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PubMed2003

Dynamic evaluation of the anorectum.

The evaluation of EP is complicated by the lack of any gold standard and a shifting clinical emphasis as management regimens go in and out of favor. As with all functional bowel disease, there is a residue of patients who are difficult to manage, and in whom a clinician will want maximum information before deciding on treatment. The examination has been criticized as lacking clinical relevance, and of having poor interobserver reliability except for rectal emptying and rectocele formation. Others have found a higher (83.3%) observer accuracy and a high yield of positive diagnoses. A questionnaire showed that clinicians found EP of major benefit in 40%, altering management from surgical to medical in 14% and vice versa in 4%. Radiographic examinations only impact on clinical management when findings alter management. Management protocols are evolving in functional disorders, but important features that EP reveals are anismus, trapping in rectoceles, IAI, and rectal prolapse. EP is the only method to diagnose some of these conditions and within defined parameters is extremely valuable in clinical management.

Barium Sulfate↗

PubMed1993

Laparoscopic rectopexy.

Laparoscopic rectopexy has been performed in four female patients with rectal prolapse. Four or five trocars were used in each case, with the same introduction places as for laparoscopic anterior resection. After dissecting the rectum free, a polypropylene mesh was introduced and fixed to the promontorium with an endoscopic stapler device, and then sutured to the rectum leaving a fourth of the anterior rectal wall free. The average operating time was three hours and the hospital stay six days. No constipation has been observed postoperatively in the patients with preoperative normal bowel habit. The introduction of laparoscopic rectopexy opens the possibility of performing different fixation techniques for various functional problems in the pelvis, offering a significant decrease in morbidity.

Aged↗

PubMed1988

Ripstein procedure. Lahey Clinic experience: 1963-1985.

We reviewed our 22-year experience with 135 Ripstein procedures for rectal prolapse in 118 women and 17 men. Follow-up ranged from one to 256 months (median, 41 months). Five patients were unavailable for follow-up. There was one perioperative death (0.7%). Complications included hemorrhage from presacral veins in 11 patients (8.1%), recurrent prolapse in 13 patients (9.6%), and stricture at the site of the sling in three patients (2.2%). Specific intraoperative technical factors could be related to recurrent prolapse in four patients (30.8%). Attention to technical details is mandatory to minimize immediate and long-term complications. Patients should be prepared for anterior resection, since a sling procedure may be inadvisable at the time of exploration. Resection may be the preferred operation for men, who have a high rate of recurrent prolapse with the Ripstein procedure.

Adult↗

PubMed1993

Laparoscopic rectopexy.

A 74-year-old female suffering from recurrent rectal prolapse underwent laparoscopic rectopexy. A modified sling rectopexy was performed with excellent results. The authors believe that this is the first report of this technique.

Aged↗

PubMedDate not supplied

[Stapled hemorrhoidopexy in the treatment of hemorroidal prolapse].

In the treatment of hemorroidal prolapse, stapled hemorrhoidopexy, according to the Longo's technique, represents an innovative and interesting procedure. The Authors consider own experience in the years 2001-2002, estimating preliminary results in the treatment of 50 patients affected by hemorrhoidal disease classified as III-IV grade, associated with mucosal prolapse, rectocystocele in 5 cases, anal fissures in 6 and hyperplastic polyp in 1. The patients were submitted to mucosal prolapsectomy with mechanical stapler (PPH 01-33 Ethicon), applying haemostatic stitch on suture line, apart from intraoperative bleeding, associated to closed anal sphincterotomy in 6 cases, and resection of anal hyperplasic polyp in 1. In 5 cases of rectocystocele a Burch's culposuspension was associated to a stapled transanal rectal resection (STARR). After 3 and 12 months the Authors performed ano-rectoscopy, anal manometry and defecography. Mean operative time was 45 minutes (range 20'-130') and mean hospital stay was 3 days (range 2-6 days). In the early postoperative course urinary ritention in 4 cases, treated with temporary catheterization in 3 and permanent for 72 hours in 1, was observed. Only 1 patient, was reoperated in day-surgery and with loco-regional anesthesia for residual fibrous hemorroid. Bleeding, severe pain, anal stenosis, impairment of continence were not observed. According to the Literature data, our experience confirm that mucoprolapsectomy represents an innovative, safe, simple and definitive operation in the treatment of hemorrhoids disease. In case of rectal prolapse associated to external fibrous hemorroids, a combined surgical treatment is requested in order to achieve better results.

Adult↗

PubMed1978

Clinical and pathologic conditions of female nude (athymic) mice in two conventional maintained colonies.

