Rectal hernia
Introduction
Introduction of rectum in the vertical wall of the intestine Intra-abdominal organs are trapped in the uterus rectum, which is called intramural herniacaused byproctoptoma. Clinical manifestations of defecation obstruction and incomplete feeling. Most occur in women, double diagnosis combined with defecation angiography is helpful for diagnosis. basic knowledge Proportion of disease: seen in patients with rectal prolapse, the incidence rate is about 0.1% - 0.3% Susceptible people: mostly occur in women Mode of infection: non-infectious Complications: abdominal pain, bloating
Cause
Rectal dislocation in the vertical intestinal wall
(1) Causes of the disease
Mainly for maternal, pelvic large tumor, intestinal cough, significant obesity, ascites and other factors causing abdominal pressure increase, such as uterine rectal fascia and rectal pubic muscle fibers loose or broken, and uterine ligament also loose and upper vaginal defect, etc. More common in women or menopausal women.
(two) pathogenesis
The rectal (inner) decompression of the vertical intestine wall is a full-thickness rectal intussusception and the rectal wall is sunken into the cavity during rectal prolapse. It occurs with the appearance of rectal intussusception during defecation, and disappears with the telescopic reset. In most cases, the hernia sac in the rectal wall is very short-lived, and often only the hernia sac (cuff) exists. The contents of the sputum may have small intestine, sigmoid colon, uterus, etc., which will be further aggravated when it enters the hernia sac. Symptoms and signs of difficulty in defecation.
In fact, rectal prolapse, rectal wall fistula caused by full-thickness rectal intrusion does not exist as a disease alone, almost coexisting with the Douglas depression formed by the deepening of the Douglas sag, in other words, the static Douglas depression and forced bowel movement with rectal prolapse, the occurrence of full-thickness rectal intussusception in the rectal wall is a pathological component of the pelvic floor hernia, the difference between the two is that the hernia sac in the rectal wall is all The rectal wall is composed; and the anterior wall of the sac of the Douglas is the cervix, the posterior wall of the vagina, and the posterior wall is composed of the rectal wall.
Prevention
Rectal prolapse prevention of vertical intestinal wall
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Rectal dislocation vertical intestinal wall complication Complications, abdominal pain, bloating
Mucus and bloody stools, abdominal pain, bloating, abnormal urination, etc. may occur.
Symptom
Rectal dislocation vertical intestinal wall sputum symptoms common symptoms anal bulge abdominal pain abdominal distension blood in the stool
1. Symptoms: There are many symptoms of pelvic floor spasm and rectal prolapse or rectal intussusception. If there is often a bowel obstruction and incomplete feeling, the number of bowel movements increases, the defecation is laborious and time consuming, the column becomes thin like a toothpaste, and even Defecation should be assisted by hand. In severe cases, defecation can be interrupted. Especially when the small intestine, sigmoid colon or uterus is invaded, other common symptoms include anal bulging discomfort, foreign body sensation in the anus, compression of the appendix and fullness of the rectum. Some patients Mucus and bloody stools, abdominal pain, abdominal distension, abnormal urination, etc. may occur.
2. Signs: Abdominal examination is more abnormal, anorectal digital rectal examination can expand the rectal cavity, rectal mucosa relaxation; paralyzed patients do defecation movement, more than 1/3 of patients in the rectum can lick the cervical-like sleeve At the top of the stack, if there is a sputum content, the double or triple sputum and sputum contents are present.
Examine
Examination of the rectum in the vertical intestine
1. Barium meal examination: pelvic lateral slices, visible intestine prolapse in the bulging sac.
2. Synchronous defecation angiography and pelvic angiography: can show the sac of the pelvic floor.
3. Simultaneous rectal anal canal, peritoneal cavity, vaginal and cystography: It is helpful to judge the pathological anatomical changes of the pelvic floor.
Diagnosis
Diagnosis and differential diagnosis of rectal dislocation in the vertical wall
The diagnosis of this disease is difficult, mainly based on symptoms, signs and digital rectal examination, double or triple diagnosis, combined with defecation angiography, especially synchronous defecation angiography and pelvic angiography, comprehensive consideration.
If the angiography can clearly show the sac of the pelvic floor, and also show rectal prolapse or rectal prolapse, rectal wall sputum can be diagnosed during rectal prolapse, and the filling of the bladder should be considered during angiography. And the size, the amount of perfusion of the rectal and sigmoid colon sputum, etc. on the morphology and extent of the peritoneal pelvic cavity, Zhang Lianyang and other scholars believe that the simultaneous rectal anal canal, peritoneal cavity, vaginal and cystography, is more conducive to a comprehensive judgment of the pelvic floor The pathological anatomy changes and can improve the accuracy of the diagnosis.
