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Query: UMLS:C0021933 (intussusception)
 3,822 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 90 patients with intussusception of the rectum (internal procidentia) has been studied. In 11 per cent of the patients there was also an enterocele and in 3 per cent, a large proctocele. Forty patients were operated upon by the Ripstein procedure. Indications for operation were, in most cases, incontinence for gas and/or feces. Seventy-five per cent of the preoperatively incontinent patients were, at follow-up 2 to 10 years after operation, continent. When indications for surgery were pain and or a sensation of obstruction, the results were poor; most of these patients had unchanged symptoms postoperatively, and some even had increased symptoms. There was one postoperative death. Of 50 patients treated conservatively during a period of 2 to 10 years, only two had to be operated upon: one due to the development of a rectal prolapse and the other due to severe pain and an increased sensation of obstruction.
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PMID:Intussusception of the rectum-internal procidentia: treatment and results in 90 patients. 114 81

Patients with intussusception of the rectum--six with anal incontinence and nine continent--were examined with respect to the function of the anal sphincters. Anal pressure was recorded continuously during rest, during maximal voluntary squeezing of the anal muscles, and during gradual expansion of the rectum by means of a balloon inserted into the rectal ampulla. The maximal anal pressure at rest, which is mainly due to activity of the internal anal sphincter, was lower (P less than 0-001) in the incontinent patients (31 mmHg +/- 5-6) than the continent (67 mmHg +/- 4-3) and the former had significantly smaller relaxations of the internal sphincter upon rectal distension (P less than 0-05). The increase in anal pressure during voluntary squeezing, a function of the external sphincter, did not differ significantly compared with healthy subjects in either incontinent or continent patients. On the basis of the above findings, it is concluded that the function of the internal sphincter is impaired in the incontinent patients.
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PMID:Function of the anal sphincters in patients with intussusception of the rectum. 126 86

Twenty-four patients with obstructed defecation due to rectal intussusception diagnosed by defecography were treated with rectopexy either by the Wells technique (9 patients) or by Orr's operation (15 patients). After follow-up from one to eight years, defecography demonstrated disappearance of the intussusception in 22 patients. None of the patients were completely relieved of their symptoms. Nine (41 percent; 95 percent confidence limits: 21-64) were improved and 13 were unchanged (59 percent; 95 percent confidence limits: 36-79), with no difference between the two procedures. One patient with solitary rectal ulcer was improved, and the ulcer disappeared. Four patients with moderate preoperative incontinence became continent postoperatively, but obstructed defecation was only improved in two of these patients. It is concluded that rectal intussusception is probably a secondary phenomenon in patients with obstructed defecation and that a conservative attitude toward surgery should be adopted.
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PMID:Internal rectal intussusception: results of surgical repair. 142 46

Construction of a neobladder utilizing intestine is currently considered to be the ideal option for the cystectomized patient. We reviewed the history as well as the physical and urodynamic principles of the substitution neobladders and continent reservoirs. In our series of patients who underwent cystectomy from January 1988 to December 1991, we have performed bladder substitution using detubularized ileum in 37 patients (18 Camey II and 16 Hautmann) and 13 patients had a continent reservoir (Mainz pouch). Patient ages ranged from 33 to 72 years (mean 60.4). The functional behaviour of the intestinal neobladders was analyzed clinically, radiologically and urodynamically. Eleven of the 18 patients with a Camey II (61.8%) and 3 of the 16 with a Hautmann (18.7%) neobladder were incontinent during the night, the difference being statistically significant (p < 0.05). Incontinence correlated manometrically with high pressure peaks in the Camey II neobladders and waves with a lower intensity were recorded in the Hautmann neobladders. Flowmetry revealed a normal peak flow in all but one Camey II that required internal urethrotomy due to urethroileal stenosis. The maximum capacity was 215-500 cc for the Camey II (mean 340 cc), 310-850 cc for the Hautmann (mean 590 cc) and 350-925 cc (mean 675) for the Mainz pouch. Intermittent catheterization was required in 3 of the Camey II and 1 of the Hautmann neobladder with important postmicturition residual urine. The patients who received the Mainz pouch had good continence, with pressure recordings less than 55 cm H2O), which is lower than the continent closing pressure. Only one case was incontinent due to failure of the intussusception mechanism. The good functional results achieved with the Hautmann procedure are underscored. The pressure recordings and the incidence of night incontinence for the foregoing procedure were lower than the Camey II. For the unviable urethra, the Mainz pouch achieves moderate pressures and is socially acceptable.
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PMID:[Urodynamic basis and findings in detubularised intestine neobladders: bladder substitutions and continent urinary reservoirs]. 149 72

