Obstructed Defecation after Stapled Hemorrhoidopexy: A Report of Four Cases

2010 ◽  
Vol 76 (6) ◽  
pp. 622-625 ◽  
Author(s):  
Jacob E. Dowden ◽  
J. Daniel Stanley ◽  
Richard A. Moore
Keyword(s):  
Staple Line ◽  
Treatment Plan ◽  
Obstructed Defecation ◽  
Rectal Mucosa ◽  
Dentate Line ◽  
Stapled Hemorrhoidopexy ◽  
Rectal Pain ◽  
Medical Interventions ◽  
Presenting Symptoms ◽  
Male Patients

Stapled hemorrhoidopexy or Procedure for Prolapse and Hemorrhoids (PPH) has become an accepted alternative to excisional hemorrhoidectomy for treating prolapsing hemorrhoids. Although rare, severe complications have been reported after this procedure. We report a series of four male patients with the unusual but debilitating symptoms of obstructed defecation (OD) after PPH. Presenting symptoms included evacuation difficulty, rectal pain, and urgency. All had scarring and stenosis at their PPH anastomotic staple line with a resultant ball-valve effect in three patients as the mobile, excessive, proximal rectal mucosa prolapsed past this relatively immobile area. The fourth patient had an anterior rectal mucosal pouch distal to the PPH staple line. In three of the four patients the anastomosis was below the dentate line or on an oblique angle. Corrective operative intervention largely relieved OD symptoms. One patient, more refractory to successful revision, was eventually diagnosed and treated successfully for pudendal neuropathy. Avoidance of the complication of OD is possible through careful patient selection, proper operative technique, and consideration of nonsurgical etiologies. These complications are complex in nature but most patients will respond to an individualized treatment plan that combines surgical and medical interventions.

scholarly journals Prevalence of pelvic floor symptoms in female patients attending the two-week wait clinic with suspected colorectal cancer

2016 ◽  
Vol 98 (6) ◽  
pp. 413-418 ◽  
Author(s):  
J Bennett ◽  
A Greenwood ◽  
P Durdey ◽  
D Glancy
Keyword(s):  
Colorectal Cancer ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Obstructed Defecation ◽  
Bowel Habit ◽  
Wexner Score ◽  
Exact Test ◽  
Female Patients ◽  
Presenting Symptoms ◽  
Pelvic Floor Symptoms

Introduction The aim of this study was to establish the prevalence of pelvic floor symptoms in women referred to a colorectal two-week wait (2WW) clinic with suspected colorectal cancer. Methods A questionnaire assessing faecal incontinence (FI) (Wexner score) and obstructed defecation syndrome (ODS) (Renzi score) was offered to 98 consecutive female patients attending a colorectal 2WW clinic at a single trust. Results Overall, 56 (57%) of the 98 patients had significant ODS and/or FI (scores >9/20), 33 (34%) had ODS and 40 (41%) had FI. Seventeen patients (17%) had both ODS and FI. Analysis of the 63 patients referred with a change in bowel habit (CIBH) showed 40 (63%) to be Renzi and/or Wexner positive compared with 16 (46%) of the 35 patients who presented without CIBH (p=0.095, Fisher’s exact test). Further analysis showed that 31 (78%) of the 40 patients with FI presented with CIBH compared with 32 (55%) of the 58 without FI (p=0.032). In terms of ODS, 23 (70%) of the 33 patients with ODS presented with CIBH compared with 40 (62%) of the 65 without ODS (p=0.506). Conclusions Over half of the female patients attending our colorectal 2WW clinic had significant pelvic floor dysfunction (FI/ODS), which may account for their symptoms (especially in the CIBH referral category). While it is important for malignancy to be excluded, many patients may benefit from investigation and management of their pelvic floor dysfunction as the cause for their presenting symptoms.

Apex Technique in the Treatment of Obstructed Defecation Syndrome Associated With Rectal Intussusception and Full Rectal Mucosa Prolapse

2014 ◽  
Vol 57 (11) ◽  
pp. 1324-1328 ◽  
Author(s):  
F. Sergio P. Regadas ◽  
Mario Abedrapo ◽  
Jose Vinicius Cruz ◽  
Sthela M. Murad Regadas ◽  
F. Sergio P. Regadas Filho
Keyword(s):  
Obstructed Defecation ◽  
Rectal Mucosa ◽  
Rectal Intussusception ◽  
Obstructed Defecation Syndrome

scholarly journals Dentigerous cyst in the maxilla: case report in a pediatric patient

2021 ◽  
Vol 10 (16) ◽  
pp. e143101623293
Author(s):  
Bianca de Fatima Borim Pulino ◽  
Raphael Capelli Guerra ◽  
Gabriel Cunha Collini ◽  
Marcello Cheloti ◽  
Eduardo Hochuli Vieira
Keyword(s):  
Pediatric Patient ◽  
Alveolar Bone ◽  
Treatment Plan ◽  
Dentigerous Cyst ◽  
Odontogenic Cysts ◽  
Long Period ◽  
Unerupted Tooth ◽  
Dentigerous Cysts ◽  
Male Patients ◽  
Almost All

