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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Stomal complications of ileostomy may occur many years after construction. An actuarial analysis of complications of 150 permanent end ileostomies constructed over a 10-year period is reported. By 20 years the incidence of stomal complications approached 76 per cent in patients operated on for ulcerative colitis and 59 per cent in those with Crohn's disease (P < 0.05). Revisional surgery rates were higher in patients with ulcerative colitis than in those with Crohn's disease (28 versus 16 per cent), albeit not significantly. The four commonest complications were skin problems (cumulative probability 34 per cent), intestinal obstruction (23 per cent), retraction (17 per cent) and parastomal herniation (16 per cent). Closure of the lateral space did not reduce the probability of developing intestinal obstruction (18 per cent at 20 years in those with closure versus 3 per cent in those without, P > 0.1). Fixation of the mesentery did not reduce the probability of developing prolapse of the ileostomy (11 per cent in those with fixation versus none in those without, P < 0.1). The incidence of parastomal herniation was not reduced by sitting through the rectus abdominis (21 per cent in those sited through the body of the rectus abdominis versus 7 per cent in those sited through the oblique muscles, P < 0.1). Some of the surgical dogmas relating to ileostomy construction are not supported by the results of this study.
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PMID:Life-table analysis of stomal complications following ileostomy. 804 64

The mucosa of the pelvic ileal reservoir undergoes adaptive changes--inflammatory, architectural, and metaplastic--on exposure to the faecal stream. Twenty three quadruple loop ileal pouches constructed for ulcerative colitis (20 patients) and familial adenomatous polyposis (FAP) (three patients) were studied. No patient fulfilled clinical, endoscopic, or histopathological criteria for pouchitis. Standard duplicate biopsy specimens were taken from the proximal limb, the anterior wall, the posterior wall, and the body of the reservoir. An established scoring system was used and showed a highly significant increase in inflammatory scores in posterior wall biopsy specimens compared with those from the anterior wall. These results suggest that the adaptive changes are the direct result of contact with static faecal contents. One patient only showed significant inflammation in the proximal limb. There was no evidence of mucosal prolapse in any anterior wall biopsy specimen. Patients with colitis showed substantially more inflammatory and architectural changes than those with FAP. Ninety six per cent of pouches showed some colonic phenotypic expression as defined by mucin histochemical and PR 3A5 immunohistochemical studies. Our results suggest, however, that there may not be complete colonic metaplasia and that the mucin changes and other phenotypic alterations may represent a non-specific response to pouch inflammation and not a prerequisite for the development of pouchitis. The focal nature of the inflammatory and architectural changes, which may be the result of direct contact with static faecal residue, are clearly shown. A single random biopsy specimen of pouch mucosa is of limited value in assessing pathological changes and screening for potential neoplastic change within the reservoir.
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PMID:Distribution of mucosal pathology and an assessment of colonic phenotypic change in the pelvic ileal reservoir. 838 56

In the 1950s the treatment of ulcerative colitis was revolutionized by Brooke by way of a colectomy combined with an eversion ileostomy. This procedure is known to be associated with a number of complications that include skin excoriation, stenosis, intestinal obstruction, retraction or prolapse of the stoma, abscess and fistula formation, and ileitis. However, adenocarcinoma arising in the abnormally placed small intestinal mucosa 20 years or more after the initial operation is being increasingly recognized and reported. This article describes one such case and includes an extensive review of the current world literature on the subject of adenocarcinoma arising as a late complication of operation for ulcerative colitis.
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PMID:Primary adenocarcinoma in an ileostomy: a late complication of surgery for ulcerative colitis. 850 31

