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Cureus Nov 2021This prospective study aimed to determine the outcomes and postoperative complications of hemorrhoid disease (HD) treated by hemorrhoidal laser procedure (HeLP).
AIM
This prospective study aimed to determine the outcomes and postoperative complications of hemorrhoid disease (HD) treated by hemorrhoidal laser procedure (HeLP).
BACKGROUND
We, herein report the results of 18 months of methodical use of mini-invasive laser procedures in 100 patients with grades 2 and 3 hemorrhoids and minimum to a mild degree of rectal prolapse. The surgical technique is called HeLP.
METHODS
Data were collected on the duration of the procedure, intraoperative complications, postoperative pain, the declivity of hemorrhoids, persistency or complete resolution, and recurrence of hemorrhoids were collected prospectively.
RESULTS
No evidence of intraoperative complications occurred. The median follow-up was nine months. Postoperative pain was not significant or null in most patients. There was no rectal tenesmus or alteration of defecation habits. Plateau of hemorrhoid symptoms and downgrading of hemorrhoid size reached approximately three to seven months post-procedure. The frequency of pain, bleeding, pruritus ani, and acute hemorrhoidal syndrome decreased by 75-80%. There was a significant reduction in hemorrhoids with the rate of recurrence being 7% over 12 months of follow-up.
CONCLUSION
Our study evaluated and demonstrated that HeLP is an effective, safe, and non-painful procedure for the management of patients with the symptomatic second or third degree of hemorrhoid with mild to the minimum degree of rectal mucosal prolapse. It is a suitable ambulatory treatment.
PubMed: 34804743
DOI: 10.7759/cureus.19497 -
Journal of the American Veterinary... Nov 2021A 4-month-old 4.2 kg sexually intact female mixed-breed dog was evaluated for rectal and vesicular tenesmus, intermittent rectal prolapse, fecal incontinence, and an...
CASE DESCRIPTION
A 4-month-old 4.2 kg sexually intact female mixed-breed dog was evaluated for rectal and vesicular tenesmus, intermittent rectal prolapse, fecal incontinence, and an anogenital cleft.
CLINICAL FINDINGS
Rectal prolapse and an anogenital cleft were confirmed on physical examination. Results of a CBC and serum biochemical analysis were within respective reference ranges, and abdominal ultrasonography revealed no abnormalities. Urinalysis revealed evidence of a urinary tract infection.
TREATMENT AND OUTCOME
An H-perineoplasty was performed and the prolapse was reduced. The repair partially dehisced and was repaired (with concurrent reduction of a recurrent rectal prolapse) but dehisced again. There was limited tissue available for additional reconstruction. In another surgical procedure, the rectum was allowed to prolapse, the most dorsal 40% of the prolapsed rectal tissue was resected, and the rectal tissue margin and skin in this region were apposed. The remaining rectal tissue flap was folded ventrally, and the lateral margins of the aborad aspect were sutured to the dorsolateral vestibular mucosa. In a subsequent surgery, 2.5 to 3 cm of the rectal tissue flap was excised. The remainder was used to create ventral margins for the rectum and vestibular mucosa. The perineal skin between the anus and dorsal vulvar commissure was closed. The patient experienced mild cutaneous partial dehiscence of the repair that healed by second intention. Over an 18-month follow-up period, some fecal incontinence persisted, but straining resolved and urinary tract infection did not recur.
CLINICAL RELEVANCE
For the dog of this report, the use of rectal mucosa in surgical repair of an anogenital cleft provided an acceptable clinical outcome.
Topics: Animals; Dog Diseases; Dogs; Fecal Incontinence; Female; Perineum; Plastic Surgery Procedures; Rectal Prolapse; Rectum; Treatment Outcome
PubMed: 34793324
DOI: 10.2460/javma.20.10.0575 -
Annals of Palliative Medicine Oct 2021Melanoma is derived from malignancies of melanocytes. Anorectal melanoma differs significantly from cutaneous melanoma in clinical presentation, genetic profile, staging...
