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PubMed1980

[Ruptures and "spontaneous" perforations of the rectum and sigmoid: a report on two cases and review of the published literature (author's transl)].

Though ruptures and "spontaneous" perforations of the rectum and sigmoid are sometimes confused they are very different affections. Ruptures of the rectum or the rectosigmoid junction are lesions due to effort in chronically constipated subjects, frequently having rectal prolapses. They are due to a particular type of trauma. Perforations of the rectum, rectosigmoid junction, or the sigmoid loop arise from a previous acute ulceration of the intestinal wall. Systematic histological examinations may confirm the etiology. A case is reported of rupture of the rectum due to effort. The second case was a double perforation, of the rectum and the rectosigmoid junction, due to a non-specific acute rectocolitis.

Adult↗
PubMed1993

[Multiple tumors of the colon and rectum].

The possible occurrence of multiple synchronous or metachronous malignant lesions in patients with a carcinoma of the colon and rectum is a well known event. In this population-based study in the Geneva area from 1970 to 1986, the frequency of synchronous colorectal carcinomas was of 1.1% and that of metachronous carcinomas of 1%. The relative risk of metachronous colorectal carcinoma is higher than in the general population (colon after rectum 1.2, colon after colon 1.7 and rectum after rectum 1.4). A high association of adenomatous polyps with multiple colorectal carcinomas was observed. The 5-year actuarial survival in case of curative resection was of 87% for metachronous carcinomas, 35% for single carcinomas and 33% for synchronous carcinomas. We conclude that complete preoperative colonoscopy, whenever possible, should be performed to screen patients with synchronous carcinomas. Finally, a lifelong follow-up of the residual colon or rectum should be planned to detect metachronous lesions.

Aged↗
PubMed1993

[Multiple tumors of colon and rectum].

The possible occurrence of multiple synchronous or metachronous malignant lesions in patients with carcinoma of the colon and rectum is a well known event. In this population-based study in the Geneva area from 1970 to 1986, the frequency of synchronous colorectal carcinomas was 1.1% and that of metachronous carcinomas 1%. The relative risk of metachronous colorectal carcinoma is higher than in the general population (colon after rectum 1.2, colon after colon 1.7 and rectum after rectum 1.4). A high association of adenomatous polyps with multiple colorectal carcinoma was observed. The 5-year actuarial survival in case of curative resection was 87% for metachronous carcinomas, 35% for single carcinomas and 33% for synchronous carcinomas. We conclude that complete preoperative colonoscopy, whenever possible, should be performed to screen patients with synchronous carcinomas. Finally, a lifelong follow-up of the residual colon or rectum should be planned to detect metachronous lesions.

Actuarial Analysis↗
PubMed1984

Circadian influence on the metaphase arrest technique in mouse cornea (light microscopy study) and rectum (flow cytometry study).

Vincristine (VC) was used to arrest metaphases in the epithelium of the cornea and rectum. The cornea was studied by light microscopy (mitotic index). The rectum was analyzed by flow cytometry (%G2 + M). The results of a dose range finding study showed that 3.0 mg/kg body weight VC did not increase the number of metaphases in the cornea or the %G2 + M for the rectum over that recorded for a dose of 1.0 mg/kg VC. Therefore 1.0 mg/kg VC was selected as the dose to use. Mice were kept on a 12:12 light-dark cycle with light from 0600 to 1800. Mice were treated with 1.0 mg/kg VC at either 0200 or 1400. 0200 is a time when the native mitotic index is increasing toward a peak level, which is attained at 0800-1000 under these conditions. 1400 is a time when the mitotic index is decreasing to trough level, which is attained at 2000 to 2200. In one experiment, subgroups of mice were killed at +3 (0500 or 1700) and +6 (0800 or 2000) hours after VC. In a replicate experiment subgroups were killed at +2 (0400 or 1600), +4 (0600 or 1800), and +6 (0800 or 2000) hours after VC. The data from the cornea (mitotic indices) and the rectum (%G2 + M) were graphed against time. For both organs the slope of the metaphase accumulation line was different when VC at 0200 data were compared to VC at 1400 data. The conclusion reached was that by changing the biological time of the experiment one can significantly change the slope of the line obtained with the stathmokinetic technique.

Animals↗
PubMed1988

Temperature gradient between the rectum and the anal canal: evidence against the role of temperature sensation as a sensory modality in the anal canal of normal subjects.

