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Rectum And Anus

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Rectum and anus Celso M. Fidel, MD, FPCS, FPSGS Diplomate Philippine Board of Surgery
Embryology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Embryology ,[object Object],[object Object]
Embryology ,[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object]
Anatomy ,[object Object],[object Object]
Anatomy ,[object Object]
ARTERIAL SUPPLY MCA IMA SMA LCA SRA Sig. A ICA RCA
Marginal artery of Drummond
Blood Supply ,[object Object],[object Object]
Venous Drainage ,[object Object],[object Object],[object Object]
LYMPHATIC DRAINAGE
lymphatic drainage ,[object Object],[object Object]
lymphatic drainage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
lymphatic drainage ,[object Object]
Anorectal Landmarks ,[object Object],[object Object],[object Object],[object Object]
ANORECTAL ANATOMY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anorectal Landmarks ,[object Object],[object Object],[object Object]
Anorectal Landmarks ,[object Object],[object Object]
Anorectal Landmarks ,[object Object],[object Object]
Anorectal Landmarks ,[object Object],[object Object],[object Object],[object Object],[object Object]
THE ANORECTUM VALVES OF HOUSTON DENTATE LINE ANAL SPHINCTERS ANAL VERGE HEMORRHOIDAL Plx.
Anorectal Vascular Supply ,[object Object],[object Object]
Anorectal Vascular Supply ,[object Object],[object Object]
ARTERIAL SUPPLY MCA IMA SMA LCA SRA Sig. A ICA RCA
Anorectal Vascular Supply ,[object Object],[object Object],[object Object],[object Object]
Anorectal Vascular Supply ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anorectal Vascular Supply ,[object Object],[object Object],[object Object]
Anorectal Vascular Supply ,[object Object],[object Object],[object Object]
Anorectal Nerve Supply ,[object Object],[object Object],[object Object]
Anorectal Nerve Supply ,[object Object]
Anorectal Nerve Supply ,[object Object],[object Object]
Anorectal Nerve Supply ,[object Object],[object Object],[object Object]
congenital anomalies ,[object Object],[object Object]
Motility, Defecation, and Continence ,[object Object],[object Object],[object Object]
Motility, Defecation, and Continence ,[object Object],[object Object],[object Object],[object Object],[object Object]
Motility, Defecation, and Continence ,[object Object],[object Object],[object Object]
Motility, Defecation, and Continence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Motility, Defecation, and Continence ,[object Object],[object Object],[object Object],[object Object],[object Object]
Motility, Defecation, and Continence ,[object Object],[object Object],[object Object],[object Object]
Motility, Defecation, and Continence ,[object Object],[object Object],[object Object],[object Object]
Motility, Defecation, and Continence ,[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object]
Clinical Evaluation ,[object Object],[object Object],[object Object]
laboratory studies ,[object Object],[object Object],[object Object],[object Object],[object Object]
laboratory studies ,[object Object],[object Object]
laboratory studies ,[object Object],[object Object]
laboratory studies ,[object Object],[object Object]
laboratory studies ,[object Object],[object Object]
laboratory studies ,[object Object],[object Object]
laboratory studies ,[object Object],[object Object]
laboratory studies ,[object Object],[object Object]
laboratory studies ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object],[object Object]
evaluation of common symptoms ,[object Object],[object Object],[object Object]
General Surgical Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
POLYPS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RECTAL POLYPS SESSILE PEDUNCULATED
CASE: MULTIPLE COLORECTAL POLYPS CLINICAL PRESENTATION BARIUM ENEMA
CASE: MULTIPLE COLORECTAL POLYPS LOCATION OF COLORECTAL POLYPS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CASE: POST- SURGICAL RESECTION
INFLAMMATORY BOWEL DISEASE ,[object Object],[object Object],[object Object],[object Object]
INFLAMMATORY BOWEL DISEASE ,[object Object],[object Object],[object Object],[object Object]
INFLAMMATORY BOWEL DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INFLAMMATORY BOWEL DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANORECTAL DISEASES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Right Anterior Right Posterior Left Lateral 3 MAJOR PILES
HEMORRHOIDAL DISEASE A P L R Primary Locations 3-7-11 o’clock positons (Left Lateral, Right Anterior and Right Posterior)
HEMORRHOIDAL DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HEMORRHOIDAL DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object]
Retrograde View from Colonoscopy Hemorrhoids
Hemorrhoids: Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hemorrhoidectomy Rubber Band Ligation Harmonic Scalpel
Hemorrhoidectomy Stapler Technique Ferguson or Excision
Anorectal Abscess and F i stula ,[object Object],[object Object],[object Object],[object Object]
Anorectal Abscess and F i stula ,[object Object],[object Object],[object Object],[object Object],[object Object]
Salmon Goodsalls rule: Anterior - straight tracts Posterior- curved tracts Exception: > 3cm curved Fistula in Ano
Fistula in Ano
COMPLICATED FISTULA IN ANO
Anal Fissure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fissure in Ano
Anal Fissure ,[object Object],[object Object],[object Object],[object Object]
Incidence of Cancer-Philippines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colorectal Carcinoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colorectal Carcinoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Colorectal Carcinoma
Distribution of Cancer : Left side total = 81 %
narrowing
Modified Dukes’ Classification ,[object Object],[object Object],[object Object],[object Object],[object Object]
Colorectal Cancer Dukes' Classification / Survival(5 years) ,[object Object],[object Object],[object Object],[object Object]
Survival By TNM ,[object Object],[object Object],[object Object],[object Object]
Colorectal Cancer-Screening ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colorectal Cancer-Screening ,[object Object],[object Object],[object Object],[object Object],[object Object]
Colorectal Cancer-Screening ,[object Object],[object Object],[object Object],[object Object]
Proctosigmoidoscopy
Colonoscopy
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Colorectal Carcinoma / Screening
 
Synchronous and Metachronous CA ,[object Object],[object Object]
Colorectal CA-Clinical Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Colorectal CA Clinical Presentation ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RECTAL CANCER ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
TNM Staging of Colorectal Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Colorectal Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colorectal Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Is there any role for surgery in patients with liver metastasis? In highly selected patients with less than four metastasis and no evidence of any other disease ( no local recurrence or further metastasis )
[object Object],[object Object]
Colostomy
[object Object],[object Object],[object Object],[object Object],[object Object],ANAL CANCER
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