Unbounded Medicine

BEWARE! Gory image

A 45 year old male with history of chronic reducible hemorrhoidal disease came to the emergency department with excruciating pain, rectal bleeding and an anal non-redicible mass after a bowel movement.

On examination, we found this:

In this case, the only way to reduce the prolapse is a procedure for prolapsing hemorrhoids (PPH) which is an innovative approach to the management of enlarged, prolapsing hemorrhoids. Rather than rely on excision of the complexes, the primary goal is to reduce the hemorrhoidal tissue and anoderm to the correct anatomical location within the anal canal. It is important to keep this goal in mind, because the misinterpretation of anodermal migration externally as external hemorrhoids leads to unnecessary excision of sensate skin during PPH. In fact, with a correctly performed procedure, the relocated anoderm will shrink over time.

For this, we need an hemorroidal circular stapler kit which includes: clear plastic anoscope, half-slit anoscope, suture threader, and the 33 mm stapler.

Here is an animation video of how the procedure works, and how does the anal canal looks like before and after the procedure.

Regards,

Jon Mikel Iñarritu, M.D.

More information of hemorrhoidal disease in this site is here:
Thrombosed Hemorrhoid

A woman came to the office because of sharp epigastric pain. On physical examination nothing was wrong except of epigastric pain. An endoscopy was performed and reported as normal. An Upper Gastrointestinal Tract Barium Examination was ordered and we found a cascade stomach, which is a rare finding. We exlude other causes of abdominal pain in the first place.

Here are the images.

As you can see in this series, the fundus, still lies in its usual position relative to the structures of the left upper quadrant but the proximal portion of the body of the stomach is in an abnormally anterior and superior position. When this type of stomach is filled with barium (erect position), static roentgenograms may demonstrate a separate fluid level confined to the fundus. At fluonoscopy, barium first fills the dependent, posterior fundus to the highest level of the “ridge” and then spills or “cascades” into the body and antrum.

On the next day we have performed an esophageal manometry and the patients had lower esophageal incompetence, so we performed a laparoscopic Nissen fundoplication with gastropexia.

Now the patient is painless and in excellent condition.

Regards,

Jon Mikel Iñarritu, M.D.