Iv413

Hemorrhoid No More

Natural Treatments to get rid of Hemorrhoids

Get Instant Access

peritoneum covering the anterior rectal wall, loss of posterior fixation of the rectum to the sacral curve, and lengthening and downward displacement of the sigmoid and rectum ( Fig. 30-4 ). Other changes, possibly resulting from the descent of a full-thickness rectal prolapse, include diastasis of the levator ani and an incompetent anal sphincter mechanism.

That intussusception was the mechanism for development of rectal procidentia can be attributed to Devadhar.[

Figure 30-4 A, Normal relationship of rectum to pelvic structures. B, Earliest stage of intussusception (prolapse) just proximal to uppermost normal fixed point of rectum. C, Fixed point lowers. Upper rectum is separated from sacrum. Intussusception commencement assumes lower position, and sigmoid mesentery elongates. Pseudomesorectum may develop. Rectosigmoid beings to straighten. D, Further lowering of fixed point. Previous changes become exaggerated. Cul-de-sac deepens, and rectum may or may not protrude. E, Area of hesitation (variable time lengths). Rectum may or may not protrude. F, Final stage of intussusception (prolapse). Commencement occurs at mucocutaneous border. There is a deep cul-de-sac (may contain small bowel), elongated sigmoid mesentery, and straight rectosigmoid. The rectum and sacrum are separated. The rectum is protruded completely. (From Theuerkauf, F.J., Beahrs, O.H., and Hill, J.R.: Rectal prolapse: Causation and surgical treatment. Ann. Surg., 171:819, 1970. Used with permission.)

Figure 30-6 Upper and lower edges of implant approximated by linen sutures. Note 1-cm gap anteriorly and the formation of a gutter. (From Morgan, C.N.: Operation for complete prolapse of the rectum. In Maingot, R. [ed]: Abdominal Operations, ed. 6, Vol. 2. New York, Appleton-Century-Crofts, 1974. Used with permission.)

Figure 30-6 Upper and lower edges of implant approximated by linen sutures. Note 1-cm gap anteriorly and the formation of a gutter. (From Morgan, C.N.: Operation for complete prolapse of the rectum. In Maingot, R. [ed]: Abdominal Operations, ed. 6, Vol. 2. New York, Appleton-Century-Crofts, 1974. Used with permission.)

Figure 30-7 A, Prolapsed rectum completely protruded. Point a (visceral peritoneum of the rectum) and point b (area of parietal peritoneum for proposed rectal attachment) are widely separated. B, Prolapsed rectum replaced, showing rectum in advanced position, proposed incision, and bowel to be resected. C, Subsequent suspension and fixation produced by joining visceral and parietal peritoneum after rectal advancement, bowel resection, excision of excess cul-de-sac, and anastomosis. (From Theuerkauf, F.J., Beahrs, O.H., and Hill, J.R.: Rectal prolapse: Causation and surgical treatment. Ann. Surg., 171:819, 1970. Used with permission.)

Was this article helpful?

0 0
Reasons, Remedies And Treatments For Heartburns

Reasons, Remedies And Treatments For Heartburns

Find Out The Causes, Signs, Symptoms And All Possible Treatments For Heartburns!

Get My Free Ebook


Post a comment