Endometriosis at the site of episiotomy scar following vaginal delivery is rare condition among the extrapelvic endometriosis implantation. We have experienced a case of episiotomy scar endometriosis. The precise anatomical location of the endometriotic lesion is confirmed using preoperative anal endosonogarphy. We believe anal endosonography to be essential when history, digital examination, and proctoscopy are not conclusive in the differential diagnosis of perianal pain or mass. The treatment of choice is complete surgical excision of the lesion and the surgical excision usually obtain permanent cure. We report a case of endometriosis at the site of episiotomy scar.
Cicatrix* ; Diagnosis, Differential ; Endometriosis* ; Endosonography ; Episiotomy* ; Female ; Proctoscopy

Rectal tumor height has been observed to increase after complete mobilization.
OBJECTIVES: 1.) to measure tumor height in resectable rectal cancers before and after complete mobilization, 2.) to describe changes in tumor height measurements at different levels of the rectum, and 3.) to determine the probability of a two centimeter increase in tumor height after mobilization in low rectal cancers.
METHODS: Prospective cross-sectional series including all resectable rectal cancer treated at our hospital from January to December, 2003. Proctoscopy measurements of rectal tumor height after induction of anesthesia were compared to measurements done after complete rectal mobilization. Logistic curve fitting was used to calculate the probability of a two centimeter increase in tumor height for low rectal cancers after complete mobilization.
RESULTS: In the 12-month period, 37 patients with adenocarcinoma of the rectum were seen. Ages of patients ranged from 26 to 86, with mean age of 57.8 years. Thirty-three patients had resectable rectal cancer. Tumor height ranged from zero to 11 cm, with mean height of 5.7 cm. After complete mobilization, tumor height increased in 50 percent of upper rectal cancers, 92 percent of mid-rectal cancers, and 32 percent of low rectal cancers. Logistic curve fitting showed probability of a two-centimeter increase in tumor height was 52 percent at seven centimeters, 40 percent at six centimeters, 28 percent at five centimeters, and 19 percent at four centimeters.
DISCUSSION: The decision to perform APR for low rectal cancers must not be based solely in pre-operative tumor height measurements since pre-operative measurements of rectal tumor height can increase when the rectum is completely mobilized.

Human ; Proctoscopy ; Rectumrectal Neoplasms ; Adenocarcinoma ; Anesthesiology ; Anesthesia ; Probability

PURPOSE: The use of barium enemas to confirm the anastomotic integrity prior to ileostomy closure is still controversial. The purpose of the study was to determine the utility of routine contrast enema prior to ileostomy closure and its impact on patient management in patients with a low pelvic anastomosis. METHODS: One hundred forty-five patients had a temporary loop ileostomy constructed to protect a low colorectal or coloanal anastomosis following low anterior resection for rectal cancer. All patients were evaluated by physical examination, proctoscopy, and barium enema prior to ileostomy closure. RESULTS: The median time from ileostomy creation to closure was 8 months. Five (3.5%) of the 144 patients were found to have clinically relevant strictures at the colorectal anastomosis on routine barium enema. One patient (0.7%) showed anastomotic leak on their barium enema. Overall, 141 patients (97.9%) had an uncomplicated postoperative course. Postoperative complication occurred in three patients (2.1%). None of them showed abnormal barium enema finding, which suggested that routine contrast enema examination did not predict postoperative complication. CONCLUSION: Routine barium enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information for postoperative colorectal anastomotic complication.
Anastomotic Leak ; Barium ; Constriction, Pathologic ; Enema ; Humans ; Ileostomy ; Physical Examination ; Postoperative Complications ; Proctoscopy ; Rectal Neoplasms

We report a case of vesico-sigmoido-appendiceal fistula from unknown origin in a 29 years old female who was presented with the chief complaints of fecaluria and bladder irritation symptoms The diagnostic procedure such as excretory urography, cystography, barium enema, cystoscopy and proctoscopy were performed, and the vesico-recto-appendiceal or vesico-sigmoido-appendiceal fistula was suspected. On operation, the tip of appendix was communicated with the sigmoid fistulous tract and opened into the bladder in a common pathway. The patient underwent appendectomy, sigmoid fistulectomy, and partial cystectomy and the postoperative course was uneventful.
Adult ; Appendectomy ; Appendix ; Barium ; Colon, Sigmoid ; Cystectomy ; Cystoscopy ; Enema ; Female ; Fistula* ; Humans ; Proctoscopy ; Urinary Bladder ; Urography

In 2005 NCCN clinical guideline in oncology of rectal cancer, it recommended four management principles of surgery. The surgeon should perform a rigid proctoscopy before initiating treatment, remove primary tumor with adequate margins, dissect draining lymphatics by total mesorectal excision, and restore organ integrity if possible. The principles of surgery has been updated four times until 2015. But it remained recommending that the surgeon should perform a rigid proctoscopy so that the surgeon can handle the size, the location and the region of the tumor and make the determination of an optimal treatment plan such as restoring anus or not. Throughout ten-year NCCN clinical guidelines, pursuing R0 resection and restoring organ integrity if possible are the basic principles for the surgical treatment of rectal cancer.
Anal Canal ; Digestive System Surgical Procedures ; Humans ; Practice Guidelines as Topic ; Proctoscopy ; Rectal Neoplasms ; surgery

