Background Ruminal microbiota in early life plays critical roles in the life-time health and productivity of ruminant animals.However,understanding of the relationship between gut microbiota and ruminant phenotypes is...Background Ruminal microbiota in early life plays critical roles in the life-time health and productivity of ruminant animals.However,understanding of the relationship between gut microbiota and ruminant phenotypes is very limited.Here,the relationship between the rectum microbiota,their primary metabolites,and growth rate of a total of 76 young dairy goats(6-month-old)were analyzed,and then 10 goats with the highest or lowest growth rates respectively were further compared for the differences in the rectum microbiota,metabolites,and animal’s immune parameters,to investigate the potential mechanisms by which the rectum microbiota contributes to the health and growth rate.Results The analysis of Spearman correlation and microbial co-occurrence network indicated that some keystone rectum microbiota,including unclassified Prevotellaceae,Faecalibacterium and Succinivibrio,were the key modulators to shape the rectum microbiota and closely correlated with the rectum SCFA production and serum IgG,which contribute to the health and growth rate of young goats.In addition,random forest machine learning analysis suggested that six bacterial taxa in feces could be used as potential biomarkers for differentiating high or low growth rate goats,with 98.3%accuracy of prediction.Moreover,the rectum microbiota played more important roles in gut fermentation in early life(6-month-old)than in adulthood stage(19-month-old)of goats.Conclusion We concluded that the rectum microbiota was associated with the health and growth rate of young goats,and can be a focus on the design of the early-life gut microbial intervention.展开更多
BACKGROUND Systemic lupus erythematosus(SLE)is a multisystem autoimmune disease that can affect the gastrointestinal tract.Most cases of lupus enteritis(LE)involve the small intestine,while the involvement of the whol...BACKGROUND Systemic lupus erythematosus(SLE)is a multisystem autoimmune disease that can affect the gastrointestinal tract.Most cases of lupus enteritis(LE)involve the small intestine,while the involvement of the whole colon and rectum without the small intestine being affected is extremely rare.CASE SUMMARY A 35-year-old woman was diagnosed with colorectal LE after initially presenting with intermittent abdominal pain and vomiting for two months.She had a regular medication history for five years following the diagnosis of SLE but had been irregular in taking medications,which may have contributed to the onset of LE and led to her current hospital admission.According to the 2019 Classification criteria for SLE of the European League Against Rheumatism/American College of Rheumatology,this case scored 14.Additionally,abdominal computed tomography revealed significant wall edema of the colon and rectum,ischemia and hyperemia of the ascending colon intestinal wall,mesenteric vessel engorgement,increased mesangial fat attenuation,ascites,and bilateral ureter-hydronephrosis,all indicative of colon and rectum LE.Laboratory tests also showed lower levels of complement C3 and C4,with an antinuclear antibody titer of 1:100.Overall,it was clear that this case involved the colon and rectum without affecting the small intestine,representing a rare manifestation of SLE.The patient received treatment with 10 mg of methylprednisolone sodium succinate,100 mL of 0.9%sodium chloride,hydroxychloroquine(100 mg),and nutrition support.After one week of methylprednisolone and hydroxychloroquine therapy,her SLE symptoms and disease activity improved significantly.CONCLUSION Although colorectal LE without small intestine involvement is very rare,early diagnosis and excellent management with corticosteroids prevented the need for surgical intervention.Physicians should be aware of colorectal LE without small intestine involvement as a manifestation of lupus flare.展开更多
