Volvulus

Acute surgical pathology of the peritoneum, which consists in twisting any part of the intestine or its part around the mesentery or its axis. The gut lumen is overlapped, the mesenteric nerves and blood vessels are squashed, a mechanical obstacle arises in the digestive tract.

Signs of inversion of the intestines should not only cause alertness, but make it urgent to seek medical help, since this condition poses a real threat to life. Rapid increase in intoxication and dehydration can lead to death of the patient during the first day.

Epidemiology

In general, this disease is twice as likely to be male than female, although women are ahead of men in the prevalence of blindness of the cecum.

On average, this pathology is common among people of middle and old age.

The most frequently encountered is the twisting of the colon, among them 80% of the twists in the sigmoid section; 15% - in the caecum; 3% - in the transverse-striated; 2% - in the zone of splenic flexure.

The average age of patients with pathology of the sigmoid colon is 60 years old, the probability of this pathology increases with age.

The turn of the cecum is affected by the younger population (the average age is 50 years). The average age of the sick in some countries, for example, India, where the majority are vegetarians, is even less - 33 years.

Children almost all cases - with localization in the small intestine and are caused by malformations.

Africans suffer from this pathology twice as often as others. According to US medical statistics: patients with gut flushes are about the twentieth of all patients with obstruction; among them, the curvature of the large intestine is one tenth of the total number of obstructions to this localization.

In the regions of the "gut flap", where the colon swelling is mainly caused by its obstruction, includes some African countries, Asian (India, Iran), Brazil and Russia. In Brazil, this disease is associated with the spread of Chagas disease.

The second most important reason for the development of obstruction of the sigmoid colon during the period of gestation is its twist. Presumably, the rapidly growing uterus moves this gut, which provokes a twisting of the large intestine. The overwhelming majority of twists in future mothers (3/4) is observed in the last three months of gestation.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

Causes of the curvature

The causes of this condition are very different, and sometimes, at first glance, very innocent. It can occur even during sleep - a change in the posture can cause a bowel turn. This can happen to a person who for many years leads an unhealthy lifestyle, improperly eats, and as a result, has problems with the gastrointestinal tract.

Parents often frighten children, claiming that there may come a turn of guts from the cud, maybe they themselves believe it. However, the chewing gum does not cause active intestinal peristalsis; it is not digested by the action of gastric juice and in the vast majority of cases it is excreted excellently by the intestine with caloric masses.

But the turn of guts from persimmons is quite likely. Persimmon, containing in excess of tannins, children's stomach does not digest, it sticks into a large lump that the intestine can not advance to the exit. This can cause intussusception - drawing a part of one colon into another. Of course, for this you need to eat more than one fruit or a half. Inversion of the intestines in children can cause not only persimmon, but also excessive absorption of mandarins, bananas and unsuitable food for the child (smoked meat, herring, etc.).

The reasons for the curvature of the intestines are often hidden in the anatomical features of the structure of the organs of the digestive system. It is fetal developmental disorders that cause this disease in infants, most often an abnormally long mesentery and active peristalsis of the intestine. Congenital gigantism of the large intestine, congenital absence of intestinal motility, congenital diaphragmatic hernia, less often, but can lead to the swelling of the intestines in the baby. Early artificial feeding can cause this disease. Cases of intussusception in infants - the tightening of the part of the narrowed intestine into the lumen of the normal, leading to obstruction, is not uncommon in pediatric practice.

The cause of congenital inversion of the intestines is called malformation of the intestinal tube of the embryo or an anomaly of fixation of the mid-gut.

Sometimes the lumen of the intestine is blocked by meconium, which has an abnormal density.

In patients older than a year, gut rotations are caused, strictly speaking, by two factors:

• the defect of the development of the mesentery, which has a length, which makes it possible to move in different directions,
• the inability of the intestine to promote the contents that have strayed into it, then each movement of its musculature leads to a twisting of the gut bends.

