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perianal dx.pptx
- 1. BENIGN PERIANAL DISEASES DrWinston Makanga, M.B.Ch.B., M.Med. (Surg) Consultant General and Laparoscopic Surgeon
- 2. Objectives of thelecture • Definitions • Anatomy of the perianal region • Common presentation • Hemorrhoids • Fistula in ano and ano-rectal abscess • Pilonidal sinus • Fissure in ano • Rectal prolapse • Pruritus ani
- 3. Definitions • Anal verge •Anorectal ring • Anal canal • Benign anal disease
- 4. Anatomy and physiology •Canal proper • Sphincter anatomy and function • Venous plexuses and function
- 5. Common presentation • Wetness •Discharge from a papule • Itch • Swelling • Bleeding • Painful defecation
- 6. Hemorrhoids • Enlargement ofanal cushions due to dilatation and congestion of submucosal venous plexus • Classification: internal, external, intero-external • Grading: I-IV • Causes: Pregnancy, constipation, rectal tumor, ?PHTN • Presentation: hematochezia, prolapsing mass, itch, wetness • Diagnosis: C/E, proctoscopy, ?DRE, colonoscopy • Rx: Dietary, medical, Surgical: hemorrhoidectomy, band ligation, sclerotherapy, stapling
- 7. Anal abscess • Puscollection in the perianal region • Results from cryptogladular colonization • Classified by site • Usually a forerunner to anal fistula • Present: Painful swelling, fever, discharge • Diagnosis: C/E, FHG • Treatment: Drainage
- 8. Fistula in ano •Abnormal communication between anal canal and perianal skin • Usually after a resolved abscess • Classification: based on sphincter • Presentation: pus discharge, perianal swelling, wetness, pain • Diagnosis: C/E, fistulogram, MRI • Rx: fistulotomy, fistulectomy, Seton, Flaps, fibrin glue, plugs
- 9. Pilonidal disease • Eitheran cyst, abscess or sinus resulting from infection of hair follicles in the natal cleft (far) superior to anal verge • Results from hair penetration of the SC tissues causing a granulomatous reaction • Causes:male, hirsute, sitting occupations, deep natal cleft, hair within the natal cleft, familial, obesity • Diagnosis: C/E, ?Ultrasound • Rx: I&D if abscess, Wide excision for multiple recurrent sinuses
- 10. Fissure in ano •Break in the anoderm extending to the anal verge exposing deeper sphincter muscles • Initially caused by minor trauma but sustained by ischemia due to sphincter hypertonicity • Classified by site and acuteness • Present: painful defecation, hematochezia • Diagnosis : C/E, proctoscopy. Must rule out underlying malignancy • Rx: Medical, Surgical – sphincterotomy (open/closed), Botulinum
- 11. Rectal prolapse • Evaginationof part (mucosal) or whole of rectal wall through the anus • Common in children and eldery multiparous ladies • Causes: diarrhea, constipation, pelvic floor weakness, incontinence • Diagnosis: C/E, confirm if full thickness, defecography • Rx: self limiting, manual reduction, control primary etiology, rectopexy (with/out mesh)
- 12. Pruritus • Intractable itching •Causes • Local: poor hygiene, excess sweat, hemorrhoids, fistula, pinworms • Skin diseases: scabies, fungal, pediculosis • Systemic diseases: Hodgkins, Obstructive jaundice, DM • Idiopathic
- 13. Review • Definitions • Anatomyof the perianal region • Common presentation • Hemorrhoids • Fistula in ano and Ano-rectal abscess • Pilonidal sinus • Fissure in ano • Rectal prolapse • Pruritus ani
- 14.