Among all diseases of the rectum, its rupture is the most dangerous pathology, which poses a threat not only to health, but also to the life of the patient. Violation of the integrity of tissues occurs due to the impact on them of any force from the outside or from the inside. With rectal ruptures, the prognosis depends on the timeliness of seeking medical help. According to statistics, every fourth case is fatal.
Causes
Rupture of the rectum (photo obtained during the X-ray examination, presented below) can occur under the influence of both external and internal factors.
These include:
- Penetrating wounds in the abdomen, buttocks or perineum caused by piercing-cutting objects or firearms.
- A fall on a solid object, such as a chair leg, ski pole, stake, metal structures.
- Pelvic fractures. Typically, this type of injury occurs in car accidents and falls from a great height.
- Violation of the algorithm or rules for conducting medical procedures. The most common cause of rupture of the rectum is the illiterate implementation of electrocoagulation of polyps, sigmoidoscopy, cleansing enema, rectal thermometry.
- Surgical intervention in adjacent organs. For example, abortion or surgery in the presence of pathologies of a urological or gynecological nature.
- Childbirth. Often the integrity of the tissues is violated during the rapid course of the process. Also, rupture of the rectum during childbirth can occur during improper actions by obstetricians.
- Compressed air. As a rule, it appears and begins to affect the intestine during a colonoscopy or in the event of an accident.
- Rough sexual contact, especially with the use of foreign objects.
- The presence of fecal calculi. Their formation occurs with narrowing of the gaps with scars, intestinal atony and disturbances of innervation.
- Ingestion of foreign objects, especially sharp ones, such as bones or seashells.
- A sharp increase in the level of intra-abdominal pressure. A similar situation occurs against the background of lifting of heavy objects, prolapse of the rectum, and the process of delivery.
- Frequent and severe constipation.
- High intensity of physical activity.
- The presence of hemorrhoidal nodes in the intestine.
In addition, the risk of rupture of the rectum remains with anomalies in the structure of the organ.
Classification
Doctors divide all defects into simple ones, caused by malfunctions of the sphincter and are complications of pathologies of internal organs. The complexity of tissue injury directly depends on the amount of damage. In addition, gaps are classified according to their location. They can form outside the abdominal cavity or directly in it.
Damage can have several degrees of severity:
- Easy. Examples: anal fissures, a slight violation of the integrity of the rectal mucosa. Injuries of this kind in most cases are treated with conservative methods and do not require surgical intervention.
- Average. Examples: stratification of the intestine, its damage while maintaining the integrity of muscle tissue in the abdominal cavity.
- Heavy. It is characterized by a violation of the integrity of the tissues in the abdominal cavity. In this case, secondary infections join and the development of various complications.
Depending on the depth of damage, tears of all layers or violation of the integrity of only the mucous membrane are distinguished.
Symptoms
The severity of symptoms directly depends on the location of the disease. Damage can occur in the pelvic region (in an ampoule or nadampular zone), often a rupture of the sphincter of the rectum occurs (the photo of the pathology is unaesthetic in nature, a schematic image is presented below).
Any violation of the integrity of the tissues is accompanied by the appearance of the following signs:
- the presence of blood impurities in the stool;
- pain, they are sharp and a high degree of intensity;
- purulent secretions;
- frequent episodes of false urge to defecate;
- spontaneous and uncontrolled discharge of feces.
Specific symptoms of rectal rupture:
- Tachycardia (the patient’s pulse is more than 100 beats per minute).
- Reducing blood pressure to critical levels.
- The patient, trying to reduce the severity of pain, takes the position of the embryo, bending his legs under him.
- Loss of consciousness (in severe cases).
- On palpation, a strong muscle tension of the anterior abdominal wall is detected.
- If you put your fingers on the patient’s stomach, he feels severe pain. If after that sharply remove the hand, they are greatly enhanced.
- The patient has frequent episodes of flatulence.
If any of the above symptoms occurs, you must call an ambulance team or independently arrive at a medical institution.
Diagnostics
To detect a rupture of the sphincter of the rectum or internal tissues, a doctor needs only a digital rectal examination. The essence of the method is to probe the organ and detect damage. The study allows you to accurately identify the location of the gap, its nature, shape and size.
Additionally, the doctor may prescribe the following methods of instrumental diagnostics:
- Anoscopy
- Rectal examination
- Ultrasound of the abdomen.
- X-ray examination.
- Sigmoidoscopy.
The doctor himself determines the appropriateness of carrying out certain additional studies. Its decision depends on the severity of the patient, clinical manifestations and the causes of the gap.
Treatment
Bowel injury is the main indication for surgery. The operation is carried out regardless of where the gap occurred.
During the surgical procedure, the doctor sews the tissues with special threads, which subsequently will not need to be removed. During the operation, the specialist makes maximum efforts in order to preserve the intestinal wall.
In severe cases, a special mesh is used, which is sewn into the fabric, thereby eliminating the gap. The device before installation is treated with an antiseptic. The mesh is gradually implanted in the tissue, its presence does not further affect the quality of human life.
With severe damage to the sphincter artificially create a new anal opening using the patient’s own tissues.
Before starting any surgical procedure, the patient is given anesthesia. As a rule, this is general anesthesia. In the presence of contraindications, epidural anesthesia is administered. After the operation is completed, the doctor installs a drainage tube. Then the patient is laid on the bed and asked for some time to lie with the lower limbs half bent at the knee and hip joints.
If the rectal rupture is insignificant, it is possible to conduct therapeutic measures with conservative methods. The main stages of therapy are taking antibacterial drugs and the local use of drugs.
Features of the postoperative period
Rehabilitation after surgery is long. The patient needs to observe bed rest, avoid physical exertion and adhere to a diet. Adjustments to the diet should be made in order to prevent constipation. Acts of bowel movement should occur no less than once every 2 days.
It is necessary to exclude from the menu:
- legumes;
- carbonated drinks;
- flour, bakery and confectionery products;
- alcohol;
- rice and semolina;
- meat (with the exception of rabbit meat and chicken);
- fried, smoked, spicy and spicy dishes.
Food should be boiled or steamed. It is necessary to eat 6-7 times a day. Moreover, the size of one serving should not exceed 200 grams.
Effects
With intraperitoneal ruptures, acute peritonitis develops in a short time. Damage outside the cavity leads to the fact that feces located in the rectum penetrate into the small pelvis, provoking the appearance of putrefactive phlegmon. Often, against the background of a violation of integrity, secondary wall necrosis occurs with its subsequent perforation. The most dangerous consequence of a rectal rupture is death.
Forecast
The outcome of the pathological condition directly depends on the nature and causes of the damage, as well as on how timely medical assistance was provided.
If the violation of the integrity of the wall or anus is minor, the prognosis in most cases is favorable. In the presence of extensive damage, the outcome is difficult to predict. According to statistics, every fourth patient dies.
Finally
Rupture of the rectum is a pathology that poses a danger not only to health, but also to the life of the patient. As a rule, damage occurs due to injuries and improper medical procedures. If you have any warning signs, you must call an ambulance team. Any patient with a suspected rupture is necessarily hospitalized. Treatment of pathology is carried out, as a rule, by operational methods.