Benign anorectal disease

ANORECTAL SUPPURATIONS- Absesses.- Fistulas.

Anorectal abscess

Anorectal abscess• Painful swelling of Anal area.• Causes:• Infection- E.coli (most) ,staph.aureus .• Truma• Neoplasm• AIDA• Diabetes

Anorectal abscess• classification:• 1-True peri-anal absess :• The swelling at the anal margin.• 2- The ischiorectal absess :• Lies lateral to the anus and occupies a large space.• 3-Submucus abscess:• 4- Pelvirectal abscess:

Anorectal abscess• The infection begins in an anal gland, from which pus

either tracks down to the perineum between the sphincters to form a peri-anal absess, or penetrates the external sphincter to reach the ischiorectal fossa and form a ischiorectal absess .

Anorectal abscess• Age common between 20 and 50 years old ,rarely in

children. • Sex more in men than in women .• Symptom:• - Main symptoms : severe , throbbing pain which makes

sitting, moving and defeacation difficult.• General symptoms : malaise , loss of appetite , sweating

and even rigors.• Systemic effect: patient with an ischiorectal absess is

more likely to be systemically unwell , as there is a large space to fill up with pus.

Fistula in ano

Fistula in ano• Fistula : • is a track,lined with epithelium or granulation tissue,

connecting two epithelial surfaces.• It may connect two body cavities or one cavity and the

body’s external surface.

Fistula in ano• Fistula in ano connects the lumen of the rectum or anal

canal with the external surface.• It is usually lined with granulation tissue.• It may associated with inflammatory bowel conditions,

typically Crohn’s disease .

Fistula in ano• Causes :• - it is caused by an abscess in the inter-sphincter space

bursting in two directions – internally into the anal canal, and externally into the skin.

• -rarely, is caused by direct infiltration and necrosis of a low rectal carcinoma.

Fistula in ano (classification)

Fistula in ano • - low level fistula :• Has its internal opening below the anorectal ring.

• The fistula which below this level may be laid open without impairing continence.

Fistula in ano • High level fistula :• Joins the rectum above the anorectal ring.• Laying this open would divide the ring and make the

patient incontinent.• More complex surgical procedure required.

Fistula in ano • Age occur at any time during adult life. It is

occasionally seen in children.• Symptoms:• - history of a peri anal absces.• - watery or purulent discharge from the external opening

of fistula.• -blubbing on defecation, as mucus is forced through the

fistula as the anal canal is stretched over the stool.• -Recurrent episodes of pain.• -pruritus ani (peri anal skin wet and macerated due to

discharge)

Fistula in ano • -minor bleeding from external opening .• - the symptoms may be episodic as the degree of

infection in the fistula.• The commonest associated condition is Crohn’s

disease ,the fistula associated with it tend to be painless.

RECTAL PROLAPSE

Rectal prolapse• An eversion of the lower part of the rectum through the

anal canal.

Rectal prolapse• Full thickness prolapse:

- The entire rectal wall, muscle and mucosa become displaced through the anus.

- It occurs when the structure in the floor of the pelvis become week and lax.

- Its always associated with impaired continence because of weakness and stretching of the anal canal.

Rectal prolapse• Age commonly in eldery.• Sex more in women who have had chidren.• Symptoms:• Large lump which appears at the anus after defaecation,

or sometimes when standing ,walking or coughing.• The lump can be pushed back into the rectum or may

return when patient lies down.• Uncomfortable, slight painful and persistent desire to

defaecate.• Secret mucus, ulcerates and bleeds.

Rectal prolapse• Partial thickness or mucosal prolapse:• Circular fold of mucosa. • Mucous membrane and sub mucosa is prolapsed• Causes :• Infant undeveloped sacral curve/ Reduced resting anal

tone.• Children Whooping cough/ Neurological disorder.• Adult Urethral obstruction /3rd degree hemorrhoids

Rectal prolapse• Mucosal prolapse in children :• Smooth , soft swelling at the anal margin after defecation.• Mucus discharge

Thank you

• Refrance:• Browse’s introduction to the symptoms and signs of

surgical disease.