Mandell I. Ganchrow

Hemorrhoidectomy revisited--a computer analysis of 2,038 cases.

SummaryA computer analysis of the 2,038 cases of consecutive patients who underwent closed hemorrhoidectomy is presented. Results based on a five-year follow-up study are tabulated.

Ischemic colitis proximal to obstructing carcinoma of the colon

SummaryA case of ischemic colitis proximal to an obstructing carcinoma of the colon is presented. The first description of the blood vessels in such cases is included. The necessity for preoperative or operative diagnosis is stressed. Significant mortality and morbidity from suture-line disruption occur in the absence of proper diagnosis. Frozen section of the proximal margin of resection is recommended to determine whether further proximal resection should be done. Particular emphasis is placed on evaluation of the blood vessels in the submucosa.

Thrombosed hemorrhoids: a clinicopathologic study.

SummaryA retrospective group of 100 patients with pathologically diagnosed thrombosed hemorrhoids and a prospective group of 30 patients with acute thrombosed hemorrhoids were studied. Thromboses had not been recognized clinically in 55 of 100 retrospective cases. The following conclusions were made: 1) All thrombosed hemorrhoids in the study were intravascular. Although the possibility of perianal hematoma cannot be excluded entirely, it is not the usual situation, and was not seen in this study; 2) There appears to be no systemic hypoor hypercoagulable state or bacterial cause of the thromboses. Focal hypercoagulability must be considered. A mechanism of thrombogenesis is postulated, based on stasis and local trauma and subsequent activation of the extrinsic clotting system; 3) Immediate operative intervention appears to be the best available treatment; 4) All patients were treated by classical radical closed hemorrhoidectomy, with no postoperative wound infection.

Inflammatory colorectal disease and pregnancy: Report of a case

SummaryA retrospective study of women in the child-bearing age with inflammatory disease of the bowel seems to suggest that these women become pregnant as often as other women in the general population. In this small study it was 100 per cent. The incidence of subjective difficulty with conception is likewise small. Patients with Crohns disease appear to feel better in pregnancy with regard to their intestinal problems, while more than 60 per cent of the patients with ulcerative colitis appear to do poorly. The live-birth rates for both conditions in our series were approximately 80 per cent. An unusual complication in two of our patients with Crohns disease was a postpartum, postepisiotomy rectovaginal fistula. This may indicate a possible danger of episiotomy in patients who have Crohns disease.

Meningitis complicating perforating wounds of the colon and rectum in combat casualties

SummarySix cases of proven meningitis complicating perforating colonic and rectal wounds and two suspected cases are described. The mortality rate was 66 per cent. The incidence of this complication in all colonic and rectal injuries is 2 per cent; in combined colorectal injuries involving primary laminectomy it is 12.5 per cent. Principles of surgical therapy which should reduce the incidence of this complication are presented.

Ischemic proctitis with obliterative vascular change

SummaryThe case of a patient who had ischemic proctitis, first seen because of stricture formation of the rectum which clinically seemed to be granulomatous colitis is presented. Abdominoperineal rectal resection eventually was necessary. The vascular changes appeared to be limited to the rectum and were of a severely proliferative, obliterative type which could lead to ischemia of the tissue distal to the obliteration.

Control of hemorrhage from a mucous fistula with Foley catheter tamponade

Massive hemorrhage from the colon is always a problem. When that bleeding occurs in a defunctionalized colonic mucous fistula, the surgeon can approach the bleeding site from both ends simultaneously. Two methods of controlling hemorrhage from a mucous fistula with the assistance of Foley catheter tamponade are presented.

Double roticulator stapling technique for low-lying rectal tumors

A method is described for achieving proper distal margins in low-lying rectal lesions after initial resection indicates that these may be inadequate. The roticulator is kept on the distal rectal stump until the specimen has been examined. If additional margins are required, a second roticulator is placed distal to the first so that an intervening amount of tissue can be safely resected for adequate margins.