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An Obstructed Malignant Inflammatory Myofibroblastic Tumour of the Rectum

Zainal Abidin ZA, Azizan N, Hayati F, Mra A, Mohd Azman ZA

Kathmandu Univ Med J (KUMJ), 2018 7 1;16(63):272-274.
PMID: 31719321

Inflammatory myofibroblastic tumour is rare but more common in children. It shows an immunophenotypic features of myofibroblastic differentiation, hence bearing neoplastic potential. The diagnosis is challenging especially if it involves rectum. Surgical resection is the mainstay of treatment if clinically obstructed. A 65-year-old gentleman presented with intestinal obstruction, which then followed by a hartmann's procedure. Final diagnosis is a rare case of inflammatory myofibroblastic tumour of the rectum. We discuss its genetic involvement with a literature review.

Matched MeSH terms: Rectum/pathology*; Rectum/surgery
The current practice of paediatric surgery in Malaysia

Somasundaram K

Aust N Z J Surg, 1978 Aug;48(4):356-9.
PMID: 282864

This 10-year review of surgical conditions in infants at the University Hospital, Kuala Lumpur, highlights some of the more common problems encountered and outlines their management. Anorectal agenesis and Hirschsprung's disease were seen relatively more frequently than other anomalies of the gastrointestinal tract. The management of these two conditions and the operation of colostomy and its complications are singled out and presented in some detail.

Matched MeSH terms: Rectum/abnormalities*; Rectum/surgery
Schistosoma japonicum-like ova in liver and rectal biopsies of three cases in Sabah, Malaysia

Kan SK, Kay RW, Thomas I

Southeast Asian J Trop Med Public Health, 1979 Mar;10(1):97-9.
PMID: 573502

Three cases of schistosomiasis in 2 Filipinos and one Chinese in Sabah are reported. Diagnosis was based on incidental histological findings of Schistosoma japonicum-like ova in the liver and rectal biopsies. As these 3 patients are immigrants to Sabah, it is assumed that they are imported cases, and that Sabah has been free of the disease from 1970 to 1977.

Matched MeSH terms: Rectum/parasitology*; Rectum/pathology
Dieulafoy's lesion of the rectum

Gul YA, Jabbar MF, Karim FA, Moissinac K

Acta Chir. Belg., 2002 Jun;102(3):199-200.
PMID: 12136541

Dieulafoy's lesion is an uncommon cause of gastrointestinal haemorrhage. It may present with massive and life threatening bleed and although more common in the upper gastrointestinal tract, it is being increasingly reported as affecting the lower gastrointestinal tract. Diagnosis is usually achieved during proctoscopic and endoscopic visualization. In cases where there is profuse and torrential hemorrhage, angiography may help to confirm the diagnosis. There are a few treatment options available, all of which have a varying degree of success. More commonly than not, a combination of treatment is warranted as illustrated by our case. Recurrent bleeding may occur just as in cases of Dieulafoy's lesion affecting the upper gastrointestinal tract. Even though endoscopic visualization of the lower gastrointestinal tract in the presence of profuse lower gastrointestinal haemorrhage may not be possible, this important procedure should not be omitted as the bleeding source may be lying in a low and accessible location for prompt interventional haemorrhage control.

Matched MeSH terms: Rectum/blood supply*; Rectum/surgery
Perineal hamartoma with accessory scrotum, anorectal anomaly, and hypospadias-a rare association with embryological significance: case report

Ramzisham AR, Thambidorai CR

Pediatr Surg Int, 2005 Jun;21(6):478-81.
PMID: 15902476

A rare case of a newborn male with a perineal hamartoma, accessory scrotum, anorectal anomaly, hypospadias, and bifid scrotum is reported, with discussion of its embryological significance. Only three other cases with such a combination of anomalies have been reported in the English literature.

Matched MeSH terms: Rectum/abnormalities*; Rectum/surgery
Duplication of the rectum: report of four cases and review of the literature

Rajah S, Ramanujam TM, Anas SR, Jayaram G, Baskaran P, Ganesan J, et al.

Pediatr Surg Int, 1998 Jul;13(5-6):373-6.
PMID: 9639621

Rectal duplications are rare anomalies. Recently, we observed four cases of rectal duplication, each presenting with different clinical features including chronic constipation, a prolapsing rectal "polyp, " a "growth" from the vulva, and acute retention of urine. The variety of clinical presentations may lead to delay in diagnosis and multiple operations.

Matched MeSH terms: Rectum/abnormalities*; Rectum/surgery
Fulltext Congenital urethrocutaneous fistula: an interesting case

Roger, A.I., Rachel, Anne J.

