Anal and Rectal Diseases Explained

225 Pages·2003·3.65 MB·English

by  Eli D.

P469 Anus Cover 3/26/04 1:52 PM Page 1
EXPLAINED SERIES
A
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l Anal and rectal
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Perianal and rectal complaints are among the most common seen by d

primary care physicians, surgeons, and gastroenterologists. re
However, the wide variety of disorders associated with these c diseases explained
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complaints are, in general, poorly understood. Illustrated throughout l
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with color images and exquisitely detailed line diagrams, Anal and
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Rectal Diseases Explained provides a practical introduction to the e
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presentation, diagnosis, and management of a broad range of anal s Eli D Ehrenpreis
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and rectal diseases. s

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"What a great idea! This book will be a wonderful resource for p
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clinicians. Every physician should have a copy on their shelf!” in
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Dr Sunanda Kane, Department of Medicine, d
Gastroenterology Division, University of Chicago
About the author
Eli D Ehrenpreis, MD, is Assistant Professor of Medicine at Rush
Presbyterian St Luke's Medical Center in Chicago, Illinois, and a
practicing gastroenterologist at Adult Care Specialists, Arlington
Heights, Illinois. Dr Ehrenpreis is the former director of the training
fellowship program in gastroenterology at the University of Chicago
and has also served as a staff physician at Cleveland Clinic, Florida. E
He is the author of more than 60 clinical research papers in the fields li D
of gastroenterology and clinical pharmacology and has authored a E
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number of chapters in gastroenterology, colorectal surgery, and critical r
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care medicine textbooks. DrEhrenpreis is married with three children, np
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and lives in Skokie, Illinois. e
is
ISBN 1-901346-67-6
9 781901 346671
Anal and rectal
diseases explained
Remedica Explained series
ISSN 1472-4138
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While every effort is made by the publishers to see that no inaccurate or misleading data, opinions, or statements
appear in this book, they wish to make it clear that the material contained in the publication represents a summary
of the independent evaluations and opinions of the authors and contributors. As a consequence, the authors,
publisher, and any sponsoring company accept no responsibility for the consequences of any inaccurate or
misleading data or statements. Neither do they endorse the content of the publication or the use of any drug or
device in a way that lies outside its current licensed application in any territory.
Published by the Remedica Group
Remedica Publishing, 32–38 Osnaburgh Street, London, NW1 3ND, UK
Remedica Inc, Tri-State International Center, Building 25, Suite 150,
Lincolnshire, IL 60069, USA
Email: [email protected]
www.remedica.com
Publisher: Andrew Ward
In-house editor: Tamsin White
© October 2003 Remedica Publishing
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, without
the prior permission of the publisher.
ISBN 1 901346 67 6
British Library Cataloguing in-Publication Data
A catalogue record for this book is available from the British Library
Anal and rectal
diseases explained
Eli D Ehrenpreis, MD
Assistant Professor of Medicine
Rush Presbyterian St. Luke's Medical Center
Adult Care Specialists
1538 N Arlington Heights Rd
Arlington Heights,
Illinois 60004
USA
Acknowledgements
I would like to thank the following people for their assistance with this book:
Avrum Epstein, MD, for assistance with radiographic images.
Alessandro Fichera, MD, for manuscript review and additions from
a surgical perspective.
Arunas Gasparitus, MD, for providing many interesting and
unusual radiographs for the book.
Charles Dye, MD, for providing endoscopic ultrasound images.
Sunanda V Kane, MD, for providing endoscopic photos for the
Crohn’s disease section.
Andrew Ward for encouraging me to write the book and providing
publication support.
Tamsin White for editorial assistance.
Foreword
This book gives a clear and detailed overview of some of the different anorectal and
colonic pathologies. Although some of these conditions are very common in our
patient population, our knowledge and our experience in managing these
conditions is sometimes lacking. The aim of this book is to provide clinicians with
a tool for rapid consultation and a source of information in order to properly
answer the patient’s questions. Each section clearly describes the condition with
up-to-date management guidelines and some very precious clinical pearls.
Each topic is outlined in a multidisciplinary fashion with the medical, surgical, and
pathological aspects clearly detailed in each section. Such a succinct overview has
long been needed. The format is very clear and certainly this will be a book to have
on a ward, in the doctor’s office, or on the shelves at home.
Alessandro Fichera, MD
Assistant Professor of Surgery
University of Chicago
Chicago, Illinois

Contents
1. General information
1.1 Anal and rectal anatomy 3
1.2 The normal process of defecation 9
2. Diagnostic procedures
2.1 Anorectal manometry 15
2.2 Anoscopy and proctoscopy 19
2.3 Barium enema 21
2.4 Biofeedback therapy 25
2.5 Colonoscopy 27
2.6 Dynamic proctography 31
2.7 Electromyography 35
2.8 Flexible sigmoidoscopy 37
2.9 Pudendal nerve terminal motor latency 41
2.10 Quantitative stool collection 43
2.11 Transanal ultrasound 45
3. Benign anorectal disorders
3.1 Anal fissure 49
3.2 Anal stenosis 53
3.3 Anorectal abscess 55
3.4 Constipation 59
3.5 Fecal incontinence 65
3.6 Hemorrhoids 69
3.7 Hidradenitis suppurativa 75
3.8 Nonrelaxing puborectalis syndrome 77
3.9 Perianal Crohn’s disease 79
3.10 Perianal fistula 83
3.11 Proctalgia fugax 87
3.12 Pruritus ani 89
3.13 Radiation proctopathy 93
3.14 Rectal prolapse 97
3.15 Rectovaginal fistula 101
3.16 Solitary rectal ulcer syndrome 103
3.17 Ulcerative proctitis 105
4. Neoplasms of the anus
4.1 Anal carcinoma 111
4.2 Other anal malignancies 115
5. Neoplasms of the rectum
5.1 Rectal carcinoma 121
5.2 Staging of rectal cancer 125
5.3 Surgery for rectal cancer 129
5.4 Medical therapy for rectal cancer 131
5.5 Other rectal malignancies 133
6. Infectious disorders of the anus and rectum
6.1 Chlamydia and lymphogranuloma venereum 139
6.2 Gonorrhea 141
6.3 Herpes simplex 143
6.4 HIV-associated anorectal disease 145
6.5 Syphilis 147
6.6 Venereal warts (condylomata acuminata) 149
7. Miscellaneous anorectal conditions
7.1 Diarrhea 155
7.2 Fecal impaction 159
7.3 Ileoanal pouch anastomosis 161
7.4 Pilonidal sinuses 167
7.5 Rectal foreign bodies 169
8. Patient information
8.1 Anal fissure 173
8.2 Fecal incontinence 175
8.3 Hemorrhoids 177
8.4 Kegel exercises 179
8.5 Nonrelaxing puborectalis syndrome 181
8.6 Perianal Crohn’s disease 185
8.7 Pruritus ani 189
8.8 Radiation proctopathy 191
8.9 Rectal prolapse 193
8.10 Solitary rectal ulcer syndrome 195
8.11 Ulcerative proctitis 197
8.12 Venereal warts 199
Abbreviations 203
Further reading 204
Index 205
Chapter 1
General information
1.1 Anal and rectal anatomy 3
1.2 The normal process of defecation 9