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PubMed2000

[Ultrasound diagnosis of penicillin-induced segmental hemorrhagic colitis].

INTRODUCTION: Penicillin-induced segmental haemorrhagic colitis (SHC) is a characteristic and striking but rarely diagnosed clinical entity. Bloody diarrhea and abdominal cramps start a few days after the intake of oral penicillin derivatives. We report the ultrasonographic and clinical findings in nine patients with SHC and compare the results with the findings in ten patients with antibiotic-related pseudomembranous colitis (PMC). METHODS: Nine consecutive patients with SHC (age: 32 +/- 10 years; five males, four females) with PMC-negative proctoscopic findings, stool cultures and negative clostridium difficile toxin and ten patients with PMC (age: 50 +/- 18 years; six males, four females) with positive proctoscopy and Clostridium difficile toxin were clinically evaluated and examined by high resolution ultrasonography. The sonographic findings of the colonic and small bowel walls as well as the clinical course of the diseases were documented. RESULTS: In all nine patients with SHC the wall of the ascending colon was asymmetrically thickened with loss of layer structure. Neither the small bowel nor the cecum were involved in patients with SHC. In all cases a distinct border between involved and uninvolved colon wall was found. During follow-up all patients recovered soon after stopping antibiotic treatment and symptomatic care. In seven of ten patients with PMC pancolitis and in three of ten with left-sided colitis were found at ultrasonography. In all patients with PMC the bowel wall was symmetrically thickened with the layers remaining distinct. DISCUSSION: The knowledge of the clinical characteristics and sonographic findings of penicillin-induced segmental haemorrhagic colitis may reduce the need for invasive endoscopic and radiological investigations in diagnosis and follow-up. The age of patients, clinical course and sonographic findings may be helpful in differentiating patients with SHC and PMC.

Adolescent↗
PubMed2002

Dieulafoy's lesion of the rectum.

Dieulafoy's lesion is an uncommon cause of gastrointestinal haemorrhage. It may present with massive and life threatening bleed and although more common in the upper gastrointestinal tract, it is being increasingly reported as affecting the lower gastrointestinal tract. Diagnosis is usually achieved during proctoscopic and endoscopic visualization. In cases where there is profuse and torrential hemorrhage, angiography may help to confirm the diagnosis. There are a few treatment options available, all of which have a varying degree of success. More commonly than not, a combination of treatment is warranted as illustrated by our case. Recurrent bleeding may occur just as in cases of Dieulafoy's lesion affecting the upper gastrointestinal tract. Even though endoscopic visualization of the lower gastrointestinal tract in the presence of profuse lower gastrointestinal haemorrhage may not be possible, this important procedure should not be omitted as the bleeding source may be lying in a low and accessible location for prompt interventional haemorrhage control.

Aged↗
PubMed1975

The spectrum of colitis associated with lincomycin and clindamycin therapy.

Ten cases of protracted diarrheal illness after the oral administration of lincomycin or clindamycin in standard dosages were observed in previously healthy subjects. An abrupt onset of diarrhea, crampy abdominal pain, fever, and leukocytosis was observed one to 12 days after discontinuation of the drug. Proctoscopic examination revealed erythematous friable mucosa covered with small raised, yellowish-white plaques that were sometimes confluent. Barium contrast studies of the colon demonstrated irregular shaggy mucosa, ulcerations, cobblestone appearance, and thumb printing. Rectal bipsy showed acute inflammation with pseudomembranes with focal or superficial ulcerations. All patients had a protracted course but recovered with supportive management. Follow-up barium enemas and proctoscopy were done on all patients and were normal. A history of diarrhea, fever, and mucosal changes seen on proctoscopy in a patient who has recently received one of these antibiotics should raise the possibility of colitis associated with clindamycin and lincomycin therapy.

Adult↗
PubMed1980

Hemolytic-uremic syndrome colitis.