Two colonies of female outbred nude (athymic) mice were maintained by conventional standards of husbandry, but with special sanitary methods and segregation from other rodents. A total of 1,526 mice entered the colonies. Of these, 802 were untreated and most remained healthy. Necropsies were performed on 312 untreated mice that were sick and were killed or died naturally, and the tissues were examined microscopically. Clinical and pathologic conditions in the untreated mice included subcutaneous abscessation, dermatitis, subcutaneous edema due to glomerulonephritis (nephrotic syndrome), rectal prolapse, and lymphomas and other neoplasms.

Abscess↗

PubMed1996

Local ischemia causes carcinoma-like changes of the rectum.

PURPOSE: Bioptic specimens of typical cancerous changes in the rectum usually reveal signs of malignancy. Our goal was to describe the clinical feature, histologic findings, and long-term outcome of patients in whom typical findings of carcinoma of the rectum were discovered by endoscopy, but whose histologic data did not confirm the diagnosis of a malignant disease. METHODS: We conducted a retrospective review of eight patients seen in our hospital with a clinical diagnosis of colorectal cancer. RESULTS: All patients had typical macroscopic findings of colorectal cancer. Endoscopic examination was performed because of chronic gastrointestinal symptoms (tenesmus, diarrhea, hematochezia, recurrent rectal prolapses; n = 5), incidental masses detected by rectal palpation (n = 2), or acute rectal bleeding (n = 1). Instead of confirming malignancy, all histologic specimens showed typical signs of intestinal ischemia. In three patients, tumors were removed by endoscopy; the other patients received symptomatic therapy. All patients were followed for an average period of 46 months. In five patients, symptoms disappeared completely. Three patients continued to suffer from intestinal discomfort. In one case, progression of ischemic damage led to subtotal stenosis, which necessitated proctectomy. CONCLUSIONS: Our results indicate that, despite its rarity, "ischemic pseudocarcinoma" is an important differential diagnosis to cancer of the rectum. Prognosis is generally good. Only patients suffering from chronic symptoms may require surgical treatment.

Adult↗

PubMed1986

Techniques in evacuation proctography in the diagnosis of intractable constipation and related disorders.

A technique of evacuation proctography using a simple barium and air mixture is described. The study can be easily combined with a barium enema examination. A series of 35 patients with intractable constipation have been studied and compared with 7 controls. Most of the abnormalities seen using more elaborate methods of defaecography were identified. Variants of rectal intussusception were found in 16 patients. Other diagnoses included rectocele, mucosal and full rectal prolapse, accentuation of puborectalis impression and solitary rectal ulcer. The technique should prove useful in the management of patients with disorders of defaecation.

Air↗

PubMed1998

[Bladder rupture in a child with Ehlers-Danlos syndrome phenotype].

We report a case of "spontaneous" bladder rupture in a child with type IV Ehlers-Danlos Syndrome phenotype. The clinical presentation was unusual with abdominal pain, urinary retention and recurrent rectal prolapse. We could not find other similar cases in the literature. We to the possibility of "spontaneous" rupture occurring in this type of patients.

Child, Preschool↗

PubMed1987

Simultaneous colpo-recto-sacropexy.

The literature concerning coexisting massive genital and intussuscepting rectal prolapse is reviewed, two cases in point are presented, and the rationale for concurrent surgical management is offered. The technique of combined colporecto-sacropexy is described in detail.

Aged↗

PubMed1982

Self-inflicted transanal stripping of colorectal mucosa: report of an unusual case.

A young mentally retarded patient with self-abusive behavior managed to dissect between the mucosa and muscularis layers of the anal canal, through the anus, using his fingers; he managed then to strip the mucosal-submucosal layers of his rectum and colon all the way up to the splenic flexure and presented with an unusual two-yard long "rectal prolapse" which was actually stripped colorectal mucosal-submucosal tube. Diagnosis and management of this unusual patient are discussed. The authors could not find any similar case report in the English Medical literature.

Adult↗

PubMed1995

Sigmoido-rectal intussusception.

Sigmoido-rectal intussusception is the least common type of intussusception seen in infants and children and is therefore usually misdiagnosed as rectal prolapse. Delay in diagnosis and treatment is due to lack of its awareness amongst surgeons, incomplete assessment of the prolapsed bowel at the anal orifice, and absence of classical traid of intussusception i.e. palpable abdominal mass, colicky abdominal pain, and bleeding per rectum.

Child↗

PubMed1984

Proctitis cystica profunda. Incidence, etiology, and treatment.

Proctitis cystica profunda is an uncommon benign rectal condition with a range of appearances that has led to confusion in nomenclature. In a personal series of 28 patients with histologically proven proctitis cystica profunda, over 50 per cent had associated rectal prolapse. Cure of the prolapse cured the proctitis cystica profunda in 80 per cent of the patients only. Direct surgical excision (local or segmental) has not been successful and two patients have required a stoma for relief of pain.

