Abstract: Based on the analysis of the diagnosis and treatment of 9 cases of anorectal foreign bodies, it is concluded that the clinical symptoms are not specific, and the history of swallowing foreign bodies is not obvious, which is easy to cause misdiagnosis in clinical practice; emphasizing the diagnosis and treatment of anal diseases by digital anorectal examination and anoscopy The important significance of the treatment: early diagnosis is the key to early diagnosis, as soon as possible to minimize the removal of foreign bodies from trauma, reduce infection to prevent secondary damage, and cooperate with anti-inflammatory, moisturizing, and local treatment, and the prognosis is good.
Keywords: anorectal; foreign body.
There were 7 males and 2 females in this group, aged 7-43 years old. The onset time: 6 cases were seen in 1/2~1 day, 1 case was seen in 2 days, and 2 cases were seen in 3 days. The main complaints were: 7 cases of severe pain in the anus, 1 case of blood in the stool; 1 case of perianal swelling and pain with fever; 1 case of abdominal pain with inability to pass stool. Foreign bodies were removed: chicken bones in 3 cases, striped bamboo strips in 2 cases, fish bones in 2 cases, pig bones in 1 case, and melon seed shells in 1 case. The foreign bodies were mostly located near the tooth line, 7 cases above the tooth line and 2 cases below the tooth line. Different degrees of congestion and edema were found in the place where the foreign body was inserted.
First, make a clear diagnosis through digital anorectal examination and anoscopy, and preliminarily judge the height of the embedded part of the foreign body and the depth of the embedded intestinal wall, and make corresponding treatment. For short foreign bodies, low embedding position, shallow anus, and loose anus, the patient should be asked to relax at the same time on digital examination, and pick out or hook out the foreign body with fingers; for long foreign bodies, the embedded position is high, the exposure is not good or the anal sphincter is tight (Spasm) If it is obvious, underwent local anesthesia, and take out the blood vessel clamp under the anal mirror. If the two ends are inserted, the foreign body can be cut from the middle and then taken out separately. Observe and treat the bleeding and bleeding. After dilution, iodine Flush with 0.1% Xinjieer Mie liquid, and for local infections, use Taining suppository, hemorrhoids to embolize the anus, local dressing change, intravenous drip or oral administration of anti-inflammatory drugs such as methenazole, oral paraffin oil, etc. to lubricate the intestinal tract and keep the stool smooth.
Case 1: Wang Mou, female, 17 years old, due to sudden anal pain during defecation in the morning, accompanied by a little blood in the stool for half a day, check: no redness and swelling of the anal skin, no mass prolapse; digital rectal examination of anal canal: anal canal tension , Very tender, 2.5 cm from the edge of the anus, you can touch a toothpick-like thick and thin hard strip that is embedded in the wall of the anal canal. Ask the patient to take a deep breath to relax the anus. The index finger is quickly and gently stretched in and back, and the foreign body slides out. , It was found that the foreign body was a fishbone about 4.5 cm long. The medical history revealed that there was a history of swallowing a fishbone accidentally after eating fish two days ago. Disinfect with diluted iodophor, wash the affected area and insert red oil plaster gauze strips, instruct the patient to have a light diet, take Maren pills to smooth the stool, and metsidazole tablets to reduce inflammation. After five days, the patient will be rechecked without swelling and pain.
