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PubMed1998

[Carcinoid tumors of the colon and rectum].

The article gives a review of the literature concerning carcinoid tumours of the colon and rectum. Carcinoid tumours of the rectum are more common than of the colon, although these tumours are rarities. The carcinoid tumour grows slowly and the patients can survive for years with the disease. Treatment of the rectal carcinoid depends on the size and invasiveness of the primary tumour, as a non-invasive tumour less than 2 cm in diameter can be locally excised. For carcinoids of the colon, the treatment of tumours of less than 2 cm and without invasion will be local excision. For larger and/or invasive tumours in both colon and rectum the treatment is resection. The prognosis for colonic carcinoids is worse than for rectal carcinoids. Adjuvant treatment forms are briefly described. Follow-up programmes for these patients are generally long (over five years) and include recto-/colonoscopy, and search for metastatic spread.

Carcinoid Tumor↗
PubMed1998

Surgical resection of villous adenomas of the rectum.

Although villous lesions comprise only about 5 per cent of all adenomas, 40 per cent are premalignant. Complete colonic evaluation and resection of all villous lesions should be performed. The purpose of this study is to examine our experience with transanal excision and low anterior resection as treatment options for large villous adenomas of the rectum. A retrospective review of all cases of villous adenomas of the rectum at this institution from January 1991 to February 1997 was performed. A total of 16 patients were identified; fourteen underwent transanal excision and two underwent low anterior resection. The average lesion size was 5 cm, and 50 per cent extended proximal to 8 cm from the anal verge. Thirty-seven per cent (six patients) had villous lesions containing adenocarcinoma. Thirty-one per cent (five patients) have required treatment for residual disease noted within 6 months of resection. Twelve per cent (two patients) have received treatment for recurrent disease presenting 6 months after resection. The minor complications included two episodes of urinary retention. The serious complications included one perforation and one postoperative hemorrhage for a 12 per cent complication rate. In summary, large villous adenomas of the rectum can be removed by sphincter-preserving techniques with low morbidity and an acceptable recurrence rate.

Adenocarcinoma↗
PubMed1976

Urologic complications following abdominoperineal resection of the rectum.

Perusal of the records of 111 consecutive patients who underwent abdominoperineal resection of the rectum for malignant diseases of the rectum or anal canal for postoperative urologic complications revealed that the urethra had been injured in two patients, the bladder in none, and the ureter in five. In only two of these last five patients was the late result of treatment of the ureteric injury satisfactory. The late result of treatment of the two urethra injuries was good. All the patients had been treated with an indwelling catheter for at least ten days after the operation. About one third of the patients still had disturbances of micturition two weeks after the operation, but only one required a permanent indwelling catheter.

Adult↗
PubMed1993

Sphincter-saving alternatives in the management of adenocarcinoma involving the distal rectum. 5-year follow-up results in 40 patients.

We reviewed the treatment outcome in 40 patients undergoing full-thickness local excision (seven patients) or electrocoagulation (33 patients) for adenocarcinoma of the rectum. Patients were followed up for a minimum of 5 years or until death (mean follow-up, 7.6 years). Twenty-two patients (55%) survived 5 years free of disease or were free of disease at the time of death due to other causes following local treatment. Eight (62%) of 13 patients with persistent or locally recurrent disease were successfully treated with additional local therapy, rectal resection, or combined radiation therapy and chemotherapy. Overall, 30 (75%) of 40 patients embarking on a program of local treatment for carcinoma of the rectum survived 5 years free of disease or were free of disease at the time of death due to other causes.

Adenocarcinoma↗
PubMed2000

Determinants of O(6)-alkylguanine-DNA alkyltransferase activity in normal and tumour tissue from human colon and rectum.

