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World Journal of Gastroenterology Jul 2016Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate...
Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.
Topics: Abscess; Adult; Anorectal Malformations; Digital Rectal Examination; Emergencies; Endoscopy; Fissure in Ano; Foreign Bodies; Fournier Gangrene; Gastrointestinal Hemorrhage; Hemorrhoids; Hirschsprung Disease; Humans; Infant, Newborn; Intestinal Obstruction; Perineum; Rectal Diseases; Rectal Neoplasms; Rectal Prolapse; Rectum; Sexually Transmitted Diseases; Thrombosis; Varicose Veins
PubMed: 27468181
DOI: 10.3748/wjg.v22.i26.5867 -
Clinics in Colon and Rectal Surgery Jan 2021Rectal prolapse is a debilitating condition that often results in impaired quality of life. Posterior compartment defects including rectal prolapse and rectal... (Review)
Review
Rectal prolapse is a debilitating condition that often results in impaired quality of life. Posterior compartment defects including rectal prolapse and rectal intussusception are often associated with middle and anterior compartment prolapse and require a multicompartment approach to treatment. In recent years, ventral rectopexy, with or without sacrocolpopexy for combined middle compartment prolapse, has emerged as a safe and effective method of treatment for rectal prolapse. In this article, we aim to review the etiology of rectal prolapse and intussusception, describe the indications and workup for surgery, discuss technical aspects of ventral rectopexy alone and in combination with sacrocolpopexy, review potential surgical complications, and describe the reported outcomes of the surgery.
PubMed: 33536851
DOI: 10.1055/s-0040-1714288 -
SAGE Open Medical Case Reports 2019Rectal prolapse is usually of benign etiology. Rarely, sigmoido-rectal intussusception results from a malignant lead-point. We report the case of a patient with a...
Rectal prolapse is usually of benign etiology. Rarely, sigmoido-rectal intussusception results from a malignant lead-point. We report the case of a patient with a partially obstructing sigmoid cancer causing a full thickness rectal prolapse requiring surgical intervention. An 82-year-old woman presented with 1 week of rectal bleeding, fecal incontinence, and weight loss. Computed tomography identified sigmoido-rectal intussusception. Colonoscopic biopsy revealed high-grade dysplasia. Magnetic resonance imaging demonstrated a 6-cm mass forming the lead point of the intussusceptum with epiploic appendages seen within the rectal lumen. She underwent laparoscopic low anterior resection with final pathology consistent with T2N0 adenocarcinoma, and recovered well. Among adult patients with rectal prolapse, suspicion for underlying malignancy should prompt a thorough investigation to inform the decision for resection, which may be safely performed by minimally invasive techniques.
PubMed: 31217975
DOI: 10.1177/2050313X19856242 -
World Journal of Gastroenterology Apr 2015To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse. (Review)
Review
AIM
To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.
METHODS
MEDLINE, PubMed, EMBASE, and other relevant database were searched to identify studies. Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.
RESULTS
Twelve non-randomized case series studies with 574 patients were included in the review. No surgical mortality was described. Conversion was needed in 17 cases (2.9%), most often due to difficult adhesiolysis. Twenty eight patients (4.8%) presented with major complications. Seven (1.2%) mesh-related complications were reported. Most frequent complications were urinary tract infection and urinary retention. Mean recurrence rate was 4.7% with a median follow-up of 23 mo. Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%. Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages. Evaluation of functional score was disparate between studies.
CONCLUSION
Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.
Topics: Constipation; Digestive System Surgical Procedures; Fecal Incontinence; Humans; Laparoscopy; Postoperative Complications; Recovery of Function; Rectal Prolapse; Recurrence; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25945021
DOI: 10.3748/wjg.v21.i16.5049 -
Clinics in Colon and Rectal Surgery Mar 2011Rectal prolapse is a condition that usually requires surgical intervention to correct. Abdominal and perineal approaches are well described in the literature. Abdominal...
Rectal prolapse is a condition that usually requires surgical intervention to correct. Abdominal and perineal approaches are well described in the literature. Abdominal approaches have traditionally been reserved for young healthy patients, but this has been challenged by perineal approaches with excellent outcomes. Laparoscopic techniques have been shown to be effective and equivalent to traditional laparotomy techniques.
PubMed: 22379404
DOI: 10.1055/s-0031-1272822 -
Clinics in Colon and Rectal Surgery Mar 2018Rectal prolapse is a common and self-limiting condition in infancy and early childhood. Most cases respond to conservative management. Patients younger than 4 years with... (Review)
Review
Rectal prolapse is a common and self-limiting condition in infancy and early childhood. Most cases respond to conservative management. Patients younger than 4 years with an associated condition have a better prognosis. Patients older than 4 years require surgery more often than younger children. Multiple operative and procedural approaches to rectal prolapse exist with variable recurrence rates and without a clearly superior operation. These include sclerotherapy, Thiersch's anal cerclage, Ekehorn's rectopexy, laparoscopic suture rectopexy, and posterior sagittal rectopexy.
PubMed: 29487493
DOI: 10.1055/s-0037-1609025 -
Journal of the Anus, Rectum and Colon 2022Pelvic organ prolapse (POP) is a condition wherein one or more of the organs in the pelvis slip down from their original position and protrude into the vagina. Pelvic... (Review)
Review
Pelvic organ prolapse (POP) is a condition wherein one or more of the organs in the pelvis slip down from their original position and protrude into the vagina. Pelvic organ prolapse surgery has increased in the urogynecological field due to higher aging society. POP patients often suffer from bowel dysfunction, such as difficulty of bowel movements and the need to strain or push on the vagina to have a bowel movement. Rectocele is often treated with the same method used for POP, but sometimes it is treated transanally. In the transabdominal approach, the vagina is divided from the rectum, and the mesh is fixed between the vagina and rectum. On the other hand, rectal prolapse is a condition wherein the rectum slips down from its original position and protrudes from the anus. Like POP surgery, rectal prolapse has been treated laparoscopically. Even though the protruding position is different, both are pelvic conditions, and the concept of treatment is similar. Recently, POP and rectal prolapse have been diagnosed at the same time, and sometimes these diseases have been treated together. In the higher aging society, incidences of POP and rectal prolapse will increase, and both will have greater chance to be treated. Although POP is a urogynecological disease, coloproctologists need to know the bowel dysfunction in order to treat POP.
PubMed: 35572489
DOI: 10.23922/jarc.2020-007 -
Indian Journal of Gastroenterology :... Dec 2019
Review
Topics: Adult; Aged; Fecal Incontinence; Female; Humans; Male; Middle Aged; Pregnancy; Rectal Prolapse
PubMed: 32002830
DOI: 10.1007/s12664-020-01014-1 -
Cureus Aug 2022Psychosis is a constellation of symptoms that present with a disconnect from reality. The duration, severity, and presentation of symptoms can present on a wide...
Psychosis is a constellation of symptoms that present with a disconnect from reality. The duration, severity, and presentation of symptoms can present on a wide spectrum, and etiologies can vary from patient to patient. Psychosis is also associated with self-injurious thinking, behavior, and suicidality. Long-term treatment of psychosis with antipsychotics can often result in side effects like constipation, sedation, dry mouth, and metabolic syndrome. Though rectal prolapse is uncommon in adolescent patients, there was a noted correlation with rectal prolapse in adult patients that were treated for chronic psychiatric disease. We report a case of a 17-year-old female with psychosis and rectal prolapse, who was admitted for inpatient treatment.
PubMed: 36059365
DOI: 10.7759/cureus.27615