Biomedical subjects
Publications and source records attributed to L F Knoepp.
Our patient had a nonulcerated rectal lesion grossly resembling a villous tumor, but microscopically proving to be a solitary rectal ulcer. We have discussed the clinical and pathologic findings and the probable relationship of the lesion to straining at the stool.
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A community experience with entericovesical fistulas is presented as well as a review of the literature. The series of 16 cases illustrates that this complication continues to present challenges in diagnosis and treatment. Diverticulitis is by far the most common primary disease process leading to the formation of entericovesical fistulas and the controversy involved in the surgical management of diverticulitis carries over to the management of this rare complication of the disease. It is felt that a one-stage procedure can often be accomplished and should be the procedure of choice in well-prepared, electively operated patients. When multiple stages are required, the two-stage approach is recommended. Familiarity with the proper treatment and a greater index of suspicion for this complication will lead to more acceptable management of patients with entericovesical fistulas.
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Colonoscopy is a relatively new and important diagnostic modality for evaluation colonic disease. In order to assess its value in the community hospital, all colonoscopies done by me (250 examinations in two hospitals) were reviewed. Colonoscopy was sometimes easy and sometimes long and tedious. It was difficult to reach the cecum consistently, but success improved with experience. Many neoplasma not seen on barium enema were found, including three carcinomas. Twenty-seven polyps were removed with the aid of the colonoscopic snare. No complications occurred. Colonoscopy should probably be restricted to those physicians who have a large enough case load and who can spend enough time learning the procedure to develop expertise.
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Colonoscopy, done to elucidate the cause of obscure rectal bleeding not diagnosable on the basis of previous proctoscopic and barium-enema examinations, resulted in a 17 per cent diagnostic yield in this series. Eighteen of 105 patients were found to have lesions: three had carcinomas, six had polyps, eight had colitis, and one had proctitis. When bleeding had been demonstrated by the physician, there was a higher diagnostic yield (22.5 per cent) than when bleeding was reported only by the patient (5.9 per cent). Descriptions of the bleeding by the patients were found to be somewhat unreliable. Sixteen of the 18 lesions revealed by the colonoscope were in the left colon. It is suggested that the basic work-up for undiagnosed rectal bleeding should include history, physical examination, sigmoidoscopy, and barium-enema study. When no diagnosis is found, subsequent work-up must be individualized. When bleeding has been demonstrated to originate from the colon, colonoscopic examination should be performed.