Management of Rectal Prolapse –The State of the Art
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The Subperitoneal Space and Peritoneal Cavity: Basic Concepts Harpreet K
ª The Author(s) 2015. This article is published with Abdom Imaging (2015) 40:2710–2722 Abdominal open access at Springerlink.com DOI: 10.1007/s00261-015-0429-5 Published online: 26 May 2015 Imaging The subperitoneal space and peritoneal cavity: basic concepts Harpreet K. Pannu,1 Michael Oliphant2 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA 2Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA Abstract The peritoneum is analogous to the pleura which has a visceral layer covering lung and a parietal layer lining the The subperitoneal space and peritoneal cavity are two thoracic cavity. Similar to the pleural cavity, the peri- mutually exclusive spaces that are separated by the toneal cavity is visualized on imaging if it is abnormally peritoneum. Each is a single continuous space with in- distended by fluid, gas, or masses. terconnected regions. Disease can spread either within the subperitoneal space or within the peritoneal cavity to Location of the abdominal and pelvic organs distant sites in the abdomen and pelvis via these inter- connecting pathways. Disease can also cross the peri- There are two spaces in the abdomen and pelvis, the toneum to spread from the subperitoneal space to the peritoneal cavity (a potential space) and the subperi- peritoneal cavity or vice versa. toneal space, and these are separated by the peritoneum (Fig. 1). Regardless of the complexity of development in Key words: Subperitoneal space—Peritoneal the embryo, the subperitoneal space and the peritoneal cavity—Anatomy cavity remain separated from each other, and each re- mains a single continuous space (Figs. -
Adult Congenital Megacolon with Acute Fecal Obstruction and Diabetic Nephropathy: a Case Report
2726 EXPERIMENTAL AND THERAPEUTIC MEDICINE 18: 2726-2730, 2019 Adult congenital megacolon with acute fecal obstruction and diabetic nephropathy: A case report MINGYUAN ZHANG1,2 and KEFENG DING1 1Colorectal Surgery Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000; 2Department of Gastrointestinal Surgery, Yinzhou Peoples' Hospital, Ningbo, Zhejiang 315000, P.R. China Received November 27, 2018; Accepted June 20, 2019 DOI: 10.3892/etm.2019.7852 Abstract. Megacolon is a congenital disorder. Adult congen- sufficient amount of bowel should be removed, particularly the ital megacolon (ACM), also known as adult Hirschsprung's aganglionic segment (2). The present study reports on a case of disease, is rare and frequently manifests as constipation. ACM a 56-year-old patient with ACM, fecal impaction and diabetic is caused by the absence of ganglion cells in the submucosa nephropathy. or myenteric plexus of the bowel. Most patients undergo treat- ment of megacolon at a young age, but certain patients cannot Case report be treated until they develop bowel obstruction in adulthood. Bowel obstruction in adults always occurs in complex clinical A 56-year-old male patient with a history of chronic constipa- situations and it is frequently combined with comorbidities, tion presented to the emergency department of Yinzhou including bowel tumors, volvulus, hernias, hypertension or Peoples' Hospital (Ningbo, China) in February 2018. The diabetes mellitus. Surgical intervention is always required in patient had experienced vague abdominal distention for such cases. To avoid recurrence, a sufficient amount of bowel several days. Prior to admission, chronic bowel obstruction should be removed, particularly the aganglionic segment. -
No.9 September 2003
