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RECTUM DISEASES. TISSUE SPACE AROUND THE RECTUM 1-Ishiorectal space 2-pelviorectal space 3-perianal space.

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Presentation on theme: "RECTUM DISEASES. TISSUE SPACE AROUND THE RECTUM 1-Ishiorectal space 2-pelviorectal space 3-perianal space."— Presentation transcript:

1 RECTUM DISEASES

2 TISSUE SPACE AROUND THE RECTUM 1-Ishiorectal space 2-pelviorectal space 3-perianal space

3 HEMORRHOID

4 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 recti Morgagni’s columna

5 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

6 HEMORRHOID changes of the microcirculation Дисфункція артеріовенозного шунта виникнення венозної гіпертензії Венозний стаз Локальне запалення Mікросудинний стаз

7 HEMORRHOID - Changes Of The Microcirculation

8 HEMORRHOID Дисфункція артеріовенозного шунта  Ламкість капілярів  Гіперпроникність Сповільнення повернення венозної крові та виникнення венозної гіпертензії Венозний стаз Mікросудинний стаз

9 HEMORRHOID CLASSIFICATION Class I – Hemorrhoid doesn’t prolapse outside the anal canal Class II – Prolapses, usually with defecation, but retracts spontaneously Class III – Requires manual replacement into the anal canal after prolapsing Class IV – Prolapsed tissue cannot be manually replaced and is typically strangulated or thrombosed

10 Interference of leukocytes with endothelium – reason of inflamation of the vein wall Interference of leukocytes with endothelium Leukocyte

11 DIGITAL EXAMINATION OF THE RECTUM

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13 RECTOSCOPY

14 RECTAL BIOPSY

15 Hemorrhoid Surgery

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20 а) V-подібний розріз; б) висічення вузла; в) перев'язка судинної ніжки і відсічення вузла Hemorrhoid Surgery

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23 Acute paraproctitis is acute inflammation of pararectal cellular tissue. They take near 30% of all diseases of rectum ACUTE PARAPROCTITIS

24 By etiology – usual, anaerobic, specific, traumatic paraproctitis. By localization – submucosal, subcutaneous, ischiorectal, pelviorectal, retrorectal paraproctitis CLASSIFICATION

25 RETRORECTAL PARAPROCTITIS

26 Ischiorectal and pelviorectal paraproctitis.

27 REMOVING OF THE CRYPT WITH INTERNAL OPENING

28 Rectal fistulas are tubular purulent canals in cellular tissue surrounding rectum and anus RECTAL FISTULAS (CHRONIC PARAPROCTITIS)

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30 VARIANTS OF PLACING OF FISTULAS IN THE PARARECTAL SPACES

31 а) інтрасфінктерний; б) транссфінктерний; в) екстрасфінктерний; г) з порожниною; д) підковоподібний; VARIANTS OF PLACING OF FISTULAS IN THE PARARECTAL SPACES

32 SONOGRAPHY

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34 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

35 3D SONOGRAPHY

36 VIEW OF THE INTERNAL OPENING

37 TRANSABDOMINAL SONOGRAPHY

38 TRANSANAL SONOGRAPHY I

39 OPERATIVE TREATMENT Fistula Canal after fistula removing

40 Suturing of the internal fistula opening Mucos removing OPERATIVE TREATMENT

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42 Scar in that place (after operation) Abscess (before operation) Ligation method

43 OPERATION REMOVING OF THE RECTAL FISTULA

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45 PREPARATION OF THE FISTULA

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47 ANAL FISTULA PLUG 1. The doctor locates the inside opening of the fistula in the anal canal using a fistula probe and irrigates the tract.

48 ANAL FISTULA PLUG 2. 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.

49 ANAL FISTULA PLUG 3. The inside opening is closed by suturing the top tissue layers of the anal canal over the AFP plug's head.

50 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.

51 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.

52 ANAL FISTULA PLUG

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55 AN ANAL FISSURE An anal fissure is a small split in the anal mucosa that may cause painful bowel movements and bleeding.

56 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

57 AN ANAL FISSURE SIGNS AND TESTS Inspection of the rectum Physical exam of the rectal mucosa

58 AN ANAL FISSURE

59 Висічення анальної тріщини з місцевою аутопластикою зміщенням шкірно- слизового клаптя. TREATMENT OF THE ANAL FISSURE

60 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.

61 EXAMINATION OF THE ANAL REGION

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63 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.

64 ENDOSONOGRAPHY

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66 PILONIDAL SINUSES

67 Planning of excision and flap

68 PILONIDAL SINUSES Trans- position of mobilized flap

69 PILONIDAL SINUSES Final appearance of wound


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