How does rectum injury do?

summary

Rectal perforation caused by direct trauma or pelvic fracture is called rectal injury. The main clinical manifestations were abdominal pain, rectal bleeding, peritonitis or perirectal infection. The rectum is the end of the large intestine, about 15-20 cm in length. It is divided into two parts. The part above the peritoneal reflexes is called the rectopelvic part, and the part below the peritoneal reflexes is called the rectoanal part. The principle of treatment is the same as that of colon injury. How does rectum injury do? Let's talk about my views.

How does rectum injury do?

Treatment 1: hemostasis should be put in the first place to save lives. The rupture of rectum should be clamped with intestinal forceps and separated from peritoneum and other organs with saline sand pad. All abdominal organs were explored comprehensively, and all abdominal injuries were treated according to the principle of "first heavy then light". Finally, rectal injury was treated. Transabdominal repair of rectal injury: it is suitable for fresh rectal laceration or stab wounds with slight intra-abdominal contamination, unobvious inflammation, single injury, and laceration less than 2cm.

Treatment 2: transabdominal resection of damaged rectum, suture closure of distal broken end, and proximal colostomy (Hartmann operation): it is suitable for injuries with serious rectal damage, wide range of injury, inability to repair or serious abdominal pollution, severe inflammation and edema of intestinal wall, and unsuitable for suture, especially explosive injury. The superior rectal artery was ligated, the rectum was dissociated, the intestinal canal was cut below the injured site, and the distal end was closed. After resection of the injured bowel, the proximal colon stump leads out the stoma from the other stoma of the left abdominal wall. After the patient recovers, the stoma colon is returned to the abdominal cavity and anastomosed with the rectal stump.

Treatment 3: transabdominal repair of rectal injury plus sigmoidostomy: Although rectal injury is not serious, sigmoidostomy should be routinely performed after rectal repair in order to make the suture easy to heal: A. combined with shock. B. Combined with pelvic fracture and other abdominal and pelvic organ injury. C. The rectum is full or the abdominal cavity is polluted seriously. D. Delayed treatment for more than 4 hours; E. Extraperitoneal rectal rupture.

matters needing attention

(1) Keep gastrointestinal decompression unobstructed until intestinal function recovery（ 2) The combination of broad-spectrum antibiotics and anti anaerobic drug metronidazole should be continued（ 3) The drainage should be unobstructed and placed properly. The drainage of rectovesical depression can be removed in 2-4 days; Repair or anastomose the drainage tube nearby until it can be confirmed that it has healed without leakage; The anterior sacral drainage starts from the third day after operation, and it takes about 7-10 days to pull out a little every day. essential