Temperature difference between the rectum and anal canal is a fundamental requirement for the hypothesis that temperature sensation is of physiological importance in discrimination of anorectal contents occurring during the 'sampling reflex'. The temperature gradient between the rectum and the anal canal was measured in 47 normal subjects (mean age 51.6 years +/- 16.8 s.d., 24 men). The maximum mean difference in temperature between the rectum and the anal canal was 0.13 degrees C (0.06-0.19, 95 per cent confidence intervals) and occurred 4 cm from the anal verge. This difference is too small to be detected by the anal canal mucosa. Under normal physiological circumstances the conscious appreciation of temperature of faeces passing from the rectum to the anal canal is impossible during the anorectal sampling reflex.

Adult↗
PubMed2001

Transverse folds of rectum: anatomic study and clinical implications.

There are controversies with respect to the location, number, and function of the transverse folds of the rectum (TFR), probably because their physioanatomic aspects have not been fully investigated. The purpose of this communication was to study the anatomic and histologic structure of the TFR aiming at elucidation of their function in the light of their structure. The TFR were studied morphologically and histologically in 18 cadavers (10 male, 8 female) with a mean age of 36.6 +/- 10.4 (SD) years. Barium enema studies were also performed in 36 volunteers (20 male, 16 female; mean age 38.6 +/- 15.2 [SD] years). The number of TFR varied, the commonest findings being two and three. In a few cases, TFR were absent or exceeded three in number. Most folds extended beyond the middle of the rectal lumen; a few were narrow. They were thick at the base and tapered gradually. Microscopically, the TFR contained circular and longitudinal smooth muscle fibers; they were rarely purely mucosal. TFR varied in location dividing the rectum into compartments; an alternating side-to-side arrangement allows for a wavy movement of the stool in the rectum. The wavy movement, compartmental division, and the shelving action of the TFR are suggested to retard stool movement in the rectum so as to allow time for fecal sampling (stool or gas) and for impulses to reach the conscious level to decide whether or not to defecate. Further studies are needed to investigate the role of the TFR in clinical practice.

Adolescent↗
PubMed2003

In-utero development of the fetal colon and rectum: sonographic evaluation.

OBJECTIVE: To construct a normal range for the internal diameter of the fetal descending colon and rectum during gestation. SUBJECTS AND METHODS: This was a prospective, cross-sectional study including 379 healthy pregnant women with normal singleton pregnancies at 19-40 weeks of gestation. Measurements of the fetal descending colon (maximum internal diameter) and the fetal rectum (at the level of the bladder, measuring the anteroposterior diameter), were performed by high-resolution transabdominal sonography. RESULTS: Adequate bowel measurements were obtained in all 379 fetuses. The diameter of the descending colon and rectum plotted as a function of gestational age had a sigmoid curve; the curve estimation was expressed by a cubic regression equation with R(2) of 0.848 and 0.831, respectively (P < 0.0001). The normal mean and the 95% prediction limits were defined. CONCLUSION: The present data provide a normal range of fetal bowel (descending colon and rectum) diameters from the early second trimester of pregnancy onwards. They may allow intrauterine assessment of the development of the fetal colon and may serve as reference values in the detection of anomalies of the fetal bowel.

Adult↗
PubMed1986

Effect of CCK-OP and intraduodenal administration of essential amino acids on intraluminal pressures of sigmoid and rectum in patients with Chagasic megacolon.

The motility of the sigmoid colon and rectum was studied by manometry in patients with Chagasic megacolon and in control individuals using two different experimental procedures: (1) intravenous infusion of saline, followed by intravenous infusion of cholecystokinin octapeptide (OP-CCK) at the dose of 20 ng/kg/hr; and (2) intraduodenal instillation of saline followed by a solution of essential amino acids at a flow of 10 ml/min. CCK-OP induced an increase in motility index in the sigmoid colon (P less than 0.05) and rectum (P less than 0.05) in the controls, whereas intraduodenal infusion of amino acids produced a significant increase in motility index exclusively in the sigmoid colon (P less than 0.005). A significant increase (P less than 0.05) in sigmoid colon motility also occurred in the control group after duodenal saline infusion was interrupted. The release of other substances in addition to CCK must have been responsible for the different behavior of sigmoid colon and rectum in response to the stimuli used. Neither procedure caused significant changes in the motility of the sigmoid colon or the rectum of the Chagasic patients. The extensive intramural denervation occurring in Chagasic megacolon probably destroys the neural pathway through which OP-CCK and the substances released by the duodenum by the infusion of essential amino acids activate the motor cells of the human terminal intestine.

