A manometric assessment of anal pressure is known to be an objective method in evaluating anorectal physiology and the function of the anal sphincter. We employed anal menometry to study the anal pressure in patients with hemorrhoids, anal fistulas, anal fissures, constipation, and fecal incontinence. This study was performed in the period from April 1994 to May 1996. The total number of patients with defecation disorder or anal disease assessed in this period at our rectal clinic by using anal manometry was 227; A control group was comprised of 10 patients with no known anal diseases or symptoms. The patient group was catergorized as follows:123 cases of hemorrhoids, 24 cases of anal fistulas, 35 cases of anal fissures, 29 cases of constipation, and 16 cases of fecal incontinence. We measured the maximal anal resting pressure (MARP) and the maximal anal squeeze pressure (MASP) in these patients as well as in the control group. We found the MARP to be higher in patients with hemorrhoids, anal fistulas, and anal fissures, compared to the control group, while the MARP was lower in the constipation group; however, these results were not statistically significant. The anal pressures of hemorrhoid patients were studied with respect to symptom, classification, past history, and the duration of symptoms. The results were as follows:The MARP was found to be increased in hemorrhoid patients with prolapse and pain and for thrombosed external hemorrhoids while it was decreased in patients with a previous hemorrhoidectomy. Furthermore, the MARP was increased in anal fissure patients when the duration of the symptom was short. In conclusion, anal manometric assessment of patients with anal diseases or defecation disorders could be valuable in determining the surgical procedure; furthermore, it could be valuable in evaluating postoperative results in fecal incontinence patients.
Anal Canal ; Classification ; Constipation ; Defecation* ; Fecal Incontinence ; Fissure in Ano ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Manometry ; Physiology ; Prolapse ; Rectal Fistula

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*

PURPOSE: Anorectal manometry is an objective means of assessing the anorectal function through the anorectal sphincter muscles. The purpose of this study was to assess the usefulness of anorectal manometry. METHODS: Manometric findings of 1145 patients with anorectal diseases were analyzed. RESULTS: In hemorrhoids, the maximum resting pressure (MRP) was significantly decreased postoperatively (P<0.05), and the maximum squeezing pressure (MSP) was decreased postoperatively. The MRP was increased in hemorrhoids, internal sphincter hypertonia, and chronic anal fissure (CAF). The MRP and MSP were significantly decreased in CAF, anal fistula, and anal stricture postoperatively (P<0.05). In anal fistula, the high pressure zone length and sphincter length were significantly decreased postoperatively (P<0.05), and the vector symmetric index was decreased to 0.79 postoperatively. Fourteen of the 57 patients with fecal incontinence did not show rectoanal inhibitory reflex (RAIR). In 22 of the 25 patients were clinically suspected of congenital megacolon (CMC), unnecessary surgery was avoided with RAIR. Twelve of the 15 patients with CMC, who had undergone surgery, showed the RAIR. In patients treated by total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP), the MRP and MSP were decreased postoperatively, and the sensation of fullness (SOF) was significantly decreased postoperatively (P<0.05). In patients with rectal cancer treated by low anterior resection, the MRP, MSP, SOF, and compliance were significantly decreased until 12 months postoperatively (P<0.05). CONCLUSIONS: Manometry appears to be an important tool to evaluate anorectal function that enables adequate surgery or treatment for the most of anorectal diseases. Furthermore, it is a valuable tool in assessing functional recovery after surgeries associated with a sphincter injury.
Adenomatous Polyposis Coli ; Anal Canal ; Colitis, Ulcerative ; Compliance ; Constriction, Pathologic ; Fecal Incontinence ; Fissure in Ano ; Hemorrhoids ; Hirschsprung Disease ; Humans ; Manometry* ; Muscle Hypertonia ; Muscles ; Rectal Fistula ; Rectal Neoplasms ; Rectum ; Reflex ; Sensation ; Unnecessary Procedures

OBJECTIVETo evaluate the efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of complex fistula-in-ano.

METHODSClinical data of 24 patients with complex fistula-in-ano who treated with LIFT in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2009 to February 2012 were analyzed retrospectively. The operative efficacy and postoperative continence were evaluated.

