Annals of Colorectal Research Annals of Colorectal Research Ann Colorectal Res http://www.colorectalresearch.com 2322-5262 2322-5289 10.5812/acr. en jalali 2017 6 25 gregorian 2017 6 25 3 4
en 10.17795/acr-32556 Is Permanent Sacral nerve Stimulation Implantation Under Local Anaesthesia Feasible and Effective? Is Permanent Sacral nerve Stimulation Implantation Under Local Anaesthesia Feasible and Effective? research-article research-article Conclusions

Implantation of permanent SNS under LA is a viable surgical option, associated with several advantages that apply to both patients and service provision. Performing this surgical procedure under LA avoids the perioperative risks involved with (general anaesthesia) GA and also offers the possibility of SNS treatment for patients in whom GA is medically contraindicated, ultimately widening the breadth of the cohort suitable for SNS treatment. Other potential benefits include reduction in time and costs involved in carrying out the surgery.

Results

Four patients suffered from underlying cardiovascular disease and LA was deemed more appropriate to minimise perioperative risks. The decision to opt for LA in the other five patients was indicated due to patient preference. The average volume of lignocaine 1% used was 25 millilitres and operative length of time was 36 minutes, with the lead inserted into the right S3 foramen in all patients. Eight patients were discharged on the day of the procedure. Long term follow up revealed that SNS alleviated the symptoms in the majority of the patients, but the benefit gained fluctuated over time. Surgical revision was required in three of these patients, these included replacement of a lead, resiting of the implantable pulse generator, and explantation of the SNS device.

Background

Sacral nerve stimulation (SNS) is a minimally invasive surgical technique that plays an important role in the treatment of disorders of the bladder and bowel. Permanent SNS implantation under local anaesthesia (LA) offers many advantages.

Objectives

To assess if implantation of permanent sacral nerve stimulation (SNS) under local anaesthesia (LA) is feasible and effective.

Patients and Methods

Using a prospective database, nine patients who had permanent SNS implantation under LA in our unit were selected and analysed.

Conclusions

Implantation of permanent SNS under LA is a viable surgical option, associated with several advantages that apply to both patients and service provision. Performing this surgical procedure under LA avoids the perioperative risks involved with (general anaesthesia) GA and also offers the possibility of SNS treatment for patients in whom GA is medically contraindicated, ultimately widening the breadth of the cohort suitable for SNS treatment. Other potential benefits include reduction in time and costs involved in carrying out the surgery.

Results

Four patients suffered from underlying cardiovascular disease and LA was deemed more appropriate to minimise perioperative risks. The decision to opt for LA in the other five patients was indicated due to patient preference. The average volume of lignocaine 1% used was 25 millilitres and operative length of time was 36 minutes, with the lead inserted into the right S3 foramen in all patients. Eight patients were discharged on the day of the procedure. Long term follow up revealed that SNS alleviated the symptoms in the majority of the patients, but the benefit gained fluctuated over time. Surgical revision was required in three of these patients, these included replacement of a lead, resiting of the implantable pulse generator, and explantation of the SNS device.

Background

Sacral nerve stimulation (SNS) is a minimally invasive surgical technique that plays an important role in the treatment of disorders of the bladder and bowel. Permanent SNS implantation under local anaesthesia (LA) offers many advantages.

Objectives

To assess if implantation of permanent sacral nerve stimulation (SNS) under local anaesthesia (LA) is feasible and effective.

Patients and Methods

Using a prospective database, nine patients who had permanent SNS implantation under LA in our unit were selected and analysed.

