Perirectal

Ulcerative colitis Fever, tachycardia (with severe disease), dehydration, arthritis, hemorrhoids, anal fissures, perirectal abscesses... 

N, Metastasis in one to three pericolic or perirectal lymph nodes... 

Local complications (involving the colon) occur in the majority of ulcerative colitis patients. Relatively minor complications include hemorrhoids, anal fissures, or perirectal abscesses. 

As with ulcerative colitis, the presentation of Crohn s disease is highly variable (Table 26-4). A single episode may not be followed by further episodes, or the patient may experience continuous, unremitting disease. A patient may present with diarrhea and abdominal pain or a perirectal or perianal lesion. 

In females, the short length of the urethra and proximity to the perirectal area make colonization of the urethra likely. Bacteria are then believed to enter the bladder from the urethra. Once in the bladder, the organisms multiply quickly and can ascend the ureters to the kidney. 

Stage II disease involves tumor invasion through the muscularis propria into the subserosa, or into the nonperitonealized pericolic or perirectal tissues (T3) or directly invading other organs or structures and/or perforates the visceral peritoneum (T4) and negative lymph nodes. 

Common complications of IBD include rectal fissures, fistulas (Crohn s disease), perirectal abscess (ulcerative colitis), and colon cancer, in addition to hepatobiliary complications, arthritis, uveitis, skin lesions (including erythema nodosum and pyoderma gangrenosum), and aphthous ulcerations of the mouth. 

Ulcerative colitis can be accompanied by complications that may be local (involving the colon or rectum) or systemic (not directly associated with the colon). With either type the complications may be rmld, serious, or even life threatening. Local complications occur in the majority of ulcerative colitis patients. Relatively minor complications include hemorrhoids, anal fissures, or perirectal abscesses, and are more likely to be present during active colitis. Enteroenteric fistulas are rare. 

Hemorrhoids, anal fissures, or perirectal abscesses may be present... 

To Tumor invades through the muscularis propria into the subserosa, or into nonperitonealized pericolic or perirectal tissues... 

Antibiotics can be used as either (1) adjunctive treatment along with other medications for active IBD (2) treatment for a specific complication of Crohn s disease or (3) prophylaxis for recurrence in postoperative Crohn s disease. Metronidazole, ciprofloxacin, and clarithromycin are the antibiotics used most frequently. They are more beneficial in Crohn s disease involving the colon than in disease restricted to the Ueum. Specific Crohn s disease-related complications that may benefit from antibiotic therapy include intra-abdominal abscess and inflammatory masses, perianal disease (including fistulas and perirectal abscesses), small bowel bacterial overgrowth secondary to partial small bowel obstruction, secondary infections with organisms such as Clostridium difficile, and postoperative complications. Metronidazole may be particularly effective for the treatment of perianal disease. Postoperatively, a 3-month course of metronidazole (20 mg/kg/day) can prolong the time to both endoscopic and clinical recurrence. 

Lynch et al. ° described an FAP patient who developed rectal carcinoma 15 months after beginning chemoprophylaxis with sulindac. There was metastatic adenocarcinoma in 6 of 20 perirectal lymph nodes. In addition to the carcinoma, her rectal mucosa contained two adenomas and multiple foci of adenomatous changes in flat mucosa. It was concluded that, while sulindac may alter the pathogenesis of FAP, those patients undergoing sulindac chemoprevention must be monitored closely by endoscopic examination. This surveillance should include an aggressive biopsy approach, since the absence of polyps does not prove the absence of malignant neoplastic changes. 

The physical examination in patients with gastric adenocarcinoma is nsnally normal. In advanced disease, a palpable abdominal mass, hepatomegaly, or ascites may be present. Lymph nodes may be palpated at the umbilicns (Sister Mary Joseph s node) or the supraclavicular region (Virchow s node). A perirectal mass may occur, with tumor deposition in the rectal pouch (Blumer s shelf), and palpable ovarian enlargement may occur with tumor seeding as well (Krukenberg tumor). 

Fig. 7.9. An 8-year-old boy with a perirectal appendiceal abscess. The image shows the needle positioned, using ultrasound guidance, through the posterior rectal wall within the abscess (courtesy of Dr. L. Fontalva, Hospital for Sick Children, Toronto, Canada)...

Transrectal sonography can directiy demonstrate whole layers of the rectal wall (Fig. 15.7) and thus make it possible to assess the depth of tumor infiltration. A tumor mass can be imaged clearly by water instillation (Kim et al. 2004). Tumor infiltration onto the muscularis mucosae, submucosa, proper muscle layer, and infiltration onto the perirectal fat can be assessed (Fig. 15.8). The accuracy has been reported as being 81-91% (Kim et al. 2004 Marusch et al. 2002 Bipat et al. 2004). Locoregional lymph node metastasis can be depicted the accuracy was reported as being 64-88% (Schaffzin and Wong 2004). 

Our option Outer connective tissue lamella of the rectal adventitia, bordering the perirectal compartment... 

What is situated outside the rectal fascia and therefore outside the perirectal subcompartment Dorsally, the presacral subcompartment is loosely attached to the perirectal compartment (see above). Laterally the supplying structures (autonomic nerves and branches of the iliac vessels) of the urogenital organs constitute a nerve-vessel plate (Fig. 1.3c). The latter is accompanied by connective tissue and fills the remaining space between the perirectal compartment... 

The ventral border of the perirectal compartment represents the border between posterior and middle compartment. It differs in a craniocaudal direction, i. e. to the peritoneum of the recto-uterine pouch at a level with the cervix uteri and the fornix vaginae and to the posterior wall of the vagina more caudally. As we have recently shown [ 1,24,36] a two layered recto-... 

Fig. 1.3a-c. Perirectal tissue (asterisks), a Axial section (5 mm) of an adult female. xO.45. b Axial MR image of an adult female. c Axial section (400 [xm) of a 24-week old female fetus. X5. nvp, nerve vessel plate r, rectum... 

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