RESUMO
Lanthanum carbonate (LC) is used as a phosphate binder in dialysed patients. Abdominal pain and constipation are known side effects of its use. Furthermore, in radiological studies, LC tablets are seen as intense radio-opaque deposits within the entire gastrointestinal tract-findings which can lead to diagnostic misinterpretations. An elderly patient on peritoneal dialysis and taking LC presented with peritonitis, secondary to a perforated colonic diverticulum. The possible association between the use of LC, worsening constipation and complications arising from colonic diverticular disease, are discussed.
RESUMO
BACKGROUND: Rectal intussusception, rectocele and rectal prolapse are anatomic disorders in obstructed defecation syndrome. A relatively new surgical approach, Stapled Transanal Rectal Resection, was designed to treat these anomalies. OBJECTIVES: To present our preliminary results with this technique. METHODS: Thirty patients with ODS not responding to medical treatment or biofeedback were operated on with the STARR technique. All the patients underwent a complete workup in the Pelvic Floor Unit. The operation was performed according to the technique described elsewhere. RESULTS: The patients' mean age was 67.1 years, and the median duration of symptoms was 7 years. The mean operating time was 40 minutes (range 35-80 min) and the mean hospital stay was 2 days (range 1-4 days). The mean follow-up was 26 months (range 6-48 months). ODS symptoms were ameliorated in 27 patients (90%), decreased significantly in 18, and in 9 patients the symptoms disappeared. The procedure failed in 3 patients (10%). Complications included minor bleeding that required homeostasis in eight patients during the operation. Three patients had transient tenesmus and five patients had anal pain. There were no cases of mortality or pelvic sepsis. CONCLUSIONS: STARR is an effective and safe procedure for the treatment of obstructed defecation syndrome due to rectal intussusception, rectocele and small rectal prolapse.