The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with i...The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with invasive adenocarcinoma of the ampullary part of the rectum and describes the atypical manifestations of these diseases. The Content: The content of this research paper includes a description of the patient, an analysis of the clinical picture, diagnostic methods and therapeutic interventions used, a report of the following disease, and the result of the presented case. The Result of the Research Work: The result of the research work is the analysis of a clinical case with two different tumors, where such a combination of tumors is rarely described in the literature. Moreover, no large specific sample with this combination of diseases is available. Patient Characteristics: The given case report describes a patient of the Palliative Care Unit of the Gerontology Clinic with a primary diagnosis of C20-rectal adenocarcinoma in the background of the anal canal, perineal skin Paget’s disease, stage IV. The presented complications of the patient’s primary diagnosis are multiple metastases in the liver;status post palliative chemotherapy;hepatomegaly;metastases to abdominal lymph nodes, inguinal lymph nodes;metastases at Th12, L4 level;pain syndrome. The presented above combination of diagnosed diseases is very rare. Applied Diagnostics: In October 2021, it was performed diagnostic manipulation: biopsy and the pathologist have provided a microscopic description. The first tissue fragment had a pronounced electrothermal lesion and the epithelial structures were not valuable. The second skin tissue fragment was covered with hyperplastic and acanthotic epithelium;its basal and middle layers contained multiple large cells proliferates extending into the medial epidermis, and the cytoplasm of these cells reacted positively with PAS (Periodic Acid Schiff reaction). It needs to be noted that the patient had previously had several years of biopsies from the perineal and anal epidermis, where Paget’s disease had also been diagnosed. The performed immunohistochemistry showed these cells to be CK20 positive, CK7 rare positive and p16 negative. The following pathohistological findings were made: morphological and immunohistochemical picture is consistent with Paget’s disease. According to the ICD-10, the patient was diagnosed with C51 malignant neoplasm of the female external genitalia. Using imaging diagnostics, it became clear that the patient’s rectal adenocarcinoma had progressed to metastatic stage with distant liver metastases in the background of anal canal, perineal skin Paget’s disease. Therapeutic Plan of the Patient: Based on the patient’s main diagnoses, the complications of the principal diagnosis, the patient’s overall severe condition, pain syndrome, age and comorbidities, palliative chemotherapy was approved as a therapeutic option in council of doctors. Monitoring and Outcome of the Patient: The patient’s general condition was becoming worse over time, and she was diagnosed with exitus latalis in December 2022. At that time, the patient was discharged from hospital and was on palliative care at home under the control of her family physician.展开更多
BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding...BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding.It emphasizes the importance of considering vascular origins in cases of atypical hematochezia,particularly in the absence of common gastrointestinal causes,and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations.CASE SUMMARY A 75-year-old man with a history of hypertension presented with 12 d of hematochezia,experiencing bloody stools 7-8 times per day.Initial computed tomography(CT)scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development.Hemoglobin levels progressively decreased to 7 g/dL.Emergency arterial angiography and iliac arterycovered stent placement were performed,followed by balloon angioplasty.Despite initial stabilization,minor rectal bleeding and abdominal pain persisted,leading to further diagnostic colonoscopy.This identified a neoplasm and potential perforation at the proximal rectum.An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall,necessitating partial rectal resection,intestinal anastomosis,and ileostomy.Postoperative recovery was successful,with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months.CONCLUSION In cases of unusual gastrointestinal bleeding,it is necessary to consider vascular causes for effective diagnosis and intervention.展开更多
This is a 54-year-old patient admitted for the management of urinary leakage through the anus that had been occurring for a month, in whom the diagnosis of a prostatorectal fistula was made. The fistula was successful...This is a 54-year-old patient admitted for the management of urinary leakage through the anus that had been occurring for a month, in whom the diagnosis of a prostatorectal fistula was made. The fistula was successfully treated by a transanorectal approach using the York Masson procedure.展开更多
