DOCSLIB.ORG

Anal/Rectal Bleeding

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anal/Rectal Bleeding MANAGE YOUR RECTAL AND ANAL BLEEDING Rectal aNd ANal bleeding caN cause a lot of aNd injectioN sclerotherapy; aNd operative room aNd infectioN coNcern, as it is aN unusual experience. The ligatioN aNd excision. caN occur aNd Nature of the bleeding caN often be a clue as to ANAL FISSURE - Simply put, a fissure is a cut. are associated the underlying cause. See a COLORECTAL It is in an area that reQuires constant use. A fissure complicatioNs. SURGEON to properly investigate aNd maNage is usually caused by a hard stool. This stretches aNd Symptoms of this coNdition. tears the opening. Anal fissures result in severe pain diverticulitis include Rectal bleeding often reveals itself as bright red oN defecation, bleeding, with aNal sphincter spasm, abdominal pain, blood oN the toilet paper—usually after a bowel aNd further tearing. Typically bleeding is seen as a fever, aNd a sudden POLYP TO CANCER PROGRESSION movement—or by turning the toilet bowl water red. streak of blood oN a hard stool. chaNge in bowel habits. Treatment may include a People having aN increased risk of colorectal Rectal bleeding caN also present as extremely dark special diet, aNtibiotics, or surgery. caNcer include those who have a family history of stool, raNging in color from deep red/marooN to DIVERTICULAR DISEASE colorectal caNcer, aNd people who have previously black, aNd sometimes appearing tar-like (melena). had caNcer or polyps. The color of the blood caN indicate where the INFLAMMATORY BOWEL DISEASE bleeding is coming from: (IBD) is an inflammation of the small or large COLONOSCOPY is the most effective way of • Bright red blood usually indicates bleeding low intestine. There are two types of IBD. One type examining the lining of the colon and rectum. By in the coloN or rectum of IBD is Crohn’s disease, marked by patches of using a fiberoptic scope designed to bend and turn • Dark red or maroon blood usually indicates inflammation occurring anywhere in the digestive with your bowel, the doctor caN perform biopsies bleeding higher in the coloN or the small bowel tract. The other type of IBD, colitis, is marked by aNd remove pre-caNcerous polyps. • Melena usually means bleeding in the stomach, inflammation in the large bowel. By removing pre-cancerous polyps, over 90% such as bleeding from ulcers There are several other types of colitis, including: of colorectal caNcers caN be prevented. The exam ANAL FISSURE • Infectious colitis (caused by an infection that is performed at the hospital as aN outpatient CAUSES Medical treatment includes avoidance of attacks the large bowel) procedure. AN intravenous line is placed so that Although rectal bleeding is common, oNly constipation by fiber supplement, laxatives, and • Ischemic colitis (the result of a poor blood you caN be given sedatioN (twilight sleep). After the about oNe-third of those affected seek treatment. stool softeners; aNd applicatioN of Nifedipine supply to the colon) sedatioN takes effect, Symptoms usually develop quickly, aNd most causes ointment to relax the sphincter muscles. If Not • Radiation colitis (following radiotherapy, the scope is inserted are treatable aNd Not serious. IN some cases, rectal healed by medical treatment, then a surgical usually for prostate, rectal, or gyNecological aNd the entire bleeding caN be a symptom of a serious disease, treatment option includes Botox injection to relax caNcer) bowel is checked such as colorectal caNcer. Therefore, all rectal sphincter muscles, cutting the sphincter muscles • Ulcerative colitis (ulcers/sores in the large for abNormalities. bleeding should be reported. partially, and advancement flap. intestine lining) If polyps are found, Rectal bleeding caN be caused by: IBD symptoms may include: they are removed • hemorrhoids ANAL PRURITIS (also kNowN