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