目的:探讨经自然腔道取标本手术治疗直肠脱垂的应用价值及近期疗效分析。方法:回顾分析2019年1月至2023年3月收治的41例直肠脱垂患者的临床资料。其中15例行经自然腔道取标本手术(观察组),26例行传统腹腔镜手术(对照组)。对比分析两组...目的:探讨经自然腔道取标本手术治疗直肠脱垂的应用价值及近期疗效分析。方法:回顾分析2019年1月至2023年3月收治的41例直肠脱垂患者的临床资料。其中15例行经自然腔道取标本手术(观察组),26例行传统腹腔镜手术(对照组)。对比分析两组手术时间、术中出血量、术后住院时间、术后疼痛评分、术后并发症及复发率,评估肛门括约肌功能、Wexner肛门失禁评分及便秘评分。结果:观察组与对照组术中出血量差异无统计学意义[48(42,50)mL vs. 47(45,50)mL,P>0.05],手术时间[(147.20±5.51)min vs.(132.61±5.88)min]、住院时间[7(6,8)d vs.12(10,13)d]、术后疼痛评分[2(1,3)分vs.5(4,6)分]差异有统计学意义(P<0.05)。术后两组肛门括约肌评分、Wexner肛门失禁评分、Wexner便秘评分与术前相比均降低,差异有统计学意义(P<0.05),两组间差异无统计学意义(P>0.05)。对照组发生3例腹壁辅助切口脂肪液化。术后无围手术期死亡,随访6个月无复发病例。结论:经自然腔道取标本手术应用于直肠脱垂的治疗安全、可行,具有康复快、术后疼痛轻、便秘与肛门失禁明显改善、复发率低的优点,值得临床推广应用。展开更多
The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical...The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.展开更多
Intestinal hemolymphangioma is a rare vascular and lymphatic malformation and is manifested as anaemia and recurrent alimentary tract hemorrhage. Few cases of hemolymphangioma occurring in small intestine, spleen, eso...Intestinal hemolymphangioma is a rare vascular and lymphatic malformation and is manifested as anaemia and recurrent alimentary tract hemorrhage. Few cases of hemolymphangioma occurring in small intestine, spleen, esophagus and other organs have been reported. We herein report a case of a 37-year-old man with severe rectal bleeding. Digital examination revealed nodular mucosa. No rectal mass was palpated, but bleeding in the ampulla was detected. Colonoscopy revealed an extensive hypervascular submucosal lesion arising from the rectosigmoid junction colon to the distal edge of the anus. Endoscopic ultrasonography demonstrated an extensive anechoic mass with clear edge. Magnetic resonance imaging (MRI) showed a significant thickness of the rectal wall, extending to the distal edge of the anus, with a narrowing lumen. A sphinctersaving rectal surgery was performed. Due to a lack of knowledge of the clinical, endoscopic and radiological features, preoperative recognition of hemolymphangioma is not easy. Computed tomography and MRI are helpful in confirming the diagnosis, and defining the extent and invasion of the lesion. For the low malignant potential tumors, a sphincter-saving rectal surgery is recommended after a full evaluation of the tumor.展开更多
Objective: To study the relationship between internal anal sphincter function and length of remaining rectum after resecting rectal carcinoma. Methods: Preoperatively, 21 patients were evaluated via patients' clin...Objective: To study the relationship between internal anal sphincter function and length of remaining rectum after resecting rectal carcinoma. Methods: Preoperatively, 21 patients were evaluated via patients' clinical date, including anal resting pressure (resting pressure) assay. Six months postoperatively, repeated manometric studies and clinical evaluations were performed to assess the level of continence . The formula use for calculating post operative resting pressure is as follows: postoperative resting pressure=0.42×preoperative resting pressure+1.56×length of remaining recturm+12.37(R 2=0.58; P <0.01).Degree of continence was graded based on severity of the dysfunction and grade of the continence score. Results: It was demonstrated the patients with low postoperative resting pressures (<4.0 Kpa) had incontinence, and those with high postoperative resting pressures (>4.7 Kpa) were continent. There were significant correlations between length of the remaining rectum and ratio of the decrease in maximum resting pressure (postoperative/preoperative maximum resting pressure;r=0.62; P <0.01). Conclusion: Continence of rectum is influenced by maximum resting pressure of function of the internal anal sphincter, length of remaining rectum is shorter, the more damage to the internal anal sphincter. It is able to foretell stool incontinence by using the postoperative resting pressure formula, and to determine the length of the remaining rectum.展开更多
Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5...Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.展开更多
