Rectal intussusception

　　Some people believe that the elongation of the rectum is a necessary condition for the development of rectal intussusception. The exact etiology is still unclear. Most authors consider rectal intussusception to be a clear functional rectal disease, and regard it as the early stage of rectal prolapse, which is very likely to develop into rectal prolapse. Some also believe that the occurrence of the disease may be related to the relaxation of the mucosa within the rectum, the long-term effort to defecate causing the stool to pull the rectal mucosa to the distal end, resulting in the displacement of the mucosa. Zhang Lianyang and others applied laparoscopic surgery to treat rectal intussusception and found that such patients often have pathologic changes such as uterine prolapse and posterior prolapse, etc. of pelvic floor prolapse.

　　The pathogenesis of this disease may be that the stool in the lower end of the rectum causes the urge to defecate. At the same time as the stool in this part is excreted, the rectal mucosa prolapses downward to block the intestinal lumen, causing the contents of the proximal intestine to be unable to enter the distal rectum. The more one pushes, the more obvious the blockage becomes, and the stronger the urge to defecate. However, when the abdomen relaxes, the mucosa retracts, the intestinal lumen opens, and the proximal stool enters the distal rectum, allowing a small amount of stool to be excreted again. Rectal examination suggests that the mucosa within the rectal lumen is relaxed, and there is mucosal堆积, with the finger wrapped in mucosa, and the intestinal lumen becoming smaller. Defecation imaging shows a typical mucosal prolapse in the shape of a cup-like image.

　　What complications can rectal intussusception easily lead to

　　What are the typical symptoms of rectal intussusception

　　How to prevent rectal intussusception

　　What kind of laboratory tests need to be done for rectal intussusception

　　Rectal intussusception is one of the common types of outlet obstructive constipation, often occurring at the distal rectum, and some patients may involve the middle segment of the rectum. The specific clinical examination of this disease is as follows:

　　One, rectoscopy

　　It can be seen that there is excessive mucosa on the anterior wall of the rectum, and during the effortful defecation action, it can be seen embedded in the lumen or appearing below the dentate line, 50% of patients can see edema of the mucosa, fragile, congested, or with ulcers, polypoid lesions, etc.

　　Two, defecation imaging

　　It is the main method for diagnosing rectal prolapse, and its imaging features are as follows.1, mucosal intussusception of the rectum

　　: During defecation, the anterior and posterior walls of the rectum at 6-8cm above the anal margin fold, and gradually descend into the anal canal, finally the lower rectum becomes a funnel-shaped sheath, with an annular intussusception about 3mm thick.2, complete intussusception of the rectum

　　: The thickness of the annular intussusception ring is greater than 5mm.

　　Barium enema can determine the starting site of rectal prolapse and rectal intussusception, and is helpful in judging the rectal emptying condition. By measuring the sacral-rectal distance, curvature of the sacrum or sacrococcygeal bone, and whether there is sacral-rectal separation during defecation, the degree of rectal fixation can be judged. Berman believes that sacral-rectal separation is one of the indications for laparoscopic surgery.

　　Three, barium enema examination

　　Understand whether there is an abnormally long sigmoid colon.

　　Four, anal-rectal manometry

　　It helps to understand the function of anal sphincters and other structures.

　　Five, colonic transit test

　　Exclude chronic constipation with colonic slow transit.

　　Dietary taboos for patients with rectal intussusception

　　Rectal intussusception can be treated conservatively first, such as guiding diet, drinking more water, eating more fibrous foods, developing a regular defecation habit, and if necessary, adjuvant suppositories or enemas can be used. Some patients can be cured. For those who are ineffective after a period of conservative treatment, surgical treatment can be considered.

　　1. Transrectal longitudinal suture and hardening agent injection fixation surgery of distal rectal mucosa:The patient takes a lithotomy position, and 3 rows of longitudinal continuous suture of the relaxed rectal mucosa are performed on the posterior wall and lateral walls of the distal rectum, respectively, with a suture height that can be referred to from the defecation imaging showing mucosal prolapse, generally 7-9cm is enough. The submucosa between the 3 rows of suture lines can be injected with a hardening agent to enhance the fixation effect. If 4% alum solution is used, the total injection volume is 20ml. Single row suture fixation can also be performed in mild cases.

　　2. Elastic ring ligation technique:Perform 3 rows of elastic ring ligation above the dentate line at the site of mucosal prolapse, with 1 to 3 ligations per row, up to a maximum of 9 ligations, to remove part of the relaxed mucosa. If necessary, a hardening agent can be added under the submucosa of the ligated site.

　　3. Transabdominal rectal fixation surgery:For patients with severe intussusception, especially those with high rectal mucosal relaxation intussusception, transrectal surgery is difficult to achieve satisfactory efficacy, and transabdominal rectal fixation surgery can be performed according to the Ripstein technique, which is particularly suitable for those with sacral rectal separation.

　　4. Delorme surgery:This operation can not only completely circumferentially resect the mucosa of rectal intussusception (4-10cm), but also simultaneously repair rectal prolapse and excise internal hemorrhoids. As long as the case selection is appropriate, and there are no diseases such as colonic slow-transit constipation, sigmoid colon hernia, sigmoid colon intussusception, levator ani syndrome, and irritable bowel syndrome, etc., the operation can be performed with good results, especially suitable for long-type intussusception (4-6cm). However, this operation is not suitable for those with diarrhea and external prolapse. Berman believes that rectal intussusception with constipation is not suitable for Ripstein surgery, as it may worsen constipation.

　　Rectal intussusception often occurs with other outlet obstruction or slow-transit constipation, and solitary rectal intussusception is rare. Therefore, it is necessary to perform defecation imaging and colonic transit test before surgery to exclude other causes of constipation. Roe reported 2 cases of rectal intussusception with failed rectal fixation, which was later confirmed to be associated with slow-transit constipation, and then underwent colonic resection and recovered..