[12], [13], [14], [15], [16], [17], [18], [19]

Risk factors

Risk factors:

1. Exit from a prolonged fasting regime, accompanied by overeating, which activates intestinal motility and can provoke a twist.
2. Systematic overeating (especially at night) causes excessive filling of the intestinal bends, simultaneously activating its motor skills, which can lead to the turn of one or several intestinal loops.
3. The sharp increase in pressure inside the peritoneum, even insignificant, due to trauma, unusually heavy physical labor, load with weak muscles of the press can cause dislocation of the intestine and provoke this pathology.
4. Cicatricial and adhesive changes in the connective tissue of the abdominal cavity, arising from surgical interventions and inflammations.
5. A diet that includes mostly rough, moist, fiber-rich foods that activate intestinal peristalsis.
6. Frequent, so-called, food poisoning, i.e. Infection with pathogenic microorganisms, accompanied by dyspeptic manifestations.
7. Constipation (constipation) is a provoking factor of sigmoid colon swelling, mostly it happens in elderly people.
8. Mesosigmoiditis, the result of it can be a deformation of the mesentery and the turn of the sigmoid colon
9. The foreign body can close the lumen of the intestine (obturation), and the neoplasm, pregnancy squeeze it from the outside (strangulation), which will lead to twisting.
10. Poisoning, taking strong medicines (suppressing intestinal peristalsis, laxatives), certain diseases of the central nervous system cause spasms or paralysis of the muscles of the intestine.
11. Massive helminthic invasion also sometimes causes a turn in the intestines.

In general, the twisting of the small intestine is caused by developmental defects, scarring and adhesive changes in connective tissue, hernia.

Curvature of the large intestine, mostly acquired pathology. The causes of this localization is the growth of scars and adhesions in the peritoneum, pregnancy, neoplasms, surgical manipulations on the intestine. The vast majority of the large intestine turns occur in the sigmoid part.

With a full curvature of the intestine, a closed obstruction of the affected sections is formed, their innervation and ischemia eventually cause gangrene and perforation of the intestinal wall.

[20], [21], [22], [23], [24], [25]

Pathogenesis

Regardless of the root cause of the development of pathology occurs as follows - the gut rotates, sometimes and repeatedly, and its lumen is completely blocked, the contents of the intestine stops, the nerves and vessels of the mesentery are pinched, the blood supply of the intestinal casing stops and it necrotic. Necrosis of the intestinal membrane increases its permeability to toxins that enter the peritoneum, and develops peritonitis.

[26], [27], [28], [29], [30], [31], [32], [33], [34]

Symptoms of the curvature

Immediately after twisting the loops of the intestine, the first signs of the disease appear - instantly combating acute pain, more often in the navel zone, then reflex vomiting begins. Specific feature - part of the abdomen is swollen and intestinal loops are seen on it. If you knock on the swollen part of the abdomen, the sound will be similar to the drum roll.

Accompanying symptoms - hypotension, constipation and gas formation without gas evolution, weakness, gray-earthy pallor. Sweat appears on the face, even delirium may begin. The patient with difficulty speaks and breathes heavily, in his stomach you can hear sounds that resemble a splash of water.

Intestinal loops can be twisted anywhere in the intestine, where there is a mesentery. The level of upheaval determines the pathology clinic and treatment tactics.

Types of bloat are classified according to the levels where it occurred:

• small intestine;
• the cecum;
• sigmoid colon;
• transverse colon.

Normally, the angle of the bend of the small intestine is up to 90 °. A turn at an angle greater than 180º causes clinical symptoms, one or more bends of the small intestine may be drawn into this movement. The cecum is nearby, therefore, the signs of its curvature will look similar.

The twist of the small (blind) gut is characterized by the following clinic:

The appearance of severe pain during an inversion is determined by the cessation of the blood supply of this area of the intestine. Sharp pain that does not subside, continuous, stitching or cutting, is felt in the upper abdomen. It is constantly increasing, becoming unbearable.

At this kind of turn-up, patients show anxiety, excitement, sometimes crying out in pain. As a rule, they press their knees to the chest, but this does not relieve the pain.

Before the place of twisting, a congestion of the contents of the intestine is formed, which provokes obstruction of the intestinal loops, activates its peristalsis visibly visible, accompanied by gurgling sounds in the abdomen and cramping pains.

If the loops of the lower sections of the small intestine or the caecum are twisted, an asymmetric swelling in the navel zone is observed due to the accumulation of fecal masses above the level of curvature.

