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PubMed2002

[Digestive involvement of scleroderma].

Digestive involvement in systemic sclerosis is frequent and serious, because it provides morbidity and fatality. From the pathophysiologic point of view, the first step could be Raynaud-associated neural dysfunction, followed by smooth muscle atrophy then irreversible muscle fibrosis. Oesophageal disorder is common with its main consequence: the occurrence of gastroesophageal reflux disease which could run into peptic erosive oesophagitis. Oesophageal manometry is the main diagnostic tool, gastrointestinal endoscopy helps to assess oesophageal mucosal inflammation and its possible sequels. Gastric involvement is rarely recognized but it is frequent in case of systematic investigation as well as small intestinal involvement which may provide a lot of complications: malabsorption, pseudoobstruction, bacterial overgrowth. At colonic level, anorectal involvement is frequent and leads to fecal incontinence and rectal prolapse. Reynold's syndrome is a special case which associates systemic sclerosis with primary biliary cirrhosis. The symptomatic treatments must be systematic and improve the disease's overall prognosis.

Diagnosis, Differential↗
PubMed1993

[Anal incontinence. Critical study of the surgical treatment].

Two million French people aged over 45 are thought to suffer from faecal incontinence. The most frequent anatomical or functional causes of this disability are: idiopathic incontinence of falling down perineum due to denervation of its striated muscle; some neurological diseases; rupture or destruction of the sphincter due to traumatic, iatrogenic or obstetrical causes; complete rectal prolapse. Each of these situations has its medico-surgical solution (post-anal repair, sphincterorrhaphy, rectopexy, Delorme's operation, myoplasty, artificial sphincter), always bearing in mind that the fundamental aim is to correct the handicap and restore a good quality continence.

Anal Canal↗
PubMed1994

Laparoscopic rectopexy.

Good results of rectopexy for complete rectal prolapse have been achieved using the transabdominal approach. With the introduction of the laparoscopic technique in cholecystectomy, many other abdominal procedures have been tried with the laparoscopic technique with varying degrees of success. The laparoscopic technique has opened up a new possibility of a minimally invasive approach to rectopexy. With the elimination of a major incision in laparoscopic rectopexy, the patients may benefit from less morbidity associated with a major abdominal wound. In this case report, laparoscopic rectal mobilization and rectopexy using Marlex mesh and a hernia stapler is reported.

Aged↗
PubMed2005

Role of pelvicography and colpocystodefecography in diagnosis of outlet obstructive constipation.

AIMS: The aim was to research the changes in pelvic floor morphology and corresponding visceras in patients with outlet obstructive constipation (OOC). PATIENTS AND METHODS: Thirty-eight patients with OOC and 12 healthy volunteers were enrolled in this study. With simultaneous pelvicography and colpocystodefecography (PCCD), including pelvicography, vaginal opacification, voiding cystography and defecography, pelvic floor morphology was observed and the anorectal angle, the level of the perineum, peritoneum and bladder were measured. RESULTS: Thirty-seven cases of internal rectal prolapse (IRP), 5 cases of rectocele (RC) and 5 cases of spastic pelvic floor syndrome SPFS were diagnosed by PCCD. 12 IRP, 4 RC and 1 SPFS were detected by common physical examination. All of these were confirmed by PCCD. Moreover, PCCD found 9 pelvic floor hernia or peritoneoceles, 6 cystoceles, 3 descending perineum syndromes and 10 uterine prolapses. Compared with controls, OOC patients had a significantly large anorectal angle during defecation, abnormal descending of the perineum at rest and during defecation, and a deep pouch of Douglas during defecation. Some patients with urinary system symptoms may have had an abnormal descent of the bladder during rest and defecation. CONCLUSION: Simultaneous PCCD has a higher positive ratio than the common physical examination in diagnosing IRP and RC, and provides information for the diagnosis of pelvic floor hernia or peritoneocele, cystocele or uterine prolapse. PCCD is helpful in the selection of a proper surgical procedure.

