Hemorrhoids, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy

 

The rectum is observed in the retroflexed maneuver.

Internal Hemorrhoids.

 The rectum is observed in the retroflexed maneuver.

 

 For more endoscopic details download the video clips by
 clicking on the endoscopic images, wait to be downloaded
 complete then press Alt and Enter; thus you can observe
 the video in full screen.

 All endoscopic images shown in this Atlas contain
 video clips.

                                        Medline.

 

Colonoscopic view of internal hemorrhoids.  Hemorrhoidal disease is a common entity in the general population and in clinical practice. The most common cause of hematochezia in adults, it remains high in the differential diagnosis of almost any anorectal complaint.

Video Endoscopic Sequence 1 of 5.

 Colonoscopic view of internal hemorrhoids.

 Hemorrhoidal disease is a common entity in the general
 population and in clinical practice. The most common cause
 of hematochezia in adults, it remains high in the differential
 diagnosis of almost any anorectal complaint.

 

 

Hemorrhoids colonoscopic view in retroflexed image.  Hemorrhoids colonoscopic view in retroflexed image. Enlarged (hypertrophied) papillae is observed . Hemorrhoids they are clusters of vascular tissue (eg, arterioles, venules, arteriolar-venular connections),  Hemorrhoids have 3 main cushions. These cushions are situated in the left lateral, right posterior, and right anterior areas of the anal canal. Minor tufts can be found between the cushions.

Video Endoscopic Sequence 2 of 5.

 Hemorrhoids colonoscopic view in retroflexed image.
 Enlarged (hypertrophied) papillae is observed
 Hemorrhoids they are clusters of vascular tissue
 (eg, arterioles, venules, arteriolar-venular connections),
 Hemorrhoids have 3 main cushions. These cushions are
 situated in the left lateral, right posterior, and right anterior
 areas of the anal canal. Minor tufts can be found between
 the cushions
.
 

Another image and video clip of internal hemorrhoids.  Although hemorrhoids are very common, their true prevalence is unknown. Their presence may be underestimated due to the large proportion of relatively asymptomatic patients. Conversely, many nonspecific anorectal symptoms can be reflexively, and falsely, attributed to hemorrhoids without the appropriate workup.

Video Endoscopic Sequence 3 of 5.

 Another image and video clip of internal hemorrhoids.

 Although hemorrhoids are very common, their true
 prevalence is unknown. Their presence may be
 underestimated due to the large proportion of relatively
 asymptomatic patients. Conversely, many nonspecific
 anorectal symptoms can be reflexively, and falsely,
 attributed to hemorrhoids without the appropriate workup.

This images observed that the hemorrhoids are congested with reddish color, that is the equivalent of the red sign of esophageal varices.  Hemorrhoids are one of the most frequent anorectal disorders encountered in the primary care settings. They are the most common cause of bleeding per rectum and are responsible for considerable patient suffering and disability. With the newer techniques of diagnosis and office-based interventions, most of the symptoms can be effectively controlled.

Video Endoscopic Sequence 4 of 5.

 This images observed that the hemorrhoids are congested
 with reddish color, that is the equivalent of the red sign of
 esophageal varices.

 Hemorrhoids are one of the most frequent anorectal
 disorders encountered in the primary care settings.
They
 are the most common cause of bleeding
per rectum and are
 responsible for considerable patient suffering
and disability.
 With the newer techniques of diagnosis and office-based
 interventions, most of the symptoms can be effectively
 controlled.

This colonoscopic view of internal hemorrhoids is appreciated using a magnifying colonoscope.

Video Endoscopic Sequence 5 of 5.

 This colonoscopic view of internal hemorrhoids is
 appreciated using a magnifying colonoscope.

 Most clinicians use the grading system proposed by Banov et al
 in 1985, which classifies internal hemorrhoids by their degree of
 prolapse into the anal canal. This system both correlates with
 symptoms and guides therapeutic approaches.

