Alejandro F. Castro

Sigmoidoscopic examinations with rigid and flexible fiberoptic sigmoidoscopes in the surgeon's office: A comparative prospective study of effectiveness in 1,012 cases

SummaryThe results obtained from 1,012 examinations in an on-going, cooperative study indicate that the overall yield provided by use of the flexible fiberoptic sigmoidoscope is 3.2 times greater than that of examinations with the rigid sigmoidoscope. More than twice (2.4 times) the number of polyps and more than three times the number of cancers were detected with the flexible fiberoptic sigmoidoscope. Experienced endoscopists can perform an examinaton with the flexible fiberoptic sigmoidoscope expeditiously in the office with minimal patient preparation, a high level of patient and physician acceptance, and relative safety when the usual mandatory colonoscopic precautions and guidelines are obeyed. The extraordinary advantages demonstrated by this study warrant wide clinical application of the flexible fiberoptic sigmoidoscope. We strongly recommend provision be made for appropriate training of physicians in the use of the instrument.

Rectovaginal fistula in Crohn's disease.

Summary and ConclusionsLow rectovaginal fistulas occur in Crohns disease but are not common. As with other manifestations of anorectal Crohns disease, their incidence is directly proportional to the closeness of the diseased segment of bowel to the anus. Rectovaginal fistula in Crohns disease signifies a bad prognosis. The fistula will not heal when treatment is limited to either medical treatment or proximal diversion of the fecal stream. Direct surgical treatment is reserved for those patients whose symptoms are unacceptable despite medical treatment. In nearly all of these cases, ileostomy and abdominoperineal excision are necessary. However, a few cases may be repaired when the rectal segment is normal and other conditions are favorable.

Colonic diverticular disease

ConclusionThere is much evidence from the history and from the geographic distribution of diverticular disease that it is the result of a deficiency of fiber, and in particular cereal fiber, in our modern over-refined diet. The symptoms of the uncomplicated form of the disease can be abolished or relieved by adding bran to the diets of the majority of patients. The low-residue diet formerly used to treat the disease is contraindicated, as it is the cause of the condition.Furthermore, surgery deals only with the complications of the disease; it does not remove the cause. Hence, we should put all our patients on a high-fiber diet post-operatively to prevent the recurrence of symptoms.

The dilemma of Crohnʼs disease

ConclusionThe results of our clinical study, generally supported by the recent literature and a consensus of colorectal surgeons, indicate that an appendectomy can safely be performed in the presence of Crohns ileitis. When fistulas do occur, they originate in the small bowel and not in the appendi