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PubMed1992

Motility and sensation of the rectosigmoid and the rectum in patients with anorectal malformations.

Motility of the rectosigmoid and rectum and reservoir function of the rectum after surgery for anorectal malformations were investigated in 32 patients (17 with high type, 6 with intermediate type, and 9 with low type anomaly) aged 5 to 16 years. All 32 patients were examined manometrically as well as with a newly devised myoelectrical method. Manometry showed that the values of maximum anal pressure and anorectal pressure difference in the high type were significantly lower than those in the low type. However, the incidence of contractile activity of the rectosigmoid was not significantly different between these two groups. The threshold sensation pressure and the maximum tolerable pressure in the high type were significantly higher than those in the low type, and the rectal compliance in the high type was significantly lower than that in the low type. Electromyography was recorded at 8 cm and 5 cm from the anal verge. Two types of slow waves were observed, a faster rhythm and a slower rhythm. Their frequency was similar in the three groups. However, the numbers of spike bursts in the high type and intermediate type were significantly higher than those in the low type. These results indicate that in addition to an inadequate anal resting pressure a loss of optimal rectal sensation or rectal reservoir function might be associated with fecal incontinence in the high type and that increased spike bursts might play some role in rectal motility.

Adolescent↗
PubMed1992

The atonic baggy rectum: a cause of intractable obstipation after imperforate anus repair.

Three children with successful imperforate anus repairs had chronic, intractable obstipation and recurrent fecal impaction refractory to diligent medical therapy. All had massive stool-filled rectums up to 14 cm in diameter on abdominal radiographs. They responded well to resection of the baggy atonic rectum with low anterior anastomosis. The massively dilated atonic rectal pouch in some children with repaired imperforate anus can demonstrate abnormal motility characterized by poor peristalsis and propulsion. This results in recurrent obstipation, impaction, and soiling refractory to the usually successful medical management.

Anus, Imperforate↗
PubMedDate not supplied

Perforation of the rectum by a Copper-T intra-uterine contraceptive device; a case report.

A case of a rare complication of a Copper-T intra-uterine contraceptive device (IUCD) producing uterine and rectal perforation is reported. The patient presented with the threads of the IUCD protruding through the anus and the device was removed from the rectum using a proctoscope. A review of the literature revealed only seven cases of perforation of the rectosigmoid by an IUCD in which the device was removed per rectum, and this report documents the first of such cases involving a Copper-T. Proctosigmoidoscopic evaluation is recommended whenever perforation of the rectosigmoid by an IUCD is suspected, since it may select those patients for whom rectal recovery of the IUCD is feasible, thus avoiding unnecessary surgical intervention.

Adult↗
PubMed1994

Prostatic ultrasound in the patient without a rectum.

Digital rectal examination, measurement of prostatic-specific antigen, and transrectal ultrasound, with or without prostate biopsy, are the urologist's primary tools for diagnosing carcinoma of the prostate. However, in the patient who has previously undergone abdominoperineal resection of the rectum such procedures are not possible. We therefore describe a simple, cost-effective method for evaluating the prostate in the patient without a rectum, via transperineal ultrasound and prostate biopsy. This procedure provides the urologist with a solution to a heretofore difficult problem.

Adenocarcinoma↗
PubMed1989

The vesicle content of catecholamine-containing axons in the rectum of the domestic fowl: effect of permanganate and chromaffin fixations.

The ultrastructural appearance of catecholamine-containing (CA) axon profiles in the rectum of the domestic fowl was compared following fixation using the chromaffin reaction or potassium permanganate. As described previously, after chromaffin fixation CA-axons in the perivascular plexuses contained many small granular vesicles (SGV) and variable numbers of large granular vesicles (LGV), whereas those in the non-vascular sites contained few small vesicles and were characterised by the presence of elongated LGV. Following fixation in potassium permanganate, CA-axons in both the non-vascular and vascular sites contained many SGV. The SGV were accompanied by variable numbers of large round vesicles which were often devoid of a core. Large vesicles comprised 16 and 26%, respectively, of total vesicles in the vascular and non-vascular axon profiles. The total number of vesicles per CA-axon profile in both the vascular and non-vascular site was not dependent on fixation procedure. It is concluded that the vesicle content of CA-axon profiles in the rectum of the domestic fowl is dependent on the fixative employed.

Animals↗
PubMed1989

The effect of cis-diamminedichloroplatinum(II) on radiation damage in mouse rectum after fractionated irradiation.

