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Clinics in Colon and Rectal Surgery Feb 2017Paradoxical puborectalis contraction (PPC) and increased perineal descent (IPD) are subclasses of obstructive defecation. Often these conditions coexist, which can make... (Review)
Review
Paradoxical puborectalis contraction (PPC) and increased perineal descent (IPD) are subclasses of obstructive defecation. Often these conditions coexist, which can make the evaluation, workup, and treatment difficult. After a thorough history and examination, workup begins with utilization of proven diagnostic modalities such as cinedefecography and anal manometry. Advancements in technology have increased the surgeon's diagnostic armamentarium. Biofeedback and pelvic floor therapy have proven efficacy for both conditions as first-line treatment. In circumstances where PPC is refractory to biofeedback therapy, botulinum toxin injection is recommended. Historically, pelvic floor repair has been met with suboptimal results. In IPD, surgical therapy now is directed toward the potentially attendant abnormalities such as rectoanal intussusception and rectal prolapse. When these associated abnormalities are not present, an ostomy should be considered in patients with IPD as well as medically refractory PPC.
PubMed: 28144209
DOI: 10.1055/s-0036-1593430 -
International Journal of Surgery Case... Mar 2024Locally advanced rectal cancer (LARC) is commonly managed with neoadjuvant chemoradiation (neoCRT) followed by surgery, though not without complications. The anatomical...
INTRODUCTION
Locally advanced rectal cancer (LARC) is commonly managed with neoadjuvant chemoradiation (neoCRT) followed by surgery, though not without complications. The anatomical exposure of the colon and rectum and pelvic radiotherapy poses risk, with rectal perforation and bowel obstruction, though rare, carrying life-threatening potential.
PRESENTATION OF CASE
This case highlights an exceptionally rare occurrence of concurrent rectal perforation and rectal obstruction in a 77-year-old male with LARC, just two months post neoCRT. Initial symptoms included rectal bleeding, and diagnostic procedures confirmed rectal T1N3adenocarcinoma with no metastasis. Emergency admission, prompted by complete bowel obstruction symptoms, led to discovery of rectal perforation during laparotomy, sealed by the bladder. Pathological analysis attributed the cause to radiation proctitis, reporting complete response to neoCRT with no residual tumor.
DISCUSSION
The rarity of both bowel obstruction and perforation as neoCRT complications, particularly in the acute phase of radiation proctitis, is noteworthy in this case. The absence of tumoral cells at the affected sites emphasizes the exceptional nature of this case.
CONCLUSION
This case underscores the importance of recognizing acute post neoCRT injuries as potentially life-threatening complications, emphasizing the need for heightened awareness and consideration in clinical management.
PubMed: 38310787
DOI: 10.1016/j.ijscr.2024.109337 -
Annals of Surgery Jun 1971
Topics: Adult; Aged; Biopsy; Colectomy; Colon, Sigmoid; Colonic Neoplasms; Colostomy; Female; Humans; Intestinal Obstruction; Intestinal Perforation; Laparotomy; Male; Middle Aged; Palliative Care; Rectal Neoplasms
PubMed: 4102925
DOI: 10.1097/00000658-197106010-00017 -
Frontiers in Surgery 2024
PubMed: 38586240
DOI: 10.3389/fsurg.2024.1400636 -
Clinics in Colon and Rectal Surgery Dec 2015The management of complicated colon cancer (locally invasive, obstructed, or perforated cancers) can pose diagnostic and therapeutic challenges to surgical management.... (Review)
Review
The management of complicated colon cancer (locally invasive, obstructed, or perforated cancers) can pose diagnostic and therapeutic challenges to surgical management. Adherence to traditional surgical oncologic principles must often be balanced with the patients' clinical presentation and other parameters. While the goal of an R0 (no residual microscopic disease) resection must always be kept in mind, situations sometimes arise which can make this difficult to achieve. Recognition of complicated disease and availability of varied therapeutic modalities is important to ensure favorable patient outcomes. This review will discuss the surgical management of complicated colon cancer, with special focus on locally advanced disease.
PubMed: 26648793
DOI: 10.1055/s-0035-1564621 -
International Urogynecology Journal Nov 2021The current study was aimed at investigating the safety, efficiency, and durability of transvaginal sacrospinous ligament suture rectopexy in women with obstructed...
INTRODUCTION AND HYPOTHESIS
The current study was aimed at investigating the safety, efficiency, and durability of transvaginal sacrospinous ligament suture rectopexy in women with obstructed defecation symptoms (ODS) and significant rectal hypermobility/folding.
METHODS
This was a prospective case series study performed during December 2018 to July 2020. Women presenting to our center with pelvic organ prolapse electing for surgical treatment were screened for ODS utilizing the PFDI-20 questionnaire. Patients were eligible for inclusion if they reported OD symptoms accompanying >50% of bowel movements (BMs), BM frequency ≥3 per week, stool type 3 or 4 based on the Bristol stool chart, absence of dyssynergic Valsalva, and dynamic ultrasound indicating a rectal compression ratio >25%. Patients underwent transvaginal sacrospinous ligament rectopexy and were followed up at 2 and 12 months postoperatively.
