Page 48 of 73 DISEASES OF THE ANUS, DIRECT AND LARGE INTESTINE
At children of younger and preschool age survey of proctal area is more informative, than manual research. The proctal crack best of all Comes to light when mother bends the child's hips, and the doctor thumbs moves apart his buttocks, slightly stretching an anus So the skin border of an anus vyvorachivaatsya outside. However manual research is obligatory at a lock, especially if the external or internal obstruction of a rectum is suspected. Correctly conducted manual research almost does not cause to the patient of pains. At first several times run well greased finger over an anus that the child got used to unusual feelings; then press on an anus a small pillow of an index finger, bending interphalangeal joints, at the same time a finger Easily and without serious consequences slips to the proctal canal.
The small anguish in the field of skin and mucous border of an anus is often observed at children of younger age and is rare at school students. Cracks are usually localized on a back wall of an anus. The reason of emergence of a crack is not always clear; it can be an injury when cleaning intestines by means of an enema, locks when big firm fecal masses, raschesa owing to an enterobiosis or eczema, other perianal diseases is allocated.
Clinical manifestations. The main manifestations — pains at defecation and any delay of a chair. After Defecation on toilet paper or Calais it is possible to see fresh scarlet blood, sometimes there are more plentiful bleedings. The diagnosis is made on the basis of survey of proctal area; especially well the crack is visible at the time of a natuzhivaniye. Skin around peripheral, the end of a crack eminates in the form of a hillock. This hillock should be distinguished from a proctal polyp; in the latter case it prolabirut from the proctal channel. Cracks can be a symptom of an illness Krone.
Treatment. The majority of cracks begins to live spontaneously if the local irritation is eliminated. Pain is caused by a spasm of the lower part of an internal proctal sphincter. Use of laxatives with the purpose to razzhizhit intestinal contents (that it passed through a spazmirovanny anus easier) gives a temporary relief as more plentiful fecal masses causes recurrence of pains. At very dense Calais it is useful to apply easy emollients, but it is not necessary to bring kcal to a liquid state. A fine emollient — bran which adds to food 1 — 3 tablespoons a day depending on age of the child. Doctors traditionally order the anesthetizing ointments, but they are often inefficient as they should be applied in 30 min. prior to defecation, and to foresee it at the small child it is impossible. Contrary to this method very good result is yielded by anus stretching: sick 2 once a day enter well greased into the proctal canal: finger; usually during 1 — 2 week there comes full healing. This method with success can apply the child's mother. The best dilator — created, but leaky kcal, besides it has no such psychoinjuring effect as manual dilatation. Also sedentary bathtubs after defecation are useful. It is often possible to observe an inflammation and excoriation of skin of all perianal area, sometimes there are multiple superficial cracks. In such cases pla ointments creams with Triamcinolonum are shown.
If the crack does not respond to conservative treatment or there is long time, then the small surgery as the calla can lead this disease to the acquired megacolon and an incontience is shown. Operation is performed under the general anesthesia; it consists in anus stretching, excision of a crack, a section of an internal sphincter or in combinations of these 3 receptions. The postoperative current is characterized by insignificant discomfort: Recurrence, as a rule, does not arise.
Perianal abscess at the child of chest age can begin with a small pustule on skin. Bacteria usually get through proctal crypts into an ishiorektalny pole and
breed in hypodermic fabrics, forming infiltrate approximately in 1,5 cm from an anus. The main symptoms — pain and consolidation. Defecation is painful, the child cannot normally sit. Temperature usually increases only after the infection extends to a pararectal fat; over an ishiorektalny pole red, hot, dense or fluctuating education is defined. Treatment consists in immediate opening and drainage of abscess under anesthesia. Drainage of the center can be begun, without waiting for emergence of fluctuation. In the postoperative period sedentary bathtubs are useful. Antibiotics are inefficient in treatment of perianal abscess. Often after operation continuous or periodic release of pus from that place where there was a drainage tube continues; it demonstrates existence of proctal fistula.
Ishiorektalny abscesses at children of preschool and school age force to think of an illness Krone or nonspecific ulcer colitis. At these diseases, as well as in the majority of other cases of pararectal abscesses, a causative factor is E. coli. Treatment consists in urgent surgical drainage of abscess.
Fistulas of the proctal channel or rectum can be inborn or acquired, in rare instances they are reported with a bladder, an urethra, a vagina or skin of perianal area. The acquired fistulas represent an abscess effect, and usually their outside opening is located on skin. In the anamnesis such patients have one or several operations for abscess. Sometimes burrowing is preceded by uncured abscess or abscess which unsuccessfully treated antibiotics.
