Epistaxis is common in young adults but the aetiology is unknown in many cases. To investigate the possibility that septal deviations are associated with epistaxis, 54 servicemen with recurrent epistaxis were compared with 46 controls. The epistaxis group were significantly more likely to have a history of nasal trauma (P = 0.008) and radiologically-proven nasal fracture (P = 0.002); on clinical examination, they were more likely to have a deviated septum (P < 0.00001), maxillary spur (P = 0.00004) and nasal obstruction (P = 0.011); they were also more likely to have radiological evidence of a deviated septum (P = 0.020). Those patients able to locate their epistaxis to one side tended to do so to the side of their septal deviation. This study supports the hypothesis that septal deviation is associated with epistaxis.
A 71-year-old man presented with vague colicky abdominal pain, change in bowel habit, intermittent constipation and a feeling of incomplete rectal emptying. Just before admission the constipation had worsened. Abdominal examination revealed a tender mass in the left iliac fossa arising from the pelvis. Flexible sigmoidoscopy showed a rigid narrowed bowel lumen.Barium enema ( Figure I ) demonstrated an elongated narrow rectum and sigmoid colon. Intravenous urography showed upwards and anterior displacement of the bladder and pelvic CT scan (Figure 2) demonstrated the presence of excess fat.Whilst under investigation the patient developed complete obstruction necessitating laparotomy. At operation the rectum and sigmoid colon were enlarged owing to excess fat in their walls and appendices epiploicae. The perirectal and perivesical spaces were distended with firmy fatty tissue as were the mesentery and retroperitoneum. The remaining colon was normal. Multiple biopsies showed only fat.A trial dissection to free the sigmoid and rectum was abandoned because of the difficulty in recognizing tissue planes and anatomical structures. A left iliac fossa loop colostomy was fashioned. Subsequent histology showed mature fat only. DiscussionIn 1959 five patients were reported with unusual appearances of the pelvic colon on barium enema. This abnormality was called pelvic lipomatosis'. Since then over 60 cases have been reported.A review of the literature shows a variety of presenting symptoms, the most common being urinary frequency, suprapubic pain and mild chronic constipation. The most common finding is of fullness in the lower abdomen and pelvis'. Sigmoidoscopy demonstrates straightening and rigidity of the rectum and sigmoid colon. Cystoscopy may be difficult because of an elongated prostatic urethra'.'. Intravenous urography commonly shows a high bladder and radiolucency of the pelvic soft tissues, and many of the patients reported had dilatation of the upper tracts'.'. Barium enema most commonly shows narrowing and 'straightening' of the sigmoid colon and rectum'. Operative findings comment on the large amount of fat in the pelvis with elevation of the bladder. Attempts to dissect around ureters and large vessels have proved difficult because of denseness of fat and the absence of tissue planes': Histology demonstrates nothing more than mature fat. Most of those presenting had urological symptoms and some required ureteric diversion for obstructive uropathies'Our case fulfils all of the above criteria and pelvic lipomatosis can be confidently diagnosed.Although a case was reported in which pelvic lipomatosis presented in association with an obstructing colonic carcinoma4, the case we describe is the only report of pelvic lipomatosis presenting as large bowel obstruction. Treatment of the condition is expectant and surgical intervention indicated only when obstruction occurs. In none of the patients who underwent surgery could enough fat be removed to alter the position of affected viscera3. Whilst the provision of a loo...
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