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PubMed1990

[Penetrating injury of the rectum and common iliac artery].

The author reports on an unusual form of a spitting accident when rectum perforation was associated with a arteria iliaca injury laceration. First the artery was reconstructed, then the wound of the rectum was sewn. After this a two tube diverting temporary anus sigmoideus was made. The author emphasises that in artery operations in a septic area one should try to use the patient's own vein and to avoid implanting an artificial prosthesis. Besides an antibiotic treatment great importance is attributed to a temporary complete disconnection of the injured section of intestine.

Accidents↗
PubMed1990

[Causes and management of local tumor recurrence after low resection of the rectum].

The postoperative course of 64 patients resected with EEA stapler because of their midrectal cancer have been followed. 13 (20.3%) local tumor recurrence have been observed in the first 24 postoperative months. 5 patients could be rectum exstirpated at the reexploration, only colostomy was performed in 8 cases. All the inoperabel patients have died in a year, but 3 of the exstirpated ones overlived this time. A direct connection have been observed between the Dukes stadium and the differentiation of the tumor, the distance of the distal resection line from the lower end of the tumor and the probability of the local recurrence. No connection has been found between the distance of the tumor from the linea dentata and the local tumor recurrence. On the basis of the oncological observations the deep rectal resection can be performed only by tumors in stadium Dukes A and B, if the tumor is well differentiated, there are no signs for local propagation or lymph node metastases, and more then 2 cm distal distance can be kept by the resection from the lower and of the tumor. In all other cases the rectum exstirpation must be the method of choice.

Humans↗
PubMed1990

Distal intramural spread of carcinoma of the rectum correlated with lymph nodal involvement.

One hundred and nineteen operative specimens of carcinoma of the rectum were prospectively studied to evaluate distant microscopic intramural spread with respect to gross tumoral margins and to determine if the degree of spread was related to involvement of the lymph nodes. Eighty-eight of the 119 specimens (74 per cent) did not have intramural extension distal to the gross distal margin of the tumor. Twenty-five (21 per cent) had intramural extension of less than 5 millimeters from the gross distal limit of the tumor. In these instances, tumoral spread was contiguous. In six (5 per cent), tumoral spread was found at more than 5 millimeters from the gross distal margin of the lesion. In all six specimens, the tumoral extension was separated from the gross lesion by undiseased tissue, the foci being located between 5 and 15 millimeters from the distal margin of the lesion. Lymph nodal involvement was found in 19 of 88 lesions without distal intramural spread, in 14 of 25 tumors with intramural spread of less than 5 millimeters and in five of six with intramural extension of 5 millimeters or more, respectively. The difference was statistically significant. With respect to the same three categories of distal extension, more than one lymph node was involved in 11 of 88 lesions, six of 25 and five of six, respectively. This difference was also statistically significant. In the six instances with distal intramural extension, results of immunohistochemical staining demonstrated the presence of tumoral embolism in both the blood and lymphatic vessels. In carcinoma of the rectum, lymph nodal involvement and its multiplicity are directly related to the extent of intramural spread.

Adenocarcinoma↗
PubMed1989

Motility effects of anterior resection of the rectum performed for diverticular disease.

Colonic motility study was performed in fiftyfive patients with symptomatic complicated diverticular disease, who underwent semielective surgery, and in twenty healthy volunteers. The pressure sensors were positioned in the descending and the true sigmoid colon. The colonic motility index was significantly higher in patients with symptomatic complicated diverticular disease than in controls in the basal (p less than 0.001) and post-prandial periods (p less than 0.001). Three months after anterior resection of the rectum with wide resection of descending colon the motility index was significantly reduced (p less than 0.001) in comparison to that before treatment; all patients were asymptomatic. Three years and five years later, the manometric findings continued to be stable and the patients continued to be asymptomatic. These data suggest that anterior resection of the rectum (with wide resection of the descending colon) lowers intraluminal pressure significantly and this effect appears long lasting.

Colon↗
PubMed1989

[A rare open injury of the rectum].

