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PubMed1983

[Surgery of the perineum, anus and rectum].

The special and highly complicated anatomy of the continence organ is the basis for surgery in the perineal region and in the region of anus and rectum. The rectal cavernous body, the sphincter ani internus, which is aganglionic, as well as the asymmetry of the female external sphincter muscle, are new facts which must be given attention in respect of pathogenesis and therapy of many diseases occurring in this region. The article discusses piles, anorectal abscesses and fistulas, prolapse of the rectum and rectal cancer under these special aspects.

Anal Canal↗
PubMed1992

Endorectal pull-through operation for diffuse cavernous hemangiomatosis of the sigmoid colon, rectum and anus.

A 6-year-old girl with diffuse cavernous hemangiomatosis of the sigmoid colon, rectum and anus underwent endorectal pull-through operation for sphincter-saving resection. Rectal mucosa was resected from 4 cm above peritoneal reflection to anal skin margin and the normal sigmoid colon was pulled down through the rectal muscular cuff. Ligation of the superior rectal and left internal iliac arteries at operation achieved satisfactory control of bleeding. Postoperative manometric studies showed almost normal sphincter tone and good response to rectal stimuli by balloon inflation. The endorectal pull-through (Soave-Denda procedure) is a common procedure for Hirschsprung's disease and the best procedure for the sphincter-saving treatment of diffuse cavernous hemangiomatosis of the colon and rectum.

Anal Canal↗
PubMed1998

Total mesorectal excision is not necessary for cancers of the upper rectum.

BACKGROUND: The technical aspects of surgery of the upper rectum (10 to 15 cm from the anal verge) and sigmoid colon are similar, but a change in technique is required for surgery of the lower rectum (< 10 cm). The aim of this study was to compare the outcomes of the treatment of upper rectal cancer (UR), in which total mesorectal excision (TME) was not performed, with outcomes of sigmoid colon cancers (S) and lower rectal cancers (LR). METHODS: Between 1980 and 1990, 891 patients were treated with curative intent for sigmoid (n = 225) and rectal cancer (UR = 229; LR = 437). The Kaplan-Meier and Cox proportional hazards analyses were used to compare outcomes. RESULTS: The risk of local recurrence alone, local and distant recurrence, death as a result of cancer, or any recurrence or death as a result of cancer was 3.5, 2.7, 2.1, and 1.9 times higher for patients with LR than for patients with UR, but the risk was not increased for UR relative to S. CONCLUSIONS: The outcome of treatment for UR is the same as for S and differs favorably from that for LR. UR should be treated by the same technique as S.

Adenocarcinoma↗
PubMedDate not supplied

Effect of magnetic stimulation on the electromechanical activity of the rectum: an experimental study.

We recently studied the effect of sacral magnetic stimulation (MS) on the rectal mechanical activity. The current communication investigates its effect on the rectal electric activity. Twelve mongrel dogs (weight 15.2 +/- 3.2 kg, 7 male, 5 female) were anesthetized, the abdomen was opened, and three electrodes were sutured to the rectal serosa. The rectal pressure was recorded by a manometric catheter. The effect of sacral MS on the rectal electric activity and pressure was recorded before and after anesthetization of the sacral skin. Stimulation parameters were set at 70% intensity, 20 Hz frequency, and 1 to 5 s burst activity. Sacral MS of the empty and full rectum effected a significant increase of the rectal electric activity and pressure as well as a decrease of the rectal neck (anal canal) pressure. MS of the anesthetized sacral skin produced no significant changes in the rectal electromechanical activity or the anal canal pressure. MS of the saline-injected sacral skin produced rectal and anal changes similar to those without saline injection. In conclusion, MS presumably produces its effect on the rectum by increasing the rectal electric activity. It might provide a more convenient method for rectal evacuation than electrostimulation through implanted electrodes. The procedure is simple, easy, and noninvasive.

Action Potentials↗
PubMed1995

DNA adduct formation of the food carcinogen 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) in liver, kidney and colo-rectum of rats.