RESULTSThe prime success rate of fistula healing was 66.7% (16/24) after the LIFT procedure. Two patients presented with intersphincteric incision infection which was successfully treated with topical of silver nitrate. Four patients had intersphincteric fistula with infection and managed with the complete laying open approach. The total clinical healing rate was 91.7% (22/24). Another 2 patients had persistent external opening with discharge. During follow-up of 6 to 44 (median 16) months, The Cleveland Clinic Florida Fecal Incontinence score revealed that no patient developed decreased continence.

CONCLUSIONLIFT is a safe and effective sphincter-preserve procedure for complex fistula-in-ano.

Although the chronic prostatitis is the most common infectious disease in the urinary tract in male, it is confusing us to diagnose and treat thoroughly. It is usually diagnosed by careful history, urinalysis, rectal palpation, and wet smear of prostatic secretions. But sometimes these findings are not identical to the true conditions of patients. 53 patients suspected of chronic prostatitis were studied by cultures of prostatic secretion and semen. And they compared to each other. The results were as follows: 1. Semen cultures, in 10 cases of the control group, showed positive findings in two cases. One was staphylococcus epidermis and the other was Gram(+) bacillococcus, but their colony counts were less than 100. 2. The positive findings on prostatic secretion culture were 37 cases (69. 8%) and on semen culture were 28 cases(52. 9%) 3. The etiologic organisms of chronic prostatitis by semen and prostatic secretion cultures revealed staphylococcus epidermis, staphylococcus aureus, streptococcus, Gram(-) diplococcus and Gram(+) bacillococcus in order of frequency. 4. Pathologic findings on prostatic biopsy according to different etiologic organisms revealed nothing remarkable except nonspecific chronic inflammation in each group. 5. Although there is no evidence the semen culture is superior to the prostatic secretion culture for diagnosis of the chronic prostatitis, it is more useful in the patient who may have an acute exacervation of chronic prostatitis, the patient whose prostatic juice can't be obtained by massage, and the patient who can't endure pain because of rectal pathology such as anal fissure or severe hemorrhoids.
Biopsy ; Communicable Diseases ; Diagnosis ; Digital Rectal Examination ; Epidermis ; Fissure in Ano ; Hemorrhoids ; Humans ; Inflammation ; Male ; Massage ; Pathology ; Prostatitis* ; Semen* ; Staphylococcus ; Staphylococcus aureus ; Streptococcus ; Urinalysis ; Urinary Tract

Anal diseases are very common and it is important for a medical practitioner to understand how to deal with these diseases. To establish diagnoses of specific conditions, detailed history taking, inspection, palpation including digital rectal examination, and anoscopic examination are performed. Sigmoidoscopy is also required if upper lesions are suspected. History taking should include information about bleeding, prolapse, swelling, pain, discharge, irritation, bowel habit, continence, abdominal symptoms, weight loss. Sims' position and lithotomy position are commonly used for physical examination of the anal area. In addition to careful inspection and palpation, digital rectal examination should be performed to evaluate the anal canal width and sphincter strength. Above all, digital examination is a very useful and cheap tool to find rectal cancer which commonly occurs after middle-ages. Common anal diseases such as hemorrhoids, anal fissure, perianal abscess and fistula-in-ano, pruritus anai, and rectal prolapse are reviewed.
Abscess ; Anal Canal ; Diagnosis* ; Digital Rectal Examination ; Fissure in Ano ; Hemorrhage ; Hemorrhoids ; Palpation ; Physical Examination ; Prolapse ; Pruritus ; Rectal Neoplasms ; Rectal Prolapse ; Sigmoidoscopy ; Weight Loss

