الفهرس | Only 14 pages are availabe for public view |
Abstract The anal canal can be the site of rare lesions. Most conditions arising in this area, however, are common and benign but may be incapacitating and interfere with the daily quality of life of patients. Moreover, these disorders are often misdiagnosed or maltreated, leading at times to disastrous consequences. A better knowledge of the functional anatomy of this portion of the gastrointestinal tract, as well as recent changes in our understanding of its physiology and that of the pelvic floor, should facilitate diagnosis and management of these ailments and result in more favorable outcomes. [Townsend et al., 2006] Hemorrhoids are a common problem and are one of the oldest ailments known to mankind. Although the majority of patients with anal complaints blame their problems on hemorrhoids, only approximately a third of these symptoms actually result from hemorrhoids. Other conditions causing anal complaints include pruritus ani, anal fissure, fistula‐in‐ano, abscess, and condyloma acuminata. Often a patient has hemorrhoids that are actually asymptomatic, but they have one of these other conditions causing symptoms that they erroneously attribute to their hemorrhoids. Surgeons who treat hemorrhoids should be familiar with these other conditions so that they can properly treat the patient. [Gregorcyk & Huber, 2008] A fissure in ano is a tear in the anoderm distal to the dentate line. The pathophysiology of anal fissure is thought to be related to trauma from either the passage of hard stool or prolonged diarrhea. Surgical therapy traditionally has been recommended for chronic fissures that have failed medical therapy, and lateral internal sphincterotomy is the procedure of choice for most surgeons. [Brunicardi et al.,2010] Anorectal abscess and fistula are common. A simplified approach to pelvic sepsis designates the abscess as the acute manifestation of infection, with the fistula representing the chronic stage of the same disease. However, both abscess and fistula can occur independently of the other. Successful treatment of these disorders with minimal morbidity requires knowledge of the anatomic spaces surrounding the anorectum and the various potential clinical presentations, application of traditional surgical principles, and employment of specific techniques tailored for each patient. [Glasgow & Dietz, 2008] Fecal incontinence is a disabling disease with severe psychosocial implications. The impact on the quality of life for patients is significant and can lead to work absenteeism, depression, and social isolation. Basic understanding of pelvic floor anatomy is essential to appreciate the etiology and treatment of Fecal incontinence. Sphincter function, rectal sensation, adequate capacity and compliance, colonic transit time, stool consistency, and cognitive and neurologic function are all factors that influence continence. [Madeleine &Herand, 2008] Neoplasms of the anal area are rare and represent a wide spectrum of benign and malignant tumors. The wide range of benign, premalignant, and malignant tumors of the anal region reflects its variation in anatomy and histology. [Ayscue & Smith, 2008] Other complications whether due to anaeshtesia or subsequent to surgery (surgical procedure) can arise and need specific treatment to each. |