O(6)-Alkylguanine-DNA-alkyltransferase (ATase) is an important modulator of alkylating agent-induced toxicity and carcinogenicity, but those factors which influence the expression of this repair protein in human tissues are poorly characterised. In this study, we have determined ATase levels in macroscopically normal and tumour tissues from 76 individuals with benign or malignant colorectal disease. All tissue samples had detectable ATase activity, with values ranging from 35 to 451 fmol/mg protein. ATase activity in normal rectal tissue was significantly higher than that in normal tissue from the sigmoid colon (148 +/- 76 vs. 100 +/- 40 fmol/mg protein, p = 0.01), whereas ATase levels within different regions of the colon (proximal vs. sigmoid colon) were similar. In normal tissue, inter-individual variation in ATase activity was 4-fold in the colon and 6-fold in the rectum, whereas in tumour tissue the corresponding figures were approx. 13.0- and 7-fold, respectively. There was no detectable difference in normal tissue ATase activity between individuals with benign or malignant disease of the colon. Normal and tumour tissue ATase activities were strongly correlated in the sigmoid colon (r = 0.80) and rectum (r = 0.59) but not the caecum (r = -0.03). In a multivariate analysis, ATase activity in normal colon tissue increased with age (p = 0.01) and current smoking (p = 0.06), whereas tumour ATase activity increased only with use of anti-histamines (p = 0.05). In rectal tumour tissue, activity decreased with age (p = 0.05) and use of anti-muscarinic medications (p = 0.01): in normal rectal tissue, no modulating factors were identified.

Age Factors↗
PubMed1988

Primary malignant melanoma of the rectum. Evidence for origination from rectal mucosal melanocytes.

Reports of rectal melanoma often attribute the lesion to tumor extension from anal melanocytes which have undergone malignant transformation while the existence of true primary melanoma of the rectum has been disputed. This dispute primarily relates to past inability to demonstrate normal melanocytes in rectal mucosa. In this case report, two polypoid melanomas clearly located in the rectum were discovered at sigmoidoscopy. Thorough histologic examination failed to demonstrate atypical anal melanocytes, and the presence of normal melanocytes in the rectal mucosa was confirmed by electron microscopy and immunohistochemistry. Although rare, it appears that primary malignant melanoma may arise from melanocytes among columnar rectal epithelium.

Aged↗
PubMed1991

Ultrastructural and cytoarchitectural features of lymphoreticular organs in the colon and rectum of adult BALB/c mice.

The structure and function of colonic mucosal lymphoid organs remain largely unexplored, especially in the rectum hidden within the pelvic vault. Two-month-old female BALB/c mice were anesthetized, and the entire colon was removed from cecum to anus. Distal colonic patches were then prepared for electron microscopy or were quick-frozen and sectioned for immunoperoxidase localization of B cells and T cell subsets. Aggregated lymphoid follicles were distributed irregularly along the entire colon with an average of 1.4 patches per centimeter of colon length. There were large collections of follicles opposite the ileocecal valve (cecal patches), variable numbers of patches throughout the colon, and at least one patch within 10 mm of the anus (rectal patch). Follicles were adjacent to branching crypts lined by epithelium infiltrated by lymphoid cells and containing few goblet cells. In electron micrographs, M cells were identified by their short, irregular microvilli; intraepithelial lymphoid cells; reduced lysosomal dense bodies; and an expanded tubulovesicular network. Small germinal centers were seen. Cytoarchitectural components of colonic lymphoid follicles and Peyer's patch follicles were remarkably similar, despite differences in surrounding mucosa and luminal microbial exposure. The presence of organized lymphoid tissue with M cells and germinal centers suggests that transepithelial particle transport and antigen recognition can take place in the rectum. Whether such tissue has the capacity for uptake of luminal microorganisms is of particular interest, not only because colonic follicles may be sites for local initiation of immune responses but also because they may be important entry points for systemic infection.

Animals↗
PubMed1975

A controlled clinical trial of three different methods of perineal wound management following excision of the rectum.

Three methods of perineal wound closure were studied in a randomized prospective clinical trial in 106 patients undergoing excision of the rectum for inflammatory or malignant disease. In method 2 the perineal wound was managed by open drainage. In both methods 2 and 3 the perineal wound was closed by primary suture, suprapubic suction drains being left down to the presacral space, but in method 2 the pelvic peritoneal floor was reconstituted, whilst in method 3 it was left unsutured. Topical and systemic antibiotics were administered to all patients submitted to primary closure of the perineal wound but not routinely to those whose perineal wound was left open. The overall operative mortality was 8-5 per cent but no deaths could be definitely attributed to perineal wound complications. The incidence of primary wound healing after methods 2 and 3 was 45-2 and 42-9 per cent respectively. Operative contamination of the perineal wound had an adverse effect on perineal wound healing. The incidence of persistent wound sinuses and unhealed wounds at 3 and 6 months after primary wound closure was rather less than that encountered after open drainage. It was concluded that primary closure of the perineal wound is the treatment of choice following excision of the rectum, except in cases in which contamination of the perineal wound has occurred during operation or the final state of haemostasis in the pelvis with diathermy and suture at the conclusion of the dissection was deemed to be unsatisfactory.

