Stricture due to changes in the rectal wall and pressure from without. Spasmodic Stricture. General division into venereal and non-venereal strictures and into fibrous and cicatricial — frequency of syphilis in connection with stricture. Non-Venereal Strictures. Congenital, dysenteric, traumatic, varieties. Stricture from hypertrophy of valves. Pathological anatomy. Changes in rectal wall above and below the stricture. Changes in parts around the stricture. Symptoms. Value of flattened passages as symptom. Signs of obstruction. Obstruction with stricture of considerable calibre. Diagnosis. Dangers to be avoided in examination. Difficulty when disease is situated high up in the bowel. Use of bougie for diagnosis. Treatment.— Advisability of anti-syphilitic medication. Palliative treatment. Medicinal treatment of threatened obstruction. Surgical measures. Dilatation, gradual or sudden — rules for gradual dilatation. Divulsion, dangers of, and methods of performing. Treatment by free division. Description of operation. Collection of cases. Results of this treatment. Comparison with colotomy. Cases from author's practice. Knife for operation, excision of non-malignant stricture. Colotomy. Restrictions to the operation. General considerations regarding it. Treatment of stricture high up.
<Callout type="important" title="Critical Diagnosis">It is crucial to diagnose strictures accurately and avoid unnecessary invasive procedures.</Callout>
Dangers to be avoided in examination include perforation, hemorrhage, and exacerbating the condition through improper use of instruments. Difficulty when disease is situated high up in the bowel requires careful consideration of surgical versus non-surgical options.
Key Takeaways
- Non-malignant strictures can be caused by various factors including congenital issues, trauma, and dysentery.
- Accurate diagnosis is essential to avoid unnecessary invasive procedures and complications such as perforation or hemorrhage.
- Treatment options include dilatation, surgical intervention like colotomy, and palliative measures.
Practical Tips
- Use a bougie for accurate diagnosis of rectal strictures when the condition is high up in the bowel.
- Consider anti-syphilitic medication if syphilis is suspected as a cause of stricture.
- Gradual dilatation can be effective but must be performed carefully to avoid injury.
Warnings & Risks
- Avoid unnecessary invasive procedures that could exacerbate the condition or lead to complications such as perforation or hemorrhage.
- When disease is situated high up in the bowel, careful consideration of surgical versus non-surgical options is necessary.
Modern Application
While some historical methods like colotomy are no longer standard practice due to advancements in medical technology and understanding, the principles of accurate diagnosis and appropriate treatment remain crucial. Modern readers can apply these lessons by seeking professional medical advice for rectal issues and understanding the importance of careful examination techniques.
Frequently Asked Questions
Q: What is the primary cause of non-malignant strictures discussed in this chapter?
The chapter discusses various causes including congenital conditions, dysentery, trauma, and hypertrophy of valves.
Q: Why is accurate diagnosis important for treating rectal stricture?
Accurate diagnosis helps avoid unnecessary invasive procedures that could lead to complications such as perforation or hemorrhage.
Q: What are the treatment options mentioned in this chapter?
Treatment options include dilatation, surgical intervention like colotomy, and palliative measures such as anti-syphilitic medication if syphilis is suspected.