Melanoma is derived from malignancies of melanocytes. Anorectal melanoma differs significantly from cutaneous melanoma in clinical presentation, genetic profile, staging system, and response to treatment. Anorectal melanoma is seldom diagnosed because most melanoma occurrences are found in the skin tissues. Here, we report 1 case of advanced anorectal melanoma, including its clinical presentation, laboratory findings, imaging, surgical treatment, and pathology. The patient complained of hematochezia and tenesmus. Colonoscopy, computed tomography (CT) scan and digital rectal examination (DRE) revealed a mass near the pectinate line. The patient underwent proctectomy along with colostomy, and subsequent pathological examinations suggested anorectal melanoma with serosa involvement (positive markers: S100, HMB-45, etc.). Evidence-based analyses (single-nucleotide polymorphism (SNPs) and programmed death-ligand 1 (PD-L1) expression) were conducted on the tumor tissue to identify the sensitivity to adjuvant therapies. SNP tests suggested no definite efficacies of commonly used chemotherapeutic agents, with PD-L1 expression implying poor sensitivity to PD-L1 inhibitors. The postoperative recovery was uneventful and the patient was discharged on day 7 after admission. However, the patient refused adjuvant therapies and died 11 months after surgery. In conclusion, anorectal melanoma tends to be mistaken for other common diseases in this region owing to its non-specific clinical presentations. Multidisciplinary treatments are recommended to yield the best possible outcome, despite poor prognosis.
Topics: Anus Neoplasms; B7-H1 Antigen; Chemotherapy, Adjuvant; Drug Resistance, Neoplasm; Fatal Outcome; Humans; Immune Checkpoint Inhibitors; Melanoma; Precision Medicine; Rectal Neoplasms; Skin Neoplasms
PubMed: 34763479
DOI: 10.21037/apm-21-2240 -
Cureus Sep 2021Neuroendocrine prostate cancer (NEPC) is a rare entity representing 1% of all prostate malignancies, associated with poor prognosis and often concomitant with...
Neuroendocrine prostate cancer (NEPC) is a rare entity representing 1% of all prostate malignancies, associated with poor prognosis and often concomitant with paraneoplastic syndromes such as Cushing's syndrome (CS) with ectopic adrenocorticotropic hormone (ACTH) production. We present a case of a 56-year-old man with recent lower urinary tract symptoms hospitalized for pelvic pain, rectal tenesmus, and fatigue. A CT scan documented a large prostatic mass, adenomegalies, and hepatic lesions. Bone scintigraphy showed dispersed osteoblastic metastization. The patient had uncontrolled hypertension and hypokalemia that lead to the diagnosis of paraneoplastic ACTH-dependent CS. Prostate biopsy confirmed small cell NEPC. Potassium supplementation, anti-hypertensive medication, and metyrapone were initiated. The patient was proposed for palliative chemotherapy but died within a few days from a urinary tract infection. The authors aim to draw attention to a case of paraneoplastic CS, a rare manifestation, within the rarity that is NEPC.
PubMed: 34703694
DOI: 10.7759/cureus.18160 -
The American Journal of Case Reports Oct 2021BACKGROUND Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the... (Review)
Review
BACKGROUND Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the diagnosis is often made late. Surgical resection remains the criterion standard for treatment of anorectal melanoma. CASE REPORT We present the case of an 81-year-old woman presenting with hematochezia, anal secretion, tenesmus, difficulty in defecation, and perianal pain. On physical examination, there was a prolapse of a 5-cm melanocytic nodule in the anal canal, hard on palpation. Biopsy confirmed anorectal melanoma. Staging revealed anal and metastatic disease, with adrenal, lymphatic, and hepatic involvement. As the patient continued to have bleeding, severe pain, and difficulty in defecation, she was submitted to a wide local excision. At 5-month follow-up, the anal lesion had relapsed, and the patient died 10 months after the procedure. CONCLUSIONS AMM is a rare and extremely aggressive tumor. Symptoms are nonspecific but early diagnosis should be pursued to allow curative treatment. Surgical resection with free margins is the goal of surgical treatment. New therapies are being studied, including immunotherapy, which can improve the dismal prognosis of this rare disease.
