Cancer of colon and rectum.
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Colonic Neoplasms↗
Biomedical subjects
R D Fry
Publications and source records attributed to R D Fry.
Internal intussusception of the rectum: a changing perspective.
Internal intussusception of the rectum is the funnel-shaped infolding of the rectum during straining to defecate. Patients present with multiple symptoms; most commonly rectal pressure and pain in association with constipation and straining. Defecography (videofluoroscopy during defecation) is the method of choice for diagnosing this problem. Rectal mobility from the sacrum, infolding of the rectum and sphincter relaxation can be used to grade the findings on defecography (Grade I-IV). The optimal therapy for internal intussusception of the rectum is unknown because the cause of the problem is unknown. Conservative management is recommended in all but the most severely symptomatic patients.
Defecation↗
Techniques and results in the management of anal and perianal Crohn's disease.
We reviewed our experience with 73 patients who had Crohn's disease and underwent local anorectal surgical procedures for perianal suppurative disease during a ten year period. All but one of these patients had intestinal granulomatous disease. The average length of follow-up study was 4.6 years. By using conservative, local anorectal surgical procedures and intensive medical treatment, we were able to establish adequate drainage of abscesses, reduce the inflammatory process and relieve symptoms. Extensive drainage procedures were avoided to preserve the anal sphincter. A sliding endorectal flap repair provided satisfactory results for rectovaginal fistulas and anterior anal fistulas. Proctectomy was eventually necessary in nine patients, the primary indication being severe perianal disease in five. By performing complete excision of the perineal disease at the time of proctectomy, we were able to achieve primary healing of the perineal wound in eight of these patients. Patients were classified according to five categories of results: healed after initial local treatment, eight patients; healed after more than one local treatment, 30 patients; incomplete healing with acceptable condition, 17 patients; healed after fecal diversion, nine patients, and required proctectomy, nine patients. The majority of patients with Crohn's disease and anal and perianal suppurative disease can be managed by meticulous drainage of sepsis and preservation of the anal sphincter.
Abscess↗
Adhesion-related variceal hemorrhage following sclerosis of esophageal varices.
A 78-year-old woman with portal hypertension had recurrent episodes of lower gastrointestinal hemorrhage two months after bleeding esophageal varices had been successfully treated with endoscopic injection sclerosis. Labeled red blood cell scans and mesenteric angiographic examination allowed a preoperative diagnosis of adhesion-related varices as the cause of bleeding. The problem was successfully treated by dividing the adhesion and resecting the involved small intestine.
Aged↗
Endorectal sliding flap repair of complicated anterior anoperineal fistulas.
This report presents experience with a safe and effective form of treatment for anal fistulas that involve a significant portion of the sphincter mechanism. The technique includes removal of the involved crypt, closure of the internal opening with a sliding endorectal flap, and counter drainage of the fistula tract. This series includes eight patients treated over a five-year period with a follow-up of up to five years. This limited series had no complications and one case of early recurrence. Most of these patients had had previous failed attempts at correction of the fistula. The main advantage of this mode of treatment is preservation of the integrity of the sphincter muscle, thus avoiding the high risk of incontinence that is inherent especially with anteriorly located fistulas in females. It is proposed that, because it does not transect the sphincter anteriorly, this technique is safer than the placement of setons, as has been previously advised for management of anterior fistulas. The different treatment techniques for anal fistulas, including complications, recurrence rates, surgical techniques, and indications for types of management are reviewed.
Adult↗
Severe complication of rubber band ligation of internal hemorrhoids.
In light of recent reports describing severe and even fatal complications, the authors would like to report good results in two patients with massive edema and one with localized necrosis following rubber band ligation of internal hemorrhoids, which were recognized early and treated aggressively. The potential for severe complications emphasizes the need for determining other causes of rectal symptoms before ligation of hemorrhoids is undertaken.
Adult↗
Juvenile polyposis. Not always a benign, self-limiting disease.
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Adolescent↗
Clinical and operative experience with non-Caucasian patients with Crohn's disease.
Fifteen black patients with Crohn's disease were seen during a ten-year period (1975-1985). They represented 11 percent of our experience with Crohn's disease during that time. These patients had an earlier age of onset of Crohn's symptoms than our white patients, and correct diagnosis was delayed for an average of four years. All 15 patients required abdominal surgery, and seven (47 percent) suffered recurrences necessitating additional abdominal operations. The five-year actuarial estimate of probability of reoperation was 77 percent. Extraintestinal manifestations were present in all patients, and six (40 percent) had multiple manifestations. These disease manifestations are more severe than those noted in series that studied predominantly caucasian Crohn's populations, and suggest that Crohn's disease in the black patient is a distinctly aggressive form.