Ampicillin↗
PubMed1982

Radical restorative surgery for poorly differentiated carcinoma of the mid-rectum.

A retrospective study was made to compare the results of restorative surgery with those of total rectal excision in the treatment of patients with a poorly differentiated adenocarcinoma of the middle third of the rectum (between 8 and 12 cm from the anal verge). Of 1163 patients presenting between 1963 and 1975, 42 with poorly differentiated tumours at this level were followed up after treatment by a radical (i.e. curative) operation. Twenty-eight underwent total rectal excision and 14 anterior resection. Examination of the preoperative biopsy correctly established the histological grade in 17 (40 per cent) of 42 cases. Pathological examination of the resected specimens showed a slightly higher proportion of Dukes' C2 tumours and those with venous invasion removed by total rectal excision, but the extent of local spread among tumours removed by either operation was similar. There was no operative mortality. Ten out of 28 patients treated by total rectal excision (36 per cent) and 6 out of 14 treated by anterior resection (43 per cent) were alive at 5 years. One patient developed a histologically proved local recurrence after anterior resection; no other proved local recurrence was recorded. It would appear, therefore, that where radical surgery is possible, anterior resection offers as good a prospect of cure as total rectal excision for poorly differentiated tumours of the mid-rectum.

Adenocarcinoma↗
PubMed1992

Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma.

This study investigated the relationships between length of residual anorectum, anorectal physiological function and clinical outcome after anterior resection for rectal carcinoma. Thirty-four patients were studied a median of 13 (range 4-100) months after anterior resection. They were compared with a control group of ten patients who had undergone sigmoid colectomy for carcinoma without rectal excision. Resting anal pressure was found to be lower after coloanal than after colorectal anastomosis, and the capacity of the (neo)rectum was less after coloanal than after colorectal anastomosis. The (neo)rectoanal inhibitory reflex was found to be present in each patient, but maximum anal pressure during this 'sampling' reflex was significantly lower (P < 0.01) after coloanal than after colorectal anastomosis, and the volume required for maximal inhibition of the sphincter was also less (P < 0.01). At 1 year after operation, median bowel frequency was greater after coloanal (4 per day) than after colorectal (2 per day) anastomosis and the degree of urgency of defaecation was also greater (P < 0.01). Quality of life in terms of anorectal function after anterior resection is thus significantly influenced by the length of rectum that is left. This, in turn, influences the functional capacity of the neorectum and the degree of inhibition of the anal sphincter during the neorectoanal inhibitory reflex.

Adult↗
PubMed2006

Anatomy of the sigmoid colon, rectum, and the rectovaginal pouch in women with enterocele and anterior rectal wall procidentia.

This study describes the anatomy of the rectovaginal pouch, the sigmoid colon, and rectum in women with posterior enterocele and anterior rectal wall procidentia. The anatomy of rectovaginal pouch, sigmoid colon, and rectum was described in 36 women with an enterocele (group A) and compared with those of 43 women (group B) without pelvic organ prolapse. Women with previous incontinence or prolapse surgery were excluded. The mean age in group A was 58 years (40-75) and in group B 35 years (19-64; P < 0.001). There were 15 nulliparas in group B. Nine women in group A had an internal anterior rectal wall procidentia, and one woman had an external anterior rectal wall procidentia. In group A, the rectovaginal pouch was significantly deeper, the sigmoid mesocolon at S1 shorter and showed more often a straight course (P < 0.05). These characteristics (termed "grande fosse pelvienne") were present in 23 women (64%) in group A and in 6 (14%) in group B, three of the latter were young nulliparas (P < 0.001). Age, parity, menopausal status, body mass index, constipation, and varicose veins were not associated with a grande fosse pelvienne. The typical anatomy in women with an enterocele and anterior rectal wall procidentia was a sigmoid colon with a straight course and a short mesentery at S1 and a rectovaginal pouch that covered more than half of the vaginal length. It may be a congenital condition and important in the development of an enterocele and rectal wall procidentia.

Adult↗
PubMed2005

Red meat consumption and risk of cancers of the proximal colon, distal colon and rectum: the Swedish Mammography Cohort.

