Anal, rectal, colon strictures
Introduction
Introduction to anal canal, rectum, and colon stenosis Anorectal and colon stenosis can be caused by congenital malformations, inflammation, trauma, tumors and surgical trauma. Colonic stenosis is caused by congenital malformations and injuries, mostly after colectomy and ulcerative colitis, granulomatous colon Complications such as inflammation. basic knowledge The proportion of sickness: 0.5--0.8% Susceptible people: no specific population Mode of infection: non-infectious Complications: constipation
Cause
Anal canal, rectum, colon stenosis
Congenital malformations and inflammation are common causes, such as perianal, periorectal abscess, extensive anorectal fistula, granulomatous colitis, ulcerative colitis, tuberculosis, schistosomiasis granuloma, flowering lymphogranuloma, put Nematode disease, etc., can cause anorectal stenosis, injury is also the most common cause, especially surgical trauma, other causes of perineal accidental injury, childbirth injury, burns, corrosive drugs, suppository damage, radiation therapy and tumor .
Prevention
Anal canal, rectum, colon stenosis prevention
In the anal surgical injury and inflammation, to prevent anal stenosis, such as hemorrhoids surgery to remove the sputum block, should retain a normal skin and mucous membrane between the sputum block, in addition, anal fistula surgery can not remove too much skin.
It is necessary to maintain local cleanliness after surgery to prevent various infections and cause anal stenosis.
Complication
Anal canal, rectum, colon stenosis complications Complications constipation
Frequent constipation can occur concurrently, even fecal impaction, long-term poor bowel movement can cause proximal straight, colon gradually enlargement leading to secondary giant straight colon disease.
Symptom
Anal canal, rectum, colon stenosis symptoms Common symptoms Anal canal stenosis anal fissure rectal stenosis anal papillary hypertrophy
Patients often have anorectal surgery, history of injury or inflammatory disease, or have used local injection therapy, corrosive suppositories, etc., and later gradually appear the above symptoms of defecation difficulties, finger examination of the anus or anal canal found narrow, sometimes only reach The tip of the small finger sometimes touches the hard fiber band, or the ring is narrow, sometimes because the stool is hard and the anus is a wire-shaped split. This situation should be distinguished from the difficulty of defecation caused by the common anal fissure, and the finger is very painful when palpating. It can only be examined and identified after local infiltration of local anesthesia. There are often feces or secretions in the anus. In order to clarify or rule out possible causes, or to consider the treatment of stenosis, an expectorant should be given. Enema to observe whether there is a knot, rectal lesions, rectal stenosis with a smooth annular surface, can be used as a Frei test to identify lymphogranuloma of the lymphoblastic sinus. When a malignant tumor is suspected, it should be performed by a proctoscopy or sigmoidoscopy. Organize the examination to confirm the diagnosis.
Examine
Examination of anal canal, rectum, and colon stenosis
Laboratory inspection
(1) blood: blood routine examination of bleeding and clotting time erythrocyte plasma protein and lack of color man test anorectal colon disease extensive abscess erythrocyte sedimentation accelerated; enteritis colitis diverticulitis tuberculosis erythrocyte sedimentation rate can also accelerate carcinoembryonic antigen (CEA) determination is cancer-induced rectum Anal stenosis surgery effect and recurrence monitoring indicators;
(2) Dung routine and culture: specimens of dilute rectal colon and anus around the anus should be vigilant °C within 1h; normal formed feces can be checked in h with a small amount of blood often from the rectum sigmoid colon and descending colon to cecal bleeding and When the upper part of the gastrointestinal tract is discharged quickly, blood may also appear, but the upper part of the gastrointestinal tract often shows a black stool, a small intestine, and a small amount of bleeding in the colon, which indicates occult blood in the feces;
(3) fecal occult blood test: a simple method to find colorectal tumors and other causes of bleeding;
(4) Fie (Fie) test: a positive method for examining inguinal lymphogranuloma indicates that infection does not indicate that the disease is active but the false positive rate is high;
(5) Exfoliated cell examination: can identify benign or malignant tumors and can identify colorectal cancer and diverticulitis.
Device inspection
(1) Exercise conduction examination: the normal latency of the pudendal and perineal nerve endings is 1.9ms, the latency of anal incontinence or urinary incontinence is increased, and the spinal cord exercise latency is normal. The external spinal sphincter L is 5.5ms. The puborectal muscle activity latency 4.8ms for people and L is 3.7ms;
(2) Ultrasound examination: Ultrasound imaging in the rectum is more accurate, sensitivity, specificity and predictive value are high, can determine the depth and stage of rectal cancer infiltration of the intestinal wall, and can find both high tumor and bladder invasion and prostate invasion and metastasis And local recurrence after surgery, but can not clearly determine lymph node invasion and pelvic spread, distinguish between inflammation and cancer, can lead to biopsy;
(3) rectal examination: see mucosal color, congestion, edema, with or without erosion, ulcers, polyps, tumor stenosis and foreign bodies, in the vicinity of the dentate line can check the internal hemorrhoids, anal nipple, anal sinus and anal fistula.
