RECTUM / ANUS Flashcards
Treatment of fistula if found at the time of abscess drainage
Clinical scenarios that says:
Do not remove fistula at the time of acute inflammation just place a seton.
Incising center and also when there is inflammation present causes increased gapping of the incision and risks incontinence
TRANSANAL EXCISION OF RECTAL LESION
CONSENT:
- radical therapy or adjuvant therapy may be needed later
- . bleeding
- . need preop bowel prep
POSITION:
- Lithotomy or prone
keep lesion in the lower half of operative field
beanbag and taping of pt. to secure position
PROCEDURE:
circumferential anal block ( local + epi )
insert operating proctoscope
mark a 1 cm margin circumferentially with cautery
maintain wide proximal margin
incise rectal wall FULL THICKNESS down to perirectal fat
dissect through this fat layer to undercut specimen
hemostasis assured
defect closed with full thickness running absorbable suture
treatment of anal fissure
If this is a typical position lateral fisher think Crohn’s, or immuno
stool softener
Nitropaste
calcium channel blocker
Biofeedback
Sphincterotomy:
Incision in the intersphincteric groove:
Between internal and external pillar
11 blade towards the anal Canal
Incision internal sphincter
