congenital anorectal stricture
Introduction
Introduction to congenital anorectal stenosis Congenital anorectal stenosis (congenitalanorectalstenosis) is due to abnormal embryonic development, resulting in an anorectal caliber too small, both male and female are visible, showing varying degrees of poor bowel movements. A history of poor bowel movements combined with local examination can confirm the diagnosis. When it is difficult to judge the stenosis section, a barium enema can be used to help confirm the diagnosis. It varies according to the degree of stenosis. Severe stenosis is difficult to defecate after birth. It is manifested as defecation when defecation, crying, and signs of low intestinal obstruction may occur in days to months. Mild stenosis can be discharged normally, only when the stool is formed, the defecation is laborious, the feces are thin strips, frequent constipation, and even fecal impaction. There are also patients who go to adulthood because of the difficulty of long-term solution. Long-term poor bowel movements can cause proximal straightness and colon enlargement leading to secondary giant straight colon disease. The anus is partially visible in the anus, even with only a small hole, and even the catheter cannot be inserted. The high middle position is narrow, the appearance of the anus can be normal, but the fifth finger cannot pass through the narrow section during the examination. basic knowledge The proportion of illness: 0.02% Susceptible population: newborn Mode of infection: non-infectious Complications: intestinal obstruction abdominal pain toxic shock syndrome dehydration
Cause
Causes of congenital anorectal stenosis
Due to abnormal embryonic development.
Prevention
Congenital anorectal stenosis prevention
There are no effective preventive measures for congenital diseases.
Complication
Congenital anorectal stenosis complications Complications, intestinal obstruction, abdominal pain, toxic shock syndrome dehydration
First, secondary giant straight colon disease.
Second, intestinal obstruction:
In addition to the unique manifestations of the primary disease, the common manifestations of intestinal obstruction are paroxysmal abdominal cramps, vomiting and bloating, and anal exhaust without defecation.
1. Paroxysmal abdominal pain often occurs suddenly, mechanical intestinal obstruction is severe, the abdominal wall of children is thin, the abdominal shape and peristaltic wave are often seen in the abdomen when abdominal pain occurs, there is no colic in paralytic intestinal obstruction, only high abdominal distension There may be persistent pain, no bowel type, and no bowel sounds.
2. Vomiting, bloating. If the obstruction site is high, vomiting occurs early and frequent, spit out gastric juice and yellow bile, only upper abdominal distension or no abdominal distension, such as low obstruction, vomiting occurs late, spit out fecal liquid, and abdominal distension is obvious, most of the paralytic ileus early Do not vomit, in the late stage can spit out stool samples, abdominal distension is obvious.
3. The anus does not defecate, no venting is the manifestation of complete obstruction of the intestine, but in the early stage of obstruction, the feces and gas remaining in the distal intestine of the obstruction can still be discharged. Do not mistakenly believe that there is no obstruction, and there may be bloody liquid when the intestine is narrowed. Excretion, in addition to the above performance, there are symptoms of systemic poisoning, such as drowsiness, pallor, dehydration and other symptoms, generally intestinal narrowing 6-8 hours can occur intestinal death, often accompanied by toxic shock, the condition is very dangerous.
Symptom
Congenital anorectal stenosis symptoms Common symptoms Anal or anal canal narrow anal area redness and painful lumps constipation intestinal stenosis
Due to the different degrees of stenosis, the performance is different. Severe stenosis is difficult to defecate after birth. It is manifested as defecation when defecation, crying, and signs of low intestinal obstruction can occur in days to months. Those with mild stenosis can be discharged normally. Only when the stool is formed, the defecation is laborious, the feces are thin, the constipation is frequent, and even the fecal impaction occurs. There are also patients who have difficulty in long-term solution until adulthood. The long-term poor bowel movement can cause the proximal end straight, and the colon gradually Enlargement leads to secondary giant straight colon disease. The anus is small in the anus, even a small hole, even the catheter can not be inserted, the high median stenosis, the appearance of the anus can be normal, but the fifth finger can not pass the stenosis during the examination segment.
Examine
Examination of congenital anorectal stenosis
1. Digital rectal examination.
2. enema film.
Diagnosis
Diagnosis and diagnosis of congenital anorectal stenosis
diagnosis
A history of poor bowel movement combined with local examination can confirm the diagnosis. When it is difficult to judge the stenosis section, the sputum enema can be used to help confirm the diagnosis.
Differential diagnosis
Rectal atresia
Anal development is normal but there is no stool after birth, accompanied by signs of intestinal obstruction, rectal examination is blocked and fluctuating, inverted X-ray examination, if the rectal membranous fistula is rectal atresia, if the rectum is absent, there is no rectal malformation, Sometimes it can be accompanied by no anal deformity.
2. Anal atresia
The child was born without meconium, and soon vomiting, abdominal distension and other symptoms of intestinal obstruction, local examination, the center of the perineum was flat, the part of the anal area was covered with skin, and some cases had a small depression with pigmentation and radiation. Wrinkles, stimulate the ring muscle contraction reaction here, when the baby is crying or holding your breath, there is a protrusion in the center of the perineum. The finger can be placed in the area to have a sense of impact. The baby is placed in the low position of the hip and the acupuncture is a drum sound.
After birth, no meconium is discharged, the anal area is covered with skin, and the anal area has a sense of impact when crying. The inverted position is on the X-ray lateral piece, the end of the rectum is located on the shame line or slightly below it, and the ultrasound is used to measure the rectal blindness. The distance from the anal area is about 1.5cm.
