Colo-Proctology: Proceedings of the Anglo-Swiss Colo-Proctology Meeting, Lausanne, May 19/20, 1983

188 Pages·1984·4.33 MB·English

by  M. Boumghar

Colo-Proctology
Edited by
1.-Cl. Givel and F. Saegesser
With Contributions by
N. V. Addison N. S. Ambrose 1. C. Bonello
M. Boumghar D. C. Britton P. Buchmann N. D. Carr
R. Cavin S.l. Cawthorn A. Essinger G. Feifel
W. Frank I. D. Fraser Ph. Gertsch F. Halter F. Harder
F. B. Huber 1.-P. Mach M.-C. Marti R.l. Maxwell
M. Merlini G. Mori R. W. Motson c.-A. Muller
A. Munro 1. Papillon W. Pugsley A. Rohner
P. Shouler T. H. Walsh H. L. Young
With 85 Figures and 66 Tables
Springer-Verlag
Berlin Heidelberg New York Tokyo 1984
Proceedings of the
Anglo-Swiss Colo-Proctology Meeting
Lausanne, May 19/20, 1983
Dr. med. Jean-Claude Givel
Chef de clinique, Service de Chirurgie "A",
Centre Hospitalier Universitaire Vaudois
CH 1011 Lausanne, Switzerland
Prof. Frederic Saegesser
Chef du Service de Chirurgie "A"
Centre Hospitalier Universitaire Vaudois
CH 1011 Lausanne, Switzerland
ISBN-13: 978-3-540-12557-0 e-ISBN-13: 978-3-642-95439-9
DOl: 10.1007/978-3-642-95439-9
Library of Congress Cataloging in Publication Data. Anglo-Swiss Colo-Proctology Meeting
(1983 : Lausanne, Switzerland) Colo-proctology. "Proceedings of the Anglo-Swiss Colo
Proctology Meeting, Lausanne, May 19120, 1983" - T.p. verso. Includes bibliographical ref
erences and index. 1. Colon (Anatomy) - Diseases - Congresses. 2. Rectum - Diseases -
Congresses. 3. Anus - Diseases - Congresses. 4. Intestines - Cancer - Congresses. I. Givel,
J.-C!. (Jean-Claude), 1946- . II. Saegesser, Frederic. III. Addison, N. V. IV. Title.
RC 860. A 54 1983 616.3'5 83-20357
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Preface
The Anglo-Swiss Colo-Proctology Meeting, held at Lausanne in
May 1983, enabled numerous specialists to share their experiences
of lower gastrointestinal tract pathology. The focus was on ischae
mic disease and tumours of the colon, rectum and anus.
By featuring ischaemic disease in our programme we hoped to
give this too often underestimated process a fair hearing. Ischaemic
lesions are far more common than is recognised on clinical grounds
alone, particularly in the gastrointestinal tract. Large intestine is
chaemia is often confused with other syndromes, especially since
the clinical features evoked are, in most cases, atypical. Thus diag
nosis is frequently late, with dramatic consequences.
The oncology section basically discusses the early diagnosis of
gastrointestinal tumours, a prerequisite for improving survival in af
fected patients, and also presentation and treatment of certain rare
tumours.
The third section of this volume covers various diverse subjects
including surgical technique, functional disorders of the large intes
tine, inflammatory bowel disease, haemorrhoids and investigatory
procedures.
Several of the articles come from international authorities in their
field. Some communications contain unpublished results, and
others may lead to new diagnostic and therapeutic methods. We feel
that the quality and variety of the texts from the Anglo-Swiss Colo
Proctology Meeting merit wide appreciation.
We are grateful to Springer-Verlag for accepting these proceed
ings for publication.
