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Acute transanal ileal evisceration.

This is the 31st report of spontaneous transanal evisceration of small bowel. This case is unique because a rectal prolapse had been repaired previously and at the time of evisceration, there was no evidence of recurrence. Inherent or acquired weakness of the anterior rectal wall combined with a sudden increase in intra-abdominal pressure appears to precipitate this rare phenomenon. Attention to basic surgical tenets applies in the management of this condition.

Adult↗

Dynamic MR imaging of outlet obstruction.

The outlet obstruction syndrome encompasses all pelvic floor abnormalities which are responsible for an incomplete evacuation of fecal contents from the rectum. It has been estimated that outlet obstruction may be observed in half of constipated patients. A detailed clinical examination still represents the cornerstone of the diagnosis of these patients. However, there is general agreement that a reliable evaluation of the different pelvic floor abnormalities and the treatment decision highly depend on the imaging assessment. Traditionally, conventional defecography has played an important role in the radiological assessment of these patients but the technique is limited by its projectional nature and its inability to detect soft-tissue structures. Dynamic pelvic MR imaging using either closed-configuration or open-configuration MR systems is a rapidly evolving technique which has been gaining increased interest over the last years. The free selection of imaging planes, the good temporal resolution, and the excellent soft-tissue contrast have transformed this method into the preferred imaging modality in the evaluation of patients with pelvic floor dysfunction including rectocele, enterocele, internal rectal prolapse, and anismus.

Constipation↗

[The surgical treatment of intestinal prolapse (prolapsus recti) in fattening swine under practice conditions].

The amputation of the prolapsed rectum of 102 pigs of a fattening unit was carried out by means of a 5-10 cm piece of a plastic hose inside and a ligation around the prolapse. The pressure necrosis due to the ligation leads to the amputation of the prolapse. The positive effect of this method on the performance of the pigs was demonstrated by comparing the 102 treated pigs with a group of pigs that were not treated and with the non-diseased control group. Additionally the influence of diarrhoea and coughing on the frequency of rectal prolapses was investigated.

Amputation, Surgical↗

Management of infection after prosthetic abdominal rectopexy (Wells' procedure).

The management and results of treatment of eight cases of implant infection after a Wells' rectopexy for rectal prolapse are reported. Most infections presented within 3 months of the rectopexy. Fever, abdominal or pelvic pain, diarrhoea, and the passage of pus per rectum were common presenting features. Removal of the infected implant per rectum or per vaginum was successful in four of five attempts and is the recommended initial approach, particularly in cases occurring early after surgery. Despite removal of the implant early after rectopexy recurrent prolapse did not occur.

Abdomen↗

Abdominal colporectopexy with pelvic cul-de-sac closure.

PURPOSE: Rectal prolapse and posthysterectomy vaginal vault prolapse often occur together and constitute a management problem. This article describes a combined colorectal and gynecologic approach to surgical management and reports the follow-up results of treatment. METHOD: Patients who presented with both rectal and gynecologic symptoms of prolapse subsequent to hysterectomy and were found on clinical examination to have overt and/or occult prolapse of both the rectum and the vaginal vault were considered suitable for a combined operative procedure. This consisted of an abdominal "mesh" rectopexy, abdominal closure of the pelvic cul-de-sac (enhanced by intravaginal endoscopic transillumination), and a colpopexy attaching forward extensions of the same mesh to the apex of the anatomically restored and reinforced vaginal vault. The operation was also accompanied by a colporrhaphy if prolapse of the lower one-third of the vagina was still evident on completion of the abdominal procedures. RESULTS: Eighty-nine patients underwent combined surgery. Sixty of these patients had a concurrent vaginal repair. The mean follow-up time was approximately five years. There were no perioperative deaths, and the morbidity rate was 9 percent. No injury occurred to the urinary tract, and no wound or pelvic infections were evident. There was no recurrence of either the rectal or vaginal vault prolapse. Improvement occurred in all major symptoms, especially in pelvic pain. CONCLUSIONS: The problem of coexisting rectal and posthysterectomy vaginal vault prolapse can be corrected by combined abdominal colporectopexy and closure of the pelvic cul-de-sac. For 89 patients this operation provided considerable relief of symptoms, with no evidence of recurrence of rectal or vaginal vault prolapse at follow-up.

Adult↗

Differences between surgical colorectal conditions seen in the temperate and tropical regions.