Journal of Surgical Academia, 2014;4(2):45-47.
MyJurnal

A congenital urethrocutaneous fistula is a rare anomaly which was first described in 1962 by Gupta. Clinically, children present when their guardian is alarmed by either frequent urinary dribbling or unusual stream when they pass urine. This congenital anomaly can present in isolation or be accompanied by a chordee, hypospadia and anorectal malformations in a newborn. The surgical management will either be a primary repair of the fistula or converting it to a hypospadia before proceeding with a single or staged hypospadia repair. Surgical technique will depend on the local tissue factors and associated anomalies.

Matched MeSH terms: Rectum
Fulltext The neorectum reservoirs

Wong M.P.K

IIUM Medical Journal Malaysia, 2020;19(1):33-37.
MyJurnal

The incidence of rectal dissection is increasing with the rise of rectal cancer all over the world. This
technique has been used regularly to provide a reasonable quality of life for patients. The concern raised
was the functions of these neorectum to replace the original rectum. Several configurations have been
suggested namely the straight end-to-end coloanal anastomosis, side-to-end coloanal anastomosis, colonic Jpouch and the transverse coloplasty to suit the anatomy of the deep pelvis. Apparently, there was no
difference in terms of functional outcome among all these four types of reconstructions. However, these
configurations have seen the emergence of anterior resection syndrome or a pragmatic defaecatory
dysfunction as their complications. Furthermore, the neorectum functions are affected by many other
factors such as preoperative chemoradiotherapy, septic complications, and others more.

Matched MeSH terms: Rectum
Fulltext Chronic rectal bleeding in Proteus syndrome

Siow SL, Sim NK

Med J Malaysia, 2010 Dec;65(4):313-4.
PMID: 21901955

Proteus Syndrome is a rare congenital hamartomatous disorder that typically manifests itself in overgrowth, vascular malformation and disregulation of fatty tissue. The tissues affected are commonly the limbs but can be of any tissue. Vascular anomalies are common and appear at random sites on the body. Diagnosis is often difficult leading to wrong treatment. We describe a case of a 17-year-old girl with Proteus syndrome presented with symptomatic anaemia secondary to chronic rectal bleeding. Computed Tomography Angiogram of Abdomen and Pelvis confirmed the presence of rectal vascular malformations.

Matched MeSH terms: Rectum
Fulltext The role of DRE in the diagnosis of prostate carcinoma

Chong WL, Sahabudin RM, Teh GC, Woo SYY, Lim TC, Khairullah A

Med J Malaysia, 2001 Jun;56(2):167-73.
PMID: 11771076

DRE has been used as a diagnostic and screening tool for prostate cancer for decades. However these are based on Western data and its local applicability has yet to be verified. We held a Prostate Health Awareness Week in August 1998 and a total of 2086 men were screened. All men aged 50 years old and above were included for the study. The subjects were evaluated on DRE findings, PSA levels and if indicated a TRUS-guided biopsy results. We concluded that DRE per se might have limited role in the screening of prostate cancer in Malaysia. Screening using DRE and PSA combined are still recognized as the most cost-effective means. Neither DRE nor PSA alone has high enough specificity for diagnosis of prostate cancer cases. Combining DRE and PSA will definitely increase the specificity significantly.

Study site: e Urology
Clinic of Kuala Lumpur Hospital

Matched MeSH terms: Rectum/pathology*
Multi-resistant Neisseria gonorrhoeae in Kuala Lumpur, Malaysia

Sam IC, Ngeow YF

Int J STD AIDS, 2006 Oct;17(10):710-1.
PMID: 17059643
Matched MeSH terms: Rectum/microbiology
Is a "dragging sensation" a symptom of female pelvic organ prolapse?

Dietz HP, Chatel C, Atan IK

Int Urogynecol J, 2018 May;29(5):703-707.
PMID: 28733790 DOI: 10.1007/s00192-017-3410-8

