1/27. Laparoscopic cecostomy for anterior ectopic anus with constipation: a new and technical proposal.A female patient of 26 years of age with faecal incontinence is presented. The anal opening was anteriorly located just posterior to the vagina. This had resulted in overflow faecal incontinence due to severe chronic constipation. NMR showed a normal musculature of the pelvic floor and sphincter. Since the patient did not agree to surgery, laparoscopic cecostomy was performed for the first time for antegrade rinsing.- - - - - - - - - - ranking = 1keywords = anus (Clic here for more details about this article) |
2/27. Dynamic graciloplasty in children with fecal incontinence: a preliminary report.BACKGROUND: Various therapeutic methods have been developed for anal incontinence. A reconstruction of the sphincter system with functional adaptation can be achieved by stimulation of the transposed gracilis muscle with an implanted stimulator. methods: The authors performed a dynamic graciloplasty in 4 boys, aged between 6 and 10 years. Causes for the incontinence were polytrauma with pelvic rupture, VACTERL syndrome with rectal urethral fistula, anal atresia with primary reconstruction and 6 consecutive operations, and coccygeal teratoma in a premature infant with surgical treatment of the recurrent tumour. All children had grade III incontinence. Postoperatively, the duration of stimulation was increased successively by telemetric programming of the pulse generator up to a continuous mode. RESULTS: One child is now almost continent, 2 show grade I incontinence, 1 is incontinent with frequent soiling (the programming has not been completed yet). CONCLUSION: An evaluation of this method for children will not be possible until more operations have been performed, under the conditions of a prospective study, which appears indicated in view of the preliminary but encouraging results presented.- - - - - - - - - - ranking = 0.029551243739808keywords = atresia (Clic here for more details about this article) |
3/27. Rectal cancer in anorectal malformation with rectovestibular fistula: sphincter-restoring surgery by anterior resection and dynamic vaginoanograciloplasty.PURPOSE: The aim of this study was to describe and discuss the anosphincter-restoring procedure adopted in an adult patient with rectal cancer, affected by anorectal atresia and rectovestibular fistula not previously treated. methods: After anterior resection and transverse dissection of the rectovaginal septum, a straight double-staple low colorectal anastomosis was performed. A subcutaneous tunnel was extended from the inter-rectovaginal space, surrounding the pseudoanal orifice. The tunnel housed a left gracilis muscle arranged counter-clockwise and connected to an implanted stimulator. The vaginal and anorectal flaps were sutured longitudinally, thereby spacing out the two orifices and creating an anorectal angle. A temporary loop right colostomy was performed. RESULTS: The postoperative course was uneventful. After continuous electrostimulation training and colostomy takedown, the patient had improved continence (stimulator on) and normal defecation (stimulator off). CONCLUSIONS: The solution described seemed a suitable alternative to a pull-through procedure, which would have involved a colocutaneous anastomosis and the loss of the anorectal sensory function. Any previous anal transposition or pull-through procedures would have prevented the saving of the pre-existing "anus," because of the interruption of the residual mesenteric vascular supply to the anorectal remnant secondary to mesorectal excision.- - - - - - - - - - ranking = 0.27955124373981keywords = anus, atresia (Clic here for more details about this article) |
4/27. Perianal mucinous adenocarcinoma: unusual case presentations and review of the literature.Perianal mucinous adenocarcinoma is a rare cancer constituting 3 to 11 per cent of all anal carcinomas. It may arise de novo or from a fistula or abscess cavity. We present two cases of this disease process. Case One is a 52-year-old man with a chronic history of perianal abscesses who presented to the emergency room with a large bowel obstruction. He required diversion and wide local excision with lateral internal sphincterotomy for relief of the obstruction. pathology from the excised material revealed the unexpected diagnosis of invasive mucinous adenocarcinoma of the anus. Case Two is a 59-year-old man with a chronic history of complex fistulas and abscesses who presented to our office with a horseshoe fistula and deep postanal space abscess. Because of the nonhealing nature of the wound, biopsies from the abscess crater, fistulous tract, and the perianal skin opening were taken. The pathology department identified the specimens as invasive mucinous adenocarcinoma of the anal canal. This is an aggressive cancer often misdiagnosed clinically as benign pathology. A high index of suspicion and biopsy of fistulous tracts and abscesses are the keys to early diagnosis and treatment. With combination chemotherapy and radiation therapy in conjunction with aggressive surgical resection long-term survival might be obtained.- - - - - - - - - - ranking = 0.25keywords = anus (Clic here for more details about this article) |
5/27. Endorectal pull-through operation for diffuse cavernous hemangiomatosis of the sigmoid colon, rectum and anus.A 6-year-old girl with diffuse cavernous hemangiomatosis of the sigmoid colon, rectum and anus underwent endorectal pull-through operation for sphincter-saving resection. Rectal mucosa was resected from 4 cm above peritoneal reflection to anal skin margin and the normal sigmoid colon was pulled down through the rectal muscular cuff. ligation of the superior rectal and left internal iliac arteries at operation achieved satisfactory control of bleeding. Postoperative manometric studies showed almost normal sphincter tone and good response to rectal stimuli by balloon inflation. The endorectal pull-through (Soave-Denda procedure) is a common procedure for Hirschsprung's disease and the best procedure for the sphincter-saving treatment of diffuse cavernous hemangiomatosis of the colon and rectum.- - - - - - - - - - ranking = 1.25keywords = anus (Clic here for more details about this article) |
