ABSCESS Symptoms anorectal abscess causes severe and continuous

ABSCESS

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.

ANORECTAL ABSCESS

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

ENDORECTAL ULTRASOUND abscess

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.

Periproctal abscess operation

Haemorrhoid, 3 rd degree

Haemorrhoid, 4 th degree

LONGO OPERATION

LONGO PROCEDURE

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

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.

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

ANAL FISSURE CHRONIC

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.

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

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)

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

FOREIGN BODY

Condyloma acuminata Buschke-Loewenstein tumour

Vernuille disease