Fecal incontinence is the involuntary passage of fecal material. It may be a single occurrence, but when recurrent, incontinence can be devastating. Several surveys indicate that fecal incontinence may occur in 7% to 15% of the population. It is more frequent in women than in men. In acutely ill hospital patients, the rate of fecal incontinence is as high as 33% to 43%. It is the…

Lymphogranuloma venereum (LGV) and sexually transmitted proctitis are relatively uncommon in the general population, occurring more often in male homosexuals and promiscuous heterosexuals. Certain infections are typically seen when proctitis is identified in a patient with a history of promiscuous sexual activity ( Table 106.1 ). LGV is rare but leads to a pathologic condition that can be confused with other granulomatous diseases ( Fig. 106.1…

Localized infection with a collection of pus in the anorectal area is designated an anorectal abscess. Usually, it results from the invasion of the normal rectal flora into the perirectal or perianal tissues. The pathologic process seems to start with inflammation of one or more of the crypts (see Chapter 104 ), spreads to the anal ducts and anal glands, and then spreads submucosally, subcutaneously, or…

Anal Fissure Anal fissure is a tear of the skin in the distal anal canal, usually in the posterior midline ( Fig. 104.1 ). Occasionally, it is in the anterior midline. When not in the midline, anal fissure is often associated with an abnormality such as Crohn disease, human immunodeficiency virus (HIV) infection, tuberculosis, syphilis, or anal malignancy. Fissures usually are acute but may become chronic.…

Prolapse of the rectum is a condition in which one or more layers of the rectum or anal canal protrudes through the anal orifice ( Fig. 103.1 ). It can be partial or complete. Partial prolapse involves only the mucosa, which usually extends no more than to 1 inch (2.5 cm) outside the anal canal. Procidentia is total prolapse, involving all the layers of the rectum. The…

Hemorrhoids are varicose dilatations of the radicals of the superior or inferior plexus of the hemorrhoidal veins. Varicosities are accompanied, in varying degrees, by hypertrophy and round cell infiltration of the perivascular connective tissue. Approximately 50% of the population is affected. Hemorrhoids usually develop in persons between 25 and 55 years of age, and they seldom develop in children. Factors in hemorrhoid formation include (1) genetic…

Rectal cancer appears to be a different disease than colon cancer. Mortality from rectal cancer in the United States is slowly decreasing, even though the incidence is slowly increasing. This indicates that early detection and treatment of rectal polyps may be preventing the formation of malignant lesions. Furthermore, there appears to be an epidemiologic difference between rectal and colon cancer, because the incidence of rectal cancer…

Gastrointestinal (GI) polyposis is the presence of multiple polypoid lesions in the GI tract ( Fig. 100.1 ). Numerous syndromes have now been classified ( Box 100.1 ). Open full size image Fig. 100.1 Familial Polyposis of the Large Intestine. Box 100.1 Modified from Feldman M, Friedman LS, Brandt LJ, editors: Gastrointestinal and Liver Disease, ed 10, Philadelphia, 2016, Saunders-Elsevier, p 2214. Gastrointestinal Polyposis Syndromes Inherited…

Colon Polyps A colon polyp is any elevation of the colon mucosal surface ( Fig. 99.1 ). It may be of any size, sessile or pedunculated, and benign or malignant. Benign polyps are categorized as neoplastic, nonneoplastic, and submucosal. Neoplastic polyps are usually considered premalignant, and most are adenomas. Adenomas may be classified histologically as tubular, tubulovillous, or villous. The polyp may demonstrate low-grade or high-grade…

Microscopic colitis is a syndrome in which patients have (1) chronic diarrhea, (2) normal findings on colonoscopy and a normal-appearing mucosa, (3) histologic evidence of increased cellular infiltrate in the lamina propria, and (4) either (a) full-blown lymphocytic colitis with intraepithelial lymphocytes and increased infiltrate in the lamina propria or (b) collagenous colitis with a collagen band below the epithelium larger than 10 mm ( Fig. 98.1…

Pharmacologic agents used for the treatment of inflammatory bowel disease (IBD) are similar for both ulcerative colitis (UC) and Crohn disease, with two major differences. Rectally instilled topical agents are effective in UC, but usually not in Crohn disease, and certainly not in Crohn ileitis. Nutritional therapy, such as the use of elemental and polymeric diets for the induction of remission, has been effective in Crohn…

Anorectal Crohn disease may consist of fissures, ulcers, abscesses, fistulae, strictures, edematous skin tags, and benign skin tags ( Fig. 96.1 ). The overall prevalence is 36%, but it is 46% when the colon is involved and only 25% when the small bowel is involved. Often, one of these lesions may appear before there is evidence of intestinal disease. Open full size image Fig. 96.1 Crohn…

Crohn disease is a transmural inflammation of the gastrointestinal (GI) tract characterized by granulomas. It involves primarily the colon and the ileum (regional enteritis) but may involve any part of the GI tract ( Fig. 95.1 ). Approximately 40% of patients have a pattern that involves the small and large intestines, 30% have only small bowel involvement, and 25% have large bowel involvement. Open full size…