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FOREIGN BODIES IN THE RECTUM The variety of foreign bodies that have found their way into the rectum is hardly less remarkable than the ingenuity displayed in their removal ( Figure 79.5 ). The di ffi culty lies in the creation of a vacuum e ff ect when trying t...

Full-thickness prolapse Complete rectal prolapse (synonym: procidentia) is less common than the mucosal variety . The protrusion consists of all layers of the rectal wall and is usually associated with a weak pelvic floor and/or chronic straining. The prolapse ...

Gastrointestinal stromal tumour Smooth muscle tumours of the rectum are rare. If the mitotic rate is high, and if there is variation in nuclear number, size and shape, hyperchromasia and frequent bizarre cells, these tumours are likely to metastasise. In these...

Gonococcal proctitis Gonococcal proctitis occurs in both sexes as the result of rectal coitus and, in the female, from direct spread from the vulva. thick pus can be expressed as the proctoscope is withdrawn. In the early stages, the diagnosis can be readily ...

Haemangioma Haemangioma of the rectum is an uncommon cause of serious haemorrhage. The symptoms may mimic ulcerative colitis, and the diagnosis is often delayed, or it may be mistaken for a carcinoma. Selective angiography and embolisation may be helpful, bu...

INJURIES The rectum or anal canal may be injured in a number of ways, all of which are uncommon: /uni25CF by falling in a sitting posture onto a pointed object; /uni25CF penetrating injury (including gunshots) to the buttocks; /uni25CF sexual assault or sexu...

Internal rectal prolapse and solitary rectal ulcer syndrome Internal rectal prolapse, or intussusception, refers to the invagination of the rectal tube during defecation. The prolapse descends towards the anal canal, where it can act as a blockage to defecati...

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Investigation Abdominal examination Abdominal examination is normal in early cases. Occasionally , in patients with stenosing tumours at the rectosigmoid junction, signs of subacute large bowel obstruction may be present, with abdominal distension. If large ...

Learning objectives To understand: The anatomy of the rectum and its relationship to surgical • disease and its treatment The pathology, clinical presentation, investigation, • differential diagnosis and treatment of diseases that affect the rectum

Liver resection Single or multiple well-localised liver metastases can now be resected with relatively low mortality and morbidity . Provided the patients are carefully selected, a reasonable long-term survival rate can be achieved (approximately 40%). Such su...

Lymphatic drainage The lymphatics of the rectal mucosa communicate freely with those of the muscle layers. The usual drainage fl ow is upwards, and only to a limited extent laterally and downwards. For this reason, surgical clearance of malignant disease co...

Lymphogranuloma venereum The modes of infection are similar to those of gonococcal proctitis but, in the female, chlamydial infection spreading from the cervix uteri via lymphatics to the pararectal lymph nodes is common. The proctological findings are simila...

Neuroendocrine tumours Neuroendocrine tumours (NETs) of the rectum constitute 19% of all gastrointestinal NETs. They are classified into well- di ff erentiated (grades 1 and 2) and poorly di ff erentiated (grade 3) tumours. Both tumour mitotic index and Ki-67 e...

PROCTITIS The patient is usually middle-aged and complains of defecatory frequency with the passage of loose motions, often with blood mixed in the stools. Inflammation is sometimes limited to the rectum; in other cases, it is associated with a similar condit...

PROLAPSE Mucosal prolapse The mucosa and submucosa of the rectum may protrude outside the anus for approximately 1–4 /uni00A0 cm. When the prolapsed mucosa is palpated between the finger and the thumb, it is evident that it is composed of no more than a doubl...

Palliative colostomy This is indicated only in cases giving rise to intestinal obstruc - tion, or where the rectal cancer is not resectable. It can be performed by either an open or laparoscopic approach. In some cases, a defunctioning colostomy is required in...

Pathogenesis Colorectal cancer originates from premalignant precursor lesions in the epithelial lining of the colon or rectum in a stepwise progression that results in increasing dysplasia due to an accumulation of genetic abnormalities. In spontaneous color...