Adult↗
PubMed1999

Laparoscopic rectopexy according to Wells.

BACKGROUND: The laparoscopic approach usually reduces the morbidity of procedures performed by laparotomy. The aim of this study was to demonstrate the usefulness of laparoscopic rectopexy. METHODS: A total of 37 patients were included in this prospective study. The indication was true rectal prolapse in all patients. Incontinence was seen in 33% of the patients. A slightly modified Wells procedure was performed laparoscopically. Postoperatively, the patients were evaluated for resolution of the prolapse and incontinence. They were also questioned about their satisfaction with the procedure. RESULTS: Laparoscopy was successful in all but one case. Follow-up is available in 32 of 37 patients. Prolapse was cured in all patients, and the incontinence resolved in 11 of 12. In addition, 38% of the patients experienced significant constipation preoperatively versus 5% postoperatively.

Aged↗
PubMed2000

Solitary rectal ulcer syndrome in children.

Solitary rectal ulcer syndrome (SRUS) is rare in children. Few reported cases have undergone detailed investigations, treatments have been extremely varied and outcome poorly documented. We report two cases of SRUS in children, each with a different macroscopic pathology. The diagnosis was delayed in both cases. The importance of appropriate investigation and the need to tailor treatment to the type of lesion are emphasised. One case of SRUS was associated with a complete, full thickness rectal prolapse and symptoms improved after an abdominal sutured rectopexy. The other patient responded well to endoanal excision of polypoid lesions. The diagnosis and management of this condition in children deserves wider recognition.

Adolescent↗
PubMed2004

Bogota bag in the treatment of abdominal wound dehiscence.

A patient who underwent emergency laparotomy for rectal prolapse developed repeated abdominal wound dehiscence and subsequently an enteric fistula. The management of abdominal wound dehiscence is discussed, specifically with regards to the Bogota bag. Use of Bogota bag has been reported worldwide but this may be the first report here.

Abdomen↗
PubMed1976

Thyrotoxicosis in a neonate of a mother with no history of thyroid disease.

A newborn infant had rectal prolapse, congenital lactase deficiency, and temporary neonatal thyrotoxicosis. The thyrotoxicosis was associated with a raised long-acting thyroid stimulator index in a mother with no personal or family history of thyroid or related autoimmune disease. The parents were first cousins.

Female↗
PubMed2005

Abnormal appearance of the internal anal sphincter at ultrasound: a specific feature of progressive systemic sclerosis?

Endosonography is now an effective tool for the assessment of anorectal pathologies. We present a case of rectal prolapse in a patient with progressive systemic sclerosis, with low resting anal pressure, no rectoanal inhibitory reflex in manometry, and a thin, heterogeneous, difficult to delineate, internal sphincter on endoanal ultrasound. We also provide a review of the literature on anorectal involvement in progressive systemic sclerosis.

Anal Canal↗
PubMed1989

Anorectal function after abdominal rectopexy: parameters of predictive value in identifying return of continence.

Posterior abdominal rectopexy was performed in 12 patients with a full-thickness rectal prolapse: 9 had faecal incontinence. The prolapse was successfully controlled in all cases and six of nine patients were rendered continent. Physiological studies in patients were compared with age- and sex-matched controls. Preoperative anal pressures were significantly lower than in controls at rest (R), during maximum pelvic floor contraction (Sq) and attempted defaecation (St) (R, P less than 0.005; Sq, P less than 0.005; St, P less than 0.005). Anorectal angles were significantly more obtuse in patients than in controls (R, P less than 0.05; St, P less than 0.025). None of these parameters changed significantly after abdominal rectopexy. Median rectal emptying significantly decreased after operation (preoperative 83 per cent/min; postoperative, 58 per cent/min, P less than 0.05). Median perineal descent during attempted defaecation also significantly decreased after operation (preoperative, 8.5 cm; postoperative, 7.1 cm; P less than 0.025). Parameters which predicted return of continence included: delayed leakage during the saline infusion test (P less than 0.025), a narrow anorectal angle during pelvic floor contraction (P less than 0.025), minimal pelvic floor descent during contraction (P less than 0.05), and a long anal canal at rest (P less than 0.05) and during pelvic floor contraction (P less than 0.025).

