, too deep thorn: clinical findings, by Flemish needle (a special long needle) treatment of gastrointestinal diseases, the occurrence of accidents stomach hurt more often not only hurt the stomach pulp film, muscle, and can be run through the entire stomach.
(Two), way too heavy, substantial lift and thrust twisting, often aggravated the injury, perforation unit enlargement and multiple perforation. There is one case of gastric perforation peritonitis caused by acupuncture, intraoperative findings stomach as much as four pinholes.
Clinical manifestations
Extent due to needle-stick injuries and the original lesion on the circumstances, can be divided into two disease severity.
One, mild: acupuncture generally light damage, perforation is small, and the stomach itself has no organic lesions. As thick and removable gastric mucosa can be highlighted from the perforation, blocked orifice, so that the stomach contents into the abdominal cavity can not, even if the infection can easily localized. Therefore, in a small perforation, especially in the case of fasting, peritoneal irritation and systemic card-like and more obvious, only abdominal pain and discomfort, local tenderness, nausea, anorexia and other mild.
Second, severe: stomach larger gap, particularly in the expansion of the stomach or satiation injury, a large outflow of stomach contents, causing intense peritoneal irritation. Coupled with abundant blood supply of the stomach, perforation, often accompanied by bleeding. Include: severe abdominal pain, vomiting, vomit contains blood, abdominal tenderness, abdominal rigidity (in particular, significantly above the abdomen), bowel sounds disappear, liver dullness disappear. In severe cases, prone to shock. X-ray examination: product gas under the diaphragm. Experimental tests: elevated white blood cell count (15,000 ~ 20,000 / mm3).
[Prevention]
A master needling depth: projection in the stomach area Acupuncture, to grasp the depth of acupuncture, one must first understand the different levels of muscular feel and response. Ren and online points to the stomach area, for example, local anatomical structure: skin, subcutaneous, abdominal superficial fascia, abdominal white line (this layer is mainly in the Ren line, relatively dense tissue, vascular innervation rarely), transverse abdominal muscle film, extraperitoneal fat layer (the layer above the navel not very significant) and parietal peritoneum. Needling depth should be limited to the parietal peritoneum among the various organizations over the case even if the needle does not appear needles sensation or feeling is not strong, it should only be used between layers of the abdominal wall lift and thrust slowly twisting, or waiting after the gas needle, re-operation. According to our experience, is characterized by abdominal acupuncture: When the needle into the muscle, the sense that there is a heavy, slightly operations, they are soreness, such as deep stab to the parietal peritoneum, the patient is feeling pain was radiating out like sting. Doctors who feel, such as the tip touches a tough film, should not be deep puncture, gently lift and thrust for small margin, slightly withdraw the needle about 0.1 inch.
Second, choose the appropriate needle: needles in the application of common diseases can be effective, try not to use awn pin or needle, especially elongated needle, needle body thin and long, if the technology is not familiar with, or the patient moves position, not only easy to stab stomach, and prone curved needle, Needle even fold needles. Clinically, the 28th two-inch needle is appropriate, too difficult to penetrate rules.
Third, to maintain a certain position: abdominal acupuncture acupoints to supine position is better, not only the patient can relax the abdominal muscles to maintain posture, medical Zheyi easy Shi needles, needle depth and experience of induction, as the “acupuncture Dacheng” says: ” Where the pin hole on the abdomen, so that people suffering from supine, so that internal organs vertical, so as not to stab suffering. ”
Fourth, careful selection of points: In the diet (especially after a meal) or acute gastric dilatation and other circumstances, as little as possible election or do not choose abdominal acupuncture points, acupuncture points that must be chosen, should strictly observe the operating practices. In the treatment of gastric ulcer, gastritis and other diseases, abdominal cavity acupuncture manipulation can not be excessive.
[Processing Method]
Light damage, perforation small body in good condition, could make it bed rest, diet, if necessary, acupuncture Zusanli Shangjuxu other points, or oral administration Shugan Qi, detoxification medicine. As a result of a small amount of exudate perforation contents, limitations caused by infection, then according to the syndrome, adopt fasting, gastrointestinal decompression, infusion, and according to the degree of infection give antibiotics.
Large perforation, the contents leaking more symptoms and poor general condition, should soon turn surgical surgery. Including abdominal exploration, ligation of damaged blood vessels and stitch gap and other measures.