Ib Balslev

Sexual dysfunction following operation for carcinoma of the rectum.

In a retrospective study, sexual and urologic dysfunction were evaluated after a personal interview with 110 patients operated upon for carcinoma of the rectum with a long observation period. Following abdominoperineal resection in 93 patients, sexual dysfunction was found in 32 per cent, and 18 per cent were totally impotent. In 17 patients who had low anterior resections, none became totally impotent, but six patients had reduced potency or no ejaculation. No relation was found between age, tumor classification size and localization, or perineal wound infection and postoperative sexual dysfunction. Potency was usually regained within two years.One-third of the patients had experienced urologic symptoms following abdominoperineal resection. Sixteen per cent had minor symptoms at follow-up. Patients were not evaluated by cystometry. No correlation was found between postoperative sexual dysfunction and urologic problems.

The place of cecostomy in the relief of obstructive carcinoma of the colon

SummarySeventy-six patients with obstructive carcinoma of the colon were treated with catheter cecostomy. Twenty-three died while still in the hospital, five of complications directly related to cecostomy. There were eight nonfatal incision infections, seemingly associated with the closing of incisions around the cecostomy catheters. Fifty per cent of the cecostomies closed spontaneously after resection.Hospital mortality and long-term results in our series after cecostomy are similar to others’ findings after transversostomy.We conclude that cecostomy should not be neglected for primary relief of ileus. Rather, it should be preferred when there is diastatic rupture of the cecum, when the patient’s condition is poor, and when the carcinoma lies in the transverse colon or in the vicinity of the splenic flexure.

Early ileus following surgical treatment of carcinoma of the rectum

~AfHEN ILEUS Of any prolonged d u r a t i o n occurs after resection or extirpation of carcinoma of the rectum, it is often difficult to be sure whether it is of paralytic or mechanical etiology. Both states usually give rise to symptoms between the third and seventh postoperative days. Patients have moderate constant abdominal pain, they vomit or the volume of aspirate increases markedly, and the abdomen is distended. Abdominal auscultation is usually inconclusive. There are no differential features, and plain roentgenograms of the abdomen often fail to give any more precise information. I t is thus difficult to institute the right treatment at the right time, and the postoperative morbidity and mortality are significantly increased as a result. This study records our experience with 60 patients in whom ileus developed after resection or extirpation for treatment of carcinoma of the rectum.

The value of barium-enema studies in patients with carcinoma of the rectum

SummaryBarium-enema studies of the colon undertaken in 1,007 patients with carcinoma of the rectum failed to demonstrate the rectal tumor in 16 per cent of cases, and failed to demonstrate coincidental tumors of the colon in 63 per cent of cases, and failed to demonstrate coincidental tumors of the colon in 63 per cent of patients with such tumors. Additionally there was a 25 per cent incidence of false-positive findings in the colon.The consequence of this analysis is that we no longer undertake barium-enema studies of the colon in patients with carcinoma of the rectum confirmed by palpation or proctoscopy. The effect of this is that the surgeon is very aware of the importance of hisperoperative palpation, and palpation has proved to be very much more reliable for detecting coincidental tumors of the colon than preoperative barium-enema studies.