RECTAL RESEARCH (Latin rectum a rectum) — a number of the diagnostic receptions which are carried out through a gleam of a rectum, for definition of the changes in the gut surrounding it bodies and fabrics, estimates of a condition of a rectum and muscles of an anus, and also diagnosis of acute inflammatory and oncological diseases of abdominal organs.
To R. and. doctors of Ancient Egypt resorted; wrote about it Hippocrates, and also the scientific Middle Ages.
In a wedge, practice manual R. is applied and. and endoscopic (see. Rektoromanoskopiya ).
According to the purposes and manual R.'s problems and. it will be out in various provisions of the patient (fig. 1). Usually it is carried out in position of the patient lying on one side, on spin or in genucubital situation. For manual R. and. upper parts of a rectum apply knee and palmar situation or situation on cards.
At manual R. and. the index finger of a hand in a rubber glove is greased with vaseline and carefully entered into an anus. At the same time estimate a tone, distensibility and elasticity of an outside sphincter of an anus, a condition of a mucous membrane of the proctal channel, existence and degree of morbidity at a research; the proctal channel is studied consistently, feeling its walls. Then the finger is carried out to an ampoule of a rectum, defining a condition of its gleam (a gaping, narrowing), consistently feel a mucous membrane of a rectum, pay attention to a condition of a prostate and seed bubbles (at men), a rectovaginal partition and a neck of uterus (at women), estimate a condition of the muscles lifting an anus, perirectal (pararectal) cellulose, an inner surface of a sacrum and a tailbone. After extraction of a finger from a rectum define existence and estimate character separated (mucous, bloody, purulent, ichorous).
River and. allows to reveal a functional condition of muscles of an anus, patol. changes of fabrics of the proctal channel and ampoule of a rectum (cracks, fistulas, hemorrhoids, hypertrophied proctal nipples, fibrous polyps, benign and malignant tumors, posttraumatic cicatricial changes, foreign bodys, narrowing of a gut); cystous and tumoral educations, inflammatory infiltrates in a pararectal fat; changes of a prostate and seed bubbles at men (adenoma, cancer) and genitalias at women, a condition of a peritoneum, rectouterine deepening (a back duglasov of space) — accumulation of liquid, purulent exudate, existence of metastasises of a tumor, etc.
For diagnosis of diseases of verkhneampulyarny and rectosigmoid departments of a rectum (cancer), pelviorektalny cellulose or pozadipryamokishechny (retrorectal) space (a paraproctitis, a presakralny cyst), an urinogenital (pelvic) peritoneum (inflammatory process or tumoral defeat) resort to a bimanual manual research. For this purpose the index finger of one hand is entered into a rectum, and fingers of other hand pressed on a front abdominal wall over a pubic symphysis (fig. 2).
At certain indications apply a rectal endoscopic research, using anoskop and a rectal speculum (see. Rectum ), or carry out a rektoromanoskopiya.
The rectal research in gynecology is made to virgins and also when the research through a vagina is complicated or it is impossible (an atresia of a vagina, a narrow opening in a hymen).
At R. and. the patient is in a dorsal decubitus. Through a rectovaginal partition a neck of uterus with her outside pharynx (an ostium of the uterus, T.) and a uterus are probed as well as at vaginal examonation (see. Gynecologic research ). The left hand press on a front abdominal wall over a pubic symphysis, push aside a uterus of a kzada and at the same time feel its front surface from a bottom to border of an internal pharynx; the finger entered into a rectum is moved, feeling a back surface of a uterus.
R. is especially important and. for detection of changes in wide ligaments of a uterus, perimetric cellulose (parametriums), rectouterine (sacrouterine) sheaves, rectouterine deepening (back duglasovy space) and on a front surface of a sacrum. It allows to diagnose tumors of appendages of a uterus for virgins, to estimate their relation to a uterus, walls of a basin, to find exudate in perimetric cellulose, rectouterine deepening.
The combined, pryamokishechnovlagalishchny research allows to reveal changes in a rectovaginal partition, a uterus, her ligaments and ovaries. For its carrying out the index finger is entered into a vagina, and a long finger of the same hand — into a rectum; fingers of other hand press on a front abdominal wall over a pubic symphysis (fig. 3). At first investigate uterus (see), then rectouterine and wide ligaments of a uterus — their length, thickness, tension, sensitivity, a smeshchayemost, small knots on their extent, etc. Then investigate ovaries (see) — the size, a form, a surface, a consistence, mobility, situation in relation to pelvic bones and their communication with a body of the womb and walls of a basin.
Bibliography: Aminev A. M. Guide to a proctology, t. 1 — 4, Kuibyshev, 1965 — 1978; Dultsev Yu. V. and Sal of m about in K. N. Paraproktit, page 97, 144, M., 1981; Malinovsky M. S. Operational obstetrics, page 44, M., 1955; M y sh V. M. Sketches of surgical diagnosis, page 117, Novosibirsk, 1948; N and - z and r about in JI. U. Fistulas of a rectum (Chronic paraproctitis), page 38, 78, M., 1966; Nelyubovich Ya. Acute diseases of abdominal organs, lane spolsk., page 48, M., 1961; About t of t of D. O an enterovulval way of a research of bodies of a small pelvis, Zhurn. akush. and wives. Bol., t. 10, No. 2, page 111, 1896; Cancer of a rectum, under the editorship of V. D. Fedorov, page 98, M., 1979; R willows Kean V. JI. and To and-p at l of l e r JI. JI. Hemorrhoids, page 89, 116, M., 1976; Yakovlev N. A. Atlas of proctologic diseases, page 4, 10, M., 1976.
A. M. Nikitin, A. A. Protasiewicz; I. T. Milchenko (gin.).