The hemolytic-uremic syndrome has varied prodromal symptoms. In a few patients the dominant initial gastrointestinal symptoms have led to a presumptive diagnosis of ulcerative colitis. The colitis tends to be self-limited, to have minimal lesions detected by proctoscopic or roentgenographic studies, and usually to resolve spontaneous without specific therapy. Rarely, more serious colonic involvement can progress to toxic megacolon, rectal prolapse, colonic perforation, intussusception, or colonic stricture. Early hemodialysis will reduce morbidity and mortality in patients with severe renal impairment. The physician should be aware of this entity when young patients present with a picture compatible with ulcerative colitis in order to circumvent delayed or inappropriate management of what would appear to be a primary bowel disorder.

Adolescent↗
PubMed1988

Barium granuloma of the sigmoid colon.

Barium granuloma (BG) is an unusual complication of barium enema that occurs due to the intravasation of barium into the colonic wall as a result of mucosal injury from an enema tip, overinflation of the rectal balloon, or intrinsic disease such as ulcerative colitis. We report a case of BG from a barium enema performed within 24 h after a proctoscopic biopsy. It was detected 5 years later when the patient developed persistent low back pain.

Adult↗
PubMed2000

Food-induced eosinophilic proctocolitis.

Food-induced eosinophilic proctocolitis appears in the first 2 months of life with blood-tinged stools. Aside from occasional apparent pain on defecation and a few infants with moderate eczema, systemic features are absent. Indeed, aside from the diaper, the infant is generally described as well. Thus, in contrast to the infant with enterocolitis, features such as emesis, failure to thrive, significant anemia, and dramatic diarrhea are not seen. In contrast to infants with the other food-induced inflammatory diseases of the bowel, most symptomatic infants are exclusively breast fed. Proctoscopic examination reveals focal erythema, erosions, and/or the nodularity of lymphoid nodular hyperplasia of the rectosigmoid. Biopsies of the rectum and lower sigmoid reveal a characteristic infiltration of the mucosa and lamina propria with eosinophils, usually in excess of 6 to 10 per high powered field. Elimination of the offending protein from the diet of the infant, through use of an extensively hydrolyzed casein-based formula or the elimination of the protein from the diet of the mother of the breast-feeding infant, leads to clinical resolution of the bleeding within 72 to 96 hours. By 1 year of age the infants routinely tolerate an unrestricted diet, and the long term prognosis is excellent.

Biopsy↗
PubMed1998

Type of health care coverage and the likelihood of being screened for cancer.

OBJECTIVES: This study explored whether type of outpatient health coverage affected the likelihood of men and women aged 20 to 64 years receiving recommended cancer screening procedures. METHODS: Data from the 1989 and 1990 California Behavioral Risk Factor Surveillance Surveys were used to compare Pap smear, mammogram, fecal occult blood test, and proctoscopic examination rates for adults with three different types of private health care coverage (Group/staff model health maintenance organization, Independent Practice Association Model health maintenance organization, indemnity plan) and no outpatient health insurance. Logistic regression models were used to control for sociodemographic and health characteristics and whether individuals had a usual health care provider. RESULTS: Individuals with Group Model health maintenance organization coverage were significantly more likely than those with indemnity plans to have had recent cervical, breast, and colorectal cancer screening, whereas screening likelihood for those with Independent Practice Association model health maintenance organization coverage did not differ substantially from those with indemnity plans. Individuals with no outpatient coverage were less likely to be screened than those with outpatient coverage. The most consistently significant predictor across cancer screening procedures for both men and women was having a usual doctor who knew their medical history. CONCLUSIONS: Adults who had private outpatient insurance were more likely to undergo recommended cancer detection procedures than those who did not. Adults who belonged to a health maintenance organization, which emphasizes and pays for a broader spectrum preventive care, were more likely to receive Pap smears, mammograms, and fecal occult blood tests than those covered by indemnity plans. Receiving care primarily from one doctor significantly increased the likelihood of having screening procedures, irrespective of type of health plan.

Adult↗
PubMed1975

Iatrogenic lesions of the colon and rectum.

