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

Defecography is a method allowing the morphodynamic evaluation of the anorectal region. The technique we employed needs two complementary times: "phase" defecography and dynamic defecography. In our series of patients affected with severe constipation, 2 groups could be identified. Group A included those patients (mean age: 38.7 years) in whom no significant changes were observed in anorectal angle and in the distance of anorectal angle from pubococcygeal line in comparison with normal subjects (Student's t-test). Group B included those patients (mean age: 63.3 years) in whom significant reduction was observed in anorectal angle on straining, together with increased distance of anorectal angle from pubococcygeal line on squeezing in comparison with normal subjects (Student's t-test). In constipated patients narrowed anal canal was observed (60%), together with rectocele (42.6%), mucosal prolapse (27.8%), rectal prolapse (18%) and solitary ulcer (14.7%). In idiopathic incontinence patients (mean age: 63.3 years), increased distance was observed of anorectal angle from pubococcygeal line on squeezing and, in the most severe cases, even at rest, with the patient sitting (Student's t-test). In incontinent patients larger anal canal was observed (67.6%), together with rectocele (36.7%), mucosal prolapse (14.7%), and rectal prolapse (11.7%).
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PMID:[Functional evaluation of the anorectal region]. 200 45

Pelvic floor function has been studied in 27 women with symptomatic utero-vaginal prolapse and 15 age-matched control subjects. There was no evidence in the patients on physiological testing of significant denervation of the pelvic floor muscles, with no significant difference in the maximum resting and squeeze anal pressures, the pudendal nerve terminal motor latency or external anal sphincter fibre density on single fibre electromyography between the groups. However, those patients with a small rectocele (less than 2 cm) had a significantly higher fibre density than the group with a large rectocele (p = 0.03) and the control group (p less than 0.001). Six of eight patients with a small rectocele had increased fibre density compared with 3/19 with a large rectocele (p = 0.006) and 2/15 control subjects (p = 0.006). This was independent of age, obstetric factors and the presence of internal rectal prolapse. These findings suggest that patients with symptomatic utero-vaginal prolapse and small rectoceles have pelvic nerve damage, and development of a large rectocele may provide some protection against perineal descent and pudendal neuropathy, although the number of patients in the small rectocele group was small and confirmation from further similar studies is required.
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PMID:Pudendal nerve function in women with symptomatic utero-vaginal prolapse. 203 49

A perineal operation is described for the treatment of rectal prolapse. The surgery improves functional outcome by correcting the anatomical anomalies associated with the condition. In 17 elderly women, there was one perioperative death and one recurrence. At a median follow-up of 24 months, 13 patients were able to control solid stool and three were profoundly incontinent. The operation may be an alternative to the more invasive abdominal procedures for the treatment of the majority of patients with prolapse.
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PMID:Perineal excision of the rectum for prolapse in the elderly. 207 Feb 35

Rectopexy associated with anterior prolepsectomy was performed for 22 patients (19 females, 3 males), with solitary rectal ulcer syndrome (SRUS) surrounding internal rectal prolapse. The different lesions of SRUS were distributed among 3 main groups (G) according to the macroscopic appearance: G1: solitary ulcer (n = 7); G2: ulcerated proctitis (n = 7); G3: muco-hemorroidal prolapse (n = 3). A significant difference (P less than 0.05) was observed between each group, concerning mean age (G1: 34 years, G2 = 49, G3: 65) and the degree of perineal descent, which was more important in G3 and G2. Posterior intersphincteric rectopexy was performed for 6 patients in G3, with descending perineum and faecal incontinence, treated in the same time by perineoplasty (Parks). Abdominal rectopexy, mainly by the antero-posterior technique (Nicholls), was performed for the other patients (n = 6). Large anterior prolapsectomy reaching the top of the mucosal prolapse (4-7 cm), allowing ulcer resection in 3 cases, was combined with rectopexy. Associated operations were: sphincterotomy (n = 8) for narrow fibrous anal canal, sigmoidectomy (n = 4) for dolichocolon. Mean healing time for the solitary ulcer group (G1) was 2 months, 1 month for lesion of G2 and G3. Failures concerned 1 solitary ulcer after abdominal rectopexy and 1 ulcerative proctitis after rectopexy without prolapsectomy. Anorectal pain (81%), rectal bleeding (76%), faecal incontinence (27%), straining (81%), were cured or improved in 80% of cases. These results tend to confirm the efficacy of rectopexy, specially using the antero-posterior technique, for the treatment of SUSR with internal rectal prolapse. Nevertheless, rectopexy seems to be insufficient to correct the mucosal component of internal rectal prolapse, bearing the ulcerated lesion which needs to be treated by associated anterior prolapsectomy. Similarly all functional or organic disorders involving the perineum, anal canal or colon leading to anorectal dysfunction must also be considered to ensure complete treatment.
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PMID:[Solitary rectal ulcer syndrome: clinical features, clinical course and treatment. Apropos of 22 cases]. 210 Jan 20

