Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0021933 (intussusception)
 3,822 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-three patients with rectal prolapse or intussusception were studied to specifically focus on the effect of posterior rectopexy on fecal continence, anal pressure, and rectal capacity. Before operation, five patients were fully continent (A), 10 were continent for solid stools (B) and eight patients were fully incontinent (C). Group A remained fully continent; continence was regained nine times in group B and in group C, three patients regained full continence, two became continent for solid stools, three patients remained incontinent. Other symptoms such as constipation, false urgency, and a feeling of incomplete evacuation were not beneficially influenced by rectopexy. The patients' continence status was correlated to anorectal manometry and rectal capacity measurement. In group B, incremental pressure (P = squeeze - basal P) increased significantly (P less than 0.02) as well as incremental volume (V = maximum tolerated volume - volume of first sensation) (P less than 0.05). We conclude that, by an increase of incremental anal pressure and incremental rectal volume, posterior rectopexy offers an 83 percent chance of regaining full continence, or a major improvement, and a 17 percent chance of stabilization of fecal incontinence.
 ...
PMID:The effect of posterior rectopexy on fecal continence. A prospective study. 200 48

One hundred twenty consecutive patients with either fecal incontinence (60 patients), chronic constipation (41 patients), or idiopathic intractable pelvic pain (19 patients) were prospectively assessed. Patients underwent concentric needle electromyography (EMG), bilateral pudendal nerve terminal motor latency evaluation, anorectal manometry, and cinedefecography. The most common EMG finding in patients with fecal incontinence was decreased recruitment of motor units with squeezing and polyphasic motor unit potentials; these are consistent with an injury pattern. The most common EMG finding in the constipated patients was paradoxical puborectalis contraction. This latter abnormality was also a frequent finding in patients with rectal pain, as was prolongation of pudendal nerve latency. Paradoxical puborectalis contraction was diagnosed more frequently with EMG than with cinedefecography. Inter-examination correlation was best in the incontinent group between EMG and manometry. Cinedefecography had poor correlation with EMG in all patient groups but was valuable in the detection of additional pathology such as rectoanal intussusception and anterior rectocele. Electromyography including pudendal nerve terminal motor latency assessment is a valuable adjunct in the evaluation of disorders of evacuation. The information it yields is complementary to that offered by more routine physiologic examinations.
 ...
PMID:Neurophysiologic assessment of the anal sphincters. 205 46

Interest in anorectal function investigation tests has increased, and new investigation techniques have been introduced, gaining new insight in the pathogenesis of fecal incontinence and constipation. Normal values in anorectal function tests have shown a large overlap between controls and patients with fecal incontinence or constipation. Therefore, the pure clinical indications for the individual anorectal function tests are small, and the strength comes from combining these test results. When the patient is not eligible for surgery or biofeedback, there is no indication to perform anorectal function tests. Guidelines for selective use of anorectal function tests are given. In patients with fecal incontinence, the clinical consequence of demonstrating severe pudendal neuropathy is not yet clear. Defecography is important to demonstrate an intussusception as a treatable cause of incontinence. In patients with constipation an anal EMG (of defecography) can diagnose the spastic pelvic floor syndrome, which should be treated with relaxation exercises or biofeedback. Patients with other anorectal diseases, patients receiving a stoma, and patients considered for reanastomosis operation after (partial) colectomy may benefit from anorectal function tests.
 ...
PMID:Clinical indications for anorectal function investigations. 227 62

Defaecography was performed in 47 consecutive patients with faecal incontinence. A gap in the anal canal with spontaneous leakage of contrast medium was observed in 19 patients and demonstrated a severe disturbance of sphincteric function. In 13 cases, an anorectal angle of more than 120 degrees that did not change during voluntary sphincter contraction and the missing dorsal impression of the anorectal junction indicated a damage of the puborectalis muscle. A rectocele was detected in 18 patients, an intussusception in 14 patients, and a complete rectal prolapse in 3 patients. Thus, mechanisms of faecal incontinence can be elucidated radiologically in more than one half of the patients examined. However, the high prevalence of a rectocele or an intussusception in patients with faecal incontinence causes doubt whether these alterations of rectal morphology are functionally relevant in the majority of patients with faecal incontinence.
 ...
PMID:[Radiologic diagnosis of anal incontinence]. 237 14

We report the results of 30 antero-posterior rectopexies (APR) for rectal kinetic disorders with descending perineum syndrome. All patients were investigated by digital subtraction defecography and ano-rectal manometry. The associated surgical procedures were: sphincterotomy (n = 13) for outlet obstruction demonstrated by anal manometry or balloon expulsion test: hypertonic sphincter (n = 7), narrow fibrous sphincter (n = 6); 10 cases of prolapsectomy with extended anterior mucosectomy to reduce anterior rectal prolapse; 2 sigmoidectomy for dolichosigmoid. Best results (mean follow-up: 12 months, 3-26) were observed for ano-rectal or pelvic pain and rectal bleeding, which were cured in more than 80% of cases. Faecal incontinence (n = 5) was cured in all cases. Although normalisation of bowel movements and easier defecation were observed in 78% of cases, improvement in the dyschezic syndrome was differently perceived by the patients. Postoperative investigation demonstrated the probable cause of surgical failures (23%): impairment of rectal sensitivity (n = 2), anismus (n = 3), motor constipation (n = 4), with dolichosigmoid (n = 3). Severe perineal deficiency was also noted in 4 cases. Solitary ulcer (n = 6), anterior proctitis (n = 8), were cured within 2 months. Postoperative defecography showed correction of rectal intussusception without impairment of anterior rectal motility during defecation. These results confirm the efficacy of ARP for treatment of rectal intussusception or anterior rectocele. This functional rectopexy avoids the rectal "sling effect" of standard rectopexy which usually increases rectal dysfunction. Nevertheless, ARP alone seems to be insufficient when the associated functional or organic disorders implicated in rectal dysfunction are not also corrected, essentially outlet obstruction and dolichosigmoid.
 ...
PMID:[Anteroposterior rectopexy for disorders of rectal stasis: clinical and radiologic results. Value of digital subtraction rectography. Apropos of 30 cases]. 260 61

