Anal canal injury
Introduction
Introduction to anal canal injury Anal canal injury (injuryofanalcanal) is rare compared with colonic injury, but because of its defecation function, improper treatment of anal canal injury can cause serious complications and affect the quality of life of the wounded and sick in the future. basic knowledge The proportion of illness: 5% - 8% Susceptible people: no specific population Mode of infection: non-infectious Complications: anal incontinence
Cause
Causes of anal canal injury
(1) Causes of the disease
Anal stab wound (25%):
Such as metal, wood chips, bamboo tips and other hard foreign objects, when the human body falls from the heights to the ground, stabbing the anus and buttocks soft tissue, mostly accidental damage, but in Vietnam's war against the United States, the Vietnamese people set bamboo pole piles, often The US military fell into a trap and injured; in the rural areas, the common horns were injured. When the fierce buffalo was angry, if the person fled, the murderous cow chased from behind, and the horn was placed on the buttocks, common anus, soft tissue stab wound in the buttocks, and anal tear.
Contusion (30%):
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 (12%):
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%.
(two) pathogenesis
Pathological change
The pathological changes of anal canal injury vary with the degree of injury, the nature of the injury and the method of action, location, extent, time and presence or absence of other organ injuries. Only the mucosal tear and the muscular layer are split, and the heavy layer is full. Intestinal wall rupture and extensive sphincter injury, if accompanied by large blood vessels and anterior venous plexus injury, can cause major bleeding and shock, anal canal injury often accompanied by surrounding tissue infection, such as gluteus maximus deep cellulitis, combined with anaerobic bacteria Infection and intestinal fecal contamination, can cause extensive necrosis, severe toxemia and sepsis, and even death.
2. Classification
(1) Contusion (hematoma).
(2) laceration:
1 unperforated (non-metallic);
2 perforations (full layer, but not completely transected);
3 large pieces of damage (avulsion, complexity, rupture, tissue loss).
Prevention
Anal injury prevention
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
Anal canal injury complications Complications, anal incontinence
Early anal canal injury due to fecal contamination, often complicated by pelvic cellulitis; long-term can cause anal canal stenosis and anal incontinence.
Symptom
Anal canal injury symptoms Common symptoms Anal pain connective tissue external hemorrhoids anal area redness and painful hard block anal pain
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.
Examine
Anal canal injury examination
Blood routine examination, white blood cell count and neutrophilia.
The anus examination should be performed under strict aseptic operation with the fingers wearing the finger sleeves as an 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
Diagnostic identification of anal canal injury
Any history of trauma to the anus, and anal pain, bleeding, anal incontinence, difficulty in defecation should be suspected of anal canal injury, anal finger test found fingertips blood, sphincter tension decreased or loose, anal wall damage, pain and A sense of emptiness can be diagnosed.
