Chapter 5

++

Principle

++

Compression and tamponade of the anal canal in case of acute distal hemorrhage as bridging for stabilization until definitive assessment or procedure is possible (Figure 5–1).

++
Figure 5–1.
Graphic Jump Location

Balloon tamponade of the anal canal.

++

Setting

++

Where needed, when no immediate access to OR.

++

Alternatives

++

Examination and surgical hemostasis in OR.

++

Indication

++

Massive hemorrhage (postsurgical, spontaneous hemorrhoidal, or Dieulafoy hemorrhage).

++

Preparatory Considerations

++

None.

++

Surgical Steps

++

  • 1. Patient positioning: any position.
  • 2. Insertion of largest available Foley catheter into anal canal.
  • 3. Insufflation of balloon with 60 mL of water/saline.
  • 4. External traction on catheter to allow balloon to exert pressure on anal canal.
  • 5. Placement of external pad pack (gauze, towels) around catheter (external counter pressure).
  • 6. Placement of hemostat clamp to catheter (under tension) at level of external packing.

++

Anatomic Structures at Risk

++

Anal canal.

++

Aftercare

++

Hemodynamic stabilization, monitoring.

++

Antibiotic coverage as long as balloon in place.

++

Maximal length of tamponade: 24 hours.

++

Plan for definitive surgical care.

++

Complications

++

Continued bleeding, anal canal necrosis, infection.

++

Cross-Reference

++ ++ ++ ++ ++ ++ ++
++

Principle

++

Decompression of perirectal abscess to allow resolution of acute inflammation and pressure (pain!). Management of fistula only of secondary priority: if I&D is performed under general anesthesia, excision of the cryptoglandular origin and definitive fistula procedure may be reasonable, but there is increased risk of creating tracts that are not truly there (inflamed tissue).

++

Setting

++

Outpatient, office (or inpatient, bedside/OR procedure in selected cases).

++

Alternatives

++

Nonoperative management: generally not indicated except if abscess spontaneously perforated.

++

Modified Hanley procedure for horseshoe abscess.

++

Indication

++

Every perirectal abscess.

++

Preparatory Considerations

++

Clinical assessment, ie, pain and local inflammatory signs; do not wait for fluctuance in perirectal area. Neither WBC nor imaging studies are needed (except in very unusual circumstances).

++

In all patients receiving general anesthesia: at least rigid sigmoidoscopy.

++

Surgical Steps

++

  • 1. Patient positioning: any ...

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