Adult↗
PubMed1987

The surgical anatomy of the rectum--a review with particular relevance to the hazards of rectal mobilisation.

The major complications of rectal surgery that are wholly or partially avoidable by the use of an anatomically based dissection are haemorrhage from presacral veins, perforation of the rectum, damage to pelvic autonomic nerves and inadequate clearance of a rectal cancer. Important technical points in minimising the incidence of these complications are: (1) posterior dissection in the presacral space; (2) entry to this space by sharp dissection immediately posterior to the superior rectal artery; (3) deliberate incision of the rectosacral fascia; (4) anterior dissection posterior to Denonvilliers fascia in benign disease; (5) removal of the entire mesorectum for low rectal cancer. Other anatomical points not widely appreciated are: 1. The middle rectal artery does not run in the lateral ligaments of the rectum, but below them, on levator ani. It reaches the rectum by penetrating Denonvilliers' fascia. 2. The lateral ligaments may contain an accessory middle rectal artery in 25% of cases. 3. The pelvic autonomic nerves are buried in endopelvic fascia on the pelvic side wall, but come to lie close to the anterior aspect of the rectum at the level of the prostate or upper vagina.

Colon↗
PubMed1977

Effects of glucagon and secretin on food- or morphine-induced motor activity of the distal colon, rectum, and anal sphincter.

The effects of glucagon and secretin on food- or morphine-induced motor activity of the distal colon, rectum, and internal anal sphincter were investigated in 12 healthy subjects. Intraluminal pressure changes were measured using a triple-lumen polyvinyl tube assembly with 3 side orifices. Glucagon, administered intravenously, caused significant inhibition of food- or morphine-induced motor activity of both the distal colon and rectum. In contrast, secretin did not suppress morphine-induced motor activity but did significantly inhibit food-stimulated motor activity of the distal colon. The inhibitory effect of secretin on motor activity of the rectum was insignificant. Morphine, but not food, elevated the pressure of the anal sphincter which was not effected by glucagon or secretin. Hyperglycemia, produced by the infusion of 5% glucose, had no effect on motor activity. These studies demonstrate that glucagon but not secretin, in the doses employed, inhibits morphine-induced motor wave activity of both the distal colon and rectum and that this inhibitory effect is not secondary to hyperglycemia. Furthermore, the rise in anal sphincter pressure is not affected by glucagon or secretin.

Adult↗
PubMed1997

Avoidance of anastomotic complications in low anterior resection of the rectum.

PURPOSE: This retrospective study was designed to evaluate the efficacy of suction-irrigation drainage systems in reducing anastomotic complications. The current trend for lesions of the upper and middle rectum emphasizes maintaining an intact anal sphincter mechanism as long as limits of resection are not compromised. Removal of the rectosigmoid colon with an anastomosis below the peritoneal reflection accomplishes this goal but with appreciable morbidity and mortality, which is in great part related to subsequent anastomotic breakdown and resultant pelvic abscess and fecal fistula formation. The presence of collections of blood, serum, and cellular debris contribute significantly to anastomotic disruption by serving as a culture medium in which bacteria may thrive, leading to abscess formation with subsequent deleterious effects on the integrity of the adjacent low lying anastomosis. Many surgeons accepted this risk and routinely performed diverting colostomies to minimize the consequences of anastomotic disruption below the peritoneal reflection. The authors felt that if this risk could be sufficiently reduced, it would obviate the need for a protecting stoma. METHODS: From 1980 to 1988, 60 consecutive patients were subjected to anterior or low anterior resections in which a closed Shirley sump irrigation system was used to facilitate postoperative drainage of the pelvis and thus avoid hematoma formation. Since this original study group of 60 patients, another 100 consecutive patients have been entered into this study. This cohort group again consisted of patients with lesions of the upper, middle, and lower rectum who underwent anterior or low anterior resections of the rectum. RESULTS: Fifty-three of the original 60 patients did not have protecting stomas. Clinical leak rate for this series was 1.67 percent. Clinical leak rate for this updated series of 100 patients was 1 percent, with overall clinical leak rate of 1.25 percent in 160 consecutive patients. There were no deaths in the series, and overall morbidity was 7.5 percent. CONCLUSIONS: The authors felt that removing blood, serum, and cellular debris from the pelvis following resections of all or part of the rectum minimizes the risk of anastomotic disruption. With this routine, covering colostomies are no longer required for most patients undergoing anterior or low anterior resections of all or part of the mesorectum.

