Anal stricture or stenosis, though uncommon, is disabling condition. It affects the quality of life due to pain, bleeding and difficulty in defecation, incontinence or increased frequency. It occurs when the normally pliable anoderm is replaced with fibrotic connective tissue, leading to an abnormally tight and inelastic anal canal. Mostly it occurs secondary to trauma, iatrogeny, inflammatory diseases, radiation or neoplasia. The treatment of anal stricture is generally considered to be difficult and various methods of treatment have been suggested. It is often unresponsive to conservative medical management. The surgical procedures such as dilatations and anoplasty are associated with significant complications which make it a difficult treatment challenge. Several good treatment options are available currently. Through this case, we report and explore a new medical treatment for anal strictures with four quadrant laser sphincterotomy.
Background: To assess the outcomes of Laser Four Quadrant stricturoplasty surgery in patients with staple line anal stricture post MIPH and STARR surgery.Methods: A prospective observational study was planned with purposive sampling. Cases with staple line stricture during the period February 2014 to July 2015 were included. There were 30 patients included in the study after informed consent and ethical clearance from hospital ethical committee. The data collected was background data, history of previous surgery, duration of Laser Four Quadrant stricturoplasty and Hospital stay, post-operative relief of symptoms and any complications, assessment of pain on VAS up to one year follow up period, overall patients’ satisfaction.Results: Out of 30 patients, 22 anal stricture patients were post STARR surgery and 8 were post MIPH surgery. The mean surgery and hospitalization duration were 24.48±6.31 minutes and 13.72±4.30 hours respectively. Symptoms reported were Obstructed defecation (n=30), painful evacuation (n=30) and episodes of minor rectal bleeding (n=9). There was significant (p<0.0001) reduction in pain from preoperative 7.13±1.04 to 1.13±0.54, 0.27±0.45, 0.16±0.38 and 0.06±0.25 at baseline (post-operative), day 7, month 1 and month 3 respectively. At the end of one year, 86.67% patient were highly satisfied, 13.33 % were not satisfied. Recurrence was reported by 3 patients within 6 to 10 weeks post-surgery.Conclusions: Laser Four Quadrant Stricturoplasty is an easy and effective surgery for the treatment of staple line stricture with a low recurrence rate.
Diaphragmatic eventration (DE) or eventration of the diaphragm is characterized by a permanent high position of 1 or rarely both the leaflets of the diaphragm, providing a potential space for the displacement of abdominal viscera on the affected side(s).It is a relatively rare condition with unknown etiology in adults. Prevalence of DE is less than 0.05% of the population, both children and adults, and is more common in males. There is a various presentation for DE and patients are mostly asymptomatic. The diagnosis of DE is vital to avoid certain serious, though rare, complications such as gastric or colon volvulus. Here is the report of an unusual presentation of eventration of the diaphragm with sigmoid colon volvulus presented with complaint of chronic constipation and 'fear to eat'. Patient was diagnosed in the operating room despite multiple imaging modalities. Eventration of diaphragm and cachexia is a rare association and to the best of authors' knowledge, it is not reported in literature. It is hoped that the current case report sensitizes physicians to the unusual presentation of eventration of diaphragm.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.