Anorectal disease can confront a general surgeon in the office, emergency department, or while on a call. The symptoms may be familiar—pain, bleeding, drainage, or a protruding mass—but the diagnosis and best course of treatment are not always obvious. A decision made during the initial examination may shape the patient’s treatment and long-term function.
Today’s Panel Session, “Common Anorectal Pathology for the General Surgeon,” will offer general surgeons practical guidance on the presentation, diagnosis, and treatment of the conditions they are most likely to encounter.
An expert panel of colorectal surgeons will speak on fistulas and abscesses, hemorrhoids and prolapse, condylomata, anal intraepithelial neoplasia (AIN), and anal cancer, and acute and chronic fissures.
The emphasis will be practical and actionable, with a focus on how to distinguish conditions that can look similar, select an appropriate treatment, and recognize when further evaluation or referral is needed. These decisions can have important implications for both immediate and long-term outcomes.
“The anus is a deceptively complex structure and, quite frankly, is really unforgiving of small errors,” said Harry T. Papaconstantinou, MD, FACS, a colorectal surgeon and session co-moderator.
Even when the symptoms are familiar, the diagnosis may not be straightforward.
Hemorrhoidal disease and rectal prolapse require different approaches yet prolapse may be mistaken for hemorrhoids. A lesion thought to be a wart or hemorrhoid could instead represent dysplasia or cancer. Pain and drainage may signal an abscess or fistula, but the anatomy and the patient’s underlying disease matter when planning treatment.
“The correct diagnosis frequently prevents an unnecessary operation,” Dr. Papaconstantinou said. When intervention is indicated, he added, “the smallest operation that solves the patient’s problem is often the best operation.”
The session will also address the range of available treatments. Hemorrhoidal disease, for example, may be managed with office-based procedures such as banding or sclerotherapy, or with hemorrhoidectomy. Understanding the options and their expected outcomes helps surgeons match treatment to the condition and the patient.
Preserving function is another important consideration when treating anorectal disease.
“One of the most important principles in managing anorectal disease—whether operatively or nonoperatively—is protecting continence,” Dr. Papaconstantinou said. “Before a general surgeon asks, ‘Can I divide this?’ they must first ask, ‘Do I understand the underlying disease, and can I clearly identify the anatomy?’ If the answer to either question is no, protecting the patient means knowing when to stop and refer. Sometimes the most important surgical decision is knowing when not to divide.”
Attendees also will consider findings that warrant a broader differential diagnosis, including Crohn’s disease and sexually transmitted infections.
For general surgeons and other specialists who evaluate patients with anorectal complaints, the session will reinforce the importance of making the right diagnosis and treatment decisions while preserving long-term function.
This Panel Session takes place 8:00–9:30 am today in Room 147AB of the Walter E. Washington Convention Center and is co-moderated by general surgeon Bryan K. Richmond, MD, MBA, FACS.
