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Constipation: Evaluation and Management
Published in Laurence R. Sands, Dana R. Sands, Ambulatory Colorectal Surgery, 2008
Badma Bashankaev, Eric G. Weiss, Marat Khaikin
Approximately 8.3% to 11% of constipated patients who undergo anorectal physiology tests have cul-de-sac hernias—also known as sigmoidoceles or enteroceles. A sigmoidocele is a protrusion of the peritoneum between the rectum and vagina that contains the sigmoid colon. An enterocele is a protrusion of the peritoneum between the rectum and vagina containing the small intestine (Figs. 11–14) (63).
Constipation
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Kaori Futaba, Yvette Perston, Tony Mak, Simon Radley
constipAtion without impAired evAcuAtion And overt psychologicAl or psychiAtric diseAse [119]. SurgicAl TreAtment Options for Obstructive DefecAtion surgicAl repAir of AnAtomicAl deformities identified in pAtients with oDss should only be cArried in those who hAve exhAusted All conservAtive treAtments. The Aim of surgery is to correct AnAtomy with A relief of AssociAted symptoms [120], Although correction of AnAtomicAl AbnormAlities Alone does not AlwAys leAd to restorAtion of normAl function [121]. to decide on the best treAtment options, understAnding the pelvic floor AnAtomy And the DelAncey level of pelvic orgAn support (tAble 63.6) will help [122]. Rectocele surgicAl repAir of rectoceles in pAtients presenting to the colorectAl surgeon is usuAlly recommended when they Are 2 cm or more in depth with the need for pAtient to digitAte to defecAte And with evidence of significAnt trApping on defecAting proctogrAm or MrI proctogrAm [123] viA trAnsvAginAl, trAnsperineAl, trAnsAnAl, or AbdominAl ApproAches. trAnsvAginAl posterior colporrhAphy wAs found to hAve the lowest rAte of recurrence of rectocele/enterocele in A CochrAne review of All rectocele repAirs [124]. DyspAreuniA hAs been reported in up to 25% of women following posterior colporrhAphy. A systemAtic review of the use of biologicAl mAteriAls in urogynecologicAl surgery hAs shown thAt there wAs no AdditionAl benefit to the use of biologicAl mAteriAl in rectocele repAir [125]. stApled trAnsAnAl rectAl resection (stArr) involves resections of internAlly prolApsed rectum circumferentiAlly using A circulAr stApling device. JAyne et Al. reported 1-yeAr outcome of pAtients who underwent stArr procedure for evAcuAtion disorder on the europeAn stArr registry. This showed significAnt improvement in symptom severity And quality of life score. However, 36% experienced complicAtions including urgency, pAin, Urinary retention, bleeding, And septic events [126]. A consensus pAnel hAs developed A treAtment Algorithm for offering stArr by experienced surgeons for pAtients with evAcuAtion disorder with A rectocele And/or intussusception [127]. Enterocele/Sigmoidocele enterocele or sigmoidocele occurs As A result of herniAtion of smAll bowel (enterocele) or sigmoid colon (sigmoidocele) through the uterosAcrAl ligAment At the vAginAl Apex into the
Very long-term outcome after resection rectopexy for internal rectal intussusception
Published in Scandinavian Journal of Gastroenterology, 2021
Annichen Durbeck, Hans-Olaf Johannessen, Anders Drolsum, Egil Johnson
The thirteen patients had defecography at short-term follow-up of median 6 months (Table 2). The IRI was removed in 10 and reduced in three patients, respectively. Anterior rectocele, enterocele and sigmoidocele in two patients each were removed. One patient developed slight incontinence.