Diseases of the rectum

Epidemiology: Approximately 11 people have rectal diseases among 10000 population/ But, after primary medical examination in 25% people are determinated rectal diseases

History: Firstly, the rectal diseases had been started learning in ancient India, Egypt and Mongoly The anorectal fistula hab be en described in 430 year before our era by Sokrat There was used sclerotherapy for treating hemorroidal veins in 1869

Anatomy of rectum

Anatomy of rectum 1 - Gear Line; 2 - perianal skin; 3 - Anal-cutaneous line; 4 - lower rectal venous plexus; 5 - Bundle of Parks; 6 - Superior rectal venous plexus; 7 - Circular layer of muscular coat rectum; 8 - Longitudinal layer muscle membrane of the rectum.

Surgical anatomy of the rectum Cross-section of lower part of rectum

Surgical anatomy of the rectum Locking the muscles of the rectum (bottom view)

Anatomy of the rectum 1) pars subcutanea, 2) pars sliperfici.'ilis, 3) pars proflilida, 4) in. puborectalis 1) Pars slibcutanea, 2) pars sliperfici.'ilis, 3) pars profniulii, 4) тп. puborectalis

Arteries of rectum

The lymphatic network of the rectum Veins of rectum (VCI = vena cava inferior = postcava) The lymphatic network of the rectum

Cavity around the rectum, filled with fatty tissue: 1) spatium ischiorectale, 2) spatium pelvirectale, 3) spatium perianale

Physiology of the rectum Evacuation Tank (650-1200) Absorptive

Diseases of the rectum Congenital anomalies of the rectum Non-tumoral diseases of the rectum Tumors of the rectum

Congenital anomalies of the rectum Disease of Hirschsprung (aganglionar megacolon) Congenital atresias of the anus and rectum

Congenital atresias of the anus and rectum Anomalies of the anus and rectum is known to occur in 0,2 ° / oo of all newborns. Among the most frequent: anal stenosis, anal atresia, atresia, the anus and rectum and rectal atresia

Classification and diagnosis Depending on whether over or under pubococcygeal line blockage is located, distinguish deep (aproctia) or high-obstruction (atresia, the anus and rectum). Under the new nomenclature adopted in Melbourne in 1970, and still produce an intermediate form.

Congenital anomalies of the rectum Congenital anomalies of the rectum: a) stenosis anus, b) atresia anus, and c) atresia anus and rectum, r) atresia of the rectum

Diagnostics To estimate the height of the obstruction is a lateral X-ray radiography in the baby's head is down (in Wangen-steen-Rice). From the distance the air, filling the blind pocket on a metal plate glued in place the anus, conclude about the height of obstruction

Treatment

Congenital atresias of the anus and rectum Operation in atresia of the anus and rectum through abdomen-surface access and Rehbein Siepliens. To access between the sacral bone and intestine, ureter directly to form a tunnel (a), through which extend a plastic tube (b), which through the hole in the bottom of the blind pocket stretch in the abdominal cavity (в)

Non-tumoral diseases of the rectum Hemorrhoids Anal fissure, papillary hypertrophy Anorectal abscess and anal fistula Archoptosis and the failure of the sphincter

Hemorrhoids Hemorrhoids - expansion of the cavernous cells of the rectum, the most common colo Proctoscope pathology. Hemorrhoid suffers approximately 12 - 13 out of 100, and its share in the overall structure of diseases of the rectum is 40%. The disease occurs almost equally common among men and women aged 30-50 years.

Hemorrhoid node The formation of hemorrhoids contribute constant constipation, persistent diarrhea, prolonged cough, vomiting, prolonged and excessive stress on your abdominal muscles (in certain sports), narrowing the space of the processes in the pelvis (tumor, pregnancy), portal hypertension.

Anatomy of hemorroid nodes The three positions: Left lateral Right rear Right front

Hemorrhoid nodes internal external

Clinic stages In the first stage internal hemorrhoid can be felt as a swelling, it can be seen in proctoscope. In the second stage of internal hemorrhoid straining falls through the anus, but after straining restored spontaneously to its place. In the third stage of the disease internal hemorrhoids fall through the anus and spontaneously restored. Only under pressure from the outside, they return to their place. At the fourth stage of internal hemorrhoid is always outside the anus is not deposited even under pressure from the outside.

