Dr. Ertan Beyatlı

What is Bowel Rot?

(Update: ) - Digestive System Diseases

If the blood supply to the intestines is reduced or cut, the intestines decay develops. Especially in the small intestine (intestin) It is seen.

It is life-threatening and needs to be treated immediately. For bowel rot in the medical field Intestinal ischemia, Intestinal Infarction ve intestinal necrosis terms are used.

Why does the bowel rot?

There are many diseases that cause intestinal rot, some of them:

  • Hernia: In strangulated hernias, it may cause intestinal rotting by decreasing the blood flow to the intestines. (see: Strangulated Umbilical Hernia)
  • Adhesion (adhesion): Adhesions may occur between intestinal sections as a past surgery ligament. This can sometimes lead to bowel rotting.
  • Clot (Embolism): Clots formed in the heart and main vessels can cause decay by occluding the intestinal vessels. This condition is due to heart attacks or an irregular heartbeat (arrhythmia, atrial fibrillation AF) can be seen in patients.
  • Shortness (Thrombosis): stenosis in the arteries or veins of the intestines (eg old age, atherosclerosis, liver diseases, cancer, etc.)
  • Low blood pressure (Hypotension)Very low blood pressure, which occurs in elderly patients or patients with stenosis of the bowel vessels, may cause bowel decay.
What is Bowel Rot

How to understand if the bowel is rotten?

The most important symptom of bowel decay Abdominal pain is. Very severe abdominal pain inconsistent with clinical findings may be seen (although there is not much sensitivity in the examination finding!). In some cases rectal or oral bleeding may occur. Nausea, vomiting and fever may occur.

Abdominal MR - strangulated hernia
Abdominal MRI - strangulated hernia detected before surgery

White blood cell elevation in blood tests in cases of infection (WBC ↑) and acid increase can be seen (acidosis). Free fluid can be seen between the intestines in the films (see: ADBG). In doubtful cases, angiogram, abdominal CT and abdominal Doppler USG can be performed.

Sometimes, despite the symptoms and tests, the diagnosis is made only during surgery.

Treatment of intestinal rot

The only solution to this situation is surgical intervention. In the intervention, the decayed intestine is removed and the viable intestine ends are stitched back together (resection + anastomosis). Postoperative complications and death in cases of delay (morbidity and mortality) the rate is quite high. In some cases, a bag can be attached to the abdomen. (ileostomy and colostomy).

Postoperative prospects (prognosis)

Intestinal rot is a very serious condition that requires urgent intervention. If surgical intervention is not performed at the right time, it may result in death. The state of recovery is proportional to the cause and duration of the decay and the general health status of the patient. Good results can be obtained when early diagnosis and treatment is applied.

What is a Strangulated Hernia?

Drowned Hernia - photo taken on the operating table.
Strangulated Hernia

The most feared complication of abdominal wall hernias is "strangulated hernia". Latin inarsere ve stangule herniated.

The more easy and problem-free simple hernia operations are for the patient and the physician, the more difficult and risky the strangulated hernia surgery.

strangulated hernia
Photographs taken in a "strangulated hernia" case that we did the intervention. Dr. Ertan BEYATLI / İZMİR-2015

Overwhelmed requiring urgent surgery hernia Surgery and normal hernia surgeries performed under the most appropriate conditions (elective) are compared below.

Strangulated hernia surgery

  • Occurs suddenly and is done in emergency conditions
  • The patient stays in the hospital for 3-4 days
  • Cost is high and uncertain
  • High risk of complications
  • Patch repairs are often risky
  • It may be necessary to remove a section of bowel

Elective hernia surgery

  • Made at the most convenient time
  • The patient is discharged on the same day
  • Cost is clear and low
  • Very low risk of complications
  • Stress-free repair with patch
  • No need to even go into the abdomen

If the intestine, which comes out from the hole in the abdominal wall, rotates around its own axis like a coil, it may be difficult to enter the abdomen again. Previously, if a hernia entering into the abdomen when lying on the back or pushing with the hand does not disappear by reaching out or by hand, it can be referred to as "strangulated" hernia:

Strangulated Hernia Stages

  • PHASE I The first sign of a strangulated hernia is that the hernia swelling no longer disappears. After a few hours, pain begins in the hernia area. If the patient does not consult a physician, the intestinal passage will also stop, and the patient becomes unable to extract gas and feces from below. Consequently, the pain of the patient spreads to the whole abdomen in the form of cramps.
  • STAGE II If the patient persists not to go to the hospital, the intestinal blood circulation, which is stuck in a narrow hole, begins to deteriorate. This causes intestinal gangrene (Bowel Rot). At this stage, the patient's leukocyte count increases and the pain becomes more severe.
  • STAGE III If the patient is still not treated, the gangrenous area of ​​the intestine is punctured and widespread peritonitis occurs in the abdomen. The patient's fever rises, his general condition deteriorates, and death develops with a picture of sepsis.
  • PHASE IV Nowadays, stage IV patients are no longer encountered in big cities.

In order not to be faced with such a threat, it is necessary to have a hernia surgery as soon as possible.

1- Abdominal MR - strangulated hernia sac (strangulated and incarcerated hernia) detected before surgery and intestinal loops are seen.
1- Abdominal MR - strangulated hernia sac (strangulated and incarcerated hernia) detected before surgery and intestinal loops are seen.
2- Strangulated Hernia - photo taken on the operating table. The irregularity and asymmetry of the abdominal wall due to hernia draws attention.
2- Strangulated Hernia - photo taken on the operating table. The irregularity and asymmetry of the abdominal wall due to hernia draws attention.
3- Strangulated Hernia - Rottening bowel part detected after laparotomy
3- Strangulated Hernia - Rottening bowel part detected after laparotomy
4- In this photo, living and non-living (decaying) intestine parts are clearly selected. In surgery, the bruised part was excised and the remaining living parts were stitched together (anastomosis).
4- In this photo, living and non-living (decaying) intestine parts are clearly selected. In surgery, the bruised part was resected and excised, and the remaining living parts were stitched together (anastomosis).
5- Anastomosis line after resection. Both intestines are seen alive.
5- Anastomosis line after resection. Both intestines are seen alive.
6- Removed rotten intestine section
6- Removed rotten intestine section
Op.Dr.Ertan BEYATLI and his surgical team. İZMİR / 2015
Op.Dr. Ertan BEYATLI and his surgical team. İZMİR / 2015
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