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PubMed2001

Common anorectal conditions: Part II. Lesions.

Patients with a wide variety of anorectal lesions present to family physicians. Most can be successfully managed in the office setting. A high index of suspicion for cancer should be maintained and all patients should be questioned about relevant family history or other indications for cancer screening. Patients with condylomata acuminata must be examined for human papillomavirus infection elsewhere after treatment of the presenting lesions. Their sexual partners should also be counseled and screened. Both surgical and nonsurgical treatments are available for the pain of anal fissure. Infection in the anorectal area may present as different types of abscesses, cryptitis, fistulae or perineal sepsis. Fistulae may result from localized infection or indicate inflammatory bowel disease. Protrusion of tissue through the anus may be due to hemorrhoids, mucosal prolapse, polyps or other lesions.

Abscess↗
PubMed1996

Total tubular duplication of the colon and distal ileum combined with transmesenteric hernia: surgical management and long-term-results.

A two-year-old male with total tubular duplication of the colon and distal ileum combined with transmesenteric hernia is presented. Recurrent abdominal pain, distention of the abdomen and chronic constipation were the main complaints. A side-to-side anastomosis created through the lowermost part of the common wall of the duplication and colon proper, plus closure of the mesenteric defect and excision of the duplicated ileal loops relieved the patient of all symptoms. Postoperative stagnation of the stool in the closed hollow end of the duplication caused distention developing into a prolapsing pouch which required excision by transanal approach six years after the laparotomy.

Child, Preschool↗
PubMed1993

[Abdominal approach of rectocele and colpocele].

The authors report a series of 62 female patients operated for rectocele and/or elytrocele via an abdominal approach. The technique was based on insertion of a retrovaginal prosthesis attached to the sacrum. Other surgical procedures can be performed at the same operation: hysterectomy, insertion of a prevaginal prosthesis, retropubic colpopexy. The anatomical and functional results were excellent in these patients previously operated for urinary incontinence or prolapse (99%). The indication for total hysterectomy during the same operation must be limited as this procedure increases the morbidity and impairs the functional results. Dyschexia is improved, but may be followed by postoperative constipation. Abdominal treatment of rectoceles and/or elytroceles by interposition of an interrectovaginal prosthesis attached to the sacrum is particularly indicated after hysterectomy in the case of associated or recurrent genitourinary prolapse.

Douglas' Pouch↗
PubMed1993

Defecating proctography: local experience.

Between October 1990 to November 1991, defecating proctography was performed on a select group of patients with complaints of persistent constipation or sensation of incomplete evacuation. Out of the 27 patients studied, a high percentage (88.8%) showed some form of anatomical or functional abnormality of the defecating mechanism. As defecating proctography is a relatively new mode of investigation locally, we briefly describe our method and results. These include rectocele formation, intrarectal mucosal prolapse, intussusception and pubo-rectalis paradox. Some of these cases may be amenable to surgical correction.

Adolescent↗
PubMed1996

Colostomy complications in infants and children.

This study analyses the morbidity and mortality of colostomy formation and closure over a 17-year period during which 138 consecutive infants and children had a colostomy formed as the initial management of Hirschsprung's disease or anorectal malformation. Complications after colostomy formation were encountered in 38 (27.5%) patients and included colostomy prolapse, stenosis, retraction, dysfunction, skin excoriation and parastomal hernia. The complication rate with transverse colostomies was higher than with other types. Colostomy closure was associated with complications in nine patients (6.5%), the most serious of which was adhesive small bowel obstruction (5). The mortality was less than 1%, but significant morbidity still exists. Refinements in surgical technique may help reduce the incidence of complications, but stoma prolapse, particularly with transverse colostomies, remains a major challenge.

Anal Canal↗
PubMed1995

Anterior vaginal suspension for vaginal vault prolapse.

