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Anus
Richard Cohen
Alastair Windsor
Editors
Surgical Treatment
and Pathology
123
Anus
Richard Cohen • Alastair Windsor
Editors
Anus
Surgical Treatment and Pathology
ISBN 978-1-84882-090-6 ISBN 978-1-84882-091-3 (eBook)
DOI 10.1007/978-1-84882-091-3
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2013957354
© Springer-Verlag London 2014
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. Exempted from this
legal reservation are brief excerpts in connection with reviews or scholarly analysis or material
supplied specifi cally for the purpose of being entered and executed on a computer system, for
exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is
permitted only under the provisions of the Copyright Law of the Publisher's location, in its
current version, and permission for use must always be obtained from Springer. Permissions for
use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable
to prosecution under the respective Copyright Law.
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.
While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility
for any errors or omissions that may be made. The publisher makes no warranty, express or
implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (
www.springer.com)
Editors
Richard Cohen, MD, FRCS
Department of GI Surgery
University College London Hospitals
London
UK
Alastair Windsor, MD, FRCS
(Lon, Ed, Glas)
Department of GI Surgery
University College London Hospitals
London
UK
For our wives Madeleine Cohen and Lily Windsor
vii
The reader might wonder why another textbook on the anus is needed. There
are three main reasons. First anal disease is exceedingly common in all parts
of the world. Secondly treatment is effective in most cases, but when surgery
is performed badly the patient can be disastrously and often irreversibly
worse. Thirdly new developments in the understanding and treatment make
proctology a dynamic fi eld for research and its application to management.
The book is not on colon and rectal surgery but rather on proctology in
which anal pathology is set within the context of wider disease where rele-
vant. “ Anus ” is edited by two internationally known and experienced sur-
geons who have themselves contributed to knowledge in the fi eld through
research, publications and teaching. They have brought together authors from
all over the world, who are recognized practitioners in the fi eld. The reader is
given an accurate account of the normal structure and function of the anus
including clinical and radiological anatomy and physiology. The importance
of histopathology is dealt with in a chapter dedicated to diagnosis and the
subsequent chapters then follow from congenital anomalies to neoplasia, pro-
lapse, incontinence, haemorrhoids, fi ssure and anorectal sepsis. There is a
section on dermatological conditions and sexually transmitted disease with
the book ending with an account of plastic procedures around the anus.
Every attempt has been made to incorporate new information regarding
etiology, diagnosis and treatment to give the reader an up-to-date account of
the subject. The use of Tables and Boxes to present data makes the book easy
to read. Many of the chapters contain high quality photographs to illustrate
diseases particularly those due to dermatological and sexual transmission.
The chapters on radiological pathological anatomy contain excellent illustra-
tions which are very useful since they summarise the various pathological
forms of anorectal sepsis and prolapse, enabling the reader to learn the radio-
logical counterpart of clinical examination . Each chapter contains a useful
bibliography which will in itself be a valuable resource enabling the reader to
gain access to the literature including classic publications and recent
developments.
The book will be valuable for consultant practitioners in proctology, but it
will also help colorectal surgeons, gastroenterologists, trainees, specialist
nurses and students who are interested in increasing their knowledge. Proctology
is in many ways still a largely clinical speciality and the theme throughout the
F o r e w o r d
viii
book implicitly recognizes this while at the same time it demonstrates where
investigations are either essential or likely to help clinical decision taking. It is
an authoritative, informed and up-to-date contribution to an important area of
disease.
John Nicholls, MA(Cantab), M.Chir, FRCS(Eng),
EBSQ(Coloproctology), hon FRCP(Lond), hon FACS,
hon FRCSE, hon FRCS(Glasg), hon ASCRS,
hon ACPGBI, hon ESCP, hon BSG
Emeritus Consultant Surgeon,
St. Mark’s Hospital, London, UK
Professor of Colorectal Surgery,
Imperial College, London, UK
Foreword
ix
Contents
1 The Normal Anus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Alexis M.P. Schizas and Andrew B. Williams
2 Anorectal Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Jonathan Gosling and Anton Emmanuel
3 Imaging the Normal Anus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Michael J. Steward, Steve Halligan, and Stuart A. Taylor
4 Surgical Treatment and Pathology: Normal Histology . . . . . . 43
Ruma Saraswati and Marco Novelli
5 Congenital Abnormalities of the Anus. . . . . . . . . . . . . . . . . . . . 49
Nigel J. Hall and Edward M. Kiely
6 Premalignant Conditions of the Anus . . . . . . . . . . . . . . . . . . . . 61
James Crosbie, Jonathan McCullough, and Paul Boulos
7 Malignant Conditions Including Squamous
Cell Carcinoma and Rare Cancers. . . . . . . . . . . . . . . . . . . . . . . 71
Sarah W. Grahn, Mary R. Kwaan, and Robert D. Madoff
8 Rectocele Pathophysiology and Presentation . . . . . . . . . . . . . . 91
Karen P. Nugent
9 Rectocele Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Bruno Roche
10 Incontinence: Causes and Pathophysiology. . . . . . . . . . . . . . . . 107
Jonathan Randall and Ridzuan Farouk
11 Incontinence Assessment: Physiology and Imaging . . . . . . . . . 115
Mostafa Abdel-Halim
12 Surgical Treatments for Incontinence . . . . . . . . . . . . . . . . . . . . 133
Marylise Boutros, Marc C. Osborne, and Steven D. Wexner
13 Haemorrhoids: Anatomy, Pathophysiology
and Presentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Ayesha Noorani and Emin Carapeti
14 Operative Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Antonio Longo, Adolfo Renzi, and Francesco Prete