Hemorroidal disease

Hemorrhoids are a common condition in adult population with prevalence of about 4%. Only a third of patients with symptomatic hemorrhoids seek medical help. The annual rate of office visits for hemorrhoids is 12 for every 1000 patients in the United States. Hemorrhoids consist of connective tissue cushions surrounding direct arteriovenous communication. They can cause bleeding, pain and itching but other anorectal diseases should be ruled out. Current guidelines recommend a minimum of anoscopy and flexible sigmoidoscopy for bright-red rectal bleeding...

In the treatment of hemorroidal prolapse, stapled hemorrhoidopexy, according to the Longo's technique, represents an innovative and interesting procedure. The Authors consider own experience in the years 2001-2002, estimating preliminary results in the treatment of 50 patients affected by hemorrhoidal disease classified as III-IV grade, associated with mucosal prolapse, rectocystocele in 5 cases, anal fissures in 6 and hyperplastic polyp in 1. The patients were submitted to mucosal prolapsectomy with mechanical stapler (PPH 01-33 Ethicon), applying haemostatic stitch on suture line, apart from intraoperative bleeding, associated to closed anal sphincterotomy in 6 cases, and resection of anal hyperplasic polyp in 1...

Second reason for consultations in proctology in our department after hemorroïds-linked illnesses, fistulas in ano constitute a chronic disease which causes therapeutic difficulties linked mainly to the futur functionning of the sphincter, especially in its most complex types. In our group of 43 patients in whom surgical exploration with stylet was the key of the diagnosis, the anorectoscopy and even less chirurgical examination were not often contributive, the fear of post-operative incontinence forced us to prefer ligation-section with rubber every time that the sphincter was involved...

Thrombosed external hemorrhoids (TEH) and anal fissure (AF) are 2 frequent sources of anal pains during childbirth. We are going to define their incidences as available in publications and in our experience in Bichat hospital. Then we will define their risk factors. According to Martin's and Corby's studies, AF was observed in 10% of the delivered women. In Bichat hospital we performed a proctological assessment to 165 pregnant women during the last third of pregnancy and within the 2 months following delivery...

The prevalence of anoperineal diseases, i.e. sexual transmitted infections, is increasing particularly in AIDS, a fact which is likely due to the alteration of mucosal immunity. However, no data were available on normal anal status. In order to study anal immunity in man, we characterized lymphocytes subtypes and Langerhans' cells (LC) using quantitative morphometric analysis and immunohistochemistry. Anal normal mucosal samples obtained from surgical specimens of 45 patients (30 suffering from hemorrhoids and 15 from fissurations) were analyzed...

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The authors report on a case of anorectal tuberculosis. Revealed by an hemorroïdal thrombosis with febrile symptoma and purulent discharge, its macroscopic aspect was the one of anal mucous membrane ulceration, irregular with elevated border. The diagnosis was confirmed by anatomopathologic exam. The course was favourable under specific treatment. Etiologic investigation did not show any other localisation. Then, present aspects of anorectal tuberculosis are discussed, as well as possible relationships with hemorroïdal disease and its complications, particularly the fissural ones...

Analysing the results of 1,000 procto-sigmoidoscopies done in Bamako (Mali), the authors asses the major indications of this examination in Africa: rectal biopsy is quite efficient for the diagnosis of schistosomiasis; hemorroides and proctitis are frequent while tumors seem rare.

Rectopexy associated with anterior prolepsectomy was performed for 22 patients (19 females, 3 males), with solitary rectal ulcer syndrome (SRUS) surrounding internal rectal prolapse. The different lesions of SRUS were distributed among 3 main groups (G) according to the macroscopic appearance: G1: solitary ulcer (n = 7); G2: ulcerated proctitis (n = 7); G3: muco-hemorroidal prolapse (n = 3). A significant difference (P less than 0.05) was observed between each group, concerning mean age (G1: 34 years, G2 = 49, G3: 65) and the degree of perineal descent, which was more important in G3 and G2...

The investigators report the clinical and pathologic features of 19 cases of intraepithelial neoplasia occurring in the anal canal mucosa of routinely excised hemorrhoidal tissue, a condition that has been infrequently described. The patients were 12 women and seven men having an age range of 21 to 74 years (mean, 48 years). Two patients had coexistent anogenital condylomata acuminata. Leukoplakia of the hemorrhoidal surface was noted in two patients. Intraepithelial neoplasia arose in the transition zone of the anal canal of 11 cases, in the squamous zone of three cases, and in both sites of five cases...

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