Restorative resection: coloanal anastomosis for benign and malignant disease.

Sixteen patients underwent anterior resection and coloanal anastomosis between October 1984 and September 1987. Indications included adenocarcinoma of the low rectum in 9, villous tumor in 2, carcinoid tumor in 1, radiation proctitis in 1, adult onset Hirschprung's disease in 1, rectourethral fistula in 1, and megarectum in 1. There was no in-hospital mortality and no anastomotic dehiscence. The Kirwan classification was used to evaluate functional results. Ninety-three percent of patients expressed satisfaction with their surgical results. Eighty-seven percent of patients are normally continent. A single patient is grossly incontinent. Eight of nine patients with carcinoma were resected for cure. A single patient has died of an unrelated disorder and the remaining seven are free of disease at an average follow-up of 24 months. The authors conclude that coloanal anastomosis is a safe procedure accompanied by minimal morbidity, or risk of local recurrence. Excellent, or at least acceptable, continence can be anticipated in the majority of carefully selected patients. The coloanal anastomosis should be strongly considered in any patient with a low-lying rectal lesion in whom body habitus precludes the possibility of conventional low anterior resection.

Sensitivity of hemoccult testing in patients with colorectal carcinoma.

This paper is a retrospective study of 100 sequentially selected cases of colorectal carcinoma treated at The Roosevelt Hospital between 1978 and 1983. In 44 of these patients, the admitting physical digital rectal examination was hemoccult-negative (HN). This group of patients showed no significant difference in tumor location, stage, size, or in presenting symptoms when compared with the 56 patients who were found to be hemoccult-positive (HP). It is concluded that a negative stool hemoccult examination should not alter the course of the patient's work-up if any suspicion of colorectal carcinoma exists. Furthermore, hemoccult sensitivity does not appear to be affected by the size, location or Dukes' classification of a colorectal neoplasm.

The use of water-soluble contrast enemas in the diagnosis of acute lower left quadrant peritonitis.

The traditional work-up of patients with lower left quadrant peritonitis often includes the eventual use of barium-enema radiography. Diagnosis is usually delayed until adequate patient stabilization allows diagnostic contrast enemas. Delay of accurate diagnosis may, at times, have serious clinical sequelae. The use of barium enema in acute lower left quadrant peritonitis has both theoretic and actual disadvantages. These include extravasation of barium, with resultant barium cellulitis and peritonitis, precipitation of acute obstruction, and delay in evaluation by endoscopy, sonography, computerized tomography, and angiography. Forty recent cases of lower left quadrant peritonitis were evaluated on admission by water-soluble contrast enema. Water-soluble contrast enemas appear to be safe and accurate and avoid the aforementioned disadvantages of barium.

Perineal abscess eight years after total proctocolectomy for ulcerative colitis.

Total proctocolectomy following surgery for ulcerative colitis and carcinoma may be associated with difficulty in healing of the perineal wound. The presentation of delayed abscesses may be insidious in nature and present a diagnostic dilemma. We present a patient with delayed abscess eight years following total proctocolectomy for ulcerative colitis. Early use of computerized tomography is helpful in evaluating the late occurrence of pain in these patients.