DNA adducts of 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) have been measured in the liver, kidney, and colo-rectum of male Fischer-344 rats given a single oral dose of IQ (20 mg/kg). The pattern and distribution of DNA adducts examined by 32P-postlabeling was similar in all tissues. N-(Deoxyguanosin-8-yl)-2-amino-3-methylimidazo-[4,5-f]quinoline (dG-C8-IQ) was the principal adduct identified and it accounted for approximately 50-70% of the observed radioactivity, followed by (deoxyguanosin-N2-yl)-2-amino-3-methylimidazo[4,5-f]quinoline (dG-N2-IQ) which accounted for 15-20% of the radioactivity. Twenty-four hours after IQ treatment, DNA modification was greatest in the liver at a level of 7.64 +/- 1.08 adducts per 10(7) bases, followed by kidney at 2.04 +/- 0.32 adducts per 10(7) bases, and colorectum at 1.08+/-0.22 adducts per 10(7) bases. Liver and colo-rectum are target tissues of tumorigenesis in the rat during chronic feeding studies with IQ; however, tumors are not formed in the kidney. Therefore, factors in addition to IQ-guanine adduct formation, such as adduct persistence, error-prone repair, and tumor promotion must contribute to organ susceptibility of IQ-induced carcinogenesis.

Animals↗
PubMed1974

Perforative carcinoma of colon and rectum.

As further statistical evidence accumulates it is becoming evident that a major factor in the differing patient salvage between perforative and uncomplicated cancer of the colon and rectum is the element of infection. The absence of abdominal sepsis is undoubtedly responsible for the lessened morbidity and mortality found in the treatment of established fistulas. Surgical attention should therefore be directed first to the eradication of the primary source of infection, the perforated tumor. The safety with which an intestinal anastomosis may be made in the presence of edema and inflammation is a matter of mature judgement on the part of the operating surgeon. Postoperative suture line leakage should be avoidable. Extirpative surgery with or without anastomosis, coupled with the judicious drainage of the peritoneal cavity, antibiotic coverage, and blood volume support should continue to give improved results in the management of this distressing complication of cancer of the colon and rectum.

Adult↗
PubMed1983

The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum.

With increasing use of low anterior resection, the length of rectum removed below the tumor is often less than the recommended 2 to 5 cm. It is important to know if this decreases the chance of cure. Between 1963 and 1975, 334 patients survived radical restorative operations for single rectal adenocarcinoma. The length of rectum below the tumor measured on fixed pinned-out pathologic specimens was 2 cm or less in 55 patients (group 1), 2 to 5 cm in 177 (group 2), and 5 cm or more in 102 (group 3). The Dukes' classification, histologic grade, and extent of local spread of the tumors were similar in the three groups. Overall crude 5-year survival rates for groups 1, 2, and 3 were 69.1%, 68.4%, and 69.6%, respectively. Corresponding cancer-specific death rates were 25.5%, 23.2%, and 21.6%. These rates were also similar in matching pathologic subgroups of the three main groups. Of 23 observed or suspected local recurrences, there were four recurrences in group 1 (7.3%), 11 in group 2 (6.2%), and eight in group 3 (7.8%). These results suggest that a margin less than 2 cm below a rectal carcinoma does not affect survival or local recurrence adversely.

Adenocarcinoma↗
PubMed2001

Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum.

