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Pathologies hémorroïdaires

Hemorrhoids

  • Périnéologie
  • Published:
Acta Endoscopica

Résumé

Les hémorroïdes consistent en un tissu hautement vascularisé mais ne sont pas simplement des varices du plexus hémorroïdaire. Elles deviennent symptomatiques quand elles saignent, se prolabent ou se compliquent et deviennent douloureuses. Du point de vue clinique, il est classique de les distinguer selon 4 degrés soit internes, soit externes, les premières se formant au niveau du canal anal proximal, les secondes dans sa partie distale, sous la ligne pectinée ou sur la marge anale où elles sont recouvertes d'un tissue cutané. Leur étiologie et leur pathogenèse sont inconnues. Le diagnostic d'hémorroïdes internes repose sur la proctoscopie. La proctosigmoïdoscopie et la coloscopie sont nécessaires chez toute personne âgée de plus de 40 ans se plaignant de saignement rectal. Le traitement des hémorroïdes volumineuses mais asymptomqtiques n'est pas nécessaire et peut même s'avérer agressif. Le traitement des hémorroïdes peut être médical, instrumental en ambulatoire, et chirurgical. Il inclut la sclérothérapie, la ligature élastique, la cryothérapie, la coagulation par infrarouge, l'électrocoagulation, la dilatation anale et la sphinctérotomie interne. L'excision chirurgicale est considérée comme indispensable pour un traitement radical et définitif des hémorroïdes. La muqueuse doit être conservée et en particulier la zone adhérant au sphincter interne à hauteur de la ligne pectinée de façon à assurer le maintien des mécanismes physiologiques de continence et de défécation. Aucune technique ne peut être considérée comme optimale et exclusive. Chacune doit adopter une attitude éclectique en fonction des patients et des nombreuses manifestations hémorroïdaires.

Summary

Hemorrhoids consist of a highly vascularized tissue, but they are not simply varices of the hemorrhoidal plexus. They become symptomatic when they bleed, or prolapse, or become complicated and cause pain. From the clinical point of view, hemorrhoids are classically distinguished in four degrees as being internal or external, the former arising in the proximal anal canal, the latter in the distal anal canal, below the dentate line, or in anal verge, with a cutaneous lining. Their etiology and pathogenesis is unnknown. The diagnosis of internal hemorrhoids is based on proctoscopy. The proctosigmoidoscopy and the colonoscopy are mandatory in all patients over 40 years old who complain rectal bleeding. Treatment of bulky but asymptomatic hemorrhoids is unnecessary and possibly harmful. Hemorrhoids treatment may be medical, instrumental on an outpatient basis, and surgical. It includes sclerotherapy, rubber-band ligation, cryotherapy, infrared coagulation, electrocoagulation, forcible anal dilation, internal sphincterotomy. Surgical excision is considered indispensable for a radical and definitive treatment of hemorrhoids. The mucosa has to be conserved especially in the zone adhering to the internal sphincter, in the dentate line area to insure the maintenance of the physiological mechanisms of continence and of defecation. There is no one technique which can be considered optimal and exclusive. One must adapt an eclectic attitude regarding the different patients and the various hemorrhoidal manifestations.

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  1. Dipartimento di Scienze Chirurgiche e Oncologiche, Clinica Chirurgica 2a Università degli Studi di Padova, Via Giustiniani, 2 35128, Padova, Italy

    G. Dodi

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Dodi, G. Pathologies hémorroïdaires. Acta Endosc 33, 389–405 (2003). https://doi.org/10.1007/BF03015754

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