Complicated injuries of the extraperitoneal part of the rectum, communicated with the injuries of sacrum, great injuries of the soft tissues following with abundant bleeding, are very difficult injuries. Above mentioned case, regarding to the way of the injury, good surgical treatment and good result, is out contribution in the treatment of the injuries of the sigmoid colon, rectum and anus.

Adult↗
PubMed1989

[Biopsies of the endoscopically normal rectum and colon: a necessity. Incidence of collagen colitis and microscopic colitis].

Collagenous colitis and microscopic colitis are histologic entities which do not have corresponding endoscopic features. Their precise incidence and role in the development of intestinal symptoms are poorly known. The aim of this study was to determine the frequency of these histologic abnormalities in patients with endoscopically normal colon and to correlate these findings with abdominal symptoms. Total colonoscopy was performed in 132 consecutive patients, 81 females and 51 males, aged 19 to 83 years (mean: 47.8 years). Patients complained of abdominal pain and/or diarrhea (66 cases), normal bowel transit or constipation (66 cases). Subjects were prepared for colonoscopy with polyethylene glycol 4,000. Three to 8 biopsies were taken from the rectum and the different parts of the colon. Histologic abnormalities were found in 36 patients (27.2 p. 100): collagenous colitis (7 cases), microscopic colitis (21 cases), and melanosis coli (8 cases). The frequency of diarrhea was significantly higher in patients with collagenous colitis and microscopic colitis than in those with melanosis coli or normal colonic mucosa. These results clearly demonstrate that routine biopsies of the rectum and colon are useful in patients with abdominal symptoms, particularly diarrhea, and normal endoscopy.

Adult↗
PubMed1989

[Solitary primary amyloid tumor of the rectum].

Solitary primary amyloidtumor of the rectum. Gastrointestinal involvement of AL and AA amyloidosis is common and shows a broad variety of clinical appearance. We report a case of amyloidosis manifestated as a sole large rectum tumor and discuss the therapeutic procedure.

Amyloid↗
PubMed1989

Tolerance of spinal cord, lung and rectum after fractionated pions and X-rays.

The chronic and late effects of fractionated negative pi-mesons (pions) and X-rays were investigated in rat spinal cord and rectum, and in mouse lung. Range modulated pions with a 6 cm Bragg peak were used at an average dose-rate of 0.2 Gy/min. Control studies were performed with 250 kV or 300 kV X-rays. The following functional and histological endpoints were used: paralysis and white matter necrosis after spinal cord irradiation, ulceration and fibrosis of the rectum, breathing frequency and pneumonitis after lung irradiation. The presence of a large low-LET component was reflected by a significant dose-rate effect for spinal cord and lung. This resulted in RBE values smaller than unity for single doses, since the reference X-irradiations were done at high dose-rate. For small fraction sizes and short exposure times the influence of the dose-rate is insignificant. The RBE values at pion doses of 1 to 2 Gy per fraction were found to be not higher than 1.5 for all tissues studied. These values are similar compared to published data for acute effects. This is in contrast to the effects of neutrons, which in general show higher RBE's for late effects. It can be concluded from our studies that the radiobiological characteristic of pions in a spread Bragg peak are influenced by the low-LET component of the beam. Unlike with neutrons, there are no significant differences between the RBE values for late and acute effects.

Animals↗
PubMed1986

Colonization of the rectum of Triatoma infestans by Trypanosoma cruzi: influence of starvation studied by scanning electron microscopy.

The colonization of the different regions of the rectum of Triatoma infestans by a Trypanosoma cruzi strain (zymodeme I) originating from the same locality as the bugs was studied by scanning electron microscopy after different periods of starvation of the bugs. Throughout the first 16 weeks no changes in colonization pattern could be observed. Parasite density was always minimal at the midgut/rectal junction and highest on the rectal pads; it was at a similar level in the other three regions of the rectum. Twenty weeks after feeding, a proportion of the bugs had died and in the surviving larvae a decreasing colonization of the cuticle occurred. Nonetheless, despite other regions being flagellate-free, a residual T. cruzi population always remained attached to the rectal pads. No changes in the proportion of trypomastigotes to epimastigotes were observed as starvation progressed.

