Solitary Juvenile Polyp at a Rural Ugandan Hospital Presenting with Recurrent Rectal Bleeding

Juvenile polyps (JP) are rare but important causes of acute gastrointestinal symptoms in children. They are a recognized cause of painless rectal bleeding in preschool age children and also the most common intraluminal disorder of the colon in children They are often solitary, pedunculated and small in size but may occasionally grow to large sizes or occur in great numbers, as in juvenile polyposis syndrome. Histologically juvenile polyps are similar to inflammatory polyps with irregular dilated glands, lamina propria expansion and granulation tissue expansion. Sporadic juvenile polyps of the colon occur in up to 2 percent of children under the age of 10 years, are usually solitary, and are not associated with an increased cancer risk. The etiology, diagnosis, clinical presentation, and management of these intestinal polyps depend on the type of polyp or polyposis syndrome. A change in bowel habits, abdominal pain, rectal bleeding, rectal prolapse, and even intussusception may be the initial presentation in children. In addition to a careful history, including a detailed family history, a physical examination, contrast studies, and endoscopic examination are vital diagnostic tools. Juvenile polyps may also present with prolapse of the polyp from the anus, abdominal pain due to intussusception or may even be asymptomatic. All such polyps should be removed by colonoscopy or transanal resection

Combined transabdominal–transanal surgical approach for iatrogenic rectovaginal fistula: two case reports

Rectovaginal fistula (RVF) is a type of anastomotic leakage that may occur after low anterior resection for rectal cancer. The repair of RVF can be challenging because of the scar tissue stenosis and incomplete obstruction. Two patients presented in our department with vaginal faecal discharge almost 7 months after the radical resection of rectal cancer. On vaginal examination, titanium nails related to the rectal surgery were found in the vaginal wall. The patients were diagnosed with RVF. Considering that RVF positions in the patients were high and might adhere to the pelvic tissue, a combined transabdominal–transanal resection and vaginal repair surgery was performed. About 3 months after surgery, both patients underwent colonic closure surgery, with consequent good recovery. A combined transabdominal–transanal approach may provide distinct advantages in surgical repair of difficult cases of RVF.

A Case of Laterally Spreading Tumor of the Rectum Treated by Endoscope-Assisted Transanal Tumor Resection

Background: Curability and function should be considered in resection of a rectal lateral spreading tumor (LST). Methods: We performed endoscopic transanal resection for a rectal LST extending to the pectinate line to preserve anal function and avoid a colostomy in 1 case and describe our procedure below. An 80-year-old man with a group 5 adenocarcinoma tub1/2 and no metastasis was considered for transanal resection because of his refusal of a colostomy and for staging and preservation of anal function. A strategy involving endoscopic submucosal dissection for mucosal cutting at the proximal side and for submucosal dissection of the maximum area at the anal side of the tumor was chosen, considering the tumor size. With the patient in a jackknife position, the tumor was marked circumferentially with coagulation dots, after which MucoUp with bosmin was injected into the submucosa at the proximal side. Mucosal and submucosal dissection was performed using DualKnife to remove the largest possible area toward the anal side. Transanal resection was performed under direct vision using an anal retractor, wherein the mucosa was cut circumferentially by extending the existing resection line along with removal of the submucosa. Results: En bloc resection with clear margins was achieved. Postoperatively, retroperitoneal emphysema was observed on a computed tomography scan, which resolved after 1 week of fasting. The patient was discharged 20 days postoperatively. Neither recurrence nor metastasis has been observed 1 year postoperatively. Conclusions: Our procedure enabled successful resection of a rectal LST with negative margins and preservation of anal function.

Síndrome de Defecación Obstructiva por Rectocele Posterior Mediante Técnica Stapled Transanal Resection (STARR)

Presentamos a un paciente varón de 35 años con una obesidad grado II (índice de masa corporal (IMC): 34,5), lumbalgia crónica y discopatía degenerativa L4-S. Es valorado por cuadro de tenesmo rectal, esfuerzo defecatorio y rectorragia esporádica desde los 10 años requiriendo en torno a una hora para lograr una evacuación incompleta, necesitando de extracción digital. Se le realiza una Rectoscopia: hemorroides internas grado II y fisura anal en proceso de cicatrización; una resonancia magnética dinámica pélvica (RMDp): rectocele posterior moderado (Figura 1). En la Manometría Anorrectal se describe una sensibilidad rectal preservada, pero sin una adecuada relajación durante la maniobra defecatoria.

Transanal resection of rectal cancer: a review

As an alternative to conventional resection of rectal tumors with low morbidity, the transanal approach has become popular and in-demand. It’s been almost 30 years since the techniques for transanal resection have been evolving steadily. The revolution started with the advent of transanal endoscopic microsurgery in the 80’s. Later, the introduction of transanal minimally invasive surgery improved the access and visibility for surgeons across the world. Concerns have been raised about recurrence rates of cancers with transanal approach and success of subsequent salvage operations. This review is an attempt to concise the available techniques, their results and also to bring about a consensus as to whether it is worth to give our patients an option of transanal resection of rectal cancer.