surgical proctology

1. Dr David Linyama
General Surgeon

2. The branch of medicine that deals with the
diagnosis and treatment of disorders
affecting the colon, rectum, and anus.

3. Anal fissures,
Anal fistula,
Haemorrhoid
Condyloma acuminata,
Chlamydiae trachomatis,
Suppurations,
Ano-rectal trauma
Prostatic disease (Urologist)

6. Dilated veins occurring in relation to the anus such
H. may be internal ,external or interoexternal.
Internal H.:
Is displaced anal cushions due to a dilatation and
enlagement of internal venous plexus .
Aetiology:
1- hereditary: cong. weakness,abnormal large
arterial supply

9. Pile may be symptomatic some other condition:
1- Ca. of rectum.
2- pregnancy:
3- straining at micturation

10. Arranged in three group 3,7 and 11 o’clock
each pile divided to three parts:
1- pedicle at anorectal ring
2- internal H below anorectal ring and dentate line
3- external H bet. Dentate and anal verge

11. Painless …1st degree
2nd degree on defecation but return
3rd degree: replaced manually
4th degree: Permanently prolapsed

12. symptoms:
1- bleeding/ painless
2- prolapse :
3- discharge and pruritis
4- pain only in complicated case
5- anaemia: profuse bleeding

13. On exam.
Inspection: no finding in int .H….early
Diagnosis by proctoscopy
Sigmoidoscopy should be done

15. 1. Profuse haemorrhage
2. Strangulation
3. Thrombosis….ulceration
….supuration
..pylephlebitis(portal pyaemia)
…fibrosis
4. Gangrene

17. An unnatural crack or tear in the anus,
usually extending from the anal opening
and located posteriorly in the midline.

19. Most anal fissures are caused by
stretching of the anal mucosa beyond its
capability. Various causes of this fissure
include:
Straining to defecate, especially if the stool
is hard and dry
Severe and chronic constipation
Severe and chronic diarrhea

20. Crohn's disease and Ulcerative colitis
Anal sex or dildo use
Anal stretching
Insertion of foreign objects into the anus
Tight sphincter muscles
Excessive anal probing

21. The symptoms of anal fissure include:
Pain during, and even hours after,
defecation
Visible tear in the anus
Blood on the stool or on toilet paper or
toilet bowl
Constipation
Burning, possibly painful, itch

22.  Topical or suppository containing anti-
inflammatory agents and local anesthetic can be
used.
 High-fiber diet,
 Stool softener,
 Analgesics
 Sitz baths

23. Painful deep fissures, on the other hand
cut through the sphincter muscle thus
making it prone to spasm, which
exacerbates the fissure and aborts the
healing process.
Nitroglycerine and nifedipine ointments
can relax the sphincter muscle

24.  Surgical intervention may be required for
persisting deep anal fissures unresponsive to the
above conservative measures. Procedures
include:
 Internal lateral sphincterotomy or excising a
portion of the sphincter
 Anal dilation or stretching of the anal canal is no
longer recommended because of the
unacceptably high incidence of fecal
incontinence

25. Abnormal opening on the cutaneous
surface near the anus.
 Abnormal connection between the
epithelialised surface of the anal canal and
(usually) the perianal skin
Usually this is from a local crypt abscess
and also is common in Crohns.

27. Anal fistulae can present with many
different symptoms:
Pain
Discharge - either bloody or purulent
Pruritus ani - itching
Systemic symptoms if abscess becomes
infected

28. The opening of the fistula onto the skin
may be seen
The area may be painful on examination
There may be redness
An area of induration may be felt -
thickening due to chronic infection
A discharge may be seen

29.  Doing nothing - a drainage seton can be left in place
long-term to prevent problems. This is the safest option
although it does not definitively cure the fistula.
 Conversion to a cutting seton - this involves a similar
process to a draining seton but the suture is tied tightly.
This gradually cuts through the muscle and skin
involved, leaving behind a small area of scarring. This
cures the fistula in most cases, but can cause
incontinence in a small number of cases, mainly of
flatus (wind).

30.  involves an operation to cut the fistula open and let it
heal naturally. This cures the fistula but leaves behind a
scar, and can cause problems with incontinence. This
option is not suitable for complex fistulae, or those that
cross the entire anal sphincter.
 Fibrin glue injection.