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Pelvic exenteration When carcinoma of the rectum has spread to contiguous organs, a more radical operation known as pelvic exenteration can remove these structures en bloc. Thus, in the male, in whom spread is usually to the bladder or prostate, a cystectomy o...

Polyps relevant to the rectum Hyperplastic polyps These are small, pinkish, sessile polyps, 2–4 /uni00A0 mm in diameter and frequently multiple. They are usually an incidental finding, unless larger in size, when full colonoscopy is warranted to exclude hyperpl...

Proctitis due to Crohn’s disease Crohn’s disease can occasionally a ff ect the rectum, although classically it is spared. Sigmoidoscopic appearances di ff er from those in non-specific proctitis. The inflammatory process tends to be patchy rather than confluent, an...

Proctitis due to specific infections Clostridium difficile An acute form of proctocolitis caused by infection with C. di ffi cile can follow broad-spectrum antibiotics. A membrane can sometimes be seen on sigmoidoscopy (‘pseudomembranous’ colitis). Bacillary dyse...

RECTAL POL YPS The rectum, along with the sigmoid colon, is the most frequent site of polyps (and cancers) in the gastrointestinal tract. Adenomatous polyps of the colon and rectum have the potential to become malignant. The chance of developing invasive ca...

Radiation proctitis Radiation therapy is used in the treatment of cervical, prostate and rectal cancers. It can produce acute radiation proctitis with bleeding, pain, diarrhoea and defecatory frequency . Most symptoms settle within a few weeks, but some patie...

Signs To examine the rectum the patient is most conveniently posi- tioned in the left lateral or semi-prone (Sims) position. Inspection Visual examination of the anus precedes rectal examination to exclude the presence of anal disease, e.g. fissure or fistula....

Stages of progression Dukes classified carcinoma of the rectum into three stages ( Figure 79.16 ). Dukes’ staging /uni25CF A: The growth is limited to the rectal wall (15%). The prognosis is excellent (>90% 5-year survival). /uni25CF B: The growth extends to t...

Treatment of rectal polyps All rectal polyps should be biopsied or removed for histological analysis. A range of techniques can be used, depending on polyp size and location. The majority are less than 1 /uni00A0 cm in size, benign and amenable to endoscopic ...

Treatment The rectum is examined under general anaesthetic with a finger and a sigmoidoscope. If penetrating injury is confirmed, laparotomy or laparoscopy is required. If an intraperitoneal rupture of the rectum is found, the perforation is closed with sutur...

Tuberculous proctitis This is nearly always associated with active pulmonary tuberculosis or tuberculous ulceration of the anus. Submucous rectal abscesses burst and leave ulcers with an undermined edge. A hypertrophic type of tuberculous proctitis occurs in...

Types of carcinoma spread Local spread Local spread occurs circumferentially rather than in a longi- tudinal direction. After the muscular coat has been penetrated, the growth spreads into the surrounding mesorectum, but is initially limited by the mesorectal ...

Ulcerative proctocolitis Proctitis is present in most cases of ulcerative colitis, and the degree of rectal involvement may influence the type of opera- tive procedure (see Chapter 75 ).

Venous drainage The superior haemorrhoidal veins draining the upper half of the anal canal above the dentate line pass upwards to become the rectal veins; these unite to form the superior rectal vein, which later becomes the inferior mesenteric vein. This for...

Aggressive bone disease The radiograph is the first imaging technique for destructive lesions in bones. There is considerable experience required in the interpretation of these films, especially with regard to whether the lesion is benign or malignant ( Figure ...

Articular cartilage damage Articular surface disease is di ffi cult to detect using non-invasive techniques. MRI is probably the best method, although it is not - sensitive to early chondral changes ( Figure 8.21 ). Higher field strength magnets (3 tesla and abov...

Basic principles of imaging methods Conventional radiography Although it is over 120 years since the discovery of x-rays by - Roentgen in 1895, conventional radiography continues to play a central role in the diagnostic pathway of many acute orthopaedics. X-r...

Bowel obstruction The plain abdominal radiograph is a useful tool in diagnosing bowel obstruction. Small bowel obstruction can generally be distinguished from large bowel obstruction by virtue of the following: the small bowel lies centrally in the abdomen wh...