The influence of cis-diamminedichloroplatinum(II) (c-DDP) on radiation injury in the rectum of mice was investigated after single dose and fractionated irradiation. Mice were exposed to single doses, or 2, 4 or 8 fractions of X-rays given daily (or twice a day for the 8 fractions) with or without 8 mg/kg of c-DDP. The incidence of rectal stenosis and of anal discharge were scored and a direct analysis of the data for linear-quadratic dose-dependence of damage was performed with correction for censoring. For each endpoint, c-DDP did not significantly change the dose-response curves after fractionated irradiation. Subtile modifications in the coefficients of the linear-quadratic relationship were observed. The drug appeared to increase the alpha term by a factor of 2.3 and the beta term by a factor of 1.5, but the differences did not reach statistical significance. For the rectal stenosis endpoint, the alpha/beta was 4.4 Gy after irradiation alone and 6.9 Gy after combination treatment. Again the differences were not significant. These data suggest that c-DDP did not reduce the repair capacity in the mouse rectum during fractionated irradiation. Combined modality therapy with c-DDP and radiation would therefore not be expected to cause an increase in late damage in the large bowel.

Animals↗
PubMed1982

The loop diuretic furosemide as non-competitive inhibitor of C1-/HCO3-ATPases of vertebrate kidneys and insect rectum.

1. The effect of the diuretic drug furosemide was studied in detail on ouabain-insensitive, SCN- and OCN- -sensitive C1-/HCO-3-ATPase in homogenates from larval dragonfly rectum (Aeshna cyanea), frog (Rana temporaria) and mouse (Mus musculus) kidney. 2. The in vitro inhibition by the drug studied on the HCO-3-activated enzyme is non-competitive with an inhibitor constant of Ki=4.3 mM furosemide in the case of insect rectum and Ki=0.9 mM furosemide in the case of frog and mouse kidney. 3. Furosemide even at 10 mM concentration which completely inhibits the anion-dependent ATPase has only a little inhibitory effect on the Na+/K+-ATPase of the 3 tissues. 4. The data suggest that furosemide may affect an active chloride transport system involving a C1-/HCO-3-ATPase.

Adenosine Triphosphatases↗
PubMed1985

Investigations into the identity of the non-adrenergic, non-cholinergic excitatory transmitter in the smooth muscle of chicken rectum.

ATP and substance P were examined as possible mediators of non-adrenergic, non-cholinergic excitatory transmission in chicken rectum. ATP and the non-degradable ATP analogue, alpha, beta-methylene ATP, mimicked the response to nerve stimulation. Substance P either produced a maintained contraction after a long latency or was inactive. After desensitization of the P2-purinoceptor by alpha, beta-methylene ATP, the responses to ATP and nerve stimulation were abolished, while the response to carbachol was little affected. It is concluded that ATP may be the transmitter in non-adrenergic, non-cholinergic excitatory nerves supplying the chicken rectum.

Adenosine Triphosphate↗
PubMed1988

Sympathetic innervation of the rectum and bladder of the skate and parallel effects of ATP and adrenalin.

1. Longitudinal muscles of the rectum of the skate are first briefly excited and then inhibited by stimulation of the sympathetic nerve fibres. 2. ATP, adrenalin and noradrenalin also produce inhibition. 3. 5HT is strongly excitatory but acetylcholine is only excitatory above 1 microM. 4. The rectum contracts strongly to mechanical stimulation; the response is not blocked by TTX. 5. The inhibitory actions of sympathetic stimulation or ATP were not blocked by guanethidine, propranalol, antazoline, theophylline or bee venom (apamin). 6. ATP continued to produce inhibition after the nerve response was blocked by TTX. 7. The urinary bladder gives slow rhythmic contractions, which are inhibited by nerve stimulation and by adrenalin but ATP has no action. 8. 5HT is strongly excitatory but acetylcholine has little action.

Adenosine Triphosphate↗
PubMed1988

The effect of peptides on the motility of the stomach, intestine and rectum in the skate (Raja).

1. Pentagastrin (10(-8)-2 X 10(-6) M) was found to increase motor activity in the cardiac stomach and spiral intestine but only occasionally in the pyloric stomach and not at all in the rectum. 2. Substance P increased motor activity in both parts of the stomach and the rectum (10(-8)-5 X 10(-7) M) but had only a slight effect on the spiral intestine. 3. No effect on the activity of any part of the gut was seen with VIP (10(-7) M), neurotensin (2 X 10(-6) M) or bradykinin (2 X 10(-5) M). 4. The responses to pentagastrin or substance P were not abolished by TTX (10(-6) M). 5. The implications of these results for the understanding of the control of gut motility in elasmobranchs is discussed.

