Purpose:Colostomy for patients with anorectal malformations decompresses an obstructed colon,avoids fecal contamination of the urinary tract,and protects a future perineal operation. The procedure is associated with s...Purpose:Colostomy for patients with anorectal malformations decompresses an obstructed colon,avoids fecal contamination of the urinary tract,and protects a future perineal operation. The procedure is associated with several significant complications. Materials and Methods:The medical records of 1700 cases of anorectal malformations were retrospectively reviewed. A total of 230 patients underwent reconstruction without a colostomy. Of the remaining 1470 patients,1420 had their colostomy performed at another institution (group A) and 50 did at our institution (group B) using a specific technique with separated stomas in the descending colon. Results:There were 616 complications identified in 464 patients of group A and in 4 patients in group B,an incidence of 33% vs 8% (P < 0.01). Complications in group A were classified into several groups. The first group was mislocation (282 cases),including 116 with stomas too close to each other,97 with stomas located too distally in the rectosigmoid (which interfered with the pullthrough),30 with inverted stomas,21 with stomas too far apart from each other,and 18 with right upper sigmoidostomies. The second largest group was prolapse (119 cases),which occurred mainly in mobile portions of the colon. The third group was composed of general surgical complications after colostomy closure (82 cases),such as intestinal obstruction (47 cases),wound infection (13 cases),incisional hernia (11 cases),anastomotic dehiscence (7 cases),sepsis (3 cases),and bleeding (1 case). Two of the septic patients died. Another group included 62 patients who received a Hartmann’s procedure,which we considered to be contraindicated in anorectal malformations. A total of 42 patients suffered from stenosis of the stoma; 29,from retraction. Conclusions:Most colostomy complications are preventable using separated stomas in the descending colon. Mislocated stomas lead to problems with appliance application,interference with the pull-through,megasigmoid,distal fecal impaction,and urinary tract infections. Loop colostomies lead to urinary tract infections,distal fecal impaction,and prolapse. Prolapse is a potentially dangerous complication that mostly occurs when the stoma is placed in a mobile portion of the colon. Recognizing this makes the complication preventable by trying to create colostomies in fixed portions of the colon or by fixing the bowel to the abdominal wall when necessary. The trend to avoid colostomies is justified; however,colostomy is the best way to prevent complications in anorectal surgery and,when indicated,should be done wit h a meticulous technique following strict rules to avoid complications.展开更多
AIM:To evaluate the role and our experience of injecti-on sclerotherapy with cow milk in the treatment of rectal prolapse in children. METHODS:In the last 30 years (1976-2006) we made 100 injections of sclerotherapy w...AIM:To evaluate the role and our experience of injecti-on sclerotherapy with cow milk in the treatment of rectal prolapse in children. METHODS:In the last 30 years (1976-2006) we made 100 injections of sclerotherapy with cow milk in 86 chil-dren. In this study we included children who failed to respond to conservative treatment and we perform ope-rative treatment. RESULTS:In our study we included 86 children and in all of the patients we perform cow milk injection sclerot-herapy. In 95.3% (82 children) of patients sclerotherapy was successful. In 4 (4.7%) patients we had recurrent rectal prolapse where we performed operative treatment. Below 4 years we had 62 children (72%) and 24 older children (28%). In children who needed operative trea-tment we performed Thiersch operation and without any complications. CONCLUSION:Injection sclerotherapy with cow milk for treatment rectal prolapse in children is a simple and effective treatment for rectal prolapse with minimal com-plications.展开更多
AIM： To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS： A retrospective review of patients aged 〉 18 years with a dia...AIM： To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS： A retrospective review of patients aged 〉 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. RESULTS： There were 20 rases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine （85%）. There were three （15%） cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. CONCLUSION： Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.展开更多
Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents...Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding,copious mucus discharge,feeling of incomplete defecation,and rarely rectal prolapse.SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings.The current treatments are suboptimal,and despite correct diagnosis,outcomes can be unsatisfactory.Some treatment protocols for SRUS include conservative management such as family reassurance,regulation of toilet habits,avoidance of straining,encouragement of a high-fiber diet,topical treatments with salicylate,sulfasalazine,steroids and sucralfate,and surgery.In children,SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases,however,it is being reported more than in the past.This condition in children is benign;however,morbidity is an important problem as reflected by persistence of symptoms,especially rectal bleeding.In this review,we discuss current diagnosis and treatment for SRUS.展开更多
