Stenosis rectum. - Narrowing of the rectum caused by inflammation, tumor lesions, traumatic injury or congenital malformation. Manifested hardship discharge of stool, pain during the act of defecation, release of blood from the anus, flushing, itching and maceration of the skin of the perianal area. With long-term existence of the disease possible fecal incontinence. Diagnosis is based on clinical symptoms, results of rectal examination, barium enema, proktografii, sigmoidoscopy, biopsy and other methods. Treatment - drug therapy, physical therapy, radical and palliative surgery.
paraproctitis, hemorrhoids, perineal in labor, other diseases and pathological states of the rectum, perineum and perianal area. The cause of rectal stenosis may also be a tumor growing in the intestinal lumen, or swelling in the nearby organ, squeezing the rectum. In some patients, strictures occur in inflammatory diseases, specific and unspecific infections, including - for ulcerative colitis, Crohn's disease, intestinal tuberculosis and paraproctitis.
In some cases, rectal stenosis developed after the introduction of aggressive chemicals (usually - when trying to self). Rarely diagnosed narrowing as a result of chronic pektenoza (scallop inflammation is localized at the base of the crypts in the zone of transition folds) arising during anal fissures, proctitis and chronic crotch paraproctitis. There are cases of stenosis of the rectum on the background of sexually transmitted diseases. Sometimes a stricture is diagnosed in patients who in the past had radiation therapy for cancer of the pelvic organs. The cause of congenital narrowing of the colon are malformations.
atresia of the anus to form the perineal, recto-urethral and recto-vaginal fistulas. Lack of bowel movements with such defects become a cause of megacolon, secondary causes inflammation and narrowing of the lower rectum. Sometimes stenosis develops in children after surgery for atresia of the anus or rectum fistulas.
proctologist draws attention to the chasm or narrowing of the anus (in children with congenital stenosis of the colon instead of a well-formed anus is sometimes found with the deepening hole in the center), the presence of areas of maceration and abnormal discharge.
Rectal patient study, suffering from stenosis of the rectum, the expert assesses the state of the sphincter, the degree of narrowing of the rectum, the length of stenosis and the condition of the intestinal wall (the presence of ulceration and infiltration). During sigmoidoscopy, the doctor is more accurate visual information about the nature and severity of rectal stenosis, and also carries material sampling for histologic examination (if necessary). Irrigoscopy proktografiya and allow us to estimate the length of stenosis, the degree of expansion of overlying intestine, the severity of violations evacuation function and so forth.
wounds. In marked stenosis narrowing of the rectum area dissected circularly, upstream and downstream sections are sewn together. In underdeveloped fixing and supporting devices may require reconstructive surgery for the prevention of rectal prolapse.
Compensated subcompensated and acquired stenosis of the rectum small extent also used conservative measures. Use Bougie Gegara. Assign paraffin, electrophoresis, diathermy and mud. In patients with stenosis of the rectum with scar changes effectively reduced the introduction of corticosteroids in the affected area. With extensive scarring, this technique is not effective. At an inefficiency of conservative methods of treatment of patients sent for surgery.
Surgery for rectal stenosis may include dissection, excision or resection of part of the colon. With limited stenosis and perform anoplasty rektoplastiku (dissection contraction zone with a transverse joints), as well as intervention by Pikus method (excision of the stricture without dissection of the sphincter). In severe stenosis of the rectum with severe inflammation and fecal incontinence in some cases required two-stage operation. In the first stage a temporary colostomy patient applied for unloading the lower intestine. After the elimination of inflammation perform dissection or excision of the stricture. With extensive and high Contractions may require resection, amputation or extirpation of the rectum.
The prognosis of a stenosis of the rectum rather favorable. In the late period in 90% of patients have a complete recovery and restoration of a satisfactory evacuation function of the lower intestine. The most difficult stenoses considered rectum, combined with fecal incontinence. In such cases, to restore normal sphincter function requires multi-stage surgery in combination with conservative therapeutic measures.