DOCSLIB.ORG

Clinical Practice Guidelines for the Treatment of Rectal Prolapse Liliana Bordeianou, M.D., M.P.H

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Practice Guidelines for the Treatment of Rectal Prolapse Liliana Bordeianou, M.D., M.P.H CLINICAL PRACTICE GUIDELINES Clinical Practice Guidelines for the Treatment of Rectal Prolapse Liliana Bordeianou, M.D., M.P.H. • Ian Paquette, M.D. • Eric Johnson, M.D. Stefan D. Holubar, M.D. • Wolfgang Gaertner, M.D. • Daniel L. Feingold, M.D. Scott R. Steele, M.D. Prepared by the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons STATEMENT OF THE PROBLEM Although rectal prolapse is a benign condition, it can be debilitating because of the discomfort of prolapsing Rectal prolapse is a disorder characterized by a full-thickness tissue both internally and externally, associated drainage intussusception of the rectal wall, which protrudes externally of mucus or blood, and the common occurrence of con- through the anus. It is associated with a spectrum of coexist- comitant symptoms of fecal incontinence, constipation, or ing anatomic abnormalities, such as diastasis of the levator both.8 Approximately 50% to 75% of patients with rectal ani, an abnormally deep cul-de-sac, a redundant sigmoid prolapse report fecal incontinence, and 25% to 50% of colon, a patulous anal sphincter, and loss or attenuation of patients report constipation.9–13 Incontinence in the set- the rectal sacral attachments. Some have hypothesized that ting of rectal prolapse may be explained by the presence the condition is associated with (and preceded by) internal of a direct conduit (ie, the prolapse), which disturbs the rectal intussusception or a traumatic solitary rectal ulcer, al- sphincter mechanism, the chronic traumatic stretch of 1–3 though these associations have never been clearly proven. the sphincter caused by the prolapse itself, and continu- Rectal prolapse is rare and is estimated to occur in ous stimulation of the rectoanal inhibitory reflex by the ≈0.5% of the general population overall, although the fre- prolapsing tissue.14 Up to one half of patients with pro- quency is higher in females and the elderly, and women lapse demonstrate pudendal neuropathy,15 which may be aged ≥50 years are 6 times more likely as men to pro- responsible for denervation-related atrophy of the exter- 4–6 lapse. Although it is commonly thought that rectal pro- nal sphincter musculature.16 Constipation associated with lapse is a consequence of multiparity, approximately one prolapse may result from intussuscepting bowel in the rec- third of female patients with rectal prolapse are nullipa- tum, creating a blockage that is exacerbated with straining, rous. The peak age of incidence is the seventh decade in pelvic floor dyssynergia, and colonic dysmotility, although women. Interestingly, although fewer men have the condi- causality versus correlation remains highly debated.11,12 tion, the age of incidence for these men is generally ≤40 The goals of surgery to correct rectal prolapse are 3-fold: years. A striking characteristic of younger patients, both 1) to eliminate the prolapse through either resection or resto- male and female, is an increased tendency to have autism, ration of normal anatomy, 2) to correct associated functional syndromes associated with developmental delay, or psy- abnormalities of constipation or incontinence, and 3) to chiatric comorbidities requiring multiple medications.7 avoid the creation of de novo bowel dysfunction. Multiple op- erations have been developed to achieve this complex 3-fold Supplemental digital content is available for this article. Direct URL goal, each with various strengths and weaknesses underscor- citations appear in the printed text, and links to the digital files are pro- ing the importance of careful patient selection and thorough vided in the HTML and PDF versions of this article on the journal’s Web patient counseling when choosing a surgical approach. site (www.dcrjournal.com). Financial Disclosure: The funding body (ASCRS) did not influence the METHODOLOGY content of this work and no other specific funding was received. These guidelines were built based on the last set of The Correspondence: Scott R. Steele, M.D., 9500 Euclid Ave/A30, Cleveland American Society of Colon and Rectal Surgeons (ASCRS) Clinic, Cleveland OH, 44915. E-mail: [email protected] practice parameters for treatment of rectal prolapse pub- 17 Dis Colon Rectum 2017; 60: 1121–1131 lished in 2011. An organized search of Medline, PubMed, DOI: 10.1097/DCR.0000000000000889 Embase, and the Cochrane Database of Collected Reviews © The ASCRS 2017 was performed from October 2011 through December DISEASES OF THE COLON & RECTUM VOLUME 60: 11 (2017) 1121 xxxxxxXXX Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. 