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) commonly presents with a "vaginal lump or bulge" and/or a "dragging sensation." The first symptom correlates strongly with clinical and imaging data. However, a "dragging sensation" may be less specific. Hence, we investigated the predictive value of both symptoms for POP.
METHODS: This was a retrospective study involving archived data sets of women seen between November 2013 and May 2014. All underwent a clinical interview, POPQ examination, and 4D translabial ultrasound (TLUS). The main outcome measure was organ descent on clinical examination and TLUS. Offline analysis for organ descent was undertaken blinded against all other data.
RESULTS: A total of 224 women were assessed. Mean age was 57 (23-84) years. Median parity was 3 (0-7). Ninety-three percent (n=208) were vaginally parous. Fifty-eight percent (n=129) complained of symptoms of prolapse: 49% (n=110) of a vaginal lump, 27% (n=61) of a dragging sensation. Clinically, mean point B anterior (Ba) was -0.86 (-3 to +7.5) cm, mean cervical station (C) was -4.1 (-9 to +8) cm, mean point B posterior (Bp) was -1.1 (-3 to +5) cm. On imaging, mean bladder, uterine, and rectal descent were -8.3 (-68.0 to 34) mm, +18.6 (-56.4 to 46.3) mm, and -5.3 (-39.8 to 36) mm respectively. On univariate analysis, both symptoms were strongly associated with objective prolapse clinically and on TLUS, with "vaginal lump" consistently the stronger predictor.
CONCLUSIONS: The symptom of a "vaginal lump or bulge" was consistently a stronger predictor of objective POP than "dragging sensation." This finding was insensitive to adjustments for potential confounders. However, a "dragging sensation" is clearly a symptom of prolapse.

Matched MeSH terms: Rectum
Fulltext A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy

Yoshida N, Naito Y, Murakami T, Ogiso K, Hirose R, Inada Y, et al.

Case Rep Gastroenterol, 2018 01 19;12(1):27-31.
PMID: 29515342 DOI: 10.1159/000486128

Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis is sometimes difficult with only white light observation. Irregular findings by narrow-band imaging (NBI) are useful for differentiating malignant lesions from benign lesions, and cases with this finding are not expected for CSP. We present a diminutive T1 cancer resected by CSP as a reflection case. A 68-year-old man underwent colonoscopy for surveillance after polypectomy. A reddish polyp 4 mm in size was detected at the rectum. White light observation showed no depression, but a slight, heterogeneous color change. NBI magnification showed irregular vessel and surface patterns. The polyp was diagnosed as intramucosal cancer. Even though cancerous lesions are regularly resected by endoscopic mucosal resection (EMR), this polyp was resected by CSP in daycare surgery because the patient requested not to be treated by EMR but by CSP, which needed an admission to our institution. The surgeon thought the polyp could be completely resected by CSP. It was thoroughly resected, and a histological examination showed submucosal cancer with a positive vertical margin. Additional surgical resection was not accepted by the patient, since he had received total gastrectomy for gastric cancer and a right hemicolectomy for colonic cancer in the past 7 years. He underwent follow-up colonoscopy 2 months after the CSP. Although there were no recurrent endoscopic findings, endoscopic submucosal dissection was performed to the scar area. The histological examination showed no residual tumor. In conclusion, CSP should only be adopted for benign cases, as cancerous lesions have a possibility for invading the submucosa, like in our case.

Matched MeSH terms: Rectum
Prediction of colorectal cancer driver genes from patients’ genome data

Muhammad-iqmal Abdullah, Nor Azlan Nor Muhammad

Sains Malaysiana, 2018;47:3095-3105.

Colorectal cancer refers to the cancer that occurs in the colon and rectum. It has been established as the third most
common cancer and the forth one in causing worldwide mortality. Cancer caused by the mutation of several genes that
usually involved in the regulation of cell proliferation, growth and cell death. The mutation that leads to abnormal
function of genes, either in enabling the genes to gain or loss of function was termed as driver mutation and the genes
with driver mutation ability was termed as driver genes. The identification of driver genes provides insight on mechanistic
process of cancer development where this information can be used to further understand their mode of action for causing
dysregulation in signaling pathways. In this study, two bioinformatic tools, i.e. CGI and iCAGES were used to predict
potential driver genes from the genome of eight colorectal cancer patients with annotated variants datasets. 44 unique
driver genes and 21 pathways have been identified; such as p53 signaling, PI3K-AKT, Endocrine resistance, MAPK and
cell cycle pathways. The identification of these pathways can lead to the identification of potential drugs targeting these
pathways.

Matched MeSH terms: Rectum
Actual and estimated adenoma detection rates: a 2-year monocentric colonoscopic screening outcome in Shenzhen, China

Zeng L, Chua EG, Xiong Y, Ding S, Ai H, Hou Z, et al.

