Surgery.

Date:: [1913]

Catalogue details

Licence: In copyright

Credit: Surgery. Source: Wellcome Collection.

237/412 (page 209)

hemorrhoidal veins join the portal and the others the systemic circulation. The lymphatics of the rectum pass to the glands in the hollow of the sacrum, in the pelvic meso- colon along the mesenteric artery and to the aortic glands. The lymphatics of the anal canal pass to the inguinal glands. The anus is guarded by the external sphincter, a voluntary muscle, and by the internal sphincter, which is a thickening of the middle coat of the gut and is an involuntary muscle. At the junction between anus and rectum some twelve processes pass upwards. They are the columns of Morgagni and the intervening hollows are the crypts of Morgagni. Above this there are three mucosal folds known as the valves of Houston. What methods are used in the examination of the Rectum and Anus ? Inspection reveals the presence of fissure, fistula, prolapsed haemorrhoids. Palpation.—The gloved finger, well lubricated, is gently inserted and can ascertain (a) the tone of the sphincters; (b) the presence of tumours or lesions of the rectal wall; (c) abnormalities of accessible viscera, e.g. uterus, prostate, seminal vesicles and the pouch of Douglas. Instrumental Inspection.—The anus and lower rectum are inspected by means of a proctoscope and the rectum and lower colon by the sigmoidoscope. X-Ray, after the administration of an opaque enema, is of more value in the upper parts of the colon. Describe the Congenital Malformations. These are of two kinds :—(a) failure of complete develop- ment ; (b) abnormal communications with other viscera. Imperforate Anus varies from complete absence of the rectum, the bowel ending blindly in the peritoneal cavity, to a persistence of the cloacal membrane. An intermediate type is due to failure of development of the proctodauun. Whatever the type, the failure to pass meconium and the signs of intestinal obstruction are present. Inspection of the perineum reveals the presence or absence of the anus