- Preemptive Analgesia Decreases Pain Following Anorectal Surgery: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial. [Journal Article]
- DCDis Colon Rectum 2018 May 15
- CONCLUSIONS: This study was limited by the small sample size and excellent pain control in both groups.Preemptive analgesia is safe and results in decreased pain in the early postoperative period following anorectal surgery. It should be implemented by surgeons performing these procedures. See Video Abstract at http://links.lww.com/DCR/A588.
- Prodromal symptoms of multiple sclerosis in primary care. [Journal Article]
- ANAnn Neurol 2018 May 08
- CONCLUSIONS: Various clinical disturbances precede MS diagnosis by several years, supporting a prodromal phase to the disease and improving our clinical knowledge of early MS. Integrating these symptoms in the diagnostic procedure may help earlier disease identification. This article is protected by copyright. All rights reserved.
- Anorectal Gastrointestinal Stromal Tumour: A Case Treated with Radical Surgery. [Journal Article]
- JNJ Nepal Health Res Counc 2018 Mar 13; 16(1):99-101
- Gastrointestinal Stromal Tumour involving rectum and anal canal is an extremely rare entity. This is a case report of a 47 years lady presented with fresh rectal bleed associated with rectal pain and...
Gastrointestinal Stromal Tumour involving rectum and anal canal is an extremely rare entity. This is a case report of a 47 years lady presented with fresh rectal bleed associated with rectal pain and foul smelling rectal mucus discharge. On rectal examination, she had a firm mass palpable about 1.5 cm from anal verge. Considering the size of the tumour and its close proximity with cervix and involvement of levator muscles, extralevator abdominal perineal excision of rectum was undertaken with good recovery after surgery. It was followed by imatinib therapy.
- Biofeedback efficacy to improve clinical symptoms and endoscopic signs of solitary rectal ulcer syndrome. [Journal Article]
- EJEur J Transl Myol 2018 Jan 12; 28(1):7327
- Solitary rectal ulcer syndrome (SRUS) is often resistant to medical and surgical treatment. This study assessed the effect of biofeedback in decreasing the symptoms and the healing of endoscopic sign...
Solitary rectal ulcer syndrome (SRUS) is often resistant to medical and surgical treatment. This study assessed the effect of biofeedback in decreasing the symptoms and the healing of endoscopic signs in SRUS patients. Before starting the treatment, endoscopy and colorectal manometry was performed to evaluate dyssynergic defecation. Patients were followed every four weeks, and during each visit their response to treatment was evaluated regarding to manometry pattern. After at least 50% improvement in manometry parameters, recipients underwent rectosigmoidoscopy. Endoscopic response to biofeedback treatment and clinical symptoms were investigated. Duration of symptoms was 43.11±36.42 months in responder and 63.9 ± 45.74 months in non-responder group (P=0.22). There were more ulcers in non-responder group than responder group (1.50 ±0.71 versus 1.33±- 0.71 before and 1.30 ± 0.95 versus 0.67 ±0.50 after biofeedback), although the difference was not significant (P=0.604, 0.10 respectively). The most prevalent symptoms were constipation (79%), rectal bleeding (68%) and anorectal pain (53%). The most notable improvement in symptoms after biofeedback occured in abdominal pain and incomplete evacuation, and the least was seen in mucosal discharge and toilet waiting as shown in the bar chart. Endoscopic cure was observed in 4 of 10 patients of the non-responder group while 8 patients in responder group experienced endoscopic improvement. It seems that biofeedback has significant effect for pathophysiologic symptoms such as incomplete evacuation and obstructive defecation. Improvement of clinical symptoms does not mean endoscopic cure; so to demonstrate remission the patients have to go under rectosigmoidoscopy.
- The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia. [Journal Article]
- KJKorean J Anesthesiol 2018 Apr 24
- CONCLUSIONS: Intrathecal fentanyl 15 μg for anorectal surgery under saddle anesthesia led to an improved pain score for the first six hours after surgery and decreased postoperative analgesic use. Rebound pain diminished with intrathecal fentanyl and adverse effects did not increase.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- An anal fissure is a common benign anorectal disease affecting both children and adults. It is defined as a painful linear tear in the posterior anoderm extending cephalad to the dentate line. Classi...
