Transcript Surgical anatomy of the rectum

Diseases of the rectum
1 - Gear Line 2 - perianal skin, 3 - Analcutaneous line, 4 - lower rectal venous plexus,
5 - Bundle of Parks, 6 - Superior rectal venous
plexus, 7 - Circular layer of muscular coat
rectum; 8 - Longitudinal layer
muscle membrane of the rectum.
Surgical anatomy of the rectum
Surgical anatomy of the
rectum
Locking the muscles of the rectum (bottom view)
Anatomy of the rectum
1) pars subcutanea, 2) pars
sliperfici.'ilis, 3) pars proflilida,
4) in. puborectalis
1) Pars slibcutanea, 2) pars sliperfici.'ilis, 3)
pars profniulii, 4) тп. puborectalis
Rectal artery
(VCI vena cava inferior = нижняя полая
вена)
The lymphatic network of the rectum
Cavity around the rectum, filled with fatty tissue: 1) spatium
ischiorectale, 2) spatium pelvirectale, 3) spatium perianale
Physiology of the rectum
• Evacuation
• Tank (650-1200)
• Absorptive
Diseases of the rectum
• Congenital anomalies of the
rectum
• Non-tumoral diseases of the
rectum
• Tumors of the rectum
Congenital anomalies of the
rectum
• Disease of Hirschsprung (aganglionar
megacolon)
• Congenital atresias of the anus and
rectum
Congenital atresias of the anus
and rectum
• Anomalies of the anus and rectum is
known to occur in 0,2 ° / oo of all
newborns. Among the most frequent: anal
stenosis, anal atresia, atresia, the anus
and rectum and rectal atresia
Classification and diagnosis
• Depending on whether over or under
pubococcygeal line blockage is located,
distinguish deep (aproctia) or highobstruction (atresia, the anus and rectum).
Under the new nomenclature adopted in
Melbourne in 1970, and still produce an
intermediate form.
Congenital anomalies of the rectum: a) stenosis anus, b) atresia
anus, and c) atresia anus and rectum, r) atresia of the rectum
diagnostics
• To estimate the height of the obstruction is
a lateral X-ray radiography in the baby's
head is down (in Wangen-steen-Rice).
From the distance the air, filling the blind
pocket on a metal plate glued in place the
anus, conclude about the height of
obstruction
Treatment
Congenital atresias of the anus
and rectum
Operation in atresia of the anus and rectum through abdomen-surface
access and Rehbein Siepliens. To access between the sacral bone and
intestine, ureter directly to form a tunnel (a), through which extend a plastic
tube (b), which through the hole in the bottom of the blind pocket stretch in
the abdominal cavity (в)
Non-tumoral diseases of the
rectum
•
•
•
•
Hemorrhoids
Anal fissure, papillary hypertrophy
Anorectal abscess and anal fistula
Archoptosis and the failure of the
sphincter
Hemorrhoids
•Hemorrhoids - expansion of the
cavernous cells of the rectum, the
most common colo Proctoscope
pathology. Hemorrhoid suffers
approximately 12 - 13 out of 100, and
its share in the overall structure of
diseases of the rectum is 40%. The
disease occurs almost equally
common among men and women
aged 30-50 years
Hemorrhoids node
• The formation of
hemorrhoids
contribute constant
constipation,
persistent diarrhea,
prolonged cough,
vomiting, prolonged
and excessive stress
on your abdominal
muscles (in certain
sports), narrowing the
space of the
processes in the pelvis
(tumor, pregnancy),
portal hypertension.
The three positions:
Left lateral
Right rear
Right front
Hemorrhoid nodes
• Inter
•Outdoor
Clinic stages
• In the first stage internal hemorrhoid can be felt
as a swelling, it can be seen in proctoscope.
• In the second stage of internal hemorrhoid
straining falls through the anus, but after
straining restored spontaneously to its place.
• In the third stage of the disease internal
hemorrhoids fall through the anus and
spontaneously restored. Only under pressure
from the outside, they return to their place.
• At the fourth stage of internal hemorrhoid is
always outside the anus is not deposited even
under pressure from the outside.
