Surgical management of recurrent rectal prolapse can be expected to alleviate the prolapse, but not necessarily fecal incontinence. Perineal proctectomies can be safely repeated. Resectional procedures may result in an ischemic segment between two anastomoses, unless the surgeon can resect a previous anastomosis in the repeat procedure. Nonresectional procedures such as the Delorme's procedure should be strongly considered in the management of recurrent rectal prolapse if a resectional procedure was performed initially and failed.
Primary linitis plastica of the colon is an uncommon tumor, with only 22 cases having been previously reported. Experience with two men and one woman between 17 and 55 years of age, portraying a spectrum of clinical presentations ranging from rectal bleeding to large-bowel obstruction, is reviewed. Clinical and radiologic characteristics and histologic features helpful in making the diagnosis are detailed. Though the prognosis is grim, resective surgery, including oophorectomy in women, should be undertaken. Adjuvant therapy has been disappointing.
Four patients, 23--34 years old, who developed endometriomas at the site of an episiotomy 19 months to 11-years postpartum are reported. Pain, Swelling and pruritus varying in intensity with the menstrual cycle were present in all. Complete excision is curative. Symptoms of incompletely excised endometriomas may be controlled by local hormonal injections or systemic hormonal manipulation. The anatomy of the endometrium and its physiologic behavior are reviewed. A concept of WHY endometriomas develop is presented which is compatible with the theories of HOW they occur.
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