Mucosal Prolapse Syndrome Research Articles

A successful treatment for mucosal prolapse syndrome by the steroid enema therapy in a postoperative patient of mesenteric panniculitis

A successful treatment for mucosal prolapse syndrome by the steroid enema therapy in a postoperative patient of mesenteric panniculitis

Endoscopic Ultrasonography in Inflammatory Bowel Diseases

Endoscopic ultrasound (EUS) was designed for the evaluation of malignancies; however, its utility has been extended to the assessment of benign disorders, which include inflammatory bowel diseases. Topics discussed in this article include instruments and methods, EUS images in various inflammatory diseases, clinical severity and EUS typing, endoscopic grading of inflammation and EUS typing, extent of disease involvement and EUS typing, response to therapy and EUS typing, changes in EUS findings by treatment, Crohn's disease, radiation proctitis, ischemic colitis, tuberculosis, and mucosal prolapse syndrome.

Histopathological changes in haemorrhoid associated mucosa and submucosa.

The histological features of haemorrhoids are detailed in this study with special attention to the mucosal changes. These include significant crypt distortion, with stromal hyperplasia which bear a remarkable resemblance to the changes seen in mucosal prolapse syndrome. We propose that the mucosal prolapse syndrome should include haemorrhoids as part of the spectrum.

ADULT INTUSSUSCEPTION DUE TO A COLONIC CANCER -REPORT OF TWO CASES-

Two cases of intussusception with a colonic cancer at the head are reported. Case 1: An 81-year-old man was admitted to the hospital because of diarrhea. Intussusception of the transvers colon was confirmed by CT and a cancer was found at the head of intussusception by colonofiberscopy. Thereafter lumbago appeared. A curative operation was performed, and perforations of the colon were confirmed. Case 2: A 76-year-old woman was admitted to the hospital because of diarrhea, constipation, and intestinal obstruction. Intussusception was proved by barium enema and CT, and then a cancer was found by colonofiberscopy. Curative operation was carried out and the resected cancer tumor was a 10×10cm Bormann type 1 lesion in the cecum. Moreover mucosal prolapse syndrome was found at the anal side of the intussusception. Adult intussusception of the transvers colon is comparatively rare and we could not find any report of intussusception caused by a Borrmann type 1 lesion with 10cm in diameter. CT and colonofiberscopy are very useful to confirm the intussusception, and operation must be performed without desintussusception because of the risk of metastasis.

Mucosal prolapse syndrome: diagnosis with endoscopic US.

To determine the value of endoscopic ultrasound (US) in the diagnosis of mucosal prolapse syndrome (MPS), also known as solitary ulcer of the rectum. Three male and two female patients (age range, 17-66 years) with biopsy-proved MPS underwent endoscopic US. The average rectal wall thicknesses of the affected areas were compared with those of normal-appearing mucosa. The gross appearance of the rectal lesions was classified into three types: polypoid (n = 2), flat (n = 1), and ulcerative (n = 2). In all three types of lesions, endoscopic US demonstrated smooth, diffuse thickening of the third layer of the rectal wall; the other layers had minimal thickening. Neither a solid hypoechoic mass nor a transmural infiltrating lesion was visible, and the five-layer structure of the rectal wall was completely preserved. In the polypoid lesions, the third layer was winding as well as thickened, and microcystic components were occasionally found. Endoscopic US enabled differentiation of MPS from other conditions such as malignant neoplasia and Crohn disease.

内視鏡的治療で症状が改善した直腸粘膜脱症候群の1例

A case of mucosal prolapse syndrome (MPS) of a 70-year-old female is reported. The patient had complained of anal bleeding and a feeling of unsatisfied defecation since 1985. She had a habit of straining on defecation. She visited our hospital because of positive fecal occult blood test in Oct 1993. Barium enema and colonoscopy showed a polypoid lesion, measuring 25×18×17 mm in size, with a stalk in the lower rectum, and the endoscopic polypectomy was performed. Histological examination of the resected specimen revealed fibromuscular obliteration of the lamina propria and colitis cystica profunda (CCP) in the submucosal layer. These histological findings confirmed the diagnosis of MPS (CCP type) . Her clinical symptoms and habit of defecation were improved significantly after endoscopic therapy.