Animals↗
PubMed1988

Prevention and treatment of urinary retention and infection after surgical treatment of the colon and rectum with alpha adrenergic blockers.

In a retrospective study, 153 male patients who underwent surgical treatment of the colon and rectum presented with complaints indicating obstruction of the prostate gland and clear indications for preoperative administration of alpha-blockers. Between the years 1982 and 1984, the alpha-blocker phenoxybenzamine hydrochloride (PB-HCl) was prohibited from use by the Ministry of Health because of suspicions of its carcinogenic properties. This enabled a comparative study between two groups of patients. Seventy-five patients (group 2a1) were prohibited from receiving PB-HCl. Urinary retention occurred in 54.7 per cent and urinary tract infection in 65.3 per cent. Seventy-eight patients (group 2a2) were administered PB-HCl. In this group of patients, urinary retention occurred in 19.2 per cent and urinary tract infection in 15.4 per cent. Forty-one patients with urinary retention of group 2a1 who were not administered PB-HCl were compared with 50 patients with urinary retention (group 3) who received PB-HCl. Spontaneous relief was observed in 21.9 and 76.0 per cent, respectively. PB-HCl was shown to be extremely effective, both as a preventative and therapeutic agent, when complaints indicating the prostate gland are present in patients undergoing surgical treatment of the colon and rectum.

Adrenergic alpha-Antagonists↗
PubMed1986

Abdomino-anal pull-through resection of the rectum.

Abdomino-anal pull-through resection of the rectum is one method of achieving resection of carcinomas involving the middle third of the rectum while allowing sphincter conservation. A number of different techniques have been described and are now reviewed along with the reported results with special reference to operative mortality, cancer curing potential, post-operative morbidity, and the quality of post operative function. Considerable variability in the published results and in the experience of different authors has prevented this procedure becoming widely adopted in the past. Its current place in the management of rectal carcinoma is discussed with reference to other sphincter saving techniques, and in particular the use of stapling devices which are now frequently used to achieve anastomosis following resection of low-lying tumours. It is considered that, at the present time, there is little place for abdomino-anal pull-through techniques in the management of rectal carcinoma.

Abdominal Muscles↗
PubMed1988

[Wound healing of the pelvis following abdominoperineal rectum extirpation. A comparison of 2 drainage procedures in a prospective randomized study].

In a prospectively randomized study we used two different ways of drainage of the sacral space after an abdomino-perineal-resection of the rectum. One group with 25 patients had a drainage anteriorly through the abdominal wall, the other 25 patients got a drainage posteriorly through the buttocks. In each case we used two closed silicone-drainage-systems without active suction. In 60% of the anterior and in 50% of the posterior drained cases we saw an unaffected primary healing of the sacral wound. There was no significant difference. The patients felt the anterior way of drainage to be more convenient. Contamination of the sacral space by disrupture of the rectum during the operation was followed by a sacral abscess in 50%.

Adult↗
PubMed1987

Spontaneous expulsion of lipoma per rectum occurring with colonic intussusception.

The spontaneous expulsion of lipoma per rectum is an extremely rare phenomenon. The present case report describes this event in a patient with lower abdominal pain and bleeding per rectum leading to exploratory laparotomy. At surgery, a large intussuscepting ulcerated submucosal lipoma remnant was identified in the transverse colon. This unusual presentation of colonic lipoma is discussed and the pertinent literature is reviewed.

Colonic Diseases↗
PubMed1978

[Nitrogen balance in patients after a radical operation on the rectum].

The nitrogen balance was studied in cancer of the rectum cases before operation and in various periods after it. For a comparative analysis the nitrogen balance studies were carried out in duodenal and gastric ulcer cases and in 25 practically healthy individuals, who constituted a control group. A persistent negative nitrogen balance was found in cancer of the rectum. The authors developed an effective pathogenic therapy with due regard for revealed changes.

Clinical Trials as Topic↗
PubMed1987

Diversion colitis. Pathologic findings in a resected sigmoid colon and rectum.

