[Perineal endometriosis with anal external sphincter involvement: a case-report]. / Endometrioma perianal involucrando esfínter anal externo: reporte de un caso.

The presence of perianal endometriosis involving the anal sphincter is a rare presentation of this disease, most cases are diagnosed late and few are reported in the literature despite the number of episiotomies performed today. We present a case in a female with perianal symptoms after an episiotomy 15 years ago and visualized by endoanal ultrasound. We also review the literature of this condition. The treatment of choice is wide excision of the lesion involving the anal sphincter so the sphincter defect should be repaired by sphincteroplasty. According to the literature, early diagnosis by clinical suspicion and confirmation by endoanal ultrasound, with wide excision of endometrioma gives satisfactory results regarding anal continence.

[Experience in surgical management of rectal prolapse in two hospitals in Mexico City]. / Experiencia del tratamiento quirúrgico del prolapso rectal en dos hospitales de tercer nivel en la ciudad de México.

BACKGROUND: Rectal prolapse is defined as a falling out of place of the rectum through anus. Surgery is the treatment of choice to reverse abnormal anatomy and to improve anorectal function. OBJECTIVE: To review the experience in recent years of surgical management of rectal prolapse in the Hospital Central Militar and Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran. METHODS: All patients with rectal prolapse who underwent surgical treatment between January 1993 through December 2008 at two institutions in Mexico City were included. Clinical information was obtained of the clinical files in both hospitals. Main study variables were age, sex, degree of prolapse, morbility and type of surgery performed. RESULTS: Fifty seven patients were included, predominantly female (59.6%) with a mean age of 45 years. The most frequent diagnosis was complete rectal prolapse. Fifteen patients (26%) were treated by perineal procedure and 42 (74%) through abdomen: 17 (40%) open and 25 (60%) laparoscopic. Morbidity rate was lower in the laparoscopic group with less length of hospital stay and a lower blood loss, but with higher recurrence rate. CONCLUSIONS: Although the laparoscopic surgery showed advantage related with a less morbility, blood loss and hospital stay, it showed higher recurrence rates."