Schwannoma is a tumor originating from the Schwann cells. Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and, in particular, rectal schwannomas are extremely rare. In fact, it is well...Schwannoma is a tumor originating from the Schwann cells. Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and, in particular, rectal schwannomas are extremely rare. In fact, it is well established that schwannomas appear more frequently in the stomach and in the small intestine, while location in the colon or in the rectum is uncommon. Reading the literature, only few cases of rectal schwannoma have been reported. Their diagnosis is confirmed by the immunohisto chemical panel(S-100 protein). When these tumors are located in the colon and in the rectum, radical excision with wide margins is mandatory, due to their tendency to recur locally or become malignant, if left untreated. In the present study, we describe a case of a rectal schwannoma occured in a 72-year-old man, presented as a small polypoid lesion, which was successfully removed in toto by hot-biopsy, during the same endoscopy, due to the dimensons. No recurrence of the lesion was observed after 6 mo of follow-up.展开更多
Paragangliomas typically develop in the extra-adrenal sites along the sympathetic and/or the parasympathetic chain.Occasionally,the tumors may arise in some exotic sites,including the head and neck region and the urog...Paragangliomas typically develop in the extra-adrenal sites along the sympathetic and/or the parasympathetic chain.Occasionally,the tumors may arise in some exotic sites,including the head and neck region and the urogenital tract.Paraganglioma presenting as a primary rectal neoplasm has not been well described in the literature.Here,we report the first case of malignant paraganglioma arising in the rectum of a 37-year-old male.He presented to the clinic because of hematochezia with tenesmus.The anorectal digital examination and colonoscopic examination revealed a polypoid mass of the rectum,measuring approximately 4 cm in diameter.The overall morphology and immunophenotype were consistent with a typical paraganglioma.However,the tumor exhibited features suggestive of malignant potential,including local extension into adjacent adipose tissue,nuclear pleomorphism,confluent tumor necrosis,vascular invasion and metastases to regional lymph nodes.In conclusion,we present the first case of rectal malignant paraganglioma.Due to the unexpected occurrence in this region,malignant paraganglioma may be misdiagnosed as other tumors with overlapping features;in particular,a neuroendocrine tumor of epithelial origin.Because of the differences in treatment,separating paraganglioma from its mimics is imperative.Combination of morphology with judicious immunohistochemical study is helpful in obtaining the correct diagnosis.展开更多
基金supported by the National Natural Science Foundation of China(32072761,32272829)the National Key Research and Development Program of China(2017YFD500500).
文摘Background Ruminal microbiota in early life plays critical roles in the life-time health and productivity of ruminant animals.However,understanding of the relationship between gut microbiota and ruminant phenotypes is very limited.Here,the relationship between the rectum microbiota,their primary metabolites,and growth rate of a total of 76 young dairy goats(6-month-old)were analyzed,and then 10 goats with the highest or lowest growth rates respectively were further compared for the differences in the rectum microbiota,metabolites,and animal’s immune parameters,to investigate the potential mechanisms by which the rectum microbiota contributes to the health and growth rate.Results The analysis of Spearman correlation and microbial co-occurrence network indicated that some keystone rectum microbiota,including unclassified Prevotellaceae,Faecalibacterium and Succinivibrio,were the key modulators to shape the rectum microbiota and closely correlated with the rectum SCFA production and serum IgG,which contribute to the health and growth rate of young goats.In addition,random forest machine learning analysis suggested that six bacterial taxa in feces could be used as potential biomarkers for differentiating high or low growth rate goats,with 98.3%accuracy of prediction.Moreover,the rectum microbiota played more important roles in gut fermentation in early life(6-month-old)than in adulthood stage(19-month-old)of goats.Conclusion We concluded that the rectum microbiota was associated with the health and growth rate of young goats,and can be a focus on the design of the early-life gut microbial intervention.
