Biomedical subjects
Publications and source records attributed to R Rintala.
A case of congenital funnel anus associated with consequent megacolon and rectosigmoidal inertia is described for the first time in a 36-year-old man. This very rare condition, a variant of low translevator anorectal malformation, did not improve after dilatation, but was treated successfully by extended left hemicolectomy and stapled coloanal anastomosis.
The Sulamaa modification of the Duhamel procedure and the early and late results of the first 48 patients are reported. A specially devised clamp is used in the colorectal side-to-side anastomosis with no intra-abdominal or intrapelvic anastomoses being required. There were no mortality and no anastomotic leaks among the patients. A postoperative septum between rectum and the pull-through segment developed in 35% of the patients. Soiling and, in some cases, constipation, were the main symptoms of septum formation. These problems ceased after reclamping of the septum. At the last follow-up, 2 to 15 years after surgery, 37 patients had normal bowel habits, 4 had occasional soiling and 7, six of whom are mentally retarded, daily soiling. None of the children had constipation. The Duhamel-Sulamaa operation gives satisfactory long-term results in the treatment of Hirschsprung's disease. Septic anastomotic complications appear to be avoidable with this technique, but the significant frequency of postoperative septum formation requires close early follow up of the operated patients.
Colo-anal sleeve resection was performed for rectal hemangioma extending from the upper end of the anal canal to the rectosigmoid in two adults and a child. The indication for surgery was recurrent rectal bleeding. Anastomotic stricture formed in one patient, but was easily dilated. After observation for 2-12 months, all patients were completely continent, with normal 24-hour stool frequency. Colo-anal sleeve resection is advocated as the treatment of choice for large rectal hemangioma.