This report updated an analysis of a 14‐year experience of moderately high‐dose (4500 to 5000 cGy) preoperative radiation as an adjuvant to low anterior resection of 95 cases of adenocarcinoma of the rectum. The treatment was well tolerated without treatment‐related mortality and with a low incidence (5.2%) of severe complications. The local recurrence rate was 4.2%, and distant failure rate was 10.5%. At 5 years, the actuarial survival rate was 66% and the disease‐free survival rate was 64%. At 10 years, the actuarial survival rate and disease‐free survival rate were 52%. The authors concluded that moderately high‐dose (4500 to 5000 cGy) neoadjuvant radiation in clinically resectable adenocarcinoma of the rectum in which one segment of the anastomosis was in the preoperative radiation field is a safe, effective adjuvant to low anterior resection and that it offered patients excellent local control, long‐term survival, and sphincter preservation. Results could be enhanced by chemotherapy, and the authors urged well‐designed prospective randomized multicenter trials to determine the most appropriate drugs, dosage, and sequencing of co‐adjuvant preoperative radiation therapy and chemotherapy with surgery.

Forty patients with carcinoma of the rectum or rectosigmoid underwent preoperative irradiation, followed by anterior resection with anastomosis. The radiation dose was 4500 rads administered in 25 fractions over a period of five weeks. One to three weeks after the radiation was completed, anterior resection of the rectosigmoid with anastomosis was done. Of the 40 patients, 23 had hand-sewn anastomoses and 17 had EEA stapled anastomoses. Fourteen of the 40 had diverting loop colostomies, all colostomies were subsequently closed, and there were no clinical postoperative anastomotic leaks. Anterior resection and anastomosis are considered to be technically safe with the surgical and radiation techniques used.

Evanescent colitis was first reported in 1971. This clinical entity is manifested by abrupt onset of colicky abdominal pain usually out of proportion to the physical findings, loose stools progressing to hematochezia, and segmental colonic involvement with spontaneous resolution in a matter of days. The diagnosis can be suggested by abdominal flat plate; confirmation depends upon barium-enema examination early in the course of the illness. The clinical presentation is identical to that of colonic ischemia with one remarkable exception: while colonic ischemia has come to be regarded as a disease of the elderly, usually with underlying vascular disease, evanescent colitis occurs in young people who are otherwise free of disease. In this report the authors present nine cases whose course is classic for colonic ischemia except that they are all less than 50 years of age and free of underlying vascular disease. Two of the patients were on oral contraceptive medication. A review of the literature revealed 15 additional cases. Five of these cases were associated with oral contraceptives. Conditions to be excluded in the differential diagnosis of this disease are the specific infectious colitides, idiopathic ulcerative colitis, granulomatous colitis and antibiotic-related pseudomembranous colitis.

No abstract