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

Spontaneous large bowel perforations have been associated with chronic constipation. The previously reported episodes of anal evisceration of small intestine have occurred in patients with a rectal prolapse. An end-stage complication of chronic third degree uterine prolapse is presented. A laceration of the anterior rectosignoid colon wall permitted small bowel extrusion through the anus. The tearing effect exerted by the prolapsed uterus at the rectouterine fold presumably caused the rectosigmoid laceration.
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PMID:Spontaneous rupture of the rectosigmoid colon with anal evisceration: a new complication of uterine prolapse. 125 4

Chronic constipation is probably the most common symptom resulting in a referral of patients for a dynamic radiologic investigation of the GI tract. The primary usefulness of defecography in chronic constipation is to provide details about the dynamic phenomenon of evacuation which cannot be elicited by any other medical technique. It is employed to demonstrate or rule out the presence of an anatomical deformity (prolapse, rectocele, intussusception) and/or a localized dysfunction (outlet obstruction, rectal inertia) of the distal GI tract. Defecography can distinguish between a grossly obstructed pattern and an overtly normal one, but a definitive diagnosis is made by manometry and electromyographic studies. On the other hand, it should be noted that a failure to show abnormalities by defecography does not necessarily imply a normal anorectal function. A better understanding of anorectal physiology is expected in the future from combined video-pressure studies, which will provide the exact timing between the pressure drop and barium passage through the distal colon.
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PMID:Functional radiology of the ano-rectal region. 175 79

Solitary ulcer of the rectum is an unusual condition occurring more often in young adults. Unfortunately the term is rather confusing, since the lesion may not necessarily be solitary, nor be confined to the rectum; moreover, it may be polypoid rather than ulcerating. The etiology is uncertain, but chronic constipation and fecal impaction could play a role. Today most authors believe solitary ulcer syndrome is a distinct clinical inflammatory manifestation associated with rectal prolapse. Surgical treatment of the prolapse is usually followed by a recovery of the solitary rectal ulcer.
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PMID:[Solitary ulcer of the rectum: a report of a clinical case associated with rectal prolapse]. 183 45

Fifty-four pediatric patients with rectal prolapse (RP) were identified by review of medical records from 1977 to 1987. Rectal prolapse was attributed to chronic constipation (15 patients), acute diarrheal disease (11 patients), cystic fibrosis (CF) (six patients), and neurologic/anatomic abnormalities (13 patients). In nine patients, no underlying cause was identified. The patients with CF did not differ from the other groups in terms of age at time of onset of prolapse, growth measurements, or number of episodes of prolapse. All patients with CF had a history of abnormalities or presented with signs and symptoms consistent with this diagnosis; none had a history of constipation. Although physicians can be reassured that CF is not a likely diagnosis in patients with RP and acute diarrheal disease or a clear history of constipation, a sweat test is indicated in all such cases as well as in those in which there is no apparent underlying cause. A sweat test is not usually indicated in patients with RP in association with underlying anatomic abnormalities.
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PMID:The cause of rectal prolapse in children. 334 23

Transabdominal posterior rectopexy with resection of the redundant left colon (Frykman-Goldberg operation) was performed on 48 selected patients with complete rectal prolapse. Uterine suspension was also performed on most of the women. The 30-day mortality rate was 2.1%. Prolapse recurred in 4 (9%) of the 45 patients followed up for 1-10 (mean 4.3) years. There were no complications attributable to bowel resection or anastomosis. Adequate data on both preoperative and postoperative anal function and bowel habit were available in 41 cases. All but two of the 32 patients with associated incontinence experienced improved anal control after the operation (9 regained normal continence). Bowel habit improved in 23 patients (56%), especially in those with chronic constipation. No patient reported increased problems of bowel management. The operation does not involve the risks associated with implantation of foreign material and can be especially beneficial for constipated patients with rectal prolapse who are fit for major abdominal surgery.
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PMID:Abdominal rectopexy and sigmoid resection (Frykman-Goldberg operation) for rectal prolapse. 337 79

Scleroderma of the colon is commonly associated with constipation, as was the case in a 70-year-old woman with rectal prolapse described by the authors. The chronic constipation in this patient may have been the cause of her rectal prolapse, but the onset of the prolapse and scleroderma at about the same time suggest that the scleroderma may have been a causative factor. A Ripstein repair of the prolapse was carried out. The authors discuss some of the complications of colonic scleroderma, which include megacolon, transverse and sigmoid colonic volvulus, telangiectasia, stenosis and diverticula and stercoral ulceration.
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PMID:Rectal prolapse in scleroderma: case report and review of the colonic complications of scleroderma. 397 Dec 25

