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PubMed1976

[Around the sphincter: problems of continence in surgery of the large intestine].

Anatomy and physiology of anal continence and incontinence are described. The surgeon's first main task is the prevention of incontinence, e.g. in the treatment of the small and mobile carcinoma of the rectum, the wide pedunculated papilloma, the fistula in ano, haemorrhoids and anal fissure. The second main task is the reconstruction of continence of rectal prolapse, ectropion, third grade rupture of the perineum and perineal injuries. The possibilities for reconstruction, reinforcement and replacement of the sphincter are described.

Fecal Incontinence↗
PubMed2003

The posterior sagittal trans-sphincteric and trans-rectal approaches.

BACKGROUND: The posterior sagittal, transphincteric approach to treat different pelvic problems has been known since the last century. Although some surgeons have embraced it and have enthusiastically advocated it's use, it has never become an overly popular technique. The purpose of this study is to evaluate the advantages and disadvantages of the approach, both from a historical perspective and from the authors' experience. METHODS: The international literature on the subject was reviewed since 1877 up to the present date. A retrospective evaluation of the authors' experience was conducted. Specific attention was paid to the final result obtained in the treatment of the original condition, surgical complications and the effect of the surgical approach. on bowel and urinary control. RESULTS: The review included 114 patients divided into two groups. Group A included 85 patients who underwent a posterior sagittal trans-sphincteric approach. Group B included 29 patients who underwent a posterior sagittal transanorectal approach, in which the anterior wall of the rectum and the sphincter were divided. Postoperative bowel control was normal in all patients except in those whose basic condition had resulted in fecal incontinence, or who had sustained an irreversible injury prior to the operation. Urinary control was normal except in cases with pre-operative incontinence. Complications included recurrence of rectogenito-urinary fistulae in 3 cases, rectocutaneous fistula in 3 patients with Hirschsprung's disease, and 2 partial wound dehisences. CONCLUSIONS: The posterior sagittal trans-sphincteric approach represents a useful technical alternative. It seems to be particularly useful to treat complications after surgery for Hirschsprung's disease, presacral masses, acquired rectogenito-urinary fistulae and idiopathic rectal prolapse. The transanorectal approach provides excellent exposure to the posterior urethra and vagina. Bowel and urinary control are not compromised.

Adolescent↗
PubMed2004

[Solitary ulcer of the rectum. Report of two cases treated by the Orr-Loygue technique].

We report two cases of solitary ulcer of the rectum treated by Orr Loygue rectopexy technique in a ten-year period at the Surgery Department of Aristide Le Dantec. The first case is about a 39 year-old female who was constipated since approximately seventeen years and had a rectal prolapse associated later to bloody stools. In 1990, she underwent haemorrhoids surgery operation with unsatisfactory results. After the recurrence of the disease, she was admitted at Aristide le Dantec Teaching Hospital, rectoscopy revealed a solitary ulcer. Orr Loygue rectoplexy technique was performed by laparotomy. In the follow up, there was no complication. The second case is about a 43 years old female who suffered from rectal syndrome since twenty years and had pelvis pains with bleeding and phlegmatic diarrhoeas. The physical examination and biologic analysis showed no particularity. Rectoscopy has revealed a solitary ulcer of the rectum which was confirmed by biopsy. Orr Loygue rectoplexy technique was performed. In the follow-up, there was a recurrence and this was confirmed by rectoscopy. The rectopexy alone does not summurize the therapeutic. A final dyskesia or an associated perineal insufficiency must be integrated in a total therapeutic strategy.

Adult↗
PubMed2003

Acute transanal evisceration of the small bowel: report of a case and review of the literature.

We report a patient who presented with rectal rupture and transanal evisceration, a rare entity with only 52 cases previously described in the world literature. Our case is the first to implicate sheer stress on the anterior rectum caused by postoperative adhesions as the major etiologic contributing feature. Moreover, this case is the third reported with chronic constipation without rectal prolapse as an additional preexisting contributory condition. A summary of the medical literature including etiology, treatment, and outcomes is presented.

Acute Disease↗
PubMed1986

Generalized juvenile polyposis coli. Clinical management based on long-term observations.

