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Perforation may be caused by trauma, bowel obstruction, diverticulitis, stomach ulcers, cancer, or infection. [2] A CT scan is the preferred method of diagnosis; however, free air from a perforation can often be seen on plain X-ray .
Fecal impaction is a common result of neurogenic bowel dysfunction and causes immense discomfort and pain. Its treatment includes laxatives, enemas, and pulsed irrigation evacuation (PIE) as well as digital removal. It is not a condition that resolves without direct treatment.
Bowel perforation is when the wall of the bowel ruptures. It is a potentially lethal complication [9] which requires emergency surgery. 49 bowel perforations caused by transanal irrigation were reported between 2005 and 2013. [19] This rate was used to calculate a risk of 2-6 perforations per 1 million procedures. [19]
Depending on the level of obstruction, bowel obstruction can present with abdominal pain, abdominal distension, and constipation.Bowel obstruction may be complicated by dehydration and electrolyte abnormalities due to vomiting; respiratory compromise from pressure on the diaphragm by a distended abdomen, or aspiration of vomitus; bowel ischemia or perforation from prolonged distension or ...
Hinchey Classification is used to describe perforations of the colon due to diverticulitis. The classification was developed by Dr. E John Hinchey (1934–present), a general surgeon at the Montreal General Hospital and professor of surgery at McGill University. Diverticulosis (the presence of bowel diverticula) is an essentially ubiquitous ...
A bowel regimen should also be started to ensure that bowel movements become normal. Opioid pain medication should be avoided as these medications can slow colonic motility and possibly worsen constipation. The key to management and prognosis is identifying the cause or causes of the underlying constipation.
The key to managing a colonoscopic perforation is diagnosis at the time. Typically, the reasons are that the bowel prep done to facilitate the examination acts to reduce the potential for contamination, resulting in a higher likelihood of conservative management.
Perforated diverticulitis often requires surgery due to risks of infection or recurrence. Recurrent diverticulitis may required resection even in the absence of perforation. Bowel resection or repair is typically initiated earlier in patients with signs of infection, the elderly, immunocompromised, and those with severe comorbidities. [16]