Prolapse of rectum usually occurs in the children with insufficient qi and blood, in the elders with declined qi and blood or deficiency of qi in the middle jiao (burner), in the women who made qi exhausted during lab...Prolapse of rectum usually occurs in the children with insufficient qi and blood, in the elders with declined qi and blood or deficiency of qi in the middle jiao (burner), in the women who made qi exhausted during labor resulting in deficiency of qi and blood, and in those with chronic diarrhea, habitual constipation and long-standing cough. All these may cause sinking of qi in middle jiao and induce the disorder. Therefore in treating the disorder, the primary causes should also be treated simultaneously.展开更多
Proctoptosis, a disease of downward displacement of the anal canal, rectal mucosa, rectum or partial sigmoid colon, is known as prolapse of the rectum in TCM, which is frequently seen in the weak and thin babies o... Proctoptosis, a disease of downward displacement of the anal canal, rectal mucosa, rectum or partial sigmoid colon, is known as prolapse of the rectum in TCM, which is frequently seen in the weak and thin babies or children of 2-4 years old. The author treated 36 cases of infantile proctoptosis by using extremely shallow puncture in the acupuncture techniques from Aug. 1995 to Dec. 1998 and obtained satisfactory results as reported in the following.……展开更多
Introduction:Rectal prolapse is a condition that occurs infrequently in men and there is little literature guiding treatment in this population.The purpose of this study was to evaluate the surgical approach and outco...Introduction:Rectal prolapse is a condition that occurs infrequently in men and there is little literature guiding treatment in this population.The purpose of this study was to evaluate the surgical approach and outcomes of rectal-prolapse repair in men.Methods:A retrospective multicenter review was conducted of consecutive men who underwent rectal-prolapse repair between 2004 and 2014.Surgical approaches and outcomes,including erectile function and fecal continence,were evaluated.Results:During the study period,58 men underwent rectal-prolapse repair and the mean age of repair was 52.7624.1 years.The mean follow-up was 13.2 months(range,0.5–117 months).The majority of patients underwent endoscopic evaluation(78%),but few patients underwent anal manometry(16%),defecography(9%)or ultrasound(3%).Ten patients(17%)underwent biofeedback/pelvic-floor physical therapy prior to repair.Nineteen patients(33%)underwent a perineal approach(most were perineal proctosigmoidectomy).Thirty-nine patients(67%)underwent repair using an abdominal approach(all were suture rectopexy)and,of these,77%were completed using a minimally invasive technique.The overall complication rate was 26%including urinary retention(16%),which was more common in patients undergoing the perineal approach(32%vs.8%,P=0.028),urinary-tract infection(7%)and wound infection(3%).The overall recurrence rate was 9%,with no difference between abdominal and perineal approaches.Information on sexual function was missing in the majority of patients both before and after surgery(76%and 78%,respectively).Conclusion:Rectal-prolapse repair in men is safe and has a low recurrence rate;however,sexual function was poorly recorded across all institutions.Further studies are needed to evaluate to best approach to and functional outcomes of rectal-prolapse repair in men.展开更多
文摘Purpose:Colostomy for patients with anorectal malformations decompresses an obstructed colon,avoids fecal contamination of the urinary tract,and protects a future perineal operation. The procedure is associated with several significant complications. Materials and Methods:The medical records of 1700 cases of anorectal malformations were retrospectively reviewed. A total of 230 patients underwent reconstruction without a colostomy. Of the remaining 1470 patients,1420 had their colostomy performed at another institution (group A) and 50 did at our institution (group B) using a specific technique with separated stomas in the descending colon. Results:There were 616 complications identified in 464 patients of group A and in 4 patients in group B,an incidence of 33% vs 8% (P < 0.01). Complications in group A were classified into several groups. The first group was mislocation (282 cases),including 116 with stomas too close to each other,97 with stomas located too distally in the rectosigmoid (which interfered with the pullthrough),30 with inverted stomas,21 with stomas too far apart from each other,and 18 with right upper sigmoidostomies. The second largest group was prolapse (119 cases),which occurred mainly in mobile portions of the colon. The third group was composed of general surgical complications after colostomy closure (82 cases),such as intestinal obstruction (47 cases),wound infection (13 cases),incisional hernia (11 cases),anastomotic dehiscence (7 cases),sepsis (3 cases),and bleeding (1 case). Two of the septic patients died. Another group included 62 patients who received a Hartmann’s procedure,which we considered to be contraindicated in anorectal malformations. A total of 42 patients suffered from stenosis of the stoma; 29,from retraction. Conclusions:Most colostomy complications are preventable using separated stomas in the descending colon. Mislocated stomas lead to problems with appliance application,interference with the pull-through,megasigmoid,distal fecal impaction,and urinary tract infections. Loop colostomies lead to urinary tract infections,distal fecal impaction,and prolapse. Prolapse is a potentially dangerous complication that mostly occurs when the stoma is placed in a mobile portion of the colon. Recognizing this makes the complication preventable by trying to create colostomies in fixed portions of the colon or by fixing the bowel to the abdominal wall when necessary. The trend to avoid colostomies is justified; however,colostomy is the best way to prevent complications in anorectal surgery and,when indicated,should be done wit h a meticulous technique following strict rules to avoid complications.