  • Grade I hemorrhoids project into the anal canal and often bleed but do not prolapse.
  • Grade II hemorrhoids may protrude beyond the anal verge with straining or defecating but reduce spontaneously when straining ceases.
  • Grade III hemorrhoids protrude spontaneously or with straining and require manual reduction.
  • Grade IV hemorrhoids chronically prolapse and cannot be reduced. They usually contain both internal and external components and may present with acute thrombosis or strangulation.
Rubber band ligation is the most effective nonoperative (without incision or excision) treatment for internal hemorrhoids.  Today, nonsurgical methods are an alternative to surgical ones.   Band ligation of internal hemorrhoids is a well-established and accepted office procedure.

Video Endoscopic Sequence 1 of 3.

 Rubber band ligation is the most effective nonoperative
 (without incision or excision) treatment for internal
 hemorrhoids.

 Rubber Band Ligation - This procedure involves placing a small
 rubber band at the base of the internal hemorrhoid. The band cuts
 off blood supply to the hemorrhoid, causing it to shrivel up and
 fall off in about four to seven days. We place two rubber bands
 for each hemorrhoid in a basis of one treatment every one week.

 Today, nonsurgical methods are an alternative to surgical
 ones.

 Band ligation of internal hemorrhoids is a well-established
 and accepted office procedure.

Endoscopic View of Rubber Band Ligation for Internal Hemorrhoids. The band causes the hemorrhoid to wither and drop off painlessly. The treatment is usually applied to one hemorrhoid at a time at intervals of 1 weeks or longer. Used only for Internal hemorrhoids.

Video Endoscopic Sequence 2 of 3.

 Endoscopic View of Rubber Band Ligation for Internal
 Hemorrhoids

 The band causes the hemorrhoid to wither and drop off
 painlessly. The treatment is usually applied to one
 hemorrhoid at a time at intervals of 1 weeks or longer.
 Used only for Internal hemorrhoids.

Retroflexed Image.    In 1954, Blaisdel invented the first automatic ligator of hemorrhoids, which was modified by Barron in 1962. From that time, the ligation of hemorrhoids is widely used as an alternative method for the treatment of internal symptomatic hemorrhoids and has replaced hemorrhoidectomy.

Video Endoscopic Sequence 3 of 3.

Retroflexed Image.

 In 1954, Blaisdel invented the first automatic ligator of
 hemorrhoids, which was modified by Barron in 1962. From
 that time, the ligation of hemorrhoids is widely used as an
 alternative method for the treatment of internal
 symptomatic hemorrhoids and has replaced
 hemorrhoidectomy.

Status Post Rubber Band for Internal Hemorrhoids.    RBL of hemorrhoids is a widely used method for the treatment of symptomatic hemorrhoids. Removal of the hemorrhoidal tissue, development of fibroconnective tissue at the point of the ligation, fixation of the mucosa and correction of the prolapse are achieved with this method.

Status Post Rubber Band for Internal Hemorrhoids.

 RBL of hemorrhoids is a widely used method for the
 treatment of symptomatic hemorrhoids. Removal of the
 hemorrhoidal tissue, development of fibroconnective tissue
 at the point of the ligation, fixation of the mucosa and
 correction of the prolapse are achieved with this method.

 

Status Post Rubber Band Ligation for Internal Hemorrhoids.  This 60 year-old lady who two days previously undergone a rubber band treatment for internal hemorrhoids, a colonoscopy was performed finding this image, immediately after the colonoscopy a second treatment was carry out.

Video Endoscopic Sequence 1 of 7.

 Status Post Rubber Band Ligation for Internal Hemorrhoids.

 This 60 year-old lady who two days previously undergone a
 rubber band treatment for internal hemorrhoids, a
 colonoscopy was performed finding this image, immediately
 after the colonoscopy a second treatment was carry out.

Retroflexed image and video clip.  Rubber band ligation is followed by a lower complication rate when performed in a single ligation.