Constipation;Faecal Incontinence;Local Anaesthesia;Sacral Nerve Stimulation Constipation;Faecal Incontinence;Local Anaesthesia;Sacral Nerve Stimulation http://www.colorectalresearch.com/index.php?page=article&article_id=32556 Sara Faily Sara Faily University of Manchester, Manchester, UK University of Manchester, Manchester, UK Moez Zeiton Moez Zeiton Department of Colorectal Surgery, University Hospital South Manchester NHS Trust, Manchester, UK Department of Colorectal Surgery, University Hospital South Manchester NHS Trust, Manchester, UK James Nicholson James Nicholson University of Manchester, Manchester, UK; Department of Colorectal Surgery, University Hospital South Manchester NHS Trust, Manchester, UK University of Manchester, Manchester, UK; Department of Colorectal Surgery, University Hospital South Manchester NHS Trust, Manchester, UK Karen Telford Karen Telford University of Manchester, Manchester, UK; Department of Colorectal Surgery, University Hospital South Manchester NHS Trust, Manchester, UK University of Manchester, Manchester, UK; Department of Colorectal Surgery, University Hospital South Manchester NHS Trust, Manchester, UK Abhiram Sharma Abhiram Sharma University of Manchester, Manchester, UK; Department of Colorectal Surgery, University Hospital South Manchester NHS Trust, Manchester, UK; Department of Colorectal Surgery, University Hospital of South Manchester, Manchester, M23 9LT, UK. Tel: +161-2916654 University of Manchester, Manchester, UK; Department of Colorectal Surgery, University Hospital South Manchester NHS Trust, Manchester, UK; Department of Colorectal Surgery, University Hospital of South Manchester, Manchester, M23 9LT, UK. Tel: +161-2916654
en 10.17795/acr-33499 Ileal Diverticulitis as a Cause of Right Lower Quadrant Pain: A Case Report and Review of the Literature Ileal Diverticulitis as a Cause of Right Lower Quadrant Pain: A Case Report and Review of the Literature case-report case-report Case Presentation

We describe a 65-year-old male with a history of ileal diverticulosis who presented with acute abdomen and was subsequently found to have perforated ileal diverticulitis with abscess formation.

Conclusions

The case, differential diagnosis, imaging studies, complications and management of this rare clinical disease are discussed.

Introduction

Small bowel diverticulitis is a rare clinical disease of the small bowel. The incidence of small bowel diverticulitis varies from 0.3 to 2.3 % in the general population. Complications of this rare clinical entity are often confused with other causes of acute abdomen such as acute appendicitis, perforated peptic ulcer, inflammatory bowel disease or ischemic bowel disease.

Case Presentation

We describe a 65-year-old male with a history of ileal diverticulosis who presented with acute abdomen and was subsequently found to have perforated ileal diverticulitis with abscess formation.

Conclusions

The case, differential diagnosis, imaging studies, complications and management of this rare clinical disease are discussed.

Introduction

Small bowel diverticulitis is a rare clinical disease of the small bowel. The incidence of small bowel diverticulitis varies from 0.3 to 2.3 % in the general population. Complications of this rare clinical entity are often confused with other causes of acute abdomen such as acute appendicitis, perforated peptic ulcer, inflammatory bowel disease or ischemic bowel disease.

Ileal Diverticulosis;Crohn’s Disease;Perforation;Acute Abdomen;Abscess Ileal Diverticulosis;Crohn’s Disease;Perforation;Acute Abdomen;Abscess http://www.colorectalresearch.com/index.php?page=article&article_id=33499 Jiten P. Kothadia Jiten P. Kothadia Department of Gastroenterology and Hepatology, Nebraska Medical Center, University of Nebraska, Omaha, United States Department of Gastroenterology and Hepatology, Nebraska Medical Center, University of Nebraska, Omaha, United States Seymour Katz Seymour Katz Department of Gastroenterology, NYU Langone Medical Center, Great Neck, United States; Department of Gastroenterology, NYU Langone Medical Center, 1000 Northern Blvd, Suite 140, NY 11021, Great Neck, United States. Tel: +516-4662340, Fax: +516-8296421 Department of Gastroenterology, NYU Langone Medical Center, Great Neck, United States; Department of Gastroenterology, NYU Langone Medical Center, 1000 Northern Blvd, Suite 140, NY 11021, Great Neck, United States. Tel: +516-4662340, Fax: +516-8296421 Lev Ginzburg Lev Ginzburg Department of Gastroenterology, NYU Langone Medical Center, Great Neck, United States Department of Gastroenterology, NYU Langone Medical Center, Great Neck, United States
en 10.17795/acr-32514 A Brief Review of Viral and Bacterial Sexually Transmitted Diseases in Colorectal Practice A Brief Review of Viral and Bacterial Sexually Transmitted Diseases in Colorectal Practice review-article review-article Conclusions

Regardless, a broad understanding of common bacterial and viral pathogens remains important part of modern colorectal practice. Remaining mindful of the manifestations of these common pathogens, options for diagnosis and management are important in disease control to limit the impact of these pathogens across the wider community.

Results

Debate exists whether the increasing incidence of STDs affecting the anorectum reported in western literature represents a real increase or a reflection of greater patient and clinician recognition and reporting.