文摘AIM:To evaluate the role and our experience of injecti-on sclerotherapy with cow milk in the treatment of rectal prolapse in children. METHODS:In the last 30 years (1976-2006) we made 100 injections of sclerotherapy with cow milk in 86 chil-dren. In this study we included children who failed to respond to conservative treatment and we perform ope-rative treatment. RESULTS:In our study we included 86 children and in all of the patients we perform cow milk injection sclerot-herapy. In 95.3% (82 children) of patients sclerotherapy was successful. In 4 (4.7%) patients we had recurrent rectal prolapse where we performed operative treatment. Below 4 years we had 62 children (72%) and 24 older children (28%). In children who needed operative trea-tment we performed Thiersch operation and without any complications. CONCLUSION:Injection sclerotherapy with cow milk for treatment rectal prolapse in children is a simple and effective treatment for rectal prolapse with minimal com-plications.
文摘AIM： To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS： A retrospective review of patients aged 〉 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. RESULTS： There were 20 rases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine （85%）. There were three （15%） cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. CONCLUSION： Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.
文摘Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding,copious mucus discharge,feeling of incomplete defecation,and rarely rectal prolapse.SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings.The current treatments are suboptimal,and despite correct diagnosis,outcomes can be unsatisfactory.Some treatment protocols for SRUS include conservative management such as family reassurance,regulation of toilet habits,avoidance of straining,encouragement of a high-fiber diet,topical treatments with salicylate,sulfasalazine,steroids and sucralfate,and surgery.In children,SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases,however,it is being reported more than in the past.This condition in children is benign;however,morbidity is an important problem as reflected by persistence of symptoms,especially rectal bleeding.In this review,we discuss current diagnosis and treatment for SRUS.
文摘Prolapse of rectum usually occurs in the children with insufficient qi and blood, in the elders with declined qi and blood or deficiency of qi in the middle jiao (burner), in the women who made qi exhausted during labor resulting in deficiency of qi and blood, and in those with chronic diarrhea, habitual constipation and long-standing cough. All these may cause sinking of qi in middle jiao and induce the disorder. Therefore in treating the disorder, the primary causes should also be treated simultaneously.
文摘 Proctoptosis, a disease of downward displacement of the anal canal, rectal mucosa, rectum or partial sigmoid colon, is known as prolapse of the rectum in TCM, which is frequently seen in the weak and thin babies or children of 2-4 years old. The author treated 36 cases of infantile proctoptosis by using extremely shallow puncture in the acupuncture techniques from Aug. 1995 to Dec. 1998 and obtained satisfactory results as reported in the following.……
文摘Introduction:Rectal prolapse is a condition that occurs infrequently in men and there is little literature guiding treatment in this population.The purpose of this study was to evaluate the surgical approach and outcomes of rectal-prolapse repair in men.Methods:A retrospective multicenter review was conducted of consecutive men who underwent rectal-prolapse repair between 2004 and 2014.Surgical approaches and outcomes,including erectile function and fecal continence,were evaluated.Results:During the study period,58 men underwent rectal-prolapse repair and the mean age of repair was 52.7624.1 years.The mean follow-up was 13.2 months(range,0.5–117 months).The majority of patients underwent endoscopic evaluation(78%),but few patients underwent anal manometry(16%),defecography(9%)or ultrasound(3%).Ten patients(17%)underwent biofeedback/pelvic-floor physical therapy prior to repair.Nineteen patients(33%)underwent a perineal approach(most were perineal proctosigmoidectomy).Thirty-nine patients(67%)underwent repair using an abdominal approach(all were suture rectopexy)and,of these,77%were completed using a minimally invasive technique.The overall complication rate was 26%including urinary retention(16%),which was more common in patients undergoing the perineal approach(32%vs.8%,P=0.028),urinary-tract infection(7%)and wound infection(3%).The overall recurrence rate was 9%,with no difference between abdominal and perineal approaches.Information on sexual function was missing in the majority of patients both before and after surgery(76%and 78%,respectively).Conclusion:Rectal-prolapse repair in men is safe and has a low recurrence rate;however,sexual function was poorly recorded across all institutions.Further studies are needed to evaluate to best approach to and functional outcomes of rectal-prolapse repair in men.
