肛门直肠异物的处理:不明原因肛门疼痛的一个原因。

B S Ooi, Y H Ho, K W Eu, D Nyam, A Leong, F Seow-Choen
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引用次数: 0

摘要

背景:很少有肛肠异物患者自愿接受经肛门引入。这些患者的长期随访结果很少。方法:从前瞻性计算机数据库中提取1989年4月至1997年4月的资料。分析了肛肠异物科室管理方案的临床特点和效果。此外,通过电话访谈获得长期结果。结果:30例患者(男性25例,女性5例),平均年龄46岁(范围16-72岁)。经肛门插入10例(33.3%),其余20例(66.7%)主诉肛门疼痛。其中,9例(45%)在常规直肠指检中发现异物,9例(45%)在x线检查中发现异物,2例(10%)在快速灌肠后意外排出。引起x光检查怀疑的因素包括不典型的性别行为、肛门括约肌松弛、直肠出血或粘液性分泌物。经肛门恢复成功,镇静12例(40%),全身麻醉13例(43.3%),开腹手术3例(10%;其中包括一例肠穿孔)。并发症2例(6.7%;一例轻微的直肠擦伤和一例支气管肺炎)。随访63个月(8-96个月),无长期大便失禁或异物再次嵌塞。结论:隐蔽性肛门疼痛患者应怀疑有异物。在镇静或全身麻醉下,明智的经肛门拔管通常是成功的,短期和长期并发症最小。
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Management of anorectal foreign bodies: a cause of obscure anal pain.

Background: Few patients with anorectal foreign bodies will freely admit to transanal introduction. The results of long-term follow-up in these patients have been sparse.

Methods: Data from April 1989 to April 1997 were extracted from a prospective computerized database. The clinical features and the results of a departmental management protocol for anorectal foreign bodies were analysed. In addition, long-term outcomes were obtained by telephone interview.

Results: Thirty patients (25 men, 5 women) with a mean age of 46 (range 16-72) years) were treated for this condition. While 10 patients (33.3%) admitted to transanal insertion, the remaining 20 (66.7%) complained of anal pain. Among the latter, the foreign body was subsequently found on routine digital rectal examination in nine patients (45%), on X-ray in nine (45%) and it was passed out unexpectedly after fleet enema in two (10%). Factors which raised suspicion for X-rays included atypical gender behaviour, lax anal sphincters and bloody or mucoid rectal discharge. Transanal recovery was successful with sedation in 12 (40%), general anaesthesia in 13 (43.3%), and laparotomy was needed in three (10%; which included one perforated bowel at presentation). There were two complications (6.7%; one minor rectal abrasion and one bronchopneumonia). There was no long-term faecal incontinence or re-impaction of foreign bodies at 63 (range 8-96) months of follow-up.

Conclusions: Foreign bodies should be suspected in patients with obscure anal pain. Judicious transanal extraction under sedation or general anaesthesia was usually successful with minimal short- and long-term complications.

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