as “pruritis • Fever during the exam aNd • anal fissure ani”) is persistent itching of the skin around • Rectal bleeding sent to pathology to • anal abscess or fistula the aNus. This coNditioN caN cause intolerable • Diarrhea be aNalyzed. • anal pruritis discomfort. Regardless of the cause, the problem • Abdominal pain and/or cramping COLONOSCOPY • diverticulosis/diverticulitis is exacerbated by a self-escalating “itch-scratch- • Intestinal blockage • inflammatory bowel disease (IBD) itch” cycle. The skin gets thinned out aNd bleeds Treatment of inflammatory bowel disease is OFFICE EVALUATION OF RECTAL • ulcers easily oN wiping. Causes include over cleaning critical aNd may involve a special diet, medicatioN BLEEDING • large polyps which caN remove Natural oils that protect the skin, to eliminate or reduce inflammation, and/or • colon cancer increased moisture, aNd food aNd drinks (mainly surgery. Colorectal surgeoNs would perform aNoscopy, coffee). Treatment includes avoiding soap, dietary proctosigmoidoscopy and flexible sigmoidoscopy HEMORRHOIDS are a Normal part of the restrictioNs, keeping area dry, avoid scratching, aNd COLONIC POLYPS AND CANCER in the office. They are also equipped with providing aNatomy. We are borN with them. We have two sets; applying aNti-fungal aNd steroid creams. Since rectal bleeding caN sometimes be a office based treatment for the commoN coNditioNs interNal aNd exterNal. Symptomatic hemorrhoids symptom of colorectal caNcer – caNcer of the causing rectal bleeding. are swollen (enlarged, dilated) veins inside aNd ANAL ABSCESS results when aN aNal coloN or rectum – this is the primary reasoN rectal outside the glaNd becomes infected. It causes severe pain in bleeding should Not be igNored. Colorectal caNcer aNus. Enlarged the regioN around the aNus. There may also be is a commoN form of caNcer that caN usually be hemorrhoids are discharge of pus or blood from the aNus with aN cured if diagNosed aNd treated early enough. usually caused offensive odor. This collectioN caN happen in the Colorectal caNcer occurs when the Normal by increased aNatomical spaces around the aNal caNal. ANal growth aNd divisioN of the cells lining the large pressure, such as abscess is treated by making aN opening in the skin bowel goes out of coNtrol, initially resulting in the straining when Near the aNus to drain the pus from the infected formatioN of a polyp. A polyp caN appear similar to coNstipated. cavity aNd thereby relieve the pressure. Often this a small mushroom that is attached to the lining of Hemorrhoids caN be doNe in the office using local aNesthetic. the large bowel. Polyps that become large caN bleed. may cause pain, While there are maNy types of polyps that are bleeding, blood DIVERTICULOSIS develops when small Not caNcerous, certain polyps are coNsidered clots, aNd itching. pouches (diverticuli) form in weakened sectioNs precaNcerous aNd caN develop into caNcer if left OFFICE EVALUATION OF RECTAL ANATOMY OF HEMORRHOIDS of intestine lining aNd protrude through the bowel untreated. Therefore, removing polyps before they BLEEDING Medical treatment includes avoidance of wall, usually in the sigmoid colon. Diverticuli develop such severe chaNges caN prevent caNcer. Colorectal surgeoNs treat a majority of the causes constipation by fiber supplement, laxatives, are a common finding among older people and ColoNoscopy is the procedure used by physiciaNs of rectal bleeding with coNservative treatment aNd stool softeners; aNd applicatioN of topical are diagNosed when seen oN a coloNoscopy or to locate aNd remove polyps to prevent colorectal aNd office based procedures. See your Colorectal hemorrhoidal aNd steroid ointments. Surgical sigmoidoscopy. caNcer. Surgeon for further evaluation and management treatment includes office based rubber baNding Diverticulosis is a benign disorder but bleeding of rectal and anal bleeding..