The twist of the small intestine is accompanied by vomiting, which starts simultaneously with pain (first erupting vomiting with bile, later - with an admixture of feces). Vomiting does not relieve the patient's condition.

Constipation and the accumulation of gases that do not find an outlet, begins later, since the motor activity of the large intestine is still normal, feces and gases continue to be released. If you immediately contact a doctor with suspicion of turning the small intestine, this stage can be avoided, but in the case of prolonged time, the release of stool and gases can stop.

The general condition is broken - there are signs of dehydration, weakness, dizziness, fainting. The symptoms of an organism's intoxication are increasing: muscle pain, tachycardia, pallor, high fever, sweat on the forehead.

Colon swelling is more common, the most frequent localization is in the sigmoid colon.

His symptoms are similar to those of a small intestine, but there are some differences.

Pain syndrome occurs sharply, but can sometimes develop gradually. It is felt, basically, in the lower abdomen and can be given to the zone of the waist. The nature of pain is constant, occasionally - paroxysmal.

Vomiting is not digested food and bile appears simultaneously with the pain and is repeated two or three times, without bringing relief. Vomiting in this case is caused more by painful irritation. Vomiting begins with feces later, with the development of peritonitis.

Constipation and no gas evolution begins immediately. First, active motility of the intestine can be noticeable, eventually it fades.

The stomach is noticeably swollen and asymmetric. The upper sections on the right side of the abdomen are enlarged - the sigmoid colon has moved after it has twisted. The accumulation of gases and feces in her stretches her loops, increasing in size. It moves up the abdominal organs, which press on the diaphragm, reducing the volume of the chest, squeezing the lungs and frustrating the respiratory process, disrupting the work of the heart. This is manifested by difficulty breathing, arrhythmia, tachycardia, pain behind the sternum.

Occasionally, the transverse colon turns into a vagus, a symptom that resembles the curvature of the sigmoid colon.

[35], [36], [37]

Forms

Classification of curls according to the angle of rotation of the intestines: a partial turn of the intestines (up to 270 °), full (270-360 °), if the bowel is twisted several times - repeated. As a rule, the bends of the intestine are twisted in a clockwise direction.

Congenital inversion of the intestines manifests itself in the first hours of the child's life. The first symptoms are pain syndrome (a restless baby, always capricious, crying), vomiting, hypotension, abdominal asymmetry, decreased intestinal peristalsis. Disturbances of gases, meconium can come out, but normal feces are not observed, mucus is released from the anus (full curvature) or the stool leaves smaller portions, the volume of which is getting smaller (partial).

The curvature of the intestines in children is manifested by high fever, acute pain in the abdomen, vomiting, blood or mucus in the feces. The child does not eat well and sleeps, often cries, is capricious, pushes his legs to the stomach. Attacks occur and recede unexpectedly, in the intervals between us the child can snatch twice. There is intense gas formation, after a while constipation begins, and the gases stop moving away. On examination, the child has a noticeable compaction in the lower abdomen.

The turn of the intestines in the fetus is difficult to diagnose, it is treated after the birth of the child. This pathology often accompanies mnogovodye in the mother and other malformations, for example, Down's disease.

[38], [39], [40], [41], [42], [43], [44], [45]

Complications and consequences

If the patient does not consult a doctor with the first symptoms, a few hours later the development of peritonitis begins. The body temperature rises and a false improvement in the state of health. The patient may feel that there is no need to worry anymore. This misconception can lead to fatal consequences.

When turning, the blood supply to the twisted portion of the intestinal wall and its innervation completely ceases. According to numerous evidence of medical research, the further quality of life of a patient, and often life itself, directly depends on the timeliness of the medical care provided.

Possible complications: dehydration, perforation and necrosis of the intestinal wall; systemic purulent infection and intoxication; adhesion and re-twisting of the intestines.

Dehydration:

• the turn of the intestines is manifested by frequent vomiting, when the body loses a lot of water and electrolytes;
• while absorbing a person, the liquid is absorbed in the large intestine, and when it is turned on, especially the small intestine, it does not enter there.

The result of dehydration is an increase in the load on the heart, hypotension, the breakdown of metabolic processes, weakness, fainting (up to comatose). If the body loses about a fifth of the water, a lethal outcome is possible.

