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

A review of 21 patients with protruded lesions in solitary ulcer syndrome of the rectum confirmed by resection is presented. Symptoms were usually the passage of blood and mucus per rectum, alteration of bowel habit, anorectal pain and rectal prolapse. Solitary or multiple polypoid lesions were found within 15 cm of the anal margin and were usually sited anteriorly. Fifteen of the patients were men and 8 were women with a mean age of 37.1 years. The diagnosis was made on the basis of histopathology; 1) fibrous obliteration of muscle fibers, 2) reactive hyperplasia of the mucous membrane with villous configuration or mild pseudoinvasion. These changes have been observed in complete rectal prolapse, colonic intussusception, and localized colitis cystica profunda, suggesting a common pathogenesis. The histological findings were almost the same as in the ulcerative lesions of this syndrome except for remarkable regenerative hyperplastic changes such as a relatively high incidence of mucous cell proliferation, dilatation of glands and serrate change in the cases showing protrusion. In the pathogenesis, the occult mucosal prolapse in association with excessive straining may be of particular importance, so that the lesions might be termed mucosal prolapse syndrome of the rectum.
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PMID:Protruded variants in solitary ulcer syndrome of the rectum. 326 Nov 11

Obstructed defaecation in the descending perineum syndrome has been attributed to anterior mucosal prolapse. Manometric and radiological measurements together with evacuation proctograms in 49 patients with obstructed defaecation and normal whole gut transit times were carried out and compared in a total of 25 controls. Proctography delineated four groups: (I) puborectalis accentuation, n = 11; (II) rectal intussusception, n = 25; (III) anterior rectal wall prolapse, n = 11; (IV) rectocele, n = 2. The anorectal angle at rest, maximum basal sphincter pressures and the rectoanal inhibitory reflex did not differ between the groups and controls. Group III achieved a greater increase in anorectal angle on straining than controls. Groups II and III exhibited significant perineal descent below the pubococcygeal line whereas group I did not. In perineal descent intussusception was the commonest morphological abnormality associated with obstructed defaecation. Isolated anterior mucosal prolapse was not observed, making local treatment aimed at reducing its bulk questionable.
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PMID:An analysis of rectal morphology in obstructed defaecation. 336 Dec 19

Defecographic evaluation was performed in 30 patients with rectal prolapse to assess the effect of posterior rectopexy on rectal function and to arrive at a selection of the best procedure. Preoperative defecography revealed rectal intussusception in all patients. Postoperative control studies showed adequate rectal fixation to the anterior sacral surface. Intussusception no longer occurred. Rectal stenosis due to the surgical procedure was absent. The described technique of posterior rectopexy eliminates the prolapse mechanism without creating new disorders and is therefore a rational procedure. Advocation of new procedures should also be based on results of colorectal tests that assess the effect of the procedures on rectal function.
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PMID:Toward a selection of the most appropriate procedure in the treatment of complete rectal prolapse. 336 34

From May 1985 through July 1987, 22 patients underwent Kock continent ileal reservoir for urinary diversion. There were 19 males and 3 females, between 38 and 82 years old (mean age 63.1 years). A one-stage radical cystectomy and Kock pouch construction were performed in 21 patients. One patients was converted from standard ileal conduit to this new reservoir. The keys to success of the Kock pouch are creation and maintenance of the nipple valve to prevent reflux and to ensure continence. Mesenteric fat is removed with CUSA for 8 cm along the afferent-efferent limbs of the pouch and exclusion of mesentery is limited for only 3-4 cm. This important modification will ensure adequate ileal intussusception and vascular supply to the valves. To prevent eversion and prolapse, the nipple valve is anchored to the wall of reservoir. A strip of sauvage filamentous Dacron serves as a collar to fix the afferent-efferent limbs to the pouch. There were 2 postoperative deaths and two major early complication: 1 acute renal failure and 1 intestinal fistula, both of which were treated conservatively. Late complications occurred in 6 patients. Of these 6 patients, 1 required reoperation and revision of the continence valve mechanism and 1 required hospitalization for entero-pouch fistula. Serum electrolytes and vitamin B12 remained normal in all patients. Patients perform self-catheterization every 4-6 hours during the day and once at night for volumes ranging up to 1,000 ml. The end result in 19 of 20 patients was excellent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical experience with the Kock continent ileal urinary reservoir]. 337 20

