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Solitary neurofibroma of the anal canal: report of two cases.

Neurofibromas are benign nerve sheath tumors commonly found in patients afflicted with neurofibromatosis-1. In the absence of multiple neurofibromas or a diagnosis of neurofibromatosis-1, neurofibromas are referred to as solitary and have been reported to involve the skin, subcutaneous tissue, deep soft tissue, and viscera of almost all areas of the body. A neurofibroma involving the anal canal is a rare entity, with only one report in the literature. We present two cases in which large masses involving the anal canal of elderly females were locally resected and proved to be neurofibromas by histopathology. Although rare, these tumors should be considered in the differential diagnosis of patients presenting with an anal mass, because resection alone is the treatment of choice.

Aged↗

Open sesame: tips for traversing the anal canal.

The key points for a minimally traumatic and pain-free anal intubation are an informed patient, gentle technique, plenty of lubricant, a relaxed, supportive atmosphere, and gradual inward pressure on the instrument or finger. Also important are knowledge of the direction of the anal canal, sideways introduction of the flexible endoscope, and the technique of gaining anal relaxation by asking the patient to push down.

Anal Canal↗

Rectal bleeding in patients less than 50 years of age.

The study group consisted of 102 patients that presented for evaluation of rectal bleeding. All patients were 50 years of age or less and were evaluated with a flexible endoscope and an anoscope. The findings from each examination were recorded independently. Sigmoidoscopy and anoscopy were performed in 56 patients less than age 40 (group I), and colonoscopy and anoscopy were performed on 46 patients between the ages of 40 but less than 50 years (group II). Anoscopy was superior to flexible endoscopy in detecting hemorrhoids in group I (P < 0.001 and group II (P < 0.004). The guaiac status of patients was not influenced by the presence of hemorrhoids. Three patients in group I and eight patients in group II had polyps. The likelihood of finding a polyp was not influenced by the guaiac status of the patients. Three patients in group I and one patient in group II had anal fissures that were missed with flexible endoscopy and detected with anoscopy. Five of 102 patients were noted to have diverticula; all of these were in group II. However, this was not felt to be the source of the bleed given the clinical history. Overall, six patients had colitis; all but one of these patients were less than 40 years of age. Flexible endoscopy and anoscopy provide complimentary information in middle-aged adults with rectal bleeding.

Adult↗

A new method of recording endoscopic and operative findings in colorectal neoplasia.

A new method of recording 12 relevant facts concerning patients with colorectal neoplasia has provided a neoplastic profile for each patient. With this information recorded on an outline of the colon one can see at a glance the date, histology, and location of the initial lesion; the number and timing of both synchronous and metachronous lesions and their histology; the size, differentiation, and location of each lesion; plus a family tree. This method provides pertinent clinical facts in chronological order and characterizes each patient's neoplastic activity without the need to refer to operative notes and laboratory reports. With this method, it is easy to record and easy to interpret, and it has been extremely useful in the clinical assessment of patients with colorectal neoplasia and in arranging appropriate surveillance for these patients.

Aged↗

Large-bowel hemangiomas.

A case of large-bowel hemangioma is presented, and radiologic and histologic abnormalities are illustrated. Ultrasonographic features, not previously described, are reported. The literature is reviewed and the frequency of misdiagnosis is emphasized. Pathologic classification, epidemiologic factors, and etiology are considered. Clinical manifestations and current approaches to recognition and management are summarized. Vascular tumors are serious, albeit uncommon, intestinal lesions. Greater awareness of the condition and earlier consideration of the diagnosis are prerequisites to lessened morbidity and improved survival.

Adult↗

The risk of developing rectal cancer after colectomy and ileorectal anastomosis in Danish patients with polyposis coli.

Fifty-eight Danish polyposis patients had been treated with colectomy and ileorectal anastomosis by the end of 1982. Three of these patients developed rectal cancer despite regular proctoscopic control, but one was probably an overlooked synchronous cancer. The cumulative risk at five and ten years after operation (actuarial method) was 3.5 and 13.3 per cent (95 per cent confidence limits 0-10.3 and 0-70.3 per cent, respectively), which seem to be acceptably low figures. This study supports the assumption that colectomy and ileorectal anastomosis is still the operation of choice in polyposis patients without rectal cancer.

Adenocarcinoma↗

Bacteremia associated with lower gastrointestinal endoscopy: fact or fiction? II. Proctosigmoidoscopy.

