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Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
What are the borders of the ischio-anal fossa?The ischio-anal fossa is a wedge-shaped, fat-filled space lateral to the anal canal Base – formed by the skin over the perineumMedial wall – formed by the anal canal and levator aniLateral wall – formed by ischial tuberosity (above) and obturator internus (above)Apex – formed by the meeting of the medial and lateral walls
Anorectal Abscess and Fistula
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Ischioanal abscess: Lateral extension along the fibroelastic septa passing through the external anal sphincter results in an ischioanal abscess. The ischioanal fossa (formerly called ischiorectal fossa) is the fat-filled space located lateral to the anal canal and inferior to the pelvic diaphragm. It is somewhat prismatic in shape, with its base directed to the surface of the perineum. High ischioanal abscesses, located just below the pelvic floor, are often difficult to diagnose by inspection and physical examination alone, as they present with constitutional symptoms and only a vague fullness in the buttock(s). Spread to the opposite side (horseshoe) is not uncommon in advanced sepsis.
Anatomy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Ernest F. Talarico, Jalid Sehouli, Giuseppe Del Priore, Werner Lichtenegger
The rectal pillar extends from the cardinal ligament to the sacrum, and conveys the middle rectal arteries and veins, and rectal nerve plexuses. The upper portion deviates laterally to accommodate the pouch of Douglas (rectouterine; cul-de-sac; Moore et al. 2014); bringing it close to the pelvic wall. The rectouterine ligament splits into an anterior leaf that emits rectal fascia, and a posterior leaf, which reaches the sacrum at the level of the anterior sacral foramina II to IV, but can extend upward beyond the sacral promontory (Figures 4.3 and 4.4). As such, this fascia creates a surgically important pelvirectal space superior to the pelvic diaphragm, in contrast to the ischio-anal fossa in the perineum. It is divided into the rectouterine and rectorectal (presacral) spaces by the lateral rectal ligaments. The retrorectal space is limited by rectal fascia and the parietal pelvic fascia, and is separated from the pararectal spaces by the rectal pillar.
Dosimetric quantification of the incidental irradiation of the ‘true’ (deep) ano-inguinal lymphatic drainage of anal cancer patients not described in conventional contouring guidelines
Published in Acta Oncologica, 2018
Hendrik Dapper, Gregor Habl, Christoph Hirche, Stefan Münch, Markus Oechsner, Michael Mayinger, Christina Sauter, Stephanie E. Combs, Daniel Habermehl
With these radiation plans we created a new volume, the expected ano-inguinal lymph drainage (AILD). These lymph vessels are usually not detectable by standard lymphangiography [17–22]. Therefore, the true or real location of the AILD had until now not exactly been known and further seems to differ with each individual. Some authors believe in an AILD through the obturator foramina, others mention a direct drainage via the soft tissue of the ischio-anal fossa [14]. However, in recent years new fluorescence-imaging methods like the indocyanine-green-method corroborate the fact, that this AILD forms a network of very thin vessels and is located in the subcutaneous adipose tissue of the medial thigh. This network is widely disseminated and can reach some cm below the anus (Figure 1A) [2,3].
Is extralevator abdominoperineal resection necessary for low rectal carcinoma in the neoadjuvant chemoradiotherapy era?
Published in Acta Chirurgica Belgica, 2020
Hikmet Erhan Güven, Bülent Aksel
Laparoscopic mesorectal mobilization was achieved dissecting the surgical field bordered by the upper edge of the coccyx, autonomous nerves, and inferior border of seminal vesicles or cervix of the uterus. Patients were given a modified lithotomy position for APR and a conventional APR was performed without removing the coccyx. During ELAPR, patients were given a prone jackknife position. The perineal incision was extended towards the lateral portion of the external anal sphincter. Dissection was extended through the ischioanal fossa until the insertion of the levator muscle is reached. Levator muscles were divided from their origin above the arcuate line and included in the specimen. Coccyx was routinely resected during ELAPR.