No abstract available.
Transanal Endoscopic Microsurgery*

Impacted bone fragment in the anal canal must not be overlooked as an unusual cause of acute anal pain. Eight cases of acute anal pain arising from impaction of ingested bone fragment within the anal canal were treated over a 4-year period. The eight cases were similar in presentation and outcome. There were six males and two females (age 45~65 years). Seven patients presented within a day of the sudden onset of severe anal pain, and one patient presented with obscure anal pain of three days. In two patients, this pain was aggravated by attempts to defecate. Inspection showed mild to marked spasm of the anal sphincter with no obvious cause for the anal pain. Digital rectal examination revealed spiculated bony fragments impacted in the anal canal at the dentate line in seven cases, and at the anorectal junction in one case. In one case, a fish bone was found penetrating into a hemorrhoid, causing edema and prolapse. In another case, a tiny fish bone was found impacting in a nylon seton applied to a fistulotomy wound. In a third case, a linear fish bone was found penetrating into an anal papilla. Six fish bones and one chicken bone were removed using forceps under proctoscopy. One fish bone was removed at the time of digital rectal examination. Sigmoidoscopy was then performed to assess anorectal injury. Pain relief was immediate, and no sequelae were noted on review at 6 weeks. In all cases, the diagnosis was readily made on simple digital rectal examination, and early removal of the bone fragment resulted in immediate pain relief without complications. Eight cases of acute anal pain due to impaction of ingested bone fragment in the anal canal are reported, and the related literature is reviewed.
Anal Canal ; Chickens ; Digital Rectal Examination ; Edema ; Female ; Hemorrhoids ; Humans ; Male ; Nylons ; Proctoscopy ; Prolapse ; Sigmoidoscopy ; Spasm ; Surgical Instruments

The term ""collagenous colitis"" was coined by Lindstrom in 1976 to describe the patient with chronic watery diarrhea who had normal rectal mucosa by proctoscopy but who had a thick subepithelial collagenous deposit on biopsy, and now collagenous colitis is recognized as one of the more common causes of chronic diarrhea of obscure origin. But in this country only a few case has been reported. We have seen a 68-year-old man with chronic watery diarrhea with abdominal pain. Physical examination, laboratory and radiologic studies were no abnormal finding. Colonoscopy disclosed grossly normal mucosa through the entire colon but by histologic examination there are chronic inflammation in the lamina propria and thickened subepithelial collagen layer. Symptoms and pathologic findings of patient improved after treatment with sulfasalazine and prednisolone.
Abdominal Pain ; Aged ; Biopsy ; Colitis, Collagenous* ; Collagen* ; Colon ; Colonoscopy ; Diarrhea ; Esophagus* ; Humans ; Inflammation ; Intestines* ; Mucous Membrane ; Numismatics ; Physical Examination ; Prednisolone ; Proctoscopy ; Stomach* ; Sulfasalazine

The term "collagenous colitis" was coined by Lindstrom in 1976 to describe the patient with chronic watery diarrhea who had normal rectal mucosa by proctoscopy but who had a thick subepithelial collagenous deposit on biopsy, and now collagenous colitis is recognized as one of the more common causes of chronic diarrhea of obscure origin. But in this country only a few case has been reported. We have seen a 68-year-old man with chronic watery diarrhea with abdominal pain. Physical examination, laboratory and radiologic studies were no abnormal finding. Colonoscopy disclosed grossly normal mucosa through the entire colon but by histologic examination there are chronic inflammation in the lamina propria and thickened subepithelial collagen layer. Symptoms and pathologic findings of patient improved after treatment with sulfasalazine and prednisolone. (Korean J Castraintest Endosc 17: 79-84, 1997)
Abdominal Pain ; Aged ; Biopsy ; Colitis, Collagenous ; Collagen ; Colon ; Colonoscopy ; Diarrhea ; Granuloma, Plasma Cell* ; Humans ; Inflammation ; Liver* ; Mucous Membrane ; Numismatics ; Physical Examination ; Prednisolone ; Proctoscopy ; Sulfasalazine

OBJECTIVETo evaluate the safety and outcomes after transanal endoscopic microsurgery (TEM)for rectal adenoma.

METHODSData of 32 patients undergoing TEM for rectal adenoma between September 2006 and February 2010 in the Ruijin Hospital were reviewed.

RESULTSThe adenoma diameter ranged from 0.6 to 10.0(2.3±1.2) cm. The mean operative time was 70(range,20-180) min. The estimated blood loss was less than 10 ml. There were no conversions to transabdominal procedure. Twenty-two(68.8%) patients underwent suturing of the wound, of whom 14 had full-thickness resection. Two patients had perforation into peritoneal cavity during full-thickness resection, which were repaired by continuous suturing and no postoperative leak occurred. R0 resection was achieved in 31(96.9%) patients. Postoperative pathology showed 12 simple adenomas, 10 adenomas with low grade intraepithelial neoplasia, 5 adenomas with high grade intraepithelial neoplasia, and 5 T1 focal carcinomas. Complications included rectal bleeding in 1 patient, acute urinary retention in 1 patient, and pulmonary infection in 1 patient. The postoperative stay was 4.5(3-8) days. The patients were followed-up for a period of 23 months(range, 2-43 months). There were 2 tumors recurred.

CONCLUSIONTEM is a safe and effective minimally invasive surgical technique for large rectal adenomas.

Adenoma ; surgery ; Aged ; Anal Canal ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Proctoscopy ; methods ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome