Diagnosis and Management of Internal Hemorrhoids: A Brief Review

Hemorrhoidal disease is a pathological condition due to the abnormal engorgement of the arteriovenous plexus beneath the anal mucosa. Anatomically, it can be located under the skin on the outer part of the dentate line, known as external hemorrhoid; or inside the anus on the proximal part of the dentate line, called internal hemorrhoid. Internal hemorrhoid may further develop from a painless anal mass into protruded and painful mass throughout the anal canal, often accompanied by inflammation and more severe symptoms. Various management strategies need to be considered carefully to ensure the success of therapy and improve the quality of life of patients with internal hemorrhoids. Conservative management is the initial stage that can be performed, including the provision of high-fiber nutrition, education related to bathroom habits, and the use of flavonoid regimens. Surgical therapy can be divided into outpatient intervention and conventional surgeries. This review will encompass the comprehensive diagnostic approach and management of internal hemorrhoids to help clinicians understand the appropriate management and provide better clinical benefits for the patients.

Adenokarsinoma Kolon: Laporan Kasus

Colorectal cancer (CRC) is a malignancy originated from the colon tissue which starts in the large intestine and rectum. In 2018, colorectal cancer was ranked fourth of the total malignancy in Indonesia with the number of cases of 30,017 (8.6% of the total cancer cases in Indonesia). We reported a case of colon cancer (adenocarcinoma) in a female aged 34 years. Diagnosis was based on anamnesis of the presence of liquid bowel movements along with blood, intermittent abdominal pain, and change of defecation pattern. Physical examination obtained tenderness in epigastric and hypochondriac right button regions. Colonoscopy was performed and revealed a colonic tumor suspicious of adenocarcinoma, suspected chronic colitis, and internal hemorrhoid. Pathological examination of the tumor tissue resulted in colonic adenocarcinoma (moderate differentiation). The management of this patient was extensive resection with anastomosis and was planned for adjuvant therapy.Keywords: adenocarcinoma colon cancer, colorectal cancer Abstrak: Kanker kolorektal (KKR) adalah keganasan yang berasal dari jaringan usus besar, yang menyerang usus besar dan rektum. Di Indonesia pada tahun 2018, kanker kolorektal menduduki posisi keempat dari keseluruhan diagnosis kanker dengan jumlah kasus 30.017 (8,6% dari seluruh kasus kanker di Indonesia). Kami melaporkan sebuah kasus kanker kolon (adenokarsinoma) pada seorang perempuan usia 34 tahun. Diagnosis ditegakkan berdasarkan anamnesis adanya buang air besar cair diserta darah, nyeri perut hilang timbul, perubahan pola defekasi. Pada pemeriksaan fisik didapatkan nyeri tekan epigastrium dan nyeri tekan bagian hipocondria kanan. Pada pemeriksaan penunjang dilakukan kolonoskopi dan didapatkan hasil tumor kolon curiga adenocarcinoma, kolitis kronik curiga kolitis ulseratif, dan hemoroid interna. Hasil patologi anatomi dari kolonoskopi yaitu kolitis kronis dengan displasia kolon ascenden dan hasil patologi anatomi jaringan tumor berupa adenokarsinoma kolon (diferensiasi sedang). Tatalaksana yang diberikan untuk pada pasien ini berupa tindakan reseksi luas dengan anastomosis dan direncanakan untuk terapi adjuvan.Kata kunci: adenokarsinoma kolon, kanker kolorektal

COMPARATIVE CLINICAL STUDY OF APAMARGAKSHARATAILA INJECTION AND INFRARED COAGULATION IN THE MANAGEMENT OF ARSHA (1ST AND 2ND DEGREE HEMORRHOIDS)

Introduction: In anorectal disorders, incidences of hemorrhoids and fissures are increasing in Indian population due to western lifestyle. Many surgical methods are available to cure anorectal disorders, but now a days, demand for Ayurveda and herbal preparation is increasing in society. Materials and Methods: In this study, ApamargaKsharaTaila Injection submucosal Route (Group A) and infrared coagulation (Group B) procedure were administered for the management of internal hemorrhoid (Arsha). This study was an open labelled, prospective, interventional study, in which patients of hemorrhoids [n=30(15eachgroup)] were selected from OPD of Institutional hospital. ApamargaKsharaTaila Injection application submucosally on internal hemorrhoids and IRC was applied at the base of hemorrhoids. In all the two groups, the patients were assessed every week for 4 weeks and were followed up for another 4 weeks for relief in signs and symptoms. Results: Obtained results were analyzed and encouraging results were observed after completion of the treatment. Conclusion: The study concluded that ApamargaKshara-Taila Injection is the most effective treatment for the management of internal hemorrhoid of 1st and 2nd de-gree in comparison to IRC procedure. Keywords: ApamargaKshartaila, Arsha, Ayurveda, hemorrhoids

RUBBER BAND LIGATION FOR HEMORRHOIDS (review)

Rubber band ligation is one of the most common and effective minimally invasive methods of treatment of chronic hemorrhoids. An analysis of the experience gained in the use of latex ligation makes it possible to evaluate the advantages and disadvantages of this technique and suggest new options for its implementation. One of the main advantages of rubber band ligation is the radicality of the procedure, which provides the closed removal of internal hemorrhoid piles, which makes it possible to standardize the widespread use of this technique in outpatient practice. When performing the procedure, tool kits of various designs are used, methods of one-stage and multi-stage ligation are used, various technical options are available for applying latex ligatures that affect the pathogenetic factors of hemorrhoidal disease. Optimization of options for the use of rubber band ligation allows to expand the range of use of this technique and provides a rational choice of individual approach.