Adult↗
PubMed1992

Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome.

To determine whether severity of the prodromal gastrointestinal illness is associated with the course and complications of the extraintestinal manifestations of hemolytic-uremic syndrome, we conducted a retrospective review of children (n = 509) hospitalized with hemolytic-uremic syndrome. Those who came to the hospital with colitis and rectal prolapse associated with hemolytic-uremic syndrome (group I, n = 40) were compared with an equal number of time-matched children with hemolytic-uremic syndrome but without prolapse (group II). Children in group I had evidence of more severe colitis than children in group II had, as indicated by increased frequency of bloody diarrhea (p less than 0.001) and longer duration of diarrhea (p less than 0.001). However, they also had more severe extraintestinal manifestations during hemolytic-uremic syndrome, including edema (p less than 0.0001), severe thrombocytopenia (p less than 0.0001), prolonged anuria (p less than 0.001), and seizures (p = 0.036). Long-term prognosis for recovery of renal function was worse for group I than group II. Within group II, patients with bloody diarrhea had milder extraintestinal illness than those with prolapse but more severe extraintestinal illness than those with watery diarrhea. Analysis of Kaplan-Meier survival curves demonstrated a better prognosis for return of normal renal function in the children with watery diarrhea but without prolapse (p = 0.009) than in children with bloody diarrhea or prolapse. These data demonstrate that the severity of the gastrointestinal prodrome reflects the severity of the extraintestinal acute microangiopathic process and the resulting long-term outcome. Widespread vascular damage, often followed by permanent sequelae, is characteristic of patients with the most severe colitis.

Adolescent↗
PubMed1994

Colonic and anorectal dysfunction in a patient with the tethered cord syndrome.

Although visceral dysfunction is commonly encountered in the tethered cord syndrome, alteration of intestinal motor and sensory function has not yet been specifically addressed in this neurological disorder. We report the case of a 54-yr-old woman with a rare form of adult onset tethered cord syndrome who presented to us for preoperative assessment of marked constipation, urinary and fecal incontinence, and a rectal prolapse. It is shown that the tethered cord syndrome causes complex clinical patterns of bowel dysfunction and that careful efforts are mandatory to differentiate their underlying pathology. Specific diagnostic procedures directed to intestinal motility and perception were of decisive importance in enabling us to apply the appropriate treatment to our patient.

Colon↗
PubMed1997

[Laparoscopic therapy of functional disorders of the rectum and pelvic floor].

Within 4.5 years, 72 laparoscopic rectopexies were performed. The indications included rectal prolapse, morphologic outlet-constipation and a combination of both. Using a modified suture rectopexy (according to Sudeck), without taking any foreign material we resected the sigmoid in 39 patients. In four cases, a resection of the sigmoid colon was carried out. Conversion rate was 2% and complications that needed reoperation occurred in 9%. No patient died; laparotomy rate was only 4%. In the mean follow up period of 24.1 months (max. 50 months), no recurrent prolapse occurred. Incontinence was abolished or improved in 64% and outlet-constipation was improved in 85%. Laparoscopic rectopexy with or without sigmoid resection seems to be of benefit for the patient: quicker convalescence; less pain; small scars; no recurrence; and improvement of constipation and incontinence.

Adult↗
PubMed1987

Natural history of anterior mucosal prolapse.

