Transanal Prolapse Research Articles

Transanal protrusion of intussusception can be sign of Waugh syndrome

Intussusception rarely occurs with transanal prolapse of intussusception (TAPI), this presentation may be a sign of Waugh's syndrome (WS), an association between intestinal malrotation and intussusception. The authors present the case of infant with an episode of TAPI, resolved with air enema, who required later diagnostic tests that showed the presence of WS, for which surgery was required after the resolution of the intussusception. At now we found only 72 cases reported of WS and some of them clinically presented with TAPI. In our opinion, patients with this type of presentation require a thorough radiological study of the intestine to rule out intestinal malrotations.

Colonoscopic reduction of atransanal prolapsed ileocolic intussusception.

Transanal protrusion of intussusception (TAPI; also known as prolapsed intussusception) is arare complication. Here, we present asuccessful colonoscopic reduction of ileocolic intussusception presented with transanal prolapse. An 8‑month male child, weighing 8 kg, was referred to our hospital presenting with amass in his anal canal, diarrhea and rectal bleeding for two days. The sonographic evaluation revealed an ileocolic intussusception in the rectosigmoid area. The patient was treated using colonoscopic reduction. To our knowledge, this is the first study reporting colonoscopic reduction for transanal prolapsed intussusceptions. Our study suggests gastroenterologists to consider colonoscopy as atherapeutic method for prolapsed intussusceptions and encourages them to attempt reducing the invagination using this method before laparotomy, especially in cases presenting within 48 h of onset of symptoms and no peritonitis symptoms.

Trans-anal protrusion of intussusception in a neonate

Abstract Intussusception in neonates is an exceedingly rare entity. The incidence of malrotation in cases of childhood intussusception is around 40%. However, there is no clear data on the incidence of such occurrence in a neonate. We describe a case of compound intussusception with intestinal malrotation in a neonate presenting as trans-anal prolapse.

1492 Sporadic Colonic Hamartoma in an Adult Patient: A Rare Finding

INTRODUCTION: Colonic hamartomas are non-neoplastic polypoid lesions that are rare in adults and most commonly encountered in children between the age of 1 and 7 years. They are histologically characterized by cystic dilation of mucus-filled glands, prominent bands of fibrous stroma, and a rich vascular network. Hamartomatous polyps are often diagnosed during endoscopy and require histological identification. CASE DESCRIPTION/METHODS: A 43-year-old male was referred due to intermittent rectal bleeding and positive fecal occult blood test (FOBT). He did endorse a positive family history of colon cancer in his mother. Colonoscopy was performed, revealing: 3 small sessile polyps <3 mm in size and a single 2 cm pedunculated polyp in the sigmoid colon (Figure 1). Polypectomy was performed for each noted polyp. Histopathological examination of the sigmoid polyp revealed a benign hamartomatous polyp with cystic dilation and focal crypt abscess (Figure 2). Pathology of rest of polyps revealed benign colonic mucosa with mild non-specific inflammation. The patient did well and remained symptom-free on follow up visit. DISCUSSION: Hamartomatous polyps are characterized by disorganized growth of tissue native to the organ in which it occurs. The reported prevalence of hamartomatous polyps in the adult population is around 0.15%. The prevalence of hamartomas in patients with colon polyps at index colonoscopy is 0.073%. Colonic hamartomas can occur sporadically or may present with distinct syndromic and hereditary features. The syndromes commonly associated with hamartomatous polyps are Peutz–Jeghers syndrome (PJS), juvenile polyposis, and phosphatase and tensin homolog (PTEN) hamartoma syndrome (PTHS). Endoscopically, these polyps can appear as pedunculated or sessile lesions making them indistinguishable from adenomatous polyps, which makes it prudent for the endoscopist to remove these lesions for histologic examination. In pediatric patients, hamartomas usually are localized to the rectum, the left colon, and may cause rectal bleeding, abdominal pain, and transanal prolapse. In adults, colonic hamartomas are most frequently found in the left colon and the rectosigmoid region. Patients are most commonly referred for colonoscopy due to positive FOBT or rectal bleeding. It is important to distinguish sporadic polyps from syndromic polyps as the sporadic polyps generally have a relatively benign course, while those associated with a syndrome have a higher lifetime malignancy risk.