PURPOSE: Rectovaginal fistulas (RVFs) are relatively uncommon diseases which account for only 5% of anorectal fistulas. The treatment of RVFs is difficult and the results are often unsatisfactory. For proper treatment, many factors must be considered, such as causes, size, location and the general condition of the patients. Generally obstetric injury has been the most common cause, but recently the incidence of RVFs associated with malignant diseases or radiotherapy has been increasing. The purpose of this study was to evaluate the clinical features of RVFs according to causes. METHODS: Thirth-two patients with RVF were managed at the Gospel Hospital, Kosin University between Jan. 1989 and Dec. 2000 were retrospectively reviewed. RESULTS: Among RVF associated malignant diseases (26 cases), there were 5 cases due to direct invasion of malignant tumors, all of which were incurable. However, of the 18 cases of radiation induced RVFs (cervical cancer in 13, rectal cancer in 4, vaginal cancer in 1), 2 who received radiotherapy due to cervical cancer and had no residual malignancy were cured with low anterior resection with coloanal anastomosis. All 3 cases of RVFs due to operative complication of malignant diseases were also curable. In RVFs associated with non-malignant diseases (6 cases), there were 2 cases of RVFs due to obstetric injuries, 1 due to trauma, and 3 due to operative complication of non- malignant diseases such as uterine myoma, hemorrhoids, and uterine prolapse. All 6 cases were curable, but only 3 were treated with single-stage operation, 3 required multiple-stage operation. Other cases frequently featured recurrence. CONCLUSION: Among many factors, the cause was the most important factor related to treatment in RVFs. Although the cases due to direct invasion of malignant tumors were incurable, the 2 who received radiotherapy due to cervical cancer were treated successfully, and their prognosis remains hopeful. All 6 cases associated with non-malignant disease were also curable. However, because of the high recurrence rate in such those cases, more careful preoperative assessment is required for patients with RVFs.
Fistula ; Hemorrhoids ; Hope ; Humans ; Incidence ; Leiomyoma ; Prognosis ; Radiotherapy ; Rectal Neoplasms ; Rectovaginal Fistula* ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms ; Uterine Prolapse ; Vaginal Neoplasms

BACKGROUND AND AIM: Solitary rectal ulcer syndrome (SRUS) is a rare disease, but it is encountered in the colorectal field. SRUS is usually associated with defecation disorders such as puborectalis dysfunction, rectal occult or overt prolapse, descending perineum syndrome, and so forth. Without knowledge about SRUS, the lesion could be easily overlooked or misdiagnosed. The histologic characteristics of SRUS are fibromuscular obliteration in the lamina propria and/or misplaced mucin-filled cysts below the muscularis mucosae, this latter condition being commonly referred to as colitis cystica profunda. However, these characteristics, even though they exist, are often missed in the initial biopsy specimens from SRUS patients, leading to misdiagnoses which cause delayed diag-nosis and treatment. In spite of the incomplete histologic indications, a careful and con-scientious clinician, using clinical features and characteristic endoscopic findings, would not misdiagnose SRUS lesions. In other words, the clinical features and endoscopic find-ings are as important as, if not more important than, the histologic findings in the diag-nosis of SURS lesions. METHODS: The authors reviewed and analyzed 18 recently experi-enced, biopsy-proven cases of SRUS with emphasis on gross classification and initial pathologic misdiagnoses. RESULTS: The most common age groups were the 5th and the 6th decades with a mean age of 46.5. The male-to-female ratio was 1.6 : 1. The most common symptoms were mucous discharge and defecation difficulty. All lesions involvedthe rectum, and the lower rectum was the most common site. Four diffuse-type lesions showed an extensive involvement up to the sigmoid colon. The most common form of SRUS was the elevated type (44.4%). The ulcerated type accounted for 27.8% of the cases and the flat type, 22.2%. Circumferential involvement of the SRUS was noticed in 3 cases. In 9 cases (50%), pathologic findings missed the characteristics of SRUS and indicated one or a combination of chronic nonspecific inflammation, a chronic ulcer, an inflam-matory polyp, an adenomatous polyp, pseudomembranous colitis, and adenocarcinoma. In three of these cases, a second biopsy was taken with the same results. Based on the clinician' s belief that SRUS was the cause of the lesions, all nine cases were reviewed by the pathologist and a final diagnosis of SRUS was reached. Associated disorders were hemorrhoids, rectoceles, rectal prolapse, perianal fistulas, descending perineum syndrome, and anal fissures. Among them, hemorrhoids and rectoceles were the most common disorders. Four SRUS cases were managed surgically with good results. The surgical treatment was an excision of the lesion itself and/or the correction of the associated disorders. CONCLUSIONS: The histologic characteristics of SRUS are the key to diagnosis, but sufficiently large biopsy specimens are necessary in order to obtain the correct diagnosis. However, the clinical features, including symptoms and associated disorders, plus the characteristic endoscopic findings can produce the correct diagnosis even in cases of insufficiently large biopsy samples or incomplete histologic reports.
Adenocarcinoma ; Adenomatous Polyps ; Biopsy ; Classification ; Colitis ; Colon, Sigmoid ; Defecation ; Diagnosis* ; Diagnostic Errors ; Enterocolitis, Pseudomembranous ; Fistula ; Hemorrhoids ; Humans ; Inflammation ; Mucous Membrane ; Perineum ; Polyps ; Prolapse ; Rare Diseases ; Rectal Prolapse ; Rectocele ; Rectum ; Ulcer*