Ileostomy polyps are uncommon and poorly described. The aim of this study was to undertake a retrospective clinicopathological review of ileostomy polyps. Seven patients with 60 polyps arising on ileostomies performed for ulcerative colitis were studied. The histopathological evaluation of archival ileostomy biopsy specimens, polypectomy or excision specimens, and clinical review of patient records was undertaken. Fifty of 60 polyps were inflammatory cap polyps and six further polyps were composed of granulation tissue only. They occurred anywhere on the stoma at any time after ileostomy construction and were strongly associated with overt stomal prolapse. Four neoplastic polyps were identified in two patients 27-36 years after ileostomy construction; all occurred at the mucocutaneous junction. One patient presented with a 2 cm polypoid invasive adenocarcinoma while in the second a 1.7 cm polypoid mucinous adenocarcinoma and a 0.7 cm ileal tubular adenoma with high grade dysplasia occurred at the site of excision of a cap polyp showing focal low grade adenomatous dysplasia six years previously. Neoplastic and non-neoplastic polyps could not be differentiated clinically. It was found that most ileostomy polyps are inflammatory cap polyps associated with stomal prolapse. Less common are polypoid adenomas or adenocarcinomas arising at the mucocutaneous anastomosis > 20 years after ileostomy construction. To prevent ileostomy carcinoma it is recommended that a biopsy of all polyps at the mucocutaneous anastomosis and of any non-prolapse associated polyps elsewhere on the stoma occurring > 15 years after ileostomy construction is done.
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PMID:Ileostomy polyps, adenomas, and adenocarcinomas. 853 59

Over an 11-year period, 17 salvage procedures were performed on a failed ileal pouch-anal anastomosis carried out for ulcerative colitis from a series of 157 patients. Ten pouches were saved, four excised and three defunctioned. Salvage procedures included five operations for fistulas (three of five successful), six reoperations on the ileoanal anastomosis (five of six successful), three new pouches after previous pouch excision (all failed), and three miscellaneous: excision of an efferent limb (successful), pouchpexy for a pouch prolapse (successful) and postanal repair for incontinence (failed). Pouch salvage may be successful in the motivated patient who wishes to avoid a permanent ileostomy.
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PMID:Results from pouch salvage. 866 97

Stomas and pregnancy is an uncommon event and the literature in this regard is scarce, this poses significant concern on its management. Among the etiology we found the ulcerative colitis, trauma, and rectovaginal fistula, etc. The management should include a perinatologist and a specialist in colon and rectum. We should be familiarized with the potential complication as the intestinal obstruction, stoma prolapse, narrowing of the stoma and bleeding. The route delivery should be vaginal and the c-section is reserved for obstetric indications. The patient must receive education regarding stoma complications, and how to copy to live with a stoma.
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PMID:[Stomas in pregnancy, clinical case and review of the literature]. 1182 4

Diverticular colitis is the term used to describe a particular pattern of active chronic inflammation in the sigmoid colon affected by diverticular disease, namely the occurrence of luminal mucosal inflammation, whether or not there is evidence of inflammation within and/or around the diverticula themselves. The pathogenesis remains uncertain but is almost certainly multifactorial. In some cases mucosal prolapse, faecal stasis and relative mucosal ischaemia have been implicated as important pathogenetic factors, whilst other cases are clearly the result of a mass effect caused by subserosal peridiverticulitis and suppuration. Symptoms and endoscopic findings are diverse. Histologically, the disease may vary from modest inflammatory changes with vascular ectasia, through classical mucosal prolapse changes, to florid active chronic inflammation, closely mimicking chronic inflammatory bowel disease, especially ulcerative colitis. Thus, accurate clinical and endoscopic correlation is vital for the attainment of the correct diagnosis. Diverticular colitis may respond well to treatment similar to that used for chronic inflammatory bowel disease, adding to the similarities of this disease, notably localised to the sigmoid colon, and ulcerative colitis. Indeed, in a few cases described in the literature, diverticular colitis may 'progress' to otherwise classical ulcerative colitis, suggesting, in some cases at least, a similar pathogenesis.
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PMID:What is diverticular colitis? 1255 96

