ABSCESS

Symptoms anorectal abscess causes severe and continuous pain. Patients may present with fever, nausea, vomiting. Physical examination reveals a tender perianal or rectal mass in inflamed surroundings.

ANORECTAL ABSCESS

Diagnosis anamnesis and rectal examination may be sufficient, in some cases rectal ultrasound or CT may help

ENDORECTAL ULTRASOUND abscess

TREATMENT The definite treatment is surgical; abscesses should be drained as soon as possible. Antibiotic prophylaxis parallel with surgery is useful only in case of diabetes, elderly patients, and immuno-suppression. Antibiotics for Gram – and Gram + bacteria are to choose.

Periproctal abscess operation

Haemorrhoid, 3rd degree

Haemorrhoid, 4th degree

LONGO OPERATION

LONGO OPERATION

LONGO PROCEDURE

Haemorrhoids with thrombosis Conservative treatment One day surgery, thrombectomy remove the clot Good result Minimal complication

MASSIVE BLEEDING FROM HAEMORRHOIDS Excessive, transfusion-requiring bleeding may develop sometimes. Diagnosis should be made using sigmoidoscope and/or colonoscope. After excluding other sources of bleeding, and correcting the anaemia, surgical procedure may be performed.

ANAL FISSURE ACUTE A linear ulcer, usually situated in the posterior raphe of the canal. Fissures situated laterally are common in Crohn’s disease.

ANAL FISSURE CHRONIC

TREATMENT Conservative: Laxative, fibre rich diet, paraffin oil Pain relief, anti-inflammatory treatment Nitrate-blocking ointment or creams to reduce the spasm of the internal sphincter muscle Use of Botox injections is in experimental phase Surgical: If symptoms are permanent.

Injury of the rectum Mechanical, external injury may be caused by: Sexual activity Foreign body Trauma Incorrect episiotomies High pressure injuries

Injury of the rectum Involve anal canal and sphincter muscle Involve the upper part of rectum Involve both part of rectum Mixed injuries: rectum and pelvic region Diagnosis: inspection, palpation, X-ray, CT Sigmoideoscopy ( intraoperatively)

Treatment of rectal injuries Urgent operation Rectum and sphincter reconstruction Necrectomy and drainage Colostomy Foreign body removal ( per rectum or laparatomy ) Antibiotics ( wide spectrum)

FOREIGN BODY

Condyloma acuminata Buschke-Loewenstein tumour

Vernuille disease