文摘BACKGROUND Systemic lupus erythematosus(SLE)is a multisystem autoimmune disease that can affect the gastrointestinal tract.Most cases of lupus enteritis(LE)involve the small intestine,while the involvement of the whole colon and rectum without the small intestine being affected is extremely rare.CASE SUMMARY A 35-year-old woman was diagnosed with colorectal LE after initially presenting with intermittent abdominal pain and vomiting for two months.She had a regular medication history for five years following the diagnosis of SLE but had been irregular in taking medications,which may have contributed to the onset of LE and led to her current hospital admission.According to the 2019 Classification criteria for SLE of the European League Against Rheumatism/American College of Rheumatology,this case scored 14.Additionally,abdominal computed tomography revealed significant wall edema of the colon and rectum,ischemia and hyperemia of the ascending colon intestinal wall,mesenteric vessel engorgement,increased mesangial fat attenuation,ascites,and bilateral ureter-hydronephrosis,all indicative of colon and rectum LE.Laboratory tests also showed lower levels of complement C3 and C4,with an antinuclear antibody titer of 1:100.Overall,it was clear that this case involved the colon and rectum without affecting the small intestine,representing a rare manifestation of SLE.The patient received treatment with 10 mg of methylprednisolone sodium succinate,100 mL of 0.9%sodium chloride,hydroxychloroquine(100 mg),and nutrition support.After one week of methylprednisolone and hydroxychloroquine therapy,her SLE symptoms and disease activity improved significantly.CONCLUSION Although colorectal LE without small intestine involvement is very rare,early diagnosis and excellent management with corticosteroids prevented the need for surgical intervention.Physicians should be aware of colorectal LE without small intestine involvement as a manifestation of lupus flare.
文摘The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with invasive adenocarcinoma of the ampullary part of the rectum and describes the atypical manifestations of these diseases. The Content: The content of this research paper includes a description of the patient, an analysis of the clinical picture, diagnostic methods and therapeutic interventions used, a report of the following disease, and the result of the presented case. The Result of the Research Work: The result of the research work is the analysis of a clinical case with two different tumors, where such a combination of tumors is rarely described in the literature. Moreover, no large specific sample with this combination of diseases is available. Patient Characteristics: The given case report describes a patient of the Palliative Care Unit of the Gerontology Clinic with a primary diagnosis of C20-rectal adenocarcinoma in the background of the anal canal, perineal skin Paget’s disease, stage IV. The presented complications of the patient’s primary diagnosis are multiple metastases in the liver;status post palliative chemotherapy;hepatomegaly;metastases to abdominal lymph nodes, inguinal lymph nodes;metastases at Th12, L4 level;pain syndrome. The presented above combination of diagnosed diseases is very rare. Applied Diagnostics: In October 2021, it was performed diagnostic manipulation: biopsy and the pathologist have provided a microscopic description. The first tissue fragment had a pronounced electrothermal lesion and the epithelial structures were not valuable. The second skin tissue fragment was covered with hyperplastic and acanthotic epithelium;its basal and middle layers contained multiple large cells proliferates extending into the medial epidermis, and the cytoplasm of these cells reacted positively with PAS (Periodic Acid Schiff reaction). It needs to be noted that the patient had previously had several years of biopsies from the perineal and anal epidermis, where Paget’s disease had also been diagnosed. The performed immunohistochemistry showed these cells to be CK20 positive, CK7 rare positive and p16 negative. The following pathohistological findings were made: morphological and immunohistochemical picture is consistent with Paget’s disease. According to the ICD-10, the patient was diagnosed with C51 malignant neoplasm of the female external genitalia. Using imaging diagnostics, it became clear that the patient’s rectal adenocarcinoma had progressed to metastatic stage with distant liver metastases in the background of anal canal, perineal skin Paget’s disease. Therapeutic Plan of the Patient: Based on the patient’s main diagnoses, the complications of the principal diagnosis, the patient’s overall severe condition, pain syndrome, age and comorbidities, palliative chemotherapy was approved as a therapeutic option in council of doctors. Monitoring and Outcome of the Patient: The patient’s general condition was becoming worse over time, and she was diagnosed with exitus latalis in December 2022. At that time, the patient was discharged from hospital and was on palliative care at home under the control of her family physician.