Generalized juvenile polyposis occurred in five patients (age range, 18 months to 16 years). Clinical findings included abdominal pain, weakness, rectal bleeding, diarrhea, rectal prolapse, intussusception, clubbing, and failure to thrive. Laboratory findings included anemia, hypoalbuminemia, hypokalemia, and skin test anergy. Diagnosis is achieved by double contrast enema, endoscopy, and biopsy. Unlike patients with solitary juvenile polyps, patients with generalized involvement require surgical intervention. Subtotal colectomy and ileoproctostomy are the procedures of choice, and we performed them in four cases. An ileoanal-endorectal pull-through procedure was required in one patient with continued rectal disease. All five patients are currently alive and well. Long-term follow-up is important as polyps may persist into adult life. Family members are at risk for developing gastrointestinal tract tumors and should be screened.

Adolescent↗
PubMed2006

Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management.

Constipation is a subjective symptom of various pathological conditions. Incidence of constipation fluctuates from 2 to 30% in the general population. Approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation constipation. Constipation of obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, this type of constipation should be differentiated by colonic slow transit constipation which, if coexists, should be managed to a second time. Assessment of patients with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which contribute to the diagnosis and the differential diagnosis of the cause of the obstructed defecation. Thereby, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery.

Anus Diseases↗
PubMed1994

Transvaginal sacrospinous colpopexy for vault and marked uterovaginal prolapse.

OBJECTIVE: To assess the results of the sacrospinous colpopexy procedure for the treatment of vault prolapse following hysterectomy and marked uterovaginal prolapse. DESIGN: A prospective study of all patients undergoing sacrospinous colpopexy for vault and marked uterovaginal prolapse between December 1991 and December 1992. SETTING: Kent and Canterbury Hospital, Canterbury. SUBJECTS: Forty women with vault prolapse following hysterectomy and 24 with marked uterovaginal prolapse. INTERVENTIONS: All patients underwent posterior vaginal repair, enterocele sac obliteration and sacrospinous colpopexy. In 48 patients an anterior vaginal repair with suburethral buttressing sutures was also performed. A long-needle bladder neck suspension operation (Raz procedure) was included for three women with coexistent stress incontinence. In 13 patients a vaginal hysterectomy was performed and in 11 the uterus was conserved. A postanal sacrorectopexy was performed on one patient with marked rectal prolapse. RESULTS: The mean follow up period was five months. So far, there have been three failures in the group treated for vault prolapse. One of these underwent a successful repeat sacrospinous colpopexy and repair. The main long term complication was cystocele formation. One sexually active patient complained of dyspareunia following surgery. CONCLUSION: The sacrospinous colpopexy is effective in the treatment of vault prolapse and compares favourably with abdominal vault supporting procedures. It avoids major abdominal surgery and allows the surgeon to correct coexistent cystocele and rectocele. This procedure is also a useful adjuvant when treating marked uterovaginal prolapse.

Adult↗
PubMed2002

[Severe chronic constipation. Is it a problem of surgery?].

Severe chronic constipation is defined as less than two bowel movements per week, hard stools, non productive urgency and the need of digital maneuvers in more than 25% of bowel evacuations. The best studied causes of chronic severe constipation are slow bowel transit constipation and pelvic floor dysfunction. However, there are mixed forms that cross link with irritable colon syndrome. The main diagnostic tests are anorrectal manometry, bowel evacuation, X-ray studies and anorrectal sphincteromyomectomy, that can be therapeutic. Five percent of patients are surgical candidates. In cases of slow bowel movement, total colectomy with ileorectal anastomosis has satisfactory results in 80 to 90% of patients. Some patients with pelvic floor dysfunction have an occult rectal prolapse, rectocele or sigmoidocele and obtain benefits with the correction of these conditions. The remaining patients require a training of bowel evacuation, known as biofeedback. We have performed a total colectomy in 10 patients with slow bowel movements with good functional results in 80%. After 56 months of follow-up, a mean 2.6 bowel movements per day is reported by the patients. Four patients were also operated due to a solitary rectal ulcer and two patients due to a sigmoidocele, with satisfactory results.

Chronic Disease↗
PubMed1990

Is solitary rectal ulcer a manifestation of a systemic disease?

