Perineal hernia after hysterectomy

Introduction to the haze after hysterectomy After hysterectomy, the abdominal organ or tissue is enlarged, and the weak pelvic floor rectal anterior peritoneum is concave. It is called perineal herniacaused by hysterectomy. It can also be called pelvic floor hernia after hysterectomy. It is after hysterectomy. One of the complications can occur after transvaginal hysterectomy or transabdominal hysterectomy. basic knowledge The proportion of illness: the probability of female disease is 0.03% Susceptible people: women Mode of infection: non-infectious Complications: constipation

Causes of vaginal discharge after hysterectomy

The pelvic cavity is enlarged and the pelvic floor is lowered (30%):

In the hysterectomy, the Douglas fossa is not closed, the pelvic cavity can be enlarged, the pelvic floor can be lowered, and a large number of abdominal cavity contents fall. In addition, the intra-abdominal pressure is increased and the pelvic floor is weak, and the pelvic peritoneum is gradually erupted and the disease occurs, especially after more than 10 years after the operation. More often than age, pelvic floor and vaginal tissue relaxation, constipation is closely related.

Damage to the superior fascia supporting structure of the vagina (20%):

The vaginal superior fascia support structure includes uterine ligament ligament, main ligament, rectal vaginal septum, etc., which can be affected by different degrees of invasion and injury during hysterectomy. The anterior pelvic floor is weak, and the vaginal dome is not fixed in the coronary artery during operation. Ligaments and uterine ligaments Some scholars have confirmed that if the vaginal humerus can be sutured and fixed in the uterus, the incidence can be greatly reduced.

Pelvic floor, vaginal tissue relaxation (10%):

In elderly patients, with the increase of age, the pelvic floor tissue gradually degenerates, relaxes, and the vagina grows with age and gradually relaxes after menopause.

Increased intra-abdominal pressure (10%):

Such as constipation, cough or other diseases that lead to increased chronic intra-abdominal pressure, can induce the disease.

Pathogenesis

The contents of the disease are mainly small intestine, sigmoid colon, omentum, often accompanied by vaginal vault prolapse, and sometimes coexist with the medial rectum.

Necrosis prevention after hysterectomy

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Postoperative hysterectomy complications after hysterectomy Complications constipation

The sputum content of this disease is mainly the small intestine, sigmoid colon omentum often accompanied by vaginal vault prolapse, and sometimes coexist with the medial rectum protrusion. Defecation angiography, synchronous defecation angiography or pelvic angiography showed a decrease in pelvic floor peritoneal abnormalities, which is of great value for definitive diagnosis. Domestic Zhang Lianyang and other scholars have reported synchronous defecation angiography or pelvic angiography in 3 cases, 2 cases of sigmoid colon infiltration, 1 case of rectal and vaginal distance of 4cm, 1 case with a mid-rectal protrusion, 2 cases with rectal prolapse . Constipation can occur.

Uve symptoms after hysterectomy Common symptoms Anal bulge anal loose constipation

About 2/3 of the elderly who are over 60 years old often have difficulty in defecation, the anus is swelled, and the feeling is not enough. The bowel movement is interrupted and the perianal is pressed to discharge the feces. As the disease progresses, the long-term force defecation, age After the growth and postmenopausal pelvic floor, the vagina gradually relaxes and the symptoms gradually worsen. About 1/4 of the patients develop chronic constipation of rectal emptying disorder 2 to 10 years after surgery.

Physical examination: the patient's position is used for simulating defecation. A soft mass is visible between the anus and the vagina. There are even vaginal posterior wall and bilateral labia majora, partial weakness, relaxation, cough and impulse, rectum, vagina. A double or triple examination may have a sputum content such as intestinal fistula between the two.

Hysterectomy after hysterectomy

Defecation angiography, simultaneous defecation angiography or pelvic angiography can show abnormal pelvic floor peritoneal abnormalities.

Diagnosis and differentiation of perineal sputum after hysterectomy

History

There was a history of hysterectomy and constipation occurred after surgery.

2. Physical examination

Double or triple diagnosis of sputum and sputum contents.

3. Defecation angiography, synchronous defecation angiography or pelvic angiography

The abnormal peritoneal pelvic floor was found to be of great value for definite diagnosis. Zhang Lianyang and other scholars in China reported synchronous defecation angiography or pelvic angiography in 3 cases, 2 cases with sigmoid colon intrusion, 1 case with rectal and vaginal distance of 4 cm, 1 case at the same time The median rectal prominence was combined and 2 cases were combined with rectal prolapse.

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