Rupture of the rectosigmoid colon with evisceration of the small bowel through the anus.
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Spontaneous rupture of the rectosigmoid colon and herniation of the small intestine through the rupture site and eventual evisceration through the anus is a very rare event. In the literature, only 42 cases have been reported. The majority of them occurred in patients with rectal prolapse and one case was reported in association with a third-degree uterine prolapse. We experienced an 81-year-old female patient with rectal prolapse and second-degree uterine prolapse complicated by spontaneous perforation of the rectosigmoid colon and anal evisceration of the small intestine. Segmental resection of the nonviable small intestine, primary repair of the ruptured rectosigmoid colon, and sigmoid loop colostomy were performed, and the patient recovered well. In our patient, both rectal and uterine prolapses cooperatively damaged the anterior wall of the rectosigmoid colon and resulted in perforation. So, rectal and uterine prolapses should be treated before the complication develops. In this patient, uterine prolapse should be treated because of the recurrence of this rare episode. (+info)
Modified mesh rectopexy: a study.
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AIM: To evaluate the efficacy of modified mesh rectopexy for complete rectal prolapse. SUBJECT AND METHODS: In a prospective study between 1989-1998, 47 patients (25 males and 22 females) underwent modified mesh rectopexy using a "Cross-shaped" knitted monofilament polypropylene. They were followed up for a period of four years postoperatively. RESULTS: Anatomical repair was achieved in all patients. Preoperative constipation, a complaint in 22 patients, was relieved in 13 patients and need for laxatives decreased in another four. There were no new cases of constipation. Sexual functions were not hampered irrespective of gender. The complications included prolonged ileus (4 patients), faecal impaction (1), partial mucosal prolapse (2) and post-operative obstruction (2). There was no recurrence. CONCLUSION: This technique aligns the rectum, avoids excessive mobilisation and division of lateral ligaments thus preventing constipation and preserving potency. We recommend this technique for patients with complete rectal prolapse with up to grade 1, 2 and 3 incontinence based on Browning and Parks classification. (+info)
Common anorectal conditions: Part II. Lesions.
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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. (+info)
Angiogenic polypoid proliferation adjacent to ileal carcinoid tumors: a nonspecific finding related to mucosal prolapse.
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Case reports have highlighted angiogenic polypoid proliferation in the mucosa adjacent to ileal carcinoid tumors, describing them as granulation tissue polyposis and florid angiogenesis. Some authors have proposed that the ileal carcinoid tumors themselves produce growth factors that cause the change. The purpose of this study was to determine the frequency of angiogenic polypoid proliferation in a large cohort of resected ileal carcinoid tumors compared with control groups. Search of the Cleveland Clinic and Summa Health System pathology files (1985 to 1999) yielded 65 resected ileal carcinoid tumors. Mucosal abnormalities adjacent to the ileal carcinoid tumors were graded 0 to 4+. Twenty ileal resection margins from colonic carcinoma cases served as normal controls. Ileal mucosa adjacent to 22 noncarcinoid neoplasms were also examined. The mucosa adjacent to 54/65 ileal carcinoid tumors (83%) showed mucosal abnormalities (vs. 3/20 normal controls), including mucosal edema, capillary ectasia, muscularis mucosae hypertrophy, fibrosis/smooth muscle proliferation within the lamina propria, club-shaped villi, and intramucosal capillary proliferation. Forty ileal carcinoid tumor cases (61%) showed some degree of angiogenic polypoid proliferation characterized by club-shaped villi and prominent intramucosal capillaries, with 17 (26%) graded as 3+ or 4+. Angiogenic polypoid proliferation was associated with hypertrophy of the muscularis mucosae, lamina proprial fibrosis/smooth muscle proliferation, and capillary ectasia similar to that described with gastrointestinal mucosal trauma/prolapse. This trauma/prolapse change was identified in 45 cases (69%) and was graded 3+ or 4+ in 23 (35%). Seventeen (77%) of the noncarcinoid neoplasms showed trauma/prolapse changes, with 7 (32%) graded as 3+ or 4+. Angiogenic polypoid proliferation also correlated with trauma/prolapse change in the noncarcinoid neoplasm controls. Neither APP (P =.24) nor the prolapse changes (P =.33) were found to be statistically different between the two tumor groups. Angiogenic polypoid proliferation of the adjacent ileal mucosa is common in patients with ileal carcinoid tumors and with noncarcinoid neoplasms. Angiogenic polypoid proliferation almost invariably coexists with fibromuscular change and capillary ectasia within the lamina propria, suggesting that mucosal trauma/prolapse plays a role in the histogenesis. The association of angiogenic polypoid proliferation with a variety of different neoplasms makes it unlikely that the tumors themselves secrete growth factors. (+info)
Circular stapling procedure for mucosal prolapse of the rectum associated with outlet obstruction.