Clinical manifestations. The acquired fistula is characterized by painful infiltrate which is periodically allowed by the expiration of purulent contents. The diagnosis is made at detection on skin near an anus of an opening into which it is possible to enter a probe.
Treatment. Proctal fistulas spontaneously do not heal. A reliable method of treatment — simple excision or opening of the fistular course. At the same time it is important not to damage a proctal sphincter as the calla can lead it to an incontience.
Gemmora occurs at children seldom. Among the reasons causing it it is possible to call obstruction hollow and mesenteric veins, Cirrhosis, portal hypertensia or other types of venous stagnation. Besides, emergence of hemorrhoids is promoted by chronic locks, fecal stones, a strong natuzhivaniye at
defecations. Surgical treatment is not shown, except for cases of acute thrombosis of outside hemorrhoidal veins. Displays of hemorrhoids, as a rule, abate if it is possible to remove the cause which caused it.
The proctal itch at children generally arises owing to an enterobiosis, a proctal crack and other local inflammatory processes; the itch can be also caused by rough or wet linen. The helminthic invasion is the most frequent reason of a night itch (eiterobioz). Treatment consists in elimination of a basic disease, washing of proctal area unirritating soap, use of soft towels. Apply various powders or lotions. Influence of sunshine or dry heat yields good results at children of chest age.
Loss of a direct and sigmoid gut
Prolapse — abnormal omission of a mucous membrane of a rectum with a protrusion (or without it) through an anus. Protsidention — full loss of all layers of a direct or sigmoid gut. Most often these states are observed at children 3 — 5-year age. At children of chest age low position of a rectum in a small basin in combination with almost flat sacrum contributes to a prolapse. Any factor which is sharply increasing the intra belly pressure, for example a natuzhivaniye at defecation can provoke omission of a wall of a gut. Are promoted the prolapse and a protsidention by disappearance of a fatty tissue in ishiorektalny space at disturbance of food and the chronic malabsorption caused, in particular, by a mucoviscidosis. In the beginning the rectum which dropped out at defecation is set spontaneously, but manual reposition is required further. Loss can be followed by bleedings and mucifying. Color of the dropped-out gut varies from bright red to crimson, length it can reach 6 cm. At a prolapse of a fold of a mucous membrane go radially, and at a protsidention — concentrically, in the form of the socket. Both states should be differentiated from intestines invagination which pole is in an anus.
Treatment consists in elimination of locks by means of the corresponding diet, education of the correct hygienic skills, elimination of the accompanying frustration (a parasitic invasion, diarrhea, polyps). Apply oral administration of mineral oil to mitigation of a chair, change position of the child during defecation so that his legs were unbent, pull together buttocks with an adhesive plaster, predvaritelyao having placed a wadded ball on proctal area.
At a protsidention put to a gut. warm compresses also slightly press on the dropped-out weight. The simple method of reposition of a gut consists that wound by toilet paper: the finger is entered into a gleam of a gut and carefully advance it in an anus. Then the finger is quickly taken out as the toilet paper which stuck to a mucous membrane allows to make it easily. In hard cases it is necessary to resort to perineal operation. If repeated attempts of therapeutic treatment of a prolapse are ineffectual, then apply submucosal injections of sclerosing substances. At loss of a direct and sigmoid gut the belly sigmopeksiya is required.
Epithelial coccygeal course
Retraction in the field of an anus is observed rather often at healthy newborns, it is located at its upper edge. Treatment, as a rule, is not required, except for cases when very deep retraction is periodically infected. If simple hygienic measures do not help, then retraction needs to be excised.
The epithelial coccygeal course connects post-natal retraction to a sacrum or a tailbone. Such course can stretch to a firm cover of a spinal cord. In the latter case the coccygeal course should be excised especially carefully to prevent development of postoperative meningitis.
The sine containing hair — the acquired state, it is not an effect or complication of post-natal retraction. The sine consists of one or several poles located dorsalny an anus; it is more often observed at children with a hirsutism. Usually see a doctor when in a sine consecutive infection develops. Hair get into a sine through skin in the field of a natal crevice. This state (during World War II it was called "an illness of drivers of the jeep") can be a consequence of excessive friction of buttocks the friend about the friend. Similar changes are observed in interdigital folds of hands at hairdressers. At obstruction of a sine the cyst containing hair or abscess is formed. Such sine or cysts give symptomatology only at their infection: there are hypostasis, heat, reddening, consolidation and fluctuation. Purulent contents can be allocated through one or several openings. At suppuration total excision of a sine and a cyst or their drainage is shown.