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

Internal procidentia or internal rectal prolapse (intussusception) still represents a therapeutic problem: it may be a secondary phenomenon in a primary functional disorder, or it may itself represent the cause of outlet obstruction amenable to cure by prolapse operation. Over a 10-year period 49 patients underwent surgery due to severe symptoms and resistance to conservative treatment. Symptoms and findings were obstructive constipation (65%), tenesmus and pain (55%), mucus discharge and bleeding (26%), and incontinence (24%). 12 (24%) of the patients had a solitary rectal ulcer syndrome. The operative procedure consisted in rectal mobilization, elevation, rectopexy, with rectosigmoid resection in 45 patients. 1-9 (mean 3) years after the operation 10 patients (21%) had a poor functional outcome, though the intussusception was cured in 48 patients. A favorable result was most frequently noticed in patients with incontinence, incipient external prolapse, and also in those with a solitary rectal ulcer syndrome. 35% of the patients with obstruction, severe pain and normal continence did not benefit from the operative procedure.
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PMID:[Internal rectal prolapse: therapy outcome and current status]. 883 Mar 95

In order to determine the frequency of posterior compartment pathology in females with anterior and middle compartment pelvic floor weakness, 10 women with urinary stress incontinence and 10 women with uterovaginal prolapse underwent detailed review of their history and clinical findings, and were studied by simultaneous evacuation proctography and cystography. Radiological findings were correlated with anorectal physiological testing. Considerable symptom overlap and occult defaecatory symptoms were revealed. The combined radiological examination visualized cystocoele, enterocoele, rectocoele and rectal intussusception, and diagnosed higher degree prolapse than did clinical examination. There was no significant difference in the frequency of any of these findings with respect to either group, nor was there any significant difference in proctographic measurements. Additionally, there was little significant difference in physiological measurements between the groups, and when cystoproctographic features were compared to the results of anorectal physiological testing, there was little correlation between results obtained from either set of tests. In conclusion, modification of standard proctographic techniques enhances the diagnostic potential of the study, allowing accurate demonstration of the site and degree of pelvic floor weakness in women. Weakness often involves all pelvic compartments, despite differing clinical presentations, suggesting a global pathology. Embarrassing symptoms may not be volunteered, and should be sought so that imaging is appropriate.
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PMID:Dynamic cystoproctography and physiological testing in women with urinary stress incontinence and urogenital prolapse. 893 21

Defecography (DG) is a useful method to detect many morpho-functional deformities of anus and rectum and pelvic floor. We report on a clinical and radiologic study of 165 patients (36 men and 129 women) suffering from defecation disorders and rectal muscosal prolapse (RMP). All the patients had been submitted to clinical examination, endoscopy and double contrast enema to rule out organic colorectal conditions. DG was performed with a dedicated conmode and high-density barium and videorecorded on VHS cassettes to assess the dynamics of evacuation phases and to reduce exposure doses. DG showed single RMP in 28% of cases and multiple RMP in 72% of cases; the condition was isolated in 22% of cases, while in 88% of cases it was associated with other anorectal dysfunctions, such as rectocele (65%), perineal descent syndrome (PDS) (15%), puborectal muscle syndrome (14%) and intussusception (8%). RMP appeared at DG as a wall defect bulging into rectal lumen, which was more evident under straining and during barium evacuation. In 12 patients with multiple RMP, dynamic CT of the pelvis was carried out to study the whole pelvic floor and in 5 cases it showed levator ani diastasis. Fifty-eight patients were submitted to surgery by elastic binding of RMP; DG follow-up showed RMP remission in 47 patients, single RMP relapse in 3 patients and multiple RMP relapse in 3 patients. One patient with PDS and intussusception was submitted to rectopexy and mucosectom.
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PMID:[Role of radiologic diagnosis in rectal mucosal prolapse]. 896 79

In the years 1972-1995 41 patients suffering from prolapse of the rectum were operated according to the Moore method. The method is based on the observations which suggest that the cause of prolapse is intestinal intussusception which can be prevented by translocating the anus under the pubic joint. The observation time is from 1 to 23 years. Two patients were reoperated; one-as a result of a recurrence of rectal prolapse and one due to a post-operative adhesive ileus. One patient died as result of peritonitis following an overlooked microperforation in the rectal wall. In the case of the remaining patients, the treatment was fully successful. Regular defecation cycle as well as incontination of stool and flatus returned and the anal sphincters almost fully regained their tension in comparison to the pre-operative state. Early and distant results of surgery of prolapse of the rectum are satisfactory.
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PMID:Surgical treatment of prolapse of the rectum--evaluation of distant results. 902 May 65