直腸粘膜脱症候群の経過観察例の検討

直腸粘膜脱症候群（MPS）を経過観察し，その臨床的および内視鏡所見につき検討した。対象は1986年4月より当院でMPSと診断され，内視鏡的に経過観察された8例である。その結果，①男女比は4対4，年齢は18-72歳で，平均年齢は38.1歳であった。②主な臨床症状は，下血・粘血便6例（75％），貧血および肛門痛が各々1例で，排便習慣は便秘4例（50％），頻回便1例（12.5％）。下剤・摘便・浣腸の使用は4例，“いきみ”の習慣は全例に認められた。病悩期間は最低2ヵ月から最高40年と幅があった。内視鏡による経過観察は最長81ヵ月から最短4ヵ月であった。③診断時の内視鏡所見は潰瘍形成4例，潰瘍形成＋ポリープ2例，ポリープ状の隆起2例であり，主に肛門縁より10cm前後の直腸前壁に病変は認められた。④“いきみ”の禁止を主として，緩下剤などで排便習慣を是正した治療を行い，経過観察した8例中7例で潰瘍・びらんの縮小，瘢痕化，ポリープの縮小が内視鏡的に観察された。直腸脱の1例に対してRipstein手術が行われた。以上，MPSの成因の大きな因子である“いきみ”の禁止によって潰瘍，びらんの改善が認められ，この効果は内視鏡による経過観察で確認された。

A Case of a Patient with a Rectal Ulcer Who Had an Unusual Defecation Habit

Abstract: This case report describes a patient with a rectal ulcer who had an unusual defecation habit. Complete healing was recognized colonoscopically after the patient was instructed to break this habit.A polyp of the ascending colon was detected by a barium enema in a 37‐year‐old man complaining of anal bleeding. He was admitted to our division to undergo a polypectomy. At the time of the polypectomy, a round ulcer, measuring 1 cm in diameter, was detected on the right wall of the rectum 3 cm from the anal verge. A diagnosis of mucosal prolapse syndrome of the rectum could not be made because the patient did not exhibit the characteristic habit of excessive “straining” mentioned by patients with this syndrome, and no characteristic finding of fibromuscular obliteration was found on histological examination of biopsied specimens taken endoscopically from the lesion. Repeated history taking, however, revealed that the patient had the unusual habit of inserting his finger into his rectum after defecation. He broke this habit following instruction to do so. As a result, on colonoscopic examination 15 month later, the ulcer was found to have become a scar:

Microvascular abnormalities in the mucosal prolapse syndrome.

Twenty two cases of colorectal mucosal prolapse from a variety of clinical situations were examined histologically to identify changes in the microvasculature which may predispose to ulceration. The findings were compared with 10 tubular adenomas and 10 hyperplastic polyps. Fibrin insudation into vessel walls and thickened mucosal vessels were significantly associated with the presence of ulceration. Possible mechanisms of ulceration are discussed, and an hypothesis based on a microvascular pathogenesis is presented.

全周性粗大結節状隆起性病変を伴う直腸粘膜脱症候群の1例

全周性粗大結節状隆起性病変を伴う直腸粘膜脱症候群の1例

Inflammatory myoglandular polyps of the colon and rectum. A clinicopathological study of 32 pedunculated polyps, distinct from other types of polyps.

Hitherto unclassified colorectal polyps were identified in 32 patients (23 men and 9 women; mean age, 53 years). The only symptom, which was observed in less than half the patients, was passage of blood or occult blood. Endoscopic examination revealed solitary pedunculated, red polyps with a smooth surface. These polyps were found in the left colon, especially in the sigmoid. Their characteristic features were inflammatory granulation tissue in the lamina propria mucosae, proliferation of smooth muscle, and hyperplastic glands with occasional cystic dilatation. The etiology of this type of polyp is unknown, but it could involve chronic trauma from the fecal stream and from peristalsis of the bowel. These polyps can be differentiated from juvenile polyps and inflammatory polyps by the presence of abundant smooth-muscle cells in the inflamed lamina propria mucosae. They also can be differentiated from Peutz-Jeghers polyps, which appear as hamartomatous structures with tree-like proliferation of muscularis mucosae covered by colonic mucosa without inflammatory granulation tissue. Their locations and macroscopic appearance distinguish these polyps from mucosal prolapse syndrome and polyps developed after colostomy. In addition, these new polyps differ from inflammatory cap polyps in that they lack a fibrin cap. We propose the name inflammatory myoglandular polyps for these polyps, which are distinct clinicopathologically from other types of colorectal polyps.

THREE CASES OF MUCOSAL PROLAPSE SYNDROME OF RECTUM

Although mucosal prolapse syndrome (MPS) of the rectum is a relatively rare disease, recently reports of the disease are gradually increasing. We experienced 3 cases of MPS of the rectum, which were different from each other in macroscopic findings.Case 1 is a 21-year-old man who had a habit of straining, complaining of diarrhea and bloody stool. Examinations showed an elevated lesion at the anterior wall of the lower rectum, and the transrectal excision of the tumor was performed. It had a mucinous cyst in the submucosa and was histologically diagnosed as MPS. The patient was followed on ambulant basis, around 7 months after operation bloody stool occurred and recurrence of elevated lesion was found. Case 2 is an 18-year-old woman complaining of anal bleeding, Examinations showed four nodular polypoid lesions, occupying the entire circumference of the lower rectum. Diagnostic excision was performed and diagnosis of MPS was made. Case 3 is a 39-year-old woman complaining of anal bleeding, who has rectal prolapse since 10 years before. Examinations showed a shallow, well demarcated ulcerative lesion at the anterior wall of the lower rectum. The patient was advised not to strain on defecation and has been asymptomatic for 4 years. Endoscopically, the ulceration became smaller, but another flat type of MPS appeared at the oral side of the lesion.