Our ability to document a number of examples of iatrogenic lesions of the colon and rectum in three general hospitals confirms the multiplicity of these lesions as presented in the literature. It appears that the careful surgeon and his associates would well heed the old admonition known as Murphy's law, that "Anything that can go wrong will go wrong." In the daily practice of the general surgeon and proctologist, it is apparent that gentleness in approaching any anal-rectal examination for either diagnostic or therapeutic purposes is mandatory. The insertion of any foreign object, be it an examining finger, a thermometer, enema tip, or proctoscope, may subject the patient to an inadvertent injury of significant proportion. The dangers inherent in the evaluation and treatment of patients with recognized disease processes is significantly greater than that associated with routine and screening examinations. Morbidity and mortality have been shown to be associated with the barium enema as well as with the barium enema as well as with some of the newer radiologic procedures such as mesenteric angiography. The use of tap water for enemas has produced morbidity both from thermal injuries and from electrolyte depletion. Antibiotics and chemotherapeutic drugs frequently result in colon and rectal disease, and therapeutic procedures directed at organs adjacent to the colon and rectum have resulted in a number of iatrogenic lesions. This reviews confirms reports of others that iatrogenic lesions of the colon and rectum are not solely due to the physician's inexperience, as significant numbers of these lesions were the result of the diagnostic or therapeutic efforts of men of considerable experience and skill. Advanced age of the patient and diseases leading to changes in the character of the bowel wall frequently were factors in the production of these lesions. A poorly prepared bowel has led to increased morbidity and mortality associated with iatrogenic perforations. The early recognition of these lesions and prompt medical and surgical management diminishes both the morbidity and mortality associated with such injuries.

Adult↗
PubMed1984

Puborectalis sphincteroplasty for anal incontinence.

Difficulty in rectal emptying, incontinence, solitary ulcer with bleeding, physical finding of lax puborectalis musculature, obtuseness of the anorectal angle, and bulging of the anterior rectal wall into the proctoscope suggest incontinence amenable to puborectalis plication. Puborectalis plication sphincteroplasty is useful in correcting patulousness and incontinence attendant with rectal procidentia, as well as certain cases of lax or nonresponsive puborectalis muscle related to idiopathic collagen disorders. Anorectal burning after correction of patulousness is related to irritable bowel aggravation, as occurred in one of my nine patients. Despite the short follow-up, preliminary results seem to warrant puborectalis sphincteroplasty in selected patients.

Aged↗
PubMed1988

Diffuse juvenile polyposis: management by ileoendorectal pull-through.

Two children with diffuse juvenile polyposis were managed by ileoendorectal pull-through. The procedure was more difficult and time-consuming because each stalk in the rectum had a well established blood supply, thus causing bleeding, and because it was difficult to manipulate the mucosal sleeve, as the polyps obstructed the lumen. Both children had satisfactory long-term results after reconstruction with an isoperistaltic pouch. I believe that in cases of diffuse juvenile polyposis, proctoscopic removal of all of the rectal polyps two to three weeks before the definitive procedure may greatly facilitate it.

Adolescent↗
PubMed1997

Anal lesions: any significant prognosis in Crohn's disease?

