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直肠异物

Foreign bodies in the rectum.

作者信息

Yaman M, Deitel M, Burul C J, Shahi B, Hadar B

机构信息

Department of Surgery, University of Toronto.

出版信息

Can J Surg. 1993 Apr;36(2):173-7.

PMID:8472230
Abstract

Although infrequent, rectal foreign bodies present a challenge in management. The authors report on their experience with 29 patients who had rectal foreign bodies. Emergency-department procedures included rectal examination, proctoscopy and abdominal radiography. Soft or low-lying objects having an edge could be grasped and removed safely in the emergency department, but grasping hard objects was potentially traumatic and occasionally resulted in upward migration toward the sigmoid. Operating-room procedures included anal dilatation under general anesthesia, transrectal manipulation, bimanual palpation if necessary and withdrawal of the foreign body. In two cases, rectal mucosa was trapped--in an open deodorant bottle in one patient and in a curtain rod in the second patient; operative release of the mucosa enabled safe removal. Two patients presented with peritonitis; both had "broomstick" injuries and required proximal colostomy. Five patients had perianal sepsis due to inadvertently ingested pieces of wood (three) and chicken bones (two). The mean hospital stay was 3 days (range from 6 hours to 6 days). There were no deaths. Because of the potential complications, rectal foreign bodies should be regarded seriously and treated expeditiously.

摘要

尽管直肠异物并不常见,但在处理上仍具有挑战性。作者报告了他们对29例直肠异物患者的治疗经验。急诊科的处理措施包括直肠检查、直肠镜检查和腹部X线摄影。边缘柔软或位置较低的异物可在急诊科安全地抓取并取出,但抓取坚硬物体可能造成创伤,偶尔还会导致异物向上移入乙状结肠。手术室的处理措施包括全身麻醉下的肛门扩张、经直肠操作、必要时的双手触诊以及取出异物。有两例患者的直肠黏膜被困住,一例是卡在打开的除臭剂瓶中,另一例是卡在窗帘杆中;通过手术松解黏膜后才得以安全取出异物。两名患者出现腹膜炎,均为“扫帚柄”损伤,需要进行近端结肠造口术。五名患者因不慎摄入木块(3例)和鸡骨头(2例)而发生肛周感染。平均住院时间为3天(范围从6小时至6天)。无死亡病例。鉴于存在潜在并发症,直肠异物应予以重视并迅速治疗。

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