OBJECTIVE: To evaluate the complications and oncologic and functional results of preoperative radiochemotherapy and sphincter-saving resection for T3 cancers of the lower third of the rectum. SUMMARY BACKGROUND DATA: Carcinomas of the lower third of the rectum (i.e., located at or below 6 cm from the anal verge) are usually treated by abdominoperineal resection, especially for T3 lesions. Few data are available evaluating concomitant chemotherapy with preoperative radiotherapy for increasing sphincter-saving resection in low rectal cancer. METHODS: Between 1995 and 1999, 43 patients underwent preoperative radiochemotherapy with conservative surgery for a low rectal tumor located a mean of 4.5 cm from the anal verge (range 2-6); 70% of the lesions were less than 2 cm from the anal sphincter. There were 40 T3 and 3 T4 tumors. Patients received preoperative radiotherapy with a mean dose of 50 Gy (range 40-54) and concomitant chemotherapy with 5-FU in continuous infusion (n = 36) or bolus (n = 7). Sphincter- saving resection was performed 6 weeks after treatment, in 25 patients by using intersphincteric resection. Coloanal anastomoses were associated with a colonic pouch in 86% of the patients, and all patients had a protecting stoma. RESULTS: There were no deaths related to preoperative radiochemotherapy and surgery. Acute toxicity was mainly due to diarrhea, with 54% of grade 1 to 2. Four anastomotic fistulas and two pelvic hematomas occurred; all patients but one had closure of the stoma. Distal and radial surgical margins were respectively 23 +/- 8 mm (range 10-40) and 8 +/- 4 mm (range 1-20) and were negative in 98% of the patients. Downstaging (pT0-2N0) was observed in 42% of the patients (18/43) and was associated with a greater radial margin (10 vs. 6 mm; P =.02). After a median follow-up of 30 months, the rate of local recurrence was 2% (1/43), and four patients had distal metastases. Overall and disease-free survival rates were both 85% at 3 years. Functional results were good (Kirwan continence I, II) in 79% of the available patients (n = 37). They were slightly altered by intersphincteric resection (57 vs. 75% of perfect continence; NS) but were significantly improved by a colonic pouch (74 vs. 16%; P =.01). CONCLUSIONS: These results suggest that preoperative radiochemotherapy allowed sphincter-saving resection to be performed with good local control and good functional results in patients with T3 low rectal cancers that would have required abdominoperineal resection in most instances.

Adenocarcinoma↗
PubMed1992

Density of lymphoid follicles in the rectum and at the anorectal junction.

To determine the density of mucosal lymphoid follicles in 10 histologically normal rectums, including the anorectal junction, we counted the follicles macroscopically after the specimens were fixed in 10% acetic acid. The mean density in the rectum was 25.6/cm2. The mean density at the anorectal junction was slightly but not significantly higher, at 29.2/cm2. We found no significant change in follicle density with increasing age in specimens from people between the ages of 17 and 90 years.

Aged↗
PubMed2001

Synchronous double cancer of the stomach and rectum with situs inversus totalis and polysplenia syndrome.

Situs solitus refers to the normal arrangement of body organs. Situs inversus totalis is a complete mirror image or reverse isomeric form of the thoracic and abdominal viscera. Any arrangement of organs between these two extremes is designated by heterotaxia. Several patterns of vascular and visceral abnormalities are associated with heterotaxia, and two loosely defined syndromes of splenic anomalies (asplenia and polysplenia) are most common. We present the case of a 71-year-old woman with situs inversus totalis and polysplenia syndrome who developed synchronous double cancer originating from the stomach and rectum. Abdominal manifestations were situs inversus totalis combined with multiple lobulated spleen, azygous continuation of the interrupted inferior vena cava, direct drainage of hepatic vein to left atrium, preduodenal portal vein, short pancreas, incomplete rotation of the colon, and malrotation of the intestine. Histologically, gastric cancer was diagnosed as papillary adenocarcinoma and rectal cancer, as moderately differentiated adenocarcinoma. The patient was successfully treated with total gastrectomy for gastric cancer and low-anterior resection of the rectum for rectal cancer.

Adenocarcinoma↗
PubMed1996

Recognition and treatment of venous malformations of the rectum.

Venous malformations of the rectum are uncommon lesions that present complex management problems (1-6). The vast majority of these lesions present with rectal bleeding in infancy or childhood. Many cases have been treated as colitis for years before the correct diagnosis was made. The correct diagnosis has generally been based on gross appearance, confirmed subsequently by plain radiographs and angiography. Heroic surgical intervention has been the only repeatedly reported "cure" in the literature. One patient has been reported who did well for 20 years with sclerosis of the hemorrhoidal vein at surgery followed by intermittent transrectal sclerotherapy (7,8). Another patient would appear to have had longterm success with radiation therapy (9-11). We report four new cases of venous malformations of the rectum and results to date of a new therapeutic option with transcutaneous ethanol sclerotherapy in two of these patients. A discussion of alternate methods of treatment is included.