Load more

Recommended publications
  • Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement
    CLINICAL REPORT Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement ÃEdwin F. de Zoeten, zBrad A. Pasternak, §Peter Mattei, ÃRobert E. Kramer, and yHoward A. Kader ABSTRACT disease. The first description connecting regional enteritis with Inflammatory bowel disease is a chronic inflammatory disorder of the perianal disease was by Bissell et al in 1934 (2), and since that time gastrointestinal tract that includes both Crohn disease (CD) and ulcerative perianal disease has become a recognized entity and an important colitis. Abdominal pain, rectal bleeding, diarrhea, and weight loss consideration in the diagnosis and treatment of CD. Perianal characterize both CD and ulcerative colitis. The incidence of IBD in the Crohn disease (PCD) is defined as inflammation at or near the United States is 70 to 150 cases per 100,000 individuals and, as with other anus, including tags, fissures, fistulae, abscesses, or stenosis. autoimmune diseases, is on the rise. CD can affect any part of the The symptoms of PCD include pain, itching, bleeding, purulent gastrointestinal tract from the mouth to the anus and frequently will include discharge, and incontinence of stool. perianal disease. The first description connecting regional enteritis with perianal disease was by Bissell et al in 1934, and since that time perianal INCIDENCE AND NATURAL HISTORY disease has become a recognized entity and an important consideration in the Limited pediatric data describe the incidence and prevalence diagnosis and treatment of CD. Perianal Crohn disease (PCD) is defined as of PCD. The incidence of PCD in the pediatric age group has been inflammation at or near the anus, including tags, fissures, fistulae, abscesses, estimated to be between 13.6% and 62% (3).
    [Show full text]
  • Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent
    Abe et al. J Clin Gastroenterol Treat 2016, 2:038 Volume 2 | Issue 4 Journal of ISSN: 2469-584X Clinical Gastroenterology and Treatment Clinical Image: Open Access Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent Takashi Abe1, Takayuki Nagai1 and Kazunari Murakami2 1Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Japan 2Department of Gastroenterology, Oita University, Japan *Corresponding author: Takashi Abe M.D., Ph.D., Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Tsurumi 4333, Beppu City, Oita 874-8585, Japan, Tel: +81-977-23-7111 Fax: +81-977-23-7884, E-mail: [email protected] Keywords Esophagus, Pulmonary parenchyma, Fistula, lung cancer, Self- expandable metallic stent A 71-year-old man was diagnosed with squamous cell lung cancer in the right lower lobe. He was treated with chemotherapy (first line: TS-1/CDDP; second line: carboplatin/nab-paclitaxel) and radiation therapy (41.4 Gy), but his disease continued to progress. The patient complained of relatively sudden-onset chest pain and high-grade fever. Computed tomography (CT) showed a small volume of air in the lung cancer of the right lower lobe, so the patient was suspected of fistula between the esophagus and the lung parenchyma. Upper gastrointestinal endoscopy revealed an esophageal fistula (Figure 1), which esophagography using water- soluble contrast medium showed overlying the right lower lobe Figure 2: Esophagography findings. Contrast medium is shown overlying the right lower lobe (arrow). (Figure 2). The distance from the incisor teeth to this fistula was 28 cm endoscopically. CT, which was done after esophagography, showed fistulous communication between the esophagus and Figure 1: Endoscopy showing esophageal fistula (arrow).
