Consent: Examination Under Anaesthesia Anorectum - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure Examination under anaesthesia of the anorectum can be performed for a number of benign coloproctological indications, such as diagnosis and management of fistula-in-ano, injection of botox for an anal fissure, or incision and drainage of a perianal abscess. It may also be performed to obtain biopsies for histological diagnosis in suspected anal or rectal cancers. Complications Intra-Operative Complication Description of Complication Potential Ways to Reduce Risk Bleeding Reassuringly, there is typically minimal blood loss during these procedures Use of diathermy to cauterise bleeding vessels Damage to the anal sphincter complex This is particularly relevant in peri-anal abscesses and fistula-in-ano where care must be taken to avoid damaging the anal sphincter complex. Always do circum-anal incisions (unless an experienced colorectal surgeon) to avoid the risk of sphincter damage Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation Early Complication Description of Complication Potential Ways to Reduce Risk Pain Simple analgesics should suffice to manage post-operative pain Bleeding There is a small risk of bleeding and bruising post-operatively Infection Superficial wound infection and further abscess formation is possible, which may necessitate further surgery or a course of antibiotics Scarring Any incision will result in a scar, which may form a keloid scar, particularly in high risk ethnicities Blood clots DVTs and PEs are a possibility in any operation, yet often EUAs are short procedure so the risk is low The patient will be given anti-embolism stockings and low molecular weight heparin peri-operatively to minimise this risk, as deemed appropriate Late Complication Description of Complication Potential Ways to Reduce Risk Recurrence If locules are left, the abscess can recur and require re-intervention. If there is presence of a fistula the patient may require definitive management with lay open or seton insertion Post-operative MRI 6-8 weeks following surgery should be performed in suspected cases to rule out an underlying fistula-in-ano Frequent questions What is the purpose of an examination under anaesthesia of the anorectum? Examination under anaesthesia of the anorectum is performed for various benign coloproctological reasons, including diagnosing and managing fistula-in-ano, administering botox for anal fissures, or performing incision and drainage of perianal abscesses. It can also be used to obtain biopsies for suspected anal or rectal cancers. What are common complications associated with examination under anaesthesia of the anorectum? Common complications include minimal bleeding, potential damage to the anal sphincter complex, and various anaesthetic risks such as nausea, vomiting, and cardiovascular issues. Careful surgical techniques and anaesthetic assessments can help mitigate these risks. How can the risk of bleeding during an examination under anaesthesia be minimised? The risk of bleeding can be minimised by using diathermy to cauterise any bleeding vessels during the procedure. This technique typically results in minimal blood loss, enhancing patient safety. What are the potential early complications following an anorectal examination under anaesthesia? Early complications may include post-operative pain, bleeding, infection, scarring, and the risk of blood clots. Management strategies such as analgesics and prophylactic measures like anti-embolism stockings can help address these issues. Why is post-operative MRI recommended after an examination under anaesthesia for suspected fistula-in-ano? Post-operative MRI is recommended 6-8 weeks after surgery to rule out any underlying fistula-in-ano, especially if locules were left during the procedure, as this may lead to recurrence and require further intervention. Rate This Article