Video Endoscopic Sequence 2 of 7.

Retroflexed image and video clip.

Rubber band ligation is followed by a lower complication rate when performed in a single ligation.

 

Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid.  Candidates for this method are patients with 2nd and 3rd degree hemorrhoids, although some authors consider RBL also suitable in appropriately selected cases of advanced hemorrhoidal disease.  cases with 4th degree hemorrhoids and permanent prolapse were also treated.

Video Endoscopic Sequence 3 of 7.

 Rubber band ligation is a procedure in which the
 hemorrhoid is tied off at its base with rubber bands, cutting
 off the blood flow to the hemorrhoid.

 Candidates for this method are patients with 2nd and 3rd
 degree hemorrhoids, although some authors consider RBL
 also suitable in appropriately selected cases of advanced
 hemorrhoidal disease, cases with 4th degree hemorrhoids
 and permanent prolapse were also treated.

Endoscopic Image of Rubber Band Ligation for Internal Hemorrhoids. The Second treatment with band that strangulated the hemorrhoids Five minutes after the second band has been applied, it is observed that the hemorrhoid started with necrosis signs, which is the result of the therapeutic success of this procedure.

Video Endoscopic Sequence 4 of 7.

 Endoscopic Image of Rubber Band Ligation for Internal
 Hemorrhoids

The Second treatment with band that strangulated the hemorrhoids

 Five minutes after the second band has been applied , it is
 observed that the hemorrhoid started with necrosis signs,
 which is the result of the therapeutic success of this
 procedure
.

Retroflexed image.  It is observed that the first hemorrhoid that was tied has a yellowih image(fibrin) and the second hemorrhoids is with little signs of necrosis.       Highlighting the efficacy and cost containment of hemorrhoidal ligation.

Video Endoscopic Sequence 5 of 7.

Retroflexed image.

It is observed that the first hemorrhoid that was tied has a yellowih image(fibrin) and the second hemorrhoids is with little signs of necrosis.

 Highlighting the efficacy and cost containment of
 hemorrhoidal ligation.

Rubber band ligation is a useful, safe and successful method for treating symptomatic 2nd and 3rd degree hemorrhoids, which can be applied successfully in selected cases with 4th degree hemorrhoids, but with an increased rate of recurrence and additional treatment requirements. Also,Rubber band ligation seems to be safe in patients with liver cirrhosis and portal hypertension.

Video Endoscopic Sequence 6 of 7.

 Rubber band ligation is a useful, safe and successful
 method for treating symptomatic 2nd and 3rd degree
 hemorrhoids, which can be applied successfully in selected
 cases with 4th degree hemorrhoids, but with an increased
 rate of recurrence and additional treatment requirements.
 Also,Rubber band ligation seems to be safe in patients with
 liver cirrhosis and portal hypertension.

 

Today, nonsurgical methods are an alternative to surgical ones. They aim at tissue fixation with or without tissue destruction (sclerotherapy, cryotherapy, photocoagulation, BiCAP, laser), or to fixation with tissue excision (rubber band ligation, RBL).

Video Endoscopic Sequence 7 of 7.

 Today, nonsurgical methods are an alternative to surgical
 ones. They aim at tissue fixation with or without tissue
 destruction (sclerotherapy, cryotherapy, photocoagulation,
 BiCAP, laser), or to fixation with tissue excision (rubber
 band ligation, RBL).

 

 Status post Rubber Band for Internal Hemorrhoids.  Rubber band ligation is the most-used remedy for grade II and grade III hemorrhoids and is the standard to which other methods are compared. A band ligature is passed through an anoscope and placed on the rectal mucosa proximal to the dentate line. The tissue necroses and sloughs off in 1-2 weeks, leaving an ulcer that later fibroses. No anesthesia is required; complications are uncommon and usually benign.

 Status Post Rubber Band for Internal Hemorrhoids.

