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PubMed1981

The Turnbull-Cutait pullthrough procedure for certain cancers of the rectum and Hirschsprung disease.

The technique of the Turnbull-Cutait pullthrough procedure as performed at the Cleveland Clinic for carcinoma of the rectum and other conditions is described. The results in 127 patients are reported. Eighty-four patients were operated upon for cancer of the rectum and 47 for miscellaneous benign conditions. The average distance of tumors from the anal margin was 7.6 cm. The average margin of resection was 4.1 cm. The overall operative mortality was 1.2% in the cancer group. Ischemic necrosis occurred in 1.2% of the cancer patients, and minor pelvic sepsis occurred in 7.1%. The five-year survival in Dukes' A, B and C carcinoma of the rectum was 100%, 57% and 53%, respectively. The incidence of pelvic recurrence of the tumor at 6% was within acceptable limits. The quality of bowel function following the pullthrough procedure is discussed. It is concluded that this pullthrough procedure has a significant role in the management of carcinoma of the rectum and other conditions.

Adolescent↗
PubMed1995

Management and survival of patients with adenocarcinoma of the colon and rectum: a national survey of the Commission on Cancer.

BACKGROUND: The Commission on Cancer (COC) of The American College of Surgeons periodically reviews criteria for evaluation of the care of patients with cancer related to diagnosis, treatment, rehabilitation, and follow-up. The COC annually performs a national survey of practices for several cancer sites. STUDY DESIGN: Data collection forms for carcinoma of the colon and rectum were field-tested and then forwarded to participating hospitals. The study included a long-term survey to permit evaluation of five-year survival rates and a short-term survey to review current practices and time trends. Specific questions were asked concerning disease presentation, preoperative evaluation, surgical treatment, postoperative care, use of adjuvant therapy, and disease status at the last follow-up examination. RESULTS: A total of 39,502 reports from 943 hospitals were analyzed, including 12,682 patients with carcinoma of the colon diagnosed in 1983, 16,527 patients with carcinoma of the colon diagnosed in 1988, 4,597 patients with carcinoma of the rectum diagnosed in 1983; and 5,696 patients with carcinoma of the rectum diagnosed in 1988. Patterns of care, including changes in presentation, diagnostic and therapeutic management, and survival rates, are presented. Specific data showing results for various ethnic groups are also included. CONCLUSIONS: The distribution of cases by anatomic site was consistent with a hypothesis of rightward migration of colon carcinoma. Colon and rectal carcinomas in African-Americans were reported in more advanced stages and with corresponding decreases in survival rates. Some patterns of nonoptimal diagnostic use were noted. The increasing use of sphincter-sparing surgical alternatives for carcinoma of the rectum was evident. Adjuvant therapy was not widely used during this period. This study suggests evolving patterns of evaluation, increased preservation of continence, and improved but varying survival among ethnic groups. It further suggests that survival as measured across these 943 hospitals may be lower than that attained at some individual centers.

Adenocarcinoma↗
PubMed1994

[Anterior resection of the rectum by double stapling. Retrospective study of 100 consecutively operated patients].

The double stapling technique for anterior resection of the rectum since its first description in 1980 has greatly facilitated the anastomosis of the low rectum. Few people use it also for high anastomosis of the rectum, the majority preferring hand-suture. We used this technique for 100 consecutive anterior resections of the rectum performed between August 1990 and November 1992. 51 patients had diverticulitis, 46 had carcinoma of the rectosigmoid colon, 2 had complications after pelvic irradiation and one had Crohn's disease. Surgical complications occurred in 22 patients. They include 8 patients with anastomotic leak (4 severe and 4 minor), all operated for carcinoma. Mortality was 3%. Our experience shows that this technique can be safely performed in a teaching hospital with many surgeons. It was a safe technique for high anastomosis. Surgical complication rate was higher in patients with recurrence of carcinoma and in patients previously irradiated.

Adult↗
PubMed1996

Signet-ring cell carcinoma of the rectum with tonsillar metastasis: a case report.

A 36-year-old man was diagnosed as a case of mucinous adenocarcinoma of the rectum, Dukes' C. Pathologic examination revealed abundant signet-ring cells in the tumor. He did not receive adjuvant radiotherapy or chemotherapy after resection of the tumor. Two years later, a 3 x 5 cm mass over the right palatine tonsil was found with associated right neck lymphadenopathy. Right tonsillectomy was performed. Metastatic mucinous adenocarcinoma of the tonsil with abundant signet-ring cells similar to the primary tumor of the rectum was found. Signet-ring cell carcinoma of the rectum with tonsillar metastasis is extremely rare. No case has been reported in the English literature. To the best of our knowledge, this is the first case of signet-ring cell carcinoma of the rectum with tonsillar metastasis. The relevant literature on metastatic tonsillar tumors is reviewed.