In an effort to elucidate whether bacteremia occurs during endoscopic examination of the lower gastrointestinal tract, two prospective studies were undertaken involving patients undergoing colonoscopy and proctosigmoidoscopy. The former group has been presented earlier, and the second study, which includes the proctosigmoidoscopy group, is the basis for this study. Fifty-seven patients undergoing proctosigmoidoscopy were studied. Excluded from the study were patients with fever, diarrhea, inflammatory bowel disease, valvular heart disease, vascular prosthesis, chemotherapy, and immunosuppression. Aerobic and anaerobic blood cultures were taken before, during, and after proctosigmoidoscopy. Additional cultures were taken after a biopsy or polypectomy. Skin cultures were taken from the venipuncture site prior to venipuncture. No bacteremia was demonstrated. Three blood cultures were positive, but all were considered contaminants on the basis of the nature of organisms. No correlates could be drawn as to the depth of insertion, length of time, or position of patient during the procedure. It is concluded that no significant bacteremia occurs during proctosigmoidoscopy. Further studies are warranted in the excluded high-risk group.

Biopsy↗

Metachronous colorectal cancer. Time interval to presentation of a metachronous cancer.

A retrospective review of 1888 colorectal cancer patients demonstrated 37 metachronous cancers in 30 patients for a metachronous cancer rate of 1.6 percent. Evaluation of the index cancers consisted of the traditional single-contrast barium enema and proctoscopic evaluation. Forty percent of the metachronous cancers appeared within two years of the index cancer. If the minimum length of the polyp-cancer sequence is three to five years, then this represents a failure of a traditional preoperative evaluation. A more sensitive evaluation potentially could decrease the metachronous cancer rate. Colonoscopy, which has been found to be more accurate in detecting synchronous neoplasms, should be included in the evaluation of all patients with colorectal cancers.

Adenocarcinoma↗

Conventional vs. triple rubber band ligation for hemorrhoids. A prospective, randomized trial.

Two hundred five patients with symptomatic first- and second-degree hemorrhoids were randomized to receive either conventional rubber band ligation or triple rubber band ligation. In conventional rubber band ligation, the hemorrhoids were ligated at one primary site per session at intervals of four weeks until symptoms were relieved or when all three hemorrhoids were ligated. In triple rubber band ligation, all three primary hemorrhoids were ligated in a single session. After completion of treatment, the patients were examined every three months, or earlier if symptoms recurred. Both methods were effective in the treatment of early hemorrhoids and the incidence of postligation pain and complications was similar. The advantages of having the treatment completed at the initial visit in triple rubber band ligation are obvious. Furthermore, less treatment sessions were required for triple rubber band ligation to control symptoms than for conventional rubber band ligation. Triple rubber band ligation is more cost-effective and therefore is recommended.

Clinical Trials as Topic↗

Screening for colorectal neoplasms. A comparison of the fecal occult blood test and endoscopic examination.

Testing for occult blood in stool is used frequently as a screening technique for colorectal carcinomas, but no study has ever shown an improved survival rate for colorectal carcinoma in patients screened by this method. Consequently, the authors have prospectively compared the sensitivity of endoscopy and occult blood testing in finding colorectal neoplasms. During the first year of the Surgical Endoscopy Service, 585 patients underwent sigmoidoscopy or colonoscopy. Seventy-nine patients (13.5 percent) were excluded from the study because their occult blood status was not recorded. Patients averaged 63 + 10 years of age and 98 percent were men. Of the 348 patients with occult blood negative stools 55.5 percent underwent colonoscopy and 44.5 percent underwent sigmoidoscopy. Polyps were found in 25.6 percent of these patients, colorectal carcinomas in 2.6 percent, and diverticulosis 36.2 percent. Of the 158 patients with occult blood positive stool, 76.5 percent underwent colonoscopy and 23.4 percent underwent sigmoidoscopy. Polyps were discovered in 39.0 percent of these patients, colorectal carcinomas in 10.1 percent, and diverticulosis in 43.0 percent. Thus, the occult blood test was negative in 59 percent of patients with polyps and 36 percent with colorectal cancers. These data indicate that lower gastrointestinal endoscopy is superior to occult blood testing in detecting colorectal neoplasms. These results further suggest that using the occult blood test as a screening test for colorectal neoplasms will result in a significant number of these lesions being missed at an early curable stage.

Aged↗