 Rubber band ligation is the most-used remedy for grade II
 and grade III hemorrhoids and is the standard to which
 other methods are compared. A band ligature is passed
 through an anoscope and placed on the rectal mucosa
 proximal to the dentate line. The tissue necroses and
 sloughs off in 1-2 weeks, leaving an ulcer that later
 fibroses. No anesthesia is required; complications are
 uncommon and usually benign.

 

Status post rubber band treatment for internal hemorrhoids.  This 36 year-old female, who 3 years previously undergone 4 rubber bands treatment for internal hemorrhoids, several scar are seen at colonoscopy close to the dentate line.

Video Endoscopic Sequence 1 of 3.

Status post rubber band treatment for internal hemorrhoids

 This 36 year-old female, who 3 years previously undergone
 4 rubber bands treatment for internal hemorrhoids, several
 scar are seen at colonoscopy close to the dentate
line.

  

One scar is observed close to the dentate line.

Video Endoscopic Sequence 2 of 3.

One scar is observed close to the dentate line.

Retroflexed image, there are 4 scar.

Video Endoscopic Sequence 3 of 3.

Retroflexed image, there are 4 scar.

Third-degree hemorrhoids seen in the colonoscopy.  Third degree hemorrhoids prolapse but require "manual reduction.

Third-degree hemorrhoids seen in the colonoscopy.

 Third degree hemorrhoids prolapse but require "manual
 reduction.

 

Rubber Band Ligation. Rubber band ligation as showed in the image, the hemorrhoid has been strangulated.   Necrotizing pelvic sepsis is a rare, but serious, complication of rubber band ligation. The diagnosis is suggested by the triad of severe pain, fever, and urinary retention. It occurs 1-2 weeks after ligation, frequently in immune compromised patients, and requires prompt surgical debridement.

Rubber Band Ligation.

 Rubber band ligation as showed in the image, the
 hemorrhoid has been strangulated.

 Necrotizing pelvic sepsis is a rare, but serious, complication
 of rubber band ligation. The diagnosis is suggested by the
 triad of severe pain, fever, and urinary retention. It occurs
 1-2 weeks after ligation, frequently in
 immune compromised patients, and requires prompt
 surgical debridement.



                                        

Status Post Rubber Band Ligation.   The hemorrhoid has been strangulated as it can be observed in white color  necrosis.

 Status Post Rubber Band Ligation.

 The hemorrhoid has been strangulated as it can be
 observed in white color “necrosis”.

 Generally the hemorrhoids, after been legated it takes
 from two to seven days to become white in
color, meaning
 that it had “necrosis”.

                                         Medline.

Status Post Rubber Band Ligation.  Rubber band ligation, as the video clip shows, two hemorrhoids have been strangulated. This method is similar to variceal ligation of the esophagus see varices.

Status Post Rubber Band Ligation.

 Rubber band ligation, as the video clip shows, two
 hemorrhoids have been strangulated.

 This method is similar to variceal ligation of the esophagus
 see varices.

Status Post Rubber Band Ligation. Status post rubber band treatment, the rectum in retroflexed view. Two yellow ulcers are observed, which is the normal process after the hemorrhoids have been fallen out after necrosis.

Status Post Rubber Band Ligation.

 Status post rubber band treatment, the rectum in
 retroflexed view. Two yellow ulcers are observed, which is
 the normal process after the hemorrhoids have been fallen
 out after necrosis.

AnalFissure1

Video Endoscopic Sequence 1 of 2.

 Anal Fissure.

AnalFissure2

Video Endoscopic Sequence 2 of 2.

 Anal Fissure.

Anal Fissure. An anal fissure is a laceration in the lining of the anal canal distal to the dentate line, which most commonly occurs in the posterior midline and is often caused by local trauma such as the passage of hard stool. Anal fissures can occasionally be seen in patients with leukemia, tuberculosis, and Crohn's disease.