Adult↗
PubMed1997

Evaluation of ability to defecate using saline evacuation from the rectum.

PURPOSE: The purpose of this study is to establish a simple technique to evaluate anorectal motility and the dynamics of defecation. METHODS: Pressure fluctuations in the rectum and anal canal during 500 ml of saline infusion in the rectum and then a saline evacuation curve were recorded using manometer and uroflowmeter. RESULTS: This study consisted of 37 patients with a mean age of 49.6 years. All patients without problems with defecation showed periodic relaxation of the anal canal, which was synchronized with rectal contractions during saline infusion. The saline evacuation curves of these patients were characterized by short evacuation time and high-peak flow. Of the 13 patients with constipation, 9 showed no rectoanal synchronization and had segmental evacuation curves. The patients with incontinence tended to have poor ability for holding saline in the rectum, resulting in low-peaked evacuation curves. CONCLUSIONS: This simple and noninvasive technique for recording anorectal pressure fluctuations and dynamics of saline evacuation from the rectum enables quantitative and qualitative evaluation of the ability to defecate.

Anal Canal↗
PubMed1980

Prospective study of the effect of resection of the rectum on male sexual function.

A prospective study to evaluate sexual dysfunction following resection of the rectum was performed in 21 male patients. Following proctocolectomy for inflammatory bowel disease (9 patients), the incidence of sexual dysfunction was 11%, and it was always partial. Following abdominoperineal excision of the rectum for carcinoma (7 patients), the incidence of sexual dysfunction was 50%, and it was total in 16%. After anterior resection with low colorectal anastomosis (5 patients), the incidence of sexual dysfunction was 40%. The risk of dysfunction following operations on the rectum increased with the age of the patient and was minimal below the age of 50 years. In patients with inflammatory bowel disease, careful dissection close to the rectum should avoid damage to the pelvic nerves, and the incidence of sexual dysfunction should be low.

Adult↗
PubMed1987

Ulcerative colitis with relative sparing of the rectum. Clinical features, histology, and prognosis.

A series of 12 patients with relative sparing of the rectum in ulcerative colitis is analyzed. Half were recorded as having normal sigmoidoscopic appearance and, in every case, double-contrast barium enema showed an apparently normal rectum but an abnormal colon. Rectal biopsy showed changes compatible with ulcerative colitis in all cases, though in four, changes were slight. Thus, complete histologic sparing of the rectum was not observed. In four of six patients treated by colectomy and ileorectal anastomosis, inflammation of the retained rectum required medical or surgical treatment.

Adult↗
PubMed1989

Rectal anastomosis with application of luminal fibrin adhesive in the rectum of dogs. An experimental study.

By performing a colorectal anastomosis, the risk of a serious clinical leakage is about 10 percent. On the basis of this, the current study described a combined fibrin adhesive-sutured anastomosis in the rectum performed with interrupted seromuscular sutures externally and fibrin adhesive in the mucosa-mucosa cleft internally. Ten dogs having combined anastomosis were compared with ten dogs having a two-layer sutured anastomosis in the rectum as a control. The median bursting strength in the rectum seven days after the operation was 280 mm Hg (range, 180 to 340 mm Hg) for the combined anastomosis and 260 mm Hg (range, 170 to 405 mm Hg) for the sutured anastomosis in the control group. Two anastomoses with two-layer sutured anastomosis had a leak demonstrated radiographically, while no leakage was demonstrated in the ten dogs with combined anastomosis. In conclusion, intraluminal applied fibrin adhesive may contribute to the security of the sutured rectum-anastomosis.

Anastomosis, Surgical↗
PubMed2003

[Total excision of the mesorectum in cancer of the lower and middle rectum. Oncological and functional results].