Vol.46, No.9 September 2003 CONTENTS Defecatory Dysfunction Pathogenesis and Pathology of Defecatory Disturbances Masahiro TAKANO . 367 Diagnosis of Impaired Defecatory Function with Special Reference to Physiological Tests Masatoshi OYA et al. 373 Surgical Management for Defecation Dysfunction Tatsuo TERAMOTO . 378 Dysfunction in Defecation and Its Treatment after Rectal Excision Katsuyoshi HATAKEYAMA . 384 Infectious Diseases Changes in Measures against Infectious Diseases in Japan and Proposals for the Future Takashi NOMURA et al. 390 Extragenital Infection with Sexually Transmitted Pathogens Hiroyuki KOJIMA . 401 Nutritional Counseling Behavior Therapy for Nutritional Counseling —In cooperation with registered dietitians— Yoshiko ADACHI . 410 Ⅵ Defecatory Dysfunction Pathogenesis and Pathology of Defecatory Disturbances JMAJ 46(9): 367–372, 2003 Masahiro TAKANO Director, Coloproctology Center, Hidaka Hospital Abstract: In recent years the number of patients with defecatory disturbances has increased due to an aging population, stress, and other related factors. The medical community has failed to focus enough attention on this condition, which remains a sort of psychosocial taboo, enhancing patient anxiety. Defecatory distur- bance classified according to cause and location can fall into one of four groups: 1) Endocrine abnormalities; 2) Disturbances of colonic origin that result from the long-term use of antihypertensive drugs or antidepressants or from circadian rhythm disturbances that occur with skipping breakfast or lower dietary -
Intestinal Obstruction
Intestinal obstruction Prof. Marek Jackowski Definition • Any condition interferes with normal propulsion and passage of intestinal contents. • Can involve the small bowel, colon or both small and colon as in generalized ileus. Definitions 5% of all acute surgical admissions Patients are often extremely ill requiring prompt assessment, resuscitation and intensive monitoring Obstruction a mechanical blockage arising from a structural abnormality that presents a physical barrier to the progression of gut contents. Ileus a paralytic or functional variety of obstruction Obstruction: Partial or complete Simple or strangulated Epidemiology 1 % of all hospitalization 3-5 % of emergency surgical admissions More frequent in female patients - gynecological and pelvic surgical operations are important etiologies for postop. adhesions Adhesion is the most common cause of intestinal obstruction 80% of bowel obstruction due to small bowel obstruction - the most common causes are: - Adhesion - Hernia - Neoplasm 20% due to colon obstruction - the most common cause: - CR-cancer 60-70%, - diverticular disease and volvulus - 30% Mortality rate range between 3% for simple bowel obstruction to 30% when there is strangulation or perforation Recurrent rate vary according to method of treatment ; - conservative 12% - surgical treatment 8-32% Classification • Cause of obstruction: mechanical or functional. • Duration of obstruction: acute or chronic. • Extent of obstruction: partial or complete • Type of obstruction: simple or complex (closed loop and strangulation). CLASSIFICATION DYNAMIC ADYNAMIC (MECHANICAL) (FUNCTIONAL) Peristalsis is Result from atony of working against a the intestine with loss mechanical of normal peristalsis, obstruction in the absence of a mechanical cause. or it may be present in a non-propulsive form (e.g. mesenteric vascular occlusion or pseudo-obstruction) Etiology Mechanical bowel obstruction: A. -
A Simplified Fascial Model of Pelvic Anatomical Surgery: Going Beyond
Anatomical Science International https://doi.org/10.1007/s12565-020-00553-z ORIGINAL ARTICLE A simplifed fascial model of pelvic anatomical surgery: going beyond parametrium‑centered surgical anatomy Stefano Cosma1 · Domenico Ferraioli2 · Marco Mitidieri3 · Marcello Ceccaroni4 · Paolo Zola5 · Leonardo Micheletti1 · Chiara Benedetto1 Received: 13 March 2020 / Accepted: 5 June 2020 © The Author(s) 2020 Abstract The classical surgical anatomy of the female pelvis is limited by its gynecological oncological focus on the parametrium and burdened by its modeling based on personal techniques of diferent surgeons. However, surgical treatment of pelvic diseases, spreading beyond the anatomical area of origin, requires extra-regional procedures and a thorough pelvic anatomical knowl- edge. This study evaluated the feasibility of a comprehensive and simplifed model of pelvic retroperitoneal compartmen- talization, based on anatomical rather than surgical anatomical structures. Such a model aims at providing an easier, holistic approach useful for clinical, surgical and educational purposes. Six fresh-frozen female pelves were macroscopically and systematically dissected. Three superfcial structures, i.e., the obliterated umbilical artery, the ureter and the sacrouterine ligament, were identifed as the landmarks