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PubMed1998

Neurofibromatosis of the colon and rectum combined with other manifestations of von Recklinghausen's disease: report of a case.

Gastrointestinal involvement of neurofibromatosis occurs in as many as 25 percent of cases. Neurofibroma occurs most frequently in the stomach and jejunum, but the colon may also be involved. This condition is characterized by multiple submucosal neurofibromas of the gastrointestinal tract and café au lait pigmentation, bony abnormalities, and neurofibromas of both central and peripheral nerves. The lesions consist of an overgrowth of neural tissue along with other mesenchymal elements. Gastrointestinal neurofibromas may cause occult bleeding, luminal obstruction, or intussusception. Malignant transformation into neurofibrosarcoma is rare. We encountered a case of neurofibromatosis diffusely involving the left colon, the sigmoid colon, and the rectum, which resulted in herniation of the mass through the anus, with intestinal obstruction. The patient also showed skin lesions of the neurofibromatosis. We report this case with a review of the literature.

Colectomy↗
PubMed1992

Transanal endoscopic microsurgery.

Transanal endoscopic microsurgery (TEM) has emerged as a minimally invasive means of resecting rectal tumors. Developed in Germany and now being used with increasing frequency in the United States, TEM utilizes a 40-mm operating rectoscope, which is sealed with an airtight facepiece. Carbon dioxide is constantly infused, thereby distending the rectum and maintaining visibility. A variety of instruments, such as tissue graspers, a high-frequency knife, suction, and needle holders, are inserted through the facepiece. Adenomas that are small, large, or even circumferential, as well as selected carcinomas up to 24 cm, can be removed with TEM instrumentation. The optics provide sixfold magnification, and this, combined with the constantly distended operative field, allows for a precise excision of the tumor as well as closure of the wound. For lesions in the mid and upper rectum, TEM is an alternative to a transsacral or transabdominal approach, with subsequently shorter hospital stay and fewer complications.

Adenoma↗
PubMed1984

Rectal procidentia in elderly and debilitated patients. Experience with the Altemeier procedure.

The term "rectal procidentia" implies circumferential full-thickness descent of the rectum through the anal sphincter. This condition occurs because of several structural and anatomic changes and offers a challenge in its management. There are over 50 different surgical procedures described to correct this condition. Unfortunately, when it occurs in the elderly and infirm, there is very little that can be done. Such poor-risk patients should be managed with a perineal repair as described by Altemeier. The purpose of this article is to review our results and experiences with Altemeier's procedure in managing rectal procidentia in elderly and debilitated patients.

Age Factors↗
PubMed1984

Diagnosis of disturbances of continence and defecation.

Defecography was performed in 60 patients with disorders of continence or defecation in whom previous investigative procedures had not revealed any abnormality that could explain the disorder. A correct diagnosis was made in 47 patients (78%). Defecography appears to be a suitable procedure to detect functional disturbances of defecation. Since anterior rectal wall abnormalities such as colitis cystica profunda and solitary rectal ulcer were seen in eight patients, it is suggested that these abnormalities are a result of functional disorders of defecation. Furthermore, the function of the pelvic floor musculature can be assessed by defecography in order to determine the cause of fecal incontinence.

Adolescent↗
PubMed1984

Management of pelvic sepsis after Ivalon rectopexy.

The consequences of pelvic sepsis after Ivalon rectopexy are described in four patients. Despite clear evidence of pelvic infection, reoperation was delayed by ineffective conservative measures and morbidity thereby prolonged. In three, the causative organism was Staphylococcus aureus and it is suggested that prophylactic antimicrobial regimens for intestinal organisms alone may be inadequate.

Abscess↗
PubMed1986

V-Y advancement for anal ectropion.

A V-Y advancement flap modified for anorectal use in reconstructive surgery for anal ectropion is described. The underlying external sphincter serves a dual function as the pivotal point for flap advancement and as the vascular pedicle to the dermal-subdermal plexus supplying the flap. This ensures viability and restores function to the newly created anus.

Anal Canal↗
PubMed1985

Disturbances in the defecation mechanism with special reference to intussusception of the rectum (internal procidentia).

Anorectal disorders that disturb normal defecation are described, especially intussusception of the rectum (internal procidentia). A review of 190 patients, half of whom were treated operatively and the other half conservatively, is presented. Diagnostic procedures, symptoms, and indications for operations are evaluated. We believe that intussusception of the rectum is a relatively common cause of difficult emptying of the rectum and, when the correct diagnosis is established, operation presents a fair chance for improvement.

Adult↗
PubMed1986

Perineal transanal colonic resection: an experimental study.

Experimental data have led to the conclusion that a transanal partial or subtotal colonic resection can safely be performed in the dog without entering the peritoneal cavity. The techniques of intussusception of the colon at the anus and resection of the colon at the perineum with modified use of the EEATM stapler are presented.

Anal Canal↗
PubMed1987

Solitary rectal ulcer syndrome. Twenty cases seen at an oncology center.

A retrospective study of 20 cases of biopsy-proven solitary rectal ulcer syndrome seen at a large oncology hospital which highlight the clinicopathologic features is presented. Thirty five percent of patients were in their sixth decade and there was a male preponderance of 2.3:1. All patients presented with anorectal symptoms. Eighty five percent had normal abdominal findings and seventy five percent had positive findings on rectal examinations. Fifty four percent had a diagnosis of carcinoma of the rectum on barium enema studies. On sigmoidoscopy, a solitary ulcer was found in 80 percent; 50 percent had lesions between 6 and 10 cm from the anal verge, and 40 percent had the lesion on the anterior rectal wall. All patients were treated conservatively and 35 percent were disease free at the end of five years, while 30 percent had persisting symptoms.

Adult↗
PubMed1985

Sphincter repair with a Silastic sling for anal incontinence and rectal procidentia.

Sixteen selected patients with rectal procidentia, anal incontinence, or both were treated by the insertion of a Dacron impregnated Silastic sling at the Lahey Clinic between 1981 and 1984. The indications for operation were incontinence in 14 patients, procidentia with incontinence in one patient, and procidentia alone in one patient. No operative deaths occurred. Immediate complications included urinary retention in the three patients and hematoma in one patient. Late complications included infection, requiring removal of the Silastic sling in four patients; however, two of these patients underwent subsequent successful reinsertion of the sling after control of local sepsis. Among patients for whom follow-up data were available, satisfaction with the results of this procedure were excellent in two patients, good in six, fair in two, and poor in one. Sphincter repair with a Silastic sling is a safe, reliable alternative in the treatment of selected patients with anal incontinence or rectal procidentia.

Adolescent↗

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