Adult↗
PubMedDate not supplied

[Recurrent leiomyoma of the rectum treated by endoscopic transanal microsurgery].

The Authors report a case of recurrent leiomyoma of the rectum treated by Transanal Endoscopic Microsurgery (T.E.M.). Leiomyoma of the rectum is a rare entity (0.1-0.3%) (the incidence of smooth muscle tumours being 7% in the digestive tract). Benign leiomyomas are usually asymptomatic; discomfort or pain, related or not to defecation, sensation of foreign body, change in bowel habits, rectal bleeding are rarely reported. The distinction between a benign leiomyoma and a leiomyosarcoma is often difficult and requires an accurate microscopic study. In most cases rectal leiomyoma is detected incidentally in the course of a rectal examination. Endoscopic examination of the rectum with biopsies and endorectal ultrasonography are useful for the diagnosis, while rarely a plain radiologic examination is sufficient. Leiomyoma of the rectum also presents a high tendency to local recurrence (31%). Therefore the choice of an adequate treatment is often difficult. The Authors believe that the treatment of rectal leiomyoma by T.E.M. may substitute conventional methodics (transanal excision, proctectomy with or without amputation of the sphincter and coloanal anastomosis, endoscopic electroexcision of the neoplasm). T.E.M. allows short-term hospitalization and implies minimal surgical trauma.

Anal Canal↗
PubMed1997

Primary malignant melanoma of the rectum: a case report.

The aim of the study was to describe the diagnostic procedure, indications for operation and operative result in a patient with primary malignant melanoma of the rectum. In the patient, hospitalized at the Department of Surgery, School of Medicine in Zagreb, a malignant melanoma of the rectum was diagnosed by rectoscopy and histology. Tumor staging was determined by endorectal ultrasonography. Operation was indicated for malignant disease with partial obstruction of the rectum. Since the tumor was locally inoperable, with liver metastases a palliative operative procedure (sigmoidal colostoma) was performed. The operative finding confirmed the tumor stage obtained by ultrasonography. The patient died 5 months after the operation due to widespread dissemination of the malignant disease. Thereby, the accuracy of preoperative tumor staging by ultrasonography was confirmed. We believe that, in view of its accuracy, endorectal ultrasonography can be used for tumor staging in patients with primary melanoma of the rectum. Therefore, expensive diagnostic imaging methods like CT and MRI are no longer necessary.

Aged↗
PubMed1980

Invasion of the rectum by carcinoma of the prostate.

Denonvillier's fascia ordinarily serves as an effective barrier to the posterior extension of carcinoma of the prostate. Consequently, it is generally unappreciated that cancer of the prostate can invade the rectum posteriorly and appear at diagnosis to be a rectal mass. Autopsy series show that this occurs in from 0.56% to 11.5% of all cases of prostatic carcinoma. When it does appear as a rectal mass, it can be confused with carcinoma of the rectum. Unless a biopsy confirms rectal carcinoma, such an error may even result in an inappropriate abdominoperineal resection of the rectum. Every surgeon must be aware of this entity, its presumed pathogenesis, and its three clinical types: rectal ulcer, stricture, and anterior rectal mass.

Aged↗
PubMed1998

Embryology and anatomy of the rectum.

Rectal cancer surgery is difficult due to the rectum's relatively inaccessible pelvic position and its direct relation to many vital structures. The surgeon is challenged to restore intestinal continuity while working in a confined space. Despite the importance of these issues, the embryology and surgical anatomy of the rectum have been poorly understood. In recent years, cadaver dissections and operative resection under direct vision have provided a clearer picture of the structure of the rectum and mesorectum, their innervation, blood supply, and surrounding structures. New imaging techniques will shed further light on the anatomy of these structures and their anatomic variations.

Anastomosis, Surgical↗
PubMedDate not supplied

Extrafascial excision of the rectum for cancer: a technique for the avoidance of the complications of rectal mobilization.

Serious complications can occur following mobilization of the rectum for cancer including: ureteric injury, rectal perforation, hemorrhage, autonomic nerve damage, and local recurrence of the tumor in the pelvis. Each of these complications can be minimized by careful dissection in correct tissue planes in the pelvis. The rectum and mesorectum are surrounded by the fascia propria, a thin fascial envelope. This envelope offers a surface for dissection that leads the surgeon to a safe plane lying inside the autonomic nerves, the ureter, and the presacral vessels, and lying outside of the mesorectum and its associated vessels and lymphatics. The surgical anatomy of the pelvis is presented, with emphasis on the rectal fascia propria, as a basis for a detailed description of the technique of extrafascial excision of the rectum.

Dissection↗
PubMed1977

Intersphincteric excision of the rectum.

