Operative surgery, for students and practitioners . margin of the anus, at the pointcorresponding to the blind external extremity of the fistulous tract,is usually marked by redness, induration, etc. An incision is madethrough the skin at this point, thus converting the sinus into a com-plete fistula, which is then treated as described above—the directoris introduced through the fistula into the rectum and the entirefistulous tract laid open. Hemorrhoids.—-External, or Itching, Piles present them-selves about the margin of the anal orifice outside, external to thesphincter; they consist of cut
Operative surgery, for students and practitioners . margin of the anus, at the pointcorresponding to the blind external extremity of the fistulous tract,is usually marked by redness, induration, etc. An incision is madethrough the skin at this point, thus converting the sinus into a com-plete fistula, which is then treated as described above—the directoris introduced through the fistula into the rectum and the entirefistulous tract laid open. Hemorrhoids.—-External, or Itching, Piles present them-selves about the margin of the anal orifice outside, external to thesphincter; they consist of cutaneous tags, which may be snippedoff with the scissors, the edges of the skin being then, if necessary,brought together with a single suture. Occasionally they contain 556 RECTUM. a varicosed vein which may be thrombosed or ruptured. These pilesare often very painful. They may be laid open, the clot turned out,,and the edges of the skin brought together with a single catgutsuture. Frequently a fissure is located at the base of one of these ex-. Fig. 247.—Operation for Hemorrhoids. An hemorrhoidal mass is seized withthe clamp and a collar cut in its base, all around, through the mucous mem-brane. The edges of the incision are pushed up and the pile drawn down, soas to obtain a pedicle of some length. ternal tags, or piles, and it is therefore wise, in all these cases, tostretch the sphincter before removing the pile. Intkeinal, or Bleeding, Piles.—These are located entirelywithin the anus, only appearing externally when the patient strains,or bears down. They may be extruded and caught in the grasp ofthe external sphincter and become strangulated. When the patient OPERATIONS UPON THE AXUS AND RECTUM. 557 strains they may appear as one or more fairly well defined mass consists of one or more arterial twigs and a bunch ofdilated, pouched, varicosed veins covered over by mucous membranewhich may be normal in appearance or may be more or less ulcerated.
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