Omphalomesenteric duct malformations comprise a wide spectrum of anatomic structures and associated symptoms (or no symptoms). They may range from a completely patent omphalomesenteric duct at the umbilicus to a variety of lesser remnants including cysts, fibrous cords connecting the umbilicus to the distal ileum, granulation tissue at the umbilicus, umbilical hernias, and the famous diverticulum of Meckel. Symptoms may involve fecal fistulas at the umbilicus, intussusception/prolapse of ileum at the umbilicus, intestinal obstruction from a variety of causes, melena and anemia, abdominal pain and inflammation, etc. Although symptoms occur most frequently during childhood years (especially in the first 2 years of life), they may occur through adult years as well. Although these malformations are found with equal frequency among the sexes, a significantly greater incidence of symptoms is encountered in males. Although one of the very most frequent malformations to be found (Meckel's diverticulum in 2% to 3% of the population), they are one of the most unlikely to cause symptoms (also Meckel's diverticulum). An awareness of the diversity of these malformations in type and symptomotology is essential to their proper and optimal management.
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PMID:Omphalomesenteric duct malformations. 913 10

Video defecography is a dynamic investigation which can influence surgical decision making in constipated patients. A study was therefore undertaken to assess the inter and intraobserver variability in video defecography. Specifically, we sought to assess the interpretation of video defecographies by a group of observers with the same training, guidelines and standards. To determine interobserver variation, four independent observers, two blinded to the patient's history, reviewed 100 randomly sequenced video defecographies performed in constipated patients. The presence or absence of sigmoidocele, rectocele, intussusception or prolapse was noted. Adequate or improper function of the puborectalis, anal canal opening, anorectal angle (ARA) and grade of emptying of the rectum were also assessed. Two weeks after the initial assessment, intraobserver variation was determined by a repeat blinded review of unlabelled randomly sequenced studies. The results of interobserver accuracy for sigmoidoceles, rectoceles, intussusception, rectal prolapse, rectal emptying, opening of the anal canal, puborectalis contraction and straightening of the ARA and rectal emptying were 89.5%, 46.0%, 87.5%, 97.5%, 86.5%, 88.5%, 83.0%, and 80.0%, respectively. The intraobserver variations were 88.5%, 83.8%, 80.5%, 94.5%, 77.0%, 84.8%, 80.5% and 85.5%, respectively. Prior knowledge of the patient's history did not significantly influence the outcome. In summery, video defecography has an overall accuracy of 83.3% and as such is a valid tool in assessing constipated patients.
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PMID:Are interpretations of video defecographies reliable and reproducible? 918 73

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.
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PMID:[Rectal prolapse]. 922 42

Generic guidelines are applied to reconstructive vaginal operations, so as to convert them to ambulatory procedures. Prototype operations are described and analyzed. These included conceptualizing vaginal prolapse as a type of intussusception caused by vaginal and ligamentous laxity in the middle or posterior parts of the vagina; the avoidance of vaginal excision, excessive tension, and refashioning excess vaginal tissue from width to length or into a partial double-layered repair; the creation of artificial neoligaments; the prevention of urinary retention by avoiding tightness in the bladder neck area; local anesthetic infiltration; and buttressing vaginal tissue during wound healing. A total of 108 patients underwent vaginal surgery on an ambulatory or overnight stay basis, 72 under local anesthesia/midazolam. Minimal postoperative pain and the absence of catheterization reduced hospital stay from a statewide mean of 8 days to 1 day, and return to normal activities from 6 weeks to 7-10 days. Cure rates (18 months) were: uterovaginal prolapse 22/22, infracoccygeal sacropexy 21/23, rectocele 36/38, cystocele/anterior vaginal wall prolapse 21/25. Applied as prototypes to reconstructive vaginal surgery, the operations appear to be as effective as traditional techniques but far less invasive. They have the potential to assist working mothers, the old and infirm, and save the community up to $5,500 per patient. It is hoped that the generic models presented may act as a basis for the future development of ambulatory vaginal surgical techniques.
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PMID:Development of generic models for ambulatory vaginal surgery--a preliminary report. 965 74

Solitary rectal ulcer, internal rectal intussusception, and complete rectal prolapse are a range of defaecatory disorders that may have a common aetiology, namely chronic straining. If the pelvic floor is weak, external prolapse is often complicated by faecal incontinence. Few patients, a lack of randomised trials, and difficulties in the interpretation of studies of anorectal physiology (the results of which often seem conflicting) have made the understanding of these disorders difficult. The basis for treatment is clear, however--patients who have symptomatic defaecatory disorders associated with an internal intussusception, or solitary rectal ulcer, or both should have a course of training of pelvic floor muscles, dietary advice, and should use fibre supplements as primary treatment. Operation should be reserved for those patients in whom medical treatment has failed, and it may be expected to relieve symptoms in above two thirds of patients. Defaecating proctography may be useful in assessing which patients may not benefit from operation. Operation is the primary treatment for external prolapse. The choice of surgical approach should be tailored according to the expertise available, the medical condition of the patient, and the presence or absence of pre-existing constipation or incontinence.
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PMID:Rectal prolapse and rectal invagination. 966 65

Rectal and colonic X-ray findings of 100 patients with constipation are presented. The study was performed by the authors' modified irrigoscopic procedure using barium enema. This made it possible not only to determine the shape, dimensions, and position of the rectum and colon, but to reveal a number of anatomic and functional changes in the rectum and pelvic floor (rectocele, rectal intussusception and prolapse, perineal descent, sigmoidocele), which was helpful in choosing a treatment policy for patients with colonic evacuatory dysfunction.
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PMID:[New methods of rectum and colon x-ray study in patients with constipation]. 968 Aug 24


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