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

A 41-year-old heterosexual African man was evaluated for persistent urethral discharge, pneumaturia and watery diarrhea. Radiographic and endoscopic procedures established the diagnosis of a rectourethral fistula. The differential diagnosis of an acquired rectourethral fistula and the significance of AIDS are discussed.
Acquired Immunodeficiency Syndrome/*complications ; Adult ; Case Report ; Diverticulum/*complications/diagnosis ; Human ; Male ; Rectal Fistula/*complications/diagnosis ; Urethral Diseases/*complications/diagnosis

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

The association between rectosigmoid polyps and polyps in the more proximal colon is still a matter of debate, and the need for colonoscopy in patients with rectosigmoid polyps that are detected by flexible sigmoidoscopy is controversial. The aim of this study was to determine whether or not certain characteristics of rectosigmoid polyps are associated with the presence and characteristics of proximal colonic polyps. Seven hundred and twenty-eight patients who underwent total colonoscopy between October 1995 and June 1998 and who had colorectal polyps were retrospectively analyzed. Patients with inflammatory bowel diseases, familial adenomatous polyposis, or any advanced cancer were excluded. The odds ratio (OR) and 95% confidence interval (CI) of prevalence of proximal colonic polyps according to the patients age and sex, as well as the characteristics of rectosigmoid polyps, were calculated. Advanced adenoma was defined as an adenoma larger than 10 mm or an adenoma of any size with villous component, high-grade dysplasia or invasive carcinoma. Among 728 patients with colorectal polyps, 356 patients (48.9%) had polyps only in the rectosigmoid region, 193 patients (26.5%) had polyps only in the proximal colon, and 179 patients (24.6%) had polyps in both the rectosigmoid and proximal colon. In 535 patients with rectosigmoid polyps, the prevalence of proximal colonic polyps, neoplastic polyps and advanced adenomas were 33.4%, 27.3% and 2.9%, respectively. The prevalence of proximal colonic polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients, in addition to the neoplastic histology of the rectosigmoid polyps. However, the prevalence of the proximal colonic polyps was not related to the size, number and shape of rectosigmoid polyps. In 179 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps such as size, number and shape were similar to those of rectosigmoid polyps. We recommend total colonoscopic examination in all patients with rectosigmoid adenomas, regardless of the size, number, and shape, especially in elderly males.
Adult ; Age Distribution ; Aged ; Colonic Polyps/epidemiology ; Colonic Polyps/complications* ; Female ; Forecasting ; Human ; Male ; Middle Age ; Polyps/etiology* ; Polyps/epidemiology ; Polyps/complications* ; Prevalence ; Rectal Diseases/epidemiology ; Rectal Diseases/complications* ; Retrospective Studies ; Sex Distribution ; Sigmoid Diseases/epidemiology ; Sigmoid Diseases/complications*

In recent years, professional societies in China including the Chinese Medical Doctor Association Anorectal Branch have issued many clinical practice guidelines and expert consensus on constipation, which played a positive role in the standardization of diagnosis and surgical treatment of chronic constipation in China. However, the diagnosis and treatment of outlet obstructive constipation (OOC) remain controversial. OOC, the most common subtype of functional constipation, is featured by various clinical symptoms, complex pelvic floor anatomy, functional and psychological aspects. We need a gold standard supported by high-level clinical research evidence. To standardize the diagnosis and treatment process of OOC in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee, and jointly sponsored by Professional Committee on Anorectal Diseases of Chinese Society of Integrated Traditional Chinese and Western Medicine, Anorectal Disease Committee of Chinese Medical Women's Association and Chinese Constipation Medical Association, and the Chinese Journal of Gastrointestinal Surgery organized and summoned a Chinese expert taskforce to focus on OOC diagnosis, classification, examination, evaluation, and various treatments (e.g. diet modification, medication, biofeedback therapy, pelvic floor function training, psychological intervention, traditional Chinese medicine and surgical treatment). Based on the latest relevant evidence in China and abroad and experts' clinical experience, the taskforce produced the " Chinese expert consensus on the diagnosis and treatment of outlet obstructive constipation (2022 edition)" after rounds of discussion and revision. The aim is to help anorectal surgeons make clinical decisions, standardize the process of diagnosis and treatment, reduce complications and improve clinical efficacy in OOC.
Humans ; Female ; Consensus ; East Asian People ; Constipation/etiology* ; Rectal Diseases/complications* ; Pelvic Floor

