1例清洁灌肠致医源性直肠损伤的经验总结及分析

Experience Summary and Analysis of a Case of Iatrogenic Rectal Injury Caused by Clean Enema

摘要: 目的：通过经治的1名因术前清洁灌肠导致迟发性直肠损伤的患者，总结过程中的经验教训。方法：回顾性分析经治的1例清洁灌肠致医源性直肠损伤的患者，吸取教训并总结经验。结果：患者术后4天发现直肠破裂，后一期行肠破裂修补术，二期行造瘘口还纳术，根据最近随访结果，患者未诉明显不适，生活质量尚可。结论：清洁灌肠致直肠损伤，污染严重但是症状出现较晚且进展快，灌肠前做好患者结直肠评估及沟通，灌肠时规范操作，灌肠后发现患者持续出现腹胀、肠鸣音减弱等情形时务必考虑肠道损伤的可能。

Abstract: Objective: Lessons learned from the process are summarized through one patient treated for delayed rectal injury due to a preoperative clean enema. Methods: A retrospective analysis was performed for one patient with iatrogenic rectal injury caused by clean enema, and lessons were learned and experience was summarized. Results: The patient was found to have a rectal rupture 4 days after the operation, and then underwent one-stage intestinal rupture repair and two-stage fistula restitution. According to the recent follow-up results, the patient did not complain of any obvious discomfort, and his quality of life was quite good. Conclusion: Clean enema causes rectal injury, serious pollution but symptoms appear late and progress quickly, do a good job of colorectal assessment and communication before enema, standardize the operation during enema, and consider the possibility of intestinal injury when it is found that the patient continues to have abdominal distension and weakened bowel sounds after enema.