[Surgery of rectal ampulla adenoma]. / Hirursko lecenje adenoma ampule rektuma.

It is necessary to diagnose and excise the adenoma of the mucous of the large intestine as early as possible in order to prevent the development of rectal carcinoma. The surgery techniques (according to Kraske and Mason) applied by the authors make it possible. Over the period from 1983 to 1990 these techniques were carried out in 37 operations of rectal adenoma. The main symptom of the disease was the appearance of mucus and sometimes of blood in faeces. The following examinations were performed during the preoperative course: digital, rectoscopic, sigmoidoscopic; several biopsies of the lesion and its surrounding tissue were made. Histopathological diagnosis obtained preoperatively was confirmed postoperatively in 32 cases. Only in 5 patients preoperative findings did not coincide with the postoperative findings. In one case the final diagnosis was adenocarcinoma, and the preoperative finding was villous-uvular adenoma. In 4 cases the preoperative findings revealed the existence of tubulous-glandular tumour, while the final diagnosis showed the early invasive carcinoma. In later operations the rectal amputation was performed in 2 cases, and rectal anterion resection in 3 cases. The recidives appeared in 3 patients during the first year after the operation. Two of them were from the villous-uvular group, and one was from the gland-uvular group. During reintervention the rectal amputation was performed twice, and resection of rectosigma once. During the postoperative course 7 spontaneously disappeared fistulae reappeared. No incontinence. Postoperative electromyographic, laboratory and rectoscopic examinations of the patients were performed each third month, during the two following years. We used Kraske and Mason operative technique in the villous adenoma operations. These villous adenomas were 2-3.5 cm long and located in the middle of the upper third of rectal ampulla, while the upper verge did not cover more than 13 cm of dental line.

[Barium peritonitis caused by perforation of the colon and rectum]. / Bariumski peritonitis kod perforacija kolona i rektuma.

Over the period from 1979 to 1988 the authors treated three patients with perforated colon and rectum, manifested during contrast barium X-ray examination. Perforation of the caecum occurred in one patient; perforation of the sigmoid flexure in the second subject and perforation of the ampulla recti in the third patient. Caecum perforation was spontaneous, and that of the rectum and the sigmoid flexure wall was due to rigid catheter during irigography. The patients were two women and one man. The youngest patient was 50 years old and the oldest was aged 75 years. Surgery of the perforated caecum and ampulla recti was carried out during the first 24 hours, and that of the sigmoid flexure on the seventh day. The following radical operations were performed: the right hemicholoctomy, sigmoid resection with temporary cholostoma, rectum amputation, manyfold drainage of abdominal cavity. Antibodies were also administered. One patient died.

[Local recidives after rectal tumour operations]. / Lokalni recidivi kod bolesnika operisanih od karcinoma rektuma.

Patients with recidives after operations for rectal tumours have better prognosis than those with recidives of other gastro-intestinal tumours. Over the period from 1 January 1983 to 1 January 1990 165 patients were operated for rectal tumours (76 females and 89 males) in Dr. Dragisha Mishovitsh Clinical and Hospital Centre. On the basis of the size of rectal tumours, their position, penetration into the wall and intraoperative status surgical treatment was carried out: local ecxision (15), posterior proctotomy (37), anterior resection (64) and rectal amputation (49). In our practice we used the international classification of the tumours (pathohistology and clinical stages), UNIA INTERNATIONALIS CONTRA CANCRUM, internationally recognized on 1.1.1984. We quarterly controlled our operated patients during the first two years: rectoscopic, laboratory, EMG anal sfincter, EHO and CT abdomen, IVP examinations were performed. In patients with rectal adenocarcinoma we performed immunological examinations (CEA and CA 50) before operation, after operation and in the second year (first month and sixth month). All postoperative control examinations were important in the early detection of recidives and future treatment. We detected recidives in our patients during the first year (12), and only two in the second year after operation. We established four recidives after rectal amputation: one UICC stage II and 3 UICC stage III; 5 recidives after anterior resection: 4 UICC stage II and 1 UICC stage III; 3 recidives after posterior proctotomy: 2 UICC stage I and 1 UICC stage II, and 2 recidives after transanal excision: both recidives UICC stage I.