. Diseases of the rectum and anus: designed for students and practitioners of medicine. unavoidably follows as healing takes place. As the ulcerationencroaches upon the anus, both sphincters may be destroyed;the anus becomes patulous and surrounded by a broad, dark 334 DISEASES OF THE RECTUM AND ANUS ring, with several club-shaped tags of skin hanging about themargins. These tags of discolored skin and the patulous con-dition of the sphincter are always indicative of serious rectaldisease. Rectal ulcers of the perforating variety may causethe formation of a recto-vesieai or recto-urethral fist
. Diseases of the rectum and anus: designed for students and practitioners of medicine. unavoidably follows as healing takes place. As the ulcerationencroaches upon the anus, both sphincters may be destroyed;the anus becomes patulous and surrounded by a broad, dark 334 DISEASES OF THE RECTUM AND ANUS ring, with several club-shaped tags of skin hanging about themargins. These tags of discolored skin and the patulous con-dition of the sphincter are always indicative of serious rectaldisease. Rectal ulcers of the perforating variety may causethe formation of a recto-vesieai or recto-urethral fistula. DIAGNOSIS The diagnosis of rectal ulceration is, in most cases, easilymade when a correct history can be obtained and a carefulexamination has been made. It is much more difficult, how-ever, to determine the character of the ulceration. Syphilitic and chancroidal ulcers are usually elongated andlissure-like, especially in old cases. Tubercular ulceration ischaracterized by its tendency to extend, the sharply-defined,undermined edges of the ulcers, the presence of miliary tuber-. Fig. 101.—Kelseys Rectal Retractor. cles in and around the lesions, and the detection of tuberclebacilli in the tissues and discharges. In malignant ulcerationthe ulcers are usually extensive and very deep, extremely pain-ful, and secondary to the breaking down of indurated deposits. When any doubt exists as to the number, size, and loca-tion of rectal ulcers, these points can be cleared up by closelyinspecting the anus and rectum by means of the finger, re-tractor (Fig. 101), speculum, or proctoscope. Some idea ofthe location of the ulcer may be had from the character of thepain. If situated in the upper rectum, there is but little pain;but, if located low down or within the grasp of the sphincter,pain is intense. PROGNOSIS Many practitioners consider rectal ulceration a trivialatTection and easy to cure. It is true that traumatic ulceration NON-MALIGNANT ULCERATION AND ESTHIOMENE 335 will, in t
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