Animals↗
PubMedDate not supplied

CT assessment of postirradiation changes in the rectum and perirectal region.

Postirradiation changes in the rectum and perirectal tissue were assessed by computed tomography (CT) in 55 patients (total of 60 examinations) and correlated with radiation dose and time elapsed. Thickening of the perirectal fascia, increased density of the perirectal fat, and swelling of the rectal wall occurred in 48, 60, and 8% of patients, respectively, regardless of radiation dose within 30 Gy. However, widening of the presacral space was seen in 8% of patients receiving a rectal dose of less than 45 Gy, a percentage that increased to 16% for patients receiving 45 Gy or more. Thickening of the perirectal fascia, increased density of the perirectal fat, widening of the presacral space, and muscular changes were seen regardless of the time from the start of therapy. CT does not appear to be reliable enough in detecting residual or recurrent tumor in the rectum. However, knowledge of the CT features of postirradiation changes is helpful for diagnosis in patients with pelvic malignancies.

Adult↗
PubMed2005

Case report: colonic manometry reveals abnormal propulsive behaviour after anterior resection of the rectum.

Anterior resection of the rectum is a frequent surgical procedure. However, abnormal bowel habits following this procedure are frequently reported. The functional evaluation of these patients is usually limited to the anorectal area. By means of colonic manometry, we have evaluated a patient with frequent urge for defecation and increased bowel frequency following anterior resection of the rectum with straight coloanal anastomosis and almost normal anorectal function. Analysis of the tracing revealed a reduction of contractile segmental activity and much more high-amplitude propagated contractions than which occur in healthy subjects. These high-amplitude propagated contractions, representing the manometric equivalent of mass movements, were always in association with urge for defecation and, sometimes, with loose stools. High-amplitude simultaneous contractions were also observed. We feel that the surgical resection of a potential physiological brake may be responsible for these observations.

Aged↗
PubMed2005

Toward a definition of a threshold for harmless doses to the anal-sphincter region and the rectum.

PURPOSE: To investigate dysfunction caused by unwanted radiation to the anal-sphincter region and the rectum. METHODS AND MATERIALS: A questionnaire assessing bowel symptoms, sexual function, and urinary symptoms was sent to 72 patients with clinically localized prostatic adenocarcinoma treated by external beam radiation therapy at the Radiumhemmet, Karolinska Hospital, in Stockholm, Sweden, 2-4 years after treatment. The mean percentage dose-volume histograms for patients with and without the specific symptom were calculated. RESULTS: Of the 65 patients providing information, 9 reported fecal leakage, 10 blood and mucus in stools, 10 defecation urgency, and 7 diarrhea or loose stools. None of the 19 and 13 patients who received, respectively, a dose of > or =35 Gy to < or =60% or > or =40 Gy to < or =40% of the anal-sphincter region volume reported fecal leakage (p < 0.05). In dose-volume histograms, a statistically significant correlation was found between radiation to the anal-sphincter region and the risk of fecal leakage in the interval 45-55 Gy. There was also a statistically significant correlation between radiation to the rectum and the risk of defecation urgency and diarrhea or loose stools in the interval 25-42 Gy. No relationship was found between anatomic rectal wall volume and the investigated late effects. CONCLUSIONS: Although the limited data in this study prevent the definition of a conclusive threshold regarding volume and dose to the anal-sphincter region and untoward morbidity, it seems that careful monitoring of unnecessary irradiation to this area should be done because it can potentially help reduce the risk of adverse effects, such as fecal leakage. Future studies should pay more attention to the anal-sphincter region and help to more rigorously define its radiotherapeutic tolerance.

Aged↗
PubMed2005

Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy.

