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Diverticula are frequently seen in the sigmoid, descending, ascending and transverse colons whereas rectal diverticula are extremely rare. The stapled rectal mucosectomy for the treatment of a prolapsed hemorrhoid is less painful and has lower morbidity; therefore, it has been commonly used despite possible complications. This paper reports a case of a rectal diverticulum that developed after a procedure for prolapsed hemorrhoids (PPH). A 42-year-old man with a history of hemorrhoidectomies came to the hospital because of constipation. On sigmoidoscopy, a 2-cm-sized, feces-filled pocket was located just above the anorectal junction. After removal of the fecal material, a huge rectal diverticulum (-4 cm in diameter) was seen. Pelvic magnetic resonance imaging (MRI) confirmed the diagnosis of rectal diverticulum outpouching through the muscular layer of the intestine in a left posterolateral direction. The patient was discharged without complication after a transanal diverticulectomy had been performed, and the direct rectal wall had been repaired.
Adult ; Colon, Sigmoid ; Colon, Transverse ; Constipation ; Diagnosis ; Diverticulum* ; Hemorrhoidectomy ; Hemorrhoids* ; Humans ; Intestines ; Magnetic Resonance Imaging ; Sigmoidoscopy

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Transanal Evisceration Caused by Rectal Laceration.

Aleix MARTINEZ PEREZ ; Maria Teresa TORRES SANCHEZ ; Jose Manuel RICHART AZNAR ; Eva Maria MARTI MARTINEZ ; Manuel MARTINEZ-ABAD

Annals of Coloproctology.2014;30(1):47-49. doi:10.3393/ac.2014.30.1.47

Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.
Abdominal Cavity ; Abdominal Injuries ; Aged ; Aged, 80 and over ; Anal Canal ; Causality ; Female ; Humans ; Intestinal Perforation ; Intestine, Small ; Lacerations* ; Pathology ; Pelvis ; Rectal Prolapse ; Rectum

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Outcomes of a Single-Port Laparoscopic Appendectomy Using a Glove Port With a Percutaneous Organ-Holding Device and Commercially-Available Multichannel Single-Port Device.

Jieun LEE ; Sung Ryol LEE ; Hyung Ook KIM ; Byung Ho SON ; Wonjun CHOI

Annals of Coloproctology.2014;30(1):42-46. doi:10.3393/ac.2014.30.1.42

PURPOSE: A laparoscopic appendectomy is now commonly performed. The push in recent years toward reducing the number of ports required to perform this surgery has led to the development of a single-port laparoscopic appendectomy (SPA). We compared postoperative pain after an SPA using a glove port with a percutaneous organ-holding device (group 1) with that of an SPA using a commercially-available multichannel single-port device (group 2). METHODS: Between March 2010 and July 2011, a retrospective study was conducted of a total of 77 patients who underwent an SPA by three surgeons at department of surgery, Kangbuk Samsung Medical Center. Thirty-eight patients received an SPA using a glove port with a percutaneous organ-holding device. The other 39 patients received an SPA using a commercially-available multichannel single port (Octo-Port or SILS Port). Operative details and postoperative outcomes were collected and evaluated. RESULTS: There were no differences in the mean operative times, times to pass gas, postoperative hospital stays, or cosmetic satisfaction scores between the two groups. The pain score in the first 24 hours after surgery was higher in group 2 than group 1 patients (P < 0.001). Furthermore, the trocar used in group 2 was more expensive than that used in group 1. CONCLUSION: An SPA using a glove port with a percutaneous organ-holding device was associated with a lower pain score during the first 24 hours after surgery because of the shorter fascia incision length and a cheaper cost than an SPA using a commercially-available multichannel single-port device.
Appendectomy* ; Fascia ; Humans ; Length of Stay ; Operative Time ; Pain, Postoperative ; Retrospective Studies ; Surgical Instruments

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Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods.

