Diffuse Tubulovillous Adenomas of the Lower Rectum and Sleeve Resection of the Rectal Mucosa by the Posterior Approach. Report of A Case

Abstract

A case of diffuse tubulovillous adenomas of the lower rectum was reported. The treatment consisted of subsacral trans-sphincteric sleeve resection of the mucosa with endto-end anastomosis. The resected mucosa was 6 cm wide with its lower end 5 mm proximal to the dentate line and its upper end 2 cm proximal to the sacrococcigeal joint. To approximate the remaining mucosal edges, the rectum was mobilized from the sacral concavity, and the proximal mucosal margin was circumferentially dissected from the muscular coat, forming a 3 cm wide cuff while the denuded muscular tube was longitudinally plicated.
Postoperatively, the anal continency was completely recovered. Anorectal manometry, however, showed absence of rectosphincteric reflex while the high pressure zone remained in the anal canal.
This procedure proved to be the treatment of choice for diffuse neoplastic lesions limited to the rectal mucosa. Besides, it provided some clue as to what is essential for the anal continency.