Introduction

Introduction

The pathological changes of anal canal injury vary with the degree of injury, the nature of the injury, and the method, location, extent, time, and presence or absence of other organ injuries. Light only mucosal tears and myometrial rupture, heavy full-thickness intestinal wall rupture and extensive sphincter damage or even transverse.

Pathogen

Cause

(1) Causes of the disease

Anal stab wound

Such as metal, wood chips, bamboo tips and other hard foreign objects, when the human body falls from the heights of the hips to the ground, stabbing the anus and buttocks soft tissue, mostly accidental damage. However, in Vietnams war against the United States, the Vietnamese people set bamboo poles, often causing the US troops to fall into a trap and causing injuries. Common horns in the countryside, when the fierce buffalo is angry, if the person flees, the murderer chasing from behind, using the horns on the buttocks, common anus, buttocks soft tissue stab wound, anal tear.

2. Firearm injury

Wartime shrapnel and bullets hit the anus. In the proportion of war wounds, the incidence rate was very low. In the counterattack of the self-defense (1979), the rectal and anal injuries accounted for only 3.64%.

3. Frustration

More common in mental abnormalities or sexual metamorphosis, with foreign bodies inserted 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.

(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, location, extent, time, and presence or absence of other organ injuries. Light only mucosal tears and myometrial rupture, heavy full-thickness intestinal wall rupture and extensive sphincter damage or even transverse. If accompanied by large blood vessels and anterior venous plexus injury, it can cause major bleeding and shock. Anal canal injury is often accompanied by infection of surrounding tissues, such as deep cellulitis of the gluteus maximus, combined with anaerobic mixed infection and continuous contamination of intestinal feces, which can cause extensive necrosis, severe toxemia and sepsis, and even death.

2. Classification

(1) Contusion (hematoma).

(2) laceration: 1 unperforated (non-metallic); 2 perforation.

Examine

an examination

Related inspection

Anal finger examination anal reflex rectal-anal motor function measurement anal inspection

Clinical examination:

1, anal pain after injury, bleeding or anal incontinence, stenosis caused by difficulty in bowel movements, fine. Early examination after injury showed laceration and bleeding in the anus and surrounding tissues. The anal canal sphincter is broken, often with feces outflow and pollution. In the case of a long time, there is a serious infection in the local area, and deep cellulitis of the gluteus maximus is seen.

2, where there is a history of trauma to the anus, and anal pain, bleeding, anal incontinence, difficulty in defecation, should be suspected of anal canal injury. Anal finger examination found that the fingertips were stained with blood, the sphincter tension was reduced or relaxed, the anal canal wall was damaged, pain and emptiness were confirmed (full layer, but not completely traversed), large pieces were damaged (avulsion, complexity, rupture, Organization lost).

Diagnosis

Differential diagnosis

Differential diagnosis of anal sphincter transection:

1. Anal fissure ulcer: The small ulcer formed after the laceration of the anal canal skin layer below the dentate line is called an anal fissure ulcer, also called an anal fissure.

2, anal pain: anal pain is a clinical manifestation of a variety of anorectal diseases. Pain of different nature reflects different disease characteristics.

3, anal pain: anal pain as the name suggests is severe pain in the anus. This usually happens during defecation, but it can also occur during non-defecation. Mainly related to the following diseases: perianal abscess, internal hemorrhoids incarceration, anal fissure, advanced anorectal cancer and anal foreign body.

4, anal external sphincter rupture: anal external sphincter from the dorsal dorsi of the tailbone and anal talus ligament, forward and downward, divided into two in the back of the anus, around the anal canal to the front of the anus, and combined into a forward In the perineum. The external sphincter is divided into three parts: the lower part of the skin, the shallow part and the deep part. The lower part of the skin is generally identifiable. There is no obvious dividing line between the shallow part and the deep part, which is difficult to distinguish, but the former is elliptical and the latter is round. The two are different in appearance. The external anal sphincter is innervated by the anal nerve. It has an important role in circumventing the anus and controlling bowel movements. If it is accidentally injured during surgery, it can cause incontinence. An external sphincter rupture can destroy the function of the external anal sphincter, leading to fecal incontinence.

5, anal fissure: anal fissure is a small ulcer formed after the anal canal skin layer laceration below the dentate line. Its direction is parallel to the longitudinal axis of the anal canal. It is about 0.5~1.0cm long. It is usually fusiform or oval, causing severe pain. It is difficult to heal. The anal canal surface laceration can not be regarded as anal fissure due to rapid self-healing, and often asymptomatic. Anal fissure is a common anal canal disorder and a common cause of severe pain in the anal canal in young and middle-aged people. Anal fissure is most common in middle-aged people, but it can also occur in the elderly and children. The average male is slightly more than female, but there are also reports of more women than men. Anal fissure often occurs in the back of the anus, in the middle of the front, mostly in the back of the anus, and less on both sides. From the beginning, there is only a small gap in the skin of the anal canal, sometimes it can be split into the subcutaneous tissue or until the shallow layer of the sphincter. The slit is linear or prismatic. If the anus is opened, the wound surface of the breach is round or elliptical.

diagnosis:

Clinical manifestations: pain in the anus after injury, bleeding or anal incontinence, stenosis caused difficulty in defecation, fine. Early examination after injury showed laceration and bleeding in the anus and surrounding tissues. The anal canal sphincter is broken, often with feces outflow and pollution. In the case of a long time, there is a serious infection in the local area, and deep cellulitis of the gluteus maximus is seen.

Anyone with a history of anal trauma, anal pain, bleeding, anal incontinence, difficulty in defecation should be suspected of anal canal injury. Anal finger examination found that the fingertips were stained with blood, the sphincter tension was reduced or relaxed, the anal canal wall was damaged, pain and emptiness were confirmed (full layer, but not completely traversed), large pieces were damaged (avulsion, complexity, rupture, Organization lost).