Delayed diagnosis of transanal prolapse of an ileo-colic intussusception in a 10-month-old infant in rural Cameroon: a case report

BackgroundTransanal protrusion of intussusception is a complication of intussusception which involves the exteriorization of the apex of the intussusceptum through the anus. However, it is rarely reported and its confusion with rectal prolapse often leads to a diagnostic delay.Case presentationA 10-month-old female with no significant past history from a rural area in the Extreme North region of Cameroon was referred from a local health centre to our emergency deparment for an irreducible mass. It was reported that the child had spent 5 days at home on over-the-counter medication, then 3 days at a health centre where she was being treated for a respiratory tract infection and a rectal prolapse. On arrival at our hospital, she was conscious and moderately dehydrated. Cardiopulmonary examination revealed generalized coarse crackles over both lung fields. Her abdomen was tender, with a left upper quadrant mass, absent bowel sounds and a dark anal mass. In view of these, diagnoses of bronchopneumonia, intestinal obstruction and a probable rectal prolapse were made. An exploratory laparotomy was carried out after resuscitation with per-operative findings of a prolapsed ileo- colic intussusception and a necrosed intussusceptum. The necrosed portion was resected and an end-to-end ileo-transverse anastomosis was carried out. The immediate post- operative period was uneventful, but the patient died 3 days after the surgery, from an overwhelming sepsis.ConclusionsTransanal protrusion of intussusception requires timely surgical intervention to prevent mortality. The similarity in presentation to rectal prolapse coupled with inadequate knowledge on the condition by primary healthcare personnel causes a delay in the diagnosis and an increased mortality. A high index of suspicion is essential for an early diagnosis and an improved referral system for timely and definitive treatment.

Impalement injury with transanal prolapse of bowel content due to intraperitoneal rectal tear.

A 48-eight-year-old female patient came with prolapse of small intestines per rectum (Fig.1) due to impalement injury with iron rod at a construction site. As the patient was hemodynamically unstable, she was taken for emergency laparotomy. A large rent in the intraperitoneal rectum was found (Fig.2), with prolapse of intestines. Luckily for the patient, there was no other intra-abdominal organ injury. As there was no fecal contamination at all, a decision against proximal colostomy was made. The rent was closed in two layers after re-placing the small bowel contents with thorough lavage. Patient made a swift recovery thereafter.

Neglected Intussusception Presenting as Transanal Prolapse of Small Bowel

Although transanal prolapse of intussusception in infants is well recognized, it is rarely reported and confusion with rectal prolapse often results in delayed diagnosis and treatment. This report highlights the problems of delayed diagnosis and the morbidity and mortality associated with this condition. The authors report a case of 9 mo old boy who presented with prolapsing small bowel mimicking rectal prolapse.

Neglected Intussusception Presenting as Transanal Prolapse of Small Bowel

Although transanal prolapse of intussusception in infants is well recognized, it is rarely reported and confusion with rectal prolapse often results in delayed diagnosis and treatment. This report highlights the problems of delayed diagnosis and the morbidity and mortality associated with this condition. The authors report a case of 9 mo old boy who presented with prolapsing small bowel mimicking rectal prolapse.

Disconnected subduroperitoneal shunt catheter induces silent bowel perforation: An unusual complication

We report a case of silent bowel perforation by a fractured subduroperitoneal shunt after surgical shunt revision. A 93-year-old bedridden man experienced transanal prolapse of a shunt catheter after defecation. Upon arrival, the patient showed no fever or acute abdominal signs. Abdominal computed tomography (CT) showed an abandoned shunt catheter in the lower abdomen with rectum perforation. The disconnected catheter was successfully removed from the anus by digital rectal maneuver, and no peritonitis or other complication developed afterward. Such broken shunts no longer provide drainage function, and also pose a risk of migrating into the hollow viscera. Therefore, even in the absence of overt peritoneal signs, disconnected catheters should be removed by laparoscopic or minimal surgery to prevent possible development of this unusual complication. Instances of the rare complication are reviewed, and pathogenesis and treatment of the condition are discussed.

Surgical correction of the efferent ileal limb for disordered defaecation following restorative proctocolectomy with the S ileal reservoir

The S ileal reservoir has been superseded in this unit but 76 patients had this operation between 1976 and 1983. Forty-one (54 per cent) patients had to catheterize the reservoir to evacuate faeces and this was primarily due to the long efferent ileal limb. In six patients, the need to catheterize and other problems with defaecation were such that surgical correction of the efferent ileal limb was undertaken. These six patients are reported. Presenting features were the need to catheterize the reservoir, difficulty in catheterizing, faecal incontinence, stenosis of the efferent ileal limb and transanal prolapse of the efferent ileal limb. All patients had an excessively long efferent ileal limb of 8 cm or more which was resected and reanastomosed to the anal canal. The resection was performed endoanally in three patients but was successful in only one. In the two patients in whom endoanal excision was unsuccessful and in the remaining three resection of at least 5 cm was performed transabdominally with endoanal reanastomosis. Three of these five patients were converted from catheterizing the reservoir to spontaneous evacuation, but two patients still needed to catheterize. All six patients benefited in terms of the need for, or frequency of, catheterization, or by improvement in continence. Excessive length of the efferent limb of an S ileal reservoir may cause unsatisfactory defaecation, which may be improved by partial resection. The transabdominal route is recommended for the resection, with endoanal reanastomosis. This surgery is potentially problematic and, although no anastomotic leakage was encountered, a covering loop ileostomy is recommended.

Diagnosis of transanal prolapse and bleeding with an inspection mirror

Diagnosis of transanal prolapse and bleeding with an inspection mirror