RESULTS
A total of 20 patients underwent the procedure and completed the follow-up. Statistically significant improvements were observed in all OD symptoms and subjective improvement (94.7% ± 13.4 and 90.6% ± 18) at 2 and 12 months after the surgery respectively. Mean rectal compression ratio, detected via ultrasound, improved from 45.5% ± 18.4 preoperatively to 9.2% ± 13.7 at 2 months (p < 0.0001) and 19.6% ± 14.4 at 12 months (p < 0.0012). Surgical failure, defined as combined subjective (ODS >50% of bowel movements) and anatomical failure (rectal compression ratio >25%), occurred in 2 patients.
CONCLUSION
Transvaginal sacrospinous ligament suture rectopexy was safe, feasible, and effectively treated ODS within this cohort of women undergoing POP surgery with rectal hypermobility confirmed by dynamic ultrasound.
Topics: Defecation; Female; Humans; Ligaments; Pelvic Organ Prolapse; Rectal Prolapse; Sutures; Treatment Outcome
PubMed: 33237356
DOI: 10.1007/s00192-020-04611-y -
Journal of the Royal Society of Medicine May 2013The field of coloproctology covers the treatment of both benign and cancerous disease of the colon, rectum and anus. Significant recent developments in the surgical... (Review)
Review
The field of coloproctology covers the treatment of both benign and cancerous disease of the colon, rectum and anus. Significant recent developments in the surgical treatment of colorectal cancer include the development of minimally invasive techniques for colorectal resections and the use of stenting for obstructed patients. The introduction of widespread screening aims to diagnose the disease at an earlier stage. Developments in chemotherapy and radiotherapy have also complimented surgical advances towards this disease. There have also been changes in the treatment of benign disease such as diverticular disease, haemorrhoids and anal fissures with a trend towards less invasive surgical techniques.
Topics: Colectomy; Colonic Diseases; Colorectal Neoplasms; Early Detection of Cancer; Humans; Laparoscopy; Rectal Diseases; Rectal Neoplasms; Robotics
PubMed: 23761526
DOI: 10.1177/0141076813479190 -
Techniques in Coloproctology Nov 2022Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some current randomised controlled trials. The aim of this study was to investigate the effect of early stoma closure on surgical and patient outcomes.
METHODS
A systematic review of the current randomised controlled trial literature comparing early and standard ileostomy closure after rectal surgery was performed. Specifically, we examined surgical outcomes including; morbidity, mortality and quality of life.
RESULTS
Six studies met the predefined criteria and were included in our analysis. 275 patients underwent early stoma closure compared with 259 patients having standard closure. Overall morbidity was similar between both groups (25.5% vs. 21.6%) (OR, 1.47; 95% CI 0.75-2.87). However, there tended to be more reoperations (8.4 vs. 4.2%) (OR, 2.02, 95% CI 0.99-4.14) and small bowel obstructions/postoperative ileus (9.3% vs. 4.4%) (OR 0.44, 95% CI 0.22-0.90) in the early closure group, but no difference across the other domains.
CONCLUSIONS
Early closure appears to be a feasible in highly selective cases after good perioperative counselling and shared decision-making. Further research on quality of life outcomes and long term benefits is necessary to help define which patients are suitable candidates for early closure.
Topics: Humans; Ileostomy; Ileus; Postoperative Complications; Quality of Life; Randomized Controlled Trials as Topic; Rectal Neoplasms
PubMed: 35596904
DOI: 10.1007/s10151-022-02629-6 -
Chirurgia (Bucharest, Romania : 1990) 2016Develop a rectal cancer management aims to establish an algorithm diagnostic, surgical treatment strategy implementation, strategy and neoadjuvant and adjuvant treatment...
Develop a rectal cancer management aims to establish an algorithm diagnostic, surgical treatment strategy implementation, strategy and neoadjuvant and adjuvant treatment response and optimal methods for assessing response to specific treatment. In trying to track this management, we studied the issues listed above, we conducted a retrospective clinical study, descriptive and included the analysis of data obtained on a sample selected 90 patients diagnosed with stenosing rectal cancer between January 2008 and December 2012 treated on the General Surgery Clinic I of "Prof. Dr. Al. Trestioreanu" Oncology Institute and on the General Surgery Clinic of Colentina Clinical Hospital, in Bucharest and aimed at analyzing the therapeutic attitudes of stenosing rectal cancer. Choosing the surgery, especially when applying preoperative and postoperative radiotherapy, with or without concomitant chemotherapy, it took into account the presence of stenosis (obstruction complete or incomplete) and the evolutionary stage locally and remotely disease.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Colectomy; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Neoplasm Staging; Preoperative Care; Radiotherapy, Adjuvant; Rectal Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 27819639
DOI: 10.21614/chirurgia.111.5.407 -
World Journal of Gastroenterology Oct 2014Colorectal cancer (CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will... (Review)
Review
Colorectal cancer (CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient's quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient's condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.
Topics: Colonic Diseases; Colorectal Neoplasms; Decompression; Foreign-Body Migration; Humans; Intestinal Obstruction; Palliative Care; Patient Selection; Prosthesis Design; Prosthesis Failure; Rectal Diseases; Risk Factors; Stents; Treatment Outcome
PubMed: 25309061
DOI: 10.3748/wjg.v20.i37.13239