Biomedical subjects
Publications and source records attributed to J A Scoma.
Carcinoid tumors of the rectum are not uncommon. However, multiple rectal carcinoids are very rare but can occur. The behavior of the rectal carcinoids is different than that of carcinoid tumors in other areas of the gastrointestinal tract. All carcinoids are malignant, and management is based on size and depth of invasion.
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Urinary retention and catheterization are among the complications involved in anorectal surgery. One hundred patients who underwent hemorrhoidectomies were able to avoid both of these complications due to a combination of operative and postoperative procedures, including the following: (1) meticulous surgical technique; (2) restriction of fluids; (3) adequate doses of narcotics, and (4) preeducation of the patient and nursing staff, which resulted in spontaneous voiding in all of the patients by the morning after the operation, with or without a hot bath.
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While villous adenomas of the rectum are common, they rarely encompass the entire rectum to the dentate line. It is even more unusual to find a tumor of this size to be benign. Fluid and electrolyte deficits associated with this tumor add to the difficulty in management. The experienced surgeon should be aware of the various modes of treatment and be able safely to use the appropriate operation. It is as grave an injustice to the patient to treat a benign lesion as a malignancy as it is to remove the rectum for a benign villous adenoma.
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The treatment of inflammatory bowel disease has gone through a dramatic evolution in the last 40 years. Although the medical treatment has shown little progress during this time, surgical concepts have continued to change. Resection of the disease with formation of a well-functioning ileostomy stoma was a great milestone. In recent years, the development of an internal reservoir with a continent ileostomy has greatly improved the status of these patients. However, a pelvic reservoir, using the natural anorectal sphincter, may well be the next step in this evolutionary process.