Ji Hye CHOI ; Byeong Geon JEON ; Sang Gi CHOI ; Eon Chul HAN ; Heon Kyun HA ; Heung Kwon OH ; Eun Kyung CHOE ; Sang Hui MOON ; Seung Bum RYOO ; Kyu Joo PARK

Annals of Coloproctology.2014;30(1):35-41. doi:10.3393/ac.2014.30.1.35

PURPOSE: A rectourethral fistula (RUF) is an uncommon complication resulting from surgery, radiation or trauma. Although various surgical procedures for the treatment of an RUF have been described, none has gained acceptance as the procedure of choice. The aim of this study was to review our experience with surgical management of RUF. METHODS: The outcomes of 6 male patients (mean age, 51 years) with an RUF who were operated on by a single surgeon between May 2005 and July 2012 were assessed. RESULTS: The causes of the RUF were iatrogenic in four cases (two after radiation therapy for rectal cancer, one after brachytherapy for prostate cancer, and one after surgery for a bladder stone) and traumatic in two cases. Fecal diversion was the initial treatment in five patients. In one patient, fecal diversion was performed simultaneously with definitive repair. Four patients underwent staged repair after a mean of 12 months. Rectal advancement flaps were done for simple, small fistula (n = 2), and flap interpositions (gracilis muscle flap, n = 2; omental flap, n = 1) were done for complex or recurrent fistulae. Urinary strictures and incontinence were observed in patients after gracilis muscle flap interposition, but they were resolved with simple treatments. The mean follow-up period was 28 months, and closure of the fistula was achieved in all five patients (100%) who underwent definitive repairs. The fistula persisted in one patient who refused further definitive surgery after receiving only a fecal diversion. CONCLUSION: Depending on the severity and the recurrence status of RUF, a relatively simple rectal advancement flap repair or a more complex gracilis muscle or omental flap interposition can be used to achieve closure of the fistula.
Brachytherapy ; Constriction, Pathologic ; Fistula* ; Follow-Up Studies ; Humans ; Male ; Muscles ; Prostatic Neoplasms ; Rectal Fistula ; Rectal Neoplasms ; Recurrence ; Surgical Flaps ; Urinary Bladder ; Urinary Fistula

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Is Microsatellite Instability Really a Good Prognostic Factor of Colorectal Cancer?.

Ui Sup SHIN ; Sang Sik CHO ; Sun Mi MOON ; Sun Hoo PARK ; Sun Hee JEE ; Eun Joo JUNG ; Dae Yong HWANG

Annals of Coloproctology.2014;30(1):28-34. doi:10.3393/ac.2014.30.1.28

PURPOSE: The aim of this study was to investigate the clinicopathologic features of and the prognosis for colorectal cancers (CRCs) with microsatellite instabilities (MSIs). METHODS: Between 2006 and 2009, genotyping was performed on 245 patients with stage II/III CRCs to establish the MSI status. The clinicopathologic differences and the prognostic value of MSI were analyzed. The median follow-up period was 38 months (range, 7-68 months). RESULTS: Of the total 245 patients, 20 (8.2%) had MSI-high (H) and 225 (91.8%) had MSI-low (L) or stable (S) CRCs. Adjuvant chemotherapies were performed on 101 stage II (87.8%) and 107 stage III patients (82.3%). Patients with MSI-H CRCs more frequently had a family history of colon cancer (10% vs. 2.7%, P = 0.003), more frequently had a cancer located at the proximal colon (90.0% vs. 19.1%, P < 0.0001), and more often showed a mucinous phenotype or poor differentiation (35.0% vs. 7.1%, P = 0.001). Despite less frequent lymph node metastasis (25% vs. 55.6%, P = 0.01), the number of retrieved lymph nodes was higher (26.3 +/- 13.1 vs. 20.7 +/- 1.2, P = 0.04) in the MSI-H group. The overall survival and the disease-free survival (DFS) did not differ with respect to MSI status. However, in the stage II subgroup, the DFS for patients with MSI-H CRCs was significantly worse (72.2% vs. 90.7%, P = 0.03). The multivariate analysis performed on this subgroup revealed that MSI-H was an independent poor prognostic factor (adjusted hazard ratio, 4.0; 95% confidence interval, 1.0-15.6, P = 0.046). CONCLUSION: MSI-H CRCs had distinct clinicopathologic features, and MSI-H was an independent poor prognostic factor in stage II CRCs. Considering the majority of stage II patients were administrated adjuvant chemotherapy, the efficacy of adjuvant chemotherapy for treating MSI CRCs might be different from that for treating MSI-L/S tumors.
Chemotherapy, Adjuvant ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Microsatellite Instability* ; Microsatellite Repeats* ; Mucins ; Multivariate Analysis ; Neoplasm Metastasis ; Phenotype ; Prognosis

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