79 T_h e rectum

ANATOMY Surgical anatomy The rectum begins where the tinea coli of the sigmoid colon join to for...

BENIGN RECTAL LESIONS Endometrioma Endometrioma is rare and may be misdiagnosed as a carcinoma. T...

Blood supply The superior rectal artery is the direct continuation of the inferior mesenteric ar...

CLINICAL FEATURES OF RECTAL DISEASE Symptoms Rectal diseases are common and can occur at any age....

Clinical features Carcinoma of the rectum can occur early in life, but the age of presentation ...

Diagnosis The anus should be inspected and the abdomen palpated. If abdominal rigidity or tendern...

Differential diagnosis Many colorectal lesions can give rise to diagnostic di ffi culty . For examp...

Endoluminal stenting An increasingly used alternative for patients with an obstruct - ing carcino...

FOREIGN BODIES IN THE RECTUM The variety of foreign bodies that have found their way into the rec...

Full-thickness prolapse Complete rectal prolapse (synonym: procidentia) is less common than the m...

Gastrointestinal stromal tumour Smooth muscle tumours of the rectum are rare. If the mitotic rate...

Gonococcal proctitis Gonococcal proctitis occurs in both sexes as the result of rectal coitus an...

Haemangioma Haemangioma of the rectum is an uncommon cause of serious haemorrhage. The symptoms...

INJURIES The rectum or anal canal may be injured in a number of ways, all of which are uncommon...

Internal rectal prolapse and solitary rectal ulcer syndrome Internal rectal prolapse, or intussus...

Introduction No content extracted automatically.

Investigation Abdominal examination Abdominal examination is normal in early cases. Occasionally ...

Learning objectives To understand: The anatomy of the rectum and its relationship to surgical •...

Liver resection Single or multiple well-localised liver metastases can now be resected with relat...

Lymphatic drainage The lymphatics of the rectal mucosa communicate freely with those of the mus...

Lymphogranuloma venereum The modes of infection are similar to those of gonococcal proctitis bu...

Neuroendocrine tumours Neuroendocrine tumours (NETs) of the rectum constitute 19% of all gastro...

PROCTITIS The patient is usually middle-aged and complains of defecatory frequency with the pass...

PROLAPSE Mucosal prolapse The mucosa and submucosa of the rectum may protrude outside the anus f...

Palliative colostomy This is indicated only in cases giving rise to intestinal obstruc - tion, or...

Pathogenesis Colorectal cancer originates from premalignant precursor lesions in the epithelial l...

Pelvic exenteration When carcinoma of the rectum has spread to contiguous organs, a more radical ...

Polyps relevant to the rectum Hyperplastic polyps These are small, pinkish, sessile polyps, 2–4 /...

Proctitis due to Crohn’s disease Crohn’s disease can occasionally a ff ect the rectum, although cl...

Proctitis due to specific infections Clostridium difficile An acute form of proctocolitis caused b...

RECTAL POL YPS The rectum, along with the sigmoid colon, is the most frequent site of polyps (an...

Radiation proctitis Radiation therapy is used in the treatment of cervical, prostate and rectal ...

Signs To examine the rectum the patient is most conveniently posi- tioned in the left lateral or ...

Stages of progression Dukes classified carcinoma of the rectum into three stages ( Figure 79.16 )...

Treatment of rectal polyps All rectal polyps should be biopsied or removed for histological analy...

Treatment The rectum is examined under general anaesthetic with a finger and a sigmoidoscope. If ...

Tuberculous proctitis This is nearly always associated with active pulmonary tuberculosis or tube...

Types of carcinoma spread Local spread Local spread occurs circumferentially rather than in a lon...

Ulcerative proctocolitis Proctitis is present in most cases of ulcerative colitis, and the degre...

Venous drainage The superior haemorrhoidal veins draining the upper half of the anal canal above...