Total restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) has become the standard of care for the surgical treatment of ulcerative colitis. Despite its correlation with an excellent quality of life and favorable long-term outcomes, RP/IPAA has been associated with several complications. Prolapse of the ileoanal pouch is a rare and debilitating complication that should be considered in the differential diagnosis of pouch failure. Limited data exist regarding the prevalence and treatment of pouch prolapse. We present the case of a recurrent J-pouch prolapse treated with a novel minimally invasive "salvage" approach involving a robotic-assisted laparoscopic rectopexy with mesh.
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PMID:Robotic-assisted laparoscopic "salvage" rectopexy for recurrent ileoanal J-pouch prolapse. 2041 43

The author investigated histopathology of 1,438 consecutive rectal specimens in the last 10 years of our pathology laboratory in Japan. A computer review of pathologic reports was done. Observations of pathologic slides were performed, when appropriate. The rectal specimens were composed of 1,022 benign lesions and 416 malignant lesions. The 1,022 benign lesions were composed non-specific proctitis (n=460, 45%), adenoma (n=248, 24%), ulcerative colitis (n=98, 10%), hyperplastic polyp (n=54, 5%), carcinoma in adenoma (n=40, 4%), rectal ulcer (n=37, 4%), serrated adenoma (n=24, 2%), hyperplastic nodule (n=21, 2%), Crohn's disease (n=9, 1%), ischemic proctitis (n=8, 0.8%), mucosal prolapse syndrome (n=7, 0.6%), juvenile polyp (n=6, 0.6%), lymphoid hyperplasia (n=5, 0.5%), lipoma (n=4, 0.4%) and amebic dysentery (n=2, 0.2%), and mature cystic teratoma (n=1, 0.1%). In this article, histopathological features of these benign lesions were described in details. In particular, adenomas were classified into adenomas with mild, moderate, and severe atypia, serrated adenoma, and carcinoma in adenoma. The later are mainly seen in large adenoma with severe atypia. Ulcerative colitis was characterized by continuous lesion, crypt abscess, abnormal branching, and deletion of goblet cells. Crohn's disease was characterized by transmural inflammation and epithelioid granulomas. Ischemic colitis was characterized by ischemic necrotic changes and pseudomembrane formation. Mucosal prolapse syndrome was characterized by abnormal muscle in the mucosa (fibromuscular obliterance). Juvenile polyp was characterized by abnormal dilations of the crypts. Lymphoid hyperplasia must be differentiated from MALT lymphoma. Lipoma was ordinary lipoma without lipoblasts. Amebic dysentery was characterized by ulcer and presence of histiocyte-like entamoeba histolitica. Mature cystic teratoma was characterized by hairs and other elements of skin and mesodermal and endodermal components.
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PMID:Histopathologic study of the rectum in 1,438 consecutive rectal specimens in a single Japanese hospital: I. benign lesions. 2341 70

We describe filiform polyps (FPs) in a series of defunctioned rectums with diversion colitis. A 6-year search of all defunctioned rectal resection specimens revealed 8 cases with 17 macroscopically observed FPs. They occurred in 4 females and 4 males aged between 12 and 64 years. Four had defunctioning colostomies for ulcerative colitis, 3 for Crohn disease and 1 for diverticular disease. Multiple lesions were seen in 6 of 8 cases: 1 case having 4 FPs, 1 patient with 3 lesions, and 4 cases with 2 lesions. The FP varied in length from 4 to 11 mm; mean length was 7.8 mm. No evidence of mucosal prolapse was seen in any of the polypoid lesions. In 65 cases without grossly observed polypoid lesions, prominent mucosal polypoid projections in keeping with FP were seen in 47 cases. These were observed in nonulcerated sections and were histologically identical to the 17 macroscopically observed FPs ranging from 3 to 8 mm, and 3 to 5 such polypoid lesions were seen in 20 cases. We suggest that FP and FP-like lesions are commonly encountered in defunctioned resection specimens.
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PMID:Filiform polyps and filiform polyp-like lesions are common in defunctioned or diverted colorectum resection specimens. 2366 87


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