Prevalence of constipation in a tertiary referral Italian Colorectal Unit.

INTRODUCTION: Epidemiology data on constipation are not commonly available, particularly in Italy Here we review the prevalence and clinical features of constipated patients attending a tertiary referral Italian center. METHODS: Clinical data of patients attending our Coloproctology Unit in the last 15 years and complaining of constipation as the main clinical features were retrospectively analyzed. Rome-III criteria were adoptedto define constipation. RESULTS: 1041/11881 patients were affected by chronic constipation (8.8%), 376 had slow-transit constipation, 497 obstructed defecation and 168 both types of constipation. 76% of them were females. Patients distribution according to sex and age was Gaussian-like only in females. In the slow-transit group, constipation was idiopathic in 59.3% and secondary to other causes in 40.7% . In patients with anatomic obstructed defecation, rectocele and intussusceptions were the main findings, while pelvic floor dissynergia was the main finding in functional outlet obstruction, although more frequently all these components were associated. In 14.8% no apparent cause was identified. CONCLUSION: Constipation accounts for about 9% of patients attending a tertiary referral Colorectal Unit. Females were much more frequently affected in both types of constipation. Anatomic and functional defecatory disturbances are frequently associated, although in 15% no evident causes were identified. KEY WORDS: Constipation, Epidemiology, Obstructed defecation, Slow transit constipation.

Coloanal anastomosis or abdominoperineal resection for very low rectal cancer: what will benefit, the surgeon's pride or the patient's quality of life?

PURPOSES: Sphincter-saving operation with coloanal anastomosis (CAA) has become an established option for very low rectal cancer, but few studies have compared its functional results and quality of life (QoL) with abdominoperineal resection (APR) showing controversial results. PATIENTS AND METHODS: Patients treated for low rectal cancer with APR or CAA, disease-free after a median follow-up period of 26.5 (8-84) and 52.5 (12-156) months, respectively, were retrospectively reviewed. General and disease-specific changes in QoL and severity of disease were evaluated by Karnofsky scale, EORTC-C30, EORTC-CR38, SF-36, PGWBI, FIQL, PAC-QoL, ICIQ-SF, Stoma-QoL, AMS, Wexner's score and obstructed defecation syndrome (ODS) score. RESULTS: Twenty-six APR patients and 34 CAA patients entered the study. Karnofsky score did not show significant differences. The median Stoma-QoL was 58.2 (45-76.6), indicating a good stoma function in 95% of patients. EORTC-C30, CR38, PGWBI and SF-36 questionnaires did not show significant differences between the two groups except for sexual function (better after CAA, p = 0.01). Eleven patients after APR and eight after CAA had urinary incontinence, and its severity did not differ significantly. Eighteen of 21 CAA patients complained of faecal incontinence [AMS, 80 (15-120); Wexner, 13 (2-19)] with an impact on their QoL [FIQL: lifestyle, 1.75 (0-4); coping/behaviour, 1.3 (0-3.5); depression, 2.1 (0-5.2); embarrassment, 2 (0-4.6)] and 11 complained of obstructed defecation [7.5 (3-16)] with significant consequences on QoL [PAC-QoL, 30.4 (19.2-80.3)]. CONCLUSIONS: QoL in patients with permanent stoma and in those after CAA did not differ significantly. APR patients had worse sexual function, while most CAA patients had faecal incontinence and sometime obstructed defecation, with important impact on their QoL.

Solitary schwannoma of the rectum mimicking rectal cancer. Report of a case and review of the literature.

A case of a submucosal tumor bulging into the rectum in an old female patient is reported. It proved to be a very rare case of rectal schwannoma, whose differential diagnosis is difficult to obtain preoperatively and optimal treatment and prognosis still uncertain. The mass was removed by means of an ultrasound device after an open anterior rectotomy. The operation was uneventful and the patient is disease free 18 months after.

Sphincteroplasty for fecal incontinence in the era of sacral nerve modulation.

The role of sphincteroplasty in the treatment of patients with fecal incontinence due to anal sphincter defects has been questioned because the success rate declines in the long-term. A new emerging treatment for fecal incontinence, sacral nerve stimulation, has been shown to be effective in these patients. However, the success rate of sphincteroplasty may depend of several patient-related and surgical-related factors and the outcome from sphincteroplasty has been evaluated differently (with qualitative data) from that after sacral nerve stimulation (quantitative data using scoring systems and quality of life). Furthermore, the data available so far on the long-term success rate after sacral nerve modulation do not differ substantially from those after sphincteroplasty. The actual data do not support the replacement of sphincteroplasty with sacral nerve stimulation in patients with fecal incontinence secondary to sphincter defects.

Brunner's gland hamartoma: a case report and review of literature.

BACKGROUND: Brunner's hamartoma is a quite rare neoformation whose origin is not completely clear. METHODS: A case of a 69-year-old man with recurrent epigastric pain and an endoscopic finding of a duodenal mass is reported. RESULTS: The complete removal of hamartoma can give a complete remission of symptoms. CONCLUSIONS: Hamartoma can be only diagnosed by endoscopy and histological exam; its therapy is always surgical, also in order to avoid possible malignant degeneration.

[The ultrasound microbubble contrast in the diagnosis and the decisional iter of the treatment of the traumatic spleen lesions]. / L'ecografia con mezzo di contrasto nella diagnosi e nell'iter decisionale del trattamento delle lesioni traumatiche spleniche.

AIM OF THE STUDY: To estimate our 3-year experience on the diagnosis and monitoring of the spleen traumatic lesions with the employment of ultrasound microbubbles contrast. METHOD: From the 174 patients who were joints to our department in regimen of urgency for abdominal traumatic lesions, we have estimated 24 patiens including our criteria. The selected patients have been subordinate to the echographic examination with microbubbles contrast and to TC multi-detector (MDCT) with contrast with multiphasic technique. RESULTS: The echographic examination has evidenced 4 patients with abdominal fluid deposit without spleen parenchimal damage and 8 patients with morphofunctional alterations of the spleen. After the introduction of the contrast in 12 patients it has been evidenced a homogenous enhancement of the spleen parenchyma and in the remaining 12 patients the enhancement has turned out dishomogenous. From 24 patients examinated with CT with contrast, the traumatic breach of the spleen was demonstrated in same the 12 patients. CONCLUSION: It comes noticed the increased sensibility of the methodical CT with contrast and microbubbles contrast, that reaches up the 100% respect of the traditional echography whose sensibility turns out 66%. The CT remains the methodical gold-standard for the spleen traumatic lesions. Our experience suggests that the microbubbles contrast introduces the same one sensibility and it is preferred for follow-up and the corrected management of the patient.