Colitis↗
PubMed1997

Congenital chloride-losing diarrhoea: absence of the anion-exchange mechanism in the rectum.

BACKGROUND: Congenital chloride-losing diarrhoea is characterized by a defect in chloride/bicarbonate exchange, which is normally present in the ileum and colon. Whether the defect is an absence or a reversal of such an exchange is unclear, and we have investigated two young children with the disorder to answer this question. METHODS: We used a previously described nonequilibrium rectal dialysis method, using different dialysate anion concentrations, to investigate the movement of sodium, potassium, chloride, and bicarbonate in the rectum of the two children. RESULTS: The results showed that chloride and bicarbonate movements were not linked in any active way, and both ions appeared to move passively in response to the electrochemical gradients generated. CONCLUSIONS: In the two subjects studied, the defect in the rectum appears to be an absence of the normal anion exchange mechanism present in the bowel, rather than its reversal.

Bicarbonates↗
PubMed1996

Primary small cell undifferentiated carcinoma of the rectum associated with ulcerative colitis.

Primary small cell undifferentiated carcinomas (SCUCs) are unusual tumors of the colon and rectum. Histologically, these lesions represent a spectrum of neuroendocrine differentiation, with oat cell carcinoma being the most primitive subtype and carcinoid tumors being the most differentiated. This observation is supported by immunohistochemical and ultrastructural findings. We report a case of SCUC of the rectum in a patient with ulcerative colitis. To date, there have been only two reported cases of primary SCUC associated with ulcerative colitis. Recent theories of tumorigenesis attribute most colorectal cancers to a single, pluripotential mucosal stem cell, regardless of the tumor's histologic type.

Carcinoma, Neuroendocrine↗
PubMed2003

Patient-reported toxicity correlated to dose-volume histograms of the rectum in radiotherapy of the prostate.

We studied 73 patients treated with 3-dimensional conformal radiotherapy for prostate cancer to determine whether there is a correlation between dose per volume to either the whole rectum, rectal wall, rectal surface, or anal canal and the development of late rectal complications measured with prostate-specific quality-of-life (QOL) questionnaires. Given doses were 66.6 to 72 Gy. The prostate cancer modules used were the UCLA-Prostate Cancer Index module (UCLA-PCI) (5 questions), the Functional Assessment of Cancer Therapy-Prostate module (FACT-P) (1 question), and the European Organization for Research and Treatment of Cancer prostate cancer module (EORTC QLQ-PR25) (4 questions). A Spearman correlation analysis between the total toxicity score and the dose-volume histograms (DVHs) was performed. All statistical tests were 2-sided. Sixty-five (89%) patients returned the questionnaire, and 18 (28%) underwent endoscopy for rectal bleeding. We found that only patients who had had an endoscopy showed a correlation between rectal toxicity and dose per volume, as compared with the other patients who showed none. Correlation between rectal toxicity and dose per volume for all 4 structures was stronger for higher doses. For 70 Gy, all contours, except the anal canal, showed a significant dose-volume correlation. Our results indicate that only in cases of pronounced rectal toxicity is there a dose-volume correlation, especially for doses of 70 Gy or more. DVHs of the whole rectum, wall, or surface, but not the anal canal, are all equivalent in predicting late rectal toxicity.

Aged↗
PubMed2004

Prevalence of fungi in the vagina, rectum and oral cavity in pregnant diabetic women: relation to gestational age and symptoms.