of 3 deeper fascial-ligamentous structures, i.e., the umbilicovesical fascia, the urogenital-hypogastric fascia and the sacropubic ligament. The retroperitoneal areolar tissue was then gently teased away, exposing the compartments delimited by these deep fascial structures. Four compartments were identifed as a result of the intrapelvic development of the umbilicovesical fascia along the obliterated umbilical artery, the urogenital-hypogastric fascia along the mesoureter and the sacropubic ligaments. The retroperitoneal compartments were named: parietal, laterally to the umbilicovesical fascia; vascular, between the two fasciae; neural, medially to the urogenital-hypogastric fascia and visceral between the sacropubic ligaments. -
The American Society of Colon and Rectal Surgeons' Clinical Practice
CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the Evaluation and Management of Constipation Ian M. Paquette, M.D. • Madhulika Varma, M.D. • Charles Ternent, M.D. Genevieve Melton-Meaux, M.D. • Janice F. Rafferty, M.D. • Daniel Feingold, M.D. Scott R. Steele, M.D. he American Society of Colon and Rectal Surgeons for functional constipation include at least 2 of the fol- is dedicated to assuring high-quality patient care lowing symptoms during ≥25% of defecations: straining, Tby advancing the science, prevention, and manage- lumpy or hard stools, sensation of incomplete evacuation, ment of disorders and diseases of the colon, rectum, and sensation of anorectal obstruction or blockage, relying on anus. The Clinical Practice Guidelines Committee is com- manual maneuvers to promote defecation, and having less posed of Society members who are chosen because they than 3 unassisted bowel movements per week.7,8 These cri- XXX have demonstrated expertise in the specialty of colon and teria include constipation related to the 3 common sub- rectal surgery. This committee was created to lead inter- types: colonic inertia or slow transit constipation, normal national efforts in defining quality care for conditions re- transit constipation, and pelvic floor or defecation dys- lated to the colon, rectum, and anus. This is accompanied function. However, in reality, many patients demonstrate by developing Clinical Practice Guidelines based on the symptoms attributable to more than 1 constipation sub- best available evidence. These guidelines are inclusive and type and to constipation-predominant IBS, as well. The not prescriptive. -
Patient Information Leaflet
9 Tighten your anal muscles once more when Not everyone is the same, a normal bowel you have finished opening your bowels. habit varies from between three times a day to three times a week. Your motion should be solid, but easy to pass. If after following the advice in this leaflet Patient Information you are still having problems with Leaflet constipation please seek further help from your Doctor, Nurse or Continence Advisor. Compliments, comments, concerns or complaints? If you have any compliments, comments, concerns or complaints and you would like to speak to somebody about them please telephone or email If you find that your anal muscles are 01773 525119 tightening instead of relaxing practising 4, 5 [email protected] and 6 will help to get these muscles working correctly. However if you are still unable to Are we accessible to you? This publication relax your anal muscles and are straining is available on request in other formats (for excessively for long periods you should seek example, large print, easy read, Braille or help from your Doctor or Continence Advisor. audio version) and languages. For free You may have a condition known as anismus translation and/or other format please call which simply means that the muscles in your 01246 515224, or email us anus contract when they should relax. This is [email protected] easily treated. Remember... Constipation Advice for ¨ Drink 1.5-2 litres of fluid a day Continence Advisory Service Patients ¨ Eat 5 portions of fruit / vegetables a day Alfreton Primary Care Centre ¨ Eat regularly ¨ Never ignore the sensation to go Church Street Not everyone has a bowel which works ¨ Allow yourself plenty of time and privacy Alfreton properly, but you may be able to improve ¨ Get into a routine Derbyshire your symptoms by following the advice - Exercise (within your capabilities) DE55 7AH offered in this leaflet - Do not strain. -