1122 BORDEIANOU ET AL: TREATMENT OF RECTAL PROLAPSE 2016. Retrieved publications were limited to the English to final publication. After initial completion of the article, language and human participants. The search strategies the entire committee reviewed and edited it. Final recom- were based on the concepts of rectal prolapse and internal mendations were approved by the ASCRS Chairman and intussusception as primary search terms. Searches were Vice Chairman of the Clinical Practice Guidelines Com- also performed based on various treatments for rectal mittee and then ultimately the Executive Council. prolapse, including rectopexy, suture rectopexy, resection rectopexy, ventral rectopexy, D’Hoore rectopexy, Delorme Evaluation of Rectal Prolapse procedure, and Altemeier procedure. An initial search identified 781 unique citations. These were ultimately 1. The initial evaluation of a patient with rectal prolapse categorized into subsets (see Table, Supplemental Digital should include a complete history and physical examina- Content 1, http://links.lww.com/DCR/A390). Directed tion with focus on the prolapse, on anal sphincter struc- searches of the embedded references from the primary ar- ture and function, and on concomitant symptoms and ticles were also performed in certain circumstances. Pro- underlying conditions. Recommendation: strong recom- spective, randomized controlled trials and meta-analyses mendation based on low-quality evidence, 1C. were given preference in developing these guidelines. Ul- A careful history and physical examination should be per- timately, 172 articles were carefully reviewed, and articles formed before considering any operative intervention. If a with poor control subjects or unclear study end points patient’s history suggests the diagnosis but no prolapse is were excluded. The final guideline was created using 110 detected on physical examination, the patient can be asked unique citations listed in the references below. The fi- to reproduce the prolapse by straining while on a toilet nal grade of recommendation was performed using the with or without the use of an enema or a rectal balloon. Grades of Recommendation, Assessment, Development, The perineum can then be inspected with the patient in and Evaluation system (Table 1).18 A panel of members the sitting or squatting position. One should be careful, of the ASCRS Clinical Practice Guidelines Committee however, to avoid confusing rectal prolapse with pro- worked in production of these guidelines from inception lapsing internal hemorrhoids or rectal mucosal prolapse. TABLE 1. The GRADE system: grading recommendations Benefit versus Methodologic quality Description risk and burdens of supporting evidence Implications 1A Strong recommendation, Benefits clearly outweigh risks RCTs without important Strong recommendation, can high-quality evidence and burdens or vice versa limitations or overwhelming apply to most patients in evidence from observational most circumstances without studies reservation 1B Strong recommendation, Benefits clearly outweigh risks RCTs with important limitations Strong recommendation, can moderate-quality and burdens or vice versa (inconsistent results, apply to most patients in evidence methodologic flaws, indirect most circumstances without or imprecise) or exceptionally reservation strong evidence from observational studies 1C Strong recommendation, Benefits clearly outweigh risks Observational studies or case Strong recommendation but low- or very low-quality and burdens or vice versa series may change when higher- evidence quality evidence becomes available 2A Weak recommendation, Benefits closely balanced with RCTs without important Weak recommendation, best high-quality evidence risks and burdens limitations or overwhelming action may differ depending evidence from observational on circumstances or patient studies or societal values 2B Weak recommendation, Benefits closely balanced with RCTs with important limitations Weak recommendation, best moderate-quality risks and burdens (inconsistent results, action may differ depending evidence methodologic flaws, indirect on circumstances or patient or imprecise) or exceptionally or societal values strong evidence from observational studies 2C Weak recommendation, Uncertainty in the estimates of Observational studies or case Very weak recommendations; low- or very low-quality benefits, risks and burdens; series other alternatives may be evidence benefits, risks, and burdens equally reasonable may be closely balanced Adapted with permission from Chest. 2006;129:174–181.18 GRADE = Grades of Recommendation, Assessment, Development, and Evaluation; RCT = randomized controlled trial. Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. DISEASES OF THE COLON & RECTUM VOLUME 60: 11 (2017) 1123 Full-thickness rectal
Load more

Recommended publications
  • 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.
