Intestinal perforation
About Acupuncture and intestinal damage accident, although recorded in ancient books much, but modern occurrence is not uncommon. The earliest of modern improper stimulation due to intestinal perforation seen publicly reported in 1959 [1], according to incomplete statistics, from the 1950s as many as 15 cases have been reported so far. Intestinal injury, though there are many less serious the organ, however, there are many severe acute peritonitis caused by perforation, or even death due to save her. Therefore, to be taken seriously, can not be taken lightly.
[Injury]
Intestines and stomach, as tough as the surface is smooth, and can automatically escape, not stabbed. In case stabbed wall, because the tiny pinhole, but also can often be self-closing, thus preventing more serious consequences. Cause intestinal perforation and acute peritonitis following main reasons.
An acupoint causes: intestinal larger projection area of the abdomen, involving points in more has happened there in the abdominal, Guan Yuan, air sea, Dubhe and other Cullen points. Should be careful not to deep puncture, particularly in the case of pathology.
Second, the pathological causes: Most thorn mistake in the case of intestinal lesions occur, including volvulus, bowel obstruction and intestinal inflammation, cancer and so on. At this point, or the performance of intestinal expansion, surface tension increased peristalsis slow, difficult to pinpoint stimulation avoidance; or performance of the organization itself intestinal edema, degeneration and necrosis. At this point, deep puncture abdominal acupuncture, easy bowel injury, not only large perforation, pinhole difficult to heal, and easy to make the contents spill into the abdominal cavity, the occurrence of acute peritonitis. If one case of male, 28 years old. Cullen sudden paroxysmal colic, with severe vomiting (vomit for a large yellow-green liquid off) stop defecation and anal exhaust 10h, worked in local abdominal acupuncture treatment (about acupuncture treatment 5-6 times), not see better, but the pain spread to the whole abdomen. Underwent laparotomy. Mesenteric root surgery see a clockwise twist 360 °. As a volvulus cases. Found that due to needle-stick injuries, caused by a 3 3 × 3cm2 bleeding spots, bowel generally inflated. Edema, approximately 20cm away from the duodenum suspensory ligament of the intestine visible on three needle marks [2].
Third, the needle causes: application of thermal needle or needle tool, easy to damage the intestine, especially in the gut itself has a case of disease, more serious fire needle pinhole, Department of burning because of the injury, and more difficult to be self-closing. And thick long needle, especially elongated needle, such as acupuncture improperly, can pass through the multi-stage bowel perforation caused several places. If one case of intestinal obstruction caused by cecal torsion in patients with 3 to 5-inch long needle deep stab in the abdomen, the result ileum, middle found four perforation.
Fourth, the operation Cause: There are two main reasons.
(A), improper practices: In addition to inappropriate deep puncture, the acupuncture points in the abdomen, repeated use of lift and thrust dramatically twisting tactics, it could have severe situation, resulting in multiple intestinal perforation. There is one case of incarcerated hernia right groin, abdomen acupuncture points, needle retention period for continued implementation practices, leading to intestinal perforation peritonitis. Surgical exploration found abscess parts of the intestine, were seen with the piercing needle thickness, ranging from one, up to a few.
(Two), the needle too deep: Due to the abdomen like the deep wells of a say, often regardless of how patient disease conditions, blindly deep assassination. Cause intestinal perforation is another reason. If a female patient with abdominal pain and eight months, no flatus and bowel movement by local doctors in the upper abdomen xiphoid acupuncture, with a long 3 to 5 inches long needle 3, into the assassination of a depth of 2/3 of the needle long. Day 16:00, go two original upper abdominal pain in the lower abdomen, the pain got worse and abdominal distension. Eight days after conservative treatment, laparotomy, intraoperative findings free cecum, and migrate to the right lower abdomen, was counterclockwise twist 320 °, cecum without necrosis. General expansion of the small intestine, the ileum visible 4 × 3cm2 and 2 × 3cm2 of two necrosis perforation; position equivalent to between xiphoid and umbilicus, find the middle of the ileum two bean-sized circular perforations parallel, two perforations about 2cm apart [ 3].
Clinical manifestations
One, mild: symptoms is not significant, or abdominal pain, generally not severe and more limited, peritoneal irritation obvious.
It should be noted, sometimes the small intestine perforation, especially ileum perforation in patients with early after injury may be a good general condition, but after a few hours, there will be significant symptoms of peritonitis, the patient’s condition deteriorated rapidly. Secondly, perforation of the colon, because the contents drier containing many bacteria, appeal was stronger than the small intestine, but less irritating. Early symptoms are often not significant, but the risk of infection is high. At diagnosis, must not negligence.
Second, severe: the more serious or multiple perforation perforation, especially those associated with other intestinal lesions. The rapid emergence of symptoms: severe abdominal pain, nausea and vomiting, increased body temperature, abdominal tenderness, rebound tenderness, abdominal rigidity, bowel sounds disappear. X-ray: How the amount of free intraperitoneal gas (pure intestinal injury, intra-abdominal gas rarely). Laboratory tests: white blood cell count increased. If serious damage or excessive bleeding, the patient is more manifestations of the phenomenon of shock.
[Prevention]
First, carefully selected points: in the treatment of acute abdomen caused by intestinal lesions, such as acute intestinal obstruction, volvulus, intussusception, etc., should carefully choose the abdomen points, it’s best to take all the way points, such as the full three years, on Shangjuxu, etc., or back acupoints. Other enteric diseases, group parties with points should also consider.
Second, pay attention to the following: abdominal acupuncture points to two inches or so of 28 needles appropriate. Do not fire needle and elongated needle for deep puncture the abdomen, such as the use of fire needle, only for superficial prick. Some abdomen abdominal acupuncture points must be selected (eg, acute intestinal obstruction with Tianshu Point, in the abdominal cavity, etc.), needling depth should not exceed parietal peritoneum. If unsure, available obliquely, flat pierce point method.
Where there are suspected of intestinal injury and acupuncture may be, or if some of the early symptoms should be closely observed, and make the necessary checks, around corners, early prevention.
[Processing Method]
One, simple intestinal perforation: generally good person, in the case of mild, no obvious symptoms, could make it break observation, according to the circumstances, give symptomatic treatment; such as perforation heavier, abdominal infection has occurred, but localized who, according to peritonitis non-surgical therapy, including fasting, gastrointestinal decompression, antipyretic, analgesic, anti-inflammatory, and supplemented by systemic therapies, such as transfusion.
For more patients in the treatment process, should pay close attention to changes in disease conditions, if abnormal, that is to take corresponding measures.
Second, severe intestinal perforation (including multiple perforations): cause acute diffuse peritonitis, or intestinal obstruction, volvulus embolism, surgical treatment should immediately turn. Including the removal of necrotic or damaged bowel overweight for solid stitching.