Treatment
• Conservative (baths, medication with
thrombophlebitis of hemorrhoidal veins
and sclerotherapy)
• Surgical
sclerotherapy
In the first
described in
1869
in stages 1 and
2, effective
30% relapse
within 4 years
Ligation of hemorrhoids with
rubber rings
2 cm proximal from
the anus
Causes necrosis and
scarring of the lining
of the rectal wall,
thus reducing the
relapse
96% of asymptomatic
for a month
Surgeon treatment
• Operation by Milugan - Morgan
• Operation by Parks
• Operation by Рижих
Operation by Milugan
Morgan
All three
hemorrhoi
dal node
tied and
cut off
Operation by Parks
Node is
separated
medially anodermy from
the outside from the
internal
sphincter
Hemorrhoidectomy by Rizhih
rectum anal fissure
Among all the diseases of the rectum
anal fissure is the frequency of the
third place (11.7%) after colitis and
hemorrhoids. Fissures are more
common in women (60%) aged 30
to 50 years. Usually, the crack has
a length of 2 cm, width 2-3 mm.
Most often anal fissure is located
in the posterior commissure anus,
due to traumatization of the zone
during defecation. Maybe a few
cracks in this case, the most
common localization of - anterior
and posterior commissure ("mirror"
the crack). The direction of the
longitudinal cracks
Anal fissure, pektenoz,
papillary hypertrophy
Anal fissure
with
caruncle
and
hypertrophi
ed anal
warts
Anal fissure, pektenoz,
papillary hypertrophy
• About anal fissure say if the boundary of
chronic ulcers anus, more or less deep
penetration into the anal canal. With a
long-term deep fissures, accompanied by
a chronic inflammatory process, there is
strong, prone to wrinkle, scar tissue, which
increasingly constricts the anal canal. This
is called pektenoziz
Anal fissure, pektenoz,
papillary hypertrophy
Internal sphincterotomy. a) Dissection of the crack and the internal
sphincter, and b) the same schematic, c) a small external wound after the
removal of Tongue
Anal fissure, pektenoz,
papillary hypertrophy
The operation is performed under
local anesthesia or intra-trachea
anesthesia, the patient is in
position for lithotomy. In the radial
direction, bordering the cut in one
piece is removed hypertrophied
papilla, crack and caruncle.
Paraproktal abscess and
paraproktal fistulas
• Stages
Acute-abscess
Chronic paraproktal fistula
Parakproktal abscesses:
a) perianal,
B) ishiorektal,
c) pelviorektal,
d) submucosal
Clinic paraproctitis acute
(abscess)
Pain
Redness
Edema
Increased body
temperature
Increased ESR
paraproctitis abscess
Autopsy and perianal
abscess ishiorektal
paraproctitis abscess
Anorectal fistula
• In the first described
by Hippocrates in
430g. BC
• Swelling, pain,
separation, or slimy
stools.
• A history of acute or
inflammatory
paraproctitis and
cancers of the colon
Anorectal fistula
According to the rule
Qoodsati, anorectal
fistulas are different
depending on their
location relative to the
perpendicular lines
drawn through the
anus
Classification of anal fistulas
• .
Diagnostic
а
в
The introduction of dyes for determination of the (a) or
holding a thin wire (a).
anorectal fistula
Excision of posterior
anorectal fistula by the
method of Parks, outer part
of the fistulous excised from
the skin in the form of a
cylinder
Archoptosis.
•Loss of part or all
of the rectal wall to
the anus.
•Accompanied with
fecal incontinence
and constipation
•Rare bleeding
•No pain
Выпадение прямой кишки
Archoptosis and the failure
of the sphincter.
• Distinguish partial loss - or loss of mucosal
and total precipitation (protsidention),
when all the layers of the rectal wall torn
out through the anus.
• Loss of mucous is easily recognized by
passing radially inverted pleats on the
mucous
failure of the sphincter.
• The simplest method for the treatment infiltration of the tissues around the colon
causing inflammation of the drug.
failure of the sphincter.
Fixing fallen rectum
"assemblies" and "reverse
intussusception"
The failure of the sphincter
Plastic tender
muscles in the way
Pickreil