Anal Fissure.

 An anal fissure is a laceration in the lining of the anal
 canal distal to the dentate line, which most commonly
 occurs in the posterior midline and is often caused by
 local trauma such as the passage of hard stool. Anal
 fissures can occasionally be seen in patients with leukemia,
 tuberculosis, and Crohn's disease.

Enlarged (hypertrophied) papillae of the rectum.  In addition to the hypertrofied papillae, some internal hemorrhoids are observed, through the image in retroflexed view.

Enlarged (hypertrophied) papillae of the rectum.

 In addition to the hypertrofied papillae, some internal
 hemorrhoids are observed, through the image in retroflexed
 view.

  

Anal fissure Retroflexed Image.  An anal fissure is a small split or tear in the anal mucosa that may cause painful bowel movements and bleeding.  There may be blood on the outside of the stool or on the toilet tissue following a bowel movement.

Video Endoscopic Sequence 1 of 2.

 Anal fissure Retroflexed Image.

 An anal fissure is a small split or tear in the anal mucosa
 that may cause painful bowel movements and bleeding.
 There may be blood on the outside of the stool or on the
 toilet tissue following a bowel movement.

 

 Anal fissure. The image and the video clip is appreciated using an anoscope.

Video Endoscopic Sequence 2 of 2.

 Anal Fissure.

 The image and the video clip is appreciated using an
 anoscope.

 Anal Fissure. An anal fissure is a small tear or cut in the skin lining the anus which can cause pain and or bleeding.

  Anal Fissure.

 An anal fissure is a small tear or cut in the skin lining the
 anus which can cause pain and or bleeding.

 

Peri Anal Tuberculosis. Cutaneous manifestations of tuberculosis are exceptional.  In patients with protracted peri-anal ulceration, a biopsy should be performed that will show a typical tuberculoid granuloma. The most frequently encountered anorectal  tuberculous lesions are suppurations and fistulae. The main differential diagnosis is Crohn's disease with anorectal manifestations.

Peri Anal Tuberculosis.

 Cutaneous manifestations of tuberculosis are exceptional.
 In patients with protracted peri-anal ulceration, a biopsy
 should be performed that will show a typical tuberculoid
 granuloma. The most frequently encountered anorectal
 tuberculous lesions are suppurations and fistulae. The main
 differential diagnosis is Crohn's disease with anorectal
 manifestations.

 

 

 

Condyloma Acuminatum. Cauliflower-like projections. Extensive perianal condyloma acuminata.  This condition is generally caused by infection with human papillomavirus.  Condylomata can reach substantial size, and multiple lesions are common. If one lesion is present, a complete genital and anorectal examination is indicated to detect additional growths.

Condyloma Acuminatum.

Cauliflower-like projections.

 Extensive perianal condyloma acuminata. This condition is
 generally caused by infection with human papillomavirus.

 Condylomata can reach substantial size, and multiple
 lesions are common. If one lesion is present, a complete
 genital and anorectal examination is indicated to detect
 additional growths.

Perianal fistula. A perianal fistula, almost always the result of a previous abscess, is a small passage connecting the anal gland from which the abscess arose to the skin where the abscess was drained.

Perianal fistula.

 A perianal fistula, almost always the result of a previous
 abscess, is a small passage connecting the anal gland from
 which the abscess arose to the skin where the abscess was
 drained.

 

 Mucocutaneous folds. are seen above and fistulous tract below.

Mucocutaneous folds

 Mucocutaneous folds are seen above and fistulous tract
 below.


  
      

Internal Hemorrhoids. In the video clip you can observe the colonoscope in retroflexed maneuvering, passing across to the anus observing the colonoscopist.

Video Endoscopic Sequence 1 of 2.

Internal Hemorrhoids.

 In the video clip you can observe the colonoscope in
 retroflexed maneuvering, passing across to the anus
 observing the colonoscopist.

