Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya-Turkey.
Department of Obstetrics and Gynecology, Sakarya University Faculty of Medicine, Sakarya-Turkey.
Ulus Travma Acil Cerrahi Derg. 2022 Mar;28(3):302-307. doi: 10.14744/tjtes.2020.26338.
Traumatic rectal injuries are uncommon and can originate due to various causes. Rectal injuries have a high mor-bidity, regardless of cause, and detection at the time of occurrence is important to prevent fistula formation and/or stoma. In this article, treatment approaches in patients with isolated rectovaginal septum injury without perineal and sphincter injury during sponta-neous vaginal delivery are presented and the current literature is reviewed.
The records of spontaneous vaginal deliveries that resulted in live births between January 2015 and January 2020 were analyzed retrospectively at our center. The records of patients with isolated rectovaginal septum injury were evaluated in terms of demographic and obstetric data, trauma, classification of injury, and early and late results.
Isolated septum injuries were detected 12 women (0.06%). Of the isolated rectovaginal septum injuries, 9 (75%) were clas-sified as Type III, 2 (16.6%) as Type IV, and 1 (8.3%) as a Type V injury according to the Rosenshein classification. Transvaginal repair was performed because all of the injuries underwent early surgical intervention, were limited, and exploration through the vagina was possible.
Rectal examination should be performed simultaneously with a detailed perineal examination after vaginal delivery. For birth-related rectal injuries detected early in appropriate patients, a primary repair without diversion stoma may be the best option.
创伤性直肠损伤并不常见,可由多种原因引起。无论何种原因,直肠损伤的发病率均较高,因此在损伤发生时及时发现对于预防瘘管形成和/或造口至关重要。本文介绍了自发性阴道分娩中发生孤立性直肠阴道隔损伤而无会阴和括约肌损伤的患者的治疗方法,并对当前文献进行了回顾。
回顾性分析我院 2015 年 1 月至 2020 年 1 月期间自发性阴道分娩导致活产的病例记录。评估了孤立性直肠阴道隔损伤患者的人口统计学和产科数据、创伤、损伤分类以及早期和晚期结果。
12 名妇女(0.06%)发现孤立性隔损伤。根据 Rosenshein 分类,9 例(75%)为 III 型,2 例(16.6%)为 IV 型,1 例(8.3%)为 V 型损伤。所有患者均因早期手术干预、损伤局限且经阴道探查可行而选择经阴道修复。
阴道分娩后应同时进行直肠检查和详细的会阴检查。对于在适当患者中早期发现的与分娩相关的直肠损伤,一期修复而不进行转流造口可能是最佳选择。