Laparoscopic suture rectopexy without resection is both safe and effective in this frequently frail population and offers a minimally invasive approach that may have potential advantages for selected groups of patients with full-thickness rectal prolapse.
node only. A small bowel enema showed thickened terminal ileum folds which was confirmed on CT-scan. A duodenal biopsy was negative for alpha-heavy chain positive, immunoproliferative small intestinal disorder (IPSID) or lymphoma. Colonoscopy was normal, and colonic and terminal ileum biopsies showed no evidence of tuberculosis or lymphoma. Screening tests for collagen vascular disease were negative. T-Iymphocyte function was slightly impaired in keeping with a chronic infectious disease, and the HIV screens were negative. In view of the negative histology the patient was discharged to be closely followed-up as an outpatient. The patient was readmitted in July 1989 desperately ill with diarrhoea, a high swinging fever, emaciation (30 kg) and profound lassitude. Blood cultures, full blood count and bone marrow examination were negative. A repeat CT-scan ofthe chest carried out because ofthe development of signs in the left base, now showed large mediastinal nodes and left lower lobe consolidation. Bronchoscopy was unhelpful with regard to bacteriology and histology, but mediastinal lymph node biopsy revealed caseating granuloma with acidfast bacilli (AFB). Her general condition improved dramatically on anti-TB treatment within 2 weeks. Twelve weeks later her weight improved, diarrhoea stopped and a small bowel enema and CT-scan were completely normal. Discussion The case highlights several problems relating to the diagnosis of suspected intestinal TB and, indeed, the
The Brown Bowel Syndrome is characterised by degeneration and pigmentation of large bowel mucosa. We present a report of this unusual syndrome in which, for the first time, a functional deficit, reflected in a reduced internal and sphincter tone, is documented. This abnormality was reversed following sub-total colectomy and vitamin E therapy.
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