Diané B, Lebeau R, Brouh Y, Boua N, Kouamé K E
Service de chirurgie générale et digestive, CHU de Bouaké, République de Côte d'Ivoire.
Med Trop (Mars). 2006 Feb;66(1):79-82.
The purpose of this study is to report our experience in the management of rectal and colonic injuries induced by enemas. A retrospective analysis was carried out in a series of 10 patients treated at the Bouake, Ivory Coast University Hospital Centre for rectal and colonic injuries induced by enemas between January 1, 1997 and December 31, 2001. There were 6 men and 4 women with a mean age of 26.2 +/- 5.6 years. Based on history taking five enemas involved criminal intent. The other five were carried out for abortion (n=3), therapy (n=1) or autolysis (n=1). The injurious product was known in 7 cases, i.e., sulphuric acid (n=4) and hot pepper (n=3). The mean quantity administered was 158 +/- 64 ml. The presenting picture involved diffuse acute peritonitis in 7 cases and abdominal pain with bloody mucoid rectal discharge in 3. One patient died at the time of admission. The remaining patients underwent either operative (n=6) or medical (n=3) treatment. Prognosis was unfavourable. Four patients died and one patient required colostomy that could not be removed due to sclerosis of the anal sphincter. Management of rectal and colonic injuries induced by enemas requires differential diagnosis to distinguish patients that require emergency laparotomy from patients that can be treated medically. For patients treated medically, close surveillance based on imaging and repeated clinical examination is of paramount importance to allow diagnosis of complications requiring surgical treatment.
本研究的目的是报告我们在处理灌肠所致直肠和结肠损伤方面的经验。对1997年1月1日至2001年12月31日期间在科特迪瓦布瓦凯大学医院中心接受治疗的10例灌肠所致直肠和结肠损伤患者进行了回顾性分析。患者中男性6例，女性4例，平均年龄26.2±5.6岁。根据病史，5例灌肠涉及犯罪意图。另外5例灌肠分别用于堕胎（3例）、治疗（1例）或自溶（1例）。7例患者的致伤物已知，即硫酸（4例）和辣椒（3例）。平均灌入量为158±64毫升。临床表现为7例弥漫性急性腹膜炎，3例腹痛伴直肠血性黏液便。1例患者入院时死亡。其余患者接受了手术治疗（6例）或保守治疗（3例）。预后不佳。4例患者死亡，1例患者因肛门括约肌硬化无法切除而需要进行结肠造口术。处理灌肠所致直肠和结肠损伤需要进行鉴别诊断，以区分需要紧急剖腹手术的患者和可以接受保守治疗的患者。对于接受保守治疗的患者，基于影像学检查和反复临床检查的密切监测对于诊断需要手术治疗的并发症至关重要。