Celiac Disease: It's Autoimmune Not an Allergy
CELIAC DISEASE: IT’S AUTOIMMUNE NOT AN ALLERGY! Analissa Drummond PA-C Department of Pediatrics Division of Pediatric Gastroenterology HISTORY OF CELIAC DISEASE Also called gluten-sensitive enteropathy and nontropical spue First described by Dr. Samuel Gee in a 1888 report entitled “On the Coeliac Affection” Term “coeliac” derived from Greek word koiliakaos-abdominal Similar description of a chronic, malabsorptive disorder by Aretaeus from Cappadochia ( now Turkey) reaches as far back as the second century AD HISTORY CONTINUED The cause of celiac disease was unexplained until 1950 when the Dutch pediatrician Willem K Dicke recognized an association between the consumption of bread, cereals and relapsing diarrhea. This observation was corroborated when, during periods of food shortage in the Second World War, the symptoms of patients improved once bread was replaced by unconventional, non cereal containing foods. This finding confirmed the usefulness of earlier empirical diets that used pure fruit, potatoes, banana, milk, or meat. HISTORY CONTINUED After the war bread was reintroduced. Dicke and Van de Kamer began controlled experiments by exposing children with celiac disease to defined diets. They then determined fecal weight and fecal fat as a measure of malabsorption. They found that wheat, rye, barley and to a lesser degree oats, triggered malabsorption, which could be reversed after exclusion of the “toxic” cereals from the diet. Shortly after, the toxic agents were found to be present in gluten, the alcohol-soluble fraction of wheat protein. PATHOPHYSIOLOGY Celiac disease is a multifactorial, autoimmune disorder that occurs in genetically susceptible individuals. Trigger is an environmental agent-gliadin component of gluten. -
The Efficacy of a Multidisciplinary Approach to the Management of Constipation: a Case Series
Journal of the Association of Chartered Physiotherapists in Women’s Health, Spring 2008, 102, 36–44 CLINICAL PAPER The efficacy of a multidisciplinary approach to the management of constipation: a case series R. W. C. Leung, B. K. Y. Fung & L. C. W. Fung Physiotherapy Department, Kwong Wah Hospital, Hong Kong W. C. S. Meng, P. Y. Y. Lau & A. W. C. Yip Department of Surgery, Kwong Wah Hospital, Hong Kong Abstract The aim of this study was to evaluate a rehabilitative programme including biofeedback training for the treatment of chronic constipation. A prospective series of patients with constipation, as defined by the Rome II diagnostic criteria, were assessed by a clinician, a dietitian and a physiotherapist. Anorectal physi- ology investigations and defecography were performed prior to and after the programme. The treatment involved consultation by the dietitian, postural re-education and pelvic floor re-education regarding the proper pattern of defecation. The subjects were followed up in alternate weeks for the first 3 months and then monthly for another 3 months. Twenty patients have been recruited into the programme since 2005. Ten subjects have completed the course of treatment and three have defaulted; the remaining seven were still undergoing treatment at the time of writing. On completion of the programme, there was a significant improvement in fibre intake (pre-treatment=12.9191.06 g; post-treatment= 20.2661.064 g; P=0.001), average straining effort (pre-treatment=6.360.391; post-treatment=3.720.391; P=0.001) and average straining time (pre- treatment=17.612.172 min; post-treatment=6.002.172 min; P=0.004). -
Redalyc.Biofeedback Treatment in Chronically Constipated Patients