The wall of the intestine, devoid of blood supply, loses its strength, breaks through, and the accumulated contents pour out into the peritoneum and cause its inflammation (fecal peritonitis). It provokes necrotic changes in the tissue of the intestinal wall (gangrene develops). In this case, urgent surgery is required with removal of the part of the intestine and antiseptic treatment of the abdominal cavity.

Adhesive disease - the formation of connective tissue fusions that appear in the areas of inflammation. Causes the dislocation of the bowels of the intestine, which can provoke the repetition of any form of obstruction of the digestive tract.

[46]

Diagnostics of the curvature

Diagnosis of inversion of the intestines, like any other disease, is based on a survey, examination, laboratory tests and instrumental examinations. Survey and examination of the patient help to guess the cause of the disease and to appoint a further examination.

There are no laboratory tests confirming or refuting the diagnosis of vomiting. However, some tests are done to identify complications (gangrene, peritonitis) and for differential diagnosis.

If there is a suspicion of inversion of the intestines, a clinical blood test is appointed, which helps to identify the deviations in the parameters characteristic for this disease: excess of the norm of the number of leukocytes and the rate of erythrocyte sedimentation; decrease in the norm of the number of red blood cells and hemoglobin content. These data suggest the presence of peritonitis and intestinal bleeding.

A biochemical blood test can show an increase in the level of lactate dehydrogenase, a decrease in the indices of albumin, potassium and chlorine.

Hepatic tests in our case are usually normal, this analysis is done for differential diagnosis.

Analysis of feces sometimes shows the presence of blood (necrosis of the intestinal mucosa).

Studies of the acid-alkaline state of the blood - in different periods show different deviations from the norm.

Instrumental diagnosis - x-ray study of the abdominal cavity (review, irrigography, oral contrast), computed tomography, diagnostic laparoscopy.

On the most common roentgenogram, obstruction of the intestine loops and the presence of obstruction are visible, and the x-ray with the barium enema determines the typical localization of the bowel turn, the oral intake of barium suspension before radiography is used to confirm the twisting of the small intestine (particularly in pediatrics).

Computed tomography is suitable in cases of blind and small intestinal flap. On the tomogram, a spiral, so-called "storm sign" is seen, obstructive changes in the intestine and thickening of its walls, swelling of the mesentery.

In children between the ages of 4 and 10 months, in cases of development of an obstruction, the inversion of the invagination is differentiated (retraction of the narrowed part of the intestine into the gut with normal lumen).

If a woman is suspected of turning up during pregnancy, the diagnosis is complicated by the fact that radiographic examination is contraindicated and is used only in the most extreme cases, diagnostic laparoscopy is not applied because of the undesirability of anesthesia, colonoscopy is due to a possible miscarriage.

Regardless of the term, ultrasound is used, it can detect obstructive changes, fluid in the peritoneum, and the like.

[47], [48], [49], [50], [51], [52], [53]

Differential diagnosis

Differential diagnosis is based on medical history, laboratory and instrumental examinations. Curls of the small intestine are differentiated from neoplasms, diverticulosis, adhesive and calculous formations. With this pathology of the sigmoid colon, malignant neoplasm, diverticulosis, mesenteric mesentery, etc. Are excluded. Twisting of the cecum must be differentiated from appendicitis, rupture of the ovarian cyst, other obstructions, infections of the urogenital organs.

The data of visual inspection have a decisive significance in differentiation.

Treatment of the curvature

The disease is a serious danger to the life of the patient, with the first symptoms you need to immediately seek medical help.

While the ambulance did not arrive, it is necessary to conveniently place the patient. Do not feed or drink, as the movements of the intestine can only aggravate twisting and provoke vomiting. In no case do not give any medicines, they can change the clinical picture and make diagnosis more difficult. Do not wash the stomach, do not put an enema, do not heat the stomach.

Hospitalization and surgical treatment is the only thing that allows saving a patient's life.

The exception is the uncomplicated turn of the sigmoid colon. The ability to spread the curvature of the sigmoid colon through the anus is dictated by its proximity to the anus. This procedure is carried out in a medical institution by specialists. It consists in forcing a solution of barium to the place of turning through the rectum. There is an increased pressure and a bloating can occur. If untwisting does not occur, surgery is used.