JGH Open, 2020 Aug;4(4):707-712.
PMID: 32782960 DOI: 10.1002/jgh3.12322

Background and Aim: While adenoma detection rate (ADR) is an important quality metric for screening colonoscopy, it remains difficult to be accessed due to the lack of integrated endoscopy and pathology databases. Hence, the use of an adenoma-to-polyp detection rate quotient and polyp detection rate (PDR) has been proposed to predict ADR. This study aimed to examine the usefulness of estimated ADR across different colonic segments in two age groups for Shenzhen people in China.
Methods: We retrospectively analyzed 7329 colonoscopy procedures performed by 12 endoscopists between January 2012 and February 2014. The PDR, actual ADR, and estimated ADR of the entire, proximal, and distal colon, and within each colonic segment, in two patient age groups: <50 and ≥50 years, were calculated for each endoscopist.
Results: The overall polyp and adenoma prevalence rates were 19.1 and 9.3%, respectively. The average age of adenoma-positive patients was significantly higher than that of adenoma-negative patients (54 ± 12.6 years vs 42.9 ± 13.2 years, respectively). A total of 1739 polyps were removed, among which 826 were adenomas. More adenomatous polyps were found in the proximal colon (60.4%, 341/565) than in the distal colon (40.9%, 472/1154). Overall, both actual and estimated ADR correlated strongly at the entire colon level and within most colonic segments, except for the cecum and rectum. In both age groups, these parameters correlated strongly within the traverse colon and descending colon.
Conclusion: Caution should be exercised when predicting ADR within the sigmoid colon and rectum.

Matched MeSH terms: Rectum
Fulltext Five-Year Review of Histopathological Findings of Colorectal Cancer Patients Operated in Hospital Tengku Ampuan Afzan Kuantan Pahang Malaysia

Azmi, M.N., Zailani, M.A., Norashikin, M.N., Asma Assaedah, Norra, H., Kalavathy, R., et al.

International Medical Journal Malaysia, 2007;6(1):1-14.
MyJurnal

PURPOSE: This review was performed to determine the association between demographic characteristics and the histopathological findings of colorectal cancer (CRC) patients operated in Hospital Tengku Ampuan Afzan (HTAA) Kuantan Pahang Malaysia. METHODS: We retrospectively reviewed the histopathological reports of 119 CRC cases operated in HTAA from January 2001 to December 2005 which met the inclusion criteria of histologically proven adenocarcinoma. The following demographic characteristics which include age, gender, and ethnicity were assessed. The histopathological related variables which include the site of primary tumor, Astler and Coller stage, tumor differentiation and lymph node metastasis were analyzed. Chi square test was used for categorical variables. Data with low expected counts were assessed using Fisher’s exact tests. RESULTS: There were 59 males and 60 females with age ranging from 23 to 93 years. 81.5% of the patients were older than 50 years (p=0.038). Malays accounted for 58.8% of the total cases, followed by Chinese (36.1%) and Indian (5%). Rectosigmoid region and rectum were the most common sites for primary tumor (55.6%). Cancer in male predominantly occurred in the rectum (p=0.023). Malays were commonly diagnosed with stage C2 (54.3%) while Chinese were diagnosed with stage B2 (58.1%) (p=0.011). Fifty percent of the patients who are less than 50 years old were diagnosed with stage C2 (p=0.024). There was significant change from well to moderately differentiated adenocarcinoma (p=0.000). Sixty percent of female patients diagnosed to have cancer with lymph node metastasis (p=0.044). Significant lymph node metastasis was also observed among Malay patients (p=0.022). CONCLUSION: The findings from the present review suggest that there are several associations between demographic distribution and histopathological characteristics of CRC. More than fifty per cent of CRC are found in the rectosigmoid region and the rectum. CRC are more common in Malay race and rectal cancer is predominantly affecting the male. About forty five percent of patients harbor metastases in the lymph nodes and fifty percent of the younger age group were presenting with nodal metastases.

Matched MeSH terms: Rectum
Fulltext Oily fish, liquid wax esters and keriorrhoea – a review

Barling, Peter Micheal, YI, Huan Foong

International e-Journal of Science, Medicine & Education, 2015;9(1):21-25.
MyJurnal

Keriorrhoea is the involuntarily passing of orange oil per rectum. One of us (PMB) had the misfortune to experience this symptom, together with considerable gastrointestinal disturbances for a prolonged period of time after consumption of a deep sea fish, orange roughy, which is rich in liquid wax esters (LWEs). This paper presents a summary of available evidence concerned with the physiology and pathology of ingestion of LWEs, which can enter the human diet in substantial amounts from consumption of several species of deep-sea fish. LWEs are poorly digested and absorbed by the human body. They generally cause keriorrhoea when ingested deliberately or accidentally. Jojoba oil, which is a plant LWE, together with certain nutritional products (e.g. olestra) and medical (e.g. Orlistat) which are not LWEs may mimic the effects of LWEs, and cause similar gastrointestinal disturbances. This paper discusses the potential effects of LWEs as components of gastrointestinal micelles, and predicts that the orange oil which is leaked from a bout of keriorrhoea may contain considerable volumes of triacylglycerols (TAGs).

