International Journal of Colorectal Disease

, Volume 24, Issue 1, pp 105–113 | Cite as

Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease

  • Felix AignerEmail author
  • Hannes Gruber
  • Friedrich Conrad
  • Jasmin Eder
  • Thilo Wedel
  • Bettina Zelger
  • Victoria Engelhardt
  • Alois Lametschwandtner
  • Volker Wienert
  • Ulrich Böhler
  • Raimund Margreiter
  • Helga Fritsch
Original Article



The pathogenesis of hemorrhoidal disease is based mainly on the vascular hyperplasia theory. The aim of this study was to reassess the morphology and the functional mechanisms of the anorectal vascular plexus with regard to hemorrhoidal disease.

Materials and methods

The anorectal vascular plexus was investigated in 17 anorectal and five hemorrhoidectomy specimens by means of conventional histology and immunohistochemistry. Vascular corrosion casts from two fresh rectal specimens were used for scanning electron microscopy. Transperineal color Doppler ultrasound (CDUS) with spectral wave analysis (SWA) was performed in 38 patients with hemorrhoidal disease and 20 healthy volunteers.


The anorectal vascular plexus was characterized by a network of submucosal vessels exhibiting multiple thickened venous vessels separated by distinct sphincter-like constrictions. CDUS and SWA showed significant flow differences in peak velocities (6.8 ± 1.3 cm/s vs. 10.7 ± 1.5 cm/s; P = 0.026) and acceleration velocities (51 ± 4 ms vs. 94 ± 11 ms; P = 0.001) of afferent vessels between the control group and patients with hemorrhoidal disease.


Coordinated filling and drainage of the anorectal vascular plexus is regulated by intrinsic vascular sphincter mechanisms. Both morphological and functional failure of this vascular system may contribute to the development of hemorrhoidal disease.


Hemorrhoids Anorectal vascular plexus Vascular sphincter Smooth muscle 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Felix Aigner
    • 1
    Email author
  • Hannes Gruber
    • 2
  • Friedrich Conrad
    • 1
  • Jasmin Eder
    • 1
  • Thilo Wedel
    • 3
  • Bettina Zelger
    • 4
  • Victoria Engelhardt
    • 5
  • Alois Lametschwandtner
    • 5
  • Volker Wienert
    • 6
  • Ulrich Böhler
    • 6
  • Raimund Margreiter
    • 1
  • Helga Fritsch
    • 7
  1. 1.Department of Visceral, Transplant and Thoracic Surgery, Center of Operative MedicineInnsbruck Medical UniversityInnsbruckAustria
  2. 2.Department of RadiodiagnosticsInnsbruck Medical UniversityInnsbruckAustria
  3. 3.Department of AnatomyChristian-Albrechts-University KielKielGermany
  4. 4.Department of PathologyInnsbruck Medical UniversityInnsbruckAustria
  5. 5.Department of Organismic Biology, Science FacultyUniversity of SalzburgSalzburgAustria
  6. 6.Department of DermatologyAachen University HospitalAachenGermany
  7. 7.Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and EmbryologyInnsbruck Medical UniversityInnsbruckAustria

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