Geographic location of a population plays a significant role in the interpretation of symptoms of some diseases of the colon. Because diverticular disease of the colon is very rare in the tropics, frank rectal bleeding, which may be suggestive of bleeding diverticulosis when it occurs in a temperate region, is suggestive of a bleeding ileal typhoid ulcer eroding terminal branches of the superior mesenteric artery. Similarly, symptoms suggestive of ulcerative colitis in a temperate region are suggestive of amebic colitis in the tropics. Anatomic variation also plays a part in the nature of some disease processes. The high incidence of freely mobile cecum and ascending colon and the freely mobile redundant sigmoid colon, seen in a tropical population, play a part in the frequent occurrence of nontumid intussusception, relatively high incidence of sigmoid volvulus, and relatively high incidence of rectal prolapse seen in the area.

Climate↗

Solitary ulcer of the rectum, A report of fiteen cases.

Fifteen cases of solitary ulcer of the rectum are described. The patients complained mainly of rectal bleeding, discomfort and passage per rectum of mucus. The lesion is most commonly situated on the anterior wall of the rectum and can be red and granular, nodular or ulcerating. Peolapse was found in nine cases. The histological lesion is similar to that seen in rectal prolapse. The condition can be mistaken for colitis, adenomatous polyp or carcinoma. Reassurance, defaecation reeducation and dealing with the patients'emotional problems alleviated the condition in some cases. Surgery to remove a prolapsing segment was performed in one case only.

Adult↗

Laparoscopic suture rectopexy.

PURPOSE: This article describes a technique for laparoscopic suture rectopexy and assesses the postoperative results. METHODS: The rectum was fixed to the presacral fascia with five to six sutures. The procedure was performed using a laparoscope in four patients. RESULTS: There were no postoperative complications. In one patient a large enterocele was observed during the operation. This patient developed a recurrence about one month postoperatively. CONCLUSION: Laparoscopic suture rectopexy might be an alternative to open rectopexy for patients with isolated rectal prolapse.

Adult↗

Internal and overt rectal procidentia.

The etiology and treatment of rectal procidentia remain controversial despite its longtime recognition. In this article, the clinical manifestations, etiology, and therapeutic options of both forms of rectal prolapse and the associated syndromes of colitis cystica profunda and solitary ulcer of the rectum are reviewed.

Humans↗

Modified Thiersch procedure with silastic mesh implant: a simple solution for fecal incontinence and severe prolapse.

Most of the surgical procedures proposed for the treatment of fecal incontinence associated with prolapse are associated with considerable morbidity and mortality. We used a modified Thiersch procedure with a Silastic mesh implant (Dow-Corning 501-3) on a series of 12 patients over a period of 2 1/2 years. Nine patients obtained excellent control of the prolapse and incontinence. Only one patient was dissatisfied with her operation. The excellent results reported by other authors using a Silastic mesh implant have been reproduced in this small series of patients. This relatively safe and simple operation may still be the procedure of choice for fecal incontinence and rectal prolapse.

Adult↗

Pathophysiology of anorectal dysfunction.

Anorectal disorders are the cause of significant discomfort and embarrassment in women. The onset typically follows childbirth and symptoms increase with age. Anal incontinence, rectovaginal fistula, rectal prolapse, anal fissure, and constipation are considered.

Adult↗

Rectal procidentia: diagnosis and management.

Rectal prolapse or procidentia is a common condition with detrimental effects on continence and social function. One of the most devastating complications for patients suffering from this disorder is fecal incontinence. The psychologic trauma these patients experience can be debilitating. This article provides an overview of rectal procidentia, including a review of the symptomatic presentation, etiology, classification, diagnosis, and treatment.

Fecal Incontinence↗

Effect of abdominal Ivalon rectopexy on bowel habit and rectal wall.

Bowel habit in 57 rectal prolapse patients was assessed before and after abdominal Ivalon rectopexy. There was a significant (chi-square = 8.7, P less than 0.01) increase in prevalence of constipation from 30 percent before to 51 percent after surgery. There were two explanations for this increased constipation. It was mainly the result of a 28 percent increase in prevalence of constipation among patients who were incontinent before rectopexy. Incontinent prolapse patients were more likely to acquire a predictable bowel habit after rectopexy if they became constipated. There was also a small (7 percent) increase in prevalence of constipation among continent patients, which could be attributed to the rectopexy procedure. In a subgroup of 15 patients, rectal wall thickness after rectopexy was assessed by pelvic computed tomographic scan carried out before and after surgery, or at more than one year after surgery. There was a significant (t = 4.5, P less than 0.001) increase in rectal wall thickness by 24 weeks after rectopexy, compared with before operation. This increase was also seen in a further five patients undergoing abdominal rectopexy without Ivalon sponge, suggesting that it was a consequence of rectal mobilization rather than the Ivalon sponge. This increased rectal wall thickness may impede the passage of formed stool into the lower rectum and contribute to the increased constipation found after rectopexy.

Aged↗

Laparoscopic rectopexy: early results.

Five patients with complete rectal prolapse were operated by laparoscopic approach. Technical details are described. Preliminary results are excellent.

Aged↗