Fecal incontinence is one of the common diseases in the field of colorectal and anal surgery. Its etiology is complex, the treatment response is suboptimal, and there are controversies in clinical care. There is no consensus on the clinical practice of fecal incontinence in China currently. Launched by Anorectal Branch of Chinese Medical Doctor Association, Expert Committee on Anorectal Disease of Anorectal Branch of Chinese Medical Doctor Association, and Clinical Guidelines Committee of Anorectal Branch of Chinese Medical Doctor Association, and organized by the editorial board of Chinese Journal of Gastrointestinal Surgery, Chinese experts on this field were convened to write the Chinese expert consensus on clinical practice of fecal incontinence based on relevant references. After rounds of discussion, the final consensus combines the latest evidence and experts' clinical experience. This expert group suggested that a comprehensive assessment of fecal incontinence should be conducted before treatment, including medical history, relevant scales, physical examination and special examinations. Special examinations include anorectal endoscopy, anorectal manometry, transrectal ultrasound, magnetic resonance, rectal sensation and compliance, balloon ejection test, pelvic floor electromyography, defecography, colonoscopy and pudendal nerve terminal motor latency. Treatment methods include life style modification, medication, surgery, traditional Chinese medicine and other treatments. This consensus aims to standardize the algorithm of fecal incontinence management and improve therapeutic efficacy.
Humans ; Fecal Incontinence/etiology* ; East Asian People ; Manometry/adverse effects* ; Rectal Diseases/complications* ; Anal Canal/innervation*

Colonic and anorectal manometry includes anorectal manometry and colonic manometry. Anorectal manometry is a common method to evaluate anorectal function, which can objectively reflect the pathological and physiological abnormalities of outlet obstructive constipation and fecal incontinence, as well as the impact of anorectal surgery on continence. Colonic manometry is a new type of colon motility detection method developed in recent years. It can record the peristalsis and contraction of the whole colon through a pressure measuring catheter, which helps physicians further evaluate various colonic diseases. However, various factors such as testing equipment, operating standards, and evaluation parameters are difficult to unify. There is no consensus on the operation and interpretation of colorectal anal pressure measurement. Under the guidance of the Anorectal Branch of Chinese Medical Doctor Association, in collaboration with Clinical Guidelines Committee, Anorectal Branch of Chinese Medical Doctor Association, Anorectal motility disorders Committee , Colorectal Surgeons Branch of Chinese Medical Doctor Association, Colonic Branch of China international exchange and promotive association for medical and healthcare, Tianjin Union Medical Center is leading the organization of domestic experts in this field. Based on searching relevant literature and combining clinical experience at home and abroad, after multiple discussions, the "Chinese expert consensus on colonic and anorectal manometry" has been prepared. This consensus discusses the indications, contraindications, pre examination management and technical procedures, treatment of complications, and interpretation of examination reports for colonic and anorectal manometry , aiming to guide the standardized clinical practice of colonic and anorectal manometry.
Humans ; Rectum ; Consensus ; Constipation ; Anal Canal ; Rectal Diseases ; Fecal Incontinence ; Manometry/methods* ; Colorectal Neoplasms/complications*

Spontaneous rupture of the rectosigmoid colon and herniation of the small intestine through the rupture site and eventual evisceration through the anus is a very rare event. In the literature, only 42 cases have been reported. The majority of them occurred in patients with rectal prolapse and one case was reported in association with a third-degree uterine prolapse. We experienced an 81-year-old female patient with rectal prolapse and second-degree uterine prolapse complicated by spontaneous perforation of the rectosigmoid colon and anal evisceration of the small intestine. Segmental resection of the nonviable small intestine, primary repair of the ruptured rectosigmoid colon, and sigmoid loop colostomy were performed, and the patient recovered well. In our patient, both rectal and uterine prolapses cooperatively damaged the anterior wall of the rectosigmoid colon and resulted in perforation. So, rectal and uterine prolapses should be treated before the complication develops. In this patient, uterine prolapse should be treated because of the recurrence of this rare episode.
Aged ; Aged, 80 and over ; Case Report ; Colonic Diseases/etiology* ; Female ; Human ; Rectal Prolapse/complications* ; Rupture, Spontaneous ; Uterine Prolapse/complications*

