Patrick H. Hanley

Multiple adenocarcinomas of the colon and rectum.

SummaryThe incidence of multiple primary adenocarcinomas of the colon at Charity Hospital in a 19-year period was 2.1 per cent. The incidence of all multiple colonic and rectal malignancies was 4.1 per cent. Thirteen patients (0.5 per cent) had multiple metachronous adenocarcinomas, and 34 patients (1.6 per cent) had multiple synchronous adenocarcinomas.The possibility of a second carcinoma makes it imperative for the physician to obtain good diagnostic studies, bariumenema studies, and proctoscopy of every patient preoperatively. The resected specimen should be examined by the pathologist at the time of operation. Postoperatively, an annual physical examination, including proctoscopy and barium-enema studies, is necessary.

Conservative surgical correction of horseshoe abscess and fistula

SummaryA conservative surgical procedure for complicated horseshoe abscess fistula-in-ano is presented. It minimizes the disadvantage associated with complete unroofing of these abscesses. The morbidity is low, anatomic deformity is minimal, and function is only slightly altered.

Giant sigmoid diverticulum

Summary A case of giant diverticulum of the sigmoid colon in a seventy-two year old man has been reported. Such large diverticula are rare. Because of the rather broad diameter of the neck of the diverticulum, it was completely delineated on barium enema examination.

Fistula-in-ano: A ten-year follow-up study of horseshoe-abscess fistula-in-ano

SummaryA preliminary report in 19654 described a conservative surgical procedure for the management of acute and chronic horseshoe anal fistulas. The operation has been used exclusively at the Ochsner Clinic for this problem since 1963. Forty-one patients were treated from 1963 to 1973.The paper reviews the pathology of acute and chronic horseshoe anal fistulas and describes the surgical procedure for both acute and chronic horseshoe abscess anal fistulas with accompanying illustrations.The excellent results with minimal deformity of the anus and anal canal are attributed to avoidance of severing the superficial external sphincter between its coccygeal origin and the anus. Of the 41 patients treated in the period from 1963 to 1973, healing was good, and there has been no recurrence.

Anorectal Abscess Fistula

Suppurative anorectal disease requires a thorough knowledge of the anatomy and structures surrounding the anorectum to enable early diagnosis and appropriate treatment. Surgical techniques are described and illustrated.

Villous tumors of the colon and rectum.

SummaryVillous tumor is a relatively rare epithelial tumor of the large intestine that occurs predominantly in the rectum. Its gross appearance and clinical behavior make it distinct from adenomatous polyps. Its malignant potential is greater than that of adenomatous polyps.We have encountered 71 cases during a period of 12 years. All of our patients, except those with extremely small lesions, were subjected to repeated proctoscopy, barium enema, barium enema with air contrast studies, as well as repeated biopsies, before treatment was instituted.Because of the variation in size and situation of the tumor and the apparent discrepancies in the clinical manifestations and pathologic alterations, the treatment must be individualized. In general, our treatment has followed a conservative trend except in instances in which the preoperative biopsy report was carcinoma, or carcinoma was strongly suspected clinically. We have had no reason to change this therapeutic approach.

The dilemma of pilonidal disease

PILONIDAL DISEASE, s ince its original des c r i p t i on more than a century ago, has generated widespread controversy as to its etiology and surgical treatment. However, it remains a frequent problem for patient and surgeon. The object of this paper is to present favorable results obtained in a large number of patients treated by simple excision of the pilonidal tissue, allowing the wound to ~anula te and heal by secondary intention.

Management of low rectovaginal fistulas associated with imperforate anus

MOST rectovaginal fistulas associated with imperforate anus can be diagnosed easily, but occasionally tenacious meconium may obstruct a small fistula and, if the examination is cursory, the fistula may not be detected. Careful inspection of the fossa navicularis often reveals a dimpling in the midiine below the hymen. Probing gently with a ball .tip probe may disclose fistula. If no fistula is discovered, immediately after birth, oral feeding should be withheld for 86 hours during which obstruction may develop and intrarectal pressure may dislodge a meconium plug with resultant evacuation of meconium through the vagina. During the period of observation when no external fistula has been discovered, opportuni ty is provided for more thorough roentgenologic study, whereby it may be possible to learn the true distance of the rectum from the anal skin and to determine if there is a connection with the urinary system 3 (Fig. 1). Fortunately, the incidence of associated anomalies in patients with rectovaginal fistulas is low. When a diagnosis of imperforate anus is made at birth, however, the surgeon must, during the first 24 to 36 hours, search for rectovesical, recto-urethral, rectovaginal, or rectoperineal fistulas, which occur in more than 50 per cen,t of the cases3 The author warns that the probability of a rectovaginal fistula occurring in female patients with Type III imperforate anus

Traumatic colonic and rectal injuries.

SummaryNinety-five consecutive traumatic injuries to the colon and rectum treated during a five-year period at Charity Hospital in New Orleans have been reviewed. Gunshot wounds accounted for 74 per cent of the colonic injuries in the series. Primary repair, the preferred treatment, was associated with the fewest complications. The most frequent complication was wound infection, and septicemia was the most common cause of death. The overall mortality rate was 10.5 per cent. Two or more organs were injured in each patient who died. No patient with an isolated colonic injury died.

Anal sphincter-preserving operation for congenital low rectovaginal or rectoperineal fistula

Abstract A slight modification of a technic, originally described by Stone, is advocated for correction of low rectovaginal or rectoperineal congenital anomalies in which the external sphincter is preserved. Excellent functional results were obtained in four patients operated upon with this method; and in the fifth patient, operated upon too recently to evaluate the final result, an entirely satisfactory immediate result has been obtained. The advantages of this procedure over that of Rizzoli are that it does not necessitate severance of the perineal body and external sphincter, and the functional and cosmetic appearances approach those of the normal anus.