Anal and Rectal Diseases: A Concise Manual

274 Pages·2012·7.71 MB·English

by  Eli D. Ehrenpreis MD

Anal and Rectal Diseases

Eli D. Ehrenpreis Shmuel Avital Marc Singer
● ●
Editors
Anal and Rectal Diseases
A Concise Manual
Editors
Eli D. Ehrenpreis, MD Marc Singer, MD
Chief of Gastroenterology and Endoscopy NorthShore University Health System
Highland Park Hospital Department of Surgery
Medical Director, Center for the Study of Division of Colon and Rectal Surgery
Complex Diseases Evanston, IL, USA
NorthShore University Health System
Clinical Associate Professor of Medicine
University of Chicago Medical Center
Highland Park, IL, USA
Shmuel Avital, MD
Chief of Surgery
Department of Surgery B
Meir Medical Center
Kfar-Saba, Israel
ISBN 978-1-4614-1101-7 e-ISBN 978-1-4614-1102-4
DOI 10.1007/978-1-4614-1102-4
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011939744
© Springer Science+Business Media, LLC 2012
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I would like to express my gratitude to my wife Ana for her encouragement, to my
children Benjamin, Jamie, and Joseph for their understanding, and to my parents,
Bella and Seymour for bringing academics and scholarship to my world.
Eli D. Ehrenpreis, MD
I would like thank my wife, Michal, for her ongoing support since I was a medical
student and her understanding of the time commitments involved in academia
beyond the obvious time needed for clinical practice.
Shmuel Avital, MD

Preface
Anorectal pathology is common in the general population. Understanding the
pathophysiology, diagnosis, and treatment of diseases of the anus and rectum is
often quite a challenge for physicians and other healthcare providers. There are
many barriers to achievement of high quality care for these conditions. Patients may
be embarrassed to admit to anorectal symptoms. Specifi c education about diseases
of the anus and rectum may be limited among primary treating physicians depending
on the institution where training takes place. Of most importance from the author’s
standpoint, a short book that connects together anorectal anatomy and pathophysi-
ology with medical and surgical treatment of anorectal disease is needed by many
in the medical fi eld.
In creating A nal and Rectal Diseases: A Concise Manual , my surgical coeditors
and I have worked diligently to fulfi ll the aforementioned unmet need. The style of
the book was developed to communicate the most important information on each
topic in brief, therefore making the book useful for reference and review. Studying
a specifi c chapter will give the reader an accurate overall picture of each subject.
We have also included many fi gures to aid the reader in their understanding of the
presented material. By adding detailed information about surgeries performed for
these conditions, it is our hope that practitioners who are not surgeons will develop
a deeper understanding of these procedures, their indications, their benefi ts to the
patient as well as their potential complications.
Throughout the book, we have included “clinical pearls,” generally summarizing
important aspects of the preceding short chapter. These small pieces of insight are
selected by choice of the individual section authors. They may represent the author’s
opinion based on experience rather than pure evidence from technical literature
about the topic. We believe that despite tremendous advances in the scientifi c appli-
cation of medical knowledge, clinical experience, refl ected in the practitioner’s art,
remains a vital dynamic in the complete care of a patient.
Highland Park, IL Eli D. Ehrenpreis, MD
Kfar-Saba, Israel Shmuel Avital, MD
Evanston, IL Marc Singer, MD
vii

Introduction
Anorectal disorders are among the most common problems encountered in primary
care practice. These maladies include a wide array of benign and malignant
conditions effecting patients of all ages spanning the pediatric to the geriatric groups.
Patients frequently present to their primary care provider with such diverse disor-
ders such as fi stula and abscess, fi ssure and stenosis, anal and rectal carcinoma,
condylomata acuminata and sexually transmitted diseases, and hemorrhoids. In
addition, symptoms ranging from pruritis ani to painless rectal bleeding are cause
for analysis by the primary care provider. Due to the prevalence of these problems
the primary care provider and trainee require access to a comprehensive, clear, and
concise volume to help them with the evaluation and management of these issues.
There are a plethora of volumes available to assist the practitioner with the manage-
ment of anorectal disorders. However, very few of these books are written from the
point of view of a gastroenterologist. As surgeons we occasionally, or perhaps
routinely, become myopically focused upon a myriad of surgical terminology,
descriptions of methodology, and illustrations of techniques.
Therefore, it was very refreshing for me to read some of the chapters in
Dr. Ehrenpreis and his coeditors’ new book which offer an alternative gastroentero-
logic perspective on anorectal disorders. The descriptive methods as well as the
diagnostic and therapeutic modalities described will be very clinically relevant for
the practicing internist, family practitioner, and gastroenterologist as well as the
trainees in those areas. I am absolutely confi dent that this book will be a welcome
additional to the clinical library of many primary care practitioners and trainees and
as such I highly commend it to gastroenterologists, family practitioners, internists,
and interns, residents, and fellows in those specialties who evaluate and manage
patients with diseases of the anus and rectum. Given the frequency of such disor-
ders, I can safely recommend this book to all of these practitioners and their respec-
tive trainees. I congratulate Dr. Ehrenpreis, Dr. Singer, and Dr. Avital for having
gathered this information and arranged and presented it in such an easy to follow
manner. I am also honored that they have asked me to write this introduction.
Weston, FL Steven D. Wexner , MD
ix