🩺 Chapter 392: Surgical Conditions of the Anus and Rectum

Nelson Textbook of Pediatrics 22nd Edition — Anorectal malformations (imperforate anus, rectourethral fistula, cloaca) require surgical repair (posterior sagittal anorectoplasty). Anal fissure: common in infants, treat with stool softeners. Perianal abscess/fistula: often self-limited in infants; surgery if recurrent. Hemorrhoids: rare, treat conservatively. Rectal prolapse: idiopathic in toddlers; treat with stool softeners, manual reduction.

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📋 30 Clinical Scenarios — Surgical Conditions of Anus & Rectum

📇 High‑Yield Review Cards (Anorectal Surgery)

🩺 Clinical Presentations: Anorectal Conditions

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of Anorectal Conditions

🔑 Key Principles — Anorectal Surgery (Nelson Ch.392)
• Anorectal malformations: Newborn exam → imperforate anus. Low lesions (perineal fistula) → anoplasty. High lesions → colostomy + posterior sagittal anorectoplasty.
• Anal fissure: Pain with defecation, bright red blood on stool. Treat constipation (PEG 3350, increased fluids).
• Perianal abscess/fistula: Male infants; often self-limited. Incision and drainage if fluctuant. Fistula may resolve spontaneously.
• Hemorrhoids: Rare. Treat with stool softeners, sitz baths. Thrombosed external hemorrhoid → incision and thrombectomy.
• Rectal prolapse: Idiopathic in toddlers (mucosal prolapse). Treat with stool softeners, manual reduction. Sclerotherapy or surgical repair if persistent.

    ⚡ Reflex Prompts — Anorectal Conditions

    📖 Anorectal Surgical Conditions — Core Summary