    [Show full text]
  • Colo-Gastric Fistula As an Uncommon Complication of Crohn's Disease
    Colo-gastric Fistula as an Uncommon Complication of Crohn’s Disease Molly Stone, MD September 28, 2019 Background - Crohn’s Disease (CD): a transmural inflammatory process which often gives rise to sinus tracts and eventually fistulization into adjacent serosa. - Fistulizing disease is a common complication of CD - Risk increases with longer disease duration - Prevalence of 15% in childhood; up to 50% at 20 yrs from dx - Fistulas most commonly form in perianal region - Intra-abdominal fistula develop in approximately 30% of patients. Common Sites of Fistulas Torres. The Lancet. 2017. Gastrocolic Fistula - First described in 1775, first case related to Crohn’s Disease reported in 1948 - Most commonly seen with peptic ulcer disease, cases also noted in gastric and colon cancers in addition to Crohn’s. - Classic Triad: diarrhea, weight loss, feculent emesis - Only present in 30% of cases - Presence of feculent emesis helps to distinguish gastrocolic from more distal entero-enteric fistulas Epidemiology - Rare complication noted in only 0.6% of CD pt - Youngest reported case in a 13 yo pt who had CD for 3 yrs, however most pts range 25-60 with disease duration >10 yrs - M=F - Predisposing factors: Ileal disease and prior ileocolic anastomoses Pathogenesis - Most form from mid- to distal transverse colon to the greater curvature of the stomach - Initiate from active area of colitis - Multiple cases with evidence of proximal disease on resection implying gastric to colic or bidirectional formation Greenstein, Diseases of Colon and Rectum. 1989.
    [Show full text]
  • Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-In-Ano, and Rectovaginal Fistula Jon D
    PRACTICE GUIDELINES Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula Jon D. Vogel, M.D. • Eric K. Johnson, M.D. • Arden M. Morris, M.D. • Ian M. Paquette, M.D. Theodore J. Saclarides, M.D. • Daniel L. Feingold, M.D. • Scott R. Steele, M.D. Prepared on behalf of The Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Sur- and submucosal locations.7–11 Anorectal abscess occurs geons is dedicated to ensuring high-quality pa- more often in males than females, and may occur at any Ttient care by advancing the science, prevention, age, with peak incidence among 20 to 40 year olds.4,8–12 and management of disorders and diseases of the co- In general, the abscess is treated with prompt incision lon, rectum, and anus. The Clinical Practice Guide- and drainage.4,6,10,13 lines Committee is charged with leading international Fistula-in-ano is a tract that connects the perine- efforts in defining quality care for conditions related al skin to the anal canal. In patients with an anorec- to the colon, rectum, and anus by developing clinical tal abscess, 30% to 70% present with a concomitant practice guidelines based on the best available evidence. fistula-in-ano, and, in those who do not, one-third will These guidelines are inclusive, not prescriptive, and are be diagnosed with a fistula in the months to years after intended for the use of all practitioners, health care abscess drainage.2,5,8–10,13–16 Although a perianal abscess workers, and patients who desire information about the is defined by the anatomic space in which it forms, a management of the conditions addressed by the topics fistula-in-ano is classified in terms of its relationship to covered in these guidelines.
    [Show full text]
  • Incidental Cholecystojejunal Fistula: a Rare Complication of Gall Stone Disease
    MedCrave Online Journal of Surgery Case Report Open Access Incidental cholecystojejunal fistula: a rare complication of gall stone disease Abstract Volume 8 Issue 4 - 2020 Cholecystoenteric fistula is a rare complication of gallstone disease and difficult to diagnose Vipul K Srivastava,1 Shilpi Roy,1 Ramniwas preoperatively. Among Cholecystoenteric fistula, cholecystojejunal fistulae are even rarer Meena,2 Rahul Khanna2 and only a few case reports have been published on it. Here we report a case of a 60-year 1Resident, Department of General Surgery, Institute of Medical male patient with cholecystojejunal fistula diagnosed intraoperatively while performing Sciences, India laparoscopic cholecystectomy. Fundus of the gall bladder was found to be communicating 2Professor, Department of General Surgery, Institute of Medical with proximal jejunum. We conclude that in elderly patients if the ultrasonography shows Sciences, India features of contracted gall bladder in presence of large gall stones one should consider an option of getting a computed tomography scan done preoperatively. Correspondence: Dr. Ramniwas Meena, Professor Department of General Surgery, Institute of Medical Sciences Banaras Hindu University, Varanasi–221005, UP, India, Keywords: cholecystoenteric, cholecystojejunal, fistula, gall-stones, cholecystitis Tel +919935141697, Email Received: October 25, 2020 | Published: December 17, 2020 Introduction Cholecystoenteric fistula (CEF) was first described by Courvoisier in 1890. They are a rare complication of gallstone disease and are formed due to ongoing inflammation.1 They are bilioenteric type of Internal Biliary fistula which is rare to find. Preoperative diagnosis of CEF is difficult to make with pneumobilia being the most common radiological finding.2 So here we report a rare case of cholecystojejunal fistula.
