rectal intussusception
Introduction
Introduction to rectal intussusception Intranectal invaginate refers to the proximal rectal full-thickness or simple mucosal layer folded into the distal intestine or anal canal during the defecation process, no more than the outer edge. Also known as rectal prolapse, recessive rectal prolapse or incomplete rectal prolapse, this disease is one of the common types of export obstructive constipation, mostly occurs in the distal rectum, and some patients may involve the middle rectum. Due to digital rectal examination, sigmoidoscopy and barium enema, the nesting has been reset, so the clinical diagnosis is difficult. Only through dynamic imaging of defecation can the diagnosis be confirmed. basic knowledge The proportion of illness: 0.02% - 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: constipation
Cause
Rectal intussusception
(1) Causes of the disease
Some people think that rectal length is a necessary condition for the onset. The exact cause is still unclear. Most authors believe that rectal prolapse is a clear functional rectal disease, and rectal prolapse is considered as the early stage of rectal prolapse. For rectal prolapse, it is also believed that the occurrence of this disease may be related to the relaxation of the mucosa in the rectum. Long-term forced defecation causes the feces to pull the rectal mucosa distally, which is related to the displacement of the mucosa. Zhang Lianyang and other applications for transabdominal surgery for rectal dissection Drowning, it is found that such patients are often accompanied by pathological changes such as intrauterine prolapse and posterior pelvic prolapse.
(two) pathogenesis
1. Pathogenesis: The mechanism may be: the feces in the lower end of the rectum cause the intention, while the part of the feces is discharged, the rectal mucosa is prolapsed to block the intestinal lumen, so that the contents of the proximal intestine cannot enter the distal rectum, the more force The more obvious the obstruction, the heavier the intention, but when the abdomen relaxes, the mucous membrane retracts, the intestine is open, and the proximal feces enter the distal rectum, so a small amount of feces can be solved again. The rectal examination indicates that the mucosa is relaxed in the rectal cavity, and the mucosa Stacked, the fingers are wrapped by mucous membranes, the intestinal lumen becomes smaller, and the faecal angiography shows a typical mucosal prolapse as a cup-shaped image.
2. Classification: According to the sheath and the extent of the nesting, the rectal intussusception can be divided into two types: rectal mucosal prolapse and full-thick rectal intussusception.
Prevention
Rectal nesting prevention
1, the diet should be light, eat less spicy, fried, fried, spirits and other non-digestive foods, eat more fruits, vegetables and fiber foods, drink more water, especially bananas, honey, laxative food.
2, do not stand for a long time sedentary, appropriate increase in exercise, especially levator ani exercise.
3, regular stools every day, (no stools should be regularly to the toilet to do defecation conditioning training), each time the stool time should not be too long, about 5 minutes is appropriate.
4, before and after the bath and fumigation, keep the anus clean.
5, every morning when you get up, drink a cup of warm salt water or cool white water to promote bowel movements.
6, if the stool is dry, you can take appropriate laxative drugs, such as: non-breast, can not use laxatives, detoxification, aloe capsules, etc., long-term use will not only increase constipation and will form drug dependence .
Complication
Rectal intussusception complications Complications constipation
Rectal intussusception often combined with other outlet obstruction or slow transit constipation, and it is rare to have a single rectal intussusception.
Symptom
Rectal intussusception symptoms Common symptoms Defecation frequency abnormal defecation does not feel mucus
Among the types of obstructive constipation patients at various outlets, males have more episodes of rectal intussusception. Symptoms are difficulty in rectal emptying, poor bowel movements, and anal blockage, but the greater the force, the more severe the blockage; patients often insert a finger or suppository into the anus to help the feces out. The reason is that the finger or suppository inserted into the anus pushes the rectal rectal mucosa back to the position, and the cause of the obstruction is relieved. For a long time, patients have unconsciously and consciously adopted this method to help the stool. Some patients have pain in the lower abdomen or ankle during defecation, occasionally with bloody stools or mucus. Some patients have psychiatric symptoms, mostly depression or anxiety.
Examine
Rectal intussusception
1. Rectal microscopy: visible mucosa of the anterior rectal wall, when forced defecation action, visible in the embedding cavity or under the dentate line, 50% of patients can see mucosal edema, brittle, congested, or ulcers, polypoids, etc. Lesion.
2. Defecation angiography: It is the main method for diagnosing rectal prolapse. The imaging features are as follows:
1 rectal endometrial intussusception: in the process of defecation, 6-8 cm on the anal verge, the anterior and posterior wall of the rectum folds, and gradually descends to the anal canal. Finally, the lower part of the rectum becomes a funnel-shaped sheath, and the ring-shaped nest is about 3 mm thick.
2 full-thickness in the rectum: the thickness of the annular sleeve ring is >5mm.
Defecation angiography can determine the rectal prolapse, the initial site of rectal prolapse, help to determine the rectal emptying, by measuring the straight spacing, the curvature of the humerus or appendix, the presence or absence of direct separation during defecation, etc. The degree of fixation of the rectum can be judged, and Berman believes that the separation of the iliac crest is one of the indications for transabdominal surgery.
3. Barium enema: to understand whether there is too long sigmoid colon.
4. Anorectal manometry: help to understand the function of the anal sphincter, Zhang Lianyang and other patients with rectal prolapse anal canal pressure measurement showed that there is a reduction in anal canal pressure, in which rectal mucosal prolapse has anal canal The polyp is reduced, while the full-thickness rectal inversion has a decrease in the anal canal resting pressure and cough pressure.
5. Colonic transmission test: Excluding colonic slow transit constipation.
6. Pelvic floor EMG.
Diagnosis
Diagnosis and identification of rectal nesting
diagnosis
When the patient complains of a sense of obstruction in the rectum, incomplete defecation, and frequent stools, the possibility of suffering from the disease should be considered each time the amount of feces is small.
The diagnosis is based on the following examinations: 1 Rectal examination can reveal mucosal relaxation at the lower end of the rectum or accumulation of mucosa in the intestinal lumen. 2 Although the sigmoid colonoscopy can not find the inner nest, because the nest has been reset when inserting the colonoscopy, ulcers, erosion, mucous membrane erythema or edema often appear in the inner nest, often misdiagnosed as rectal inflammatory disease. 3 defecation dynamic angiography is a valuable method of examination, which can clarify the diagnosis of this disease.
The typical manifestation is that the rectal lateral radiograph shows a funnel-like image of mucosal prolapse, and some patients have a sacral rectal separation: some people believe that the symptoms and clinical manifestations of rectal intussusception and perineal descending syndrome are similar. When the perineum is lowered, due to excessive hernia during defecation, the mucosa of the anterior rectal wall may be prolapsed, so both may be a disease. It only has different performances at different stages of development.
When there are ulcers, erosions, erythema or edema in the inner nest, attention should be paid to the identification of rectal inflammatory diseases.
