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[Chronic colitis].

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Chronic Disease↗

[Rectorrhagia].

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Female↗

Ischemic fecal incontinence and rectal angina.

In 36 patients who consulted for fecal incontinence or rectal pain, or both, there was grossly visible scarring of the rectum and biopsy revealed mucosal atrophy and fibrosis. A steal from the hemorrhoidal arteries to the iliac vessels was demonstrated in 3 subjects. Maximum tolerable volumes within a rectal balloon were smaller than in control subjects, both in men (192 vs. 273 ml) and in women (142 vs. 217 ml) (p less than 0.01). The rectoanal inhibitory reflex was abnormal in all but 1 patient. Specific abnormalities were a decreased amplitude or a prolonged duration of the reflex. It was totally absent in 2 patients. This study is compatible with the hypothesis that chronic ischemia of the rectum may cause fecal incontinence or rectal pain.

Adult↗

Flexible fiberoptic sigmoidoscopy.

The 35-cm flexible fiberoptic proctosigmoidoscope is a cost-effective instrument for the family physician. Nonendoscopists have mastered its use with no reported complications. Patient tolerance is high compared to tolerance for the rigid scope. The pathology yield per procedure is two to four times greater than that reported with the rigid sigmoidoscope. Yields with the 35-cm instrument have matched those documented with the 65-cm fiberoptic instrument.

Aged↗

Polyposis coli presenting with Streptococcus bovis endocarditis.

Streptococcus bovis bacteremia is an important early clue to the presence of serious and clinically unexpected gastrointestinal disease, particularly carcinoma of the colon. S. bovis bacteremia has also been associated with carcinoma of the esophagus and stomach, gastric lymphoma, pancreatic adenocarcinoma, intestinal diverticulosis and single adenomatous polyps and villous polyps of the colon. We report a patient with S. bovis endocarditis as the initial clinical manifestation of extensive polyposis of the colon and rectum. All patients with S. bovis bacteremia need thorough investigation of their gastrointestinal tract even in the absence of symptoms, signs, or positive laboratory tests suggestive of gastrointestinal pathology.

Adenoma↗