Outlet constipation syndrome caused by elongation of the rectosigmoide as a frequent etiology for pelveo-abdominal pain and intestinal troubles in women with endometriosis

The aim of the study was to isolate from the clinical history and examination, symptoms, or combination of symptoms highly suspicious for intestinal infiltration in endometriosis patients. In a prospective study, preoperative anamnesis on defecation problems and pain symptoms was correlated with the vaginal examination and the laparoscopic findings in 2,000 consecutive patients with suspicion of intestinal endometriosis; 65.7% of the patients reported a typical symptomatology combining left-sided pelvic pain irradiating systematically to the back and occasionally to the left leg, with dyschesia, abdominal bloating, and/or sensation of a doubt masse in the left lower or middle abdomen, sometimes rectorrhagia and an improvement in the pain after defecation. In the absence of a palpable endometriotic nodule of the rectovaginal space, the combination of this symptoms correlated in 93.7% of the patients with an outlet constipation syndrome due to a significant elongation with kinking of the rectosigmoide. In the patients with a palpable endometriotic nodule of the posterior fornix (n = 712), the combination of an apareunia with the apparition of constipation for 2–3 days at the beginning of the period bleeding followed by a diarrhea until the end of the period shows a positive predictive value for deep intestinal infiltration of 95%. In all endometriosis patients undergoing a laparoscopy for pain and intestinal disorders, the elongation of the rectosigmoide must be perceived and recognized as a potential cause for an outlet constipation syndrome which can be cured easily by a left-sided sigmoidopexy. In patients with a macroscopic endometriotic nodule of the posterior fornix, the presence of an apareunia and the apparition of constipation at the beginning of the menstruation followed 2–3 days later by a diarrhea are strong arguments for an invasive intestinal endometriosis, and those patients must be primarily referred to a tertiary referral center. No financial support was received for this study.     

Anatomic specificity in the diagnosis and treatment of internal rectal prolapse

Distal bowel evacuation was studied by cinedefecography in 85 women with obstinate constipation, tenesmus, and incomplete evacuation in whom a diagnosis of internal rectal intussusception was clinically suspect. Sixty-five patients showed radiographic evidence of intussusception—mostly of the distal rectum, without rectosacral separation. Patients with distal intussusception who did not respond to nonoperative measures were treated by Delorme's transrectal excision with excellent results. Internal rectal intussusception is a real and demonstrable entity which may be symptomatically disabling and whose documentation may be integral to effective and anatomically specific treatment. The syndromes of perineal descent, solitary rectal ulcer, levator syndrome and so-called recurrent hemorrhoids may be diagnostic intermediaries in the evolution of internal rectal intussusception. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 6 to 10, 1985.     

聚乙二醇4000散剂在肛肠病术后的应用

为探讨聚乙二醇4000散剂在肛肠病术后的应用效果,选择200例肛肠病患者,随机分为观察组与对照组各100,例,观察组100例加服聚乙二醇4000散剂,对照组100例采用常规综合疗法。观察两组腹胀及排便情况。结果显示,排便正常观察组为81．5％,对照组为52．4％,两组差异有统计学意义（P〈0．01）。结果表明,聚乙二醇4000散剂可促进肛肠病术后胃肠功能恢复及纠正术后排便困难,其疗效显著。