Objective: To investigate the safety and efficacy of pelvic peritoneal reconstruction and its effect on anal function in laparoscopy-assisted anterior resection of low and middle rectal cancer. Methods: A prospective cohort study was conducted. Consecutive patients with low and middle rectal cancer who underwent laparoscopy-assisted transabdominal anterior resection at Naval Military Medical University Changhai Hospital from February 2020 to February 2021 were enrolled. Inclusion criteria: (1) the distance from tumor to the anal verge ≤10 cm; (2) laparoscopy-assisted transabdominal anterior resection of rectal cancer; (3) complete clinical data; (4) rectal adenocarcinoma diagnosed by postoperative pathology. Exclusion criteria: (1) emergency surgery; (2) patients with a history of anal dysfunction or anal surgery; (3) preoperative diagnosis of distant (liver, lung) metastasis; (4) intestinal obstruction; (5) conversion to open surgery for various reasons. The pelvic floor was reconstructed using SXMD1B405 (Stratafix helical PGA-PCL, Ethicon). The first needle was sutured from the left anterior wall of the neorectum to the right. Insertion of the needle was continued to suture the root of the sigmoid mesentery while the Hemo-lok was used to fix the suture. The second needle was started from the beginning of the first needle, after 3-4 needles, a drainage tube was inserted through the left lower abdominal trocar to the presacral space. Then, the left peritoneal incision of the descending colon was sutured, after which Hemo-lok fixation was performed. The operative time, perioperative complications, postoperative Wexner anal function score and low anterior resection syndrome (LARS) score were compared between the study group and the control group. Three to six months after the operation, pelvic MRI was performed to observe and compare the pelvic floor anatomical structure of the two groups. Results: A total of 230 patients were enrolled, including 58 who underwent pelvic floor peritoneum reconstruction as the study group and 172 who did not undergo pelvic floor peritoneum reconstruction as the control group. There were no significant differences in general data between the two groups (all P>0.05). The operation time of the study group was longer than that of control group [(177.5±33.0) minutes vs. (148.7±45.5) minutes, P<0.001]. There was no significant difference in the incidence of perioperative complications (including anastomotic leakage, anastomotic bleeding, postoperative pneumonia, urinary tract infection, deep vein thrombosis, and intestinal obstruction) between the two groups (all P>0.05). Eight cases had anastomotic leakage, of whom 2 cases (3.4%) in the study group were discharged after conservative treatment, 5 cases (2.9%) of other 6 cases (3.5%) in the control group were discharged after the secondary surgical treatment. The Wexner score and LARS score were 3.1±2.8 and 23.0 (16.0-28.0) in the study group, which were lower than those in the control group [4.7±3.4 and 27.0 (18.0-32.0)], and the differences were statistically significant (t=-3.018, P=0.003 and Z=-2.257, P=0.024). Severe LARS was 16.5% (7/45) in study group and 35.5% (50/141) in control group, and the difference was no significant differences (Z=4.373, P=0.373). Pelvic MRI examination 3 to 6 months after surgery showed that the incidence of intestinal accumulation in the pelvic floor was 9.1% (3/33) in study group and 46.4% (64/138) in control group (χ(2)=15.537, P<0.001). Conclusion: Pelvic peritoneal reconstruction using stratafix in laparoscopic anterior resection of middle and low rectal cancer is safe and feasible, which may reduce the probability of the secondary operation in patients with anastomotic leakage and significantly improve postoperative anal function.
Anastomotic Leak/surgery* ; Humans ; Intestinal Obstruction/surgery* ; Laparoscopy ; Postoperative Complications/surgery* ; Prospective Studies ; Rectal Diseases/surgery* ; Rectal Neoplasms/surgery* ; Retrospective Studies ; Syndrome ; Treatment Outcome

This study aimed to investigate the relationship between bladder trabeculation, urinary function, and the stage of pelvic organ prolapse (POP). The medical records of 104 patients with POP who underwent cystoscopies and urodynamic studies were reviewed retrospectively. Age, incidence of detrusor instability, stage and site of POP, and the parameters of urodynamic studies of patients with and without bladder trabeculation were compared. The difference in the incidence of bladder trabeculation was estimated between patients with and without a suspected bladder outlet obstruction. There were significant differences in the patients' age, stage of POP, and maximal voiding velocity. Patients with a suspected bladder outlet obstruction had a significantly higher incidence of bladder trabeculation. In addition, patients with advanced stages of POP were also found to have a higher incidence of bladder trabeculation.
Uterine Prolapse/complications ; Urodynamics/*physiology ; Urinary Bladder Neck Obstruction/complications ; Urinary Bladder Diseases/*physiopathology ; Retrospective Studies ; Rectal Prolapse/complications ; Prolapse ; Pelvic Floor/physiopathology ; Middle Aged ; Humans ; Female ; Aged