A CASE OF MUCOSAL PROLAPSE SYNDROME

A case of mucosal prolapse syndrome of the rectum is presented. The case was a 20-year-old man complaining of prolapse of a tumor and slight bleeding from the anus after defecation since 1987, who was pointed out the rectal tumor which was gradually increasing in mass by a near practitoner. After admission, digital examination showed a movable tumor at the left-anterior wall of the rectum. Radiologically and endoscopically, the tumor appeared irregularly elevated lesion, and situated left-anterior wall, 2-3cm from the anal ring. The mucosal surface seemed normal, and the biopsy specimen showed no neoplastic changes. Preoperative diagnosis was mucosal prolapse syndrome of the rectum. Transrectal excision of the tumor was performed on May 16, 1989. Histological examination also confirmed mucosal prolapse syndrome, because fibromuscular obliteration, a characteristic examination also confirmed mucosal prolapse syndrome, because fibromuscular obliteration, a characteristic finding of mucosal prolapse syndrome, could be seen.

Pathophysiology and Management of Solitary Ulcer Syndrome of the Rectum

Solitary ulcer syndrome of the rectum, solitary ulcer of the rectum, mucosal prolapse syndrome and colitis cystica profunda belong to the same disease category with typical clinical manifestations of blood/mucus discharge and abnormal bowel habit. The lesions are either ulcerated or polypoid, mostly present in the anterior rectal wall and often multiple. Overt or occult full-thickness rectal prolapse or partial mucosal prolapse is found to be underlying pathogenic mechanism and perineal descent is also a common feature. Abnormal bowel habit does exist in these patients characterized by straining at defecation. Fibromuscular obliteration of the lamina propriae is a diagnostic feature which makes differential diagnosis from carcinoma or adenoma easy. Conservaive treatment by normalizing bowel habit with laxatives and high roughage diet is usually satisfactory in most cases, but local excision of large polypoid/ulcerated lesion together with surgical procedure for overt rectal/mucosal prolapse, if present, is required when conservative treatment is unsatisfactory.

Protruded variants in solitary ulcer syndrome of the rectum.

A review of 21 patients with protruded lesions in solitary ulcer syndrome of the rectum confirmed by resection is presented. Symptoms were usually the passage of blood and mucus per rectum, alteration of bowel habit, anorectal pain and rectal prolapse. Solitary or multiple polypoid lesions were found within 15 cm of the anal margin and were usually sited anteriorly. Fifteen of the patients were men and 8 were women with a mean age of 37.1 years. The diagnosis was made on the basis of histopathology; 1) fibrous obliteration of muscle fibers, 2) reactive hyperplasia of the mucous membrane with villous configuration or mild pseudoinvasion. These changes have been observed in complete rectal prolapse, colonic intussusception, and localized colitis cystica profunda, suggesting a common pathogenesis. The histological findings were almost the same as in the ulcerative lesions of this syndrome except for remarkable regenerative hyperplastic changes such as a relatively high incidence of mucous cell proliferation, dilatation of glands and serrate change in the cases showing protrusion. In the pathogenesis, the occult mucosal prolapse in association with excessive straining may be of particular importance, so that the lesions might be termed mucosal prolapse syndrome of the rectum.

Polyp-simulating mucosal prolapse syndrome in (pre-) diverticular disease.

Eight patients with anal blood loss were referred for endoscopic polyp removal (4) or because of problems with the differential diagnosis (4). These patients were referred because of an apparent discrepancy between the initial diagnosis (malignancy, ulcerative colitis and hemangioma) and the clinical and/or radiographic and endoscopic findings. At endoscopy a polyp-simulating lesion was found in all patients; this was not adenomatous in nature, but was made up of bright red, hyperemic prolapsing redundant mucosa. Also, polypoid excrescences were present with a clearly distinguishable transition between the intensely red congested mucosa and the normal pink adjacent epithelium at the base of the stalk. The distribution of the lesions was confined to the sigmoid area. After institution of a fibre-enriched diet, regression of the lesions was documented. However, the conspicuous hypercontractility and thickening of the mucosal layer persisted. The clinical significance of the recognition of this polyp-simulating mucosal prolapse syndrome lies in the fact that endoscopic polyp removal is not indicated and that such abnormalities may be responsible for low-grade, chronic and recurrent bleeding.

Mucosal prolapse syndrome

Mucosal prolapse syndrome

Mucosal prolapse syndrome--a unifying concept for solitary ulcer syndrome and related disorders.

Nineteen cases of classical solitary ulcer of the rectum syndrome (SURS) and sixteen examples of rectal mucosal prolapse are described. Similarities in the histological and histochemical features of the two groups lead us to suggest that the term "mucosal prolapse syndrome" be used to describe this group of disorders in which mucosal prolapse--overt or occult is the common underlying pathogenetic mechanism.