Topics: Aged, 80 and over; Anal Canal; Anus Neoplasms; Female; Humans; Melanoma; Neoplasm Staging; Rectal Neoplasms; Rectum
PubMed: 34699518
DOI: 10.12659/AJCR.933032 -
BMC Gastroenterology Oct 2021Gastrointestinal hemangiomas are very rare and are even rarer in the mesorectum. It is not clear whether mesorectal hemangiomas originate in the bowel wall or in the...
BACKGROUND
Gastrointestinal hemangiomas are very rare and are even rarer in the mesorectum. It is not clear whether mesorectal hemangiomas originate in the bowel wall or in the mesorectum. For clinicians, to correctly identify the imaging features of mesorectal hemangiomas is important.
CASE PRESENTATION
We herein describe a case of a 31-year-old male that presented with hematochezia and sensation of rectal tenesmus. Both the rectal MRI and contrast-enhanced CT scan of the whole abdomen indicated rectal wall thickening, marked dilatation, and tortuous vessels around the rectum. In addition, a contrast-enhanced portal venous phase CT scan showed the dilation of portal vein, splenic vein and inferior mesenteric vein. The dilated inferior mesenteric vein extending down to the mesorectum, and became marked dilatation and tortuous vessels around the rectum. The patient underwent laparoscopic surgical resection of the mesorectal lesion and the involved portions of the rectum. The surgical samples underwent pathological analysis, and a diagnosis of cavernous hemangioma was confirmed. Seven days after surgery, the patient was discharged without postoperative complications.
CONCLUSIONS
This case highlights the imaging features of mesorectal hemangiomas. In addition, in this current case, the mesorectal hemangioma more likely originated in the mesorectum.
Topics: Adult; Hemangioma, Cavernous; Humans; Laparoscopy; Magnetic Resonance Imaging; Male; Rectal Neoplasms; Rectum
PubMed: 34654369
DOI: 10.1186/s12876-021-01949-5 -
BMJ Case Reports Oct 2021The article presents a series of four patients with primary anorectal melanoma presenting to our institute between 2016 and 2021. The primary objective of the series is...
The article presents a series of four patients with primary anorectal melanoma presenting to our institute between 2016 and 2021. The primary objective of the series is to give an overview of the variable presentation of this rare entity from a high-volume colorectal tertiary care centre in a developing country. The patients ranged in age from 55 to 73 years and were mostly women (except one). The clinical presentation varied from bleeding per rectum to tenesmus and mucus in stools, overlapping with those of inflammatory bowel disease and primary anorectal adenocarcinoma. All patients were treated with surgery (laparoscopic or open), ranging from local excision to abdominoperineal resection. All our patients had a good outcome after surgery with no mortality at 30 or 90 days after surgery. The article aims to present a comprehensive overview of the various options of management with evidence from the surgical literature.
Topics: Adenocarcinoma; Aged; Female; Humans; Melanoma; Middle Aged; Rectal Neoplasms; Rectum; Skin Neoplasms
PubMed: 34598968
DOI: 10.1136/bcr-2021-245449 -
Przeglad Gastroenterologiczny 2021Ulcerative colitis is a chronic inflammatory bowel disease of the colon. The most frequent symptoms include bloody diarrhoea with rectal urgency and tenesmus. It is... (Review)
Review
Ulcerative colitis is a chronic inflammatory bowel disease of the colon. The most frequent symptoms include bloody diarrhoea with rectal urgency and tenesmus. It is often complicated by the presence of primary sclerosing cholangitis, a chronic, cholestatic liver disease, characterised by the inflammation and fibrosis of bile ducts. The presence of primary sclerosing cholangitis seems to alter the course of ulcerative colitis, changing its natural course.
PubMed: 34584578
DOI: 10.5114/pg.2021.108983 -
The American Journal of Case Reports Sep 2021BACKGROUND Xanthogranulomatous prostatitis is rare, with no more than 10 to 15 cases reported to date. The presentation typically includes lower urinary tract or lower...
