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Transanal Total Mesorectal Excision for Rectal Cancer
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
The first step in assessing a patient for taTME is a thorough history and physical examination. Many patients with rectal cancer are asymptomatic, but symptoms may include rectal bleeding, rectal pain, tenesmus, change in bowel habits or stool caliber, weight loss, nausea, or fatigue. Prior pelvic surgery, such as prostate or gynecological surgery, and/or pelvic radiation can affect TME dissection planes and increase the complexity of transanal dissection and the risk of wrong-plane surgery. Information about baseline urinary and sexual function are important to document because of the risks of pelvic autonomic nerve injury associated with TME. Likewise, a history of fecal incontinence is critical in preoperative evaluation, as fecal incontinence would preclude a patient from sphincter preservation surgery. A comprehensive medical history should identify other medical conditions that may warrant additional assessment to optimize the patient prior to surgery. Diabetes, obesity, immunosuppression, and smoking have been associated with anastomotic leak in taTME and should be addressed before surgery [20]. Laboratory studies should include complete blood count, electrolyte panel, coagulation studies, and type and screen. Serum carcinoembryonic antigen (CEA) should be obtained to facilitate postoperative surveillance.
Diagnosis of Chronic Fatigue Syndrome
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
Rectal exam is helpful in CFS to make the diagnosis of proctalgia fugax. This disorder is usually a myofascial pain syndrome of the levator am. Many patients report sudden severe episodes of rectal pain which are usually brief, but may last as long as a half-hour or so. This problem, formerly consigned to the psychosomatic “waste-basket” until it was conceptualized and examined properly, is surprisingly common if one asks. It does not usually accompany burning rectal dysesthesias, another cardinal symptom of somatization disorder, although it may. Trigger point elimination techniques are helpful in treating proctalgia fugax. Levator ani trigger points, as well as those in the coccygeus muscle, can cause coccygeal pain, common in CFS. Stretch, post-isometric relaxation, massage, and high voltage pulsed galvanic stimulation are treatment modalities suitable for pelvic floor trigger points.
Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
A change in bowel habit is often the presenting symptom with an increase or decrease in frequency of defaecation or a change in stool consistency. Alternating diarrhoea and constipation is highly suspicious of cancer. Blood per rectum is another symptom that leads patients to seek medical advice. It varies in quantity depending on the degree of tumour ulceration and vascularity. The blood will be bright red and more likely streaked on the outside of the stool if the tumour arises in the rectum or sigmoid, or dark red and mixed in with the stool if the tumour arises more proximally in the colon. Mucus per rectum is more likely to be noticed with distal lesions. Tenesmus is a frequent urge to defaecate but leading to the passage of a little stool on each occasion and the lack of the feeling of complete rectal emptying. This is usually seen in rectal tumours, particularly if bulky or invading deeply and may be associated with rectal pain. Obstructive symptoms can manifest as intermittent colicky abdominal pain. They are more common in tumours of the descending colon where the faeces are more solid compared with right colon tumours where the stool is more liquid. Chronic bleeding leads to iron deficiency and in turn anaemia. It is a particular feature of right-sided colonic tumours, which may have few associated gastrointestinal symptoms.
Giant Anal Fibroepithelial Polyp in a Healthy Teenage Boy: A Case Report and Literature Review
Published in Fetal and Pediatric Pathology, 2022
Kelley Park, Paulette Abbas, Scott Langenburg, Janet Poulik, Abdul Hanan, Bahig M. Shehata
This is a previously healthy 15-year-old male who presented to an outside hospital with complaints of rectal pain and an associated mass. The patient states that the mass has been present for the past two to three years but has been growing in size and causing increased discomfort and pain. He notes that it has been intermittently limiting his activity. The patient denies any drainage from the lesion and denies any changes in bowel habits or bloody bowel movements. He has no history of constipation or anal trauma. He was noted to be hemodynamically stable at the outside hospital and physical exam noted a large rectal mass for which he was transferred to our institution for higher level of care. Upon arrival to our hospital, he was again noted to be hemodynamically stable. Laboratory work-up consisting of a CBC and BMP were unremarkable. On examination, a large pedunculated mass extended from the anal verge. The lesion had an area of ulceration but was not actively bleeding or draining. Given the size of the lesion as well as the symptomatic presentation, the patient was taken to the operating room the following day for excision of the lesion. He was placed in prone jackknife position on the operating room and, upon further examination of the patient under general anesthesia; the mass was noted to have a stalk emanating from the anal verge. The entire lesion measured 15 × 15 x 10 cm (Figure 1). The lesion was successfully excised with no operative complications. Patient has since been followed up in gastroenterology clinic three times. This included two clinical visits and endoscopy without recurrence. CT scan was negative for any other vascular or lymphatic abnormalities.
Child Sexual Abuse Exam Results in West Alabama
Published in Journal of Child Sexual Abuse, 2020
Michael A. Taylor, John C. Higginbotham
In addition to being a female, being African-American, and being pubertal, a history of having one or more of several symptoms for females increased the likelihood of having significant physical exam findings (PE 3-4). Those symptoms were vulvar pain, vaginal discharge, vaginal bleeding, and vaginal itching. For males as a group, no symptom was statistically significant for an increased likelihood of PE3-4 findings, but for AA males, a history of rectal pain was significant.
Surgical challenges in the treatment of perimenopausal and postmenopausal endometriosis
Published in Climacteric, 2018
E. S. Ozyurek, T. Yoldemir, U. Kalkan
Postmenopausal recurrence commonly presents as low back or rectal pain, painful defecation, ‘deep’ dyspareunia, rectal/vaginal bleeding or hematuria/flank pain or even hydronephrosis and renal failure27–29. Specific biomarkers or imaging criteria to detect recurrences are still lacking30.