INTRODUCTION: The introduction of total mesorectal excision (TME) in the treatment of rectal cancer has improved survival rates and decreased recurrence. Our objective was to analyse perioperative data as well as the results of the follow-up examination. Risk-factors for local recurrence should be identified since the indication for adjuvant therapy in "optimal surgery" has to be redefined. PATIENTS AND METHODS: Between March 1997 and December 2001, 108 patients with adenocarcinoma of the lower and middle rectum were operated on by three surgeons according to the concept of total mesorectal excision. In 75 (69.4%) patients,a lower anterior resection and in 32 (29.2%) cases an abdominoperineal resection was performed. One patient received a Hartmann's resection. There were 15 cases of stage IV (UICC) present and in 53 patients the tumor extension was restricted to the wall. Demographic and perioperative data as well as the results of the follow-up examination were registered prospectively. The median follow-up period amounted to 24 months (2-56). RESULTS: A total of 87 patients underwent a curative resection. Fourteen lymph nodes were dissected (median). Pelvic autonomic nerve preservation was possible in 90 patients. The median intraoperative blood loss was 500 ml. As surgical complications, anastomotic leakage occurred in 18% of cases, perineal wound infection in 33%, and bladder dysfunction (requiring catheterisation) in 5.6%. The overall rate of recurrence was 17.5%. The rate of local recurrence was 4.9% and the survival rate was 91% over 3 years. Risk factors for local recurrence are N2-disease, transmural growth and tumor localisation in the lower third of the rectum. CONCLUSIONS: TME offers good oncological and functional results with low complication rates for the treatment of cancer in the middle and upper third of the rectum. Interdisciplinary multicenter studies are still necessary to redefine the place of adjuvant radiation and chemotherapy in cases of cancer in the lower two thirds of the rectum and stage III disease.

Adenocarcinoma↗
PubMed2003

Fetal surgery for repair of myelomeningocele allows normal development of the rectum in sheep.

To determine whether fetal surgery in a fetus with myelomeningocele (MMC) allows normal development of rectal muscles and nerves, we analyzed the rectum after fetal surgery in a sheep model. An MMC lesion was surgically created in 13 fetal sheep at 75 days of gestation. One fetal sheep died after the lesion was created. Eight fetal sheep were repaired at 100 days of gestation; the others were not repaired, as a control (n=4). Three methods were used for fetal surgery of MMC: standard neurosurgical repair (4 fetal sheep), covering of the MMC lesion by Alloderm (2 fetal sheep), and covering of the MMC lesion by Gore-Tex (2 fetal sheep). At 140 days of gestation, fetal sheep were harvested and histo-pathological analysis was performed on the rectum using hematoxylin and eosin staining for muscles and S-100 protein staining for nerves. One fetal sheep treated by standard neurosurgical repair died before harvesting. The four untreated fetal sheep had hypoplastic longitudinal muscles of the rectum but well developed-circular muscles. In addition, the untreated fetuses had a hypoplastic submucosal nerve plexus but a well-developed intermuscular nerve plexus. In contrast, treated fetal sheep had well-developed longitudinal and circular muscles except for one sheep treated with standard neurosurgical repair. In addition, except for the same fetal sheep, treated fetal sheep had well-developed nerve plexuses. There was no difference in muscle and nerve development of the rectum among the three repair methods. Fetal surgery for repair of MMC allows normal development of rectal muscles and nerves.

Animals↗
PubMed1997

Trypanosoma cruzi in the rectum of the bug Triatoma infestans: effects of blood ingestion of the vector and artificial diuresis.

The population density and the percentage of different developmental stages of an established infection of Trypanosoma cruzi were determined at 40 days after the last feeding of the fourth instar in the rectum (lumen, anterior and posterior wall) of fed and unfed groups of fifth instars of Triatoma infestans. Additionally, the rectum and the Malpighian tubules were incubated in saline, inducing diuresis by addition of the diuretic hormone. The rectum contained an average of 200,000-400,000 T. cruzi. After feeding the percentages of spheromastigotes and drop-like intermediate stages were reduced from < 7% and 15%, respectively, to < 3%, but those of slender intermediate stages increased statistically significantly from < 7% to 10%. After 4 h of diuresis the in-vitro-incubated isolated rectum with the four Malpighian tubules showed the same trends, indicating that diuresis rather than factors of the hemolymph or digestive products induces the development of metacyclic trypomastigotes of T. cruzi originating from epimastigotes.

Animals↗