Jean-Claude Givel
Frederic Saegesser
Contents
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . XI
Part I: Vascular Disorders of the Intestine ............ 1
Ischaemic Damage to the Distal Bowel Following Angioplastic
Surgery for Infrarenal Aortic Aneurysm or
Aorto-Ilio-Femoral Obstruction (Leriche's Syndrome)
(M. Boumghar and M. Naef) . . . . . . . . . . . . . . . 3
The Colonic Microcirculation (N. D. Carr and P. F. Schofield) 11
Why is Mortality still so high in Ischaemic Bowel Disease?
(F. B. Huber) . . . . . . . . . . . . . . . . . . . . 26
Vasopressin and Blood Flow in the Canine Colon
(RJ. Maxwell and T.G. Parks) . . . . . . . . . . 31
Mesenteric Vessel Obstruction and Oral Contraceptives
(R. Cavin, G. Chapuis, and F. Saegesser) . . . . . . . 35
Successful Treatment of Acute Mesenteric Ischaemia
(Ph. Gertsch, G. Buchheim, and R Mosimann) . . 46
Elective Colonic Resection for Ischaemic Strictures
(N. V. Addison) ................... 50
Part II: Tumours of Colon, Rectum and Anus . . . . . . . . . .. 55
Peutz-Jeghers Syndrome. The Experience of Sixteen Patients
(I. D. Fraser, J. P. S. Thomson, and H.J. R Bussey). . . . .. 57
Leiomyomata and Leiomyosarcomata of the Rectum and Anal
Canal (T. H. Walsh and C. V. Mann) . . . . . . . . . . . .. 59
Desmoid Disease Associated with Adenomatous Polyposis.
One Hospital's Experience of Twenty-three Patients
(I. D. Fraser, J. P. S. Thomson, H.J. R Bussey, and
P. R. Hawley) ...................... 63
Monoclonal Antibodies against Carcinoembryonic Antigen for
the Detection of Human Colon Carcinoma by
Immunoscintigraphy (J.-P. Mach, F. Buchegger, M. Forni,
J. Ritschard, Ch. Haskell, S. Carrel, A Froidevaux, and
A. Rohner) . . . . . . . . . . . . . . . . . . . . . . . .. .. 66
Asymptomatic Faecal Occult Blood Screening: A Practical
Solution to the Diagnosis and Treatment of Colorectal
Cancer? (D. C. Britton, P. A Farrands, and R. L. Griffiths) 73
The Value of Cytology in the Diagnosis of Colonic Cancer
(F. Halter, A Dolder, P. Meyrat, U. Scheurer, and P. Gretillat) 74
The Value of CEA as a Determinant of Prognosis in Colorectal
Cancer (w. Pugsley and R H. Grace). . . . . . . . . . . .. 78
Causes of Delay in the Early Diagnosis of Colorectal Cancer
(C.-A Muller) . . . . . . . . . . . . . . . . . . . . 81
The Ultrasonic Imaging of the Rectum (G. Feifel,
U. Hildebrandt, B. Kock, and C. Alzin) ...... 86
Surgical Treatment and Prognosis in Colorectal Cancer. Report
on 1357 Cases (M. Merlini, A Besson, and F. Saegesser). 92
Multidisciplinary Approach of Anal Canal Epidermoid
Carcinoma (M.-C. Marti, G. Pipard, and R Peytremann) . 98
Liquid Nitrogen in Palliative Treatment of Low Rectal and
Anal Carcinoma (w. Frank and G. Kost) ...... . 102
New Prospects in the Management of Squamous Cell
Carcinoma of the Anal Canal (J. Papillon). . . . . . . 112
Part III: Miscellaneous ...................... 117
Abnormalities of Anorectal Function in Patients with Chronic
Constipation who are Unable to Defaecate. (P. Shouler,
M. R B. Keighley, and P. W. Dykes) .............. 119
Defaecography (M.-C. Marti and D. Mirescu) . . . . . . . . . . 122
The Electromyography of the External Sphincter Muscle in
Supercontinent and Incontinent Patients (G. Mori,
D. Passerini, G. Pezzoli, and A Tajana) ..... . 127
Park's Per-Anal Repair of Recto-Prostatic Fistula
(R W. Motson, R. C. Tiptaft, and J. P. Blandy) . . . 136
