Which patient characteristics are associated with rectal prolapse? • Chronic constipation • Deep pouch of Douglas • Neurologic disease • Patulous anus • Female sex • Diastasis of the levator ani muscles • Nulliparity • Lack of fixation of the rectum to the sacrum • Redundant rectosigmoid colon • Previous anorectal surgery
Rectal prolapse Surgery Resection (standard or laparoscopic approach) of redundant colon and rectum with a rectal fixation (rectopexy) is generally associated with the best long-term results in patients who are fit for a major operation. For patients at higher risk for major surgery, other procedures have been described, including narrowing the anal orifice (Thiersch operation) …
What is perianal Paget disease Perianal (extramammary) Paget disease is characterized by a scaly, inflamed dermis resembling eczema. Biopsy reveals typical Paget cells with round, pale, vacuolated, mucin-positive cytoplasm with an eccentric reticular nucleus. It is often a chronic condition, but underlying carcinoma must be ruled out as invasive anorectal cancer may be associated with …
Fournier gangrene Fournier gangrene is a necrotizing soft tissue infection of the perineum. Although rare, it can present as a suspected perirectal abscess, so a high index of suspicion must be maintained. Treatment is prompt surgical debridement. • Local signs —crepitance, bullae, cellulitis • Systemic signs —altered mental status, hypotension, oliguria
When is anorectal suppurative disease especially dangerous? In the presence of neutropenia, as associated with chemotherapy. Unfortunately, surgery and even anorectal digital examination may be contraindicated. Often bacterial infection is widespread without formation of purulence or a classic abscess.
treatment options for anorectal fistulas • Fibrin sealant glues • Collagen plug • Monoclonal anti–tumor necrosis factor antibodies for Crohn’s fistulas • Park fistulotomy procedure, with excision and debridement of the fistula tract, muscle repair, advancement flap coverage of the internal opening, and drainage of the external portion of the fistula tract
What is a seton? A seton is a drainage device used to control and treat an anal fistulous abscess. It is inserted through and through a fistula tract and secured to itself, thus making a circle about some portion of the anal sphincter muscle. It serves as a cutting device to exteriorize the fistula slowly. …