Dentigerous cysts are the second most common odontogenic cysts of the jaws, and sometimes inhibit the eruption of teeth. Almost all of the dentigerous cyst encloses the crown of an unerupted tooth and the radiolucent area is attached to the tooth at the cementoenamel junction. Dentigerous cyst is more common in male patients and most commonly develop in the second and third decades of life. Clinically, a localized swelling of the alveolar bone can be detected, however, dentigerous cysts can be asymptomatic during a long period of time, leading to a significant destruction of bone. The conventional treatment plan is cyst removal and marsupialization. Marsupialization therapy can be useful to promote the spontaneous eruption of the involved tooth within the cyst. However, tooth eruption does not always occur spontaneously after marsupialization. This article aims to report a clinical case of the diagnosis and treatment of a dentigerous cyst in the maxilla associated with an unerupted canine in a pediatric patient and discussion of the treatment performed.

scholarly journals Psychosocial Aspects of Pain

2000 ◽  
Vol 2 (4) ◽  
pp. 37-42 ◽  
Author(s):  
Robert Kerns
Keyword(s):  
Psychological Treatment ◽  
Treatment Plan ◽  
Multidisciplinary Treatment ◽  
Management Strategies ◽  
Medical Interventions ◽  
Pain Disability ◽  
High Prevalence ◽  
Provide Pain Relief ◽  
Prevalence Of Pain

Abstract The high prevalence of pain associated with MS is increasingly well documented. Although MS-related pain may be managed satisfactorily with pharmacologic and other medical interventions, many individuals still suffer from persistent pain. A multidimensional model of chronic pain may be applicable for MS-related pain in these circumstances. This model encourages specific attention to identification and treatment of the source of pain and efforts to provide pain relief, but also encourages assessment and a treatment plan targeting associated disability and emotional distress. The model further encourages attention to numerous psychological and interpersonal contributors to the experience of pain, disability, and distress. Psychological interventions, often provided in the context of a multidisciplinary treatment approach, are particularly encouraged. Additional research is needed to increase understanding of the role of psychosocial factors in the perpetuation of MS-related pain and to examine the effectiveness of psychological treatment approaches in the development of optimum pain management strategies.

scholarly journals A Rare Case of Disseminated Mycobacterium avium-intracellulare Presenting as Proctitis

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Chukwunonso Chime ◽  
Peter Bhandari ◽  
Masooma Niazi ◽  
Harish Patel
Keyword(s):  
Mycobacterium Avium ◽  
Rare Case ◽  
Rectal Mucosa ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Receptive Anal Intercourse ◽  
Rectal Ulcer ◽  
Elevated Alkaline Phosphatase ◽  
Presenting Symptoms ◽  
Mycobacterium Avium Intracellulare

Mycobacterium avium intracellulare (MAI) infections are common in Human Immuno-deficiency Virus (HIV) positive patients. MAI infection can have localized or disseminated presentation, patients with low CD4 count presenting with disseminated infection. Fever, abdominal pain, diarrhea, and weight loss are generally the presenting symptoms of disseminated MAI. We present a rare case of a patient with HIV and low CD4 count presenting with proctitis as manifestation of disseminated MAI infection. A 25 year-old-man with HIV came to the emergency room (ER) with complaints of intermittent rectal bleeding for two months. His CD4 count was less than 20 cells/µL. He was MSM (men having sex with men) and has receptive anal intercourse with men. His stool work-up was unrevealing for infectious etiology. Swabs for gonorrhea and chlamydia were negative. Colonoscopy revealed erythematous, congested, friable rectal mucosa with two superficial ulcers. Biopsies of the ulcer were positive for acid fast staining bacteria and the culture grew MAI. His blood culture was negative for growth of acid-fast bacteria (AFB). However, liver biopsy performed for elevated alkaline phosphatase of 958 units/L revealed noncaseating granuloma. Gastro-duodenoscopy with duodenal biopsy did not reveal any mucosal abnormality. He was managed as with disseminated MAI infection using clarithromycin, ethambutol, and rifabutin in addition to HAART therapy. Interval Colonoscopy in 20 months showed resolution of rectal ulcer. The gut is often involved in patients with disseminated MAI infection, with the duodenum being the most common site. MAI infection should be suspected as possible etiology for proctitis in HIV positive patient with low CD4 count, as proctitis, though infrequent can be the sole presentation for disseminated MAI infection in patients with HIV and low CD4 count.

