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The results of five consecutive perineal rectosigmoidectomies were reviewed to evaluate the role of this approach for complete rectal prolapse. There were two male and three female patients, with a median age of 75 years (range 45–82 years). On average, 23.6 cm (range 15–35 cm) of sigmoid colon and rectum was resected. There was no operation‐related mortality. One patient developed postoperative chest infection and another acute retention of urine. No recurrence of the prolapse was detected during a median follow‐up period of 25 months (range 6–42 months). Perineal rectosigmoidectomy is an effective and the least invasive procedure for complete rectal prolapse. It is the preferred approach for patients who have had multiple previous abdominal operations and for the frail elderly patient in whom, particularly, constipation is a major associated feature.   相似文献   

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Rectal prolapse is common in infants and children. It should initially be managed conservatively, as prolapse often resolves with the growth of the child. We encountered an 8-month-old infant with complete rectal prolapse associated with pararectal herniation of ileum between the 2 walls of the prolapsed rectum. This rare event led to strangulation of the ileal segment within the prolapsed rectal walls. We present this extremely uncommon case with a brief review of the relevant literature.  相似文献   

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An extremely rare case of progressive perineal clostridial myonecrosis secondary to Thiersch's operation for rectal prolapse illustrates the need for early recognition of the initial clinical findings to maximize the chances for survival. Management of these infections include prompt administration of shock therapy, a broad spectrum of antibiotics, and thorough surgical debridement of all involved tissue. Prophylactic systemic antibiotic therapy must be considered, especially in high risk patients.  相似文献   

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This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff. There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow-up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re-operated for recurrent symptomatic prolapses at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse. Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbidity.  相似文献   

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Technical features of laparoscopic rectopexy include complete rectal mobilization without division of the lateral stalks to avoid parasympathetic denervation and postoperative problems with defecation. Suture rectopexy is equally effective as posterior mesh rectopexy in preventing recurrences and eliminates the use of foreign material which is sometimes associated with intense fibrosis, sepsis and increased constipation. According to two randomised studies constipation seems to be less after resection rectopexy than suture or posterior mesh rectopexy alone perhaps by eliminating possible kinking at the rectosigmoid region by falling of the redundant sigmoid colon in the pouch of Douglas. Randomized studies are, however, needed to validate the need for colonic resection and to determine its optimal extent in patients who suffer from rectal prolapse, constipation and slow transit.  相似文献   

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