Treatment Conservative (baths, medication with thrombophlebitis of hemorrhoidal veins and sclerotherapy) Surgical

Sclerotherapy At first described in 1869 in stages 1 and 2, effective 30% relapse within 4 years

Ligation of hemorrhoids with rubber rings 2 cm proximal from the anus Causes necrosis and scarring of the lining of the rectal wall, thus reducing the relapse 96% of asymptomatic for a month

Surgical treatment Operation by Milugan - Morgan Operation by Parks Operation by Rijih

Operation by Milugan Morgan All three hemorrhoidal node tied and cut off

Operation by Parks Node is separated medially - anodermy from the outside - from the internal sphincter

Hemorrhoidectomy by Rizhih

Rectal anal fissure Among all the diseases of the rectum anal fissure is the frequency of the third place (11.7%) after colitis and hemorrhoids. Fissures are more common in women (60%) aged 30 to 50 years. Usually, the crack has a length of 2 cm, width 2-3 mm. Most often anal fissure is located in the posterior commissure anus, due to traumatization of the zone during defecation. Maybe a few cracks in this case, the most common localization of - anterior and posterior commissure ("mirror" the crack). The direction of the longitudinal cracks.

Anal fissure, pectenoz, papillary hypertrophy Anal fissure with caruncle and hypertrophied anal warts

Anal fissure, pectenoz, papillary hypertrophy About anal fissure say if the boundary of chronic ulcers anus, more or less deep penetration into the anal canal. With a long-term deep fissures, accompanied by a chronic inflammatory process, there is strong, prone to wrinkle, scar tissue, which increasingly constricts the anal canal. This is called pectenoziz.

Anal fissure, pectenoz, papillary hypertrophy Internal sphincterotomy. a) Dissection of the crack and the internal sphincter, and b) the same schematic, c) a small external wound after the removal of Tongue

Anal fissure, pectenoz, papillary hypertrophy The operation is performed under local anesthesia or intra-trachea anesthesia, the patient is in position for lithotomy. In the radial direction, bordering the cut in one piece is removed hypertrophied papilla, crack and caruncle.

Paraproctal abscess and paraproctal fistulas Stages Acute-abscess Chronic paraproktal fistula

Paraproctal abscess Paraproctal abscesses: a) perianal, B) ishiorektal, c) pelviorektal, d) submucosal

Clinic of the acute paraproctitis (abscess) Pain Redness Edema Increased body temperature Increased ESR

Paraproctitis (abscess) Opening perianal and ishiorectal abscesses

Paraproctitis (abscess) Opening of ischiorectal and pelviorectal fistulas

Anorectal fistula In the first described by Hippocrates in 430g. BC Swelling, pain, separation, or slimy stools. A history of acute or inflammatory paraproctitis and cancers of the colon

Anorectal fistula According to the rule Qoodsati, anorectal fistulas are different depending on their location relative to the perpendicular lines drawn through the anus

Classification of anal fistulas .

Diagnostic а в The introduction of dyes for determination of the (a) or holding a thin wire (a).

Anorectal fistula Excision of posterior anorectal fistula by the method of Parks, outer part of the fistulous excised from the skin in the form of a cylinder

Archoptosis Loss of part or all of the rectal wall to the anus. Accompanied with fecal incontinence and constipation Rare bleeding No pain Loss of rectum

Archoptosis and the failure of the sphincter Distinguish partial loss - or loss of mucosal and total precipitation (protsidention), when all the layers of the rectal wall torn out through the anus. Loss of mucous is easily recognized by passing radially inverted pleats on the mucous

Failure of the sphincter The simplest method for the treatment - infiltration of the tissues around the colon causing inflammation of the drug.

Failure of the sphincter. Fixing fallen rectum "assemblies" and "reverse intussusception"

The failure of the sphincter Plastic tender muscles in the way Pickreil

Tactics of GP In admittion of patient with rectum disease general practitioner must perform followings: Careful picking of anamnesis; To perform rectoromanoscopy; To perform colonoscopy; Taking in laboratory methods of research; As appropriate direct the patient in surgery in-patient department.