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Introduction Anal pain is defined as pain originating from the anal canal or the perianal area that can be attributed to a variety of medical problems. The current study's aim was to evaluate the role of combined endoanal, transperineal, and in married women, transvaginal ultrasound in clarifying the etiology of anal pain among our patient study group. Methodology A total of 180 patients presented to our radiology department complaining of anal pain and were examined using transperineal, endoanal, and in women, transvaginal ultrasound aided with three-dimensional capability. The final diagnosis was reached, according to the surgical results and the histopathology reports in cases diagnosed with anorectal neoplasms and perianal masses. Results A total of 100 patients were diagnosed with perianal fistulas. Twenty-five cases presented with anal abscesses. In four cases, pilonidal sinus extended to the perianal spaces. Three cases had hiradenitis suppurativa, 13 cases showed occult anal sphincter defects, two cases had anorectal neoplasms, and one case was diagnosed with soft tissue ependymoma overlying the coccyx. Three cases were diagnosed with perianal soft tissue masses. One case was detected with recto vaginal fistulas, 10 cases showed thick internal anal sphincter, two cases had perianal cysts, and one case had perianal hematoma. Two cases showed hemorrhage in Douglas' pouch, and one case had pelvic collection sequelae of perforated pelvic appendicitis. Three cases had pelvic endometriosis; one case was detected with missed contraceptive device in the rectum. Three cases were diagnosed with prostatitis and two cases with prostatic abscesses. Two cases had prostatic carcinoma and one case had prostatic sarcoma. Conclusion The combined approaches of endoanal, transperineal, and in women, transvaginal ultrasound aided with three-dimensional capability proved highly valuable in clarifying the etiology of anal pain in our study group.

A perianal hematoma is a localized collection of blood outside of blood vessels under the skin located around the border of the anus. Perianal hematomas can present over a short period of time and be extremely painful. The main symptom is pain and the swelling around the anus. Pain can range from mild to severe depending on the size of swelling that can be treated through Jalaukavacharana, a para surgical procedure in Ayurveda.Jalaukavacharana i.e. blood- letting by Jalauka is used in a variety of inflammatory conditions especially when Pitta Dosha is vitiated and gets lodged in the blood. Its mode of action depends on the injection of leech saliva into patient's tissues during the process of bloodsucking. Leech saliva contains bioactive constituents which possess anti-inflammatory, analgesic, thrombolytic, vasodilator, anti-coagulant and blood circulation enhancing properties. The aim of the study is to evaluate the effect of Jalaukavcharana (Leech Therapy) in the Perianal hematoma. A 42-year male patient having complains of pain and swelling in perianal region diagnosed as perianal hematoma in Shalya OPD of GAC Nagpur. Treatment of choice was Jalaukavacharana with three sittings given at alternate days and it was found to be very effective in Perianal Hematoma.

Background: Increasing incidence of haemorrhoids in population consuming diet rich in calories, low in fibre, spicy food, tropical climate and other known factors has led to development of new techniques for haemorrhoid treatment. The aim of study is to compare pros and cons of haemorrhoidectomy with stapler v/s enseal. Methods: A prospective randomized trial was conducted on a total of 240 patients having 3rd and 4th degree haemorrhoids, divided into two groups of 120 each during 2012-2014 at NIMS Medical College and Hospital, Jaipur, India. Pre-operative complaints (bleeding P/R, rectal/perianal pain, mass coming out of anus), operative and post-operative outcomes, operative time, post-operative pain, bleeding, urinary retention, faecal/flatus incontinence, thrombosis of external haemorrhoids/perianal hematoma, anal/rectal stenosis, wound problems and recurrence were assessed. Results: Average operating time was 1.5 times in Stapler Haemorrhoidectomy(SH) v/s Enseal Haemorrhoidectomy (EH), average hospital stay, recovery time and total analgesics required during 5 POD was almost 0.5 in SH v/s EH. Post-operative complications like bleeding, urinary retention, faecal/flatus incontinence, anal discomfort, rectal/anal stenosis and wound infection were found significantly less in SH v/s EH. Residual skin tags prolapse and recurrence was almost three times in SH v/s EH. Conclusions: Both SH and EH are probably equally valuable techniques in modern haemorrhoid surgery. However Enseal has an advantage because ease of technique, but SH is a better technique with over all better outcomes.