Evidence Acquisition

The most common bacterial pathogens include Chlamydia trachomatis and Neisseria gonorrhea with synchronous infections at presentation occurring frequently. Patients often present with proctitis. Gonorrhea patients can also experience bloody purulent perianal discharge. Less common bacterial pathogens include syphilis, chancroid and donovanosis. The commonest STD worldwide remains human papillomavirus. Given its vast array of subtypes its manifestations include benign hyperproliferative lesions like perianal warts and extend to anal intraepithelial neoplasia and squamous cell carcinoma. Other important viral infections of the anorectum include human immunodeficiency virus and subsequent acquired immune deficiency disease as well as herpes simplex virus and molluscum contangiosum.

Context

Sexually transmitted diseases (STDs) are a common source of presentation to colorectal surgeons. Clinicians need to remain mindful of the possibility of STDs when faced with atypical clinical presentations. This article aims to provide surgeons with a synopsis of common pathogens, their clinical presentations, diagnostic investigations and treatment regimens.

Conclusions

Regardless, a broad understanding of common bacterial and viral pathogens remains important part of modern colorectal practice. Remaining mindful of the manifestations of these common pathogens, options for diagnosis and management are important in disease control to limit the impact of these pathogens across the wider community.

Results

Debate exists whether the increasing incidence of STDs affecting the anorectum reported in western literature represents a real increase or a reflection of greater patient and clinician recognition and reporting.

Evidence Acquisition

The most common bacterial pathogens include Chlamydia trachomatis and Neisseria gonorrhea with synchronous infections at presentation occurring frequently. Patients often present with proctitis. Gonorrhea patients can also experience bloody purulent perianal discharge. Less common bacterial pathogens include syphilis, chancroid and donovanosis. The commonest STD worldwide remains human papillomavirus. Given its vast array of subtypes its manifestations include benign hyperproliferative lesions like perianal warts and extend to anal intraepithelial neoplasia and squamous cell carcinoma. Other important viral infections of the anorectum include human immunodeficiency virus and subsequent acquired immune deficiency disease as well as herpes simplex virus and molluscum contangiosum.

Context

Sexually transmitted diseases (STDs) are a common source of presentation to colorectal surgeons. Clinicians need to remain mindful of the possibility of STDs when faced with atypical clinical presentations. This article aims to provide surgeons with a synopsis of common pathogens, their clinical presentations, diagnostic investigations and treatment regimens.

Sexually Transmitted Diseases;Colorectal Surgery;Proctitis Sexually Transmitted Diseases;Colorectal Surgery;Proctitis http://www.colorectalresearch.com/index.php?page=article&article_id=32514 Hajir Nabi Hajir Nabi Department of Surgery, Mater Hospital, Brisbane, Queensland, Australia; Department of Surgery, Logan Hospital, Brisbane, Queensland, Australia; Discipline of Surgery, School of Medicine, University of Queensland, Brisbane, Australia; Mater Hospital Brisbane, Raymond Terrace, South Brisbane Qld 4101, Queensland, Australia. Tel: +61-731638111, Fax: +61-731638548 Department of Surgery, Mater Hospital, Brisbane, Queensland, Australia; Department of Surgery, Logan Hospital, Brisbane, Queensland, Australia; Discipline of Surgery, School of Medicine, University of Queensland, Brisbane, Australia; Mater Hospital Brisbane, Raymond Terrace, South Brisbane Qld 4101, Queensland, Australia. Tel: +61-731638111, Fax: +61-731638548
en 10.17795/acr-32700 Comparison Between Swenson and Soave Pull-Through in Hirschprung Disease Comparison Between Swenson and Soave Pull-Through in Hirschprung Disease research-article research-article Conclusions

There were no significant differences in the early and late complications between Soave and Swenson pullthrough procedures.

Results

Sixty patients (30 patients undergone Soave, 30 patients undergone Swenson) had adequate data for matching and analysis. Mean follow-up time was 3 years for both groups. Mean (SD) age of patients at the time of pullthrough procedure was 43.1 (35.6) months in Swenson group (range; 1 - 168) and 41.9 (49.6) months in Soave group (range; 1 - 132) (P value = 0.920). No significant differences were seen in mean (SD) operating time (Soave: 156.7 (59.0) minutes, Swenson: 134.3 (51.4) minutes) (P value=0.145). There were no significant differences between 2 groups with regard to operative time, hospital stay, early and late complications such as postoperative obstructive symptoms, enterocolitis, fecal incontinence, perianal abscess and fistula, anastomotic leakage, peritonitis, and pelvic abscess formation. Rate of complication was 47% for Soave group and 40% for Swenson group (P value = 0.795, risk ratio = 1.147).

