1. Diseases of the rectum

3. rectum; 8 - Longitudinal layer muscle membrane of the 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.

4. Surgical anatomy of the rectum

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

6. 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

7. Rectal artery

8. The lymphatic network of the rectum
(VCI vena cava inferior = нижняя полая вена)
The lymphatic network of the rectum

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

10. Physiology of the rectum
Evacuation
Tank ( )
Absorptive

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

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

13. 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

14. 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.

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

16. 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

17. Treatment

18. 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)

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

20. Hemorrhoids
Hemorrhoids - expansion of the cavernous cells of the rectum, the most common colo Proctoscope pathology. Hemorrhoid suffers approximately 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 years

21. Hemorrhoids 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.

22. The three positions:
Left lateral
Right rear
Right front

23. Hemorrhoid nodes
Inter
Outdoor

24. 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.

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

26. sclerotherapy In the first described in 1869
in stages 1 and 2, effective
30% relapse within 4 years

27. 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

28. Operation by Milugan - Morgan Operation by Parks Operation by Рижих
Surgeon treatment
Operation by Milugan - Morgan
Operation by Parks
Operation by Рижих

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

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

31. Hemorrhoidectomy by Rizhih

32. rectum 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

33. Anal fissure, pektenoz, papillary hypertrophy
Anal fissure with caruncle and hypertrophied anal warts

34. Anal fissure, pektenoz, 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 pektenoziz

35. Anal fissure, pektenoz, 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

36. Anal fissure, pektenoz, 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.

37. Paraproktal abscess and paraproktal fistulas
Stages
Acute-abscess
Chronic paraproktal fistula

38. Parakproktal abscesses:
a) perianal,
B) ishiorektal,
c) pelviorektal,
d) submucosal

39. Clinic paraproctitis acute (abscess)
Pain
Redness
Edema
Increased body temperature
Increased ESR

40. paraproctitis abscess
Autopsy and perianal abscess ishiorektal

41. paraproctitis abscess

42. 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

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

44. Classification of anal fistulas.

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

46. 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

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

48. 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

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

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

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