Inferior Hemorrhoidal Veins Research Articles

EFFECT OF CITRAKADI KSARA LĒPA IN THE MANAGEMENT OF SECOND-DEGREE INTERNAL HAEMORRHOIDS

Background and Objectives: Haemorrhoids are dilated veins within the anal canal in the sub-epithelial region formed by radicles of superior, middle, and inferior rectal veins. It hampers the routine life of an affected person. In India about 50% of the population would have haemorrhoids at some point in their life. Achārya Vāgbhata defines Arsas (haemorrhoids) as an abnormal growth which obstructs the anal canal and troubles continuously like an enemy The objective of the study is to assess the efficacy of citrakādi kṣāra lēpa in the management of second- degree internal haemorrhoids. The study also aims to find out an easy, effective and less complicated procedure for second-degree haemorrhoids. The 15 participants with second degree internal haemorrhoids were selected as per inclusion criteria. After doing all the preoperative procedures, the citrakādi kṣāra lēpa was done in a single sitting. The duration of the study was 30 days. The assessment of reduction of size of haemorrhoids, mucosal changes after the procedure and frequency of bleeding were done before the treatment, on 1st, 3rd, 5th, 7th, 15th, and 30th day using the required assessment tools. The symptoms, constipation and mucous discharge were assessed on the 0th and 30th days. The follow up was done on the 60th day. The statistical analysis of the results was done using non- parametric tests. On analysing, it was found that the Citrakādi kṣāra shows 86.11% of the efficacy in the reduction of both subjective and objective parameters. Key words: Haemorrhoids, Arsas, Citrakādi kṣāra

A REVIEW OF JALUKAVACHARANA (LEECH THERAPY) IN THE MANAGEMENT OF THROMBOSED HAEMORRHOIDS - CASE REPORTS

Haemorrhoids are dilated veins within the anal canal in the subepithelial region formed by radicles of superior, middle and inferior rectal veins. It is a common ano-rectal disease. Thrombosed hemorrhoid is a painful swelling in the anal tissues caused by a clot in one or more small veins in the anal canal. According to modern science, there are many operative and non-operative procedures for the management of haemorrhoids. Most of the operative pro- cedures are not patient friendly, cause high economic burden and associated with complications like pain, bleeding and recurrence. Acharya Vagbhata defines Arsas (haemorrhoids) as an abnormal growth which obstructs the anal canal and troubles continuously like an enemy. Shalyatantra deals with Sastra karma (surgical procedures), Anusas- tra karma (parasurgical procedures) and conservative management in the different types of diseases. Jaluka is con- sidered as best among Anusastra. Acharya Vagbhata indicates Jalukavacharana in haemorrhoids when they are hard and swollen. The present article deals with Jalukavacharana in two patients having thrombosed haemorrhoids attended in outpatient department of VPSV Ayurveda College Kottakkal. Application of Jaluka (leech) provided improvement in features like pain, edema, tenderness and discoloration of mass. Keywords: Thrombosed haemorrhoids, Arsha, Raktamokshana, Jalukavacharana.

Varices rectales, una causa rara de hemorragia masiva en la hipertensión portal

Rectosigmoidal varices are a extremely uncommon manifestations of portal hypertension but can cause massive hematochezia. Rectal varices occur as submucosal anastomoses between the superior rectal veins of the inferior mesenteric system and the middle and inferior rectal veins of the iliac system. In portal hypertension there is an increased flow and pressure through these anastomotic channels. Rectal varices are so rare beause in most people the rich coronary azygos system is better developed and thus shunts more blood. Because of congenital or anatomic variations, the rectal anastomosis are better developed in some people and will shunt more blood, causing rectal varices.