    [Show full text]
  • Inflammatory Bowel Disease Irritable Bowel Syndrome
    Inflammatory Bowel Disease and Irritable Bowel Syndrome Similarities and Differences 2 www.ccfa.org IBD Help Center: 888.MY.GUT.PAIN 888.694.8872 Important Differences Between IBD and IBS Many diseases and conditions can affect the gastrointestinal (GI) tract, which is part of the digestive system and includes the esophagus, stomach, small intestine and large intestine. These diseases and conditions include inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). IBD Help Center: 888.MY.GUT.PAIN 888.694.8872 www.ccfa.org 3 Inflammatory bowel diseases are a group of inflammatory conditions in which the body’s own immune system attacks parts of the digestive system. Inflammatory Bowel Disease Inflammatory bowel diseases are a group of inflamma- Causes tory conditions in which the body’s own immune system attacks parts of the digestive system. The two most com- The exact cause of IBD remains unknown. Researchers mon inflammatory bowel diseases are Crohn’s disease believe that a combination of four factors lead to IBD: a (CD) and ulcerative colitis (UC). IBD affects as many as 1.4 genetic component, an environmental trigger, an imbal- million Americans, most of whom are diagnosed before ance of intestinal bacteria and an inappropriate reaction age 35. There is no cure for IBD but there are treatments to from the immune system. Immune cells normally protect reduce and control the symptoms of the disease. the body from infection, but in people with IBD, the immune system mistakes harmless substances in the CD and UC cause chronic inflammation of the GI tract. CD intestine for foreign substances and launches an attack, can affect any part of the GI tract, but frequently affects the resulting in inflammation.
    [Show full text]
  • 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.
    [Show full text]
  • Delayed Presentation of a Retained Fecalith
    Open Access Case Report DOI: 10.7759/cureus.15919 Delayed Presentation of a Retained Fecalith Fawwad A. Ansari 1 , Muhammad Ibraiz Bilal 1 , Muhammad Umer Riaz Gondal 1 , Mehwish Latif 2 , Nadeem Iqbal 2 1. Medicine, Shifa International Hospital, Islamabad, PAK 2. Gastroenterology, Shifa International Hospital, Islamabad, PAK Corresponding author: Fawwad A. Ansari, [email protected] Abstract A fecalith is a common cause of acute appendicitis, and laparoscopic surgery is the mainstay of its management. Literature review shows that a fecalith may be retained in the gut following a laparoscopic appendectomy in some rare cases. In most cases, the fecalith becomes symptomatic with time due to the formation of an abscess, fistulous tract, or inflammation of the appendicular stump (stump appendicitis). We report a case of retained appendicular fecalith presenting with symptoms similar to acute appendicitis, 15 years after laparoscopic appendectomy. Categories: Gastroenterology, General Surgery Keywords: colonoscopy, acute appendicitis, appendectomy, fecalith, right iliac fossa pain, complications Introduction A fecalith is a hard stony mass of feces in the intestinal tract. Fecal impaction occurs when a large amount of fecal matter gets compacted and cannot get evacuated spontaneously [1]. In its extreme form, fecal impaction can lead to the formation of a fecalith due to the hardening of fecal material that forms a mass separate from other bowel contents [2]. It can occur in any part of the intestine [1]. Most often, a fecalith arises in the colon (mostly sigmoid) or rectum and very rarely in the small intestine [2]. Here we present a case of a retained appendicular fecalith in a patient who presented with an acute abdomen.
