Rectal prolapse surgeries using perineal, trans-anal and extra-anal approach

Nowa Medycyna ◽  
2019 ◽  
Vol 26 (4) ◽  
Author(s):  
Małgorzata Kołodziejczak ◽  
Przemysław Ciesielski
Keyword(s):  
Rectal Prolapse ◽  
Wedge Resection ◽  
Rectal Mucosa ◽  
Rare Condition ◽  
Epidemiological Data ◽  
Levator Ani ◽  
Therapeutic Success ◽  
Perineal Rectosigmoidectomy ◽  
Pelvic Prolapse ◽  
Surgical Methods

Rectal prolapse is a rare condition. Epidemiological data estimate that 4/1,000 adults are affected. Although rectal prolapse in most often seen in older women, it may develop in both men and women at any age. In the last century, perineal access was the primary surgical approach in patients with rectal prolapse. Currently, a number of transabdominal (laparotomy, laparoscopy) and transperineal techniques are used. Proper preoperative qualification is of key importance for therapeutic success in a patient with rectal prolapse. Indications for perineal rectal prolapse surgery include advanced age, general comorbidities, short-segment prolapse, incarceration and necrotic rectal prolapse. Advantages of the perineal approach include prolapse repair by resection, simultaneous repair of pelvic prolapse, and, in the case of overlapping anal sphincter insufficiency (which is common), the possibility of simultaneous anterior and posterior levator ani repair. Perineal rectosigmoidectomy (Altemeier’s procedure) and Delorme’s procedure are the most common perineal surgical procedures performed in patients with full-thickness rectal prolapse. Anal encirclement (Thiersch wire) is a historical method, which is used in rare cases of patients not eligible for other procedures. STARR (stapler transanal rectal resection), wedge resection of the rectal mucosa, mucosal plication (Gant-Miwa procedure) may be used in patients with partial-thickness rectal prolapse. The paper presents the above mentioned surgical methods, along with their indications, uses, advantages, disadvantages, and possible complications.

scholarly journals Composite phaeochromocytomas—a systematic review of published literature

2021 ◽  
Author(s):  
K. Dhanasekar ◽  
V. Visakan ◽  
F. Tahir ◽  
S. P. Balasubramanian
Keyword(s):  
Case Reports ◽  
Descriptive Analysis ◽  
Management Strategies ◽  
Gastrointestinal Symptoms ◽  
Rare Condition ◽  
Epidemiological Data ◽  
Human Case ◽  
Rare Tumour ◽  
Palpable Mass

Abstract Introduction Composite phaeochromocytoma is a tumour containing a separate tumour of neuronal origin in addition to a chromaffin cell tumour. This study reports on two cases from a single centre’s records and presents a systematic literature review of composite phaeochromocytomas. Methods In addition to describing 2 case reports, a systematic search of the Medline database from inception up to April 2020 was done for human case reports on composite phaeochromocytomas. Relevant titles and/or abstracts were screened, and full texts were reviewed to identify appropriate studies. Data was extracted and a descriptive analysis of presentation, clinical features, management strategies and outcomes was performed. The quality of included studies was assessed using a critical appraisal checklist. Results There were 62 studies included, with a total of 94 patients. Of 91 patients where data was available, the median (range) age of patients was 48 (4–86) years. Of 90 patients where information was provided, 57% were female. In at least 28% of patients, a genetic cause was identified. Common presenting features include abdominal pain, palpable mass, cardiovascular and gastrointestinal symptoms. The most common tumour component with phaeochromocytoma is ganglioneuroma; other components include ganglioneuroblastoma, neuroblastoma and malignant peripheral nerve sheath tumours. In patients with follow-up data (n=48), 85% of patients were alive and well at a median (range) follow-up time of 18 (0.5–168) months. Conclusion Composite phaeochromocytoma is a rare tumour, with a significant genetic predisposition. This review summarises available epidemiological data, which will be useful for clinicians managing this rare condition.

Unusual presentation of Crohn’s disease

2021 ◽  
Vol 14 (6) ◽  
pp. e242703
Author(s):  
Kate Edwards ◽  
Karen Yearsley
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Wedge Resection ◽  
Rare Condition ◽  
Unusual Presentation ◽  
Protein Losing Enteropathy ◽  
Inflammatory Bowel ◽  
Alpha 1 Antitrypsin ◽  
Underlying Pathophysiology

A previously well 37-year-old woman attended the emergency assessment unit with symptoms of lethargy, breathlessness and peripheral oedema, whereby initial basic investigations revealed an iron deficiency anaemia and serum hypoalbuminaemia. The patient subsequently had multiple admissions to secondary care over a 2-year period due to worsening peripheral and central oedema. Investigations ruled out non-gastrointestinal causes of serum hypoalbuminaemia, such as renal, cardiac and hepatic failures. Gastrointestinal investigations later revealed raised faecal alpha-1 antitrypsin and small bowel ulceration on capsule endoscopy, with a histological diagnosis of Crohn’s disease made after a small bowel wedge resection. This case describes the unusual presentation of Crohn’s disease displaying symptoms primarily of protein-losing enteropathy, an uncommon and under-recognised consequence of inflammatory bowel disease. A review of current literature and the underlying pathophysiology for this rare condition are discussed, particularly in relation to Crohn’s disease.