6/27. Artificial sphincter with colonic reservoir for severe anal incontinence because of imperforate anus and short-bowel syndrome: report of a case.Anal sphincter replacement is a treatment option for severe anal incontinence that is not amenable to direct repair. We describe the unusual case of a 25-year-old male who has been successfully treated by implantable artificial sphincter for severe anal incontinence caused by imperforate anus and concomitant short-bowel syndrome. In early life, the patient underwent several surgical procedures, including a perineal colostomy for a high imperforate anus associated with a rectourethral fistula. At aged 21 years, he underwent a subtotal small-bowel resection and a restorative jejunotransverse anastomosis for acute intestinal necrosis related to intestinal malrotation with volvulus. The length of remnant jejunum was 90 cm. Consequently. the patient became permanently incontinent and required nutritional therapy. An artificial sphincter, after the creation of colonic reservoir, was implanted around the pulled-through colon. At two-year follow-up after implantation, despite short remnant bowel, the patient was fully continent without medication. Normal nutritional status was maintained under 100 percent oral nutrition. The patient's quality of life improved dramatically. He has returned to work and had no major restriction in his level of social functioning. Our case illustrates for the first time the original concept of artificial anal artificial sphincter implantation around a pulled-through colon, which constitutes a different situation from disease with rectum in place.- - - - - - - - - - ranking = 1.5keywords = anus (Clic here for more details about this article) |
7/27. Gracilis muscle transposition for anal incontinence in children: long-term follow-up.We report a series of 7 patients, aged 6.5 to 19 years (mean, 12.9), who have been treated for uncontrollable fecal incontinence since 1976: 5 had imperforate anus and multiple subsequent operative procedures, 1 had a low myelomeningocele with bi-sphincteric incontinence, and 1 had a traumatic destruction of the sphincter apparatus. A modified Pickrell procedure was performed, with the gracilis muscle transposed subcutaneously, without constructing a pulley through the median raphe as originally described. All patients were evaluated by anorectal manometry preoperatively and post-operatively. They were followed-up for a period of 0.5 to 12.5 years (mean, 4.4). All patients were continent at follow-up, with a normal defecation pattern and no enemas required. None of the patients had evidence of fibrosis of the muscle or anal canal, and tension in the transposed muscle was maintained. Voluntary contractions remain efficient in all cases. Age was thought to be an important factor: personal motivation and compliance with physiotherapy, essential for a good outcome, is unlikely to be present in the younger child. We conclude that the gracilis sling procedure is an excellent long-term alternative for total fecal incontinence when time and other therapeutic measures have failed.- - - - - - - - - - ranking = 0.25keywords = anus (Clic here for more details about this article) |
8/27. An implanted neuromuscular stimulator for fecal continence following previously implanted gracilis muscle. Report of a case.A young woman had been treated previously with a gracilis muscle transposition because of anal atresia thus enabling her to maintain continence by active muscle contraction, which, however, she could sustain for only a few minutes. Implantation of a neuromuscular stimulator resulted in perfectly controllable sphincter function.- - - - - - - - - - ranking = 0.029551243739808keywords = atresia (Clic here for more details about this article) |
9/27. adenocarcinoma arising at the perineal wound after pull-through procedure for imperforate anus.An extremely rare case is presented here, of an adenocarcinoma at the site of a long-standing perineal wound, the presence of which was a result of a pull-through procedure for imperforate anus. Wide local excision of a huge mass, including the perineal skin and the distal rectosigmoid segment, was carried out en-bloc on a 35 year old male. This tumor may have been caused by the repeated trauma and frequent ulceration around the perineal wound as a result of poor hygiene due to a fecal incontinence.- - - - - - - - - - ranking = 1.25keywords = anus (Clic here for more details about this article) |
10/27. Repair of anorectal incontinence in an adolescent boy with neonatal anal atresia.Fecal continence, the ability to retain intestinal contents until evacuation is desired, requires the complex interaction of several factors. They include: the motor action of the sphincters, sensibility of skin and sphincters and function of the rectum and central nervous pathways. Appropriate and effective management is available to treat many disorders of continence. However, the success of these treatments depends on careful delineation of the various contributing factors. The authors present the case of an 18-year-old boy with disabling fecal incontinence, secondary to neonatal anal atresia and its primary management, in order to illustrate the importance of careful assessment of each of the contributing factors. His staged surgical treatment has been successful in returning him to a more normal state.- - - - - - - - - - ranking = 0.14775621869904keywords = atresia (Clic here for more details about this article) |
| | Next -> |