This document discusses rectal prolapse, which is the protrusion of the rectum outside of the body. It describes the types of rectal prolapse as partial or complete. Risk factors include weakened muscles, trauma from childbirth, and conditions that increase abdominal pressure. Treatment depends on the type and severity of prolapse, ranging from injections to repair surgery via abdominal or perineal approaches. Complications of surgery include nerve damage, infection, and recurrence of prolapse.
This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Rectal Prolapse - Cedars Sinai Medical Center - Medicine Resident TalkTheSurgeryGroupofLA
Presentation by Yossef Nasseri, M.D.
Yosef Nasseri, M.D., is a founding member of The Surgery Group of Los Angeles, a Los Angeles based physician group providing a comprehensive approach to surgical care through advanced technology, long-term patient follow-up, and direct physician access. Dr. Nasseri is double board-certified in general and colorectal surgery and specializes in cutting-edge robotic and minimally invasive techniques for the treatment of colon and rectal cancers, inflammatory bowel disease, benign anorectal diseases, a variety of hernias, and general surgery.
Rectal prolapse (Surgical anatomy of rectum, pathology and management0sunil kumar daha
Please find the powerpoint on Rectal prolapse. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Meckel`s Diveticulum.pptx Meckel's diverticulum is the most common congenital...DrSabinShrestha1
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It results from incomplete obliteration of the vitelline duct leading to the formation of a true diverticulum of the small intestine.
The embryology, clinical features, diagnosis, and treatment of Meckel's diverticulum are reviewed here. The clinical evaluation of various gastrointestinal symptoms (abdominal pain, gastrointestinal bleeding, bowel obstruction) in children and adults is found in separate topic reviews. General considerations for the management of other congenital anomalies of the gastrointestinal tract are reviewed elsewhere.
Meckel's diverticulum is a true diverticulum, containing all layers of the small bowel wall. It arises from the antimesenteric surface of the middle-to-distal ileum. The diverticulum represents a persistent remnant of the omphalomesenteric duct, which connects the midgut to the yolk sac in the fetus.
The omphalomesenteric duct normally involutes between the fifth and sixth weeks of human gestation as the bowel settles into its permanent position within the abdominal cavity.
Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract [1]. There is probably no familial predisposition for Meckel's diverticulum, although a few cases of occurrence within the same family have been reported . The prevalence of Meckel's diverticulum is increased in children born with major malfo
Small intestine/Intestinal obstruction/crohns disease/ileostomy/viscous organ...RajeevPandit10
all about small intestine, anatomy, physiology, intestinal obstruction, crohns disease/ileostomy/viscous organ perforation, meckels diverticulum, mysenteric ischemia, short bowel syndrome, celiac disease
Enucleation and evisceration. ophthalmology
contains the two methods of eye ball removal, with indications, surgery, complications, treatment, etc
its has animated clips and picture
wonderful slide i have prepaired
can be used for clinical as well as educational purpose
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2. • Prolapse of the mucous membrane or the entire rectum
outside the anal verge.This condition is common in
children and elderly patients.
• TYPE
• Partial prolapse
• Complete prolapse
3. Aetiology
• Decreased sacral curvature and decreased anal canal tone are the
probable causes in infants.
• Diarrhea, cough, malnutrition are the additional factors in children.
• It may be due to reduced ischiorectal fossa fat, neurological causes,
fibrocystic disease of pancreas or poorly developed pelvis.
• In adults, it is common in females, common in multipara—repeated
birth injuries to perineum results in damage to the perineal nerve
supply.
• It is due to weakening of supporting tissue and levator ani muscle,
atony of the sphincter, increased intraabdominal pressure due to any
cause like chronic cough, stricture urethra.
4. Partial prolapse
• Here only mucosa and submucosa of the rectum
descends, not more than 3.75 cm.There is no descent of
the muscular layer. It is the commonest type of rectal
prolapse.
• Clinical Features
• History of mass per anum, which can be observed when child is
allowed to strain in squatting position.
• It is pink in colour and circumferential.
• It differs from piles (differential diagnosis), the piles are not
circumferential and are plum or blue coloured (not pink).
5. Treatment
In infants and young children
• Digital repositioning
• The parents are taught to replace the protrusion, and any underlying
causes are addressed.
• Submucosal injections
• If digital repositioning fails after 6 weeks’ trial, injections of 5%
phenol in almond oil are carried out under general anaesthestic. As a
result of the aseptic inflammation following these injections, the
mucous membrane becomes tethered to the muscle coat.
• Surgery
• Occasionally, surgery is required and, in such cases, the child is
placed in the prone jack-knife position, the retrorectal space is
entered, and the rectum is sutured to the sacrum.
6. In adults
• Local treatments
• Submucosal injections of phenol in almond oil or the
application of rubber bands are sometimes successful in cases
of mucosal prolapse.
• Excision of the prolapsed mucosa
• When the prolapse is unilateral, the redundant mucosa can be
excised or, if circumferential, an endoluminal stapling
technique can be used.
7. Complete Prolapse
• • Also called as procidentia, is less common than partial prolapse
• It is common in females (6 : 1 :: female : male).
• It is due to weakened levator ani and supporting pelvic tissues.
• The descent is always more than 3.75 cm, contains all layers of the
rectum (i.e. including muscular layer). Often descends down up to
10-15 cm.
• It is often associated with the uterine descent (uterine prolapse).