The contribution of evacuation proctography (EP) to the evaluation of pelvic prolapse was assessed in 74 consecutive patients. A rectocele was demonstrated in 73 patients (99%); large rectoceles frequently showed barium trapping, but there was no correlation between these findings and rectal symptoms. An enterocele was detected at evacuation proctography in 13 patients (18%) (including two enteroceles seen only retrospectively), and a sigmoidocele was shown in four patients (5%). Physical examination resulted in detection of only seven enteroceles and of none of the sigmoidoceles. In 48 patients (65%), additional findings were evident at EP, including excessive pelvic floor descent, anal incontinence, rectal intussusception, and spastic pelvic floor. These data suggest that EP is particularly useful in the preoperative evaluation of pelvic prolapse if the patient has anorectal symptoms or is at risk for an enterocele. EP contributes to surgical planning by enabling identification of clinically unsuspected enteroceles and sigmoidoceles and coexistent disorders of rectal evacuation.
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PMID:Pelvic prolapse: assessment with evacuation proctography (defecography) 843 Feb 10

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.
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PMID:Clinical indications for anorectal function investigations. 227 62

A controlled radiologic study of anorectal function was performed with the use of defecography in 19 patients with constipation and 13 with incontinence. All patients were age and sex matched to control subjects who were referred for barium enema study and who had no defecation disorder. There were no statistically significant differences between either patient group and the control group in anorectal angle and excursion of the anorectal junction. In the 32 patients and 155 consecutive patients referred for defecography because of a variety of defecation disturbances, approximately twice as many rectal wall abnormalities were seen compared with findings in the control group. These findings included intussusception, rectal prolapse, rectocele, mucosal prolapse, spastic pelvic floor, descending perineum syndrome, and solitary rectal ulcer syndrome. In conclusion, the main role of defecography is to document rectal wall changes during defecation straining as possible causes of evacuation difficulties. Clinical symptoms should also be taken into account when treatment is contemplated.
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PMID:Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography. 229 37

Twelve patients presented with symptomatic internal intussusception of the rectum between 1979 and 1987. All were women with a mean age of 55.5 years. Ten patients had symptoms of obstructed defaecation and only three were completely continent. Polyvinyl alcohol sponge abdominal rectopexy was performed in each patient. Over a mean follow-up period of 26.9 months there was no recurrence of internal intussusception. The functional results, however, were mixed but only one patient remained incontinent for solid stool. Rectal discomfort and defaecatory difficulties persisted; six patients continued to strain at stool and in three this was worsened by the operation. Abdominal rectopexy can be recommended for those with associated incontinence, significant rectal bleeding or solitary rectal ulcer but may not benefit those who have obstructed defaecation.
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PMID:Rectopexy for internal rectal intussusception. 238 28

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%).
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PMID:Soiling: anorectal function and results of treatment. 270 80

After cystoprostatectomy for cancer of the bladder 43 men were provided with a detubularized, low pressure ileal reservoir (Kock pouch) connected to the urethra. Reflux was prevented by an intussusception valve. There was no operative mortality and few early complications. At followup the mean postoperative observation time was 13 months, with a range of 5 to 20 months. Late complications included manifestations of local tumor recurrence or distant metastases in 9 patients within 6 months postoperatively, which made adequate functional evaluation impossible. In 18 patients reflux to the upper urinary tract due to eversion or sliding of the antireflux valve occurred at various postoperative intervals. In 16 of these patients incontinence developed as a consequence of the reflux. Surgical correction of the failing antireflux valve restored reflux prevention and continence. Within 3 to 6 months the capacity of the reservoirs had reached an ultimate volume of approximately 600 ml. Pressure waves exceeding 40 cm. water seldom occurred in the mature reservoirs and then only at high filling volumes. The mean urethral resting resistance to flow was 64 cm. water. The configuration and function of the upper urinary tract improved or stabilized postoperatively. Of 34 evaluable patients 30 were continent during the day with a voiding frequency of 3 to 5 times and dry at night with a frequency of 0 to 2.
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PMID:Replacement of the bladder by the urethral Kock pouch: functional results, urodynamics and radiological features. 270 96


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