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Query: UMLS:C0019270 (hernia)
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Two patients, 1 adult and 1 infant, with complete duplication of the penis are described. The adult had a single bladder, a bifid scrotum, a low abdominal wall hernia, separation of the symphysis pubis, bilateral inguinal hernias, rectal prolapse, bilateral vesicoureteral reflux and bilateral staghorn calculi. The infant had duplication of the bladder, hypoplasia of the left kidney, lumbosacral anomalies, a hypoplastic left lower extremity, an imperforate anus, a infraumbilical wall hernia and separation of the symphysis pubis. A survey of the anomalies accompanying the 2 main types of diphallus (shaft and glans, and glans alone)showed that there was a preponderance of anomalies of posterior structures such as colon, bladder and spine in the shaft and glans diphallus, and a higher incidence of isolated exstrophy of the bladder in diphallus of the glans alone. The embryogenic implications of these findings are discussed.
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PMID:Embryologic considerations of diphallus and associated anomalies. 87 47

There are two schools of thought concerning the aetiology of rectal prolapse. On the one hand it was conceived to be a sliding hernia through a defect in the pelvic fascia, while on the other hand radiological studies have demonstrated prolapse to be represented by an intussusception of the rectum. Various operative procedures have been proposed for the treatment of rectal prolapse based on the belief in one or the other of these concepts. The anatomic defects which have been described with prolapse include a defect in the pelvic floor with diastasis of the levatores ani, loss of the normal horizontal position of the rectum, an abnormally deep cul-de-sac of Douglas, a redundant rectosigmoid, and a patulous anal sphincter. The popularly used procedure in Great Britain is that in which a sheet of Ivalon sponge is sutured to the sacrum and wrapped around the rectum thus anchoring it in place. Various authors have reported good results using this technique. The mortality and morbidity rate appear to be acceptable. In the U.S.A. a popular procedure is the Ripstein technique where a sheet of Teflon is wrapped around the rectum anteriorly anchoring the rectum to the sacrum. This technique also has its proponents who rport satisfactory results. Abdominal proctopexy and sigmoid resection, although not in common general use, has been found to be effective with an acceptable morbidity and mortality rate. These three procedures have some drawbacks but the one problem common to all the repairs so far developed for prolapse is their inability to guarantee to restore continence. Probably half the patients operated upon continue to be incontinent. Faradic stimulation of the sphincter has not proved to be as helpful as initially hoped.
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PMID:Treatment of rectal prolapse. 118 58

Access to lesions in the mid-rectum can be difficult. This report summarizes our experience with a posterior approach to the rectum in 22 men and 13 women, age range 21 to 96 years. Surgical indications included villous tumours, rectal prolapse, rectal strictures or rectal fistulae. No postoperative complications were observed in 20 patients, but fistulae developed in seven patients, of whom three required proximal colostomy and surgical treatment. Four healed spontaneously. Two patients developed sacrococcygeal hernia. Pathologic examination of villous tumour showed extensive malignant change in three cases requiring rectal resection with end-to-end colo-anal anastomosis. In two patients mild incontinence developed, treated by biofeedback. Residual peri-anal pain was reported by two patients. The posterior approach to the rectum is particularly useful for benign lesions too high for a transanal resection and too low for a transabdominal resection.
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PMID:Posterior approach to the rectum for treatment of selected benign lesions. 187 16

Rectal prolapse and solitary rectal ulcer syndrome are both benign conditions affecting the rectum, mainly in women; prolapse tends to occur late in life, while solitary rectal ulcer syndrome has a predilection for the younger adult. Complete rectal prolapse probably starts as a mid-rectal intussusception, although a combination of this theory and the 'sliding hernia' theory has been proposed by Altemeier et al (1971). The pelvic floor weakness associated with prolapse, which gives rise to incontinence, is most likely due to a traction injury to the pudendal nerve. Anorectal manometry will indicate those incontinent patients likely to benefit from rectopexy. Abnormal descent of the perineum may be found in rectal prolapse and solitary rectal ulcer syndrome as well as descending perineum syndrome per se. The clinical features of these three conditions can overlap. Solitary rectal ulcer syndrome is essentially due to prolapse and traumatization of the rectal mucosa. Inappropriate puborectalis contraction, abnormal perineal descent, and overt rectal prolapse have all been cited as possible mechanisms of development of the condition. Defecography is the radiologic investigation of choice. Electromyography, as in rectal prolapse, may show evidence of pudendal nerve damage although incontinence is rare.
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PMID:The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome. 353 17

In recent years patients with cystic fibrosis (CF) have experienced longterm survival and have demonstrated a number of intra-abdominal complications. This report evaluates the intra-abdominal complications seen in 69 of 189 children with cystic fibrosis from 1972 to 1983. Forty-one patients were boys and twenty-eight girls. Complications occurred in 36 neonates, with meconium ileus (MI) noted in 33 and giant cystic meconium peritonitis (GCMP) in 3. Meconium ileus equivalent occurred in seven older children presenting with bowel obstruction. In addition, rectal prolapse occurred in 12, inguinal hernia in 10, intussusception in 3, cholelithiasis in 3, GE reflux in 4, stress ulcer in 1 and appendicitis in 1. Three infants with GCMP survived resection and enterostomy. Infants with MI were divided into simple (15) or complicated (18) cases. Nonoperative therapy using gastrografin enema was successful in three of eight with simple MI. Operative enterotomy and irrigation was successful in three cases while resection and enterostomy was done in nine. MI was complicated by atresia, volvulus and/or perforation in 18 cases requiring resection and anastomosis or enterostomy. Survival for MI was 86% compared to 36% in 25 MI patients treated in the previous two decades. Meconium ileus equivalent was successfully managed using gastrografin enema in five of seven children. Only 3 of 12 children with rectal prolapse required repair. Two cases of intussusception were reduced while one required resection. Three of 10 children had hernia recurrence due to chronic pulmonary problems.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intra-abdominal complications of cystic fibrosis. 404 71