BACKGROUND Xanthogranulomatous prostatitis is rare, with no more than 10 to 15 cases reported to date. The presentation typically includes lower urinary tract or lower urinary tract infection symptoms. The present case report describes a 65-year-old man diagnosed with xanthogranulomatous prostatitis after a prolonged course of atypical symptoms. Symptom remission was achieved with low-dose Cymbalta and 6 weeks of ciprofloxacin. CASE REPORT A 65-year-old man had a 1-year history of pelvic floor disorder, including treatment-resistant tenesmus and rectal and perineal pain. The patient eventually developed a reduced urinary steam with urinary retention. On digital rectal examination, his prostate was non-tender and had significant firmness on the left side. Magnetic resonance imaging of the prostate with and without contrast showed a Prostate Imaging-Reporting and Data Stem 5 lesion involving the left peripheral zone of the prostate with diffuse enhancement and low signal throughout the gland. Suspicious adjacent lymphadenopathy also was present. The patient's prostate-specific antigen level was within the normal range at 2.4 ng/mL. All 13 left prostatic biopsy specimens showed acute and chronic inflammatory changes with prominent xanthogranulomatous features and without evidence of necrosis. All of the patient's symptoms, including pain, resolved after he started taking Cymbalta and completed a 6-week course of ciprofloxacin. CONCLUSIONS The present case report describes an atypical presentation of xanthogranulomatous prostatitis, which started with symptoms of pelvic floor disorder that preceded urinary symptoms by at least 1 year. The patient's symptoms improved after he started taking Cymbalta and completed a 6-week course of ciprofloxacin, 500 mg twice daily, and without concurrent treatment with an alpha blocker, corticosteroids, or pelvic floor therapy.
Topics: Aged; Humans; Magnetic Resonance Imaging; Male; Prostatitis; Rare Diseases; Urinary Tract Infections
PubMed: 34475372
DOI: 10.12659/AJCR.932869 -
Journal of Gastrointestinal and Liver... Aug 2021A 49-years-old woman with a recent history of tenesmus, constipation, abdominal and rectal pain referred to our Unit. There was no previous history of rectal bleeding or...
A 49-years-old woman with a recent history of tenesmus, constipation, abdominal and rectal pain referred to our Unit. There was no previous history of rectal bleeding or a family history of gastrointestinal diseases. Laboratory tests showed haemoglobin 10.9 g/dl, MCV 72fl, ferritin 18 U/l. Physical examination was normal. The patient underwent a colonoscopy which identified a single ulcer of 2.5 cm of diameter without bleeding signs in the distal rectum, 4 cm from the anal margin. Histopathological examination revealed shallow ulceration with fibrosis in lamina propria. We decided to treat the ulcer with one application of Purastat. Four weeks later, a follow-up colonoscopy revealed a complete mucosal healing with only mild residual mucosal erythema. Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon benign proctologic disease usually affecting young adults with a prevalence of 1:100.000 per year, equally affecting women and men with a slight predominance in young women. SRUS is characterized by chronic rectal pain and bleeding, constipation, incomplete evacuation, tenesmus and mucous discharge impairing the patients' quality of life. In past years several topical agents have been used reporting clinical improvements, also if none of them has been evaluated in prospective controlled trials. Purastat (3D-Matrix Europe SAS, France) is a novel self-assembling peptide developed as a haemostatic agent for endoscopic and surgical procedures. In addition to the known haemostatic effect, it has been hypothesized that the activated Purastat nanostructure favors the cell and tissue proliferative process since the similarity of the activated Purastat 3-D nanostructure with the natural extracellular matrix (ECM-SM) scaffold material would result in an adequate adherence of cells and regenerative tissues, achieving more effective healing of the mucosa. Based on this hypothetical re-epithelizing property of Purastat, we decided to use it in this patient, achieving mucosal healing and symptoms improvement.
PubMed: 34375377
DOI: 10.15403/jgld-3680