Adolescent↗
Entrapped ovary syndrome.
Formulation of pelvic cysts afer proctectomy is an entity which is described in this paper with the cause supposed to be due to descent of the ovary from an intraperitoneal to an extraperitoneal position at the time of proctectomy. A simple surgical technique for fixing the ovary out of the pelvis to prevent this complication is described.
Adult↗
Adenocarcinoma of the rectum. Results of radiotherapy and resection, endocavitary irradiation, local excision, and preoperative clinical staging.
The management of rectal cancer in 102 patients at the Jewish Hospital of St. Louis is reviewed. Therapy combining external irradiation, endocavitary irradiation, local excision, and excisional operation has been used in the treatment of adenocarcinoma of the rectum. Pretreatment evaluation for tumor fixation, ulceration, palpable presacral lymph nodes, distance of tumor from dentate line, size of tumor, and histologic grades was used to assign patients to treatment groups. Local recurrence is less than 2 percent, and two-year tumor-free survival is approximately 87 percent in patients receiving 2000 R or 4500 R preoperatively. Pathologic downstaging of tumors was noted more frequently with 4500 R preoperative irradiation. Endocavitary irradiation appears adequate to treat only favorable lesions. Only tumor fixation and histologic grade of the tumor notably affected survival. A logical plan for choosing the appropriate method of treatment using combined modalities is proposed.
Adenocarcinoma↗
Loop ileostomy. Techniques and indications.
The records of 15 patients whose surgical treatment involved the construction of a loop ileostomy were reviewed. Indications for loop ileostomy include the necessity to protect multiple or complicated anastomoses, the protection of ileorectal anastomoses in patients with inflammatory disease, and the necessity of diverting the flow of intestinal contents in patients with fulminant inflammatory bowel disease. The technique of constructing and taking down a loop ileostomy is described.
Adult↗
Internal intussusception of the rectum. Diagnosis and surgical management.
Internal intussusception of the rectum is described as a specific clinical entity. A review of the cases treated at the Colon and Rectal Surgery Service at Jewish Hospital is presented, along with the specific diagnostic procedures that have been developed and the surgical technique that allows relatively simple correction of the problem. It is believed that this entity presents commonly to the practitioner of colon and rectal surgery, and specific diagnoses and therapy will be an important addition to the armamentarium of the colon and rectal surgeon.
Adolescent↗
Abdominal colectomy with ileorectal anastomosis.
From 1980 to 1983, 20 patients had abdominal colectomy with primary ileorectal anastomosis. Fourteen operations were elective and six were emergency. Elective indications included familial polyposis (five), inflammatory bowel disease (four), colon cancer associated with multiple polyps (four), and colon cancer associated with diverticulosis and a history of massive hemorrhage (one). Emergency operations were performed for obstructing sigmoid or rectosigmoid cancer (three), massive lower gastrointestinal hemorrhage (two), and right colon cancer associated with obstructing diverticulitis (one). All patients survived the operation; in three patients complications developed in the immediate postoperative period for a morbidity of 15%. Our experience suggests that abdominal colectomy with primary ileorectal anastomosis can be safely performed in carefully selected cases.
Adolescent↗
Inflammatory bowel disease.
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Colitis, Ulcerative↗
Treatment of rectal carcinoma by intracavitary irradiation.
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Adenocarcinoma↗
Severe coarctation of the aorta with pulmonary edema. An unusual presentation of a traumatic aortic aneurysm.
A patient with an unrecognized rupture of the ascending aorta developed severe pulmonary edema three weeks following the initial injury. This is a distinctly unusual manifestation of this injury. Emergency resection of the traumatic aneurysm was required to reverse the rapidly deteriorating clinical situation. The early recognition and surgical treatment of this lesion would have avoided this complication.
Adult↗
Successful emergency replacement of the ascending aorta and aortic and mitral valves in the Marfan syndrome.
A 37-year-old man with the Marfan syndrome and chronic mitral regurgitation suffered an acute dissecting aneurysm of the ascending aorta with aortic regurgitation. Emergency replacement of the mitral valve, aortic valve, and ascending aorta was carried out, and the patient made an uneventful recovery. He is doing well 18 months after surgery. This is the first reported case of survival from such a procedure in the face of acute dissection with Marfan's syndrome. Indications for elective surgery are discussed and the uncertainties about the prognosis outlined. Continued reporting of the results and follow-up data are necessary for final assessment of the surgical treatment of the cardiovascular manifestations of this disease.
Adult↗