Urethral stricture in the tropics may be a serious public health problem; the majority of cases are caused by the gonococcus. The pathology is varied, and many advanced cases with complications are seen. Most strictures are seen in the posterior urethra, where fibrosis and narrowing may extend from a short length of under 5 mm to well over 10 cm. A wide variety of complications occurs. Diagnosis is easy when the patient presents in acute retention or with a history of difficult micturition, but more difficult when stricture is the underlying cause of perianal abscess, gangrene of the scrotum caused by extravasation, uremia or hypertension, hernia or rectal prolapse, urinary infection, or elephantiasis of scrotum with multiple fistulae. A careful history is helpful, paricularly if previous gonorrhea is involved. Physical examination varies according to mode of presentation and complications; a rectal examination and neurological examination should be included. Definitive investigation to prove the presence of a stricture includes urethrography and urethroscopy, if facilities are available. Indirect methods of diagnosis include tests for hemoglobin, blood urea, plain X-ray of the whole urinary tract, urinalysis, and others. It is preferable to leave instrumentation until last in diagnostic cases, to avoid infection, but a diagnostic bougie may be passed under strict aseptic conditions prior to treatment. The mainstay of treatment is regular bouginage for life, which is best done in a bougie clinic held at regular intervals. Equipment for bouginage, in order of desirability, includes soft plastic bougies, straight metal bougies, or curved metal bougies in larger sizes, a large stainless steel instrument tray, a basin for sterile water, and lubricant. Care should be taken during bouginage not to pass bougies into acutely inflamed strictures, and not to overstretch the urethra. Plastic bougies are preferable, until a stable situation has been reached. Surgery is indicated for a persistently impassable stricutre, for 1 requiring difficult bouginage at frequent intervals with many failures, for an established false passage, and for complications, especially bladder neck stenosis. Instructions for intravenous pyelograms and for urethrography from below and above, and diagrams of urethrograms indicating various pathological states and a diagnostic schema for urethral stricture are included.
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PMID:Urethral stricture. 469 33

The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described. Spontaneous perforation of the intestine and massive gastrointestinal haemorrhage are uncommon but potentially lethal complications of the Ehlers-Danlos syndrome. Less dangerous abnormalities, such ;as external hernia, hiatus hernia, eventration of the diaphragm, intestinal diverticula, and rectal prolapse were all encountered in patients in the series. Abdominal surgery in affected patients may be made difficult by fragility of tissues and a bleeding tendency. In the postoperative period, tearing out of sutures and wound dehiscence may occur.
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PMID:Gastrointestinal complications of the Ehlers-Danlos syndrome. 530 59

The various modified fixation procedures used for rectal prolapse take into account the pathophysiologic concept of complete prolapse of the rectum as a sliding hernia of the pouch of Douglas. The possibility of intussusception by reinforcement of the wall of the extensively mobilized rectum was successfully prevented by a new technique. The use of this simple technique in another form of prolapse, namely, prolapse of the terminal colostomy, convinced us to its usefulness.
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PMID:A new concept for the management of rectal prolapse. 746 26

The widespread success of laparoscopic cholecystectomy has led to the development of a wide range of laparoscopic surgical procedures. Procedures for treating rectal prolapse (Procidentia) may constitute some of the best applications for colorectal laparoscopic techniques. A technique of laparoscopic rectopexy performed using the endo-stapler is described. Twenty-nine consecutive patients have undergone laparoscopic rectopexy. The median age was 71 years (52-89), and male:female ratio was 27:2. One procedure had to be converted to open due to ventilatory difficulties. The mean operative time was 95 minutes (50-190). The mean hospital stay was 5 days (4-15). There was no mortality in this series. Morbidity included incisional hernia through a port hole (n = 1), extraperitoneal haematoma (n = 1), and urinary tract infection with retention (n = 1). In conclusion, laparoscopic abdominal rectopexy is a safe and effective technique in the management of rectal prolapse.
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PMID:Stapled laparoscopic rectopexy for rectal prolapse. 759 3

This report presents a summary of 93 bowel resections which were considered to be for preventable causes and performed during 5 years (1984-1988) in our Hospital in Zaria. These resections constituted 57% of the total bowel resections performed in that period and were responsible for an annual resection rate of 19 "avoidable" bowel resections. The resections included 48 for strangulated external groin hernia with gangrene of the bowel or doubtful viability, typhoid perforation eleven, vehicular trauma ten, anastomotic dehiscence eight and other non-neoplastic causes of faecal fistula eight. Multiple special forms of preventable causes of bowel resection accounted for 8 resections. These were foreign body impacted in the ileum 1, incisional hernia 1, large irreducible scrotal hernia in a recently gangrenous scrotum 1, irreducible rectal prolapse 2, paracolostomy abscess 1, bowel necrosis from residual pelvic abscess 1 and from multiple intra-abdominal abscesses one.
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PMID:Preventable causes of bowel resection in Zaria, Nigeria: a report of 93 cases. 792 58


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