anal trauma
Introduction
Introduction to anal trauma Anal trauma refers to anal trauma due to anal puncture or other injuries. Rectal and colonic trauma are more common in both normal and wartime situations. Post-injury anal pain, hemorrhage or anal incontinence, stenosis caused difficulty in defecation, fine, early examination after injury can be seen in the anal and surrounding tissue laceration, bleeding, anal sphincter transection, often feces outflow, pollution, time There is a serious infection in the local area, and deep cellulitis of the gluteus maximus is seen. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: anal fistula
Cause
Cause of anal trauma
Accidental injury (35%):
Anal stab wounds such as metal, wood chips, bamboo tips and other hard foreign objects, when the human body attaches to the ground from a high point, stabbing the anus and buttocks soft tissue, mostly accidental damage, but in Vietnam's war against the United States, the Vietnamese people set Bamboo tip piles often cause the US military to fall into a trap and cause injury; in rural areas, the common horns are injured. When the fierce buffalo is angry, if the person flees, the murderous cows chase from behind, use the horns to the top of the buttocks, common anus, buttocks soft tissue stab wounds. Anal tear.
Contusion and laceration (20%):
More common in mental abnormalities or sexual metamorphosis, with foreign body stuffed into the anorectal injury; can also occur in iatrogenic, such as with a proctoscope, sigmoidoscopy, the patient is afraid of force to contract the anus, and the examiner is violent; In addition, the body temperature of the anus was forgotten to be removed, and the body temperature was cut and the anus was cut, and the damage was lighter. In the anal surgery, such as an anal fistula, the anal incontinence was more serious.
Firearm injuries (5%):
Wartime shrapnel, bullets hit the anus, in the proportion of war injuries, the incidence is very low, our army against the self-defense counterattack (1979), rectal, anal injury only accounted for 3.64%.
Prevention
Anal trauma prevention
Medical staff in the application of rectaloscopy, sigmoidoscopy, should inform the patient not to be afraid, otherwise it will cause anal trauma due to fear of contracting the anus, and the examiner should be as gentle as possible; in addition, do not forget to remove the anal body temperature to avoid the thermometer The fracture cuts the anus.
Complication
Anal trauma complications Complications
1. Deep gluteal muscle cellulitis.
2. Hematoma rupture and bleeding.
Symptom
Anal trauma symptoms Common symptoms Anal short-term paroxysmal dull pain Anal severe pain Anal reflex weakened or disappeared Anal pain Anal external sphincter fracture Anal sphincter transection
1. History: Regardless of war wounds or usual trauma, the history of anal trauma is the primary method for obtaining a diagnosis.
2, clinical manifestations: pain after anal pain, bleeding or anal incontinence, stenosis caused by difficulty in bowel movements, fine, early examination after injury can be seen in the anus and surrounding tissue laceration, hemorrhage, anal sphincter transection, often fecal outflow , pollution, long-term local severe infection, visible deep gluteal muscle cellulitis.
classification
1, contusion (hematoma).
2, laceration:
(1) unperforated (non-metallic);
(2) perforation (full layer, but not completely transected);
(3) Large pieces of damage (avulsion, complexity, rupture, loss of tissue).
Examine
Anal trauma examination
Rectal examination: Under strict aseptic operation, use the fingers of the fingertips for anus, rectal examination, finger movement into the anus should be gentle, and the anus of the injured person should be contracted to understand whether there is an anal sphincter fracture, if there is a break, Then the anus loses tension and relaxes. If only the part is torn, the sphincter can still feel the tension. Through the finger test, it can also understand whether the lower rectum is worn or not. It can be judged from the examiner's feeling. If the intestinal wall is smooth, there is no damage. If worn, there is local pain and emptiness.
Diagnosis
Diagnosis of anal trauma
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Pay attention to the identification of anal canal injury and rectal injury.
