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

Imaging currently plays a limited role in the investigation of pelvic floor disorders. It is obvious that magnetic resonance imaging has limitations in urogynecology and female urology at present due to cost and access limitations and due to the fact that it is generally a static, not a dynamic, method. However, none of those limitations apply to sonography, a diagnostic method that is very much part of general practice in obstetrics and gynecology. Translabial or transperineal ultrasound is helpful in determining residual urine; detrusor wall thickness; bladder neck mobility; urethral integrity; anterior, central, and posterior compartment prolapse; and levator anatomy and function. It is at least equivalent to other imaging methods in visualizing such diverse conditions as urethral diverticula, rectal intussusception, mesh dislodgment, and avulsion of the puborectalis muscle. Ultrasound is the only imaging method able to visualize modern mesh slings and implants and may predict who actually needs such implants. Delivery-related levator trauma is the most important known etiologic factor for pelvic organ prolapse and not difficult to diagnose on 3-/4-dimensional and even on 2-dimensional pelvic floor ultrasound. It is likely that this will be an important driver behind the universal use of this technology. This review gives an overview of the method and its main current uses in clinical assessment and research.
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PMID:Pelvic floor ultrasound: a review. 2035 Jun 40

Reported herein is an experience with retrograde intussusception. The index case was a 25-year-old African American woman who was status post-multiple previous intraperitoneal procedures, including a truncal vagotomy, distal gastrectomy, and Roux-en-Y gastrojejunostomy for the treatment of gastric outlet obstruction secondary to type 2 peptic ulcer disease. The patient presented most recently with symptoms and signs of a high-grade mechanical intestinal obstruction. Preoperatively, computerized axial tomography revealed retrograde intussusception. Urgent exploratory celiotomy confirmed retrograde intussusception of a segment of the common channel just distal to the jejunojejunostomy. The jejunojejunostomy, including the nonreducible intussusceptum and intussuscipiens, was resected. The alimentary tract was reconstituted in conventional fashion. Light microscopic histopathologic analysis revealed acute greater than chronic inflammation, transmural edema, ischemia/necrosis of the intussusceptum, and hypertrophy of the intussuscipiens. Mechanistically, intussusception has been characterized as an internal prolapse. It usually is aboral/antegrade/isoperistaltic in direction with circumferential intraluminal invagination/prolapse/propagation/telescoping of the proximal/cephalad intussusceptum into the distal/caudad intussuscipiens. Retrograde intussusception is the reverse. More specifically, retrograde intussusception is adoral/retrograde/antiperistaltic in direction with circumferential extraluminal exvagination/propagation/telescoping of the proximal/cephalad intussuscipiens over and around the distal/caudad intussusceptum. We speculate that suture lines, staple lines, adhesive disease, and incomplete closure of mesenteric defects are proximate and determinant causes of retrograde intussusception.
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PMID:Retrograde jejunojejunal intussusception status following Roux-en-Y gastrojejunostomy. 2071 27

Chronic constipation is a symptom complex caused by a wide variety of diseases. Primary causes of constipation, including enterocele, rectocele, rectum prolapse and intussusception, involve changes of the bowel which either delay or prevent the passage of bowel content. This condition has been termed "obstructed defaecation syndrome" (ODS).This article is based on clinical experience and a review of selected literature. The complexity of chronic constipation warrants interdisciplinary work-up and treatment. The diagnostic work-up includes taking a focus on the history of patient's complaints. This can be objectified using a standardized scoring system, e. g. Longo score. Gynaecological examinations must be performed on all female patients. Intraluminal abnormalities are best excluded by colonoscopy and rectoscopy. An abnormal score in combination with negative findings on endoscopy and gynaecologic examinations warrant a radiological assessment with a defaecogramm in symptomatic patients. Treatment is usually medical, involving changes in life style, bowel habits and the use of laxatives. Biofeedback has been shown to be effective in some patients. Surgery is indicated for selected patient who do not improve after medical treatment. A range of surgical procedures have been shown to be effective in the treatment of chronic constipation. The minimal invasive double stapled trans anal rectum resection (STARR procedure) has been proven effective in treating rectocele and rectum prolapse in selected patients. The advantages of the STARR procedure include: short hospital stay, reduced postoperative pain and an early return to work. We consider this procedure as safe and effective when performed by a well trained surgeon in selected patients.
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PMID:[Surgical options in the treatment of the obstructed defaecation syndrome]. 2141 77

Gastroduodenal intussusception is not a common clinical condition. It is usually caused by transpyloric prolapse of a benign gastric lesion into the duodenum. In the present report, the authors present an extremely rare case of gastroduodenal intussusception in which gastric carcinoma served as the lending point. Pre-operative diagnosis was made from endoscopy and biopsy. The patient was treated successfully by subtotal gastrectomy with D2 lymph node dissection. The clinical presentation, diagnosis, and management of this entity were discussed and the literature was reviewed. Both the condition itself and the leading tumor, gastric carcinoma, are extremely rare and to the authors' knowledge. This is the first report in Thailand.
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PMID:Transpyloric prolapse of a pedunculated polypoid gastric carcinoma: a case report and review of the literature. 2186 86