We present here the detailed pathologic findings in the resected colon and rectum from a paraplegic patient with severely symptomatic diversion colitis and lack of anorectal function. Previous reports of the pathology of this condition have been confined to biopsy findings. A diffuse nodularity caused by lymphoid hyperplasia and an inflammatory process confined to the colorectal mucosa with erosions, crypt abscesses, mucin granulomas, and aphthoid ulcers were the main features. There was minimal distortion of crypt architecture. The pathologic features of this entity are compared to those of other inflammatory disorders of the colon and rectum.

Adult↗
PubMed1986

[Occurrence of so-called spontaneous ruptures in the rectum of horses. 1. Pathologicoanatomic and experimental studies].

In the ampulla roof of the wave-like extending horse rectum the muscular coat is only weakly developed as a deltoid-shaped tuna muscularis area, thus forming a place of minor resistance. With regard to the degree of development of the muscular coat a rectal ampulla with a stable form and strong muscles can be distinguished from an ampulla with a labile form and weak muscles. The rupture of the intestinal wall in this region in the case of rupture-experiments as well as the frequent occurrence of diverticula reveals this area as being a place of minor resistance which requires extreme caution during rectal examination. The forensic judgement of a rectal perforation has to be based on detailed pathoanatomical investigations. If the rules of veterinary art had been neglected, the proof of blamelessness for the investigator is being out of consideration. If all rules of veterinary art, however, had fully been observed during rectal exploration, the proof of blamelessness for the investigator is very difficult to be obtained, when a perforation or a rupture has resulted. Only if the rupture is located in the dorsal part of the rectum, there exists the possibility, that it is a spontaneous one, if anatomical conditions, thickness of the muscular coat or the presence of diverticula do support this.

Animals↗
PubMed1986

Transsphincteric approach to the rectum.

During a transsphincteric operation the patient is prone with the legs sliahtly abducted and the hip and knee joints flexed at right angles. The pelvic floor is opened by means of a left parasacral incision and, if necessary, the sphincters are divided providing an excellent exposure of the caudal rectum and anal canal. At the end of the procedure the pelvic floor and the sphincters are repaired anatomically so that normal defecation and continence are preserved. 106 surgical interventions on the rectum were performed by the sphincter splitting parasacral approach from January 1974 to June 1985. Very good results were obtained by this technique when applied to benign tumours, fistulas and traumatic lesions. Radical resection of certain very low malignant tumours restricted to the bowel wall as well as lymph node staging are possible by this technique. In the case of recto-sigmoid prolapse, resection of the protruding bowel segment and tightening of a lax pelvic floor are achieved by the parasacral transsphincteric operation. The transsphincteric approach is also a highly suitable technique in the treatment of high fistulae and traumatic lesions. Severe complications are rare assuming accurate preliminaries and surgical skill.

Adult↗
PubMed1986

[The problem with the occurrence of so-called spontaneous ruptures of the rectum in horses. 2: Forensic evaluation].

In the ampulla roof of the wave-like extending horse rectum the muscular coat is only weakly developed as a deltoid-shaped tunica muscularis area, thus forming a place of minor resistance. With regard to the degree of development of the muscular coat a rectal ampulla with a stable form and strong muscles can be distinguished from an ampulla with a labile form and weak muscles. The rupture of the intestinal wall in this region in the case of rupture-experiments as well as the frequent occurrence of diverticula reveals this area as being a place of minor resistance which requires extreme caution during rectal examination. The forensic judgement of a rectal perforation has to be based on detailed pathoanatomical investigations. If the rules of veterinary art had been neglected, the proof of blamelessness for the investigator is being out of consideration. If all rules of veterinary art, however, had fully been observed during rectal exploration, the proof of blamelessness for the investigator is very difficult to be obtained, when a perforation or a rupture has resulted. Only if the rupture is located in the dorsal part of the rectum, there exists the possibility, that it is a spontaneous one, if anatomical conditions, thickness of the muscular coat or the presence of diverticula do support this.

Animals↗