Background

Considerable controversy exists regarding the optimal surgical technique for the treatment of Hirschsprung disease. Currently, both Swenson and Soave procedures are used for its treatment.

Objectives

The purpose of this study was to compare outcomes and complications of Swenson and Soave pullthrough using a matched case control analysis.

Patients and Methods

A cross-sectional study was done on patients with Hirschsprung disease (HD) admitted in Mofid Children’s hospital from 2006 to 2012. Children with HD who underwent Soave procedure and sufficient data to analyze were matched 1:1 to a Swenson study sample. Patients were matched with respect to gestational age (37 - 42 weeks), age of patient at pullthrough procedure, operation stages, level of aganglionosis (rectosigmoid, sigmoid, descending and transverse colon) and the presence of comorbidities (major cardiac, trisomy 21, and other syndromes). SPSS version 18.0 was used for statistical analysis. Descriptive statistics and the Chi-square test and Student t-test were used. P < 0.05 was considered as significant.

Conclusions

There were no significant differences in the early and late complications between Soave and Swenson pullthrough procedures.

Results

Sixty patients (30 patients undergone Soave, 30 patients undergone Swenson) had adequate data for matching and analysis. Mean follow-up time was 3 years for both groups. Mean (SD) age of patients at the time of pullthrough procedure was 43.1 (35.6) months in Swenson group (range; 1 - 168) and 41.9 (49.6) months in Soave group (range; 1 - 132) (P value = 0.920). No significant differences were seen in mean (SD) operating time (Soave: 156.7 (59.0) minutes, Swenson: 134.3 (51.4) minutes) (P value=0.145). There were no significant differences between 2 groups with regard to operative time, hospital stay, early and late complications such as postoperative obstructive symptoms, enterocolitis, fecal incontinence, perianal abscess and fistula, anastomotic leakage, peritonitis, and pelvic abscess formation. Rate of complication was 47% for Soave group and 40% for Swenson group (P value = 0.795, risk ratio = 1.147).

Background

Considerable controversy exists regarding the optimal surgical technique for the treatment of Hirschsprung disease. Currently, both Swenson and Soave procedures are used for its treatment.

Objectives

The purpose of this study was to compare outcomes and complications of Swenson and Soave pullthrough using a matched case control analysis.

Patients and Methods

A cross-sectional study was done on patients with Hirschsprung disease (HD) admitted in Mofid Children’s hospital from 2006 to 2012. Children with HD who underwent Soave procedure and sufficient data to analyze were matched 1:1 to a Swenson study sample. Patients were matched with respect to gestational age (37 - 42 weeks), age of patient at pullthrough procedure, operation stages, level of aganglionosis (rectosigmoid, sigmoid, descending and transverse colon) and the presence of comorbidities (major cardiac, trisomy 21, and other syndromes). SPSS version 18.0 was used for statistical analysis. Descriptive statistics and the Chi-square test and Student t-test were used. P < 0.05 was considered as significant.

Hirschsprung Disease;Complications;Swenson Pullthrough;Soave Pullthrough;Children Hirschsprung Disease;Complications;Swenson Pullthrough;Soave Pullthrough;Children http://www.colorectalresearch.com/index.php?page=article&article_id=32700 Leily Mohajerzadeh Leily Mohajerzadeh Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122227033, Fax: +98-2122924489 Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122227033, Fax: +98-2122924489 Ahmad Khaleghnejad Tabari Ahmad Khaleghnejad Tabari Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mohsen Rouzrokh Mohsen Rouzrokh Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ali Reza Mirshemirani Ali Reza Mirshemirani Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Naser Sadeghian Naser Sadeghian Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Javad Ghoroubi Javad Ghoroubi Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Fathollah Roshanzamir Fathollah Roshanzamir Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ali Reza Mahdavi Ali Reza Mahdavi Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Zahra Gilaki Zahra Gilaki Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 10.17795/acr-32980 Sclerotherapy Using Aluminum Potassium Sulfate and Tannic Acid (ALTA) for Haemorrhoids in Patients With Liver Cirrhosis Sclerotherapy Using Aluminum Potassium Sulfate and Tannic Acid (ALTA) for Haemorrhoids in Patients With Liver Cirrhosis brief-report brief-report Conclusions

ALTA sclerotherapy could bring an acceptable outcome for haemorrhoidal patients concurrent with liver cirrhosis. Using transanal ultrasonography, we could visualize the difference of blood flow in the haemorrhoid plexus and anorectal varices in vivo. This might be useful for treatment of haemorrhoids for patients with liver cirrhosis. We confirmed the efficacy and safety of ALTA sclerotherapy for haemorrhoidal patients with liver cirrhosis. Using 3D-PDA, we could visualize three-dimensionally the hemorrhoid plexus in patients with liver cirrhosis.