The colonoscopist (myself) is observing the colonoscope that has been removed by this route from the rectun and anus in retroflexed maneuver.

Video Endoscopic Sequence 2 of 2.

 The colonoscopist (myself) is observing the colonoscope
 that has been removed by this route from the rectun and
 anus in retroflexed maneuver.

Status after rubber band ligation of internal hemorrhoid.   The rubbers bands have strangulated the hemorrhoid, and ulcerated the mucosa, as a result of the treatment, which is normal. The complete cure of this status can be expected within average of 3 weeks for each hemorrhoid. You can get treatment by this method as an outpatient, one a weekly basis; that means one treatment each week This treatment is exclusive for internal hemorrhoids.

 Status after rubber band ligation of internal hemorrhoid.

 The rubbers bands have strangulated the hemorrhoid, and
 ulcerated the mucosa, as a result of the treatment, which is
 normal. The complete cure of this status can be expected
 within average of 3 weeks for each hemorrhoid. You can get
 treatment by this method as an outpatient, one a weekly
 basis
; that means one treatment each week
 This treatment is exclusive for internal hemorrhoids. 

Colonoscopic view of internal hemorrhoids, a status of after  rubber band ligation of internal hemorrhoid is seen.

Video Endoscopic Sequence 1 of 2.

 Colonoscopic view of internal hemorrhoids, a status of
 after rubber band ligation of internal hemorrhoid is seen.
     

Same case as above. Retroflexed image.

Video Endoscopic Sequence 2 of 2.

 Same case as above. Retroflexed image.
 

Hypertrophied Papillae. Large Anal hypertrophied papillae that introduced into the rectum.   The presence of Hypertrophied anal papillae and fibrous anal polyps are often ignored in the proctology practice. But the experience is that they tend to produce minor but disturbing symptoms.  Removal of hypertrophied anal papillae and fibrous polyps should be carried out as a routine during surgical treatment of anal fissure. This would add to effectiveness and completeness of the procedure.

Hypertrophied Papillae.

 Large Anal hypertrophied papillae that introduced into
 the rectum.
 The presence of Hypertrophied anal papillae and fibrous
 anal polyps are often ignored in the proctology practice.
 But the experience is that they tend to produce minor but
 disturbing symptoms.
 Removal of hypertrophied anal papillae and fibrous polyps
 should be carried out as a routine during surgical treatment
 of anal fissure. This would add to effectiveness and
 completeness of the procedure.

Endoscopic Image of Anal Fissure.

Video Endoscopic Sequence 1 of 4.

Endoscopic Image of Anal Fissure

Anal fissure Retroflexed Image.

 

AnALfISUREZX2

Video Endoscopic Sequence 2 of 4.

Anal fissure Retroflexed Image.

AnALfISUREZX3

Video Endoscopic Sequence 3 of 4.

Anal fissure Retroflexed Image.

AnALfISUREZX4

Video Endoscopic Sequence 4 of 4.

Anal fissure Retroflexed Image.

Magnifying Image

.

Prolapsed Hemorrhoid. Stage III - Internal hemorrhoids that bleed and prolapse with straining and require manual effort for replacement into the anal canal.

Video Endoscopic Sequence 1 of 4.

Prolapsed Hemorrhoid

 Stage III - Internal hemorrhoids that bleed and prolapse
 with straining and require manual effort for replacement
 into the anal canal.

 

Stage III - Internal hemorrhoid that Prolapsed internal hemorrhoids extend into the anal canal or through the anus, outside the anal sphincter; with these, pain usually ensues.    (If the internal hemorrhoid pushes out of the anal opening, this hemorrhoid is called a prolapsed hemorrhoid).

Video Endoscopic Sequence 2 of 4.

 Stage III - Internal hemorrhoid that Prolapsed internal
 hemorrhoids extend into the anal canal or through the anus,
 outside the anal sphincter; with these, pain usually ensues.

