Anorectal Disease

Author: Janet Skinner / Editor: Adrian Boyle / Reviewer: Emma Everitt, Mohamed Elwakil / Codes: Published: 26/09/2022

This session covers the diagnosis, management and treatment of anorectal conditions that commonly present to the emergency department.

After completing this session you will be able to:

  • Describe the causes of anorectal pain and bleeding that commonly present to the emergency department
  • Perform an assessment of a patient who presents with an anorectal condition
  • Institute appropriate emergency department management for patients with anorectal conditions
  • Make appropriate admit/discharge decisions and arrange appropriate follow-up in patients with anorectal conditions
  • Describe the medical and surgical management of common anorectal conditions

References:

  1. Coates WC. Anorectum. In: Wall R, Hockberger R, et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th edn. Elsevier. 2022.
  2. Burgess BE, Bouzoukis JK. Anorectal disorders. In: Tintinalli JE, Kelen GD, Stapczynski JS et al, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 6th edn. New York: McGraw-Hill, 2003.
  3. Acheson A G, Scholefield J H. Management of haemorrhoids BMJ 2008; 336 :380.
  4. Dunlop M. Anorectal conditions. In: Garden OJ, Bradbury AW, Forsythe JLR et al, eds. Principles and Practice of Surgery. 5th edn. Edinburgh: Churchill Livingstone, 2007:332-340.
  5. Nelson RL. Treatment of anal fissure. BMJ. 2003 Aug 16;327(7411):354-5.
  6. Greenhalgh R, Cohen C R, Burling D, Taylor S A. Investigating perianal pain of uncertain cause. BMJ 2008; 336 :387
  7. National Institute for Health and Care Excellence. Haemorrhoids. NICE CKS. Revised: 2021.
  8. Alonso-Coello P, Guyatt G, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev. 2005 Oct 19;2005(4):CD004649.
  9. Nelson RL, Thomas K, Morgan J, Jones A. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD003431.
  10. Lumb KJ, Colquhoun PH, et al. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006 Oct 18;2006(4):CD005393.
  11. Nelson RL, Chattopadhyay A, Brooks W, Platt I, Paavana T, Earl S. Operative procedures for fissure in ano. Cochrane Database Syst Rev. 2011 Nov 9;2011(11):CD002199.
  12. McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006213.

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