    [Show full text]
  • Discharge Instructions After Fistulotomy
    FAIRFAX COLON & RECTAL SURGERY, P.C. DONALD B. COLVIN, M.D., F.A.S.C.R.S. PAUL E. SAVOCA, M.D., F.A.S.C.R.S. LYNDA S. DOUGHERTY, M.D., F.A.S.C.R.S. DANIEL P. OTCHY, M.D., F.A.S.C.R.S. LAWRENCE E. STERN, M.D., F.A.S.C.R.S. KIMBERLY A. MATZIE, M.D., F.A.C.S. COLORECTAL/ANORECTAL SURGERY, COLONOSCOPY, ANORECTAL PHYSIOLOGY (703) 280-2841 DISCHARGE INSTRUCTIONS AFTER FISTULOTOMY An anal fistula is an abnormal channel or tunnel-like chronic infection that starts inside the anus and ends outside on the skin around the anus. Its development is usually the result of a previous anal infection or abscess. About 50% of people with an anal abscess end up with a fistula. Most fistulas are short and superficial and are best treated by simply opening the entire tunnel and leaving it open to heal in gradually. Occasionally a patient can have a complex fistula with multiple tracts or the tunnel may traverse a considerable amount of the sphincter muscle. For this reason the surgical treatment has to be individualized for each particular patient depending on the location and anatomy of the fistula. Frequently, the surgeon cannot guarantee exactly what will need to be done until the examination that is done under anesthesia at the time of the surgery. It is important to realize that the operative procedure can change depending on what is found at the time of the surgery. At times a fistula will require more than one surgery to cure.
    [Show full text]
  • What Is Enterocutaneous Fistula?
    Patient Education What Is Enterocutaneous Fistula? An enterocutaneous fistula is an opening from the intestines to the top of the skin that leaks fluids or stool. This liquid usually comes from your stomach or intestines. How do I know if I have Enterocutaneous Fistula? Symptoms of an enterocutaneous fistula include: • Intestinal fluid or stool leaking through and onto the skin (seen as drainage coming from the stomach). • The stomach becomes unable to absorb nutrients (malabsorption). • Dehydration (not drinking enough water). What causes Enterocutaneous Fistula? • Problems from abdominal surgery • Trauma resulting from penetrating wounds (such as stabbings or gunshot) • Inflammatory disorders (Crohn’s disease) • Side effect of radiation to the abdomen or pelvis (can occur years after treatment) How can I fix it? Treatment for an enterocutaneous fistula depends on the size, location, patient’s history, cause of fistula, and problems related to the fistula. At times an enterocutaneous fistula closes on its own after a few weeks to months. If problems happen and/or the fistula does not heal on its own after a couple of months surgery will be needed. If the enterocutaneous fistula is draining a large amount of gastrointestinal (stomach and intestinal) fluid, the fistula is managed as a stoma (an opening in the belly for getting rid of wastes). The use of an ostomy device may also be used. Sometimes patients may need nutritional support with TPN (intravenous source of nutrition). How can I learn more? You can also find information through the American Society of Colon & Rectal Surgeons (ASCRS) at http://www.fascrs.org/patients/conditions/ Do you have any questions or comments for your doctor? _________________________________ ____ ____________________________________ PTED#0000118 Division of Colon & Rectal Surgery.