AIM: Work-up of anoperineal lesions usually includes indices of clinical activity as well as diagnostic criteria of Crohn's disease but their prognostic implication remains unclear. This prospective study was conducted in order to evaluate the overall incidence of anoperineal lesions and their relation to the natural history of underlying intestinal Crohn's disease with special reference to the steroid-dependent state of the patients. PATIENTS AND METHODS: One hundred and one patients (46 males, 55 females, aged 34 +/- 14 years; range: 15-79) were consecutively referred to our institution (May 1991 to May 1994) for intestinal symptoms related to Crohn's disease (mean duration 66 +/- 66 months). They all underwent a proctological examination regardless of perineal symptoms. The Cardiff classification was used to describe anoperineal lesions. Patients with anal lesions (64) differed from those without (37): male predisposition (53% vs. 32%, P<0.05), more frequent rectal involvement (75% vs. 24%, P<0.001) and more acute lesions observed at proctoscopic examination (42% vs. 16%, P<0.05). Age of onset, surgical past history of Crohn's disease, colonic or ileal involvement, or Harvey-Bradshaw score were not different between groups. RESULTS: Patients with anal ulceration (43) as compared to patients having anal involvement without ulceration experienced pain more frequently (constant pain: 56 vs. 14%; defecatory pain: 35 vs. 19%) and a more severe evolution of intestinal (40 vs. 22%, P<0.05) and anal (42 vs. 12%, P<0.05) involvement. In those with an aggressive ulceration (U2, 28 patients), daily stool frequency (5.1 +/- 3 vs. 3.6 +/- 2.5, P<0.05) and clinical score (9 +/- 5 vs. 7 +/- 3) were more pronounced. Steroid therapy dependency occurred more frequently in the group with anal ulceration (35 vs. 16% and 40 vs. 17%, respectively, P<0.05). Similar associations were observed for cases of anal involvement (34 vs. 5%, P<0.01) and azathioprine was more frequently required (39 vs. 5%, P<0.01) than in those free of anal lesions. During follow-up, eight other patients required azathioprine (steroid dependence in six) and seven of them had anal lesions at referral. At the endpoint of the study, one out of two patients with anal lesions required azathioprine most often due to steroid dependency of the intestinal involvement (30/64 vs. 4/37, P<0.005). CONCLUSION: Anal ulcerations are a reliable severity index of Crohn's disease in both short- and long-term prognosis but their link to the steroid status of the intestinal disease remains unclear.

Adolescent↗
PubMed1978

Histiocytic ulcerative colitis in a Boxer dog.

A 2-year-old male Boxer dog had passed loose faeces mixed with fresh blood and mucus for 8 months. Tenesmus after defaecation was a feature. Colitis was diagnosed from the proctoscopic appearance of the recto-colonic mucosa and confirmed from a biopsy. The disorder proved unresponsive to sulphasalazine therapy, but oral chloramphenicol, betamethasone and prednisolone enemas administered over a 6-week period produced a satisfactory clinical improvement, which persisted for a further 3 weeks without treatment. However, follow-up proctoscopy showed only a marginal improvement in the appearance of the mucosa and appeared to exacerbate further bloody diarrhoea, which persisted. The dog was destroyed and histiocytic ulcerative colitis confirmed at autopsy.

Animals↗
PubMed1982

Pseudomonas aeruginosa and Klebsiella pneumoniae on the perinea of males with spinal cord injuries.

Pseudomonas aeruginosa colonization is found in a high percentage of males with spinal cord injury. The perineum is the body site most frequently colonized, and specific serotypes may persist for weeks. We examined patients for the presence of P. aeruginosa and Klebsiella pneumoniae on the perineum and adjacent body sites by using contact plates. P. aeruginosa, K. pneumoniae, or both were cultured from perineal swabs of 22 male patients. Wells (2.5 cm2) containing agar medium selective for these organisms were used to examine samples from 32 sites adjacent to the perineum in each patient. P. aeruginosa was most frequently cultured from samples taken from the perineum, the scrotum, and the penile shaft. K. pneumoniae isolation was more variable; this organism was most commonly found on the perineum and scrotum. Rectal swabs, obtained through a proctoscope, were positive for P. aeruginosa in four of eight patients with this organism on the perineum and positive for K. pneumoniae in eight of nine patients with this organism on the perineum. These studies more clearly define the extent of the colonization of the perineum and adjacent body sites which provides potential reservoirs of P. aeruginosa and K. pneumoniae.

Humans↗
PubMed1981

Proctoscopy in infancy with reference to its use in necrotising enterocolitis.