Restorative Proctocolectomy with Ileal Reservoir (A Rohner
and R.de Peyer) ......................... 144
Healing of the Perineal Wound after Intersphincteric
Dissection of the Rectum for Inflammatory Bowel Disease
(A Munro, P.F.Jones, and RAKeenan) ........... 146
Prevention of Anastomotic Leakage in Colorectal Surgery:
Results of a Prospective Randomised Double-Blind Trial of
Aprotinin (Trasylol) in Colonic Surgery (H. L. Young and
M. H. Wheeler) ...................... . 153
The Parasacral Approach for Rectal Prolapse (F. Harder,
M. Durig, and A Huber) . . . . . . . . . . . . . . . . . . 159
A Prospective Randomised Trial to Compare Mezlocillin and
Metronidazole with Cefuroxime and Metronidazole as
VIII
Prophylaxis in Elective Colorectal Operations
(N.S.Ambrose, D. W.Burdon, M.R.B.Keighley, and
1. Alexander-Williams) . . . . . . . . . . . . . . . . . . 163
Ten-Year Experience with a Modified Whitehead
Haemorrhoidectomy (1. C. Bonello and G. B. Thow) . .. . 165
Why Do Patients with Haemorrhoids Benefit from Lord's
Procedure? (P. Buchmann and I. Babotai) . . . . . . . .. . 166
A Simple Combined Clinical and Laboratory Index ofCrohn's
Disease (S.l.Cawthorn and C.G.Marks) . . . . . . . .. . 169
Iatrogenic Lesions of the Rectum (A. Essinger and S. Aguet) . . 173
Subject Index ............................ 181
IX
List of Contributors
N. V.Addison, The Royal Infirmary, GB-Bradford BD9 6RJ,
West Yorkshire, England
N.S.Ambrose, The General Hospital, GB-Birmingham B4 6NH,
England
J. C. Bonello, Carle Foundation Hospital, University of Illinois,
Urbana, IL 61801, USA
M. Boumghar, Service Universitaire de Chirurgie A, CHUV,
CH-1011 Lausanne, Switzerland ..
D. C. Britton, Royal United Hospital, GB-Bath BA1 3NG, England
P. Buchmann, Chirurgische Klinik A, Universitatsspital,
CH-8091 Zurich, Switzerland
N.D.Carr, Withington Hospital, GB-Manchester M20 8LR
R. Cavin, Service Universitaire de Chirurgie A,
CHUV, CH-1011 Lausanne, Switzerland
S.J.Cawthorn, The Royal Surrey County Hospital, GB-Guildford,
Surrey, England
A. Essinger, Service Universitaire de Radiologie, CHUV,
CH- 1011 Lausanne, Switzerland
G. Feifel, Abteilung fUr allgemeine Chirurgie, Universitatsklinik,
D-6500 Homburg, Saar, Germany
W. Frank, Klinik Nymphenburg, MontenstraI3e 3,
D-8000 Munchen 19, Germany
I. D. Fraser, St. Mark's Hospital, GB-London EC1V 2 PS, England
Ph. Gertsch, Service Universitaire de Chirurgie B, CHUV,
CH-1011 Lausanne, Switzerland
F. Halter, Abteilung fUr Gastroenterologie, Inselspital,
CH-3010 Bern, Switzerland
XI
F. Harder, Department fUr Chirurgie, Kantonspital, CH-4031 Basel,
Switzerland
F. B. Huber, Chirurgische Abteilung, Krankenhaus,
CH-8810 Horgen, Switzerland
J.-P. Mach, Ludwig Institute for Cancer Research,
CH-l066 Epalinges, Switzerland
M.-C. Marti, Policlinique Universitaire de Chirurgie, Hopital
Cantonal, CH-1211 Geneve, Switzerland
R.J.Maxwell, Department of Surgery, The Queen's University of
Belfast, IHL-Belfast BT12 6BJ, Northern Ireland
M. Merlini, Service Universitaire de Chirurgie A, CHUV,
CH- 1011 Lausanne, Switzerland
G. Mori, 3a clinica Chirurgica della Universita di Milano, Ospedale
policlinico, Via F.Sforza, 35 - I-Milano, Italy
R. W. Motson, The London Hospital, GB-London El1BB, England
C.-A Muller, 11-13 rue de Bourg, CH-l003 Lausanne, Switzerland
A Munro, Department of Surgery, Raigmore Hospital,
GB-Inverness IV2 3UJ, Scotland