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The aim of this study was designed to investigate the outcome from using the new circular stapling device in the surgical treatment for mucosal prolapse of the rectum associated with outlet obstruction. The treatment consisted of resection of the mucosal prolapse through a transverse incision and resecting a suitable part of the mucosa between the rectum and the anal canal, using an HCS33 circular stapler. Eleven patients successfully underwent this operation without morbidity or mortality, and were assessed clinically and by rectoanal manometry and defecography pre- and post-operation. The mean operating time was 39 (range 22-49) min. The postoperative proctalgia and complications were mild, and the patients were discharged at 4 days after the operation. The pre-operative constipation was improved, and the patient's satisfaction was increased at one month after operation in comparison with the preoperative level. Rectoanal function test at 6 months after the operation demonstrated normalization of the maximum resting and squeezing pressures of the anal canal and rectal compliance to the normal levels. No patient has had recurrence of symptoms during the follow-up period. Our data suggest that this procedure may be a useful surgical treatment, as it causes little postoperative complication and enables early discharge of the patients. However, long-term outcomes of recurrence, continence, and constipation need to be evaluated in a more extended follow-up. (+info)
The pathophysiology of pelvic floor disorders: evidence from a histomorphologic study of the perineum and a mouse model of rectal prolapse.
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The muscle changes related to pelvic floor disorders are poorly understood. We conducted an anatomical and histological study of the perineum of the normal mouse and of a transgenic mouse strain deficient in urokinase-type plasminogen activator (uPA-/-) that was previously reported to develop a high incidence of rectal prolapse. We could clearly identify the iliococcygeus (ILC) and pubococcygeus (PC) muscles and anal (SPA) and urethral (SPU) sphincters in male and female mice. The bulbocavernosus (BC), ischiocavernosus (ISC) and levator ani (LA) muscles could be found only in male mice. Histochemical analysis of the pelvic floor muscles revealed a majority of type IIA fibres. Rectal prolapses were observed only in male uPA-/- mice. The most obvious finding was an irreducible evagination of the rectal mucosa and a swelling of the entire perineal region corresponding to an irreducible hernia of the seminal vesicles through the pelvic outlet. The hernia caused stretching and thinning of the ISC, BC and LA. Myopathic damage, with degenerated and centronucleated myofibres, were observed in these muscles. The PC, ILC, SPA and SPU were not affected. This study provides an original description of a model of pelvic floor disorder and illustrates the differences existing between the perineum of humans and that of a quadruped species. In spite of these differences, the histopathologic changes observed in the pelvic floor muscles of uPA-/- mice with rectal prolapse suggest that prolonged muscular stretching causes a primary myopathic injury. This should be taken into account in the evaluation of pelvic floor disorders. (+info)
Thyrotoxicosis in a neonate of a mother with no history of thyroid disease.
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A newborn infant had rectal prolapse, congenital lactase deficiency, and temporary neonatal thyrotoxicosis. The thyrotoxicosis was associated with a raised long-acting thyroid stimulator index in a mother with no personal or family history of thyroid or related autoimmune disease. The parents were first cousins. (+info)
Awareness of swimming pool suction injury among tour operators.
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A 6 year old girl suffered rectal prolapse after being sucked onto a swimming pool drain from which the cover had been removed. After six days in hospital she made a full recovery. The severe form of this injury may result in evisceration of small bowel, short bowel syndrome, and the need for long term parenteral nutrition. A survey of travel agents revealed a low awareness of this potentially devastating hazard, and a failure on the part of some companies to take adequate responsibility for customer safety. Preventive measures are reviewed. (+info)