Anorectal emergencies

Abstract

Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.

Keywords: Anorectal; Emergencies; Hemorrhoid; Fissure; Abscess; Rectal prolapse; Sepsis; Complication; Sexually transmitted disease; Imperforate anus; Rectal cancer

Core tip: Anorectal emergencies refer to anorectal disorders presenting with acute symptoms and signs which might require an immediate management. Anorectal emergencies usually include acutely thrombosed external hemorrhoid, complicated internal hemorrhoid, anal fissure, irreducible rectal prolapse, anorectal sepsis, sexually transmitted proctitis, obstructing rectal cancer and early complications after anorectal procedures. A detailed history taking, careful physical examination including digital rectal examination and anoscopy, and some radiological imaging are essential for correct diagnosis and plan of treatment. Clinicians should be familiar with these conditions especially anorectal sepsis which could be potentially lethal if delay in diagnosis and management.