Травма прямої, товстої кишки та промежини в дітей

Abstract

Purpose - to improve the treatment of children with traumatic injuries of the rectum, perineum and intestines. Materials and methods. In the clinic of the Department of Pediatric Surgery of the Shupyk National Healthcare University of Ukraine for 30 years, 9 children with traumatic injuries of the rectum, perineum and colon were treated. The age of the patients ranged from 1.5 to 16 years. There were 2 female patients (22.23%) and 7 male patients (77.77%). Results. The study found that among 9 patients who had damage to the rectum, concomitant damage to the descending colon in 1 (11.11%), sigmoid in 1 (11.11%), penetrating into the abdominal cavity in 3 (33.33%), urinary bladder in 1 (11.11%), vagina in 2 (22.22%). In 1 (11.11%) patient, a traumatic injury to the rectal wall was noted. Thus, among 9 patients fatigue was used in 8 (88.89%) children, of which in 3 (33.33%) double-barreled fatigue was initially imposed, requiring the distal colon to be turned off. Primary reconstructive surgeries were performed in 8 (88.89%) patients, and in 1 (11.11%) child with a delay of 2 weeks due to an inflammatory process in the rupture of the rectum and vagina in a 1.5-year-old child. Our own research has shown that the use of suspended or split fatigue on a spur is not an effective method of disconnecting the injured both colon and rectum from the contents. Traumatic damage to the rectum and vagina with rupture of the sphincter apparatus was found in 2 (22.22%) patients. Adhesive obstruction was found in 1 (11.11%) patient. All patients were discharged from the clinic. Conclusions. Visualization of the damage volume should be complete and performed under general anesthesia in the operating room. Surgical treatment of traumatic damage to the perineum of the rectum and colon requires an individual and should be phased: the imposition of a separate or final colostomy, as well as reconstructive and restorative surgery of the perineum, sphincter apparatus with mandatory electromyoidentification of the sphincter apparatus. Treatment of patients with perineal injury due to sexual abuse requires psychological and social rehabilitation. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: children, trauma, rectum, perineum, vagina, colon.