Case notes of 250 patients (M:F, 1:2.7; age 48.7 +/- 16.5 years) in whom anterior mucosal prolapse had been diagnosed, at one hospital between 1974 and 1976, were reviewed. The commonest symptoms were bleeding (56 per cent), pain (32 per cent) and a sense of prolapse (32 per cent). The prevalence of constipation was significantly higher among women (47 per cent) than men (29 per cent). Perineal descent was present in 20 per cent of cases and was significantly more frequently associated with excessive straining at defaecation (28 per cent) compared with patients in whom there was no history of excessive straining (12 per cent). Sixty-six patients (26 per cent) experienced recurring symptoms over the 10 year period following presentation but did not deteriorate, while 28 patients (11 per cent) deteriorated. Deterioration was associated with a history of symptoms for longer than 1 year at the time of presentation, female sex, and the presence of perineal descent on clinical examination. The risk of developing perineal descent was less than 10 per cent over the 5 years after presentation while that of developing sphincter laxity among patients who had already developed perineal descent was 30 per cent over this period. Complete rectal prolapse occurred in 20 per cent (3/15) of patients with clinical perineal descent and sphincter laxity but was not seen in the absence of these signs. The results of treatment by submucosal phenol injection, mucosal rubber banding, or glycerine suppositories were the same.

Adult↗
PubMed1986

Anal sphincter function and sphincter preserving surgery.

This article reviews the methods of assessing anal sphincter function and the place of sphincter-saving surgery in patients seen in the Gatrointestinal Unit of the Birmingham General Hospital between 1976 and 1984. (The main parameters for assessing sphincter function are maximinal and pressure at rest, maximum squeeze pressure, length of the high pressure zone, electromyography and parameters of rectal sensation.) Poor functional results were observed for patients having restorative surgery for rectal cancer when there is evidence of extrarectal tumour infiltration. It has now become our policy to avoid primary resection and anastomosis for fixed rectal cancer and for cancer involving the side walls of the pelvis. We would also question the value of low sphincter-saving surgery in patients with manometric evidence of a weak anal sphincter. Assessment of rectal capacity has been of predictive value in selecting patients suitable for ileorectal anastomosis in Crohn's disease. Sphincter preserving surgery in ulcerative colitis by ileorectal anastomosis or ileoanal anastomosis with pouch is unpredictable and continence is often imperfect. Repair of a rectal prolapse alone by a posterior rectopexy restores continence to 70% of patients but if incontinence persists post anal repair is beneficial in approximately 50% of cases. Incontinence which does not improve with medical therapy can often be restored by surgical treatment. Post anal repair restores continence to approximately 70% of cases and sphincter reconstruction to 80%.

Anal Canal↗
PubMed1975

Reversible ureteral stenosis as a delayed complication of operation on the colon and rectum.

A non-direct ureteral lesion following operations on the colon and rectum is described. The complication was observed 10 to 64 days postoperatively, and is characterized by a unilateral or bilateral, relatively long stenosis. A total of 8 cases are presented: 7 of ulcerative colitis and one, a rectal prolapse. The main symptoms were unilateral abdominal or lumbar pain, moderate fever, and a pronounced ureteral stenosis revealed at i.v. urography. In 7 cases, full restitution occurred after antibiotic treatment, supplied by ureteral catheterisation in 4 cases, while operation was necessary in one case. The discrepancy between the seriousness of the roentgenological picture and the good final result of conservative treatment was striking.

Adult↗
PubMed1997

[Laparoscopic rectopexy].

Within 4 years 66 laparoscopic rectopexies were performed. The indications were: rectal prolapse, morphologic outlet-constipation and a combination of both. Using a modified suture rectopexy (according to Sudeck), we did not take any foreign material and resected the sigmoid in 35 patients. Conversion rate was 2%, complications that needed reoperation occurred in 9%. In the follow up period of 24.1 months in the mean (max. 50) no recurrent prolapse occurred. Incontinence was abolished or improved in 64%, outlet-constipation was improved in 85%. Especially in rectopexy the laparoscopic technique seems to be of benefit for the patient: quicker convalescence, less pain, small scars, a.o. But all these potential advantages have to be proven in prospective-if possible randomised-studies.

Adult↗