PURPOSE: Coloanal anastomosis (CAA) following ultralow anterior resection became more popular techniques for preservation of anal sphincter in distal rectal cancer. The purpose of this study is to evaluate a functional and oncologic safety of patients who underwent ultralow anterior resection and coloanal anastomosis for distal rectal cancer. METHODS: Forty-eight patients underwent coloanal anastomosis following ultralow anterior resection between January 1988 and January 1998. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 8 cm in length with GIA 95. All patients were followed up for fecal or gas incontinence, frequency of bowel movement and local or systemic recurrences. RESULTS: Mean tumor distance from anal verge was 4.0 cm. Postoperative complications were transient urinary retention (N=7), anastomotic stenosis (N=3), anastomotic leakage (N=3), rectovaginal fistula (N=2), cancer positive margin (N=1; patient refuses reoperation). Overall recurrences occurred in 7/48 (14.5%). Local recurrence (N=1) and systemic recurrence (N=1) in Astler-Coller stage B2, local recurrence (N=1), systemic recurrence (N=2) and combined local and systemic recurrence (N=2) in Astler-Coller stage C2. Mean frequency of bowel movement were 6.1 per day at 3 month, 4.4 at 1 year and 3.1 at 2 years. Kirwan grade for fecal incontinence were 2.7 at 3 months, 1.8 at 1 year and 1.5 at 2 years. CONCLUSIONS: With careful selection of patients and good operative techniques, CAA can be performed safely in distal rectal cancer. Normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation without compromising the rate of local recurrence.
Anal Canal ; Anastomotic Leak ; Autonomic Pathways ; Colon ; Colonic Pouches ; Constriction, Pathologic ; Fecal Incontinence ; Humans ; Postoperative Complications ; Rectal Neoplasms* ; Rectovaginal Fistula ; Recurrence ; Urinary Retention

Twelve patients with inflammatory bowel disease had been operated at the department of surgery, Chonnam University Hospital during the period from March 1988 to February 1997. In this study, we report on the operative cases regarding age, sex, symptoms, duration of disease, location of disease, preoperative diagnosis, operative indication, frequency of operation, histopathologic findings and follow up. The results were as follows: 1) The male to female ratio in ulcerative colitis was 1 : 1, and the mean age was 54.5 years. In Crohn's disease, male to female ratio was 2.3 : 1 and the mean age was 42.1 years. 2) The mean duration of symptoms in ulcerative colitis was 39 months and in Crohn's disease was 13.9 months. The common symptoms in ulcerative colitis were abdominal pain, bloody diarrhea, indigestion, weight loss and in Crohn's disease abdominal pain, palpable mass, weight loss, indigestion. Extraintestinal symptoms in Crohn's disease were cholelithiasis like symptom, anal fistula, anal fissure. 3) The involvement site in ulcerative colitis was large bowel only, but in Crohn's disease small bowel (50%), large bowel (20%), small and large bowel (30%) were involved. 4) Preoperative diagnosis in ulcerative colitis was accurate, but in Crohn's disease accurate diagnosis was made only in 20% and the other cases were operated under the impression of different diseases or conditions (intestinal tuberculosis (50%), bowel perforation (20%), mechanical ileus (10%)). 5) The indication of surgery in ulcerative colitis was intractability to medical treatment, on the other hand, in Crohn's disease most operative cases were made under the emergentconditions (bowel perforation, bowel obstruction, enterocutaneous fistula, abdominal mass). The frequency of operation in ulcerative colitis were two times in one case, three times in one cases. In Crohn's disease half of cases experienced two or three times of surgery. The method of operation in ulcerative colitis was total proctocolectomy with J-pouch ileoanal anastomosis. In Crohn's disease resection of diseased bowel segment was performed.
Abdominal Pain ; Cholelithiasis ; Colitis, Ulcerative ; Colonic Pouches ; Crohn Disease ; Diagnosis ; Diarrhea ; Dyspepsia ; Female ; Fissure in Ano ; Follow-Up Studies ; Hand ; Humans ; Ileus ; Inflammatory Bowel Diseases* ; Intestinal Fistula ; Jeollanam-do ; Male ; Rectal Fistula ; Tuberculosis ; Weight Loss