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)

Anorectal manometry in hirschsprung's disease - abstract

Normal anorectal reflexes are a relaxation of the internal anal sphincter and a simultaneous contraction of the external anal sphincter, in response to rectal distension. The internal anal sphincter (involuntary, smooth muscle sphincter) relaxation is mediated via a local reflex arc involving the ganglion cells in the bowel wall. Whereas the external sphincter (voluntary, striated muscle) contraction involves a spinal relex arc with afferent limb through the hypogastric nerves, efferent limb through the pudendal nerves and the neurons in the sacral segment of the spinal cord. Hence the study of the response of the anal sphincters to rectal distension, i.e. anorectal manometry, provides information about the functional state of the muscle and the integrity of the reflex arcs. This forms the basis for its apllication in the diagnosis of congenital aganglionic megacolon (hirschsprung's disease) (AU)

Rectal lymphogranuloma venereum in Jamaica

A brief history of lymphogranuloma with special reference to rectal involvement is given. Experience in Jamaica in the treatment of 144 cases of rectal lymphogranuloma is reported. In cases of proctocolitis, patients can be relieved of rectal stricture only by its removal but symptoms may be relieved by more conservative treatment. Excision operations should be reserved for the severe cases. The prognosis of proctectomy with preservation of sphincter function should be guarded. The abdomino-end-anal operation of Dimitriu and Gregoresco has given promising results. (Summary)