    [Show full text]
  • Gastroenterology and the Elderly
    3 Gastroenterology and the Elderly Thomas W. Sheehy 3.1. Esophagus 3.1.1. Dysphagia Esophageal disorders, such as esophageal motility disorders, infections, tumors, and other diseases, are common in the elderly. In the elderly, dysphagia usually implies organic disease. There are two types: (1) pre-esophageal and (2) esophageal. Both are further subdivided into motor (neuromuscular) or structural (intrinsic and extrinsic) lesions.! 3.1.2. Pre-esophageal Dysphagia Pre-esophageal dysphagia (PED) usually implies neuromuscular disease and may be caused by pseudobular palsy, multiple sclerosis, amy trophic lateral scle­ rosis, Parkinson's disease, bulbar poliomyelitis, lesions of the glossopharyngeal nerve, myasthenia gravis, and muscular dystrophies. Since PED is due to inability to initiate the swallowing mechanism, food cannot escape from the oropharynx into the esophagus. Such patients usually have more difficulty swallowing liquid THOMAS W. SHEEHY • The University of Alabama in Birmingham, School of Medicine, Department of Medicine; and Medical Services, Veterans Administration Medical Center, Birming­ ham, Alabama 35233. 87 S. R. Gambert (ed.), Contemporary Geriatric Medicine © Plenum Publishing Corporation 1983 88 THOMAS W. SHEEHY than solids. They sputter or cough during attempts to swallow and often have nasal regurgitation or aspiration of food. 3.1.3. Dysfunction of the Cricopharyngeus Muscle In the elderly, this is one of the more common forms of PED.2 These patients have the sensation of an obstruction in their throat when they attempt to swallow. This is due to incoordination of the cricopharyngeus muscle. When this muscle fails to relax quickly enough during swallowing, food cannot pass freely into the esophagus. If the muscle relaxes promptly but closes too quickly, food is trapped as it attempts to enter the esophagus.
    [Show full text]
  • Constipation
    Constipation Caris Diagnostics Health Improvement Series What is constipation? Constipation means that a person has three bowel movements or fewer in a week. The stool is hard and dry. Sometimes it is painful to pass. You may feel‘draggy’and full. Some people think they should have a bowel movement every day. That is not really true. There is no‘right’number of bowel movements. Each person's body finds its own normal number of bowel movements. It depends on the food you eat, how much you exercise, and other things. At one time or another, almost everyone gets constipated. In most cases, it lasts for a short time and is not serious. When you understand what causes constipation, you can take steps to prevent it. What can I do about constipation? Changing what you 4. Allow yourself enough time to have a bowel movement. eat and drink and how much you exercise will help re- Sometimes we feel so hurried that we don't pay atten- lieve and prevent constipation. Here are some steps you tion to our body's needs. Make sure you don't ignore the can take. urge to have a bowel movement. 1. Eat more fiber. Fiber helps form soft, bulky stool. It 5. Use laxatives only if a doctor says you should. is found in many vegetables, fruits, and grains. Be sure Laxatives are medicines that will make you pass a stool. to add fiber a little at a time, so your body gets used to Most people who are mildly constipated do not need it slowly.
    [Show full text]
  • Case Studies of Two Cystic Fibrosis Patients with Distal Intestinal Obstruction Syndrome (DIOS) and a Literature Review
    Case report Case Studies of Two Cystic Fibrosis Patients with distal intestinal obstruction syndrome (DIOS) and a Literature review Johanna Pacheco A., MD,1 Olga Morales M., MD,2 Alejandra Wilches L., MD.3 1 Pediatrician from the University of Antioquia, Abstract Master’s Degree Student in Pediatric Clinical Nutrition at INTA in Chile Patients with cystic fibrosis (CF) have greater than normal mucosal viscosity and prolonged intestinal transit 2 Pediatric Pulmonologist in the Faculty of Medicine at times which can result in meconium ileus, distal intestinal obstruction syndrome (DIOS) and constipation of the University of Antioquia in Medellin, Colombia varying severity. 3 Pediatric Gastroenterologist at San Vicente Fundación Hospital Universitario in Medellín, The cystic fibrosis working group of the European Society of Gastroenterology, Hepatology and Pediatric Colombia Nutrition produced a consensus in 2010 that defined distal intestinal obstruction syndrome (DIOS) as acute intestinal obstruction which may be complete or incomplete. Fully developed DIOS is defined as bilious vo- The cases reported here were treated at San Vicente Fundación Hospital Universitario in Medellín, miting and/or sufficient amounts of fluid and air in the small intestine to be observed in an abdominal X-ray, a Colombia. fecal mass in the ileocecal area, pain and/or bloating. Incomplete DIOS is defined as abdominal pain and/or No financial resources or other resources from any bloating and fecal mass in the ileocecal area, but without the other signs of complete obstruction. Colombian or international entity were received for this research. The incidence of this condition in cystic fibrosis patients varies. Depending on the definition used, the preva- lence of DIOS has been measured between 7% and 8% in children with cystic fibrosis, but has been reported ........................................