(4) sigmoidoscopy: a simple and easy method to develop, more than 70% of rectal and colon cancer can be directly seen with this mirror; in the conventional sigmoidoscopy, adenoma and other lesions found up to 39%, 15% of adenomas have malignancy Change, and can treat the disease in the rectal colon through sigmoidoscopy to improve the diagnostic accuracy.
(5) fiber colonoscopy: can directly examine the rectum, colon, cecum, ileocecal valve and ileum, can also do biopsy, cancer screening, polypectomy and cauterization, is conducive to early diagnosis of colon disease.
(6) X-ray examination: chest X-ray examination to determine whether there is tuberculosis and tumor metastasis of the abdomen, to determine the presence or absence of colon stenosis and obstruction, barium enema examination can be seen in the large intestine, especially the rectal anal stenosis and mucosal arrangement shape, with or without destruction of polyps and Tumor.
(7) CT scan examination: It is a sensitive method for examining anal canal and rectal cancer. It can detect cancer invasion of anterior iliac crest, pelvic wall, pelvic organs and lymph nodes, determine the size of cancer, intestinal wall, fat around the rectum, uterus and muscle. Expansion, preoperative and postoperative scans can help in the development of surgical, radiotherapy treatment options.
(8) MRI examination: preoperative examination and recurrence examination of rectal cancer can be performed to determine the extent of residual cancer after radiotherapy, and the rectal and anal stenosis and its degree of disease can be diagnosed.
Diagnosis
Diagnosis and diagnosis of anal canal, rectum and colon stenosis
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1) rectal tumor: tumor-induced stenosis, general short history, progressive aggravation, and more history of dark red blood or pus and blood, early rectal cancer more asymptomatic, occasional bloody stool history, it is difficult to find, the formation of narrow, All have lesions to the advanced stage, the position is low, the diagnosis can touch the mass, irregular, uneven, hard, tender, blood on the finger, the position is higher, should be sigmoidoscopy or fiberoptic examination, endoscopy See a rectal mass, intestinal mucosa is relatively complete, biopsy can be diagnosed, rectal cancer low anastomosis or other stenosis after anal sphincter preservation, multiple biopsies must be performed to rule out the possibility of local recurrence.
2) Sexually transmitted lymphogranuloma: The patient is mainly female, with a history of sexually transmitted diseases. The lesions are mainly in the genital and inguinal lymph nodes. They are viral infections. Defecation is often accompanied by anal irritation. Mucus pus and bloody stools can be complicated by anal fistula and more stenosis. Located above the tooth line, the texture is hard and the surface is smooth, the color is pale, the anus is open, Frye test, complement fixation test and virus test positive.
3) Chronic ulcerative proctitis: multiple rectal ulcers can form a wide range of granulomas and a large number of scars during the healing process, leading to rectal stenosis. These patients often have a history of chronic recurrent colitis.
4) Crohn's disease: due to fibrosis and scar formation in the lesion, 25% to 30% of patients may have intestinal stenosis, and the clonal disease involves the anorectal rectum. The lesion is mostly above the tooth line, and a few can be in the anal canal. The stenosis is mostly tubular and gradually migrates to the normal intestinal tract. It is different from congenital and invasive annular stenosis. If the anorectal stenosis is accompanied by abscess, the fistula should be highly valued and further traced.
5) Intestinal tuberculosis: patients with hyperplastic intestinal tuberculosis, due to extreme hyperplasia of tuberculous granuloma, forming a mass and causing intestinal stenosis, ulcerative intestinal tuberculosis, if adhesion to the mucous membrane, can pull or compress the intestine; if the ulcer heals, fibrosis Scar contracture can make the intestines narrow, but these patients have a history of tuberculosis or other extraintestinal tuberculosis, and have systemic manifestations of tuberculosis, such as hot flashes, night sweats, weight loss, etc., anti-caries treatment is effective.
6) Schistosomiasis enteropathy: advanced schistosomiasis, rectal wall due to egg granulation, granuloma formation and fibrosis hyperplasia, can form different masses in the rectum, some merge into a mass, hard texture, uneven, easy Confused with tumors, this type of patients have a history of exposure to water, and local mucosal biopsies of schistosomiasis in the feces can be diagnosed.
