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Colonoscopy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Ian D. Sugarman, Jonathan R. Sutcliffe
An important component of the examination is palpation to exclude abdominal masses in the right lower quadrant (suggestive of terminal ileitis in Crohn's disease) and perineal inspection. The presence of tags, deep fissures, and induration makes the diagnosis of Crohn's disease more likely and this information may help differentiation from ulcerative colitis. Prior to intubation of the anus, a rectal examination should be performed to exclude a distal polyp. Proctoscopy not only allows visualization of the distal rectum but also allows liquid stool to be drained from within the rectum which in turn improves examination of the rectal ampulla.
Colon, rectum and anus
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
In addition to the fibre-optic light source there is a connection for air insufflation using a rubber bulb. The sigmoidoscope is inserted for a few centimetres through the anus, with anterior angulation of the scope being required to negotiate the 90-degree anorectal junction. The obturator is removed and the scope window secured to provide an air-tight seal. The rectal ampulla is inspected and the lumen of the bowel identified. Air is introduced via the instrument to open up the lumen ahead. Patients should be warned that air is being introduced and they may feel the need to pass flatus but ask them to try and retain the air if they can.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Other causes such as inflammatory edema, fecal impaction, constipating drugs (such as opioids, anticholinergics), and dehydration are likely to contribute to the development of bowel obstruction or to worsen the clinical picture. to all the abdomen or above the obstacle, ascites, as well as painful sites; and (7) presence of feces in the rectal ampulla (rectal exploration).
Angiogenesis inhibitors and symptomatic anal ulcers in metastatic colorectal cancer patients**
Published in Acta Oncologica, 2018
Francesca Bergamo, Sara Lonardi, Beatrice Salmaso, Carmelo Lacognata, Francesca Battaglin, Francesco Cavallin, Luca Saadeh, Sabina Murgioni, Antonino Caruso, Camillo Aliberti, Vittorina Zagonel, Carlo Castoro, Marco Scarpa
As per clinical practice at our Institution, all patients complaining of proctologic symptoms underwent evaluation at our proctologic outpatient clinic. Digital rectal examination (always performed with lidocaine gel) was the main diagnostic maneuver and often the only one feasible because of evoked pain preventing the insertion of an anoscope. The evaluation of the walls of the anal canal and rectal ampulla allows the identification of areas of tenderness and delineation of anal lesions, such as fissures, ulcers and swellings, according to their profile. Digital examination was diagnostic for anal ulcers because with the finger the margins and the depth of the ulcers were clearly definable and they could not be confused with a simple fissure or with hemorrhoids. Clearly, the pain at examination was not the outcome measure of the maneuver, but it was just an unpleasant and unsought side effect that we measured. The magnitude of the pain evoked at digital rectal examination was rated on a Likert scale (0: no pain; 1: mild pain; 2: moderate pain, 3: severe pain).
Tailgut cyst: report of three cases and review of the literature
Published in Acta Chirurgica Belgica, 2019
Ann-Sophie Hufkens, Peter Cools, Paul Leyman
A 67-year old woman arrived at the emergency department complaining of anal pain. She experienced a squeezing anal sensation and reported absence of bowel movements for five days. For the same symptoms she was previously diagnosed with internal hemorrhoids, that were treated by sclerotherapy. Two days after the sclerotherapy the patient experienced a more severe anal pain and had a fever of 38 °C. The family doctor was consulted and a treatment with amoxicillin-clavulanic acid was started. Upon presentation at the emergency department she was found to have fever over 39 °C. A blood sample determined an elevation of the inflammatory parameters. On physical examination the patients’ abdomen was non-tender and painless; the digital rectal examination (DRE) showed a painful soft bulging mass anally. A pelvic CT scan demonstrated an exophytic tumoral mass, closely related to the rectal ampulla with a left side pararectal adenopathy. A pelvic MRI scan revealed a retrorectal cystic mass, diagnosed as a tailgut cyst (Figure 1). The antibiotics were continued and an elective en bloc surgical resection was performed. A posterior approach with the patient in prone, ‘jack-knife’-position, was used and because of a poor peroperative visualization a partial coccygectomy was also performed. During surgical resection smaller ‘daughtercysts’ were seen posteriorly of the large central cyst. At pathology examination a multicystic retrorectal lesion with signs of an old hemorrhage and acute inflammation was seen. These findings were compatible with a retrorectal cystic hamartoma, also described as tailgut cyst. The patient was discharged three days postoperatively, antibiotic therapy was continued upon discharge. A subsequent control with MRI scan performed after six months, showed no signs of recurrence.
Assessment of feasibility of abdominal mesh vaginorectopexy in the repair of multiple pelvic organ prolapse
Published in Alexandria Journal of Medicine, 2023
Mohamed Mazloum Zakareya, Walid Galal Elshazly, Ahmed Mohamed Moaz, Bassem Khamis Hegazy
Fecal incontinence is a common clinical finding in patients with total RP (especially in the aged patients). In our study, we recorded a statistically significant improvement (100%) and a statistically significant cure (80%). These results were consistent with those obtained by D’Hoore et al., where a significant improvement occurred in 90% of patients after laparoscopic ventral rectopexy. This finding is in agreement with the results of classic rectopexy and reflects the importance of preserving the rectal ampulla [19].