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)

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.
 ...
PMID:Treatment of rectal prolapse. 118 58

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.
 ...
PMID:Rectopexy for internal rectal intussusception. 238 28

A prospective clinical, manometric, electromyographic and radiological study was conducted to judge the degree of success achieved with anterior-posterior rectopexy in 18 female patients suffering from obstructed defecation and varying degrees of incontinence. Prior to being operated on, 6 of the patients showed symptoms of intussusception, 4 an internal prolapse of the anterior rectum wall, and 5 a rectocele at least 2 cm in size; all of them had significant perianal descent. The main aim of this study was more precise definition of the pre- and postoperative bowel evacuation using a defecation index. This study shows that obstructed defecation is significantly associated with a lasting feeling of needing to defecate after evacuation, a sensation of incomplete evacuation, perianal pain and necessity for manual support during defecation. The patients had a mean age of 62 (range, 38-78) years. All underwent anterior-posterior rectopexy (Ivalon or Vicryl) with posterior pelvic repair of the puborectalis muscle. In 2 patients rectopexy was combined with sigmoidectomy, in 11 cases, with left hemicolectomy, and in 2, with subtotal colectomy. The median follow-up was 40.8 months (range, 6-66 months). Postoperatively anorectal manometry showed a significant increase in the resting anal pressure and the maximum voluntary pressure (P = 0.05). Continence was improved in 10 patients (55%), 7 (39%) of whom regained normal continence. No significant change in pelvic descent or anorectal angle was observed. Only 8 patients reported a complete evacuation of the rectum postoperatively.
 ...
PMID:[Value of abdominal rectopexy in obstructive disorders of defecation. A prospective study using a defecation index, manometry and radiology]. 847 1

Rectal prolapse is the transposition of the entire rectal wall into the rectal lumen, the anal canal or through the anal canal out side. It differs from anal prolapse in thickness, circular plication of the mucosa and, if large, its extent. The cause is not clearly established, but disorders in bowel movement seem to be of importance. Symptoms reach from the feeling of incomplete evacuation to defecation block and irreducible prolapse. The diagnosis of outer prolapse is easy. The inner prolapse [intussusception] can be suspected by anamnesis and in the presence of solitary rectal ulcer. Defecography gives the conclusive examination. Conservative therapy is analogous to hemorrhoids: Fibres and sufficient liquid intake. Operative procedures can be divided in transabdominal and perineal procedures. From the latter Delorme's procedure gives good results with low stress for the patient. Of the transabdominal procedures we favor rectopexy with Ivalon-sponge, preservation of the lateral bands and sigmoid resection. This procedure can easily be done by laparoscopy. Postoperative constipation is observed above all if the lateral bands are dissected and no sigmoid resection is done. Preexistent constipation Improves in about 50% of the cases. Same does incontinence.
 ...
PMID:[Rectal prolapse]. 922 42