Perineal approaches for the treatment of complete rectal prolapse.

Perineal approaches for rectal prolapse are particularly useful in high-risk patients or in patients presenting with strangulation. Each technique is useful in certain clinical situations. Altemeier's procedure, with the addition of rectopexy and levatorplasty (Dis Colon Rectum 29: 547-552, 1986) may be the best available perineal operation for long-term correction of prolapse and treatment of associated incontinence.

Angiosarcoma of the breast. Two case reports and a review of the literature.

Two cases of angiosarcoma of the breast are presented. They are of particular interest in that one patient is a long-term survivor, the 19th reported to date, and the other presented with contralateral breast involvement without evidence of disseminated disease. The world literature is reviewed and a discussion is presented of the clinical features, treatment, histopathologic features, and prognosis of this rare breast neoplasm. Tumor size and degree of tumor differentiation are the most important prognostic indicators, and in general a simple mastectomy is the treatment of choice. The value of adjuvant irradiation and chemotherapy is uncertain.

Management of penetrating colon injuries. A prospective randomized trial.

Fifty-six patients with penetrating colon injuries were entered into a randomized prospective study. Management of the colon injury was not dependent on the number of associated injuries, amount of fecal contamination, shock, or blood requirements. Twenty-eight patients were treated with primary repair or resection and anastomosis and 28 patients were treated by diversion (24 colostomy, 3 ileostomy, 1 jejunostomy). The average Penetrating Abdominal Trauma Index score was 23.9 for the diversion group and 26 for the primary repair group. There were five (17.9%) septic-related complications in the diversion group. This included four intra-abdominal abscesses and one subcutaneous wound infection. There were six (21.4%) septic-related complications in the primary repair group. This included one wound infection, two positive blood cultures, and three intra-abdominal abscesses. There were no episodes of suture line failure in the primary repair/anastomosis group. The authors conclude that, independent of associated risk factors, primary repair or resection and anastomosis should be considered for treatment of all patients in the civilian population with penetrating colon wounds.