What is the Goodsall rule The Goodsall rule helps predict the location of the internal opening of an anal fistula based on the site of its external opening. Accurately determining the criminal crypt of fistula origin on the dentate line is important at the time of surgical treatment, generally fistulotomy. If the anus is divided into imaginary […]
Causes of anorectal abscesses and fistulas A cryptoglandular origin seems to provide the best explanation. Four to 10 anal glands enter the anal canal at the level of the crypts in the dentate line. The glands extend back into the internal sphincter two thirds of the time and into the intersphincteric space half the time.
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How is an acute thrombosed external hemorrhoid best treated? Excision of the clot and involved hemorrhoidal complex (as opposed to incision alone) best prevent future recurrence at the same site.
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Minimally invasive outpatient treatments of internal hemorrhoids Outpatient treatments are rubber band ligation, bipolar cautery, direct current electrical therapy, infrared coagulation, sclerotherapy, and cryotherapy.
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How are acute hemorrhoids treated? Topical medicines such as anesthetics, hydrocortisone preparations, and astringents (witch hazel, glycerin, magnesium sulfate) can be used. Emergency hemorrhoidectomy is performed to excise the inflamed hemorrhoid. Circular stapling devices have also been used to treat larger hemorrhoids.
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Differences between external and internal hemorrhoids External hemorrhoids originate distal to the dentate line of the anus and are covered by squamous epithelium. External hemorrhoids may thrombose or become filled with clotted blood. Typically these are painful, involving the anoderm. Internal hemorrhoids arise above (proximal to) the dentate line and are covered with transitional and columnar epithelium. First-degree hemorrhoids
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What type of ileal pouches are used? Although higher-volume pouches are advocated (W = quadruple, S = triple, and J = two-limbed), the long-term functional results may not be all that different. The author prefers a long (15 cm) J pouch (when feasible in one stage) preserving the anal transition zone. The procedure has classically
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