Fecal fistula

　　Anal fistula is mostly due to the failure of perineal third-degree laceration suture operation, or the suture piercing the intestinal mucosa when the perineal incision and suture are performed. Small intestine and colon vaginal fistula are less common, but mostly due to surgical injury or postoperative adhesion.

　　Anal fistula can be complicated with vulvitis, and occasionally coexists with vesicovaginal fistula. It needs to be distinguished from anal fistula. The causes of anal fistula are basically the same as those of vesicovaginal fistula. In addition, many are due to the failure of perineal third-degree laceration suture operation, or the suture piercing the intestinal mucosa when the perineal incision and suture are performed. Small intestine and colon vaginal fistula are less common, but mostly due to surgical injury or postoperative adhesion.

　　If the fistula is large and close to the vaginal orifice, formed or semi-formed feces can be discharged through the vagina, and there are uncontrollable排气 symptoms, and the above symptoms are more serious when the feces are loose. If the fistula is small, the feces are also relatively dry, then there is no feces discharged from the vagina, but only when the feces are loose, feces overflow through the vagina, but the排气 cannot be controlled. If anal fistula coexists with vesicovaginal fistula, feces or simultaneous exhaust gas are often mixed in the urine leakage. The vulva and perineum are often stimulated by feces and secretions containing feces, leading to chronic vulvar dermatitis.

　　To prevent anal fistula, the main thing is to assist in childbirth correctly during female childbirth, to avoid severe perineal laceration; attention should be paid to not piercing the rectal mucosa when the perineal incision and suture are performed. Pay attention to routine rectal examination after perineal suture, and remove the suture in time if the rectal mucosa is found to have a suture. For abdominal surgery, the pelvic stripping surface is large, and it is necessary to cover the sigmoid colon, attention should also be paid to not piercing the intestinal wall when sutured with the pelvic peritoneum. When suturing the pelvic peritoneum, attention should be paid not to expose the rough surface, so as to avoid intestinal adhesion, infection, necrosis, and the formation of vaginal fistula.

　　The symptoms of anal fistula are relatively simple, so the diagnosis is easier than that of vesicovaginal fistula. Large fistulae can be seen under the exposure of the vaginal speculum or felt during palpation; small fistulae are not easy to be found, or only a small bright red granulation tissue can be seen on the posterior vaginal wall. The uterus probe can be explored from this place, at the same time, the other hand finger can be inserted into the anus, when the finger meets the deep needle, the diagnosis can be confirmed. If suspected of small intestine or colon vaginal fistula, in addition to combining with the analysis of surgical history, barium enema or barium meal examination can be considered.

　　Pay attention to light and healthy diet, mostly easy to digest and absorb foods such as vegetable congee, noodles soup, etc. The following introduces two food therapy recipes.

　　1, lotus seed, Chinese yam, pig large intestine head, stew and take, one dose per day.

　　2, Astragalus 30g, Codonopsis 20g, Angelica sinensis 6g, live crucian carp 1 tail, remove internal organs, stew, drink the soup, eat the meat, one dose per day.

　　The treatment of anal fistula is surgical repair. The repair effect is better than that of urinary fistula. The chance of spontaneous healing after injury is also more than that of urinary fistula. Fresh trauma (such as surgery or trauma) should be repaired immediately. For old anal fistula, if it is a high rectovaginal fistula, it should follow the principles, methods, and surgical requirements of urinary fistula repair, separate the surrounding tissue of the fistula, separate the vaginal wall and rectal mucosa, first suture the rectal wall (not permeable mucosa), and then suture the vaginal wall. If the rectal vaginal wall is close to the anus, first cut the vaginal rectal septum between the anus and the fistula from the middle, so that it becomes a third-degree perineal laceration, and then perform repair.

　　If both fecal fistula and urinary fistula coexist, they should be repaired at the same time. If the fecal fistula is large or there is a lot of scar tissue, and it is estimated that the operation is difficult, it can be first performed abdominal colostomy and urinary fistula repair, and then perform fecal fistula repair after 4 weeks after the urinary fistula heals, and then reposition the colostomy after the repair is successful. Although this situation is rare, it is necessary to consider it carefully in terms of methods and procedures in combination with the specific situation.

　　The fistula of rectovaginal fistula is large, with excessive scar tissue (usually caused by vaginal corrosive sitz bath), the fistula has failed after multiple repairs, and there is no hope of success after discussion, it can be considered to perform permanent artificial anus surgery.

　　For confirmed vaginal fistula of small intestine or colon, abdominal repair or intestinal resection and anastomosis should be performed.

　　Preoperative preparation and postoperative management of anal fistula, which is closely related to the healing of anal fistula repair. Therefore, start eating渣-free semi-liquid food 3 to 5 days before surgery, and give 0.2g of metronidazole, 3 to 4 times a day; take for 3 to 4 days, 80,000U of gentamicin, intramuscular injection, twice a day, for 3 to 4 days, or take 1g of neomycin per day before surgery, or take 1g of streptomycin per day, for 3 to 4 days, to reduce the chance of intestinal infection. Take 15g of senna leaves (infusion) the day before surgery, or clean the anal area before surgery at night, and rinse the vagina. After surgery, continue to provide渣-free semi-liquid diet and control defecation for 3 to 5 days, and can give 5% opium tincture 5ml, three times a day; continue to give metronidazole and other preventive infection measures to promote wound healing. Starting from the fourth day after surgery, take 30 to 40ml of liquid paraffin at night, or take 15g of senna leaves per day, to make the stool loose or soft and easy to pass (if the number of bowel movements is too frequent, stop taking). In addition, the perineum should be kept clean after surgery.