Rectal stricture: A clinical analysis of 58 cases, with observations on 154 Frei-positive cases of lymphogranuloma inguinale

Abstract

1. 1. In this communication there are reported 154 cases of lymphogranuloma inguinale, all with positive Frei reactions, which were observed within a four-month period at the New Orleans Charity Hospital. The number of cases indicates that the disease is more prevalent in general hospitals with a large negro population than has hitherto been suspected. The disease is predominantly a disease of the negro race, but the white race is by no means exempt. 2. 2. In the foregoing series are included 58 cases of inflammatory stricture of the rectum, in 55 of which the Frei test was positive. These cases are analyzed in some detail. 3. 3. The evidence in favor of lymphogranuloma inguinale as the etiologic factor in nearly all cases of rectal stricture is briefly summarized. 4. 4. A definite clinical picture of inflammatory stricture of the rectum is presented, and the associated lesions are analyzed. 5. 5. The chief pathologic features of rectal stricture are presented, and its symptomatology, diagnosis and treatment are briefly considered. 6. 6. Five cases of rectal stricture observed at autopsy are included in this communication. Three of these cases were observed clinically and represent, we believe, the first recorded instances of rectal stricture associated with lymphogranuloma inguinale which came to autopsy diagnosed as such. The findings in all 5 cases clearly indicate that the terminal stage of involvement of the rectum by the virus of lymphogranuloma inguinale is the pathologic entity of chronic ulcerative stenosing proctitis and periproctitis, the etiology of which has hitherto been obscure. 7. 7. In 2 of the cases studied at autopsy positive Frei reactions were observed during life, and it is concluded that these important cases, which, so far as the author knows, are the first of the sort on record, ∗ furnish the missing link between the clinical entity of rectal stricture due to lymphogranuloma inguinale and the aforementioned pathological entity.