Psychosocial Factors in Early Release from Psychiatric Hospitalization

1971 ◽  
Vol 28 (1) ◽  
pp. 251-257
Author(s):  
Maurice Korman ◽  
Donald W. Giller
Keyword(s):  
Psychiatric Hospitalization ◽  
Psychiatric Patients ◽  
Marriage And Family ◽  
Early Release ◽  
Presenting Symptoms ◽  
History Of ◽  
Male Patients ◽  
Severe Pathology ◽  
Relationship Of ◽  
The Relationship

Extensive demographic and psychometric information was collected on 813 consecutively admitted psychiatric patients. Those male patients who were discharged with medical advice in 75 days or less tended to show less severe pathology on admission together with a history of some stability and interpersonal success, yet saw themselves as troubled in a number of areas and in need of help. While a more favorable diagnosis was equally predictive of early release in females, measures reflecting the significance of marriage and family were featured prominently. Males and females differed markedly, however, with regard to the relationship of presenting symptoms (as derived by the Cornell Index) to early release from hospitalization.

scholarly journals Multi-Modal Treatment Approach to Painful Rib Syndrome: Case Series and Review of the Literature

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E465-E471 ◽  
Author(s):  
Andrew Germanovich
Keyword(s):  
Literature Review ◽  
Chest Wall ◽  
Treatment Plan ◽  
Case Series ◽  
Intercostal Nerve ◽  
Pain Clinic ◽  
Review Of The Literature ◽  
Presenting Symptoms ◽  
Modal Treatment ◽  
Manual Manipulation

Background: Mechanical chest wall pain is a common presenting complaint in the primary care office, emergency room, and specialty clinic. Diagnostic testing is often expensive due to similar presenting symptoms that may involve the heart or lungs. Since the chest wall biomechanics are poorly understood by many clinicians, few effective treatments are offered to patients with rib-related acute pain, which may lead to chronic pain. Objective: This case series and literature review illustrates biomechanics involved in the pathogenesis of rib-related chest wall pain and suggests an effective multi-modal treatment plan using interventional techniques with emphasis on manual manipulative techniques. Study Design: Case series and literature review. Setting: Pain clinic in an academic medical center. Results: This is a case series of 3 patients diagnosed with painful rib syndrome using osteopathic palpatory physical examination techniques. Ultrasound-guided intercostal nerve blocks were followed by manual manipulation of mechanically displaced ribs as a part of our multi-modal treatment plan. A review of the literature was undertaken to clarify nomenclature used in the description of rib-related pain, to describe the biomechanics involved in the pathogenesis of mechanical rib pain, and to illustrate the use of effective manual manipulation techniques. Limitation: This review is introductory and not a complete review of all manual or interventional pain management techniques applicable to the treatment of mechanical ribrelated pain. Conclusions: Manual diagnostic and therapeutic skills can be learned by physicians to treat biomechanically complex rib-related chest wall pain in combination with interventional imageguided techniques. Pain physicians should learn certain basic manual manipulation skills both for diagnostic and therapeutic purposes.: Key words: Chest wall pain, rib pain, intercostal neuralgia, slipping rib syndrome, chest pain, intercostal nerve block, chest trauma

scholarly journals Relation between pelvic floor neurophysiological abnormalities and erectile dysfunction in patients with obstructed defecation

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Mervat Sheta Elsawy ◽  
Emmanuel Kamal Aziz Saba
Keyword(s):  
Erectile Dysfunction ◽  
Pelvic Floor ◽  
Nerve Terminal ◽  
Pudendal Nerve ◽  
Obstructed Defecation ◽  
Life Questionnaire ◽  
Anal Pressure ◽  
Motor Latency ◽  
Male Patients

Abstract Background Obstructed defecation is a common pelvic floor medical problem among adult population. Pelvic floor disorders were reported to be associated with sexual dysfunction including erectile dysfunction among male patients. The aim was to determine the relation between pelvic floor neurophysiological abnormalities and erectile dysfunction in male patients with obstructed defecation. Methods This cross-sectional study included 65 married male patients with obstructed defecation and a control group consisted of 15 apparently healthy married males. Assessment of obstructed defecation severity was done by using modified obstructed defecation score, time of toileting and Patient Assessment of Constipation-Quality of Life questionnaire. Assessment of erectile functions was done using erectile function domain of International Index of Erectile Function questionnaire and Erectile Dysfunction-Effect on Quality of Life Questionnaire. Anal manometry and dynamic pelvis magnetic resonance imaging were done. Electrophysiological studies included pudendal nerve motor conduction study and needle electromyography of external anal sphincter, puborectalis and bulbocavernosus muscles. Results There were 32 patients (49.2%) who had erectile dysfunction. The maximum straining anal pressure was significantly higher among patients with erectile dysfunction. Pudendal nerve terminal motor latency was significantly delayed and the percentage of bilateral pudendal neuropathy was significantly higher among patients with erectile dysfunction. The percentage of electromyography evidence of denervation with chronic reinnervation in the external anal sphincter and bulbocavernosus muscles were significantly higher among patients with erectile dysfunction. Regression analysis detected three co-variables to be associated with significantly increasing the likelihood of development of erectile dysfunction. These were maximum straining anal pressure (odd ratio = 1.122), right pudendal nerve terminal motor latency (odd ratio = 3.755) and left pudendal nerve terminal motor latency (odd ratio = 3.770). Conclusions Erectile dysfunction is prevalent among patients with obstructed defecation. It is associated with characteristic pelvic floor electrophysiological abnormalities. Pelvic floor neurophysiological changes vary from minimal to severe neuromuscular abnormalities that usually accompanying erectile dysfunction. Pudendal neuropathy and increased maximum straining anal pressure are essential risk factors for increasing the likelihood of development of erectile dysfunction in patients with obstructed defecation.

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