Editorial
Copyright ©The Author(s) 2016.
World J Gastroenterol. Jul 14, 2016; 22(26): 5867-5878
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.5867
Table 1 Technical notes for urgent hemorrhoidectomy
Preoperative intravenous antibiotics
Surgery under general anesthesia, regional anesthesia, or intravenous sedation plus perianal infiltration of local anesthetic agent(s)
Prone jackknife position
Manual reduction of prolapsing hemorrhoids
Compression of hemorrhoids to reduce edema
During an operation, use of large-diameter anoscope e.g., Fansler anoscope
Anoderm or mucosa-sparing hemorrhoidectomy (preferably semi-closed technique)
Allowance of at least 1-cm mucosal bridge between surgical wounds and at least 50% of good circumferential mucosa
Use of long-lasting absorbable sutures e.g., polyglactin 910 for mucosal approximation
If applicable, instead of hemorrhoidectomy, plication of hemorrhoid may be applied to small lesions
Oral postoperative antibiotics against anaerobes for 1 wk
Table 2 Diagnosis and treatment of common infectious organisms causing sexually transmitted proctitis (by the frequency of occurrence)
Disease (causative organism)Common symptoms and signsSuggested investigationsRecommended first line treatment
Chlamydia (Chlamydia trachomatis serovars D-K)Commonly asymptomatic, mild proctitis, cervicitis, vaginitis, urethritisNucleic acid amplification test (NAAT) from rectal, endocervical or urethral swab specimensAzithromycin 1 g orally in a single dose
OR
Doxycycline 100 mg orally twice a day for 7 d
Gonorrhea (Neisseria gonorrhoeae)Lower abdominal pain, diarrhea, rectal bleeding, tenesmus, purulent rectal discharge, urethral discharge and/or pharyngeal infectionGram stain (Gram-negative diplococci) and bacterial culture from anogential and pharyngeal swabCeftriaxone 250 mg IM in a single dose
PLUS
Azithromycin 1 g orally in a single dose
Herpes simplex virus (Herpes simplex virus)Painful multiple vesicular or ulcerative lesions at perianal skin and anal canal, painful defecation, feverViral culture or polymerase chain reaction (PCR) from vesicular lesionsAcyclovir 400 mg orally three times a day for 7-10 d
OR
Acyclovir 200 mg orally five times a day for 7-10 d
Syphilis (Treponema pallidum)Depending on the stage of infection - Primary syphilis: painless ulcers or chancre in the anorectal regionDarkfield examination and test to detect T. pallidum from lesion exudate or tissueBenzathine penicillin G 2.4 million unit IM in a single dose
Secondary syphilis: maculopapular rash, condyloma lata, snail-track ulcer and mucous patch at the rectum, lymphadenopathyOR
Ceftriaxone 1-2 g either IV or IM for 10-14 d
OR
Doxycycline 100 mg orally twice a day for 14 d
Lymphogranuloma venereum (Chlamydia trachomatis serovars L1, L2 and L3)Anal pain, mucous or bloody rectal discharge, anorectal ulcer, fever, inguinal or femoral lymphadenopathyCulture, direct immunofluorescence or nucleic acid detection form rectal lesion and lymph node specimenDoxycycline 100 mg orally twice a day for 21 d
OR
Erythromycin base 500 mg oral four times a day for 21 d
Table 3 Common anorectal disorders presenting with delay or failure to pass meconium in the neonates
DiagnosisRateCommon physical findingsSuggested investigation: expected findingsInitial management
Meconium plug syndrome1/500-1000Abdominal distension, normal anus and anal sphincter complexContrast enema radiologic examination: meconium plug in colonRectal stimulation with finger or saline enema
Hirschsprung’s disease1/4000Abdominal distension, tight anal sphincter, empty rectum, sudden evacuation of stool on digital rectal examination if “transitional zone” is reachedContrast enema radiologic examination without colonic preparation: transitional zone separating aganglionic segment and dilated proximal colonIntravenous hydration, gastric decompression, rectal washout with warm saline, and consider colostomy in high-grade obstruction and intravenous board-spectrum antibiotics in those with suspected diagnosis of Hirschprung-associated enterocolitis
Imperforate anus (IA)1/5000Absence or stenosis of anus, perineal fistula (low IA), meconium in urine (rectourinary fistula: low or high IA), flat or not well formed median raphe (high IA), cloaca (high IA), VACTERL anomalies1Inverted lateral radiography (invertography) or transperineal ultrasonography: differentiation between low IA and high IAAnal or fistula dilatation for temporary relief of obstruction and plan for elective posterior sagittal anorectoplasty (low IA), loop sigmoid colostomy (high IA or some low IA)
- Low IA = distal rectal pouch lining below or at the puborectalis muscle
- High IA = distal rectal pouch lining above the puborectalis muscle