文摘BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding.It emphasizes the importance of considering vascular origins in cases of atypical hematochezia,particularly in the absence of common gastrointestinal causes,and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations.CASE SUMMARY A 75-year-old man with a history of hypertension presented with 12 d of hematochezia,experiencing bloody stools 7-8 times per day.Initial computed tomography(CT)scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development.Hemoglobin levels progressively decreased to 7 g/dL.Emergency arterial angiography and iliac arterycovered stent placement were performed,followed by balloon angioplasty.Despite initial stabilization,minor rectal bleeding and abdominal pain persisted,leading to further diagnostic colonoscopy.This identified a neoplasm and potential perforation at the proximal rectum.An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall,necessitating partial rectal resection,intestinal anastomosis,and ileostomy.Postoperative recovery was successful,with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months.CONCLUSION In cases of unusual gastrointestinal bleeding,it is necessary to consider vascular causes for effective diagnosis and intervention.
文摘This is a 54-year-old patient admitted for the management of urinary leakage through the anus that had been occurring for a month, in whom the diagnosis of a prostatorectal fistula was made. The fistula was successfully treated by a transanorectal approach using the York Masson procedure.
文摘目的:探讨经自然腔道取标本手术治疗直肠脱垂的应用价值及近期疗效分析。方法:回顾分析2019年1月至2023年3月收治的41例直肠脱垂患者的临床资料。其中15例行经自然腔道取标本手术(观察组),26例行传统腹腔镜手术(对照组)。对比分析两组手术时间、术中出血量、术后住院时间、术后疼痛评分、术后并发症及复发率,评估肛门括约肌功能、Wexner肛门失禁评分及便秘评分。结果:观察组与对照组术中出血量差异无统计学意义[48(42,50)mL vs. 47(45,50)mL,P>0.05],手术时间[(147.20±5.51)min vs.(132.61±5.88)min]、住院时间[7(6,8)d vs.12(10,13)d]、术后疼痛评分[2(1,3)分vs.5(4,6)分]差异有统计学意义(P<0.05)。术后两组肛门括约肌评分、Wexner肛门失禁评分、Wexner便秘评分与术前相比均降低,差异有统计学意义(P<0.05),两组间差异无统计学意义(P>0.05)。对照组发生3例腹壁辅助切口脂肪液化。术后无围手术期死亡,随访6个月无复发病例。结论:经自然腔道取标本手术应用于直肠脱垂的治疗安全、可行,具有康复快、术后疼痛轻、便秘与肛门失禁明显改善、复发率低的优点,值得临床推广应用。
文摘The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.
基金Supported by National Natural Science Foundation of China,No. 81000189
文摘Intestinal hemolymphangioma is a rare vascular and lymphatic malformation and is manifested as anaemia and recurrent alimentary tract hemorrhage. Few cases of hemolymphangioma occurring in small intestine, spleen, esophagus and other organs have been reported. We herein report a case of a 37-year-old man with severe rectal bleeding. Digital examination revealed nodular mucosa. No rectal mass was palpated, but bleeding in the ampulla was detected. Colonoscopy revealed an extensive hypervascular submucosal lesion arising from the rectosigmoid junction colon to the distal edge of the anus. Endoscopic ultrasonography demonstrated an extensive anechoic mass with clear edge. Magnetic resonance imaging (MRI) showed a significant thickness of the rectal wall, extending to the distal edge of the anus, with a narrowing lumen. A sphinctersaving rectal surgery was performed. Due to a lack of knowledge of the clinical, endoscopic and radiological features, preoperative recognition of hemolymphangioma is not easy. Computed tomography and MRI are helpful in confirming the diagnosis, and defining the extent and invasion of the lesion. For the low malignant potential tumors, a sphincter-saving rectal surgery is recommended after a full evaluation of the tumor.
