Damage to the rectum

Damage to the rectum can be caused by different reasons. Relatively frequent breaks sphincter, anal canal, and the front wall of the intestine during labor. They sew immediately after birth.
The trauma of the rectum may occur as a result of falling crotch on sharp or protruding objects (for example, on the pins of the fence, iron pipes, chair legs and so on). Possible injury to the bowel wall broken cisternam tip, thermometer, foreign body through Masturbation. The painful subject can penetrate through the anus or soft tissue perineal or buttocks. The wound is usually contaminated with debris damage of the subject, scraps of clothing, as well as the contents of the intestines, urine. Injury to the bowel may come and fractures of pelvic bones with rupture of the intestinal wall or removing the cancer from anal ring, and sometimes with simultaneous damage of the bladder, urethra or vagina. There are vnebrachnyi damage to the rectum and such accompanied by damage to the peritoneum, and sometimes abdominal organs, first of all of the intestinal loops. Extensive damage to the penetration into the abdominal cavity or in combination with bone injuries of the pelvis, bladder, large vessels can lead to shock and significant blood loss, pain in the lower abdomen, the tension of the abdominal wall, vomiting.
When combined injury of the rectum and bladder or urethra may get gas and feces in the bladder urine and rectum.
Gunshot wounds rectum in life are rare, and in war be 0.15-0.5% of all injuries; intra-abdominal about 5% . There are wounds tangents, front, sagittal, oblique and vertical. Damage projectile often damage the bone and soft tissue, as well as the prostate gland and other organs (intestines, bladder, ureters). Rectal injuries are related to heavy; gunshot wounds ampullar rectum give up to 40% of deaths in the first week after the injury.
The diagnosis. To recognize the damage and rectal injuries if significant damage is not difficult; with little damage and the location of the input of wound apertures not in the immediate vicinity of the anus and rectum (for example, buttocks, lower abdomen, and sometimes in the field of Tazo-hip) damage to the intestinal wall, especially in vnepechnoj part of the intestine, it is easy to view. This is facilitated by the absence of bleeding due to the closure of the sphincter. Therefore, for any damage Sacro-pelvic area and the lower part of the abdomen should be an examination of the rectum, including external examination of the perineum and anus and binding digital examination and inspection of the rectum using a mirror. At detection of pathological accumulations in the vial (blood, mucus, pus, the addition of urine) necessary sigmoidoscopy. The appearance of the wound urine or fecal Kala and gases in the urine indicates simultaneous damage to the bladder or urethra.
To distinguish simultaneous damage of the bladder from damage to the urethra is possible by means of a catheter inserted into the bladder that if the catheter enters the urine mixed with stool and intestinal gas, there is a wound of the bladder; if the catheter is clean urine and the wound was discovered urine, l clean the wound of the urethra. Damage to the pelvic bones accompanied by severe pain with a change of position and relatively easily detected on x-rays. Intra-abdominal wound soon manifested symptoms of irritation and inflammation of the peritoneum.
Treatment. Carry a wounded in a sitting or semi-sitting position in order to avoid penetration of feces, urine and blood in the abdominal cavity in case of damage of the peritoneum. When surgical treatment is required good orientation in the location and extent of damage, which sometimes have to expand the wound or to go to the dissection of the sphincter and the lining of the rectum, and for better access - resection of the coccyx and of the sacrum. For suspected damage to the abdominal part of the rectum shown urgent chrevosechenie and stitching defect with the removal penetrated into the abdominal cavity foreign bodies, scraps of clothing, blood and intestinal contents, with the introduction of antibiotics (penicillin, streptomycin, colimycin) and leaving drainage tube through which 1-2 times a day to enter into the abdominal cavity antibiotics. The imposition of unnatural anus sigmoid or cross the colon with the purpose of assignment of feces should be widely applied to all intra-abdominal and significant vnebrachnyi wounds rectum. Only in case of small damages nizhneangarsky and anal areas of the rectum can be limited to less intervention type sphincterotomy back or cut the sphincter and the wall of the rectum.