Surgical techniques are selected individually, given the location of the curvature, the condition of the damaged parts of the intestine and the patient's well-being.

Operations to eliminate this defect are carried out under general anesthesia. A laparotomic incision (from the top down the midline of the abdomen, the navel remains on the right) is needed for a good view of the operating field and accessibility under various manipulations.

Through the incision loosen the loops of the intestine and remove the accumulated contents. If the intestinal loops are viable - after the recovery is restored to their normal appearance, motor and blood supply, the operation is finished. Wash the abdominal cavity with antiseptics, install a drainage tube and suture the
Wound.

If complications are revealed, the volume of the operation increases: the dead loops are removed, an anastomosis is applied or the ends of the intestine are removed to the surface of the abdominal wall (ileostoma), which allows to adjust the process of feeding the patient when the intestine is disconnected and continue the anti-inflammatory treatment. When the condition is normalized, the patient is operated to restore the integrity of the intestine.

The principles of carrying out operations with different localizations of the curvature are similar, with some specific differences.

If the operation has gone without removing part of the intestine, the patients recover quickly. After resection of the bowel turn, the patient is expected to have a long rehabilitation, during this period, certain restrictions must be observed. Restorative postoperative measures consist of bed rest, anesthesia, postoperative wound treatment, physiotherapy procedures, respiratory gymnastics, dietary nutrition.

Postoperative patients must comply with strict bed restraint in order to avoid divergence of sutures. One day after the operation, you can start to do simple gymnastics with your hands (raise-lower, bend-unbend), careful turns from one side to the other. After another day or two, it is recommended to get out of bed and walk for a short time in the ward and in the corridor. Easy physical loading after surgery improves blood circulation, precedes the occurrence of decubitus and reduces the risk of blood clots.

An important point in the rehabilitation process is effective anesthesia.

Depending on the condition of the patient and individual sensitivity, analgesics of different groups are used.

At the very beginning of the operation, narcotic drugs are used which effectively relieve severe pain, for example, morphine or omopon.

Omnupon is a complex drug consisting of three narcotic analgesics (morphine, codeine, tebain) and papaverine, which prevents spastic contractions of the smooth muscles of the intestine. Inhibits any pain sensations without turning off consciousness, while retaining the remaining sensations.

Patients are prescribed subcutaneous injections in a dosage of 10 mg of the drug from three to four times a day.

May cause nausea, vomiting, respiratory depression. Continued use causes drug addiction.
Contraindicated in respiratory dysfunction, dystrophy, patients of advanced age.

To remove the manifestations of inflammation and pain in the area of the postoperative suture, use non-steroidal anti-inflammatory drugs, for example, indomethacin or ketorolac.

Ketorolac - an active analgesic, relieves fever, swelling and inflammation. Prostaglandin production inhibitor. Prevents thrombosis. It is indicated for postoperative pain.
You can combine with narcotic pain medications. Patients are prescribed intravenously in a dosage of 30 mg with an interval of six hours. Like all non-steroidal anti-inflammatory drugs, there are a lot of contraindications and side effects from allergies to neuropsychic disorders. It is not used in pediatrics, during pregnancy and lactation.
To relax the muscles of the intestine, inactivate its motor skills and prevent spasms use antispasmodics.

Drotaverin is an active antispasmodic acting relaxing on the smooth muscles of the gastrointestinal tract and blood vessels. Has analgesic effect, expanding the vessels and contributing to their saturation with oxygen.

Drotaverina hydrochloride penetrates the placental barrier. Pregnant and lactating women and children 0-12 years old are not assigned.

Patients are prescribed intramuscularly for 40 - 80 mg with an interval of eight hours. The drug is well tolerated, allergic reactions and other undesirable events are extremely rare.

Treatment of the wound after the operation is carried out from the first day until complete healing, once or twice a day, according to the indications. It is performed to prevent purulent infection and inflammatory processes. Each time in the process of dressing the wound is washed with antiseptic means, for example, betadine and alcohol (70%), examine and re-impose several antiseptic impregnated layers of gauze and fix them with a sterile bandage.

