Download Free Medical Anal Canal-Surgical Anatomy Pilonidal Sinus Perianal Abscess Fistula In ANO PowerPoint Presentation

Anal Canal-Surgical Anatomy Pilonidal Sinus Perianal Abscess Fistula In ANO PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Anal Canal – Surgical anatomy, Pilonidal sinus, Perianal abscess, fistula In Ano" by Dr Amit Gupta.
This medical PowerPoint presentation talks about the anal canal, a tube-like structure that extends from the rectum to the anus. It is approximately 3-4 cm in length and is surrounded by several important structures, including the sphincter muscles, the perianal skin, and the anal glands.
Pilonidal sinus is a condition where a small pit or opening develops in the skin overlying the tailbone (coccyx). This pit can become infected, leading to the formation of a painful abscess or cyst. Treatment may involve drainage of the abscess, removal of the sinus tract, or surgical excision of the entire affected area.
A perianal abscess is a collection of pus that forms near the anus. It is usually caused by an infection in the anal glands or nearby skin. Symptoms may include pain, swelling, redness, and fever. Treatment typically involves incision and drainage of the abscess and antibiotics to treat the infection.
A fistula in ano is a tunnel that connects the anal canal to the skin near the anus. It is usually the result of an infection in the anal glands. Symptoms may include pain, discharge, and recurrent abscesses. Treatment may involve surgery to remove the affected tissue and create a new passage for fecal matter to exit the body.

Tags : Anal Canal, Surgical anatomy, Pilonidal sinus, Perianal abscess, fistula In Ano, surgery, surgery PowerPoint presentation

Published on : Mar 27, 2023 | Views : 1156 | Downloads : 1

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Slide 1-

Anal Canal – Surgical anatomy, Pilonidal sinus, Perianal abscess, fistula In Ano Dr Amit Gupta Associate Professor Dept Of Surgery
Slide 2-

Measures 2 to 4 cm in length longer in men than in women. The dentate or pectinate line marks the transition point between columnar rectal mucosa and squamous anoderm. The 1 to 2 cm of mucosa just proximal to the dentate line shares histologic characteristics of columnar, cuboidal, and squamous epithelium and is referred to as the anal transition zone. The dentate line is surrounded by longitudinal mucosal folds, known as the columns of Morgagni, into which the anal crypts empty. These crypts are the source of cryptoglandular abscesses
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Lining of the anal canal
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Anorectal Anatomy Anal verge Anal canal Arterial Supply Inferior rectal A middle rectal A Venous drainage Inferior rectal V middle rectal V 3 hemorrhoidal complexes L lateral R antero-lateral R posterolateral Lymphatic drainage Above dentate: Inf. Mesenteric Below dentate: internal iliac Nerve Supply Sympathetic: Superior hypogastric plexus Parasympathetic: S234 (nerviergentis Pudendal Nerve: Motor and sensory
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Pilonidal sinus Pathogenesis: A sinus tract at natal cleft resulting from: Blockage of hair follicle Folliculitis Abscess followed by sinus formation. Hair trapping Foreign body reaction The sinus tract is cephald Associated with: Caucasians Hirsute Sedentary occupations Obese Poor hygeine
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Presentation & Treatment
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Perianal Abscess Infection originates in the intersphincteric plane, most likely in one of the anal glands. This may result in simple intersphincteric abscess extend vertically either upward downwards horizontally circumferentially resulting in varied clinical presentations.
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Aetiology & Pathogenesis: 4-10 glands at dentate line. Infection of the cryptglandular epithelium resulting from obstruction of the glands. Ascending infection into the intersphincteric space and other potential spaces. Bacteria implicated: E.Coli., Enterococci, bacteroides Other causes: Crohn TB Carcinoma, Lymphoma and Leukaemia Trauma Inflammatory pelvic conditions (appendicitis)
Slide 11-

Pathophysiology
Slide 12-

Clinical presentation
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Treatment Abscesses should be drained when diagnosed. Simple and superficial abscesses can most often be drained under local anesthesia Patients who manifest systemic symptoms, immunocompromised and those with complex, complicated abscesses are best treated in a hospital setting. An intersphincteric abscess is drained by dividing the internal sphincter at the level of the abscess
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Modification of Hanley's technique for incision and drainage of horseshoe abscess Incision and drainage of anorectal abscess
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Fistula in Ano In anorectal abscess 50% develop a persistent fistula in ano. The fistula usually originates in the infected crypt (internal opening) and tracks to the external opening, usually the site of prior drainage. The course of the fistula can often be predicted by the anatomy of the previous abscess. Majority of fistulas are cryptoglandular in origin, trauma, Crohn's disease, malignancy, radiation, or unusual infections (tuberculosis, actinomycosis, and chlamydia) may also produce fistulas. A complex, recurrent, or non healing fistula should raise the suspicion of one of these diagnoses.
Slide 16-

Diagnosis Patients present with persistent drainage from the internal and/or external openings. An indurated tract is often palpable. Goodsall's rule can be used as a guide in determining the location of the internal opening Fistulas with an external opening anteriorly connect to the internal opening by a short, radial tract. Fistulas with an external opening posteriorly track in a curvilinear fashion to the posterior midline. Exceptions: Anterior external opening is greater than 3 cm from the anal margin. Such fistulas usually track to the posterior midline.
Slide 17-

Goodsall's rule to determine location of internal opening
Slide 18-

Fistulas are categorized based upon their relationship to the anal sphincter complex and treatment options are based upon these classifications: Intersphincteric fistula tracks through the distal internal sphincter and intersphincteric space to an external opening near the anal verge. Transsphincteric fistula often results from an ischiorectal abscess and extends through both the internal and external sphincters Suprasphincteric fistula originates in the intersphincteric plane and tracks up and around the entire external sphincter Extrasphincteric fistula originates in the rectal wall and tracks around both sphincters to exit laterally, usually in the ischiorectal fossa
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Intersphincteric Transsphincteric Suprasphincteric Extrasphincteric
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Treatment Goal of treatment of fistula in ano is eradication of sepsis without sacrificing continence The external opening is usually visible as a red elevation of granulation tissue with or without concurrent drainage. The internal opening may be more difficult to identify. Injection of hydrogen peroxide or dilute methylene blue may be helpful
Slide 21-

Simple intersphincteric fistulas can often be treated by fistulotomy ,curettage, and healing by secondary intention. Fistulas that include less than 30% of the sphincter muscles can often be treated by sphincterotomy without significant risk of major incontinence. High transsphincteric and suprasphincteric fistulas are treated by initial placement of a seton. Extrasphincteric fistulas are rare, and treatment depends upon both the anatomy of the fistula and its etiology. Complex and/or nonhealing fistulas may result from Crohn's disease, malignancy, radiation proctitis, or unusual infection. Proctoscopy should be performed in all cases of complex and/or nonhealing fistulas to assess the health of the rectal mucosa. Biopsies of the fistula tract should be taken to rule out malignancy.