Although there is considerable evidence that high consumption of red meat may increase the risk of colorectal cancer, data by subsite within the colon are sparse. The objective of our study was to prospectively examine whether the association of red meat consumption with cancer risk varies by subsite within the large bowel. We analyzed data from the Swedish Mammography Cohort of 61,433 women aged 40-75 years and free from diagnosed cancer at baseline in 1987-1990. Diet was assessed at baseline using a self-administered food-frequency questionnaire. Over a mean follow-up of 13.9 years, we identified 234 proximal colon cancers, 155 distal colon cancers and 230 rectal cancers. We observed a significant positive association between red meat consumption and risk of distal colon cancer (p for trend = 0.001) but not of cancers of the proximal colon (p for trend = 0.95) or rectum (p for trend = 0.32). The multivariate rate ratio for women who consumed 94 or more g/day of red meat compared to those who consumed less than 50 g/day was 2.22 (95% confidence interval [CI] 1.34-3.68) for distal colon, 1.03 (95% CI 0.67-1.60) for proximal colon and 1.28 (95% CI 0.83-1.98) for rectum. Although there was no association between consumption of fish and risk of cancer at any subsite, poultry consumption was weakly inversely related to risk of total colorectal cancer (p for trend = 0.04). These findings suggest that high consumption of red meat may substantially increase the risk of distal colon cancer. Future investigations on red meat and colorectal cancer risk should consider cancer subsites separately.

Adult↗
PubMed1984

Lumen perfusion of the human rectum in situ: a method to study mechanisms for rectal drug transport in humans.

A lumen perfusion system was developed to study rectal transport mechanisms in humans. With this technique it is possible to perfuse a well-defined area of the rectum wall under single-pass and recirculation conditions. Sodium benzoate was used as a test drug. After absorption, sodium benzoate is conjugated with glycine to give hippuric acid which is rapidly eliminated (t 1/2 = 0.5 h). Due to the short half-life it is possible to reach a steady-state concentration within 2.5 h of perfusion. Plasma concentrations of hippuric acid were determined by HPLC. The absorption influx of sodium benzoate per unit area (phi in) could be calculated using the steady-state concentration of hippuric acid during rectal perfusion, the separately measured total body clearance after intravenous injection, and a designated absorption surface of the rectum. It was shown that with this technique reproducible phi in values within one subject could be obtained. Four volunteers were perfused with four different solutions of sodium benzoate, and it was found that phi in was proportional to the four concentrations used. In the case of recirculation perfusion (two volunteers), it was found that the amount of the perfusate lost equalled the amount absorbed into the general circulation. Therefore, the possibility of major drug accumulation in the rectal lumen or mucosa could be excluded. The perfusion technique elaborated in the present study can be used to investigate the mechanism of rectal absorption in humans as well as the factors that may influence this process.

Benzoates↗
PubMed1982

Proctitis cystica profunda and radiation fibrosis in the rectum of the female Wistar rat after X irradiation: a histopathological study.

Part of the rectum of the female Wistar rat was X-irradiated (1500 rad-3000 rad) without surgery. In the early phase (second week after irradiation) radiation damage of the rectum was haemorrhagic radiation proctitis and in the late phase a rectal obstruction. The dose-effect relationship using rectal obstruction as the end point is a sigmoid curve with a LD50 of 2150 rad. Latency time decreases with increasing dose and is 150 days at the LD50. Histopathologic findings revealed excessive submucosal radiation fibrosis and numerous mucosal glands and cysts within the fibrotic submucosa. As the time after irradiation increased the extension of submucosal mucinous glands increased and sometimes the entire submucosa was replaced completely by mucosal glands and cysts. It is suggested that invasion of mucosal epithelium into the submucosa was allowed by manifold fragmentation of the muscularis mucosae due to lymphocysts having developed immediately after irradiation. The small arteries showed proliferation of the endothelium and adventitia, thickening and hyalinization of the wall, resulting in severe narrowing and even occlusion of the lumen.

Animals↗
PubMed1995

Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States).