Revista Latinoamericana de Psicología ISSN: 0120-0534 [email protected] Fundación Universitaria Konrad Lorenz Colombia Simón, Miguel A.; Bueno, Ana M.; Durán, Montserrat Biofeedback treatment in chronically constipated patients with dyssynergic defecation Revista Latinoamericana de Psicología, vol. 43, núm. 1, 2011, pp. 105-111 Fundación Universitaria Konrad Lorenz Bogotá, Colombia Available in: http://www.redalyc.org/articulo.oa?id=80520078010 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Biofeedback on dyssynergic defecation Biofeedback treatment in chronically constipated patients with dyssynergic defecation Biofeedback aplicado al tratamiento de pacientes con estreñimiento crónico debido a defecación disinérgica Recibido: Marzo de 2009 Miguel A. Simón Aceptado: Agosto de 2010 Ana M. Bueno Montserrat Durán University of A Coruña, Department of Psychology, Research Group in Clinical and Health Psychology, Spain Correspondence: Miguel A. Simón, Full postal address: Research Group in Clinical and Health Psychology, Department of Psychology, University of A Coruña, Campus of Elviña, 15071 A Coruña, Spain Abstract Resumen The aim of this study was to evaluate the effects of El objetivo de este estudio fue evaluar los efectos del electromyographic biofeedback training in chronically entrenamiento -
Adult Intussusception
1 Adult Intussusception Saulius Paskauskas and Dainius Pavalkis Lithuanian University of Health Sciences Kaunas Lithuania 1. Introduction Intussusception is defined as the invagination of one segment of the gastrointestinal tract and its mesentery (intussusceptum) into the lumen of an adjacent distal segment of the gastrointestinal tract (intussuscipiens). Sliding within the bowel is propelled by intestinal peristalsis and may lead to intestinal obstruction and ischemia. Adult intussusception is a rare condition wich can occur in any site of gastrointestinal tract from stomach to rectum. It represents only about 5% of all intussusceptions (Agha, 1986) and causes 1-5% of all cases of intestinal obstructions (Begos et al., 1997; Eisen et al., 1999). Intussusception accounts for 0.003–0.02% of all hospital admissions (Weilbaecher et al., 1971). The mean age for intussusception in adults is 50 years, and and the male-to-female ratio is 1:1.3 (Rathore et. al., 2006). The child to adult ratio is more than 20:1. The condition is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. Intussusception in adults occurs less frequently in the colon than in the small bowel (Zubaidi et al., 2006; Wang et al., 2007). Mortality for adult intussusceptions increases from 8.7% for the benign lesions to 52.4% for the malignant variety (Azar & Berger, 1997) 2. Etiology of adult intussusception Unlike children where most cases are idiopathic, intussusception in adults has an identifiable etiology in 80- 90% of cases. The etiology of intussusception of the stomach, small bowel and the colon is quite different (Table 1). -
Post-Operative Small Bowel Intussusception in a Pediatric Trauma Patient: a Literature Review and Unique Case Report
ACS Case Reviews in Surgery Vol. 1, No. 3 Post-Operative Small Bowel Intussusception in a Pediatric Trauma Patient: A Literature Review and Unique Case Report AUTHORS: CORRESPONDENCE AUTHOR:* AUTHOR AFFILIATIONS: Walsh NJa, Dadzie KAb, Jones AJb, Hatley RMa.c Andrew J. Jones, MD a Department of Surgery, Augusta University 1120 15th St, BI-4070 Health, Augusta, GA, USA Augusta, GA, 30912 b Medical College of Georgia at Augusta University, [email protected] Augusta, GA, USA (770) 827-8816 c Section of Pediatric Surgery, Augusta University Health, Augusta, GA, USA Background Intussusception is a well-documented cause of acute abdomen in the pediatric population; however, post-traumatic and post-operative intussusceptions are exceptionally uncommon. Summary An otherwise healthy eight-year-old girl presented as a level II trauma via EMS following a motor vehicle accident (MVA). The patient complained of diffuse abdominal pain and back pain on arrival. Physical exam was remarkable for tachycardia, right coastal margin tenderness to palpation, non-labored breathing, diffuse abdominal tenderness and a seatbelt sign. Abdominal computed tomography (CT) scan was suspicious for duodenal and/or mesenteric injury, warranting an exploratory laparotomy. After this initial operation, she later presented with symptoms of small bowel obstruction. Repeat CT of the abdomen obtained on post-operative day 14 showed dilated loops of distant small bowel, air fluid levels and a swirled appearance of the mesentery, concerning for a closed loop obstruction. She was taken back to the operating room and intra-operative findings revealed a feathery adhesion of the small bowel to the transverse colon with no dilation of the proximal small bowel and a distal jejunojejunal intussusception.