Vaginal prolapse may occur following hysterectomy or may evolve with the uterus in place. Current treatment options for vaginal prolapse have a limited success rate or are associated with significant morbidity. In this retrospective review, we present our experience with a new procedure for repair of vaginal prolapse. This technique relies on anterior suspension of the vaginal vault to the anterior rectus sheath in a fashion similar to bladder neck suspension. Forty patients have undergone this procedure. All patients had vaginal prolapse, cystocele, and urinary incontinence. In addition, 34 patients had enterocele, six had uterine prolapse, 33 had rectocele, and two had urethral diverticula. All patients had anterior vaginal suspension (AVS), with cystocele repair and bladder neck suspension. Six patients had vaginal hysterectomy, 34 had enterocele repair, 33 had rectocele repair, and two had urethral diverticulectomy. The mean hospital stay was 2.5 days (range, 1-7 days), and their mean follow-up was 30 months (range, 12-54 months). Thirty-six (90%) patients have excellent support of the vagina with no evidence of recurrent cystocele, enterocele, or rectocele. Four (10%) patients have recurrent enterocele. Thirty-three (82.5%) patients are dry or have rare episodes of urinary incontinence (less than one episode/month), whereas four (10%) patients have recurrent stress incontinence and three (7.5%) have urge incontinence. Constipation and fecal incontinence were resolved in all patients. All patients who were sexually active preoperatively remained so postoperatively, and none reported dyspareunea. Vaginogram in 10 patients demonstrated that posterior angulation of the vaginal axis was retained in all patients. AVS is associated with an excellent success rate in terms of resolution of symptoms and correction of prolapse. Morbidity is minimal, and hospital stay is short. The technique is simple and relies on anatomy that is familiar to all urologists. In addition, the vaginal approach allows for simultaneous correction of all components of vaginal prolapse and any associated vaginal pathology.

Adult↗
PubMed2006

Jumbo biopsy is useful for the diagnosis of colonic prolapsing mucosal polyps with diverticulosis.

We report here a case of multiple prolapsing mucosal polyps with diverticulosis in the sigmoid colon. A 52-year-old man was admitted to our hospital because of bloody diarrhea. Colonoscopy and barium enema showed multiple diverticula, markedly thickened mucosal folds and polypoid lesions with mucus on the top of them in the sigmoid colon. Endoscopic ultrasonography showed thickening of the mucosal and submucosal layers. Several endoscopic biopsy specimens were taken from the polypoid lesions. Histological examination revealed only chronic inflammatory cell infiltration. In order to obtain a definite diagnosis, we performed endoscopic jumbo biopsy for the polypoid lesions after obtaining informed consent. Histological examination revealed marked lymphocyte infiltration, hemosiderin deposits and fibromuscular obliteration in the lamina propria, features similar to those of mucosal prolapsing syndrome. After anti-diarrhetic treatment, clinical findings were improved. Thus, jumbo biopsy is useful for diagnosis and treatment of prolapsing mucosal polyps.

Biopsy↗
PubMed2001

[Differential surgical therapy in hemorrhoids].

Haemorrhoids 3 degrees should be treated operatively. In segmental lesions, excisional haemorrhoidectomy (Milligan-Morgan, Ferguson, Parks) is the procedure of choice. For more circular haemorrhoidal piles, circular stapled haemorrhoidectomy has been used in Germany since 1998. In cases of additional prolapsing anoderm reconstructive anoplasty might be superior. Using a classification orientated therapeutical regime for haemorrhoidal disease offers high healing rates with a low rate of complications and recurrences.

Hemorrhoids↗
PubMed1986

[Therapy of pediatric anorectal prolapse].

No generally valid and accepted views, applicable to all severities, have so far existed regarding aetiopathogenesis and therapeutic strategies for surgical approach to anorectal prolapse in childhood. More ground has been assumed in recent years by sclerosing therapy. The injections therapy has proved to be highly suitable for severity stages One and Two and for Type I according to Reifferscheid and Altemeier. It should be used before more invasive surgical interventions are decided. This conclusion has been drawn by the authors of this paper from their own therapeutic results obtained from 37 cases of anorectal prolapse in childhood, with therapeutic sclerosing being used in 23 instances.

Child, Preschool↗
PubMed1993

Colpocystodefecography.