文摘Objective: To study the relationship between internal anal sphincter function and length of remaining rectum after resecting rectal carcinoma. Methods: Preoperatively, 21 patients were evaluated via patients' clinical date, including anal resting pressure (resting pressure) assay. Six months postoperatively, repeated manometric studies and clinical evaluations were performed to assess the level of continence . The formula use for calculating post operative resting pressure is as follows: postoperative resting pressure=0.42×preoperative resting pressure+1.56×length of remaining recturm+12.37(R 2=0.58; P <0.01).Degree of continence was graded based on severity of the dysfunction and grade of the continence score. Results: It was demonstrated the patients with low postoperative resting pressures (<4.0 Kpa) had incontinence, and those with high postoperative resting pressures (>4.7 Kpa) were continent. There were significant correlations between length of the remaining rectum and ratio of the decrease in maximum resting pressure (postoperative/preoperative maximum resting pressure;r=0.62; P <0.01). Conclusion: Continence of rectum is influenced by maximum resting pressure of function of the internal anal sphincter, length of remaining rectum is shorter, the more damage to the internal anal sphincter. It is able to foretell stool incontinence by using the postoperative resting pressure formula, and to determine the length of the remaining rectum.
基金Supported by the National Natural Science Foundation of China,No.81600413 and No.81600414
文摘Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.
文摘Schwannoma is a tumor originating from the Schwann cells. Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and, in particular, rectal schwannomas are extremely rare. In fact, it is well established that schwannomas appear more frequently in the stomach and in the small intestine, while location in the colon or in the rectum is uncommon. Reading the literature, only few cases of rectal schwannoma have been reported. Their diagnosis is confirmed by the immunohisto chemical panel(S-100 protein). When these tumors are located in the colon and in the rectum, radical excision with wide margins is mandatory, due to their tendency to recur locally or become malignant, if left untreated. In the present study, we describe a case of a rectal schwannoma occured in a 72-year-old man, presented as a small polypoid lesion, which was successfully removed in toto by hot-biopsy, during the same endoscopy, due to the dimensons. No recurrence of the lesion was observed after 6 mo of follow-up.
文摘Paragangliomas typically develop in the extra-adrenal sites along the sympathetic and/or the parasympathetic chain.Occasionally,the tumors may arise in some exotic sites,including the head and neck region and the urogenital tract.Paraganglioma presenting as a primary rectal neoplasm has not been well described in the literature.Here,we report the first case of malignant paraganglioma arising in the rectum of a 37-year-old male.He presented to the clinic because of hematochezia with tenesmus.The anorectal digital examination and colonoscopic examination revealed a polypoid mass of the rectum,measuring approximately 4 cm in diameter.The overall morphology and immunophenotype were consistent with a typical paraganglioma.However,the tumor exhibited features suggestive of malignant potential,including local extension into adjacent adipose tissue,nuclear pleomorphism,confluent tumor necrosis,vascular invasion and metastases to regional lymph nodes.In conclusion,we present the first case of rectal malignant paraganglioma.Due to the unexpected occurrence in this region,malignant paraganglioma may be misdiagnosed as other tumors with overlapping features;in particular,a neuroendocrine tumor of epithelial origin.Because of the differences in treatment,separating paraganglioma from its mimics is imperative.Combination of morphology with judicious immunohistochemical study is helpful in obtaining the correct diagnosis.