Wide excision of the rectum in inflammatory bowel disease is both unnecessary and undesirable as the healthy pelvic floor is damaged and the pelvic nerves put at risk. An operative technique is described which includes dissection of the anal canal and rectum in the intersphincteric plane, i.e. the plane of fusion between the visceral rectum and anal canal and the somatic pelvic musculature, which minimizes these undesirable elements. Fifty-three cases are presented. Perineal wound healing rates are comparable with those of other methods of resection and only 1 of 14 men reported partial sexual dysfunction following this operation.

Adult↗
PubMed1990

Low anterior resection of the rectum using a double stapling technique.

Using a double stapling technique in 30 patients, anterior resection of the rectum was attempted for low rectal carcinoma (n = 28), giant rectal adenoma (n = 1) and radiation-induced rectal stricture (n = 1). There were three emergency operations. The rectum was stapled transversely more than 3 cm below the tumour using the adjustable-angle linear stapler (Roticulator). Colorectal or coloanal anastomoses were constructed using the EEA circular stapler introduced per anum through the anorectal stump staple line. Ten coloanal and 19 low rectal anastomoses were achieved. A protecting transverse loop colostomy was fashioned in one patient with coloanal anastomosis who developed a vaginal tear during the procedure. In one patient technical failure necessitated conversion to abdominoperineal excision of the rectum. All staple rings and resection margins were intact and free from tumour. There were two clinical anastomotic leaks, both treated successfully with a defunctioning transverse loop colostomy. One patient developed a small infective pelvic haematoma 2 weeks after surgery which required drainage. Hospital stay ranged from 6 to 15 days (mean 8 days). Continence was normal in all patients at 8 weeks. One soft coloanal anastomotic stricture required dilatation. No recurrences have been detected during a follow-up of between 10 and 22 months.

Adult↗
PubMed1991

Carcinoma of the rectum: a 10-year experience.

A consecutive series of 303 patients with carcinoma of the rectum and distal sigmoid colon treated by a single surgeon over a 10-year period are reported. Of these, 202 underwent an anterior resection, 85 an abdominoperineal excision of the rectum and 16 a coloanal anastomosis. Surgery was considered palliative in 52 patients undergoing anterior resection and 24 undergoing abdominoperineal resection. The 30-day hospital mortality rate was six patients (3 per cent) for anterior resection and two patients (2 per cent) for abdominoperineal resection. Peroperative anastomotic testing demonstrated leakage in five stapled anastomoses; these were rectified and no clinical sequelae occurred. Two patients (1 per cent) developed a clinical anastomotic leak, one of which proved fatal; in each case the intraoperative test was negative. The overall 5-year survival rate was 64 per cent after anterior resection and 52 per cent after abdominoperineal resection; the median follow-up was 64 months. The incidence of local pelvic recurrence was 6.4 per cent after anterior resection and 14 per cent after abdominoperineal (not significant). These results confirm the success of sphincter-saving anterior resection combined with total mesorectal excision, routine full mobilization of the splenic flexure and cancercidal lavage of the distal rectum in the treatment of low rectal carcinomas; morbidity, local recurrence and survival are not compromised.

Adult↗
PubMed1995

Expression of cytochrome P450 mRNAs in the colon and the rectum in normal human subjects.

The expression of mRNA for three isozymes of cytochrome P450, CYP1A1, 1A2 and 3A3, was examined in biopsied samples of colon and rectum from five healthy subjects. Using RT-PCR, it was possible to detect the three CYP mRNA species at both sites in all samples examined. The expression of each CYP mRNA was site-specific in that rectum had higher levels of CYP1A1 mRNA than colon, while colon had higher levels of CYP3A3 mRNA than in rectum. In contrast, there was no consistent trend in CYP1A2 mRNA expression between the two sites. Variability of alimentary CYP expression may contribute to individual differences in susceptibility to carcinogens and/or drugs.

Aged↗
PubMed1991

Posterior approach to the rectum for treatment of selected benign lesions.

Access to lesions in the mid-rectum can be difficult. This report summarizes our experience with a posterior approach to the rectum in 22 men and 13 women, age range 21 to 96 years. Surgical indications included villous tumours, rectal prolapse, rectal strictures or rectal fistulae. No postoperative complications were observed in 20 patients, but fistulae developed in seven patients, of whom three required proximal colostomy and surgical treatment. Four healed spontaneously. Two patients developed sacrococcygeal hernia. Pathologic examination of villous tumour showed extensive malignant change in three cases requiring rectal resection with end-to-end colo-anal anastomosis. In two patients mild incontinence developed, treated by biofeedback. Residual peri-anal pain was reported by two patients. The posterior approach to the rectum is particularly useful for benign lesions too high for a transanal resection and too low for a transabdominal resection.

Adenoma↗
PubMed1982

Opposite interactions between alpha- and beta-endorphin fragments with dopamine mediated responses on the rat rectum in vitro.

