Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study

Purpose@#There are few reports on outcomes following surgical repair of recurrent rectal prolapse. The purpose of this study was to examine surgical outcomes for recurrent rectal prolapse. @*Methods@#We conducted a multicenter retrospective study of patients who underwent surgery for recurrent rectal prolapse. This study used data collected by the Korean Anorectal Physiology and Pelvic Floor Disorder Study Group. @*Results@#A total of 166 patients who underwent surgery for recurrent rectal prolapse were registered retrospectively between 2011 and 2016 in 8 referral hospitals. Among them, 153 patients were finally enrolled, excluding 13 patients who were not followed up postoperatively. Median follow-up duration was 40 months (range, 0.2–129.3 months). Methods of surgical repair for recurrent rectal prolapse included perineal approach (n = 96) and abdominal approach (n = 57). Postoperative complications occurred in 16 patients (10.5%). There was no significant difference in complication rate between perineal and abdominal approach groups. While patients who underwent the perineal approach were older and more fragile, patients who underwent the abdominal approach had longer operation time and admission days (P < 0.05). Overall, 29 patients (19.0%) showed re-recurrence after surgery. Among variables, none affected the re-recurrence. @*Conclusion@#For the recurrent rectal prolapse, the perineal approach is used for the old and fragile patients. The postoperative complications and re-recurrence rate between perineal and abdominal approach were not different significantly. No factor including surgical method affected re-recurrence for recurrent rectal prolapse.

Bisphosphonate Treatment for Chronic Recurrent Multifocal Osteomyelitis in an Adolescent

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a non-bacterial inflammatory disorder of unknown cause occurring in children and adolescents. It is characterized by the insidious onset of pain and swelling to multifocal involved bones, recurring over months to years. Non-steroid anti-inflammatory drugs (NSAIDs) and steroids are the first choice for the initial and relapse treatment. However, multifocal and frequent relapses might require more intensive anti-inflammatory treatment. Here, we report that an adolescent with CRMO refractory to antibiotics, NSAIDs and steroids over a two-year responded well to bisphosphonate. To our knowledge, this is the first case using bisphosphonate in adolescent refractory CRMO in Korea.

Spontaneous Spinal Epidural Hematoma in a Patient on Cilostazol / 대한뇌졸중학회지

Cilostazol is a phosphodiesterase inhibitor that has been shown to have similar efficacy in stroke prevention but fewer hemorrhagic events compared with aspirin. We report a case of spontaneous spinal epidural hematoma (SSEH) in a 67-year-old woman who has been treated with cilostazol for cerebral infarction. The patient was presented with sudden neck pain and right hemiparesis. Thirteen days after the onset, she recovered completely. Even cilostazol, which is a relatively safer drug in terms of bleeding risk compared to other antiplatelet agents, may cause SSEH. Therefore, physicians should keep in mind rare, but potentially fatal, bleeding complications such as SSEH when prescribing antiplatelet agents.

A Case of Intraaortic Mass

Primary aortic malignant tumors are extremely rare. When symptomatic, aortic intimal sarcomas give clinical findings secondary to embolic phenomena;they can produce mesenteric ischemia, hypertension, skin necrosis, absence of peripheral pulses. The diagnosis can be suspected radiologically Fibrosarcoma is the most common primary aortic malignancy, but angiosarcoma and leiomyosarcoma may also occur. We experienced a case of intraaortic mass, that was suspected as angiosarcoma, that diagnosed by chest CT, transesophageal echocardiography, aortography, and biopsy.