We present a new surgical stapling technique for treatment of rectocele when associated with internal mucosal prolapse or haemorrhoids using only one circular mechanical stapler. Eight female patients, mean age 53 years (range, 42-70), complaining of obstructed defecation with vaginal digitation because of rectocele associated with internal mucosal prolapse underwent transanal repair of rectocele and rectal mucosectomy using one circular stapler between April and July 2004. A running horizontal mattress suture was placed through the base of the rectocele including mucosa, submucosa and the muscle layer of the whole anterior anorectal junction wall. The prolapsed mucosa and the muscular layer were then excised with an electrical scapel. A continuous pursestring rectal mucosa suture was placed 0.5 cm before the previous anterior mucosa and muscle layers resected wound, including the anorectal junction wall which was kept separate from the posterior vaginal wall by a Babcock forceps. Posteriorly, the pursestring suture included only mucosal and submucosal layers. The stapled suture was positioned between normal anterior rectal wall and the anal canal, 0.5 cm above the pectinate line. The stapler was then closed, fired and withdrawn. One patient complained of a perianal hematoma on the seventh postoperative day, requiring surgical excision. Postoperative defecography showed correction of the rectocele and outlet obstruction disappeared in all patients. This novel combined manual-stapled technique for rectocele and rectal internal mucosal prolapse seems to be a safe procedure and the preliminary results are encouraging. Further investigations have to be performed to assess long-term outcome in a larger number of patients.

PURPOSE: The aim of the study was to investigate the usefulness of the contrast agent Levovist® in ultrasound assessment of anal fistula. METHODS: Fifteen patients (11 females, mean age 46) with a diagnosis of anal fistula were assessed by physical examination, conventional ultrasound, Levovist®-enhanced ultrasound, and surgery. Levovist® was injected via a cannula into the fistula. The results of physical examination, conventional ultrasound and Levovist®-enhanced ultrasound were compared with surgical findings as criterion standard. RESULTS: At physical examination, three intersphincteric fistulas and two sinuses were diagnosed. Using conventional ultrasound, five intersphincteric and five transsphincteric fistulas were found; four fistulas and one sinus were not detected. Levovist®-enhanced ultrasound revealed one sinus, five intersphincteric, seven transsphincteric, and one extrasphincteric fistulas; only one fistula was not detected. At surgery, three intersphincteric, seven transsphincteric, and two sinuses were found; however, the extrasphincteric fistula detected by Levovist® was missed. Compared with physical examination, Levovist®-enhanced ultrasound and surgery were significantly favorable in the diagnosis of anal fistula (P < 0.05 in chi-squared test and Fisher’s exact probability test). The concordance rate of surgery with conventional ultrasound was 69 percent (9/13) and with Levovist®-enhanced ultrasound was 77 percent (10/13). However, because the extrasphincteric fistula was missed at surgery, the accuracy of Levovist®-enhanced ultrasound was in fact 85 percent (11/13) if surgical finding was not used as the standard. The internal opening was detected at physical examination in 2 patients (13 percent), with conventional ultrasound in 4 patients (27 percent), with Levovist®-enhanced ultrasound in 9 patients (60 percent) and during surgery in 11 patients (85 percent). Consistently, Levovist®-enhanced ultrasound and surgery were significantly better than physical examination in the diagnosis of internal opening (P < 0.05). One secondary extension and two sphincter defects were detected by both types of ultrasound. The extension was not confirmed during surgery. No patients developed recurrence or nonhealing of wound. One patient developed incontinence to flatus and one developed a perianal hematoma. CONCLUSION: Levovist®-enhanced ultrasound is better at assessing anal fistula than physical examination and conventional ultrasound. However, a future trial comparing Levovist®, hydrogen peroxide, and magnetic resonance imaging is needed to establish which is the most cost-effective preoperative imaging technique to use.

A case of ruptured common iliac artery aneurysm is reported. The patient presented with a perianal hematoma and had undergone repair of a leaking abdominal aortic aneurysm seven years previously. The presentation and man agement are discussed.

A retrospective group of 100 patients with pathologically diagnosed thrombosed hemorrhoids and a prospective group of 30 patients with acute thrombosed hemorrhoids were studied. Thromboses had not been recognized clinically in 55 of 100 retrospective cases. The following conclusions were made: 1) All thrombosed hemorrhoids in the study were intravascular. Although the possibility of perianal hematoma cannot be excluded entirely, it is not the usual situation, and was not seen in this study; 2) There appears to be no systemic hypoor hypercoagulable state or bacterial cause of the thromboses. Focal hypercoagulability must be considered. A mechanism of thrombogenesis is postulated, based on stasis and local trauma and subsequent activation of the extrinsic clotting system; 3) Immediate operative intervention appears to be the best available treatment; 4) All patients were treated by classical radical closed hemorrhoidectomy, with no postoperative wound infection.

SIGNS and symptoms in a patient with ruptured aneurysm of the abdominal aorta vary, according to the site of the rupture, which may occur into the free peritoneal cavity, into the small bowel, most commonly the duodenum, into the inferior vena cava1 2 3 or into the sigmoid mesocolon. In the case reported below, a rapidly expanding hematoma, which followed rupture of an aortic aneurysm, dissected posteriorly to the sigmoid colon, through the pelvic wall, between the levators and, and appeared around the anus as a perianal hematoma. This sign, if early detected and properly considered may lead to the correct diagnosis . . .