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Massarat Zutshi
Editor
Anorectal Disease
Contemporary
Management
123
Anorectal Disease
Massarat Zutshi
Editor
Anorectal Disease
Contemporary Management
Editor
Massarat Zutshi
Department of Colorectal Surgery
The Cleveland Clinic Digestive Disease Institute
Cleveland , Ohio , USA
ISBN 978-3-319-23146-4 ISBN 978-3-319-23147-1 (eBook)
DOI 10.1007/978-3-319-23147-1
Library of Congress Control Number: 2015954574
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2016
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.
Printed on acid-free paper
Springer International Publishing AG Switzerland is part of Springer Science+Business Media
(www.springer.com)
This book is dedicated to all my teachers, from my parents Mr. Tajammul Hussain
and Ms. Shahazamani Hussain who taught me to successfully deal with adversity
and believed in my dreams, to my teachers in medical school and residency,
especially Dr. A R Undre and Dr. H R Manchanda in India who imparted their
knowledge unselfi shly in at a time when there was no internet and to my teachers
at the Cleveland Clinic especially Dr. V W Fazio, Dr. I Lavery, Dr. S Strong and
Dr. J Wu. The book is also dedicated to my husband Chiranjiv Zutshi who is
always teaching me life’s lessons, my brother Anjum Hussain who counsels me on
all topics and now my new teacher in this the modern world, my son Samir Zutshi.
F o r e w o r d
The management of anorectal disease dates back over several millennia and continues
to represent a challenge for both the patient and the physician. The earliest known
reference to these disorders is seen in the Edwin Smith Surgical Papyrus that originated in 3000–2500 BCE when practitioners like the high priest Pepyankh, known as
Iry, served as the Pharaohs’ palace physician and chief of the medical corps. He was
also an important specialist and bore the titles of “one understanding the internal fl uids” and “guardian of the anus.” In that era, the only mentioned treatment was an
ointment derived from Acacia leaves that was applied to linen strips and placed within
the anus. More than 1000 years later, the Ebers Papyrus showed that the management
of these anorectal disorders had only slightly progressed as 33 prescriptions or recipes
were detailed. In addition to cathartics, enemas, liniments, and ointments, suppositories containing cinnamon, cumin, cuttlebone, frankincense, juniper, honey, myrrh, and
yellow ochre were “to be put in the hinder part” as a remedy for “burning in the anus”
or in an attempt “to heal the anus when it is ill.”
Operations for anorectal disorders were not mentioned until the Greek physician
Hippocrates of Kos (460–370 BCE) extensively wrote about them during the Age
of Pericles as evidenced by his dissertations “On Hemorrhoids” and “On Fistula.”
He discussed hemorrhoid inspection using a speculum, treatment with topical therapies, and surgical management that instructed the physician to “make the irons redhot, and burn the pile until it be dried up, and so as that no part may be left behind.”
His essay about fi stula-in-ano described drainage of an abscess “while still unripe,
before it suppurate and burst into the rectum” as well as the use of fi stulotomy and
cutting setons comprised of “a very slender thread of raw lint” wrapped “with a
horse hair.”
During the Middle Ages, Sainte Fiacre (unknown–670) became the patron saint
for hemorrhoid sufferers, but little else changed until Master John of Ardene (1307–
1380), who is considered by many to be a founder of modern-day surgery, used his
inventive skills to introduce new and lasting surgical techniques, especially those
used for the management of fi stula-in-ano that endure today. Moreover, Ardene
challenged his peers to question dogma and adopt best-practice behavior.
Much interest over the ensuing centuries was focused on other areas (e.g., rectal
cancer, stomas, traumatic injuries), but this began to change when Frederick Salmon
(1796–1868) founded an institution with seven beds on London’s Aldersgate
Street in 1835 for the “poor affl icted with fi stula and other diseases of the rectum.”
vii
viii
Foreword
This was the beginning of St. Mark’s Hospital established in 1854. Surgeons from
around the globe came to London to learn from the pioneers working at St. Mark’s
Hospital. Among these visitors was Joseph M. Mathews (1847–1928) who returned
to the USA to publish an extensive treatise on “Diseases of the Rectum, Anus, and
Sigmoid Colon” as well as serve as the inaugural president of the American
Proctologic Society that later evolved into the American Society of Colon and
Rectal Surgery.
This brief overview of the historical management of anorectal diseases underscores the signifi cant role these disorders have played in the fi eld of colon and rectal
surgery. In this book, Dr. Massarat Zutshi has fashioned a comprehensive review of
the subject that includes several issues our forefathers never encountered or imagined. Each author was carefully selected for her or his thoughtful approach and
clinical experience related to the assigned topic. Furthermore, Dr. Zutshi’s editing
of the book draws from her own acumen based on decades of professional practice
and innovative research dedicated to treating patients with both benign and malignant anorectal disorders. The completed product should serve as a resource for surgeons, physicians, trainees, and students with an interest in the management of
patients affl icted with anorectal diseases. Furthermore, as advocated by Master John
of Ardene centuries ago, the book encourages the reader to abandon unproven
dogma, embrace contemporary evidence-based approaches, and prepare for future
developments.
Chicago , IL , USA Scott A. Strong
Pref ace
Learning has always been a choice borne out of the desire for knowledge, which is a
powerful tool. Teaching, however, has been an obligation upon us from the time we
begin to receive knowledge. Teaching is an art form that is within all of us but perfected
by only those who wish to share their love of learning. In today’s world of instant
access, knowledge is a few clicks away and can come from various sources, some of
which may not be from “experts” in their fi eld. In order to assimilate this knowledge,
the topic to be learnt has to be presented in such a way that it not only imparts the
knowledge but also sparks the interest to be taught again to another student.
I have been the recipient of such “sparks” in my student life and beyond, but
those that impacted me most are those that I use daily and that include the knowledge of the medical sciences. True teachers give not to receive and impart their
wisdom fi lled with emotion. Such knowledge creates a permanent place in a student’s mind and comes forth when needed.
This book is the fruit of devotion of such teachers who took upon topics of anorectal disease which is essential not only to the medical student and resident but also to
the practitioner who wants to go beyond the call of treating illnesses that are considered treatable based on their daily practice. This book is also for the new and practicing colorectal surgeon who has in-depth knowledge of many life-threatening diseases
but may have paid little attention to what may be a common condition in a daily
practice requiring patience and the knowledge of anatomy to successfully treat it.
Anorectal disease affects every population, race, ethnicity, and gender. It can be simple to diagnose and miss or complicated to treat even by the experts. Herein lies the
charm for our expert teachers to simplify these topics such that they not only can be
informative to the reader but also can be the source to make decisions of when they can
treat and when the sufferer needs the attention of those with the expertise to treat them.
The authors have made a concerted effort to make most chapters case based with
discussions that make reading this topic, which is vast for the small anatomical area it
represents, easy to understand. There have been many books on this topic. This book
aims to update the current knowledge, and the authors have taken time to make it easy
to read and understand and to guide patients. The authors are from many countries to
make this book as comprehensive as possible, yet simple to read and understand.
Cleveland, OH, USA Massarat Zutshi, MD
ix