Abdominal rectopexy to the promontory is an effective treatment for total rectal prolapse, internal procidentia and solitary ulcer. This paper is designed to stress the risk of severe constipation following rectopexy, a complication which required surgical resection in 5 cases. This raises the problems of the physiological mechanisms of this complication, the definition of a possible high risk population (young women, patients who were constipated preoperatively?), and an alternative to promontory rectopexy: sacral fixation of the rectum, associated sigmoidectomy, Delorme's operation?
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PMID:[The role of colorectal resection in severe constipation after promontory rectopexy]. 218 56

The surgical treatment of complete rectal prolapse has been the object of great controversy. Currently, it is believed that best results are obtained by transabdominal rectopexy. Even though these operations have low morbidity and mortality, a laparotomy may not be advisable for certain elderly or poor-risk patients. An alternative would then be the Delorme operation. The principle consists of an extensive perineal excision of the mucosa covering the prolapse, and a longitudinal plication of the rectal wall. From January 1988 to March 1989, 12 patients underwent the Delorme repair of rectal prolapse in our service with good results.
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PMID:[Status of the Delorme operation in surgery of rectal prolapse]. 219 60

We studied histologic sections and clinical data from six patients with multiple rectosigmoid polyps that could not be readily classified. Features common to all were: 1) numerous polyps restricted to the rectosigmoid colon without evidence of polyposis or gastrointestinal disease elsewhere, 2) severe clinical symptoms mimicking inflammatory bowel disease, 3) no family history of polyposis or evidence of infection and 4) histology showing minimally inflamed polypoid hyperplastic mucosa with surface erosions or pseudomembranes. Three patients underwent colectomies; three showed a response to oral steroids. One had rectal prolapse. Although reminiscent of inflammatory cloacogenic polyps or solitary rectal ulcer syndrome, the polyps extended into the sigmoid colon, were quite numerous, and showed only mild smooth muscle insinuation in the lamina propria. Whether these lesions are due to occult prolapse or are an unusual manifestation of inflammatory bowel disease remains unclear.
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PMID:Eroded polypoid hyperplasia of the rectosigmoid. 219 59

This is a report of a simple transanal operation performed on six patients (age range, 19 months to 18 years), who underwent unsuccessful nonoperative management of complete rectal prolapse for at least 1 month (range, 1 month to 13 years). All patients had normal sweat chloride levels, normal chest radiographs, and normal barium enemas. None of the patients were neurologically compromised. At the time of surgery, all but one patient had occurrence of reducible prolapse with minor straining or with every bowel movement. No severe mucosal ulcerations were present. Surgical therapy consisted of the transanal mucosal sleeve resection described herein. In this series, there were no anastomotic leaks, no clinically evident strictures and no recurrence of prolapse in 1.5- to 19-year follow-up. Surgical therapy for rectal prolapse in infants and children is rarely necessary. Various complicated or ineffective operations for the treatment of this condition have been recommended in the past. This technique offers a simple, safe, and effective method of treating complete, medically intractable rectal prolapse in children.
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PMID:Transanal mucosal sleeve resection for the treatment of rectal prolapse in children. 219 58

Using a posterior repair and rectal suspension procedure for those patients who need surgical treatment of rectal prolapse, we have treated 46 patients over a period of 17 years at Children's Mercy Hospital in Kansas City, MO. One patient with caudal dysgenesis died of multiple congenital anomalies following two unsuccessful attempts at posterior repair and suspension. Four patients developed a recurrence afterwards, which was found to be due to sigmoid intussusception and, presumably, had played a major part in their original prolapse. Two of these required resection, one from the transanal approach and one from the transabdominal approach. One resolved spontaneously and another is as yet unresolved. Three patients had minor mucosal prolapse that was transient and two patients had extrusion of silk sutures but continued to have a very satisfactory result. Overall, 42 patients had satisfactory resolution of their rectal prolapse. Three of the four patients who had unsatisfactory results had associated anomalies that contributed to their poor outcome.
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PMID:Rectal prolapse: 17-year experience with the posterior repair and suspension. 221 53

Women with incontinence were divided into 30 with anorectal incontinence and 63 with complete rectal prolapse. The former group comprised 14 with a sphincter disruption and the remainder with intact sphincters. After anterior sphincter repair 70% were restored to acceptable continence. Success was associated with a rise in resting and voluntary contraction pressures and improved anal sensation. Patients with prolapse underwent either anterior and posterior rectopexy, or resection rectopexy. Continence was improved in both groups. Postoperatively, 90% following resection rectopexy and 80% following anterior and posterior rectopexy were restored to acceptable continence. Postoperative defaecatory straining and incomplete evacuation were reduced, with no significant differences between the two procedures. Restoration of continence was not associated with any change in sphincter pressures. However, rectal sensory threshold and anal sensation were both improved.
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PMID:The physiological evaluation of operative repair for incontinence and prolapse. 222 61


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