Experience with the fairly simple and safe technique of proctoscopy in an infant using an ordinary auroscope is reported. The use of the auroscope showed the presence of a frank colitis in 13 of 14 consecutive cases of necrotising enterocolitis. A prospective study was made during a 6-month period of 51 infants with diarrhoea referred to a gastroenterology isolation unit; proctoscopic findings that suggested colitis were found in 10. Of these, 3 appeared to have necrotising enterocolitis; 3 had salmonella or shigella dysentery; in 3 of the remaining 4 the findings were localised to the anus, with normal mucosa above. This was attributed to a mild rectal prolapse on straining. There was no correlation between the severity of the diarrhoea and the presence of colitis. Proctoscopy is safe and valuable in the early diagnosis of necrotising enterocolitis. It is also helped in assessing the progress of the disease.

Acute Disease↗
PubMed1985

Sigmoidoscopy/proctoscopy service with open access to general practitioners.

Many hospitals now offer barium enema examinations to general practitioners on an open access basis, so bypassing the traditional sequence of first carrying out a sigmoidoscopy. An open access sigmoidoscopy/proctoscopy service was therefore opened with requests for a barium enema being denied unless preceded by sigmoidoscopy. During the first three and a half years 1458 patients referred direct from their general practitioners were examined using a rigid sigmoidoscope. Patients were also examined with a proctoscope if thought appropriate. After the first year of the service a subsequent examination with a fibreoptic sigmoidoscope was also carried out if the presenting symptom was bleeding for which no cause could be found with the rigid instruments. A total of 516 abnormalities were found to account for symptoms in 506 patients giving a diagnostic rate of 35%. The most common lesion was piles (307 cases). Other relatively common disorders included inflammatory bowel disease (107 cases), benign tumours (44), and malignant tumours (38). Of 41 patients subsequently undergoing fibreoptic sigmoidoscopy a cause for the bleeding was found in 32, the most common being a malignant tumour (16). Most general practitioners in the district used the service and a questionnaire survey indicated that most found it very helpful. Requests from general practitioners for a barium enema fell substantially over the period.

Adolescent↗
PubMed1990

Fine needle aspiration cytology of rectal masses.

This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure.

Adenocarcinoma↗
PubMedDate not supplied

Prevalence of occult human papillomavirus infection, determined by cytology and DNA hybridization, in heterosexual men attending a genitourinary medicine clinic.

One hundred and five heterosexual men without evidence of clinical anogenital warts and attending a genitourinary medicine clinic were studied. Three separate specimens for cytology were taken from (i) the distal urethra including the perimeatal area, (ii) the penile shaft and glans penis including the sub-preputial area, and (iii) from the anorectal area using a proctoscope. Pooled specimens of exfoliated cells from these sites were also taken for the detection of human papillomavirus (HPV) by DNA hybridization. Twenty-eight (27%) of the men had cytological evidence suggestive of HPV infection. HPV genome was detected in 21 (20%) of the men by DNA hybridization and 95% of them were carrying HPV 16 genotype either alone or in combination with other genotypes. A total of 42 (40%) of patients had evidence of occult HPV infection using cytology and/or DNA hybridization techniques collectively. None of the epidemiological risk factors were significantly associated with occult HPV infection in this study. The significance of this high incidence of sexually transmissible HPV genomes, mostly HPV16 in the anogenital area of heterosexual men attending genitourinary medicine clinics requires further study.

Adolescent↗
PubMed1983

Barium enemas of carcinoma of the colon: sensitivity of double- and single-contrast studies.

A total of 1,140 primary colorectal carcinomas found in 1084 patients during a 5 1/2-year period (1976 to mid-1981) at the Mayo Clinic was reviewed to evaluate the accuracy of detection by the double- and single-contrast barium enema examinations. Both methods were equally sensitive in detecting colon cancer above the proctoscopic level. The error rate (ulcerative colitis excluded) was 4.8% for the single-contrast enema and 4.7% for the double-contrast study. Neither type of examination was superior in finding smaller lesions or earlier staged lesions. Several causes for error were identified: fluoroscopic inexperience, technical factors, misinterpretation of radiologic findings, and distraction.

Adenocarcinoma↗