Part of the TeachMe Series

Consent: Examination Under Anaesthesia Anorectum

Not yet rated
based on ratings

Last updated: March 11, 2021
Revisions: 11

Last updated: March 11, 2021
Revisions: 11

format_list_bulletedContents add remove

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