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At least 19 recordsLinked to original sources

Determination of the peritoneal reflection using intraoperative proctoscopy.

PURPOSE: Rectal carcinomas are amenable to transanal excision in 3 to 5 percent of cases. Location below the peritoneal reflection is one requirement for transanal excision and transanal endoscopic microsurgery. The location of the peritoneal reflection has not been extensively studied in living patients. METHODS: This study investigated the location of the peritoneal reflection in 50 patients undergoing laparotomy. The distance from the anal verge to the peritoneal reflection was measured in each patient via simultaneous intraoperative proctoscopy and intra-abdominal visualization of the peritoneal reflection. The mean distance to the peritoneal reflection, range of measurements, and complications of proctoscopy were recorded. RESULTS: Intraoperative proctoscopy was performed on 50 patients after informed consent. The mean lengths of the peritoneal reflection were 9 cm anteriorly, 12.2 cm laterally, and 14.8 cm posteriorly for females, and 9.7 cm anteriorly, 12.8 cm laterally, and 15.5 cm posteriorly for males. The lengths of the anterior, lateral, and posterior peritoneal measurements were statistically different from one another, regardless of gender (P < 0.01). There were no complications of proctoscopy. CONCLUSIONS: Our data indicated that the peritoneal reflection is located higher on the rectum than reported in autopsy studies, and that there is no difference between males and females. Knowledge of the location and position of a rectal carcinoma in relationship to the peritoneal reflection will help the surgeon optimize the use of transanal techniques of resection.

Adult↗

Overall use of proctoscopy in general practice and possible relation to the stage of rectal cancer.

Data from the Danish National Health Service records on activities of each of 146 general practices in the county of North Jutland, Denmark, were studied to determine whether the use of proctoscopy influenced the stage at which cancer of the rectum was recognized. Information for all patients in the county who received the diagnosis of cancer of the rectum was obtained from the Danish Cancer Registry. Proctoscopy was performed significantly more often in partnership practices (96%) than in single practices (81%). The frequency with which the test was used varied from 1 to 107 proctoscopies per general practitioner per year. In the 95 patients with cancer of the rectum, no relationship was found between the stage (Dukes') at the time of diagnosis and work-load, size and activity of practice, or use of proctoscopy.

Denmark↗

Predicting polyposis severity by proctoscopy: how reliable is it?

PURPOSE: Patients with familial adenomatous polyposis need prophylactic colectomy and ileorectal anastomosis or restorative proctocolectomy. Preoperative rectal polyp counts have been used as one factor to determine which operation should be done, triaging patients according to risk of rectal cancer or completion proctectomy after ileorectal anastomosis. This study was designed to examine the reliability of preoperative proctoscopy in predicting familial adenomatous polyposis severity and outcome after ileorectal anastomosis. METHODS: Familial adenomatous polyposis patients were categorized according to preoperative proctoscopy as follows: Group 1, 5 or fewer adenomas; Group 2, 6 to 19 adenomas; Group 3, 20 or more adenomas. Familial adenomatous polyposis severity was defined as mild if there were < 1,000 polyps in the colon at colectomy and severe if there were > 1,000 polyps. RESULTS: A total of 213 patients were reviewed, 80 in Group 1, 59 in Group 2, and 74 in Group 3. There was no difference among the groups in mean age at presentation. Patients with fewer than five rectal adenomas were predominately females. They rarely had symptoms (22.8 percent), had mostly mild polyposis (86.5 percent), and in 74 of 80 cases underwent ileorectal anastomosis. Only six underwent restorative proctocolectomy. Of those having an ileorectal anastomosis, five needed later proctectomy, none for cancer. Patients with 6 to 19 rectal polyps were a similar group to those with 5 or fewer. Most were asymptomatic (67.8 percent), most had mild polyposis (81.6 percent), and 54 of 59 underwent ileorectal anastomosis (5 had restorative proctocolectomy). Only 3 of the 54 having ileorectal anastomosis needed subsequent proctectomy, 2 for rectal cancer. The patients with 20 or more rectal polyps were different. They usually presented with symptoms (86 percent), the majority (56.6 percent) had severe polyposis, and only 50 percent (37/74) underwent ileorectal anastomosis, the other half having restorative proctocolectomy. Of the 37 patients with an ileorectal anastomosis, 13 needed later proctectomy (35.1 percent), 4 for cancer (10.8 percent). CONCLUSION: Fewer than five rectal adenomas at presentation almost always predicts mild disease, and patients do well after ileorectal anastomosis. Twenty or more adenomas usually means severe disease. Patients with 6 to 19 adenomas are often mildly affected, but their phenotype is less benign than that of patients with fewer than five polyps. Although not foolproof, proctoscopy is a useful test in triaging patients with familial adenomatous polyposis according to disease severity.

Adenomatous Polyposis Coli↗

Bacteremia after proctoscopy and hemorrhoidal injection sclerotherapy.

The incidence of bacteremia following proctoscopy and hemorrhoidal injection sclerotherapy was studied in 50 outpatients undergoing both procedures. Bacteremia was found in 2 per cent of the subjects after proctoscopy and in 8 per cent after sclerotherapy. None of the subjects developed symptoms of septicemia following the procedure. It is concluded that antibiotic prophylaxis should be used before sclerotherapy in patients with valvular heart disease or compromised host defense.

Adult↗

Proctoscopy in infancy with reference to its use in necrotising enterocolitis.