 (If the internal hemorrhoid pushes out of the anal opening, this
 hemorrhoid is called a prolapsed hemorrhoid).

 Third degree hemorrhoids prolapse but require "manual
 reduction.

 

Protrusion can occur with both internal and external varicosities; while some may regress spontaneously, others may require manual replacement. Other symptoms may include steady aching in the affected area, non-severe pain, soreness, discomfort, burning, swelling, mild inflam-mation, mucous discharge, and seepage.

Video Endoscopic Sequence 3 of 4.

 Protrusion can occur with both internal and external
 varicosities; while some may regress spontaneously, others
 may require manual replacement. Other symptoms may
 include steady aching in the affected area, non-severe pain,
 soreness, discomfort, burning, swelling, mild inflam-mation,
 mucous discharge, and seepage.

 

Retroflexed image.

Video Endoscopic Sequence 4 of 4.

Retroflexed image.

A fistula-in-ano is a hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Secondary tracts may be multiple and from the same primary opening.  Fistula-in-ano is nearly always caused by a previous anorectal abscess. Anal canal glands situated at the dentate line afford a path for infecting organisms to reach the intramuscular spaces. Other fistulae develop secondary to trauma, Crohn disease, anal fissures, carcinoma, radiation therapy,

Fistula-in-ano

 A fistula-in-ano is a hollow tract lined with granulation
 tissue connecting a primary opening inside the anal canal to
 a secondary opening in the perianal skin. Secondary tracts
 may be multiple and from the same primary opening.

 Fistula-in-ano is nearly always caused by a previous
 anorectal abscess. Anal canal glands situated at the
 dentate line afford a path for infecting organisms to reach
 the intramuscular spaces

 Other fistulae develop secondary to trauma, Crohn disease,
 anal fissures, carcinoma, radiation therapy.

The cryptoglandular hypothesis states that an infection begins in the anal gland and progresses into the muscular wall of the anal sphincters to cause an anorectal abscess. Following surgical or spontaneous drainage in the perianal skin, occasionally a granulation tissue–lined tract is left behind, causing recurrent symptoms. Multiple series have shown that the formation of a fistula tract following anorectal abscess occurs in 7-40% of cases.   Physical examination findings remain the mainstay of diagnosis. The examiner should observe the entire perineum, looking for an external opening that appears as an open sinus or elevation of granulation tissue. Spontaneous discharge via the external opening may be apparent or expressible upon digital rectal examination.

Fistula-in-ano

Pathophysiology

 The cryptoglandular hypothesis states that an infection
 begins in the anal gland and progresses into the muscular
 wall of the anal sphincters to cause an anorectal abscess.
 Following surgical or spontaneous drainage in the perianal
 skin, occasionally a granulation tissue–lined tract is left
 behind, causing recurrent symptoms. Multiple series have
 shown that the formation of a fistula tract following
 anorectal abscess occurs in 7-40% of cases.

 Physical examination findings remain the mainstay of
 diagnosis. The examiner should observe the entire
 perineum, looking for an external opening that appears as
 an open sinus or elevation of granulation tissue.
 Spontaneous discharge via the external opening may be
 apparent or expressible upon digital rectal examination.

 

Digital rectal examination may reveal a fibrous tract or cord beneath the skin. It also helps delineate any further acute inflammation that is not yet drained. Lateral or posterior induration suggests deep postanal or ischiorectal extension.   The examiner should determine the relationship between the anorectal ring and the position of the tract before the patient is relaxed by anesthesia. The sphincter tone and voluntary squeeze pressures should be assessed before any surgical intervention to delineate whether preoperative manometry is indicated. Anoscopy is usually required to identify the internal opening,

Fistula-in-ano

 Digital rectal examination may reveal a fibrous tract or
 cord beneath the skin. It also helps delineate any further
 acute inflammation that is not yet drained. Lateral or
 posterior induration suggests deep postanal or ischiorectal
 extension.

