Treatment of low rectal carcinoma by transanal electrocoagulation

This study reports the first 13 cases of biopsy-proven low rectal carcinoma treated by transanal electrocoagulation using a locally manufactured instrument. At the University Hospital of the West Indies, over a 16-year period, 9 patients were treated for cure, six of whom have no clinical evidence of recurrence for one to 12 years. Four cases who were offered this procedure for palliation defaulted after a single treatment. Transanal electrocoagulation provides an additional option for treating patients with small, mobile low rectal cancers, following careful screening for evidence of nodal or distant spread. The procedure can also be used in the local control of disease in patients with distant spread or in whom a major operation is not feasible (AU)

Hartmann's operation: does it still have a place? - abstract

In 1923 Hartmann described an operation where, for an advanced rectal carcinoma, he completely excluded the rectum and brought out an end sigmoid colostomy. Since then, this procedure has been widely used for cases where rectal anastomosis is regarded as unsafe. In 23 consecutive cases in which Hartmann's operation was indicated (gangrenous sigmoid volvulus 3, trauma 6, pelvic sepsis 9, tumour 6) the authors elected to do an "unsafe" anastomosis with a totally defunctioning proximal colostomy. Only two (2) cases developed complications (minor). Hartmann's operation should only be done in the situation where there is absolutely no intention to restore gut continuity as pelvic dissection to reconstitute the gut can be very difficult. If rectal anastomosis is regarded as unsafe it should still be carried out and a defunctioning colostomy done since the second stage only involves colostomy closure (AU)

Solitary rectal ulcer syndrome

Solitary rectal ulcer syndrome (Rectal prolapse syndrome) is an uncommon and imperfectly understood entity which, however, should be included in the differential diagnosis of ano-rectal symptoms. This article reports on the nine cases so far diagnosed at the University Hospital of the West Indies (UHWI), and offers a brief review of the condition (AU)

Sphincter saving procedures in low rectal cancer - abstract

Radical resection for rectal cancer has not improved survival over the past 50 years, and leaves the patient with the permanent burden of a colostomy. Methods of sphincter conservation, evolved over the past decade, achieve the same level of control of disease locally and do not impair survival. In view of this, a policy of sphincter conservation was prospectively adopted since 1983 for low rectal tumours: 33 consecutive cases were managed, of which 12 had local excision; 9 abdomino-anal pull through and 12 low anterior resections were performed. There were 2 local recurrences treated by abdomino-perineal resection and one anastomotic leak which healed with stricture formation. One patient had persistent mild faecal soiling. Sphincter conservation is safe and effective, and should be considered the treatment of choice in the management of low rectal cancer (AU)

Colorectal cancer: prospects for prevention

Primary prevention has too often been elusive and mythical with regard to the activities of a physician. Colorectal cancer appears too often as an exceptionally opportunity. New information about the epidemiology, the development of a better method of testing for occult blood and the flexible fiberoptic endoscopic has made mass screening for precursors of an early stage of cancer of the colon practical and cost effective (AU)

Leiomyosarcoma of the rectum

The only case of leimyosarcoma of the rectum seen at the University Hospital of the West Indies is reported. The natural history and pathology of this tumour are similar to those of smooth muscle tumours occurring elsewhere in the gut. When rectal leimyosarcoma invades adjacent organs such as the vagina and bladder, it may give rise to considerable morbidity. In addition, widespread metastases may occur. Aggressive surgical therapy is therefore warranted for early lesions if therapy is expected to be curative (AU)

Carcinoma of the colon and rectum at the University Hospital, Jamaica

Carcinoma of the colon and rectum has a low incidence in Jamaica. The patients with this disease seen at the University Hospital between 1952 and 1966, have been studied. Apart from a higher proportion of rectal cases, and a different frequency of symptoms, the pattern of the disease is similar to that found elsewhere. The prognosis in these cases is poor, but comparable with other reports. Factors which may determine the poor prognosis, are outlined (AU)

Colorectal cancers in Jamaica: a review (1958-1967)

Two conditions seem necessary for better results in the treatemnt of colorectal cancer in Jamaica: dissemination to the public information about the early signs and symptoms of cancer, and a greater alertness by the medical profession in the interpretation of the patient's gastointestinal complaints. (Summary)

Ano rectal carcinoma in Jamaica

Sixty-eight patients attended the University College Hospital from September 1952 to December 1960 for treatment for carcinoma of the rectum. For the early lesion, which formed the minority of our patients, the prognosis is good. Eleven patients were treated for carcinoma of the anus and anal canal. The prognosis of this lesion is poor. The association of ano rectal carcinoma and lymphogranuloma venereum is discussed (AU)

Rectal lymphogranuloma venereum in Jamaica

Lymphogranuloma venereum is a major public health problem in Jamaica. With improvement in the standard of living, better housing, better general education, a healthier sex education, and a more active programme of venereal disease control, the incidence of rectal lymphogranuloma should diminish. The early diagnosis and treatment of the proctocolitis by drugs is effective and should reduce the incidence of stricture. Major operations should be reserved for cases in which the more conservative methods of treatment are unlikely to succeed or have failed. At present, in Jamaica, operation necessitating a permanent colostomy should be considered more carefully than in this country. Unfortunately our attempts to eradicate the disease by operation and leave the patient with a functioning anus have been attended with only very limited success. Some of the failures may be attributed to insufficent experience with these operations, but involvement of the sphincter in the dense fibrotic process is probably responsible for the majority. In these fibrotic sphincters functional control is impossible. In a small number of cases intra-sphincter proctectomy in one stage by the method described by Dimitrui and Gregoresco (1933) has given promising results where the sphincter is free. The disease appears to be self-limiting. There has been no evidence of reactivation after removal of the affected gut even though this is rarely a complete en bloc excision or indeed even after colostomy only. Our follow up has been short. I have deliberately avoided the term "cure" because rarely has the compliment fixation reaction been reversed to negative. The significance of a persistently positive serological reaction in the absence of clinical evidence of disease is yet to be assessed. We have come a long way since John Hunter described the bubo 175 years ago and Frei placed the study of the disease on a firm aetiological basis 140 years later. In the past 35 years our knowledge of the lympho-granuloma venereum virus has increased, but the problem of treatment of rectal stricture, the most disabling complication of the disease, awaits solution. Morte (1933) stated: "The study of the stricture of the rectum is as fascinating as the treatment is discouraging. " In 1960 we can say: "Treatment of rectal stricture is often disappointing, but the results are encouraging" (Summary)

Carcinoma of the ano-rectal junction

The importance of anal ducts in the pathogenesis of disease at the ano-rectal junction is stressed. A knowledge of the anatomy of this area helps to clarify the pathogenesis of certain infections such as cryptitis and fistula in ano and modifies the treatment of such disorders. A knowledge of the embryology of this area also provides a clearer explanation of the morphological complexities of malignancies encountered in this region. A case is presented with a transitional cell carcinoma occurring at the ano-rectal junction. The findings and treatment are discussed. Complete transposition of the viscera was an interesting additional finding. (AU)