Rectal prolapse into the sigmoid colon

　　The main causes of rectal prolapse and intussusception within the rectal wall are factors that increase abdominal pressure, such as childbirth, large pelvic tumors, intestinal cough, significant obesity, ascites, etc., causing the fascia between the uterus and rectum and the rectal pubococcygeal muscle fibers to become loose or broken, and the uterine ligaments also become loose and there is an upper vaginal defect. This disease is more common in multiparous women or postmenopausal women.

　　Rectal (internal) prolapse and intussusception within the rectal wall are formed by the indentation of the rectal wall into the cavity when the rectum is prolapsed and intussuscepted, which appears with the occurrence of rectal intussusception during defecation and disappears with the复位 of intussusception. Most of the time, the sac of rectal wall intussusception exists for a very short time, and often only the sac (intussusception) exists. The hernia content can include small intestine, sigmoid colon, uterus, etc., and when they enter the hernia sac, they will further aggravate the symptoms and signs of defecation difficulty.

　　In fact, the intussusception within the rectal wall caused by rectal prolapse and complete rectal intussusception is not an independent disease, but almost always coexists with Douglas陷凹疝 formed by the deepening of Douglas陷凹. In other words, both the static Douglas陷凹疝 and the rectal wall intussusception that occurs with defecation due to rectal prolapse and complete rectal intussusception are pathologic components of pelvic floor hernia. The difference between the two lies in that the sac of rectal wall intussusception is entirely composed of rectal wall, while the anterior wall of Douglas陷凹疝 is cervix and posterior vaginal wall, and the posterior wall is composed of rectal wall.

　　Patients with rectal prolapse and intussusception within the rectal wall often have concurrent symptoms of pelvic floor hernia and rectal prolapse or intussusception. As long as the protrusion and the other supporting tissue relaxation are properly repaired, the prognosis will be good, without any special complications.

　　Patients with rectal prolapse and intussusception within the rectal wall often have concurrent symptoms of pelvic floor hernia and rectal prolapse or intussusception, such as frequent complaints of排便 obstruction and incomplete defecation, increased frequency of defecation, difficult defecation, and the fecal column becoming thinner like toothpaste, sometimes requiring manual assistance for defecation. Severe cases may experience interrupted defecation, especially when the small intestine, sigmoid colon, or uterus herniates into the hernia. Other common symptoms include anal坠胀不适, a sensation of foreign body in the anal canal, pressure on the coccyx, and a feeling of rectal distension. Some patients may experience mucus-containing blood stools, abdominal pain, abdominal distension, and abnormal urination. Abdominal examination usually shows no abnormalities, and rectal and anal canal examination can palpate an enlarged rectal cavity and relaxed rectal mucosa. Instruct the patient to perform defecation in a squatting position, and more than 1/3 of patients can palpate the top of the cervical-like intussusception within the rectum. If there is hernia content, bimanual or three-hand palpation can detect the presence of hernia content.

　　There is currently no effective preventive measure for this disease, early detection and early diagnosis are the key to the prevention and treatment of this disease.As long as the protrusion and other associated supporting tissue relaxation are properly repaired, the prognosis will be good.. .

　　Rectal intussusception within the rectal wall is formed by the rectal wall inwardly凹陷 when the whole layer of rectum is intussuscepted and the rectum prolapses, and the presence of hernia contents can be palpated by digital rectal examination or three-finger rectal examination. Its main clinical examination is as follows.

　　1, Barium meal examination: Pelvic lateral film, showing the intestine prolapse within the protruding hernia sac.

　　2, Synchronous defecation contrast and pelvic contrast: It can display the protruding hernia sac of the pelvic floor.

　　3, Perform rectal and anal, peritoneal cavity, vaginal, and bladder contrast simultaneously: It is conducive to judging the pathoanatomical changes of the pelvic floor.

　　Patients with rectal intussusception within the rectal wall should have a light and easily digestible diet, pay attention to less residue to avoid increased frequency of defecation. Patients with habitual constipation or poor defecation should eat more vegetables and fruits rich in fiber in their daily diet to keep the stool soft, do not strain too hard during defecation or sit on the toilet for too long. Adults should defecate in a semi-recumbent position, not in an upright position, pay attention to dietary adjustment, avoid constipation or diarrhea, and prevent rectal prolapse. Patients should also avoid eating excessive amounts of spicy oil, mustard, chili, and other刺激性 foods, do not eat too greasy things, and also pay attention to eating less of fish and crab.

　　The treatment of rectal intussusception within the rectal wall should be based on the treatment principles of pelvic floor hernia and rectal prolapse, and the two should be combined for comprehensive consideration. Non-surgical treatment includes dietary therapy, developing good defecation habits, participating in physical exercise, and using the chest-knee position for anal muscle exercises, etc. However, it is generally believed that rectal intussusception causing intramural hernia should be treated surgically. The surgical approaches include perineal and abdominal approaches, except for rectal prolapse with incarcerated hernia, which uses perineal approach. The main methods of abdominal surgery are ripstein surgery, wells surgery, and modified orrs surgery.