Betadine is a complex antiseptic, which is an iodine compound with polyvinylpyrrolidone. Contact with the skin releases an active ion of iodine from the compound, which reacts with cellular proteins to form iodamines. It can be used for a long time without the risk of developing immunity. Has a bactericidal, fungicidal effect, destroys viruses and protozoa. It lasts longer than the products containing inorganic iodine, practically does not irritate the surface being treated. Influences, until the color disappears from the surface of the skin. Contraindicated in case of sensitization to iodine, increased thyroid function, pregnant and lactating women, infants. It is not used in conjunction with other antiseptic agents for external use containing silver, hydroperitone, chlorhexidine, enzymatic preparations and medicines containing mercury.

During the recovery period, the patient can be prescribed physiotherapy treatment: therapy - ultra-high-frequency, laser, magnetic; diadynamics; electrophoresis.

All patients after surgery are shown breathing exercises: accelerated deep breaths and exhalations or inflation of air balls for ventilation of the lungs as prevention of the development of hypostatic pneumonia and other complications from the respiratory organs. This gymnastics is recommended to be done several times a day, in particular, during a prolonged bed rest.

Dietary food

For several days immediately after eliminating the curvature of the intestines with the ectomy of the part of the intestine, nutrients, liquid, trace elements and vitamins are administered to the patient intravenously via a dropper. After three or four days the patient's condition is stabilized and it is possible to eat naturally.

Begin the natural diet with a zero diet, the goal of which is to supply the body with a minimum of essential nutrients, while preventing an active reduction of smooth bowel musculature and gas formation, which negatively affects the healing of tissues in the operated area.

Zero diet involves frequent (8 times a day) food intake in small portions (not more than 300 g) only in the liquid state. Food and drink are heated up to 45 ° C, the daily liquid norm is about two liters, the food is not salty.

You can eat: a weak broth from dietary meat varieties - veal, rabbit, turkey breast and mashed potatoes; decoction of rice mashed porridge; skim curd mass and a drink from rose hips; jelly and baked apple; jelly and not strong tea.

Then diet № 1а, assuming to eat six times a day, all - in a warm, liquid and frayed form

You can eat: wiped buckwheat, rice, semolina porridge on broth or milk, diluted with water (1: 4); rubbed soups from cereals on vegetable broth; protein omelet for steaming; steamed fish of low-fat varieties in the form of a souffle; jelly, not strong tea, fresh from sweet fruit.

In the absence of complications, they go on to diet No. 1b, which, in addition to the previous one, includes: crackers from white bread; steamed meatballs and meatballs; boiled (steam) vegetables, meat and fish in the form of puree; sour cream.

Approximately two to three weeks after the operation, at discharge from the hospital, diet No. 1 is prescribed. Restrictions are less - the temperature of food is warm or indoor, the products that activate the secretion of gastric juice and intestinal peristalsis are not recommended. It is allowed to use lactic acid products, biscuits, low-fat cookies, yesterday's bread. The first and second dishes are boiled and steam, their ingredients are ground.

The transition to the usual way of life occurs for about one and a half months.

[54], [55], [56], [57]

Alternative Medicine

Inversion of the intestines can not be attempted at home. The use of alternative medicine or homeopathic medicines will not solve the problem, but will only exacerbate it. But as a preventive measure of curvature of the intestines, in the recovery period, alternative treatment and homeopathy can help. However, before taking alternative treatment, it is necessary to consult a doctor in charge.

Inversion of the intestines can provoke different causes. For some of them, for example, congenital pathologies, prescriptions for alternative medicine are unlikely to work. Most of the others are amenable to adjustment.

The factor of a serious risk of swelling of the intestines is called chronic constipation. Here you can successfully apply alternative treatment.

The most simple recommendations - in the morning on an empty stomach, take a tablespoon of vegetable oil in your mouth and chatter it in your mouth for as long as possible, spit out the leftovers (they should be discolored) and rinse your mouth. This procedure also removes the intoxication of the body.

There is in the morning for breakfast salad "broom" from raw shabby beets, carrots and finely chopped cabbage with vegetable oil.

Infusion of beets on the water. 0,5 kg of root crops to clean, chop, pour a liter of boiling water, let it brew for three or four hours. Then pour 150 g of sugar and a teaspoon of dry yeast, put on a day in a dark place. After a day, drain. Eat 1/2 cup three to four times a day. Relaxes the musculature of the intestine, has an anticonvulsant and antiseptic effect, normalizes peristalsis.