An anal fissure is a common benign anorectal disease affecting both children and adults. It is defined as a painful linear tear in the posterior anoderm extending cephalad to the dentate line. Classically these are caused by a large, firm, forceful bowel movement. This results in cycles of recurring anal pain and bleeding leading to chronic anal fissures in as many as 40% of patients who develops fissures. An anal fissure can typically be diagnosed based on history alone. Patients will describe moderate to severe anal pain with bowel movements with variable amounts of bleeding. The bleeding is described as blood on the toilet paper with wiping. The pain commonly persists for 15 to 30 minutes following a bowel movement. The exposed internal anal sphincter frequently spasms, leading to significant pain. If this persists, this muscle becomes hypertrophied leading to nonhealing anal fissures. Typically, in children, these are self-limiting, whereas in adults these can require surgical intervention. The majority of anal fissures (90%) are located in the posterior midline. Fissures can be located in the anterior midline in as many as 25% of females and 8% of males. Fissures in the lateral position should raise concern for other disease processes like inflammatory bowel disease or granulomatous diseases. There are several medical therapies including salves, fiber and topical nitroglycerin that aids in spontaneous closure early in the disease process. Surgical therapies include botulinum toxin injections, fissurectomy, advancement flaps, and internal lateral anal sphincterotomy. Surgical intervention is typically indicated with chronic fissures or for fissures that are not amenable to medical therapy. Internal lateral anal sphincterotomy provides prompt symptomatic relief and has greater than 95% cure rate at 3 weeks post-procedure. Currently, it is considered the gold standard surgical intervention.
- Successful Treatment of Paradoxical Puborectalis Contraction and Intractable Anorectal Pain With Sacral Neuromodulation. [Journal Article]
- FPFemale Pelvic Med Reconstr Surg 2018 Mar 21
- CONCLUSIONS: Sacral neuromodulation is an established therapy for overactive bladder syndrome, urinary retention, and fecal incontinence. In urology, the use of sacral neuromodulation has been described to benefit some patients with pelvic floor pain. Sacral neuromodulation can be a successful treatment for PPC and functional anorectal pain with resulting improvement in quality of life without the sequelae of an invasive and irreversible surgery.
- Functional Gastrointestinal Disorders: Functional Lower Gastrointestinal Disorders in Adults. [Journal Article]
- FEFP Essent 2018; 466:21-28
- Functional lower gastrointestinal disorders include irritable bowel syndrome (IBS), functional constipation, functional fecal incontinence, and functional anorectal pain. These disorders are common a...
Functional lower gastrointestinal disorders include irritable bowel syndrome (IBS), functional constipation, functional fecal incontinence, and functional anorectal pain. These disorders are common and have significant medical and social effects. They also can be challenging to manage. Patients with mild symptoms may benefit from lifestyle modification. IBS is classified into two subtypes: diarrhea-predominant and constipation-predominant. Depending on the IBS subtype and its likely etiology, patients may benefit from treatment with antispasmodics, antidepressants, guanylate cyclase-C agonists, chloride channel activators, antidiarrheal agents, probiotics, and/or antibiotics. Functional constipation responds to many of the same treatments as constipation-predominant IBS, which include guanylate cyclase-C agonists and chloride channel activators. The management of functional fecal incontinence includes behavioral therapy, relief of constipation (disimpaction, bulking agents), and antidiarrheal drugs. Functional anorectal pain management has not been well studied, but patient symptoms may improve with physical therapy, antispasmodics, nerve block, or onabotulinumtoxinA injection.
- Treatment of Fistula-in-ano With OTSC® Proctology Clip Device: Short-term Results. [Journal Article]
- CECir Esp 2018 Mar 07
- CONCLUSIONS: The treatment of anal fistulae with the OTSC® device is a safe sphincter-saving technique in the short term.
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- A case report of primary central nervous system lymphoma with intestinal obstruction as the initial symptom. [Case Reports]
- MMedicine (Baltimore) 2018; 97(10):e0080
- CONCLUSIONS: IO can be an initial, unspecific symptom of spinal cord compression in patients with PCNSL.