PURPOSE: To retrospectively test the hypothesis that rectal distension on the planning computed tomography (CT) scan is associated with an increased risk of biochemical and local failure among patients irradiated for prostate carcinoma when a daily repositioning technique based on direct prostate-organ localization is not used. METHODS AND MATERIALS: This study included 127 patients who received definitive three-dimensional conformal radiotherapy for prostate cancer to a total dose of 78 Gy at The University of Texas M. D. Anderson Cancer Center. Rectal distension was assessed by calculation of the average cross-sectional rectal area (CSA; defined as the rectal volume divided by length) and measuring three rectal diameters on the planning CT. The impact of rectal distension on biochemical control, 2-year prostate biopsy results, and incidence of Grade 2 or greater late rectal bleeding was assessed. RESULTS: The incidence of biochemical failure was significantly higher among patients with distended rectums (CSA >11.2 cm(2)) on the planning CT scan (p = 0.0009, log-rank test). Multivariate analysis indicates that rectal distension and high-risk disease are independent risk factors for biochemical failure, with hazard ratios of 3.89 (95% C.I. 1.58 to 9.56, p = 0.003) and 2.45 (95% C.I. 1.18 to 5.08, p = 0.016), respectively. The probability of residual tumor without evidence of radiation treatment (as scored by the pathologist) increased significantly with rectal distension (p = 0.010, logistic analysis), and a lower incidence of Grade 2 or greater late rectal bleeding within 2 years was simultaneously observed with higher CSA values (p = 0.031, logistic analysis). CONCLUSIONS: We found strong evidence that rectal distension on the treatment-planning CT scan decreased the probability of biochemical control, local control, and rectal toxicity in patients who were treated without daily image-guided prostate localization, presumably because of geographic misses. Therefore, an empty rectum is warranted at the time of simulation. These results also emphasize the need for image-guided radiotherapy to improve local control in irradiating prostate cancer.

Aged↗
PubMed2005

Volume and hormonal effects for acute side effects of rectum and bladder during conformal radiotherapy for prostate cancer.

PURPOSE: To identify dosimetric variables predictive of acute gastrointestinal (GI) and genitourinary (GU) toxicity and to determine whether hormonal therapy (HT) is independently associated with acute GI and GU toxicity in prostate cancer patients treated with conformal radiotherapy (RT). METHODS AND MATERIALS: This analysis was performed on 336 patients participating in a multicenter (four hospitals) randomized trial comparing 68 Gy and 78 Gy. The clinical target volume consisted of the prostate with or without the seminal vesicles, depending on the risk of seminal vesicle involvement. The margin from the clinical target volume to the planning target volume was 1 cm. For these patients, the treatment plan for a total dose of 68 Gy was used, because nearly all toxicity appeared before the onset of the 10-Gy boost. Acute toxicity (<120 days) was scored according to the Radiation Therapy Oncology Group criteria. The dosimetric parameters were obtained from the relative and absolute dose-volume/surface histograms derived from the rectal wall (rectal wall volume receiving > or =5-65 Gy) and the bladder surface (bladder surface receiving > or =5-65 Gy). Additionally, relative and absolute dose-length histograms of the rectum were created, and the lengths of rectum receiving more than a certain dose over the whole circumference (rectal length receiving > or =5-65 Gy) were computed. The clinical variables taken into account for GI toxicity were neoadjuvant HT, hospital, and dose-volume group; for GU toxicity, the variables pretreatment GU symptoms, neoadjuvant HT, and transurethral resection of the prostate were analyzed. The variable neoadjuvant HT was divided into three categories: no HT, short-term neoadjuvant HT (started < or =3 months before RT), and long-term neoadjuvant HT (started >3 months before RT). RESULTS: Acute GI toxicity Grade 2 or worse was seen in 46% of the patients. Patients with long-term neoadjuvant HT experienced less Grade 2 or worse toxicity (27%) compared with those receiving short-term neoadjuvant HT (50%) and no HT (50%). The volumes of the prostate and seminal vesicles were significantly smaller in both groups receiving neoadjuvant HT compared with those receiving no HT. In multivariate logistic regression analysis, including the two statistically significant clinical variables neoadjuvant HT and hospital, a volume effect was found for the relative, as well as absolute, rectal wall volumes exposed to intermediate and high doses. Of all the length parameters, the relative rectal length irradiated to doses of > or =5 Gy and > or =30 Gy and absolute lengths receiving > or =5-15 and 30 Gy were significant. Acute GU toxicity Grade 2 or worse was reported in 56% of cases. For patients with pretreatment GU symptoms, the rate was 93%. The use of short-term and long-term neoadjuvant HT resulted in more GU toxicity (73% and 71%) compared with no HT (50%). In multivariate analysis, containing the variables pretreatment symptoms and neoadjuvant HT, only the absolute dose-surface histogram parameters (absolute surface irradiated to > or =40, 45, and 65 Gy) were significantly associated with acute GU toxicity. CONCLUSION: A volume effect was found for acute GI toxicity for relative, as well as absolute, volumes. With regard to acute GU toxicity, an area effect was found, but only for absolute dose-surface histogram parameters. Neoadjuvant HT appeared to be an independent prognostic factor for acute toxicity, resulting in less acute GI toxicity, but more acute GU toxicity. The presence of pretreatment GU symptoms was the most important prognostic factor for GU symptoms during RT.