Hyperplastic polyps of the colon reveal a geographic distribution similar to that of colorectal cancer and adenomatous polyps. However, unlike adenomas--known precursors of colorectal cancer--little is known about the etiology or clinical significance of the hyperplastic polyp. In this prospective study, we set out to determine the main dietary and other lifestyle factors in the United States that might be associated with this lesion. Hyperplastic polyps of the distal colon and rectum were diagnosed in 219 of 12,922 men of the Health Professionals Follow-up Study having had an endoscopic procedure between 1986 and 1992, and 175 of 15,339 women of the Nurses' Health Study who had undergone an endoscopy for a variety of reasons between 1980 and 1990. After adjusting for age, family history of colon cancer, history of previous endoscopy, and total energy intake using multiple logistic regression, those consuming 30 g or more of alcohol per day were at increased risk relative to nondrinkers among men (relative risk [RR] = 1.69; 95 percent confidence interval [CI] = 1.01-2.80) and women (RR = 1.79, CI = 1.02-3.15). Current smoking also was found to be associated strongly positively with hyperplastic polyps in men (RR = 2.45, CI = 1.59-3.75) and women (RR = 1.96, CI = 1.16-2.86). High intake of folate was associated inversely with risk in both men (RR = 0.74, CI = 0.49-1.11, between high and low intakes of folate) and women (RR = 0.45, CI = 0.28-0.74, between high and low intakes of folate). Among macronutrients, a suggestive increase in risk existed with intake of animal fat, although this was attenuated in the full multivariate model (RR[men] = 1.48, CI = 0.94-2.41, and RR[women] = 1.22, CI = 0.77-1.94) between high and low quantities of animal fat intake. These prospective data provide evidence of associations between low folate intake, alcohol consumption, and current cigarette smoking, and risk of hyperplastic polyps of the distal colon and rectum. These same factors also have been found to be related to adenoma and cancer of the colon. The hyperplastic polyp is an indicator of populations at high risk for colorectal carcinoma, and it also may serve as a marker for factors that influence neoplastic evolution.

Adult↗
PubMed1996

[Defecation flowmetry. A new study technique for evaluating the evacuation function of the rectum].

In a prospective study carried out on 78 patients with chronic constipation (31, with slow transit, 47 with obstructive defecation disorders) the evacuation function of the rectum during defecation was assessed by defecoflowmetry. These patients were compared to a control group of normal volunteers (n = 32). The following parameters were evaluated: defecation and retention volume, defecation fraction, defecation time, maximum flow, mean flow rate and time to maximum flow. As expected, there was no difference in evacuation function between the group of patients with slow transit and the control group. Significant differences, however, existed between the two types of constipation, as well as between obstructive defecation disease and controls, regarding all parameters mentioned above. Evacuation function depends neither on rectal neck pressure nor on intrarectal pressure. In patients with obstructive defecation disorders, three subgroups were discernable: one with prolonged time of defecation and satisfactory evacuation, one with prolonged time of defecation and poor evacuation, and one small group of patients who were not able to defecate. Each group is based on a different underlying pathomechanism. We conclude that changes in evacuation function of the rectum refer either to volume or to time of defecation, or to both. Changes are found only in obstructive type constipation, not in slow transit constipation. Therefore, defeconflowmetry as a dynamic procedure can be used in screening for the classification of chronic constipation.

Adult↗
PubMed1995

Variant type of teratoma appearing as a primary solid dermoid tumor in the rectum: report of a case.

We report herein the rare case of a 39-year-old woman found to have a primary solid dermoid tumor in the rectum. The patient presented after noticing a small amount of anal bleeding, and physical examination revealed a walnut-sized hard tumor, palpable in the anterior rectum, located about 9 cm from the anal verge. Morphologic examinations revealed a polypoid lesion with some hair surrounded by rectal mucosa, and four biopsy specimens from the lesion showed normal squamous epithelium. The tumor, which measured 2.5 x 2.1 x 1.3 cm, was removed by endoscopic polypectomy. Microscopically, the tumor was diagnosed as a solid dermoid tumor without a cyst, a variant type of mature teratoma or dermoid cyst. Since 1914, only 12 such cases, including ours, have been reported in Japan. The clinical features and diagnostic and therapeutic methods applied thereto are discussed.

Adult↗
PubMed1989

Endoluminal ultrasonic examination of sessile polyps and early carcinomas of the rectum.

The results of conventional endosonographic techniques in the assessment of early carcinomas and sessile polyps of the rectum have been unsatisfactory. We therefore developed a new technique in which the rectal cavity is filled directly with water. Using this technique, the anatomy of small rectal tumors is preserved and the layers of the rectal wall are easier to differentiate, especially with a 10-MHz scanner. The clinical results in 66 patients demonstrate that this new technique is very accurate in the preoperative staging of adenomas and T1-carcinomas of the rectum.

Carcinoma↗