Dopamine causes a dose-dependent contraction of the rat rectum in vitro followed by a relaxation. This contraction can be inhibited by apomorphine and phenylephrine. This inhibition can be attenuated by the beta-endorphin (beta E) fragments 2-17 (des-Tyr1-gamma-endorphin, DT gamma E) and 6-17 (des-enkephalin-gamma-endorphin, DE gamma E). beta E 6-17 seems to be the shortest sequence with full activity in this respect since a shorter fragment (beta E 10-17) was less effective. The atypical neuroleptics oxypertine, sulpiride, and clozapine, the classic neuroleptic haloperidol and metoclopramide have a similar action to DE gamma E. The peptides and atypical neuroleptics do not affect the dopamine response per se while the classic neuroleptics haloperidol and metoclopramide enhance the dopamine response. The effects of the alpha-type endorphins are opposite to those of the gamma-type endorphins, since des-Tyr1-alpha-endorphin (DT alpha E, beta E 2-16) and des-enkephalin-alpha-endorphin (DE alpha E, beta E 6-16) enhance the phenylephrine-induced decreased responsiveness to dopamine. Structure-activity studies revealed that the active moiety of the alpha-endorphin fragments probably resides in the 6-9 region. In addition the alpha-type endorphins directly inhibit the dopamine response. It is concluded that the rat rectum may be used to analyse neuroleptic-like action. In this model alpha- and gamma-endorphin fragments may directly or indirectly influence the interaction of dopamine with the rectum. Because of the strong similarities between the effects of gamma-type endorphins and that of neuroleptics the results support the purported neuroleptic-like action of gamma-type endorphins. The influence of alpha-type endorphins and gamma-type endorphins on the apomorphine or phenylephrine induced decreased responsiveness to dopamine, although opposite, seems to be mediated by an influence on different dopamine sensitive systems.

Acetylcholine↗
PubMed1995

Hexose accumulation by enterocytes from the jejunum and rectum of chickens adapted to high and low NaCl intake.

We have studied the effects of adaptation to low NaCl intakes on hexose transport using suspensions of enterocytes isolated from the jejunum and the rectum of the chicken. Animals (12-13 weeks old) were kept for 11 days on either a high-Na+ (HS) or a low Na+ (LS) diet. On day 11, mean serum aldosterone concentration was 46 pg/ml in HS birds and 236 pg/ml in LS birds. Results of transport studies show that: (1) adaptation to a LS diet reduces the cellular 3-oxymethyl-D-glucose cumulative capacity by 40% in the jejunum and is virtually abolished in the rectum; (2) LS adaptation reduces initial alpha-methyl-D-glucoside influx (1 mmol/l) by 22% in the jejunum and by 54% in the rectum; (3) the influx of the membrane potential sensor tetraphenyl-phosphonium (TPP+) in enterocytes strongly suggests that rectal cells of LS birds are significantly depolarized; (4) the presence of 0.1 mmol/l amiloride increases the capacity of the rectal cells of LS birds to establish a sugar gradient across the membrane; (5) incubation of enterocytes with cytochalasin B increases sugar cumulative capacity of the jejunal cells of both HS and LS birds, and has no effect on the rectal cells of LS birds. We conclude that the effects of LS adaptation on sugar transport may involve a reduction in the membrane electrical potential.

Amiloride↗
PubMed1984

[Principles and results of narrow rectum continence resection in cancer].

The special anatomy of the "Rectum-Grenzlamellen" is the reason for justification to carry out a curative sphincter-preserving resection in carefully selected cases. In a small segment just above the pelvic floor muscles there are not any lymphnodes, when the lateral ligaments are divided and the rectum is thoroughly mobilized from the sacral concavity and stretched. The length of rectum below the tumor measured on fixed pinned-out pathologic specimens was about 2 cm. The local recurrences were 6% of 196 cases. The 5-year survival rate of this low restorative resection at St. Marks Hospital was excellent. These results suggest that a margin about 2 cm below a rectal carcinoma does not affect survival or local recurrence adversely.

Fecal Incontinence↗
PubMedDate not supplied

Colonic pseudo-obstruction: value of prone lateral view of the rectum.

BACKGROUND: Collection of fluid within the rectum of patients with gas-distended bowel can simulate as obstructive lesion. METHODS: In 12 patients with suspected distal colonic obstruction on plain radiographs, we obtained 2 additional films comprising a right lateral decubitus view of the abdomen followed by a prone lateral view of the pelvis. RESULTS: Significant gaseous distension of the rectum was achieved in 75% of the 8 patients with pseudo-obstruction. Gaseous filling of the rectum did not occur in any patient with a structural obstructive lesion. CONCLUSIONS: In the appropriate clinical setting this approach could exclude the presence of obstruction and avoid unnecessary barium enemas in the majority of patients with colonic pseudo-obstruction.

Aged↗