Adolescent↗

PubMed2000

[Most frequent causes of fecal incontinence in our environment].

The objective of this piece of work was to assess the most frequent causes of fecal incontinence in our environment. 204 patients undergoing fecal incontinence of various types of severity were evaluated and later referred to "motilidad digestiva" department of Gastroenterology floor of Hospital de Clínicas José de San Martín, in an eight year span of time, 58 male (28.43%) and 146 female (71.56%) of an average age of 56 years. Every patient underwent a serious anamnesis, a proctologic examination, anoscopy, a rectosigmoid study, an anorectal manometry, and, a preventive electromyography was performed to those patients with a possible neurologic damage. The most frequent cause of incontinence was idiopathic 37.7%, followed by post surgery (19.6%) and rectal prolapse (13.7%), post menopause (11.2%), post delivery (9.8%), Neurogenic Incontinence (4.9%) and Traumatic Incontinence (2.9%). Doctor's performance may prevent some of the causes of incontinence.

Aged↗

PubMed1985

The management of procidentia. 30 years' experience.

This is a retrospective study evaluating 179 patients with complete rectal prolapse operated on at the University of Minnesota affiliated hospitals from 1953 to 1983 with no mortality. One hundred and two of 138 patients who underwent abdominal proctopexy and sigmoid resection were followed from six months to 30 years with a recurrence rate of 1.9 percent. Twenty-two of the 33 patients who underwent perineal rectosigmoidectomy were followed from six months to three years with no recurrence. Nine patients who underwent abdominal proctopexy and subtotal colectomy because of colonic inertia associated with procidentia were followed from one to six years with no recurrence. Patient interviews revealed that 72 to 80 percent considered their results as excellent or good. Incontinence or persistent constipation caused the remaining patients to consider their results fair or poor, despite anatomic correction of the prolapse. Abdominal proctopexy and sigmoid resection was more likely to result in improvement of continence than was perineal rectosigmoidectomy.

Adolescent↗

PubMed2006

[Gastrointestinal involvement in systemic sclerosis].

Gastrointestinal involvement is frequent in systemic sclerosis (SSc), occurring in 75 to 90% of patients with diffuse or limited cutaneous SSc. Although all regions of the gut may be affected, the esophagus is the most common gastrointestinal localization of this disease. If not diagnosed at an early stage, resulting complications may include esophagitis (leading to stenosis, strictures, and Barrett's esophagus) and increased risk of interstitial lung disease. Esophageal manometry is the most sensitive test for accurate diagnosis of motor dysfunction. Antisecretory agents (mainly proton-pump inhibitors) are effective for treating esophageal manifestations. Gastrointestinal involvement is reported in 50-88% of patients with SSc. It remains associated with a poor prognosis and leads to death in 6 to 12% of cases. Gastrointestinal impairment may lead to life-threatening complications, including severe dyspepsia, hemorrhage related to watermelon stomach (gastric antral vascular ectasia), malabsorption syndrome (related to bacterial overgrowth), and intestinal pseudo-obstruction. Treatment for the latter two remains difficult, although octreotide has proven to be effective in SSc patients. Small bowel manometry is useful for careful selection of SSc patients who will benefit from this treatment. Anorectal involvement is frequent in SSc patients (50-70%) and causes fecal incontinence and rectal prolapse. Other digestive manifestations, including liver impairment, are less common in SSc.

Barrett Esophagus↗

PubMed1997

[Therapy: perineal operation].

In most cases, the pelvic floor insufficiency is the result of combined traumas, degeneration and functional disorders of the rectum, pelvic floor and the anal canal with a great variety of terms and, therefore, unclear indication of special operative procedures. The internal or complete rectal prolapse may be removed by the Delorme's procedure, without causing damage to the pudendal nerves. The increase in defaecatory control is significant and the complication rate is tolerable. The best outcome will be achieved by suturing of the traumatic dissected sphincter muscles, without neurogenic injury during vaginal delivery in about 80 to 90 percent. Parks' post-anal repair, in addition to the other procedures, may increase the resistance to the egress of rectal contents.

Fecal Incontinence↗

PubMed1985

[Results of repair and direct reconstructive procedures of the sphincter system].

Direct sphincter repair gives good surgical results. In 8 out of 10 patients operated on, incontinence was clearly improved. In 15 patients posterior repair was performed simultaneously with posterior rectosigmoidal resection because of rectal prolapse. 14 patients had been incontinent. Incontinence was improved clearly in 7 patients, remained unchanged in 4 and worsened in 3. However, the good clinical results did not correspond completely to those achieved by perfusion manometry.

Anal Canal↗