Cases reported "Hemorrhoids"

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1/14. CO 2 laser surgery in hemophilia treatment.

    The use of CO 2 laser surgery between 1985 and 1991 in south africa and portugal for treatment of disorders in patients with mild to moderate cases of hemophilia A is discussed. Six cases of oral procedures and excision of skin tumors performed during this period are reported. In most of the cases of mild hemophilia no pre- or postoperative infusion of factor viii or desmopressin (DDAVP) was required. In some cases of moderate hemophilia, patients were infused with desmopressin (0.3 mug/kg body weight) and were treated postoperatively with the use of nasal desmopressin spray (150 mug to each nostril for four weeks following surgery). factor viii levels were measured before surgery. Follow up of four weeks was uneventful. The mean average power of the CO 2 laser was 20 W continuous and the pulse duration was 0.1 s for ablational procedures. For dermatologic procedures, a flexible plastic CO 2 laser hollow fiber was used (Flexilase, Sharplan, Allandale, NJ). We concluded that CO 2 laser surgery for hemophiliacs has a confirmed place in modern laser technology provided the standard precautions are taken and facilities are available.
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2/14. Necrotizing fascitis after injection sclerotherapy for hemorrhoids: report of a case.

    A case report of a patient who underwent submucosal injection sclerotherapy for hemorrhoids is presented. Subsequently developed necrotizing fascitis of the anorectum, perianal region, and scrotum necessitated emergency debridement and defunctioning colostomy. Postoperatively, the patient developed septicemia and renal failure requiring an extended hospital stay. Restoration of bowel continuity was done after three months. A brief review of known complications of this technique was made. It would appear that necrotizing fascitis can be added to this list.
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3/14. The prepuce flap in the reconstruction of male anal stenosis.

    Circumferential stenosis of the male anal canal was repaired using a subcutaneous prepuce flap. The stenosis was released to create a rhomboid defect. Then, to cover the defect a rectangular flap was designed on the hairless ventral side of the penis. The flap was raised over the Buck's fascia while preserving the subcutaneous vessels in the dartos fascia, which formed the pedicle of the flap. The flap was transposed to the defect by passing it through a tunnel in the perineum. The postoperative course was uneventful and the result was good. The flap had reliable vascularity, was very thin, and pliable so that it could adapt to the rhomboid defect in the anal canal.
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4/14. Unusual 'recurrence' sites for colorectal cancer.

    Five patients are reported. Four underwent major 'curative' restorative colorectal resections and developed perineal 'recurrence', 2 developed 'recurrence' in the distal ends of previously identified fistulae in ano and 2 developed 'recurrence' at the site of a previously performed haemorrhoidectomy. The fifth patient developed metastasis to a fistula track prior to surgical intervention. The danger of implantation of exfoliated tumour cells in patients with distally situated 'raw' mucosal sites is recognized and anorectal procedures should not be performed prior to resection. Minor anorectal procedures should not be performed at the same time as colorectal resections for carcinoma in these patients either. Some 'recurrences', such as those described in this paper, may be inevitable and in fact really represent preoperative metastases. Routine flexible sigmoidoscopy prior to the performance of any anorectal procedure might identify patients at risk of such 'recurrences' but this may not be cost-effective.
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5/14. Malignant melanoma of the anorectal area. Report of two cases.

    BACKGROUND/AIMS: Primary anorectal melanoma is a very rare malignant tumor with no more than 300 cases reported in the literature. methods: Two cases of anorectal melanoma are reported herein. RESULTS: Both patients, aged 44 and 74 years, presented at the outpatient department with anal bleeding, one after being treated for 3 months with antihemorrhoidal drugs. The diagnosis was established with proctoscopy and biopsy, and a palliative abdominoperineal resection in the presence of lymph node metastases was performed followed by chemotherapy with vindesine. Although the procedures were not curative, both patients had an uneventful postoperative recovery, and lived 4 years and 21 months, respectively, without bleeding problems albeit with the inconvenience of a colostomy. CONCLUSIONS: For the time being there is no convincing proof of the value of either types of proposed surgical management. We agree with those who believe that abdominal perineal resection has an advantage regarding the prognosis and quality of life.
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6/14. Anaesthetic management of a child with type VIIc ehlers-danlos syndrome.

    ehlers-danlos syndrome type VIIc is characterized by altered tensile strength of connective tissue. Several severe complications exist but skin fragility is the origin of perioperative morbidity during routine procedures. We describe the difficulties encountered during the anaesthetic management of a child suffering from the disease, and suggest special care advices to avoid any skin injury.
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7/14. Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations.

    Stapling procedure is a new technique for the surgical management of third-degree hemorrhoids. Even if long-term experience has not been reported, this new technique is generating a lot of interest and its use is becoming more common in europe. Some articles have just been published about severe adverse effects of this operation, and in the present article we describe a case of a life-threatening complication that occurred with the use of the stapling technique for hemorrhoidectomy. A patient with perineal descensus and third-degree hemorrhoids underwent a stapling procedure for the treatment of hemorrhoids. retropneumoperitoneum and pneumomediastinum developed on postoperative Day 2 and a colostomy was performed, allowing a quick recovery of the patient. After six months the colostomy was closed and bowel function restored. Our experience, taken together with some other cases previously published of severe complications after such an operation, suggests caution in the use of this new technique for the treatment of a benign disease.
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8/14. Life-threatening urinary retention after haemorrhoidectomy and internal sphincterotomy.

    Postoperative urinary retention (UR) is a common complication following haemorrhoidectomy. This report presents a female patient who developed long-lasting UR after haemorrhoidectomy and internal sphincterotomy, which progressed to renal failure. The precipitating cause was represented by a non-healing anal ulcer and excruciating anal pain at evacuation. An unhealed anal wound, an inappropriate low-fibre diet, and excruciating anal pain commonly represent the key factors initiating the sequence ending into UR. history, presentation, diagnostic work-up, and treatment for this patient are described.
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9/14. Bacterial endocarditis following rubber band ligation in a patient with a ventricular septal defect: report of a case and guideline analysis.

    rubber band ligation is a common option used to treat symptomatic internal hemorrhoids. Severe complications such as pelvic sepsis are a rare occurrence. We report a case of endocarditis leading to septic pulmonary and renal emboli following single-quadrant rubber band ligation. The patient had a known ventricular septal defect and developed low back pain and fever after ligation of a right anterior internal hemorrhoid. He was found to have septic pulmonary emboli, a renal wedge septic infarct, and a large vegetation on his membranous ventricular septal defect requiring operative intervention. Before this report, rubber band ligation has not been associated with endocarditis. According to several guidelines, this patient did not require antibiotic prophylaxis. It is unclear whether prophylaxis could have prevented this complication. Surgeons utilizing rubber band ligation need to be familiar with all potential complications.
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10/14. Management of hemophilia in colon and rectal surgery. Report of a patient with factor viii inhibitors and review of the literature.

    With the introduction of factor viii concentrates, surgery on patients with hemophilia has become possible. The mortality in recent large series is zero. The morbidity has been variable, with postoperative hemorrhage the most common complication. There is a dramatic change in therapeutic strategy with the development of factor viii inhibitors. In reviewing the literature, there are no reports discussing this patient population with respect to the subspecialty of colon and rectal surgery. The authors present a report of a patient with hemophilia who, after hemorroidectomy, developed factor viii inhibitors and continued hemorrhage. This article also reviews the literature and centralizes the management of colon and rectal surgery patients with hemophilia.
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