Massive Bleeding From Hemorrhoidal Varices in Portal Hypertension

GASTROINTESTINAL bleeding in patients with portal hypertension frequently results from ruptured esophagogastric varices. Although an alternative site of natural decompression of the portal system occurs via communications from the superior hemorrhoidal to the middle and inferior hemorrhoidal veins through the submucosa of the distal rectum, severe bleeding from such hemorrhoidal varices has rarely been reported. The management of such bleeding is a matter of conjecture, and recommendations range from watchful waiting to the performance of a portasystemic shunt.^1,2Our recent experience with a cirrhotic patient who bled massively from hemorrhoidal varices is illustrative of the problem and suggests a rational approach to therapy. <h3>Report of a Case</h3> A 55-year-old man with known alcoholic cirrhosis, portal hypertension, ascites, and esophageal varices was admitted to the Medicine Service of the Veterans Administration Hospital, San Diego, because of rectal bleeding. For several months before this hospital admission, he had had numerous episodes

WHAT CAUSES HEMORRHOIDS?A NEW THEORY OF ETIOLOGY.

There are two main types of hemorrhoids—vascular and mucosal. Vascular piles, occurring most commonly in young men, are caused by straining at defecation, when the anal sphincter relaxes, subjecting the anorectal tissues to a high pressure gradient. The superior hemorrhoidal plexus is filled initially by blood which is forced at very high pressure from the superior rectal venous radicles lying in the lower part of the ampulla of the rectum. Distention of the plexus is limited and is confined to the veins of the upper part of the anal canal by a tube-valve mechanism which also has a similar, but less direct, effect on the inferior rectal veins.

Recurrence after curative excision of carcinoma of the large bowel.

A major difference is noted between the recurrences of carcinoma of the rectum as compared with carcinoma of the colon; as for example, in the first three years following surgery, 6% of patients with carcinoma of the rectum showed systemic metastasis compared with 1% of those with carcinoma of the colon. The most likely avenues for spread are the middle and inferior hemorrhoidal veins. Accordingly, the authors recommend that ligation of the inferior mesenteric vascular pedicle be undertaken following mobilization of the rectum.

The valves and anastomoses of the hemorrhoidal and related veins

1. 1. The dog shows both competent and incompetent valves in the portal venous system. Two of the three bodies examined had competent valves in the superior hemorrhoidal vein. 2. 2. The hemorrhoidal plexus in the macaque rhesus monkey resembles that in the human. No valves were found in the larger tributaries of the portal system. 3. 3. The newborn infant has valves in the smaller portal tributaries of the gastric and colic regions. The sites of atrophic valves were noted at the mouths of the superior hemorrhoidal veins. The middle and inferior hemorrhoidal veins were protected by competent valves. The degree of anastomosis between the caval and portal systems is slight. 4. 4. The adult has less numerous valves in the portal system. In one body there was a well developed valve in the superior hemorrhoidal vein. The central ends of the middle and inferior hemorrhoidal veins were protected by competent valves. 5. 5. The degree of anastomosis between the portal and caval systems increases with age and is more marked in bodies showing well developed hemorrhoids. 6. 6. The chief site of anastomosis is between the superior and middle hemorrhoidal veins and occurs in the rectal submucosa well above the anorectal line. 7. 7. In cases of portal obstruction varix formation occurs in these veins in the rectal mucosa and these varices are visible on proctoscopic examination.

THE PATHOLOGY AND SYMPTOMATOLOGY OF HEMORRHOIDS, ANAL FISTULA, AND ANAL FISSURE.Read in the Section on Surgery and Anatomy at the Forty-fifth Annual Meeting of che American Medical Association held at San Francisco, June 5-8, 1894.

HEMORRHOIDS. Although anatomically divided into external and internal, and presenting some pathologic features peculiar to their situation, hemorrhoidal tumors are essentially similar in structure, whether located in the rectum within the sphincter muscles, or about the margin of the anus. Pathologically considered they are identical, and composed primarily of the same morbid elements—enlargement or varicosis of the venous hemorrhoidal plexuses, and infiltrated connective tissue. Within the dense areolar membrane which enters into the structure of the lower part of the rectum and verge of the anus, is a network of tortuous veins, the inferior or external, and the superior or internal hemorrhoidal plexuses. From the former, the blood finds its way into the general venous circulation through the middle and inferior hemorrhoidal veins which communicate with the internal iliacs; from the latter, through the superior hemorrhoidal vein into the portal system. The absence of valves in the hemorrhoidal veins; the