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RECTUM DISEASES
TISSUE SPACE AROUND THE RECTUM
1-Ishiorectal space 2-pelviorectal space 3-perianal space
HEMORRHOID
ANATOMY OF THE ANAL CANAL
m. puborectal
m. levator ani
Morgagni’s crypt
Pectineal line
Internal sphincter ani
External sphincter ani
Subcutaneous part of the external sphincter ani
Anal glands m. longitudinal rectiMorgagni’s columna
VIEW OF THE ANAL CANAL
m. puborectalis
m. corrugator cutis ani
m. levator ani
Internal sphincter ani
Morgagni’s columna
Profundus pars of the external sphincter ani
Subcutaneous pars of the external sphincter ani
Superficialis pars of the external sphincter ani
HEMORRHOID changes of the microcirculation
Дисфункція артеріовенозного шунта
виникнення венозної гіпертензії
Венозний стаз
Локальне запалення
Mікросудинний стаз
HEMORRHOID - Changes Of The Microcirculation
HEMORRHOID
Дисфункція артеріовенозного шунта
Ламкість капілярів
Гіперпроникність
Сповільнення повернення венозної крові та виникнення венозної гіпертензії
Венозний стаз
Mікросудинний стаз
HEMORRHOID CLASSIFICATION
Class I – Hemorrhoid doesn’t prolapse outside the anal canalClass II – Prolapses, usually with defecation, but retracts spontaneouslyClass III – Requires manual replacement into the anal canal after prolapsingClass IV – Prolapsed tissue cannot be manually replaced and is typically strangulated or thrombosed
Interference of leukocytes with endothelium – reason of inflamation of the vein wall
Interference of leukocytes with endothelium
Leukocyte
DIGITAL EXAMINATION OF THE RECTUM
DIGITAL EXAMINATION OF THE RECTUM
RECTOSCOPY
RECTAL BIOPSY
Hemorrhoid Surgery
Hemorrhoid Surgery
Hemorrhoid Surgery
Hemorrhoid Surgery
Hemorrhoid Surgery
а) V-подібний розріз; б) висічення вузла; в) перев'язка судинної ніжки і відсічення вузла
Hemorrhoid Surgery
Hemorrhoid Surgery
Hemorrhoid Surgery
Acute paraproctitis is acute inflammation of pararectal cellular tissue. They take near 30% of all diseases of rectum
ACUTE PARAPROCTITIS
By etiology – usual, anaerobic, specific, traumatic paraproctitis.
By localization – submucosal, subcutaneous, ischiorectal, pelviorectal, retrorectal paraproctitis
CLASSIFICATION
RETRORECTAL PARAPROCTITIS
Ischiorectal and pelviorectal paraproctitis.
REMOVING OF THE CRYPT WITH INTERNAL OPENING
Rectal fistulas are tubular purulent canals in cellular tissue surrounding rectum and anus
RECTAL FISTULAS (CHRONIC PARAPROCTITIS)
RECTAL FISTULAS (CHRONIC PARAPROCTITIS)
VARIANTS OF PLACING OF FISTULAS IN THE PARARECTAL SPACES
а) інтрасфінктерний; б) транссфінктерний; в) екстрасфінктерний; г) з порожниною; д) підковоподібний;
VARIANTS OF PLACING OF FISTULAS IN THE PARARECTAL SPACES
SONOGRAPHY
SONOGRAPHY
SONOGRAPHY ANATOMY OF THE ANAL CANAL
зовнішній анальний сфінктер (EAS)
пластиковий ковпачок
датчика
m. transversus perinei
переднє кільце EAS
слизова і подслизова оболонки
внутрішній анальний сфінктер (IAS)
повздовжній м’яз
3D SONOGRAPHY
VIEW OF THE INTERNAL OPENING
TRANSABDOMINAL SONOGRAPHY
TRANSANAL SONOGRAPHY
I
OPERATIVE TREATMENT
FistulaCanal after fistula removing
Suturing of the internal fistula openingMucos removing
OPERATIVE TREATMENT
OPERATIVE TREATMENT
Scar in that place (after operation)
Abscess (before operation)
Ligation method
OPERATIONREMOVING OF THE RECTAL FISTULA
OPERATIONREMOVING OF THE RECTAL FISTULA
PREPARATION OF THE FISTULA
PREPARATION OF THE FISTULA
ANAL FISTULA PLUG1. The doctor locates the inside opening of the fistula in the
anal canal using a fistula probe and irrigates the tract.
ANAL FISTULA PLUG2. The AFP plug is pulled into the inside opening. The doctor notes where the plug enters the primary opening and cuts the plug to size.
ANAL FISTULA PLUG3. The inside opening is closed by suturing the top tissue layers of the
anal canal over the AFP plug's head.
4. Finally, the doctor sutures the tip of the plug to the edge of the exterior opening at skin level (optional). The exterior opening is not
closed to allow for drainage. The tip of the plug is trimmed at skin level.
Once the AFP is implanted, human body’s cells, tissues, and blood vessels will grow into it. Eventually, the plug will be incorporated into
body and completely replaced by human’s own tissue.
ANAL FISTULA PLUG
ANAL FISTULA PLUG
ANAL FISTULA PLUG
AN ANAL FISSURE
An anal fissure is a small split in the anal mucosa that may cause painful bowel movements and bleeding.
AN ANAL FISSURE
SYMPTOMS
Pain while having a bowel movement
Blood on the surface of stool (not mixed in with stool)
Blood on toilet tissue or wipes
A crack in the skin that is visible (the fissure is almost always in the midline)
Constipation, often with painful bowel movements
AN ANAL FISSURE
SIGNS AND TESTS
Inspection of the rectum
Physical exam of the rectal mucosa
AN ANAL FISSURE
Висічення анальної тріщини з місцевою аутопластикою зміщенням шкірно-слизового клаптя.
TREATMENT OF THE ANAL FISSURE
PILONIDAL SINUSES
Pilonidal disease is a common disorder of the sacrococcygeal region. It comprises a variety of problems, including infection/abscess and the development of a chronic sinus cavity.
EXAMINATION OF THE ANAL REGION
EXAMINATION OF THE ANAL REGION
DIAGNOSTIC PROGRAM
1. Anamnesis and physical examination.2. Finger examination of rectum.3. Examination of rectum by a rectal mirror.4. Proctosigmoidoscopy.5. General analysis of blood and urine.6. Biochemical blood test.7. Coagulograma.
ENDOSONOGRAPHY
ENDOSONOGRAPHY
PILONIDAL SINUSES
PILONIDAL SINUSES
Planning of excision and flap
PILONIDAL SINUSES
Trans-position of mobilized flap
PILONIDAL SINUSES
Final appearance of wound