A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.
Adult ; Diagnosis, Differential ; Humans ; Male ; Rectal Diseases/*complications/drug therapy/*pathology ; Rectal Neoplasms/pathology ; Syphilis/*complications/drug therapy/*pathology

Rectal syphilis, known as a great masquerader, can be difficult to diagnose because of its variable symptoms. Gastroenterologists should be aware of the possibility of rectal syphilis when confronted with anorectal ulcers, and should gather a detailed history about sexual preferences and practices, including homosexuality. We report a case of primary rectal syphilis mimicking rectal cancer on radiologic imaging. In this report, we described the clinical, endoscopic, and radiologic features of this rare case.
Humans ; Male ; Middle Aged ; Rectal Diseases/*diagnosis/pathology/radiography ; Rectal Neoplasms/*pathology/radiography ; Syphilis/*diagnosis/pathology/radiography

OBJECTIVETo evaluate the feasibility, maneuver and efficacy of plasma prostate electrovaporization system in the treatment of rectal cicatricial stenosis.

METHODSAccording to similar procedure of transurethral resection prostate(TURP), intrarectal cicatriclectomy was performed with plasma prostate electrovaporization system in 7 patients with rectal low cicatricial stenosis after rectal cancer treatment (5 patients with transabdominal low anterior resection,2 patients with 3-dimension precise radiotherapy) to remove obstruction and dilate enteric cavity.

RESULTSSeven patients underwent 12 operations, including one operation in 3 patients, two operations in 3 patients, 3 operations in one patient. Resected rectal cicatricial tissue ranged from 5 to 15 g. Mean operation time was 41 min (25 to 40). Operation successful rate was 100% without complications such as perforation, bleeding and infection. All the patients had smooth defecation.

CONCLUSIONPlasma prostate electrovaporization system is an effective treatment for rectal cicatricial stenosis with tiny trauma.

Aged ; Cicatrix ; complications ; Constriction, Pathologic ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Rectal Diseases ; etiology ; pathology ; surgery ; Rectal Neoplasms ; surgery

We report three cases of solitary rectal ulcer syndrome (SRUS). The diagnosis was established according to histopathologic criteria. But, the initial clinical diagnosis was carcinoma, non-specific ulcer and localized proctitis respectively. SRUS is considered as one of functional disorder in pelvic floor which might go underdiagnosed due to unfamiliar concept in Korea. So we should consider SRUS to be one of the differential diagnosis in cases of complaining anorectal symptoms.
Case Report ; Diagnosis, Differential ; Female ; Human ; Middle Age ; Proctitis/diagnosis ; Proctoscopy ; Rectal Diseases/*diagnosis/pathology ; Rectal Neoplasms/diagnosis ; Syndrome ; Ulcer/diagnosis/pathology

Acupuncture Therapy ; Anal Canal ; pathology ; Female ; Humans ; Intervertebral Disc Displacement ; complications ; Middle Aged ; Pain ; etiology ; Rectal Diseases ; etiology ; pathology ; therapy

Intersphincteric resection (ISR) is the ultimate sphincter-preserving surgical technique for low rectal cancer. To promote the standardized implementation of ISR, this review discusses the important issues regarding the clinical application of ISR with reference to the latest Chinese expert consensus on ISR. In terms of ISR-related pelvic anatomy of the rectum/anal canal, hiatal ligament is not identical with the anococcygeal ligament. At the level where the rectourethralis muscle continuously extends to the posteroinferior area of the membranous urethra from the rectum, the neurovascular bundle is identified between the posterior edge of rectourethralis muscle and the anterior edge of the longitudinal muscle of the rectum. This knowledge is crucial to detect the anterior dissection plane during ISR at the levator hiatus level. The indication criteria for ISR included: (1) stage I early low rectal cancer; (2) stage II-III low rectal cancer undergoing neoadjuvant treatment, and supra-anal tumors and juxta-anal tumors of stage ycT3NxM0, or intra-anal tumors of stage ycT2NxM0. However, signet ring cell carcinoma, mucinous adenocarcinoma and undifferentiated carcinoma should be contraindicated to ISR. For locally advanced low rectal cancer (especially anteriorly located tumor), neoadjuvant treatment should be carried out in a standardized manner. However, it should be recognized that neoadjuvant chemoradiotherapy was a risk factor for poor anal function after ISR. For surgical approaches for ISR, including transanal, transabdominal, and transanal transabdominal approaches, the choice should be based on oncological safety and functional consequences. While ensuring the negative margin, maximal preservation of rectal walls and anal canal contributs to better postoperative anorectal function. Careful attention must be paid to complications regarding ISR, with special focus on the anastomotic complications. The incidence of low anterior resection syndrome (LARS) was higher than 40%. However, this issue is often neglected by clinicians. Thus, management and rehabilitation strategies for LARS with longer follow-ups were required.
Humans ; Rectal Neoplasms/pathology* ; Postoperative Complications ; Laparoscopy/methods* ; Anal Canal/pathology* ; Anus Neoplasms/pathology* ; Anus Diseases/surgery* ; Low Anterior Resection Syndrome ; Carcinoma, Signet Ring Cell/pathology* ; Treatment Outcome