    [Show full text]
  • Uterine Prolapse Treatment Without Hysterectomy
    Uterine Prolapse Treatment Without Hysterectomy Authored by Amy Rosenman, MD Can The Uterine Prolapse Be Treated Without Hysterectomy? A Resounding YES! Many gynecologists feel the best way to treat a falling uterus is to remove it, with a surgery called a hysterectomy, and then attach the apex of the vagina to healthy portions of the ligaments up inside the body. Other gynecologists, on the other hand, feel that hysterectomy is a major operation and should only be done if there is a condition of the uterus that requires it. Along those lines, there has been some debate among gynecologists regarding the need for hysterectomy to treat uterine prolapse. Some gynecologists have expressed the opinion that proper repair of the ligaments is all that is needed to correct uterine prolapse, and that the lengthier, more involved and riskier hysterectomy is not medically necessary. To that end, an operation has been recently developed that uses the laparoscope to repair those supporting ligaments and preserve the uterus. The ligaments, called the uterosacral ligaments, are most often damaged in the middle, while the lower and upper portions are usually intact. With this laparoscopic procedure, the surgeon attaches the intact lower portion of the ligaments to the strong upper portion of the ligaments with strong, permanent sutures. This accomplishes the repair without removing the uterus. This procedure requires just a short hospital stay and quick recovery. A recent study from Australia found this operation, that they named laparoscopic suture hysteropexy, has excellent results. Our practice began performing this new procedure in 2000, and our results have, likewise, been very good.
    [Show full text]
  • Food and Ibd Condition Your Guide Introduction
    CROHN’S & COLITIS UK SUPPORTING YOU TO MANAGE YOUR FOOD AND IBD CONDITION YOUR GUIDE INTRODUCTION ABOUT THIS BOOKLET If you have Ulcerative Colitis (UC) or Crohn’s Disease (the two main forms of Inflammatory Bowel Disease - IBD) you may wonder whether food or diet plays a role in causing your illness or treating your symptoms. This booklet looks at some of the most frequently asked questions about food and IBD, and provides background information on digestion and healthy eating for people with IBD. We hope you will find it helpful. All our publications are research based and produced in consultation with patients, medical advisers and other health or associated professionals. However, they are prepared as general information and are not intended to replace specific advice from your own doctor or any other professional. Crohn’s and Colitis UK does not endorse or recommend any products mentioned. If you would like more information about the sources of evidence on which this booklet is based, or details of any conflicts of interest, or if you have any feedback on our publications, please visit our website. About Crohn’s and Colitis UK We are a national charity established in 1979. Our aim is to improve life for anyone affected by Inflammatory Bowel Diseases. We have over 28,000 members and 50 local groups throughout the UK. Membership costs from £15 per year with concessionary rates for anyone experiencing financial hardship or on a low income. This publication is available free of charge, but we © Crohn’s and Colitis UK would not be able to do this without our supporters 2015 and 2016 and members.
    [Show full text]
  • Therapeutic Enema for Intussusception
    Therapeutic Enema for Intussusception Therapeutic enema is used to help identify and diagnose intussusception, a serious disorder in which one part of the intestine slides into another in a telescoping manner and causes inflammation and an obstruction. Intussusception often occurs at the junction of the small and large intestine and most commonly occurs in children three to 24 months of age. A therapeutic enema using air or a contrast material solution may be performed to create pressure within the intestine and "un-telescope" the intussusception while relieving the obstruction. This exam is usually performed on an emergency basis. Tell your doctor about your child's recent illnesses, medical conditions, medications and allergies, especially to barium or iodinated contrast materials. Your child may be asked to wear a gown and remove any objects that might interfere with the x-ray images. An ultrasound may be performed to help confirm the diagnosis. What is a Therapeutic Enema for Intussusception? What is intussusception? Intussusception is a serious disorder in which one part of the intestine slides into another part of the intestine, similar to a collapsing telescope. The intestine becomes inflamed and swollen and can cause an obstruction or blockage. Symptoms can include severe abdominal pain, fever, vomiting or abnormal stools. Intussusception may occur anywhere along the gastrointestinal tract; however, it often occurs at the junction of the small and large intestine. The condition most commonly occurs in children three months to 24 months of age. Intussusception is a medical/surgical emergency. If your child has some or all of the symptoms of intussusception, you should call your physician or an emergency medical professional immediately.
    [Show full text]
  • Prolapse of the Rectum J
    Postgrad Med J: first published as 10.1136/pgmj.40.461.125 on 1 March 1964. Downloaded from POSTGRAD. MED J. (I964), 40, 125 PROLAPSE OF THE RECTUM J. C. GOLIGHER, CH.M., F.R.C.S. Professor of Surgery, University of Leeds; Surgeon, The General Infirmary at Leeds PROLAPSE of the rectum is a rare, somewhat rectum, as of the uterus, especially if there had misunderstood and neglected condition, which is been a rapid succession of pregnancies. It is a fact, generally held to occur at the extremes of life. moreover, that the majority of women with rectal XVe are almost totally ignorant of its cause. prolapse have borne children, but the proportion Misconceptions regarding its clinical presentation of parous to non-parous patients is probably a are common. Its management is confused for the good deal less than in the general female population average surgeon-who sees relatively few of of the same age distribution. The striking thing these cases-by the availability for its treatment really is the relatively large number of unmarried of a multitude of methods, the merits of which and childless women who present with rectal are hotly disputed by experts. Finally its prognosis, prolapse. Though vaginal or uterine prolapse may when it afflicts adults, is often considered to be be associated with prolapse of the rectum, par- very poor even with treatment, a state of affairs ticularly where there is a history of numerous or that is accepted with some measure of complacency difficult confinements, not more than io% of my because of the frequent belief that the sufferers female patients with rectal prolapse have been so are usually nearing the end of their life-span and complicated.
    [Show full text]
  • A Case of Solitary Rectal Diverticulum Presenting with a Large Retrorectal Abscess T
    Annals of Medicine and Surgery 49 (2020) 57–60 Contents lists available at ScienceDirect Annals of Medicine and Surgery journal homepage: www.elsevier.com/locate/amsu Case report A case of solitary rectal diverticulum presenting with a large retrorectal abscess T ∗ Stefanos Gorgoraptisa,Sofia Xenakia, ,1, Elias Athanasakisa, Anna Daskalakia, Konstantinos Lasithiotakisa, Evangelia Chrysoub, Emmanuel Chrysosa a Department of General Surgery, University Hospital of Heraklion Crete, Greece b Department of Radiology, University Hospital of Heraklion Crete, Greece ARTICLE INFO ABSTRACT Keywords: Colonic diverticular disease is a common condition, affecting 50% of the population aged above 80. In contrast, Rectal diverticulum rectal diverticular disease is a rare condition with very few cases reported, while symptomatic rectal diverticular Abscess disease is even rarer. We present a case of a symptomatic large rectal diverticulum presenting with a retrorectal Diverticulitis abscess. A 49-year-old Caucasian female was brought to the emergency department complaining of abdominal Complications pain and weakness in the lower limbs. She was found to have obstructive uropathy and unilateral sciatic neu- ropathy. She rapidly developed acute abdomen and emergency laparotomy revealed a giant purulent rectal diverticulum. The patient underwent exploratory laparotomy and a loop colostomy was made to decompress the colon. 1. Introduction Neurologic examination revealed asymmetric paraparesis and hy- poesthesia in the lower limbs, affecting hip extension, knee flexion, Despite the high incidence of colonic diverticular disease, the oc- ankle dorsiflexion, plantarflexion, eversion and big toe extension, with currence of rectal diverticula is extremely unusual, with only few, brisk tendon reflexes in the knees but absent in the ankle, in keeping sporadic published reports since 1911 [11].
    [Show full text]