 The examiner should determine the relationship between
 the anorectal ring and the position of the tract before the
 patient is relaxed by anesthesia. The sphincter tone and
 voluntary squeeze pressures should be assessed before
 any surgical intervention to delineate whether preoperative
 manometry is indicated. Anoscopy is usually required to
 identify the internal opening
.

Trombosed hemorrhoids.  There are two hemorrhoids that are trombosed one is external and one is internal both are trombosed contain both internal and external components with acute thrombosis and  strangulation . Are hemorrhoids that have clotted on the inside of the anus (a ‘thrombus’). These clots form in the veins of the rectum just under the skin. External hemorrhoids can be seen and/or felt. Sometimes they are soft. Other times they are hard.

 Sequence 1 of 2.

Acute Trombosed hemorrhoids

This is the case of a 62 year-old male that during 12 years have been suffering from internal hemorrhoids grade III hemorrhoids protrude spontaneously and require manual reduction but never seek medical help, suddenly had an acute trombosed internal and external hemorrhoids .

 There are two hemorrhoids that are trombosed one is
 external and one is internal both are trombosed
contain
 both internal and external components with acute
 thrombosis and strangulation

 Are hemorrhoids that have clotted on the inside of the anus
 (a ‘thrombus’). These clots form in the veins of the rectum just
 under the skin. External hemorrhoids can be seen and/or felt.
 Sometimes they are soft. Other times they are hard.

 

Internal hemorrhoids drain through the superior rectal vein into the portal system.

 Sequence 2 of 2.

 Internal hemorrhoids drain through the superior rectal vein
 into the portal system. External hemorrhoids drain through
 the inferior rectal vein into the inferior vena cava. Rich
 anastomoses exist between these 2 and the middle rectal
 vein, connecting the portal and systemic circulations
.

Fistula-In-Ano: External opening of fistulus tract is apparent in photo above. Proximal opening would be at level of crypts, within the anal canal. Fistulas are frequently associated with perirectal abscesses,  though none are present in this case.

 Sequence 1 of 7.

Fistula in Ano

 Fistula-In-Ano: External opening of fistulus tract is apparent in
 photo above. Proximal opening would be at level of crypts,
 within the anal canal. Fistulas are frequently associated with
 perirectal abscesses, though none are present in this case.

Anal Fistulax2

 Sequence 2 of 7.

 

Anal Fistulax3

 Sequence 3 of 7.

 

Anal Fistulax4

 Sequence 4 of 7.

 

Anal Fistulax5

 Sequence 5 of 7.

 

Anal Fistulax6

 Sequence 6 of 7.

 

An anal fistula usually lasts until it is surgically removed. The fistula tract must be opened along with the source of the infection. Usually, tissue around the external opening and the internal opening is excised along with a small margin of tissue lining the tract, called a fistulotomy. Excision of the complete tract is called a fistulectomy.

 Sequence 7 of 7.

 An anal fistula usually lasts until it is surgically removed.
 The fistula tract must be opened along with the source of
 the infection. Usually, tissue around the external opening
 and the internal opening is excised along with a small
 margin of tissue lining the tract, called a fistulotomy.
 Excision of the complete tract is called a fistulectomy.

 

UlceratedHemorroid1

Video Endoscopic Sequence 1 of 4.

Ulcerated Internal Hemorrhoid

 This is the case of a 79 year-old male, who had several
 episodes of hematemesis, the hemoglobin drop until
 5.9 Gr./dl, the colonoscopy was negative.

 

UlceratedHemorroid2

Video Endoscopic Sequence 2 of 4.

Endoscopic Image of Ulcerated Internal Hemorroid

UlceratedHemorroid3

Video Endoscopic Sequence 3 of 4.

Video Endoscopic Image of Ulcerated Internal Hemorroid

UlceratedHemorroid4

Video Endoscopic Sequence 4 of 4.

Video clip of Ulcerated Internal Hemorroid