Perianal appearances associated with constipation

Article Abstract:

Constipation occurs frequently in children. The physical appearance of the region surrounding the anus during periods of constipation has not been described in detail. This description should be defined to distinguish physical signs of constipation from those of sexual abuse. Some of the physical signs of sexual abuse in children include dilation of the anus; the presence of fissures; reddening; congestion and swelling of veins with bluish discoloration; and scars, warts, and tags, or small growths, in the perianal region. Constipated children were also shown to have anal dilation, fissures, and tags in the perianal region. Anal dilatation and fissures were also detected in children without constipation and who were not victims of sexual abuse. The incidence and characteristics of perianal signs were examined in 136 constipated children. Anal dilatation, fissures, tags, warts, perianal edema or accumulation of fluid, redness, blueness, and veins were observed in these children. Anal dilatation was detected in 24 children and occurred after firm lateral traction of the buttocks in eight children. Fecal loading and perianal signs were observed in 75 percent of children with anal dilatation. Thirty-five children had fissures and seven children had tags. Fissures were associated with reddening of the perianal skin, whereas anal dilatation was associated more with a bluish discoloration. These observations suggest that childhood constipation is not associated with distinctive perianal signs. Standards for the procedure of examining the anus should be developed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Medical examination, Constipation, Symptomatology, Signs and symptoms, Anus

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Factors associated with nighttime incontinence following ileoanal pullthrough

Article Abstract:

An uncomfortable problem that may occur following colectomy, proctectomy and intestinal pullthrough procedures is minor nighttime incontinence of stool. A study was undertaken of 38 patients who underwent ileoanal pullthrough operations (removal of a portion of the intestine and rectum with rejoining of the second portion of the small intestine with the anus); in this group of patients, surgery was performed for colonic polyps. These patients were selected for assessment because the possibility of surgical injury to the anal sphincter was minimal. Nighttime incontinence was experienced by 12 patients (32 percent). The incontinence resolved within six months in nine patients. Women had a significantly higher rate of incontinence than men (57 percent versus 17 percent). Patients with nighttime incontinence had significantly smaller sized pouches and a higher frequency of stool early in the postoperative period. The duration of illness, history of pregnancy and childbirth, previous surgery and anal sphincter pressures (measured before and after surgery) were not associated with nighttime incontinence of stool. These findings indicate that nighttime incontinence commonly occurs following surgical removal of the rectum, even after simple procedures. The precise causes of this problem have not been determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Fecal incontinence, Polyps (Pathology), Polyps, Rectum, Colectomy

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HTLV-I-associated neurologic manifestations in four generations of a Brazilian family

Article Abstract:

A study of neurological abnormalities associated with human T-cell lymphotropic virus type I (HTLV-I) infection in four generations of a Brazilian family of African descent is presented. Several previous studies have indicated that HTLV-I can cause tropical spastic paraparesis (TSP), which is characterized by partial paralysis of the lower body, and adult T-cell lymphoma/leukemia (ATLL). Of 32 family members, eight were infected with HTLV-I. Of those eight, three had TSP and four had minor neurological disorders. No uninfected family members had any neurological abnormalities. In the third generation, all individuals who were breast-fed for longer than four months were infected compared with none who were breast fed for only a few weeks. In the fourth generation, the two children of HTLV-positive mothers were not breast fed and were not infected.

Health aspects, Brazil, HTLV-I infections, Paraparesis, Tropical spastic, Tropical spastic paraparesis

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