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Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis.

Roriz-Silva R, Andrade AA, Ivankovics IG - Int J Surg Case Rep (2013)

Bottom Line: The patient had diarrhea for 2 years associated with asthenia.Various surgical techniques are proposed, but in extensive circumferential lesions of the rectum they are difficult to apply.Eversion of the rectal stump and external coloanal anastomosis may be a good surgical alternative for resecting giant rectal adenomas.

View Article: PubMed Central - PubMed

Affiliation: Division of General Surgery, Hospital de Base, Porto Velho City, Brazil. Electronic address: roriz-silva@unir.br.

No MeSH data available.


Related in: MedlinePlus

Everted rectal stump showing a large villous tumor with distal margin along the pectineal line.
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fig0005: Everted rectal stump showing a large villous tumor with distal margin along the pectineal line.

Mentions: The patient was submitted to median transverse infraumbilical laparotomy with ample anterior release of the rectum, until the plane of the levator ani muscles, and release of the descending colon until the splenic angle. Posteriorly, rectal eversion was performed, for distal section under direct visualization. An extensive circumferential lesion was noted, measuring approximately 14 cm in its longest diameter (Fig. 1). Then, the rectum was sectioned with a distal margin of 2.5 cm, along the pectinate line. The proximal colon was lowered through the anal canal. Next, the lowered colon was attached to the preserved rectal segment, and the external (perianal) coloanal anastomosis was made in two layers – one in the seromuscular plane (silk 3.0, separate stitches), and another in the full plane with polyglactin 3.0 in continuous suture (Fig. 2). Lastly, endoanal anastomosis reduction was done, along with the preparation of a protective loop transversostomy. The patient progressed satisfactorily in the first five days after the procedure, eliminating flatus and feces through colostomy. Upon digital rectal examination presented no changes in anastomosis with mucus eliminated and anal sphincter with preserved tonus. In the sixth postoperative day, presented respiratory distress and hypoxemia that required mechanical ventilation and progressed to death in the second postoperative week due to severe pneumonia. The histopathological diagnosis of the surgical specimen confirmed the diagnosis of villous adenoma with mild dysplasia and free surgical margins on microscopy (Fig. 3).


Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis.

Roriz-Silva R, Andrade AA, Ivankovics IG - Int J Surg Case Rep (2013)

Everted rectal stump showing a large villous tumor with distal margin along the pectineal line.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921655&req=5

fig0005: Everted rectal stump showing a large villous tumor with distal margin along the pectineal line.
Mentions: The patient was submitted to median transverse infraumbilical laparotomy with ample anterior release of the rectum, until the plane of the levator ani muscles, and release of the descending colon until the splenic angle. Posteriorly, rectal eversion was performed, for distal section under direct visualization. An extensive circumferential lesion was noted, measuring approximately 14 cm in its longest diameter (Fig. 1). Then, the rectum was sectioned with a distal margin of 2.5 cm, along the pectinate line. The proximal colon was lowered through the anal canal. Next, the lowered colon was attached to the preserved rectal segment, and the external (perianal) coloanal anastomosis was made in two layers – one in the seromuscular plane (silk 3.0, separate stitches), and another in the full plane with polyglactin 3.0 in continuous suture (Fig. 2). Lastly, endoanal anastomosis reduction was done, along with the preparation of a protective loop transversostomy. The patient progressed satisfactorily in the first five days after the procedure, eliminating flatus and feces through colostomy. Upon digital rectal examination presented no changes in anastomosis with mucus eliminated and anal sphincter with preserved tonus. In the sixth postoperative day, presented respiratory distress and hypoxemia that required mechanical ventilation and progressed to death in the second postoperative week due to severe pneumonia. The histopathological diagnosis of the surgical specimen confirmed the diagnosis of villous adenoma with mild dysplasia and free surgical margins on microscopy (Fig. 3).

Bottom Line: The patient had diarrhea for 2 years associated with asthenia.Various surgical techniques are proposed, but in extensive circumferential lesions of the rectum they are difficult to apply.Eversion of the rectal stump and external coloanal anastomosis may be a good surgical alternative for resecting giant rectal adenomas.

View Article: PubMed Central - PubMed

Affiliation: Division of General Surgery, Hospital de Base, Porto Velho City, Brazil. Electronic address: roriz-silva@unir.br.

No MeSH data available.


Related in: MedlinePlus