scholarly journals Surgical treatment of rectal prolapse: experience and late results with 51 patients

2004 ◽  
Vol 59 (4) ◽  
pp. 168-171 ◽  
Author(s):  
Carlos Walter Sobrado ◽  
Desidério Roberto Kiss ◽  
Sérgio C. Nahas ◽  
Sérgio E. A. Araújo ◽  
Victor E. Seid ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Fecal Incontinence ◽  
Rectal Prolapse ◽  
Late Results ◽  
Long Term Results ◽  
Complete Rectal Prolapse ◽  
Presacral Space ◽  
Perineal Rectosigmoidectomy ◽  
Study Results ◽  
Low Incidence

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

scholarly journals Perineal rectosigmoidectomy for strangled rectal prolapse: A case report

2014 ◽  
Vol 03 (01) ◽  
pp. 64-66
Author(s):  
Alpha Oumar Toure ◽  
Cheikh Tidiane Diop ◽  
Fode Baba Toure ◽  
Thomas Marcel M. Wade ◽  
Gabriel Ngom
Keyword(s):  
Case Report ◽  
Rectal Prolapse ◽  
Perineal Rectosigmoidectomy

scholarly journals Single Dose of Methotrexate Therapy Followed By Suction Curettage for Management of Cesarean Scar Pregnancy

2019 ◽  
Vol 3 (1) ◽  
pp. 01-04
Author(s):  
Hend S Saleh ◽  
Hala E Sherif ◽  
Eman M Mahfouz
Keyword(s):  
Single Dose ◽  
Gestational Age ◽  
Wedge Resection ◽  
Rare Condition ◽  
Prospective Clinical Study ◽  
Maternal Complications ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Suction Curettage ◽  
The Mean

Objective Implantation of the pregnancy in a cesarean scar is a rare condition named ; Cesarean scar pregnancy (CSP). Maternal complications can be prevented with the early diagnosis and an appropriate management .It is a Prospective clinical study to evaluate the efficacy and success rate of single dose use of methotrexate (MTX) followed by dilation and suction (D&S) regimen in management of women with cesarean scar pregnancy (CSP) . Methods 50mg of MTX in the form of a single dose Intramuscular injection then cervical dilatation and suction aspiration with a Karman cannula(D&S) under guidance of ultrasound after 48 preeceeded by vaginal misoprostol 2 tablet (200 mg) 4 hours ago. Results The mean gestational age at diagnosis was (8.5±1.6 ) and The mean level of serum b-human chorionic gonadotropin was (7424±2.560 ) and The mean gestational age of pregnancy was (8.5±1.6 ) .88.7% is the successive rate without complication need intervention, 2 (5.7%) patients needed intrauterine Foley's catheter for 24 hours as a mechanical hemostasis . 2 (5.7 %) had laparotomy with wedge resection of the gestational sac lesion and successful repair of the uterine defect and one (2.8 %)underwent subtotal hysterectomy. Conclusion: Systemic single dose MTX injection followed by D&S is an effective and harmless management for CSP. Nevertheless more studies are required to prove the efficiency, safety, and reproductive outcome of variant modalities in treatment of CSP.

Perineal Rectosigmoidectomy for Primary and Recurrent Rectal Prolapse

2012 ◽  
Vol 55 (6) ◽  
pp. 666-670 ◽  
Author(s):  
Jian-Hua Ding ◽  
Jorge Canedo ◽  
Seung-Hyun Lee ◽  
Sudhir N. Kalaskar ◽  
Lester Rosen ◽  
...  
Keyword(s):  
Rectal Prolapse ◽  
Perineal Rectosigmoidectomy

Juvenile nasopharyngeal angiofibroma—20 years of experience in endoscopic treatment

2020 ◽  
Vol 74 (6) ◽  
Author(s):  
Witold Szyfter ◽  
Andrzej Balcerowiak ◽  
Wojciech Gawęcki ◽  
Robert Juszkat ◽  
Małgorzata Wierzbicka
Keyword(s):  
Endoscopic Treatment ◽  
Endoscopic Approach ◽  
Individual Development ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Years Of Experience ◽  
Therapeutic Success ◽  
Nasopharyngeal Angiofibroma ◽  
Imaging Results ◽  
Surgical Methods ◽  
Wide Range

Background: Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. Material and Methods: The material covers 71 patients treated in the years 1985-2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or a double approach—classic with the use of endoscopes—or only the endoscopic approach was used. In the entire population, external surgeries were performed in 30 patients, double access in 8 and endoscopic access in 26 patients. Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation. Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.

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