rectal instruments


By • Дек 21st, 2010 • Category: Rectum

Non-congenital rectal strictures not associated with an oncological lesion are met with relatively rarely’. They occur as a result of trauma, acute necrotic. anorectal abs­cess, chemical burns caused by an erroneously adminis­tered enema, inflammatory lesions of the pelvic genitalia, or, finally, may be due to venereal lymphogra-nuloma.

Most of the strictures are to be operated on.

In low stricture, up to 5 cm from the anal opening (Fig 149,1) the stricture should be dissected transanally in 2 or 3 places along the rectal radius. When localized 5 to 12 cm from the anal orifice (Fig. 149,11), it is our practice to excise the stricture by making posterior proc-totomy (rectotomy).

In rectal and sigmoid strictures located more than 12 cm from the anus (Fig. 149,111), low anterior resection is indicated.

The operation for transanal dissection of stricture is

performed under local or inhalation anesthesia with the patient lying in the same position as in hemorrhoidec-tomy.

The rectum is dilated with rectal speculum as far as the site of the stricture (Fig. 150.1) and this is dissected by means of a narrow scalpel (Fig. 150.2) under visual or finger control. The speculum is then withdrawn, the stricture site is forcibly dilated with a finger, and a thick rubber tube wrapped with gauze is introduced into the rectum superior to the stricture (Fig. 150,3). After the operation dilatations of the rectum are made at regular intervals

Operation for narrowing of the rectum

Fig. 149. Operation for narrowing of the rectum:

I. Transanal section.

II. Posterior proctotomy.

III. Low anterior resection.

Fig. 150. Transanal dissection of the stricture:

1. Appearance of rectal stricture located 4 cm from the anus.

2. The stricture is being dissected with a scalpel.

3. A thick rubber tube wrapped with fat gauze has been passed through the anus superior to the stricture.

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