PURPOSE: To assess, in one single procedure, a complete study of the female pelvis, including the Douglas pouch. METHODS: Colpocystodefecography (CCD) combines vaginal opacification, voiding cystography, and defecography. Three hundred examinations are reviewed. RESULTS: Thanks to the simultaneous visualization of the pelvic structures, CCD proved to be more useful than clinical evaluation to diagnose prolapses and particularly Douglas pouch hernias (enteroceles), the clinical diagnosis of which was missed in 93 of 111 cases. Moreover, in addition to morphologic and functional information, CCD brings about a new insight in the study of pelvic organs reciprocal influences, should they be positive (supporting function) or negative (external compression). Finally, significative pelvic surgery and particularly hysterectomy enhances greatly the risk of enteroceles. CONCLUSION: CCD is helpful in the preoperative staging, especially in the selection of the surgical procedure that will least likely predispose to possible late postoperative complications such as vaginal prolapses or enteroceles.

Adult↗
PubMed2007

Ultrasonographic patterns in patients with obstructed defaecation.

BACKGROUND: Anal ultrasound is helpful in assessing organic anorectal lesions, but its role in functional disease is still questionable. The purpose of the present study is to assess anal-vaginal-dynamic perineal ultrasonographic findings in patients with obstructed defecation (OD) and healthy controls. MATERIALS AND METHODS: Ninety-two consecutive patients (77 women; mean age 51 years; range 21-71) with symptoms of OD were retrospectively evaluated. All patients underwent digital exploration, endoanal and endovaginal ultrasound (US) with rotating probe. Forty-one patients underwent dynamic perineal US with linear probe. Anal manometry and defaecography were performed in 73 and 43 patients, respectively. Ultrasonographic findings of 92 patients with symptoms of OD were compared to 22 healthy controls. Anismus was defined on US when the difference in millimetres between the distance of the inner edge of the puborectalis muscle posteriorly and the probe at rest and on straining was less then 5 mm. Sensitivity and specificity were calculated by assuming defaecography as the gold standard for intussusception and rectocele and proctoscopy for rectal internal mucosal prolapse. Since no gold standard for the diagnosis of anismus was available in the literature, the agreement between anal US and all other diagnostic procedures was evaluated. RESULTS: The incidence of anismus resulted significantly higher (P < 0.05) in OD patients than healthy controls on anal (48 vs 22%), vaginal (44 vs 21%), and dynamic perineal US (53 vs 22%). A significantly higher incidence of rectal internal mucosal prolapse was observed in OD patients when compared to healthy controls on both anal (61.9 vs 13.6%, P < 0.0001) and dynamic perineal US (51.2 vs.9% P = 0.001). For the diagnosis of rectal internal mucosal prolapse, anal US had a 100% sensitivity and specificity. For diagnosis of rectal intussusception, anal US had an 83.3% sensitivity and 100% specificity and perineal US had a 66.6% sensitivity and 100% specificity. In the diagnosis of anismus, anal ultrasonography resulted in agreement with perineal and vaginal US, manometry, defaecography, and digital exam (P < 0.05). Other lesions detected by US in patients with OD include solitary rectal ulcer, rectocele and enterocele. Damage of internal and/or external sphincter was diagnosed at anal US in 19/92 (20%) patients, all continent and with normal manometric values. CONCLUSION: Anal, vaginal and dynamic perineal ultrasonography can diagnose or confirm many of the abnormalities seen in patients with OD. The value of the information obtained by this non-invasive test and its role in the diagnostic algorithm of OD is yet to be defined.

Adult↗
PubMed2004

[Hemorrhoids. Differential diagnosis and therapy].

Hemorrhoidal disease results from the pathological enlargement and distal displacement of the upper hemorrhoidal plexus. This disorder is very widespread in modern industrial society. Hereditary predisposition, malnutrition with constipation and abnormal bowel habits seem to be the most relevant causes for pathogenesis. The exact classification of hemorrhoids according to the degree of prolapse as well as the correct evaluation of accompanying anal diseases are very important in order to choose the appropriate conservative or surgical treatment with the goal of long-term avoidance of recurrence.

Administration, Rectal↗