Chemotherapy, Adjuvant↗
PubMed2004

Toxic effects of nonsteroidal antiinflammatory drugs on the small bowel, colon, and rectum.

The gastrointestinal toxicity of conventional nonsteroidal antiinflammatory drugs (NSAIDs) is not confined to the stomach and proximal duodenum but extends also to the rest of the small bowel, colon, and rectum. Long-term NSAID therapy usually induces clinically silent enteropathy characterized by increased intestinal permeability and inflammation. Chronic occult bleeding and protein loss may result in iron-deficiency anemia and hypoalbuminemia. NSAIDs can also induce small bowel ulcers that infrequently lead to acute bleeding, perforation, or chronic scarring responsible for diaphragm-like strictures. At the colon and rectum, NSAID use can result in de novo lesions such as nonspecific colitis and rectitis, ulcers, and diaphragm-like strictures. NSAIDs have been implicated in the development of segmental ischemic colitis. In patients with diverticular disease, NSAID use increases the risk of severe diverticular infection and perforation. NSAIDs can trigger exacerbations of ulcerative colitis or Crohn's disease. With selective COX-2 inhibitors, the risk of gastrointestinal toxicity is reduced as compared to conventional NSAIDs but is not completely eliminated. Experimental studies suggest that long-term COX-2 inhibitor therapy may cause damage to the previously healthy small bowel. Similar to conventional NSAIDs, COX-2 inhibitors may be capable of triggering exacerbations of inflammatory bowel disease.

Animals↗
PubMed2006

Purinergic control of the quail rectum: modulation of adenosine 5'-triphosphate-mediated contraction with acetylcholine.

Electrical field stimulation (EFS) induces frequency-dependent contractions of the longitudinal muscle of isolated quail rectum which were sensitive to tetrodotoxin. The aim of the present study was to investigate whether purinergic neurons are implicated in the response to nerve stimulation. The shape of the EFS-induced contractile response was different depending on stimulus frequency; low frequencies (0.5-2 Hz) induced fast monophasic contractions with a small subsequent relaxation; whereas higher frequencies (5-50 Hz) induced biphasic contractile response that comprised fast initial component (as in case of low frequency) and a slow delayed contractile component in addition to the relaxation that follows the fast contractile component. Prior application of atropine (10 microM) completely abolished the slow delayed component but significantly enhanced the fast initial contractile component. Physostigmine (1-10 microM) significantly enhanced the slow delayed component with an inhibitory effect on the initial fast component. The nonspecific purinergic receptor antagonist, suramin (100-500 microM) significantly inhibited the fast initial contractile component with no significant effect on the slow delayed one. Complete blockade of the fast component was achieved by prior application of a combination consisted of suramin (50 microM) and pyridoxicalphosphate-6-azophenyl 2',4'-disulphonic acid tetrasodium (PPADS; 10 microM). Exogenous applications of adenosine 5'-triphosphate and acetylcholine (10 microM each), produced contractile responses that mimicked those induced by EFS. These data suggest that ATP is the main noncholinergic excitatory transmitter controlling the contractile activity of the quail rectum; and that its action could be modulated by acetylcholine.

Acetylcholine↗
PubMed1999

Injury of the rectum during vaginal surgery.

OBJECTIVE: We sought to report our experience with injury of the rectum during vaginal surgery. STUDY DESIGN: A retrospective chart review of a vaginal surgery database was performed. RESULTS: Nine injuries were identified. Four patients with posthysterectomy vault prolapse incurred a rectal laceration just above the perineum during an attempt to develop the rectovaginal space. Another rectal laceration occurred just above the perineum during an attempt to develop the rectovaginal space during vaginectomy-hysterectomy for gender dysphoria. Three other injuries occurred between the vaginal cuff and peritoneum while posterior culdotomy for vaginal hysterectomy was attempted. The remaining injury was in a Schuchardt incision. All 9 injuries were recognized, repaired, and healed without complication. CONCLUSIONS: Laceration of the rectum is an uncommon complication of vaginal surgery. Prompt recognition and repair result in uncomplicated primary healing.

Female↗