Operative treatment of rectal urethra
- 12 Jun 23:15
- Hemorrhoid Treatment
One of the most common reasons that leads a patient to the proctologist's office is the rectal fistula. This very unpleasant condition can develop in people of different sex and age due to certain circumstances. Most often, such problems affect the able-bodied men, rarelycases of fistulae occur in young women after childbirth, more rarely in children, including infants. This situation relates to the surgical direction of proctology and is eliminated only by operational means.
- 1 What is the problem of
- 2 Classification of
- 3 Clinical manifestations of
- 4 Diagnosis and treatment of
What is the problem of
? The rectal hole is a chronic inflammation of paraesthetic fiber( chronic paraproctitis) with the formation of a pathological channel that opens into the gut lumen,another hollow organ( for example, a vagina) or in the perineum.
Most commonly, the formation of rectal urethra is the next stage of acute paraproctitis and may be due either to an improperly performed operation, or to a late treatment of a patient to a doctor.
It has been established that for the onset of the disease, an infection from the intestinal lumen or inflammatory foci from other organs requires anal crypt( special folds in the wall of the rectum).They are located approximately at a depth of 3 cm from the anus, through these formations mucus is removed from the glands located in the submucosal layer of the intestinal wall. Pathogenic microbes fall first into anal cripples( develops crypt), then into the space surrounding the rectum( there is paraproctitis).
The main causes of fistula formation are:
- involuntary segmentation of the acute abscess and outlet out of the contents - after that the patient feels relief, believed to be cured, but the inflammation in the anal crypt remains, gradually leading to purulent melting of the surrounding tissues and the formation of fistula;
- complications after hemorrhoids removed;
- misdiagnosis of acute paraproctitis - an abscess was detected and drained and swollen, but without radical excision of the surrounding damaged tissues;
- heavy labor( breaks in the perineum, gross obstetric intervention);
- malignant tumor;
- rectal trauma;
- Crohn's disease;
- specific diseases( syphilis, intestinal tuberculosis, chlamydia,
For convenience of proctologists in the choice of the method of surgical treatment distinguish several classifications of fistulas of the rectum. The number of openings is:
In relation to the fistula, 3 types of fistulas are distinguished:
- transphincter - the most common, located in the ampullary part of the rectum, above the anal sphincter, often have a branched pattern;
- non-fibrinating - located below the level of the upper rectal sphincter;
- intraperitoneal( subcutaneous-mucous) - the simplest form with a direct channel, characteristic of fresh fistulas.
The most complicated is the second group, the severity of which distinguishes 4 stages of such fistulous passages:
- channel direct direction, scarring around the inner opening is not observed, abscesses in the fiber;
- there are scars around the fistula's internal intestine, abscesses in fiber yet;
- narrowed entrance to the channel, infiltration is determined in the fiber;The
- entrance is wide, there are numerous scars, ulcers in the fiber.
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All types of fistulas, despite their diversity, have similar symptoms that are most pronounced in the period of exacerbation of the disease. Typical manifestations are:
- discomfort and pain in the anus, which increases with tension, prolonged sitting, cough;
- is an itchy dermatosis around the anus due to permanent purulent or bloody nature, an unpleasant odor of the fistula;
- general symptoms - weakness, low-grade fever, headache and muscle pain.
The outer hole looks like a small wound, when pushed out, there is a squirrel or purulent detachable. If the fistula is wide, then gases and stool masses pass through it. The disease can last for many years, until the patient turns to the proctologist for help and he does not heal it.
If the operation is not carried out for a long time, such a chronic fistula may be transformed into cancer or lead to the spread of infection and the development of peritonitis.
Diagnosis and treatment of
The list of necessary diagnostic measures includes a number of studies necessary to clarify the diagnosis. Beginning with the collection of anamnesis, external examination of the patient and digital rectal examination, the doctor then assigns a certain amount of analyzes and procedures individually for each patient:
- rectal sensing;
- coloring test;
- fistulography with colorants;
- sphincterometry - Determining the degree of disorder of the sphincter.
According to the results of the study, they are determined by the tactics of treatment. Sweatshould be eliminated only with the help of surgical treatment. Conservative methods are more prevalent for patients, some of them leave feedback on the use of sedentary baths with salt, rinsing with antiseptic solutions, using antibiotic ointments at the forums. All these methods have a temporary effect. Proctologists are the only one in one - cure fistula can only surgery.
When choosing the method of surgical treatment proceed from the classification of fistulas by type, form of location, the presence of scar tissue and the severity of inflammatory changes. The operation can be performed according to different techniques, but the essence of one - the excision of the fistula and inflamed tissues around it. The procedure is performed under general anesthesia, antibiotics may be prescribed in the period before and after the intervention, depending on the patient's condition. Patient feedback is mostly positive, although there are doubts and fears about the return of the disease.
Successful surgery usually does not leave a chance for relapse, although no proctologist can give one hundred percent guarantee.
It is important to remember that the fistula does not appear in an empty place, before the appearance of the patient there were already proctologic problems. The operation cures from fistula, but can not relieve the repetition of the problem while preserving the former lifestyle, nutrition, attitude to their health.