1. ABSCESS

2. Symptoms
anorectal abscess causes severe and continuous pain. Patients may present with fever, nausea, vomiting. Physical examination reveals a tender perianal or rectal mass in inflamed surroundings.

3. ANORECTAL ABSCESS

4. Diagnosis
anamnesis and rectal examination may be sufficient, in some cases rectal ultrasound or CT may help

5. ENDORECTAL ULTRASOUND abscess

6. TREATMENT
The definite treatment is surgical; abscesses should be drained as soon as possible. Antibiotic prophylaxis parallel with surgery is useful only in case of diabetes, elderly patients, and immuno-suppression. Antibiotics for Gram – and Gram + bacteria are to choose.

7. Periproctal abscess operation

8. Haemorrhoid, 3rd degree

9. Haemorrhoid, 4th degree

10. LONGO OPERATION

11. LONGO OPERATION

12. LONGO PROCEDURE

13. Haemorrhoids with thrombosis
Conservative treatment
One day surgery, thrombectomy remove the clot
Good result
Minimal complication

14. MASSIVE BLEEDING FROM HAEMORRHOIDS
Excessive, transfusion-requiring bleeding may develop sometimes.
Diagnosis should be made using sigmoidoscope and/or colonoscope.
After excluding other sources of bleeding, and correcting the anaemia, surgical procedure may be performed.

15. ANAL FISSURE ACUTE
A linear ulcer, usually situated in the posterior raphe of the canal. Fissures situated laterally are common in Crohn’s disease.

16. ANAL FISSURE CHRONIC

17. TREATMENT Conservative: Laxative, fibre rich diet, paraffin oil
Pain relief, anti-inflammatory treatment
Nitrate-blocking ointment or creams to reduce the spasm of the internal sphincter muscle
Use of Botox injections is in experimental phase
Surgical: If symptoms are permanent.

18. Injury of the rectum Mechanical, external injury may be caused by:
Sexual activity
Foreign body
Trauma
Incorrect episiotomies
High pressure injuries

19. Injury of the rectum Involve anal canal and sphincter muscle
Involve the upper part of rectum
Involve both part of rectum
Mixed injuries: rectum and pelvic region
Diagnosis: inspection, palpation, X-ray, CT
Sigmoideoscopy ( intraoperatively)

20. Treatment of rectal injuries
Urgent operation
Rectum and sphincter reconstruction
Necrectomy and drainage
Colostomy
Foreign body removal ( per rectum or laparatomy )
Antibiotics ( wide spectrum)

21. FOREIGN BODY

22. Condyloma acuminata Buschke-Loewenstein tumour

23. Vernuille disease