OBJECTIVES: To estimate the prevalence of fungi in the vagina, rectum and oral cavity in pregnant women with diabetes mellitus (DM) type I or gestational diabetes mellitus (GDM) and in healthy controls; to assess the influence of gestational age on the prevalence of fungi; to compare the vaginal symptoms within the groups; and to analyze the multifocality of fungal invasions. METHODS: A total of 251 women were examined: 47 with DM, 72 with GDM and 132 controls. Samples were collected from the vagina, rectum and oral cavity of all women and cultured on Sabouraud media. RESULTS: Fungi were found in 59.8% in at least one of the three locations in all women. Vaginal mycosis was diagnosed more often (p < 0.001) in pregnancies with DM [40.4%, odds ratio (OR) 4.3, confidence interval (CI) 2.41-4.85] than with GDM (22.2%, OR 1.84, CI 0.99-2.12) and nondiabetics (13.6%, OR 1.0). The risk of trifocal mycosis was higher in DM women (OR 2.7, CI 1.72-4.45), than in the controls. Only in 27.6% of symptomatic women were fungi detected in vagina. However, 60.4% of women with vaginal mycosis had symptoms. Among women without mycosis, 42.4% were symptomatic, and discharge was more common in the DM group (50%) than in the GDM group (21.4%) and the controls (28.1%; p < 0.002). The prevalence of fungi in the groups was not influenced by gestational age. CONCLUSIONS: The risk of vaginal mycoses in DM women is more that four times higher and in pregnancies with GDM nearly two times higher than in controls. The risk of trifocal mycosis in DM women is nearly three times higher than in nondiabetics. There is a poor correlation between symptoms of vaginitis and fungal infection. We did not confirm the influence of the gestational age on the prevalence of fungi.

Adult↗
PubMed2005

Three-dimensional biomechanical properties of the human rectum evaluated with magnetic resonance imaging.

A method to evaluate the three-dimensional (3-D) geometry of the human gastrointestinal wall may be valuable for understanding tissue biomechanics, mechano-sensation and function. In this paper we present a magnetic resonance imaging (MRI) based method to determine rectal geometry and validation of data obtained in three volunteers. A specially designed rectal bag was filled in a stepwise manner while MRI and bag pressure were recorded. 3-D models of curvatures, radii of curvature, tension and stress were generated and the circumferential and longitudinal strains were calculated. The computed bag volumes corresponded to the infused volumes. A pronounced bag elongation and decrease in wall thickness was observed during the bag filling. The spatial distributions of the biomechanical parameters were distinctly different between individuals and non-homogeneous throughout the rectal wall due to its complex geometry. The average tension and stress increased as a function of infused volume and circumferential strain. The present study provides a method for characterizing the complex in vivo 3-D geometry of the human rectum. The non-homogenous spatial curvature distribution suggests that simple estimates of tension based on pressure and volume do not reflect the true 3-D biomechanical properties of the rectum.

Adult↗
PubMed1994

The augmented rectal bladder for urinary diversion: experience with the original valved rectum and a valve-less modification.

Kock's augmented and valved rectum was created in 10 patients following total cystectomy. During an observation period of up to 46 months, 4 patients died (1 from a recurrence of cancer, 1 from multiple organ failure subsequent to diabetes mellitus, 1 from coronary insufficiency, and 1 from cerebral hemorrhage). Post-operative complications included valve failure in 1, hydronephrosis in 2, and mild nocturnal urinary incontinence in another. Hyperchloremic metabolic acidosis was particularly notable in the cases without an intussuceptive valve of the rectum. Their base excess ranged from -6.9 to -15.0 mM/l but the condition was satisfactorily controlled by oral administration of alkaline agents. Although the present method has a number of shortcomings, the absence of a stoma and elimination of the need for self-catheterization are outstanding benefits. For these reasons, we believe that it is an effective option for urinary diversion.

Aged↗
PubMed2006

Defining the rectum: surgically, radiologically and anatomically.

The terminology used in relation to the rectum varies considerably, added to this there is the subjective nature of clinical assessment and variability in the anatomy of the rectum and anus. It is imperative that definitions are clarified and standardized for use by all members of the multidisciplinary team involved in the care of patients with rectal cancer.

Anal Canal↗