Over a 2 1/2 year period a prospective study was undertaken to evaluate the occurrence and symptoms of rectal intussusception (internal procidentia). The condition was found in 28 female patients. 17 patients were operated on due to severe obstruction during defaecation, perineal pain, solitary rectal ulcer syndrome, and partial incontinence. The endopelvic findings were similar to those encountered in patients with complete, external rectal prolapse, and the operative procedure was identical (rectal mobilization, elevation, fixation, with rectosigmoid resection in most cases). Results were favorable. Conservative treatment seemed to be adequate in 7 of the 11 remaining patients.
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PMID:[Internal rectal prolapse]. 338 80

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

Forty-three patients with histologically proven solitary ulcer syndrome of the rectum were examined by defaecography and 33 by barium enema. Barium enema showed changes in the rectum in all cases. Thickening of the rectal folds and spasm were most common, followed by ulceration and pseudopolypoid change. None of these changes is individually pathognomonic of the solitary ulcer syndrome, but viewed in conjunction they are highly suggestive of the condition. During defaecography, intussusception of the rectum was observed in 34 cases (79%). In 19 (44%) a complete external prolapse was present while intra-anal and intra-rectal intussusception was found in 15 (35%). Intussusception arose in most cases from the mid-rectum, and rarely from a rectal mucosal prolapse of the ampulla. Awareness of the abnormalities of the solitary ulcer syndrome on barium enema enables the radiologist to suggest the diagnosis and recommend defaecography to establish the functional disorder, which may help determine the appropriate medical or surgical treatment.
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PMID:Barium enema and defaecography in the diagnosis and evaluation of the solitary rectal ulcer syndrome. 361 39

Rectal prolapse occurs mostly in the geriatric female patient and can be a very disabling condition. The etiology is intussusception of the rectosigmoid secondary to excessive and prolonged straining. Medical therapy for this disease process is not helpful and patients will require a surgical procedure. The two best surgical procedures for the correction of rectal prolapse are low anterior resection of the rectosigmoid and proctopexy. A few patients who are unfit for laparotomy may require the Thiersch Wire procedure. Two unresolved problems after surgical therapy are continuing constipation and incontinence. Constipation is treated by dietary measures, stool softeners, and periodic enemas. Laxatives are to be discouraged. Incontinence in patients with rectal prolapse improves in most patients after a procedure to correct the prolapse. In those patients in which incontinence persists, no form of therapy has been found to be uniformly successful.
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PMID:Rectal prolapse. 383 Mar 77

The solitary rectal ulcer and colitis cystica profunda are different manifestations of the solitary rectal ulcer syndrome. The cause of solitary rectal ulcer syndrome remains unknown. Since defecation disorders are common among patients with solitary rectal ulcer syndrome, defecography is indicated. Defecography was performed on 19 patients with solitary rectal ulcer syndrome. In five patients, the spastic pelvic floor syndrome had occurred. Twelve patients had internal intussusception of the rectum, and one patient had an anterior rectal wall prolapse. In one patient, no abnormalities could be detected. These abnormalities led to severe straining, which can damage the anterior rectal wall. Findings strongly support the hypothesis that solitary rectal ulcers are traumatic lesions caused by straining. Defecography is a suitable procedure for detecting the causative disorder of defecation and for selecting patients for treatment.
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PMID:Diagnosis of functional disorders of defecation causing the solitary rectal ulcer syndrome. 394 22

Defecography is a technique of examining the rectum and anal canal in which the patient is studied while sitting down rather than recumbent and recordings are obtained both at rest and during straining. The authors describe their findings in 83 patients with dyschezia. Defecation was normal in 28 patients. Prolapse of the anal mucosa was seen in 13 patients and internal procidentia in 23, 12 of whom also had intussusception manifested as rectal prolapse. A deep rectogenital fossa associated with an enterocele was seen in 16 patients; 13 had a proctocele, while fecal retention was seen in 5. Descent of the pelvic floor and changes in the angle between the rectum and anal canal were assessed. The authors recommend defecography as a more physiological means of assessing rectal dysfunction.
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PMID:Defecography. 397 18


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