Results

All patients’ symptoms (prolapse and/or bleeding) improved. However, two cases re-prolapsed during five years. Although two patients experienced slight bleeding after treatment and three patients experienced retention of ascites, there were no serious complications. 3D-PDA showed higher or lower vascularization in haemorrhoidal tissue in patients with liver cirrhosis. The prevalence of anorectal varices and haemorrhoids in cirrhotic patients had no association to Child-Pugh’s grading. Two patients with hyper-vascularity in haemorrhoidal tissue experienced slight bleeding after treatment.

Background

Symptomatic haemorrhoids in liver cirrhosis are difficult to handle due to rich collateral circulation and possible concomitant coagulo-therapy.

Objectives

The purpose of this study was to investigate the efficacy and safety of ALTA sclerotherapy in treating symptomatic haemorrhoids in patients with liver cirrhosis and to demonstrate the differences of blood flow in hemorrhoidal tissue in patients with liver cirrhosis in vivo, using transanal ultrasonography.

Patients and Methods

Eleven patients with liver cirrhosis and haemorrhoidal disease were included in this study. The blood flow in the haemorrhoids was identified using three-dimensional power Doppler angiography (3D-PDA). All patients performed ALTA sclerotherapy.

Conclusions

ALTA sclerotherapy could bring an acceptable outcome for haemorrhoidal patients concurrent with liver cirrhosis. Using transanal ultrasonography, we could visualize the difference of blood flow in the haemorrhoid plexus and anorectal varices in vivo. This might be useful for treatment of haemorrhoids for patients with liver cirrhosis. We confirmed the efficacy and safety of ALTA sclerotherapy for haemorrhoidal patients with liver cirrhosis. Using 3D-PDA, we could visualize three-dimensionally the hemorrhoid plexus in patients with liver cirrhosis.

Results

All patients’ symptoms (prolapse and/or bleeding) improved. However, two cases re-prolapsed during five years. Although two patients experienced slight bleeding after treatment and three patients experienced retention of ascites, there were no serious complications. 3D-PDA showed higher or lower vascularization in haemorrhoidal tissue in patients with liver cirrhosis. The prevalence of anorectal varices and haemorrhoids in cirrhotic patients had no association to Child-Pugh’s grading. Two patients with hyper-vascularity in haemorrhoidal tissue experienced slight bleeding after treatment.

Background

Symptomatic haemorrhoids in liver cirrhosis are difficult to handle due to rich collateral circulation and possible concomitant coagulo-therapy.

Objectives

The purpose of this study was to investigate the efficacy and safety of ALTA sclerotherapy in treating symptomatic haemorrhoids in patients with liver cirrhosis and to demonstrate the differences of blood flow in hemorrhoidal tissue in patients with liver cirrhosis in vivo, using transanal ultrasonography.

Patients and Methods

Eleven patients with liver cirrhosis and haemorrhoidal disease were included in this study. The blood flow in the haemorrhoids was identified using three-dimensional power Doppler angiography (3D-PDA). All patients performed ALTA sclerotherapy.

Haemorrhoids;Liver Cirrhosis;ALTA;Transanal Ultrasonography Haemorrhoids;Liver Cirrhosis;ALTA;Transanal Ultrasonography http://www.colorectalresearch.com/index.php?page=article&article_id=32980 Hidenori Miyamoto Hidenori Miyamoto Department of Surgery and Proctologic Surgery, Miyamoto Hospital, Anan, Japan; Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan; Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan. Tel: +81-886337137, Fax: +81-886319698 Department of Surgery and Proctologic Surgery, Miyamoto Hospital, Anan, Japan; Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan; Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan. Tel: +81-886337137, Fax: +81-886319698 Tateo Nakagawa Tateo Nakagawa Department of Surgery, Mizunomiyako Memorial Hospital, Tokushima, Japan Department of Surgery, Mizunomiyako Memorial Hospital, Tokushima, Japan Hideyuki Miyamoto Hideyuki Miyamoto Department of Surgery and Proctologic Surgery, Miyamoto Hospital, Anan, Japan Department of Surgery and Proctologic Surgery, Miyamoto Hospital, Anan, Japan Atsushi Takata Atsushi Takata Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
en 10.17795/acr-33500 Solitary Rectal Ulcer: A Literature Review Solitary Rectal Ulcer: A Literature Review review-article review-article Evidence Acquisition

Although this disease is not uncommon in Iran, there are very few studies from Iran, therefore, in this review we will describe our experience with patients with SRU in affiliated hospitals of Shiraz University of Medical Sciences. We will also review previously published articles about SRU that are indexed in PubMed and Google scholar, emphasizing the challenging issues.