Forty-five patients with soiling but without faecal incontinence were evaluated by means of anorectal function investigations (anal manometry, rectal capacity and saline infusion test). The causes of soiling and the effect of treatment on both soiling and anorectal function were studied. The results were compared with a control group of 161 patients without soiling or incontinence. The diagnoses were haemorrhoids (10), mucosal prolapse (7), rectal prolapse (6), fistulae (5), proctitis (3), faecal impaction (2), rectocele with intussusception (2), scars after fistulectomy (2) and others (8). Simple inspection and proctoscopy were generally sufficient to establish a diagnosis. For two patients the diagnosis rectocele was made after defaecography. Anorectal test results did not differ between the soiling and control group, did not contribute to establish a diagnosis and did not change after treatment. Only patients with a rectal prolapse had abnormal results in anorectal function tests: a low basal sphincter pressure and a limited continence reserve. Appropriate therapy resulted in complete recovery (44%) or improvement of symptoms (29%).
 ...
PMID:Soiling: anorectal function and results of treatment. 270 80

In this paper, an account is given of our experience with continent colostomy in man. In five patients, the end-sigmoidostomy was provided with an intussusception valve. Evacuation of the bowel by irrigation through a catheter was laborious and time-consuming and this method was abandoned. In another group of 30 patients, the cecum was isolated from the rest of the colon and its distal end was provided with an intussusception valve. Of the 30 patients, eight were later given continent ileostomies, two were converted to conventional sigmoidostomies, and one patient with fecal incontinence preferred to have intestinal continuity reestablished. Thus, 19 patients still have continent cecostomies and are satisfied with their function. When comparing the function of the continent cecostomy with that of the continent ileostomy, however, it is obvious that the ileostomy function is superior. The experience obtained with this group of patients has resulted in a widening of the indications for constructing a continent ileostomy, including selected patients with various anorectal disorders.
 ...
PMID:Continent cecostomy. An account of 30 patients. 405 74

A transverse colonic conduit incorporating an intussusception valve and skin-flapped cutaneous aperture was constructed in nine patients with combined faecal incontinence and disordered evacuation. Intestinal continuity was restored with a colocolonic anastomosis. Median follow-up was 4 (range 2-15) months and daily irrigation with a median of 1.2 (range 0.3-2.0) litres of water resulted in evacuation in less than 1 h. At 1 month after operation there was no leakage of solid or liquid faeces from the anus between irrigations. The valve was continent to faeces and irrigation fluid, and no stoma appliances were required.
 ...
PMID:Continent colonic conduit for the treatment of faecal incontinence associated with disordered evacuation. 748 52

In the present work the Authors have studied 19 patients with occult rectal prolapse evaluating symptoms and functional results after posterior abdominal rectopexy. Symptoms of internal rectal procidentia appear as a definite syndrome. In our patients pain upon defecation, this being often localized to the perineal and sacral region, was observed in 14 on 19 cases, while fecal incontinence was present in 5 cases (29%) and rectal bleeding in 8 (44%). These compliances are relieved by the anatomical correction of the rectal intussusception, but the preexisting functional disorders in the mechanism of defecation appear to be unaffected by rectopexy. (Sensation of obstruction 11 cases (58%) preop. e 9 cases (53%) postop.).
 ...
PMID:[Occult rectal prolapse: functional results after rectopexy]. 792 91

Faecal incontinence is a disabling condition caused by: (1) sphincter damage caused by childbirth, anorectal surgery, trauma, fistulae and abscesses; (2) pudendal neuropathy ("idiopathic faecal incontinence") caused by stretch injury by long-standing constipation or prolonged labor; (3) diminished rectal compliance in proctitis, low anterior resection or small pouches; (4) faecal impaction causing paradoxal diarrhoea; (5) neurological disease involving the pelvic floor and or the central nervous system; (6) diarrhoea. Often several factors play a role in a patient. A medical history and physical examination will generally provide a reasonable diagnosis. Anorectal function tests can show one or more abnormalities. Anal manometry can show low sphincter pressures; rectal compliance can show a small rectal volume; anal mucosal sensitivity measurement can show a high threshold and neurophysiological tests can demonstrate diminished muscle activity and a delayed pudendal nerve motor latency. Anal endosonography and defaecography have a direct clinical impact. Anal endosonography is a promising diagnostic tool demonstrating sphincter defects, even those not previously suspected. A sphincter defect demonstrated by anal endosonography provides a solid basis for a sphincter repair. Defaecography can reveal an intussusception, which is an indication for performing a rectopexy in the incontinent patient. A suggested work-up of the incontinent patient is given in a table. Besides the classic surgical treatments such as sphincter repair, rectopexy and post-anal repair new (surgical) options have been tried. The most promising new therapy seems the dynamic gracilis repair.
 ...
PMID:Faecal incontinence 1994: which test and which treatment? 802 94


1 2 3 Next >>