J. Papillon, Centre Leon Berard, 28 rue Laennec, F-69008 Lyon,
France
W.Pugsley, The Royal Hospital, GB-Wolverhampton WV121BT,
England
A Rohner, Clinique Universitaire de Chirurgie Digestive, Hopital
Cantonal, CH-1211 Geneve, Switzerland
P. Shouler, The General Hospital, GB-Birmingham B46NH,
England
T. H. Walsh, St. Mark's Hospital, GB-London EGl V 2PS, England
H. L. Young, University Department of Surgery, Welsh National
School of Medicine, Heath Park, GB-Cardiff CF4 4XN, Wales
XII
Part I
Vascular Disorders of the Intestine
Ischaemic Damage to the Distal Bowel Following Angioplastic
Surgery for Infrarenal Aortic Aneurysm or Aorto-Ilio-Femoral
Obstruction (Leriche's Syndrome)
M. Boumghar and M. Naef
Introduction
It is well known that following aorto-ilio-femoral revascularisation surgery, clinical
evidence ofischaemic syndromes of the brain, heart, kidneys and extremities can be
seen. However, ischaemic lesions to the distal bowel are few in number and are of
ten undiagnosed or confused with other diseases. The danger of these lesions is un
derestimated, particularly in European countries where few papers have been writ
ten on this subject [5,8, 10, 11, 13, 14].
Experience acquired from aorto-ilio-femoral angioplastic surgery over the last
20 years shows that anyone operated upon for a terminal aortic aneurysm, or for
Leriche's Syndrome, is exposed to a 1 %-2% risk of distal bowel ischaemia in the
post-operative period as shown by the study of a large number of cases of aorto-ilio
femoral angioplastic surgery. [2, 3, 7] The risks of intestinal ischaemia are low (about
0.03%) in the post-operative period following elective surgery, but are particularly
high after resection of a ruptured aneurysm in a patient operated upon during hy
povolemic shock (1,4%). These figures are probably lower than the reality, as the
majority of publications concern only cases of segmental gangrenous necrosis of
the colon discovered at autopsy or during reoperation; one rarely mentions fibrotic
colo-rectal stenosis and transient ischaemic colitis, which are the most frequent
forms in which large bowel ischaemia presents. Recent prospective studies based on
systematic post-operative colonoscopies show that signs of colonic mucosa ischae
mia are present in 7.4% of distal aortic aneurysm operations and 4.3% of aorto-ilio
femoral operations, whereas the clinical symptoms are discreet and non-specific [1, 4].
Ischaemic damage of the distal bowel is, in general, a consequence of focalised or
diffuse, transient or durable, slight or severe insufficiency in the perfusion of the
bowel wall, resulting from haemodynamic disturbances and concomitant obstruc
tive lesions of the intestinal arteries. The degree of shock, aorto-iliac clamping, liga
tion of the inferior mesenteric artery, and obstruction of the hypogastric arteries in
sufficiently compensated by collateral supply are the origin of a certain number of
ischaemic lesions of the distal bowel which are severe enough to play an apprecia
ble role in the operative mortality and morbidity. The parts of the bowel most fre
quently involved are the left colon, the area around the splenic flexure, and the sig
moid colon, that is to say the areas where the vascularisation is rather precarious.
Ischaemic lesions are rarer elsewhere, in the right colon, the caecum, the small intes
tine and the rectum [6].
3