Matched MeSH terms: Rectum
Fulltext Chronic Trichuris trichiura Infection Presenting as Ileocecal Valve Swelling Mimicking Malignancy

Tuan Sharif SE, Ewe Seng C, Mustaffa N, Mohd Shah NA, Mohamed Z

ISRN Gastroenterol, 2011;2011:105178.
PMID: 21991493 DOI: 10.5402/2011/105178

A 46-year-old man presented with a history of passing bright red blood per rectum over the last one month. He also had on and off diarrhea with visible mucus in the stool for two months' duration. Further history was unremarkable, and physical examination revealed hemorrhoids which were subsequently banded. A colonoscopy was arranged in view of the prolonged diarrhea whereby an edematous and swollen ileocecal valve was seen. This was shown to be due to Trichuris trichiura infection, confirmed on histopathological examination of biopsies taken from the site. The patient was started on oral albendazole treatment and has been asymptomatic on latest followup. This case illustrates an accidental finding of T. trichuria infection on colonoscopic examination, which was done to investigate the patient's prolonged diarrhea.

Matched MeSH terms: Rectum
Fulltext The influence of the bowel and bladder preparation protocol for radiotherapy of prostate cancer using kilo-voltage cone beam CT: Our experience

Heng SP, Low SH, Sivamany K

Indian J Cancer, 2015 Oct-Dec;52(4):639-44.
PMID: 26960504 DOI: 10.4103/0019-509X.178386

The purpose of this study is to determine the influence of bladder and bowel preparation protocols on the dose-volume histograms (DVHs) of these organs using the cone beam computed tomography (CBCT)-based intensity modulated radiotherapy (IMRT) treatment planning for prostate cancer patients. The pelvic DVHs of 12 prostate cancer patients were studied using CBCT images obtained immediately before each treatment. Six patients had bladder and bowel preparation protocol whilst the other six patients were the control group. Contoured bladder and rectal volumes on CBCT images were compared with planning computed tomography. All patients were treated with IMRT with 7800 cGy in 39 fractions over 8 weeks. Compared with the patient with bladder preparation protocol, patients without bladder preparation instruction had higher bladder volume and dose variation. The maximum variation in bladder volume was as high as 98% in the control group. Without bowel preparation protocol, the rectal volumes were more variability. Owing to changes in rectal filling on the day of treatment, the maximum variation in rectal volume was as high as + 96%. With bowel preparation protocol, the maximum rectum volume variations were less than 25%. The changes in prostate target dose compared with planning dose were minimal as would be expected from positioning with daily image guidance and gold seed implanted.

Matched MeSH terms: Rectum
A Meta-Analysis and Systematic Review of Perioperative Outcomes of Laparoscopic-assisted Rectal Resection (LARR) Versus Open Rectal Resection (ORR) for Carcinoma

Memon MA, Yunus RM, Memon B, Awaiz A, Khan S

Surg Laparosc Endosc Percutan Tech, 2018 Dec;28(6):337-348.
PMID: 30358650 DOI: 10.1097/SLE.0000000000000589

AIMS AND OBJECTIVES: The aim was to conduct a systematic review and meta-analysis of the randomized evidence to determine the relative merits of perioperative outcomes of laparoscopic-assisted (LARR) versus open rectal resection (ORR) for proven rectal cancer.
MATERIALS AND METHODS: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English-language randomized clinical trials comparing LARR and ORR. The meta-analysis was prepared in accordance with the PRISMA statement. Thirteen outcome variables were analyzed. Random effects meta-analyses were performed due to heterogeneity.
RESULTS: A total of 14 randomized clinical trials that included 3843 rectal resections (LARR 2096, ORR 1747) were analyzed. The summary point estimates favored LARR for the intraoperative blood loss, commencement of oral intake, first bowel movement, and length of hospital stay. There was significantly longer duration of operating time of 38.29 minutes for the LARR group. Other outcome variables such as total complications, postoperative pain, postoperative ileus, abdominal abscesses, postoperative anastomotic leak, reintervention and postoperative mortality rates were found to have comparable outcomes for both cohorts.
CONCLUSIONS: LARR was associated with significantly reduced blood loss, quicker resumption of oral intake, earlier return of gastrointestinal function, and shorter length of hospital stay at the expense of significantly longer operating time. Postoperative morbidity and mortality and analgesia requirement for both these groups were comparable. LARR seems to be a safe and effective alternative to ORR; however, it needs to be performed in established colorectal units with experienced laparoscopic surgeons.

Matched MeSH terms: Rectum/surgery*

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