Recent developments in diagnostic imaging have made gynecologists, colorectal surgeons and gastroenterologists realize as never before that they share a common interest in anorectal and pelvic floor dysfunction. While we often may be using different words to describe the same phenomenon (e.g. anismus/vaginismus) or attributing different meanings to the same words (e.g. rectocele), we look after patients with problems that transcend the borders of our respective specialties. Like no other diagnostic modality, imaging helps us understand each other and provides new insights into conditions we all need to learn to investigate better in order to improve clinical management. In this review we attempt to show what modern ultrasound imaging can contribute to the diagnostic work-up of patients with posterior vaginal wall prolapse, obstructed defecation and rectal intussusception/prolapse. In summary, it is evident that translabial/perineal ultrasound can serve as a first-line diagnostic tool in women with such complaints, replacing defecation proctography and MR proctography in a large proportion of female patients. This is advantageous for the women themselves because ultrasound is much better tolerated, as well as for healthcare systems since sonographic imaging is much less expensive. However, there is a substantial need for education, which currently remains unmet.
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PMID:Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation. 2204 64

Although transanal prolapse of intussusception in infants is well recognized, it is rarely reported and confusion with rectal prolapse often results in delayed diagnosis and treatment. This report highlights the problems of delayed diagnosis and the morbidity and mortality associated with this condition. The authors report a case of 9 mo old boy who presented with prolapsing small bowel mimicking rectal prolapse.
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PMID:Neglected intussusception presenting as transanal prolapse of small bowel. 2386 98

Colonic lipomas larger than 2 cm in diameter are likely to be symptomatic. In some cases a complication is the first clinical sign. Massive lower intestinal bleeding or obstruction, acute bleeding, prolapse or perforation or, rarely, acute intussusception with intestinal obstruction require urgent surgery. Diagnosis is often made following colonoscopy, which can also have a therapeutic role. Imaging procedures such as CT has a secondary role. Patients with small asymptomatic colonic lipomas need regular follow up. For larger (diameter > 2 cm) and/or symptomatic lipomas, resection should be considered, although the choice between endoscopic or surgical resection remains controversial. We believe that even lipomas > 2 cm can safely be removed by endoscopic resection. If surgery is indicated, we consider laparoscopy to be the ideal approach in all patients for whom minimally invasive surgery is not contraindicated.
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PMID:Colonic lipomas. Three surgical techniques for three different clinical cases. 2314 Sep 30

Obstructed defecation (OD) syndrome is associated with several abnormalities of the pelvic organs, namely anterior rectal mucosa prolapse, anterior rectocele, recto-anal intussusception, and a deep Douglas pouch which predisposes to enterocele or rectocele. Surgical repair of the anatomical deformities should be attempted, only after thorough selection of patients and conservative treatment has been exhausted. Transperineal procedures include resection-plication of the anterior rectal wall and stapled transanal rectal resection, and are indicated for the treatment of anterior rectocele and internal rectal prolapse. Functional results are satisfactory in approximately 75 percent of the cases. Transabdominal procedures include posterior prosthesis rectopexy, resection suture-rectopexy and ventral prosthesis colporectopexy. These procedures are indicated in patients with large rectocele and rectal intussusception and enterocele or sigmoidocele. The rate of repair of anatomical deformities is very high and improvement of symptoms is accounted in more than 80 percent of the cases. Ventral prosthesis colporectopexy seems a very promising approach, but further evidence is mandatory.
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PMID:Functional results after surgery for obstructed defecation. 2337 55

Female pelvic floor dysfunction encompasses a number of highly prevalent clinical conditions such as female pelvic organ prolapse, urinary and fecal incontinence, and sexual dysfunction. The etiology and pathophysiology of those conditions are, however, not well understood. Recent technological advances have seen a surge in the use of imaging, both in research and clinical practice. Among the techniques available such as sonography, X-ray, computed tomography and magnetic resonance imaging, ultrasound is superior for pelvic floor imaging, especially in the form of perineal or translabial imaging. The technique is safe with no radiation, simple, cheap, easily accessible and provides high spatial and temporal resolutions. Translabial or perineal ultrasound is useful in determining residual urinary volume, detrusor wall thickness, bladder neck mobility and in assessing pelvic organ prolapse as well as levator function and anatomy. It is at least equivalent to other imaging techniques in diagnosing, such diverse conditions as urethral diverticula, rectal intussusception and avulsion of the puborectalis muscle. Ultrasound is the only imaging method capable of visualizing modern slings and mesh implants and may help selecting patients for implant surgery. Delivery-related levator injury seems to be the most important etiological factor for pelvic organ prolapse and recurrence after prolapse surgery, and it is most conveniently diagnosed by pelvic floor ultrasound. This review gives an overview of the methodology. Its main current uses in clinical assessment and research will also be discussed.
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PMID:Pelvic floor ultrasonography: an update. 2341 16

Obstructed defecation is a common problem that adversely affects the quality of life for many patients. Known causes of obstructed defecation include pelvic dyssynergy, rectocele, rectal intussusception, enterocele, pelvic organ prolapse, and overt rectal prolapse. Management of this condition requires an understanding of urinary, defecatory, and sexual function to achieve an optimal outcome. The goal of surgical treatment is to restore the various pelvic organs to their appropriate anatomic positions. However, there is a poor correlation between anatomic and functional results. As the pelvis contains many structures, a pelvic support or function defect frequently affects other pelvic organs. Optimal outcomes can only be achieved by selecting appropriate treatment modalities that address all of the components of a patient's problem.
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PMID:Treatment of obstructed defecation. 2344 41


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