Anorektal Kanamalar
Özet
Anorektal kanamalar, acil servislere başvuru nedenleri arasında önemli bir yer tutan ve acil müdahale gerektirebilen durumlardır. Çoğu yaşamı tehdit edici olmasa da doğru tanı koymak için ayrıntılı bir öykü, fizik muayene ve radyolojik görüntüleme yöntemleri hayati öneme sahiptir. Kanamaya yol açan en sık benign nedenler hemoroidler ve anal fissürler olarak öne çıkmaktadır. Hemoroidlerin tedavisi evresine göre konservatif yöntemlerden cerrahi müdahalelere kadar değişiklik gösterirken, tromboze vakalarda süreye bağlı olarak eksizyon veya drenaj tercih edilir. Genellikle posterior orta hatta mukoza yırtığı olarak gelişen anal fissürlerde ise tedavi, ağrı ve spazm döngüsünü kırmaya odaklanır; medikal tedaviye dirençli kronik olgularda lateral internal sfinkterotomi veya botulinum toksini enjeksiyonu uygulanır. Bu yaygın hastalıkların yanı sıra rektal prolapsus, anorektal tümörler ve cinsel tatmin gibi nedenlerle yerleştirilen rektal yabancı cisimler de anorektal kanama ile acil başvurulara yol açabilir. Rektum kanserinin en sık belirtisinin bu kanamalar olması nedeniyle malignite ayrımı kritik bir öneme sahiptir. Tanı sürecinde anaskopi ve proktoskopi muayenenin ayrılmaz parçalarıdır.
Anorectal bleedings represent significant emergency presentations that demand precise evaluation and potentially urgent intervention. Although most cases are not life-threatening, establishing an accurate diagnosis requires a comprehensive patient history, detailed physical examination, and appropriate radiological imaging. Hemorrhoids and anal fissures constitute the most frequent benign etiologies of bleeding. Management of hemorrhoids varies from conservative lifestyle and dietary modifications to surgical procedures based on the disease stage, with acute thrombosed cases managed via excision or drainage if presented within forty-eight hours. Anal fissures, predominantly occurring at the posterior midline, require treatments aimed at breaking the pain-spasm cycle; chronic cases refractory to medical therapy are effectively treated with lateral internal sphincterotomy or botulinum toxin injection. Beyond these common conditions, rectal prolapse, anorectal tumors, and rectal foreign bodies often inserted for sexual gratification can prompt emergency visits due to acute bleeding. Crucially, as anorectal bleeding is the most prevalent clinical manifestation of rectal cancer, ruling out colorectal malignancies is a vital component of patient assessment.
Referanslar
Mittal RK, Tuttle LJ. Anorectal Anatomy and Function. Gastroenterology Clinics of North America 2022 Mar;51(1):1-23. doi: 10.1016/j.gtc.2021.10.001. PMID: 35135656.
Sabry AO, Sood T. Rectal Bleeding. 2022 May 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 33085290.
Tarasconi A, Perrone G, Davies J et all. Anorectal emergencies: WSES-AAST guidelines. World Journal of Emergency Surgery. 2021 Sep 16;16(1):48. doi: 10.1186/s13017-021-00384-x. PMID: 34530908; PMCID: PMC8447593.
London S, Hoilat GJ, Tichauer MB. Anoscopy. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29083587.
Alemrajabi M, Akbari A, Sohrabi S, et all. Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome. Annals of Coloproctology 2022 May 16. doi: 10.3393/ac.2022.00017.0002. Epub ahead of print. PMID: 35570403.
Cristea C, Lewis CR. Hemorrhoidectomy. 2022 May 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 31751054.
Picciariello A, Rinaldi M, Grossi U, et all.. Management and Treatment of External Hemorrhoidal Thrombosis. Frontiers Surgery 2022 May 3;9:898850. doi: 10.3389/fsurg.2022.898850. PMID: 35592120; PMCID: PMC9110961.
van Reijn-Baggen DA, Dekker L, Elzevier HW, et all. Management of chronic anal fissure: results of a national survey among gastrointestinal surgeons in the Netherlands. Internal Journal of Colorectal Disease 2022 Apr;37(4):973-978. doi: 10.1007/s00384-022-04115-9. Epub 2022 Feb 22. PMID: 35194670; PMCID: PMC8976773.
Newman M, Collie M. Anal fissure: diagnosis, management, and referral in primary care. British Journal of General Practice. 2019 Aug;69(685):409-410. doi: 10.3399/bjgp19X704957. PMID: 31345824; PMCID: PMC6650108.
Nelson RL, Thomas K, Morgan J, et all. Non surgical therapy for anal fissure. Cochrane Database Systematic Reviews 2012 Feb 15;2012(2):CD003431. doi: 10.1002/14651858.CD003431.pub3. PMID: 22336789; PMCID: PMC7173741.
Bordeianou L, Hicks CW, Kaiser AM et all. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. Journal of Gastrointestinal Surgery 2014 May;18(5):1059-69. doi: 10.1007/s11605-013-2427-7. Epub 2013 Dec 19. PMID: 24352613.
Vogler SA. Rectal Prolapse. Diseases of the Colon and Rectum. 2017 Nov;60(11):1132-1135. doi: 10.1097/DCR.0000000000000955. PMID: 28991075.
Daram SR, Lahr C, Tang SJ. Anorectal bleeding: etiology, evaluation, and management (with videos). Gastrointestinal Endoscopy journals 2012 Aug;76(2):406-17. doi: 10.1016/j.gie.2012.03.178. PMID: 22817792.
Phan HD, Tan HT, Tabibian JH. Bleeding Beyond the Line: Anorectal Melanoma as a Cause of Lower Gastrointestinal Bleeding. Journal of Gastrointestinal Cancer. 2021 Sep;52(3):1090-1092. doi: 10.1007/s12029-020-00545-2. Epub 2020 Nov 18. PMID: 33206348.
Bhasin S, Williams JG. Rectal foreign body removal: increasing incidence and cost to the NHS. Annals of The Royal College of Surgeon of England. 2021 Nov;103(10):734-737. doi: 10.1308/rcsann.2020.7129. PMID: 34719960.
Ploner M, Gardetto A, Ploner F, et all. Foreign rectal body - Systematic review and meta-analysis. Acta Gastro-Enterologica Belgica 2020 Jan-Mar;83(1):61-65. PMID: 32233273.