We report 33 patients with the solitary rectal ulcer syndrome seen between 1975 and 1982. Twenty-four were women and the median age was 32 years. The principal symptoms were bleeding (89 per cent), chronic constipation (64 per cent), rectal pain (42 per cent), tenesmus (42 per cent), and mucous discharge (45 per cent). Twenty-eight patients gave a history of straining (85 per cent). A full-thickness rectal prolapse was present in six patients, an anterior rectal prolapse was observed in 11, and 12 patients had clinical evidence of perineal descent. Defecation was only possible by digital evaluation in six women, and three male patients were passive homosexuals. Manometric studies were performed on 16 patients; eight patients were unable to tolerate rectal distention with 200 cc of air and impaired rectal sensation was present in two. Rectal distention was associated with bursts of involuntary external sphincter activity in three patients, and the distention reflex was absent in six, despite normal ganglia on rectal biopsy. In only four patients was there electromyographic evidence of contraction of the puborectalis during attempted defecation. Fourteen patients were treated by rectopexy; healing of the ulcer occurred in five of six with a full-thickness prolapse compared with only two of eight without a complete prolapse.
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PMID:Clinical and manometric features of the solitary rectal ulcer syndrome. 646 84

The establishment of a linear relationship between perineal descent (PD) and pudendal nerve motor terminal latency (PNMTL) is important in understanding the pathophysiology of pudendal neuropathy. The amount of stretching of the pudendal nerve resulting from the extent of PD, should correlate with the amount of injury sustained (PNMTL). The two key previous studies which used different techniques to measure PD, have differed on this vital issue. A prospective study was undertaken in 141 consecutive patients with PD (M:F = 57:84; mean age 46.3 SEM 1.6 years) to clarify this discrepancy. The patients had chronic constipation (81), neurogenic faecal incontinence (31), rectal mucosal prolapse (17) or female urinary stress incontinence (9). All underwent measurements of PD (by perineometry), anal sphincter pressures, single fibre anal sphincter electromyography and PNMTL. These variables, as well as age were analyzed for a linear relationship with PD by multiple regression analysis. Age was the only independent variable predicting PD at rest (T = -3.2; p < 0.005). PNMTL was the only independent variable predicting PD on straining (T = -3.0; p < 0.005). In conclusion, a linear relationship between PD on straining and PNMTL was confirmed, supporting the previous study which also measured PD by perineometry. The other study which refuted such a relationship measured PD radiologically, and it is likely that the difference was in the measurement technique.
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PMID:The neurophysiological significance of perineal descent. 763 69

The association of genital prolapse and rectal prolapse is rare. The authors report six cases of simultaneous mixed prolapse treated surgically via an abdominal approach. The latter technique enables the treatment of genital prolapse by uterine fixation to the promontory and rectal prolapse by rectopexy using the Orr-Loygue technique. Chronic constipation and obstetric trauma are constantly found among etiological factors. Four of our patients had urinary stress incontinence. There were no preoperative complications. One patient reported worsening of her constipation. Mean follow-up is only 20 months (2 months to 3 years), but no recurrences have occurred. Review of the literature and of series with more than fifteen years follow-up shows that the Orr-Loygue operation is reliable with a low complication rate and only rare recurrences.
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PMID:[Uterine fixation to the promontory and the Orr-Loygue operation in associated genital and rectal prolapse]. 850 2

The successful management of faecal incontinence can dramatically improve the quality of life of affected children. The introduction of the non-refluxing, catheterisable appendico-caecostomy provides the opportunity to treat previously resistant patients. Over a 6-year period, 29 children had a Malone antegrade continent stoma for enema administration (MACE). Incontinence was related to spina bifida in 12 children, ano-rectal anomaly in 12, Hirschprung's disease in 2, followed excision of a pelvic tumour in 2, and was secondary to intractable chronic constipation in 1. The conduit was fashioned from the appendix (20), a caecal tube (8), or a gastric tube (1). Surgical complications were stomal stenosis (11), wound infection (1), anastomotic leak (1), MACE stoma prolapse (1), and a pressure sore (1). Colonic irrigation was achieved with washouts of saline (24), saline plus phosphate (4), and saline plus Picolax (1). Twenty-three patients have complete control of bowel function, but 4 still soil. Two remain incontinent, 1 of whom is still being instructed. One child subsequently had a colostomy, but still uses the MACE stoma. Successful bowel management requires motivation, dedication, commitment, and the input of a clinical nurse specialist. The MACE is a relatively straightforward operative procedure that provides an effective washout technique that is acceptable to both parents and children.
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PMID:The Malone antegrade colonic enema procedure: outcome and lessons of 6 years' experience. 963 20


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