Results

SRU is not an uncommon disease in Iran, however the number of published articles about it, is very low. Multicentric studies are necessary to find out the definite reason of this issue.

Conclusions

There are still many conflicting controversies about the etiology, pathogenesis, diagnosis and also treatment of SRU, which need further investigation and longer follow up of the patient in each therapeutic approach to be better understood.

Context

Solitary rectal ulcer (SRU) is a disease with many challenging issues. There are several controversies about the basic pathophysiology of this disease. Despite its name, “solitary rectal ulcer”, more than a quarter of patients do not show any ulcer in colonoscopy. Instead, many patients show multiple polypoid lesions. Some previous reports have suggested calling this disease “rectal mucosal prolapse” instead of SRU, however, most of the patients do not have mucosal prolapse. In addition, colonoscopic findings can be very similar to cancer and inflammatory bowel disease, so without histologic evaluation, accurate diagnosis is not always possible. In patients with SRU, sometimes the rectal mucosa is so fibrotic that mucosal biopsy is inadequate, and even a pathologist cannot diagnose the characteristic histologic findings. There are various therapeutic approaches for the treatment of SRU, both surgical and nonsurgical, all of which are not optimal, and recurrence rates are still high with many patients experiencing complications even after surgery, resection and rectopexy.

Evidence Acquisition

Although this disease is not uncommon in Iran, there are very few studies from Iran, therefore, in this review we will describe our experience with patients with SRU in affiliated hospitals of Shiraz University of Medical Sciences. We will also review previously published articles about SRU that are indexed in PubMed and Google scholar, emphasizing the challenging issues.

Results

SRU is not an uncommon disease in Iran, however the number of published articles about it, is very low. Multicentric studies are necessary to find out the definite reason of this issue.

Conclusions

There are still many conflicting controversies about the etiology, pathogenesis, diagnosis and also treatment of SRU, which need further investigation and longer follow up of the patient in each therapeutic approach to be better understood.

Context

Solitary rectal ulcer (SRU) is a disease with many challenging issues. There are several controversies about the basic pathophysiology of this disease. Despite its name, “solitary rectal ulcer”, more than a quarter of patients do not show any ulcer in colonoscopy. Instead, many patients show multiple polypoid lesions. Some previous reports have suggested calling this disease “rectal mucosal prolapse” instead of SRU, however, most of the patients do not have mucosal prolapse. In addition, colonoscopic findings can be very similar to cancer and inflammatory bowel disease, so without histologic evaluation, accurate diagnosis is not always possible. In patients with SRU, sometimes the rectal mucosa is so fibrotic that mucosal biopsy is inadequate, and even a pathologist cannot diagnose the characteristic histologic findings. There are various therapeutic approaches for the treatment of SRU, both surgical and nonsurgical, all of which are not optimal, and recurrence rates are still high with many patients experiencing complications even after surgery, resection and rectopexy.

Solitary Rectal Ulcer;Iran;Review Solitary Rectal Ulcer;Iran;Review http://www.colorectalresearch.com/index.php?page=article&article_id=33500 Bita Geramizadeh Bita Geramizadeh Pathology Department, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Pathology Department, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7136473238 Pathology Department, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Pathology Department, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7136473238 Mohammad Baghernezhad Mohammad Baghernezhad Pathology Department, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Pathology Department, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Arezoo Jahanshani Afshar Arezoo Jahanshani Afshar Pathology Department, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Pathology Department, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.17795/acr-34673 Effect of Nylon Vs. Polyglactin (Vicryl) in Appendectomy Skin Sutures Effect of Nylon Vs. Polyglactin (Vicryl) in Appendectomy Skin Sutures letter letter Nylons;Polyglactin;Appendectomy;Skin Nylons;Polyglactin;Appendectomy;Skin http://www.colorectalresearch.com/index.php?page=article&article_id=34673 Hajar Khazraei Hajar Khazraei Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7136281453 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7136281453 Abdul-Razzak Kalaf Hassan Abdul-Razzak Kalaf Hassan Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Masoomeh Rahimi Masoomeh Rahimi Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran