In his 1890 description of operative repair of complete rectal prolapse, Caddy used the following words to describe the physical appearance of his patient's rectal prolapse: "A complete prolapse of the rectum, six inches in length, and eleven inches in circumference. The mucous membrane, which was in numerous circular folds, was covered with slimy mucus, and was bleeding slightly at several small points." 1 With that description, it is easy to see that rectal prolapse, or rectal procidentia, is a morbid condition characterized by protrusion of the rectal wall through the anus. 2 Definition and AssociationsTrue rectal prolapse is the protrusion of all rectal layers through the anal sphincters. 3 The prolapse is classified by the degree of severity. The categories in order of decreasing severity include complete full-thickness rectal prolapse, mucosal prolapse, and internal or occult prolapse. 4 The leading clinical sign is the protrusion itself, with additional symptoms including constipation, sensation of incomplete evacuation, rectal bleeding, rectal pain, incontinence, urgency, and tenesmus. 5 Multiple associated findings on history and physical exam are seen in patients with rectal prolapse. A history of obstetric trauma or previous anorectal surgery is often present. Other associated abnormalities include spina bifida, prior back injury or surgery, psychiatric illness, old age, and female gender. Symptoms of fecal incontinence and constipation are reported in up to 75% and 25-50%, respectively, of patients with prolapse. 3 Patients often have other pelvic floor derangements including rectocele, cystocele, enterocele, and uterine prolapse, and a complete evaluation of constipation and prolapse should be performed. 6 Solitary rectal ulcer syndrome is directly related to rectal prolapse and is caused by injury and ischemia of the mucosa after internal prolapse of the rectal wall. 7 EtiologyThe cause of rectal prolapse is not completely understood and, like many poorly understood diseases, many procedures (more than 100) have been described for its treatment. The two accepted theories regarding the etiology of rectal prolapse involve either a sliding hernia that protrudes through a defect in the pelvic floor 7 or a circumferential intussusception of the upper rectum and rectosigmoid colon. 6 These theories are based on the anatomic defects associated with rectal prolapse: diastasis of the levator ani muscles, deep pouch Keywords ► rectal prolapse ► rectopexy ► mesh repair ► laparoscopy AbstractRectal prolapse is a debilitating condition with a complex etiology. Symptoms are most commonly prolapse of the rectum and pain with bowel movements or straining, with worsening fecal incontinence over time due to progressive stretching of the anal sphincters. Physical findings are fairly consistent from patient to patient-most notably diastasis of the levator ani muscles, deep pouch of Douglas, redundant sigmoid colon, a mobile mesorectum, and occasionally a solitary rectal ulcer. Evaluation includes a physical exam or im...

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Quantitative analysis of ex vivo colorectal epithelium using an automated feature extraction algorithm for microendoscopy image data," J. Med. Imag. 3(2), 024502 (2016), doi: 10.1117/1.JMI.3.2.024502. Abstract. Qualitative screening for colorectal polyps via fiber bundle microendoscopy imaging has shown promising results, with studies reporting high rates of sensitivity and specificity, as well as low interobserver variability with trained clinicians. A quantitative image quality control and image feature extraction algorithm (QFEA) was designed to lessen the burden of training and provide objective data for improved clinical efficacy of this method. After a quantitative image quality control step, QFEA extracts field-of-view area, crypt area, crypt circularity, and crypt number per image. To develop and validate this QFEA, a training set of microendoscopy images was collected from freshly resected porcine colon epithelium. The algorithm was then further validated on ex vivo image data collected from eight human subjects, selected from clinically normal appearing regions distant from grossly visible tumor in surgically resected colorectal tissue. QFEA has proven flexible in application to both mosaics and individual images, and its automated crypt detection sensitivity ranges from 71 to 94% despite intensity and contrast variation within the field of view. It also demonstrates the ability to detect and quantify differences in grossly normal regions among different subjects, suggesting the potential efficacy of this approach in detecting occult regions of dysplasia.

There were no differences in overall survival and cancer-related mortality between blacks and whites, and this may have resulted from identical treatment. The previously noted disparities in treatment and overall survival at our institution have disappeared.

Objectives: On completion of this article, the reader should be able to determine risks profiles for venous thromboembolism and pulmonary embolism in patients undergoing colon and rectal surgery, and to discuss the benefits of mechanical and pharmacologic venous thromboembolism prophylaxis.Venous thromboembolism (VTE) is common after major general surgery. The risk of VTE is estimated to be 20% for general surgical patients and 30% for patients undergoing colorectal procedures.1 Pulmonary embolism (PE) is recognized as the most common cause of preventable hospital deaths, accounting for up to 200,000 deaths annually in the United States. 2-9 Prevention of postoperative VTE is considered a quality and patient-safety measure in most mandated quality-improvement initiatives. The Centers for Medicare and Medicaid Services (CMS) considers VTE in hospitalized patients a "never event," which is pegged to the "pay for performance" initiative. 10,11 The majority of patients who develop perioperative VTE are asymptomatic; thus, it is difficult to assess the actual incidence. Studies utilizing venography and fibrinogen uptake test have shown the incidence of deep venous thrombosis (DVT) to be up to 25%. The incidence is even higher in patients with malignancy. 12,13 Using the NSQIP database, Fleming et al showed that the postdischarge clinical incidence of DVT was 0.47 and 0.26% for PE among 52, 555 colorectal surgery patients. 14 The incidence of DVT in patients undergoing colorectal procedures is decreased by 67% with the use of perioperative prophylaxis. 15,16 Despite this, studies assessing the practice of surgeons have found that 50% of general surgery patients received incorrect VTE prophylaxis and half of these did not receive any prophylaxis at all. 17 InterventionsVarious interventions have been utilized for prophylaxis of venous thromboembolism. These include mechanical devices such as graduated compression stockings (GCS), intermittent pneumatic compression (IPC) devices, and pharmacologic agents such as unfractionated heparin, low-molecular-weight heparin, and fondaparinux. Most of the strategies employ a combination of mechanical methods and pharmacologic agents. Mechanical Devices Graduated Compression StockingsThe exact mechanism of action of GCS is not well understood.They are believed to work by compressing both the superficial Keywords ► venous thromboembolism ► deep venous thrombosis ► pulmonary embolism ► prevention ► mechanical agents ► pharmacologic agents ► risk stratification AbstractVenous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measure in most mandated quality i...