    [Show full text]
  • Classic “Outlet” Rectal Bleeding Does Not Require Full Colonoscopy to Exclude Significant Pathology
    Classic “Outlet” Rectal Bleeding does not Require Full Colonoscopy to Exclude Significant Pathology ORIGINAL CONTRIBUTION Eric L. Marderstein, M.D., M.P.H. James M. Church, M.D. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio PURPOSE: Full diagnostic colonoscopy often is performed CONCLUSIONS: In patients with classic outlet bleeding, the to exclude significant pathology in patients presenting yield of a complete diagnostic colonoscopy is low. If the with rectal bleeding. In patients with classic “outlet” history is classic for outlet bleeding and no other bleeding, defined as bright red blood after or during indication for colonoscopy exists, flexible sigmoidoscopy defecation, with no family history of colorectal neoplasia is enough to exclude significant pathology. or change in bowel habits, we hypothesize that the diagnostic yield of complete colonoscopy will be low. The purpose of this study was to determine whether complete KEY WORDS: Outlet bleeding; Gastrointestinal bleeding; colonoscopy is necessary in the evaluation of patients with Colonoscopy; Sigmoidoscopy. “outlet” rectal bleeding. METHODS: Information for all patients undergoing colo- olonoscopy is an important diagnostic tool in the noscopy by a single endoscopist was prospectively C workup of a variety of gastrointestinal symptoms. It recorded. Before each colonoscopy, a complete history, is very sensitive for the detection of pathology, resulting including indication for the examination, was obtained. in lower gastrointestinal bleeding, and can be used to 1,2 Using standard definitions, patients with outlet bleeding, provide treatment at the time of the examination. suspicious bleeding, hemorrhage, and occult bleeding Additionally, it has proven effective as a screening exa- were accessed and the findings of their colonoscopies mination for the early diagnosis of colorectal cancer.
    [Show full text]
  • Colonic Ischemia 9/21/14, 9:02 PM
    Colonic ischemia 9/21/14, 9:02 PM Official reprint from UpToDate® www.uptodate.com ©2014 UpToDate® Colonic ischemia Authors Section Editors Deputy Editor Peter Grubel, MD John F Eidt, MD Kathryn A Collins, MD, PhD, FACS J Thomas Lamont, MD Joseph L Mills, Sr, MD Martin Weiser, MD All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Aug 2014. | This topic last updated: Aug 25, 2014. INTRODUCTION — Intestinal ischemia is caused by a reduction in blood flow, which can be related to acute arterial occlusion (embolic, thrombotic), venous thrombosis, or hypoperfusion of the mesenteric vasculature causing nonocclusive ischemia. Colonic ischemia is the most frequent form of intestinal ischemia, most often affecting the elderly [1]. Approximately 15 percent of patients with colonic ischemia develop gangrene, the consequences of which can be life-threatening, making rapid diagnosis and treatment imperative. The remainder develops nongangrenous ischemia, which is usually transient and resolves without sequelae [2]. However, some of these patients will have a more prolonged course or develop long-term complications, such as stricture or chronic ischemic colitis. The diagnosis and treatment of patients can be challenging since colonic ischemia often occurs in patients who are debilitated and have multiple medical problems. The clinical features, diagnosis, and treatment of ischemia affecting the colon and rectum will be reviewed here. Acute and chronic intestinal ischemia of the small intestine are discussed separately. (See "Acute mesenteric ischemia" and "Chronic mesenteric ischemia".) BLOOD SUPPLY OF THE COLON — The circulation to the large intestine and rectum is derived from the superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and internal iliac arteries (figure 1).