In a prospective study of 22 patients with solitary rectal ulcer, we tried to define the features of this condition, especially the associated systemic features, that may give some clues to its etiopathogenesis. In 15 of these patients a single rectal ulcer was found, whereas in seven patients two ulcers were present in each. Of the total 29 ulcers in these patients, 19 were located on the anterior or anterolateral wall of the rectum and 10 were on the posterior or posterolateral wall. The sigmoidoscopic appearance of the ulcer was quite characteristic, yet a biopsy was considered essential to rule out other pathologic processes. Histological features of the solitary rectal ulcer comprised fibrous obliteration of the lamina propria with disorientation of the muscularis mucosa and extension of muscle fibers into the lamina propria. Evident rectal prolapse was present in only three patients. Recurrent oral ulcerations occurred in four (18.2%) patients and erythema nodosum in one of them (4.5%). Sacroiliitis was present in six of 19 (31%) patients studied radiologically, and human leukocyte antigen (HLA)-B27 occurred in four of the 20 patients (20%) tested for HLA class I antigens. All the four HLA-B27-positive patients had associated sacroiliitis and showed good response to sulfasalazine. These associations raise the possibility that solitary rectal ulcers may be a part of a systemic disease or of several diseases with varied etiology.

Adolescent↗
PubMedDate not supplied

Results of the double stapling procedure in pelvic surgery.

The double stapling technique for rectal reconstruction after resection involves closing the lower rectal segment with a linear stapler and performing the anastomosis using a circular stapler across the linear staple row. The purpose of this report is to review the results of double stapling, present our experience, and draw conclusions from the material available. We have utilized the double stapling technique in 80 patients for primary anastomoses and in 11 patients for secondary anastomoses following Hartmann procedures. Twenty-one anastomoses were at or near the dentate line. Fifty-six patients had rectal carcinoma, 29 patients had diverticulitis, 3 patients had carcinoma of the ovary, and 1 patient each had traumatic rectal perforation, volvulus, or rectal prolapse. Complications in the total 91 patients included 3 anastomotic leaks (3.3%), 1 postoperative hemoperitoneum (1.1%), and 3 strictures (3.3%). No anastomosis was protected by diverting colostomy. There were no operative deaths. Of 43 patients with cancer available for follow-up, 4 patients have developed local recurrence. The technique has been modified for ileoanal anastomosis during abdominal restorative proctocolectomy for ulcerative colitis and familial polyposis and early results are favorable. The double stapling technique provides a safe method for rectal reconstruction at or near the dentate line and offers the following advantages over other stapler techniques: (1) It eliminates the frustrating distal pursestring; (2) The rectal segment is not opened, minimizing contamination; and (3) It avoids gathering the sometimes generous circumference of the rectum on a pursestring thus allowing a more precise distal donut.

Anal Canal↗
PubMed2006

[Colorectal polyps in children. A study of 34 patients].

AIM: To assess the frequency and the clinical features of polyps of the colon and rectum in children. METHODS: A total of 34 patients (20 boys and 14 girls, mean age: 5.4 years) were enrolled in this 14-years retrospective study. Diagnosis was done for almost all patients by colonoscopy (n=8) or recto-sigmoidoscopy (n= 19). After endoscopic polypectomy, polyp's type is determined by histological examination. RESULTS: Minimal and relapsing rectal bleeding was the most frequent finding of polyps of the colon and rectum (85.3%) followed by spontaneous emission of polyp (n=3), rectal prolapses (n=2), chronic constipation (n=1) and abdominal pain (n=1). The polyp was unique in all cases and with a mean size of 12 mm. The majority of polyps were localized in the rectum or sigmoid (97%) and were pediculate (81.2%). Endoscopic polypectomies concerned 26 polyps while two small polyps were left. Most of the polyps corresponded histologically to juvenile polyps (96.2%). The immediate post-op course was uneventful for 26 children. CONCLUSION: Our study suggests that rectal bleeding is the most frequent finding of polyps of the colon and rectum in childhood. Outcome after endoscopic polypectomy is good.

Adolescent↗
PubMed1988

[Primary clinical, endoscopic and histologic findings in solitary rectal ulcer].