Case 2: Huang Mou, male, 33 years old, paraanal swelling and pain for three days. He was seen in an outside hospital due to perianal swelling and pain two days ago. The suspected "anal carbuncle" was treated with anti-inflammatory treatment such as Pioneermycin for two days without relief, and the swelling and pain Gradually aggravate, intensify when stool, a little blood in the stool. Check: 5*3cm redness and swelling on the anal margin at 3 o'clock in the lithotomy position, hard in quality, no fluctuation; digital examination: tension of anal sphincter, burning in the anus, and transverse embedment of a hard strip-shaped foreign body about 3cm from the anal margin. The wall of the anal canal is not moved. The diagnosis is: the foreign body in the anal canal is incarcerated and infected. Immediately remove the foreign body in the anal canal under local anesthesia: Routine disinfection, gently expand the anus under local anesthesia, see under the anal mirror: both ends of the foreign body They are all embedded in the intestinal wall, and the surrounding mucosa is congested and edema. The foreign body is deeply embedded and difficult to pull out. So it is cut from the middle, and the vascular clamp is used to pull out the intestinal tube. The diluted iodophor is used for local washing. After checking that there is no bleeding, Insert Huazhi suppository, red oil ointment gauze strip, topical Huanglian ointment, intravenous drip of metronidazole, cephalosporin, etc. for 4 days, orally maren pills for laxative bowel movement, light diet, review after 1 week, all symptoms are all Disappear. It was found that the foreign body was chicken ribs, about 5.5 cm long, and the medical history revealed that he had a gathering of friends 5 days ago, drank excessively, and seemed to have swallowed large pieces of braised chicken.
Modern studies have found that there are a wealth of highly specialized sensory nerve endings in the epithelium on the upper and lower denticles. There are a variety of chemical and mechanical sensory organs with fine discrimination. Therefore, foreign bodies swallowed by mouth can pass through narrow and curved Digestive tract lumen and physiological curvature, such as duodenum, ileocecal area, colon liver flexure, colon splenic flexure, etc., but when a foreign body passes through the central area of the anal tooth line, it can cause a slight stimulation to the intestinal wall Protective anal reflex, where sharp foreign bodies are embedded in the wall of the anorectum, damage the intestinal wall, trigger sphincter spasm, and produce clinical symptoms. The disease is mostly caused by foreign bodies swallowed by mistake or directly inserted through the anus. In most cases, the source can be known by asking the medical history. However, most patients cannot report their foreign body entry history at the time of consultation. The clinical manifestations (main complaints) are mostly anal swelling and pain, blood in the stool Symptoms of common anal diseases such as constipation, abdominal pain, etc., are easy to be ignored by patients and doctors. If the patient has a history of hemorrhoids, anal fissures and other pain, and blood in the stool, it is more likely to be misdiagnosed as recurrence or aggravation of the original disease. Diagnosis or anoscopy is easy to be misdiagnosed and delay treatment. Therefore, digital anorectal examination and anoscopy are particularly important for the diagnosis of anal diseases.
The specific clinical manifestations are related to the size and shape of the foreign body, the height of the embedding site, and whether the treatment is timely. For example, the low position has severe pain; the high position has mild pain, mainly the anus and abdomen swelling, painful defecation, and difficulty defecation. In the early visits, direct injury is the main symptom; in the late visits, the main symptom is usually complicated by peripheral infection or with abdominal distension, perianal abscess, and anal fistula. Through clinical observation, this disease has its common clinical characteristics: the onset is sudden, the symptoms are heavier than common anal diseases, most of which are sudden severe pain in the anus during defecation, which is continuous afterwards, and it is obviously aggravated during defecation or activity. The key to urgent treatment is to remove the foreign body as soon as possible, relieve the pain, eliminate the source of infection, and avoid further damage. During the operation, attention should be paid to discover the size, shape, nature of the foreign body and the position of the foreign body embedding height, depth, etc., as far as possible, fully exposed under the state of good anesthesia and relaxation of the anal sphincter, and adopt methods to avoid enlarged damage as much as possible. , Take it out in the direction of the intestine; if the foreign body is too long or inserted into the intestinal wall, it can be taken out from the middle. The key to postoperative treatment is local and systemic anti-inflammatory treatment to control infection and prevent secondary perianal abscess, anal fistula, etc. ; In addition, cooperate with the symptomatic treatment of local swelling, pain relief and hemostasis to keep the stool smooth, and generally improve quickly to achieve recovery.