Experience with the fairly simple and safe technique of proctoscopy in an infant using an ordinary auroscope is reported. The use of the auroscope showed the presence of a frank colitis in 13 of 14 consecutive cases of necrotising enterocolitis. A prospective study was made during a 6-month period of 51 infants with diarrhoea referred to a gastroenterology isolation unit; proctoscopic findings that suggested colitis were found in 10. Of these, 3 appeared to have necrotising enterocolitis; 3 had salmonella or shigella dysentery; in 3 of the remaining 4 the findings were localised to the anus, with normal mucosa above. This was attributed to a mild rectal prolapse on straining. There was no correlation between the severity of the diarrhoea and the presence of colitis. Proctoscopy is safe and valuable in the early diagnosis of necrotising enterocolitis. It is also helped in assessing the progress of the disease.

Acute Disease↗

Extraperitoneal rectal perforation due to retroflexion fiberoptic proctoscopy.

The increasing use of retroflexion proctoscopy to evaluate the distal rectum is not without complications. We report a series of three patients who experienced extraperitoneal rectal perforation secondary to retroflexion proctoscopy and discuss our success with conservative management. By evaluating each clinical situation individually and following certain principles, successful outcome can be achieved without surgical intervention. Success depends on several factors: 1) the injury must be below the peritoneal reflection; 2) the patient must have undergone a complete bowel preparation before endoscopy; 3) postinjury, the patient must continue to show no evidence of peritonitis or hemodynamic instability; and 4) the patient must be given nothing by mouth, started on intravenous antibiotics and possibly parenteral nutrition, and closely monitored with serial abdominal examinations. The presence of comorbid conditions does not necessarily diminish the chance that conservative therapy will succeed.

Aged↗

An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: which is better?

BACKGROUND: Current dogma suggests that the diagnosis of rectal injury can be made after physical examination and proctoscopy (PR). However, anecdotal evidence suggests that these modalities lack specificity when applied to children and that computed tomography (CT) scanning may be superior. A direct comparison between CT scanning and PR has not been performed. We therefore sought to compare CT with PR in the diagnosis of rectal injury by analyzing our large institutional experience. METHODS: To assess institutional outcome, the charts of all children younger than 18 years admitted to our level I trauma center (1999-2004) were prospectively collected and retrospectively assessed. Demographics, diagnostic accuracy (PR vs CT), and outcome (length of stay, days in the intensive care unit [ICU], Injury Severity Score, and missed injury) were assessed. RESULTS: There were 24 injuries (63% boys, 71% blunt, 100% survival), and diagnostic modality included the following: PR, 37.5%; CT, 37.5%; laparotomy alone, 8%. Length of stay (PR 5.7 +/- 6.2 vs CT 13.7 +/- 22.2, NS) were similar between groups. Of the missed rectal injuries, 66% of patients undergoing PR had missed injuries that were ultimately detected by CT whereas 33% of the patients undergoing CT scan had a missed injury. CONCLUSION: CT is at least as accurate as PR in diagnosing pediatric rectal injury. Consideration of early scanning as opposed to PR may improve diagnosis and outcome in these patients.

Adolescent↗

Colonoscopy, proctoscopy, and ileoscopy.

Colonoscopy and proctoscopy are primarily performed on dogs and cats with signs of chronic large bowel or rectal disease, and ileoscopy is typically performed in patients with signs of either large or small bowel disease. These techniques should not be used indiscriminately but only on animals that have a reasonable chance to benefit from their use. Even then, the techniques must be performed carefully so that the results are meaningful instead of misleading. We first consider what does and what does not constitute a reasonable indication for endoscopic examination of the lower intestines. After that, we turn to the specific techniques involved.

Animals↗

[Retropneumoperitoneum and pneumomediastinum following proctoscopy (author's transl)].

A 66-year-old patient developed a retropneumoperitoneum and pneumomediastinum after a proctoscopy. Following the examination, which was done as an out patient, he had some pain but was able to reach home without difficulty. Radiography of the abdomen on the next day showed definite gas collection round the right kidney and below the middle of the diaphragm. The mediastinum showed some translucencies consistent with cranial spread of air from the retropneumoperitoneum; it was particularly marked round the aorta. The film also showed supraclavicular emphysema. After being placed supine the patient's symptoms rapidly disappeared. There were no complications and no treatment was necessary. The case is discussed in relation to the relevant literature.

Aged↗

Amebic colitis: correlation of proctoscopy before treatment and barium enema after treatment.

Twenty-seven patients with severe acute amebic dysentery were studied at the International Centre for Diarrhoeal Diseases Research Hospital in Dacca, Bangladesh. Patients were divided into two groups according to their pretreatment proctoscopic mucosal pattern. Those with mild lobular patterns (five patients) had a milder illness; posttreatment air-contrast barium enema examinations were normal except for subtle mucosal abnormalities in two (40%). In contrast, patients with necrotic ulceration proctoscopic patterns (22 patients) had a more severe illness; 19 (86%) had ulcerations, haustral abnormalities, and/or strictures demonstrated on posttreatment barium enema examinations. Persistent strictures were found in eight of 10 patients with necrotic ulceration patterns who had sequential barium enema examinations up to 9 months after treatment. These observations indicate that despite successful therapy with metronidazole, there is a high incidence of persisting colonic abnormalities in patients with the necrotic ulceration pattern. Since proctoscopy has a useful predictive value, it should be performed in all patients with severe amebic dysentery.

Barium Sulfate↗