    [Show full text]
  • Fistula-Related Cancer in Crohn's Disease: a Systematic Review
    cancers Systematic Review Fistula-Related Cancer in Crohn’s Disease: A Systematic Review Andromachi Kotsafti 1,* , Melania Scarpa 1 , Imerio Angriman 2 , Ignazio Castagliuolo 3 and Antonino Caruso 4 1 Laboratory of Advanced Translational Research, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; [email protected] 2 First Surgical Clinic Section, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35128 Padua, Italy; [email protected] 3 Department of Molecular Medicine DMM, University of Padua, 35121 Padua, Italy; [email protected] 4 Gastroenterology Unit, ULSS2 Marca Trevigiana, Montebelluna Hospital, 31044 Montebelluna, Italy; [email protected] * Correspondence: [email protected] Simple Summary: Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease. The relationship between perianal fistula in CD (Chron’s disease) and SCC (squa- mous cell carcinoma) development is not clear but chronic inflammation of ano-rectal mucosa, delayed wound healing and cell turnover may play important roles. The aim of this systematic review was to determine the clinical characteristics of patients with squamous cell carcinoma arising from perianal fistula in CD, the surgery and oncological treatment, the role of HPV infection, im- munosuppression and the survival of these patients. Fistula-related carcinoma in CD can be very difficult to diagnose. An early diagnosis has the potential to improve the outcome of disease. Abstract: Perianal fistulizing Crohn’s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn’s disease are also at risk of perianal fistula-related squamous Citation: Kotsafti, A.; Scarpa, M.; cell carcinoma (SCC).
    [Show full text]
  • Rectal Prolapse: an Overview of Clinical Features, Diagnosis, and Patient-Specific Management Strategies
    J Gastrointest Surg (2014) 18:1059–1069 DOI 10.1007/s11605-013-2427-7 EVIDENCE-BASED CURRENT SURGICAL PRACTICE Rectal Prolapse: An Overview of Clinical Features, Diagnosis, and Patient-Specific Management Strategies Liliana Bordeianou & Caitlin W. Hicks & Andreas M. Kaiser & Karim Alavi & Ranjan Sudan & Paul E. Wise Received: 11 November 2013 /Accepted: 27 November 2013 /Published online: 19 December 2013 # 2013 The Society for Surgery of the Alimentary Tract Abstract Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangulation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to understand each patient’s symptoms, bowel habits, anatomy, and pre-operative expectations. Preoperative workup includes physical exam, colonoscopy, anoscopy, and, in some patients, anal manometry and defecography. With this information, a tailored surgical approach (abdominal versus perineal, minimally invasive versus open) and technique (posterior versus ventral rectopexy +/− sigmoidectomy, for example) can then be chosen. We propose an algorithm based on available outcomes data in the literature, an understanding of anorectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients. Keywords Rectal prolapse . Management . Surgery . ’ . Liliana Bordeianou and Caitlin W. Hicks are co-first authors.
    [Show full text]
  • Radiologic Diagnosis of Tracheoesophageal Fistula in Children
    11 Review Article Page 1 of 11 Radiologic diagnosis of tracheoesophageal fistula in children Ercan Ayaz, Mithat Haliloglu Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey Contributions: (I) Conception and design: All authors; (II) Administrative support: E Ayaz; (III) Provision of study materials or patients: M Haliloglu; (IV) Collection and assembly of data: E Ayaz; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Mithat Haliloglu, MD. Professor of Radiology, Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey. Email: [email protected]. Abstract: Radiological imaging plays an essential role in the diagnostic algorithm of tracheoesophageal fistula (TEF) in the prenatal and postnatal period. Although the primary imaging modality is esophagogram with water-soluble contrast, there are various imaging techniques to make the diagnosis. As ultrasound and magnetic resonance imaging (MRI) are compatible during the prenatal period, computed tomography (CT) and plain radiographs may provide additional information to contrast studies in the postpartum period. Imaging is also crucial to identify other associated anomalies and to predict the outcome. Moreover, radiological examinations are often necessary in the postoperative period to define complications and recurrent TEF. The aim of this article is two folds; first to describe indications, imaging methods and findings of congenital, acquired, and recurrent TEF and accompanying conditions to confirm the diagnosis, and second, to discuss the yield of different imaging methods in line with the literature. While describing congenital TEF, concomitant anomalies, such as esophageal atresia (EA) and tracheal agenesis were depicted systematically according to the prevalent classifications.
    [Show full text]