Adenomatous Polyps ; pathology ; Colonic Polyps ; pathology ; Colorectal Neoplasms ; pathology ; Diagnosis, Differential ; Hamartoma Syndrome, Multiple ; pathology ; Humans ; Intestinal Polyposis ; pathology ; Intestinal Polyps ; pathology ; Peutz-Jeghers Syndrome ; pathology ; Rectal Diseases ; pathology

We experienced two unusual cases of tumor-like polypoid lesions involving the rectosigmoid colon. They could not be readily classified into any well known polypoid tumors of the rectosigmoid colon, but appeared to have some similarities to the previously documented "eroded polypoid hyperplasia (EPH)". A collective review of our seven cases of solitary rectal ulcer syndrome (SRUS), which proved to be due to paradoxically over-reactive muscle tone of the puborectalis, was performed, and clinicopathologic comparisons between EPH and SRUS were carried out. They shared histopathologic characteristics such as vascular congestion, crypt hyperplasia, and eroded surface, but they were different from each other in clinical symptoms, location of lesions and gross features. Furthermore, in one EPH case there was an altered much profile which was similar to that seen in SRUS and complete rectal prolapse. Conceivably, the pathological features of both EPH and SRUS were thought to have a possible connection with mucosal prolapse syndrome (MPS). Considering that MPS is a group of diseases encompassing SRUS and the related disorders of the colorectum and the anus, it is speculated that EPH of the rectosigmoid colon might be the proximal analogue of SRUS, a mucosal prolapse of the more distal colon.
Adult ; Aged ; Case Report ; Colonic Polyps/*pathology ; Comparative Study ; Female ; Human ; Hyperplasia ; Intestinal Mucosa/*pathology ; Male ; Manometry ; Middle Age ; Rectal Diseases/*pathology ; Rectum/*pathology ; Sigmoid/*pathology ; Syndrome ; Ulcer/pathology

OBJECTIVETo evaluate stenosis of the lower rectum following PPH with special respect to potential predictive factors or stenotic events.

METHODSA retrospective analysis of 554 consecutive patients, which underwent PPH from July 2000 to December 2004 was performed.

RESULTSOnly patients with follow-up check were evaluated, thus the analysis includes 489 patients (489/554, 88.3%) with a mean follow-up of (324 +/- 18) days. Rectal stenosis was observed in 12 patients (12/489, 2.5%), the median time to stenosis was 89 - 134 (125 +/- 5) days. All the patients complained of obstructive defecation and underwent strictureplasty with electrocautery or balloon dilation through colonoscopy. A statistical analysis revealed that patients with stenosis had significantly more often prior sclerosis therapy for hemorrhoids (58.3% vs. 20.0%, P = 0.02) and severe postoperative pain (25.0% vs. 6.7%, P = 0.003). Other factors, such as gender (P = 0.32), prior surgery for hemorrhoids (P = 0.11), histological evidence of squamous skin (P = 0.77) or revision (P = 0.53) showed no significance.

CONCLUSIONRectal stenosis is an uncommon event after PPH. Early stenosis will occur within the first four months after surgery. The majority of the stenosis can be cured through colonoscopy surgery. The predictive factors for stenosis are previous sclerosis therapy for hemorrhoids and severe postoperative pain.

Adult ; Aged ; Constriction, Pathologic ; surgery ; Female ; Hemorrhoids ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Proctoscopy ; Rectal Diseases ; etiology ; pathology ; surgery ; Rectal Prolapse ; surgery ; Retrospective Studies ; Surgical Stapling ; adverse effects

Rectal enema used for diagnostic and therapeutic purposes infrequently causes colitis. In medical practice, enemas are known to incidentally bring about colitis by mechanical, thermal, or direct chemical injuries. Coffee enema is told to ameliorate the constipation in alternative medicine. We hereby report a case of acute colitis resulting from coffee enema, which was presented with severe abdominal pain and hematochezia.
Acute Disease ; Aged ; Coffee/*adverse effects ; Colitis/chemically induced/*diagnosis/pathology ; Colonoscopy ; *Enema ; Gastrointestinal Hemorrhage ; Humans ; Male ; Rectal Diseases/*diagnosis ; Tomography, X-Ray Computed