Whey kvass with celandine. For 3 liters of serum will need a glass of finely chopped herbs celandine, and granulated sugar. Clean the celandine with sugar, pour it on a cut of gauze, tie it in a knot, place it in a bowl with serum, cover with gauze and put it in a dark place for 14 days. Remove the bundle, wring out, drain. Store the jar with kvass in the refrigerator, under the cap nylon. Eat 1/2 cup twice a day for half an hour before meals. Course - 14 days, after two or three days to finish off the scheme of the remnants of kvass.

Treatment with herbs can help not only with constipation, but also with overeating and food poisoning.

As a laxative, you can prepare a decoction from the buckthorn bark: 100g of crushed raw material pour a liter of water, to burn one hour in a weak flame (do not boil). Allow to cool, drain.

Eat five or six times a day, one tablespoon for half an hour before or one hour after eating.

When overeating, the root of the calamus helps very well , eat half a teaspoon of the crushed root of the calamus and drink it with water.

It helps yarrow infusion : a teaspoon with top brew boiling water, a minute later - to drain, a little cool - to drink.

The consequences of food poisoning can be leveled by taking chicory infusion : 25g of crushed dry raw material to brew a glass of steep boiling water, wrap and leave for the night. Drink a day in three to four meals before eating for half an hour. To drink infusion of chicory it is necessary, having preliminary cleared a stomach, for what drink three glasses of the salted water. You can clean the stomach several times.

An infusion of dried raspberry leaves or mint leaves is also prepared . They are drunk on an empty stomach in the morning and at night. You should drink slowly, with small sips.

Homeopathy also refers to conservative methods of treatment, therefore it is unacceptable to eliminate this problem with homeopathic preparations.

To prevent bloating and combat chronic constipation, as well as inflammatory bowel diseases, there are many drugs, such as:

Causticum (Causticum) - is used for constipation with hard, dry faeces, sometimes with mucous secretions; defecation occurs with great difficulty and stress;

Bryonia (Bryonia) - with dry mucous membranes of the anal passage, rectum, the same sensations in the mouth, strong thirst, in the tongue - plaque, there is no urge to defecate; bloating; can be used in pregnant women;

Hydrastis (Hydrastis) - chronic constipation in patients who have been taking laxatives for a long time; pregnant, who want to eat meat, not vegetable dishes;

Natrium muriaticum (Natrium muriaticum) - cracks, anus fractures with bleeding; Stit out after stool; mucous membranes overdried; all this causes the patient to be angry; rectal rectal paresis; constipation in patients with a dislocation of the internal organs of the small pelvis; patients are sweaty, very weak, like salty.

Homeopathic remedies should be prescribed by a homeopathic doctor who will study the patient's anamnesis, lifestyle, habits and addictions. This is all taken into account in appointments, and self-medication even with homeopathic medicines used in negligible small doses is unsafe.

[58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68]

Prevention

Prevention of inversion of guts is a way of life that does not predispose to the development of this disease. In particular, this is of great importance for people with congenital anatomical features of the abdominal organs.

Preventive maintenance of the given disease consists, first of all, in observance of a diet. Prolonged fasting with excessive satiety afterwards, consumption of a large amount of food of plant origin increases the risk of a twisting of the intestines.

It is recommended to eat small meals in a regular and varied manner, 4-5 meals a day, and people at risk should prefer liquid, shredded food. Remove from the diet very hot or cold, fatty, smoked, salty foods, alcohol.

It is necessary to get rid of embarrassment in time. With a tendency to constipation due to weak peristalsis of the intestine, you need to consume more plant food, which normalizes the mobility of the intestine and promotes a more rapid release of the body from stool.

For constipation caused, for example, by neoplasms, products stimulating intestinal motility must be removed from the daily menu. Since in this case active intestinal motility may provoke a turn of the bowel.

In time, treat acute inflammatory processes of the peritoneum and intestinal infections, which can lead to the development of adhesions and other complications.

[69], [70], [71], [72]

Forecast

The forecast of a turn of bowels directly depends on speed of the reference for medical aid. With timely treatment, it is favorable, and delaying the time can lead to death.

[73], [74]