This study presents clinical, endoscopical and histological primary findings of solitary ulcer of the rectum obtained in 24 patients. Solitary ulcer of the rectum is preferably a disease of young women. The main symptom is recurrent rectal bleeding. Endoscopically in 50% of all cases mucosal ulcerations can be observed. The other cases are non-ulcerous lesions with uncharacteristic endoscopical findings. The majority of the lesions are within 6-8 cm of the anal margin. In 44% of the patients there are findings, which are suspicious of preexisting rectal prolapse. The histological main criterion is a fibromuscular hyperplasia of the lamina propria. Full agreement of endoscopical and histological diagnosis at primary examination could be obtained in only 17% of the cases.

Adult↗
PubMedDate not supplied

Perineal herniorrhaphy: perioperative data from 100 dogs.

One hundred dogs (83 intact males, 15 castrated males, and two intact females) underwent 110 perineal herniorrhaphy procedures. Mixed-breed dogs (n = 32), miniature poodles (n = 14), Boston terriers (n = 11), and Pekingese (n = 9) were represented most frequently. Perineal swelling (n = 48) and a perineal defect on rectal palpation (n = 31) were common clinical signs. Twenty dogs had urinary bladder retroflexion and were significantly more likely to have elevated serum urea nitrogen and creatinine concentrations, hyperkalemia, hyperphosphatemia, and neutrophilic leukocytosis. Only five of 43 dogs evaluated radiographically had prostatomegaly. Of 30 dogs receiving oral barium, all had rectal deviation. The most frequent complications during the hospitalization period were incisional (n = 35), followed by rectal prolapse (n = 9), tenesmus (n = 8), and depression (n = 8). Fifty-six of 70 dogs with follow-up had no complications.

Animals↗
PubMed1980

[Solitary ulcer of the rectum (author's transl)].

Solitary ulcer of the rectum is no longer considered as an idiopathic or autonomous disease. It is probably due to mucosal microtraumas, the most frequent being that resulting from anterior or complete rectal prolapse. Characteristic histopathological features can easily be recognized in biopsies taken from the edges or around the ulcers. This concept leads to a policy of consistent therapeutic measures: re-education of bowel habit and as a last resort surgery, either abdominal proctopexy or postanal pelvic floor repair.

Adult↗
PubMed1998

[Laparoscopic colorectal resections: indications, surgical technique and outcome in 410 prospective cases].

UNLABELLED: From April 1993 to August 1997 410 patients underwent laparoscopic surgery for colon and rectal diseases. In the beginning we only operated on patients with benign disorders. Since July 1995 colorectal malignancies have also been resected. A total of 181 patients (47.6%) with benign colorectal diseases were operated on; 116 patients (31%) had diverticulosis, diverticulitis or benign tumor; 26 with rectal prolapse were resected in MIS-technique. In all, 199 patients were treated for colorectal malignancies, 171 (85.9%) with curative intention. RESULTS: Mean operation time was between 60 and 520 min. After 40 operations the learning curve had reduced the operation time significantly. Severe complications appeared in 4.7% of all cases.

Colonic Diseases↗
PubMed1992

Solitary rectal ulcer: an unusual cause of rectal bleeding in children.

The solitary rectal ulcer syndrome (SRUS) is a disease which is commonly diagnosed in adults but only rarely described in children. Rectal prolapse and intussusception are frequently associated with this entity. A relationship between SRUS and chronic constipation due to spastic pelvic floor syndrome (SPFS) is often observed. Thus biofeedback defaecation training is an efficient treatment of both conditions. We describe two paediatric patients suffering from SRUS associated with SPFS who showed complete recovery after biofeedback defaecation training.

Child↗
PubMed1988

Solitary rectal ulcer syndrome: findings at barium enema study and defecography.

Sixteen cases of histopathologically proved solitary rectal ulcer syndrome were encountered. Fifteen patients underwent barium enema study; in nine cases the findings--including rectal stricture, granularity of the mucosa, and thickened rectal folds-were nonspecific. In six cases the study was normal. All patients had a long history of defecation disorders, and defecography was performed in all. In seven cases, intussusception of the rectal wall was seen; in another case the intussusception was accompanied by a rectocele. One case showed rectal prolapse. In four cases, failed relaxation of the puborectalis occurred and prevented the passage of the bolus; in another case there was abnormal perineal descent. In two patients studies were normal. In patients with defecation disorders, the possibility of this syndrome should be considered. Defecography is the method of choice for establishing the diagnosis.

Adult↗