• It is also thought to be as an intussusception of the rectum.
• Once complete prolapse is more than 5 cm, anteriorly it drags
peritoneum as pouch which often contains small intestine. On
digital pushing it reduces with gurgling.
• Patulous anal sphincter is typical with mucus discharge and faecal
incontinence
8. Aetiological factors
• Weak anus, external sphincter and pelvic muscle
• Lax, mobile rectum
• Obliterated ano-rectal angle
• Abnormally mobile rectum with descent
9. Clinical Features
• Complete descent of the rectum which is red in colour and
often painful, as mass per anum.
• Faecal incontinence is very common. It is due to disruption of
the anal sphincter and prolapsed rectal mucosal discharge.
• Pain per anum.
• Bleeding can occur because of the congestion
• Sepsis, discharge, fever, anaemia are other features.
• P/R examination shows lax sphincter. Anteriorly, peritoneal
sac comes down as a pouch which may contain small bowel.
10. Investigations
• Defecography reveals increased mobility of the rectum
from sacral fixation point with redundant mesorectum
and funnel formation. It is fluoroscopic and spot filming
in lateral projection after instilling radioopaque material
into the rectum done in sitting posture over a
radiolucent commode.
• Cinedefecography, triple contrast cinedefecography,
dynamic MRI defecography, colpocystodefecography
are helpful to delineate complex pelvic floor problems.
• Defecography abnormalities- megarectum,
incontinence, nonrelaxing puborectalis, abnormal
perineal descent (2.5 cm), mucosal prolapse, solitary
ulcer rectocoele, enterocele.
• Sigmoidoscopy. • Anal manometry. • Pudendal nerve
latency study.
11. Treatment
• Surgery is required, and the operation can be performed
via the perineal or the abdominal approaches. An
abdominal rectopexy has a lower rate of recurrence but,
when the patient is elderly and very frail, a perineal
operation is indicated. As an abdominal procedure risks
damage to the pelvic autonomic nerves, resulting in
possible sexual dysfunction, a perineal approach is also
usually preferred in young men.
12. Perineal approach
• Thiersch operation
• This procedure, which aimed to place a steel wire or, more
commonly, a silastic or nylon suture around the anal canal, has
become obsolete.The reasons for its lack of popularity were that
the suture would often break or cause chronic perineal sepsis, or
both, or the anal stenosis so created would produce severe
functional problems. Delorme’s operation is now the preferred
perineal operation.
13. • Delorme’s operation
• In this procedure, the rectal mucosa is removed circumferentially
from the prolapsed rectum over its length.The underlying
muscle is then plicated with a series of sutures, such that, when
these are tied, the rectal muscle is concertinaed towards the anal
canal.The anal canal mucosa is then sutured circumferentially to
the rectal mucosa remaining at the tip of the prolapse.The
prolapse is reduced, and a ring of muscle is created above the
anal canal, which prevents recurrence.
• Altemeier’s procedure
• This consists of excision of the prolapsed rectum and associated
sigmoid colon from below, and construction of a coloanal
anastomosis.
14. Abdominal approach
• The principle of all abdominal operations for rectal prolapse is to
replace and hold the rectum in its proper position.They are
recommended in patients with complete prolapse who are otherwise
in good health.
• Many variations have been described: inWells’ operation, the rectum
is fixed firmly to the sacrum by inserting a sheet of polypropylene
mesh between them; Ripstein’s operation involves hitching up the
rectosigmoid junction by aTeflon sling to the front of the sacrum;
many surgeons simply suture the mobilised rectum to the sacrum
using four to six interrupted non-absorbable sutures – so called
sutured rectopexy.
• Recently, the technique has been performed laparoscopically, thus
reducing the operative trauma and limiting the time in hospital.
15. Complications of Surgery
• Injury to hypogastric nerve causing impotence.
• Bladder dysfunction.
• Bleeding from sacral venous plexus.
• Injury to rectum and colon causing faceal fistula.
• Constipation after rectopexy is a known complication.
• Recurrence of prolapse.
• Improper correction of continence occurs in 50% cases.
• Infection – proctitis/pelvic abscess, etc
16. Defecographic grading of rectal
prolapse
• N – Normal rectal fixation and sphincter relaxation and rectal
emptying.
• 1 – Nonrelaxed puborectalis.
• 2 – Mild intussusception
• 3 – Moderate intussusception.
• 4 – Severe intussusception.
• 5 – Prolapse.
• R – Rectocele.
18. • Clinical condition characterized by rectal bleeding, copious
mucous discharge, anorectal pain and difficult evacuation
• SRUS can have single rectal ulcer, multiple ulcers or even
no ulcers
• When present, ulcers usually occur on the anterior rectal
wall just above the anorectal ring
• Ulcers usually appear as shallow lesions with punched out
gray-white base that is surrounded by hyperemia
• Cause unclear, associated with chronic inflammation or
trauma (internal intussception or prolapse of the rectum,
direct digital trauma, or forces to evacuate hard stool)
19. Management
• Conservative therapy (e.g. high fiber diet, lifestyle
changes etc) should be tried first
• Pharmacologic therapy (e.g. anti-inflammatory
enemas and suppositories), limited success but
worth trying
• If symptoms persists, localized resection may be
considered
• Patients with prolapse, prolapse need to be treated
either with perineal procedures or abdominal
procedures