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患者男性64岁,农民。间歇性直肠脱出20余年。初期,排便时脱出,便后能自行回缩;近5～6年脱出后需手托复回;此次因不能手托复回并伴坠胀疼痛7小时,于82年1月4日急诊入院。10年前作过痔核切除术。体检:全身未见异常。局部于肛门外可见巨大脱出直肠,长约15厘米,横径约15厘米,肠管肥厚,粘膜皱襞呈环状,充血水肿呈暗红色,可见散在浅表小溃疡,表面粘液甚多。肛门指诊括约肌较松弛。化验白细胞14900/mm~3,中性89％。余正常。治疗经过:入院后手法复位未成,出现坏死趋向。故在硬膜外麻醉下行经会阴直肠切除术。术中尤宜注意处理直肠后壁,应由
Male patient 64 years old, farmer. Intermittent rectal prolapse more than 20 years. Early, prolapse prolapse, then they can self-retraction; nearly 5 to 6 years after the need to take care of the complex back; this time because of the back can not handle and with bulging pain for 7 hours, January 4, 82 emergency Admission. Hemorrhoidectomy was performed 10 years ago. Physical examination: no abnormalities in the whole body Large part of the anus can be seen from the rectum, about 15 cm long, about 15 cm in diameter, bowel hypertrophy, mucosal folds were ring-shaped, congestion and edema was dark red, visible scattered superficial small ulcers, mucus on the surface. Anal fingering sphincter relaxation. Laboratory white blood cells 14900 / mm ~ 3, 89% neutral. More than normal. After treatment: reduction of approach after admission, necrosis tends to occur. Therefore, the epidural anesthesia through the perineal resection. Surgery should pay special attention to the rectal wall, should be