Nihon Daicho Komonbyo Gakkai Zasshi

Histological Features and Significance of Anal Glands Observed in Operated Hemorrhoidal Tissues and Fistulous Tracts

T. Utsunomiya, O. Shibata, S. Kikuta, Y. Horichi, T. Kawano, T. Yao

2006 Volume 59 Issue 5 Pages 251-258
Published: 2006
Released on J-STAGE: June 05, 2009

DOIhttps://doi.org/10.3862/jcoloproctology.59.251

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Histological features and differences of the anal glands between males and females were examined in operated hemorrhoidal tissues (22 males and 20 females) and resected fistulous tracts (30 males and 7 females). A high proportion of anal glands in hemorrhoidal tissues was found to be unbranched and extending caudad in both sexes. In men, the ducts were frequently lined with transitional epithelia associated with columnar cells, but there were no differences in size, depth and position of the anal glands between the men and women. Mucous production ability of the ducts in females was found to be weaker than in males. The majority of the anal ducts in fistulous tracts were lined with columnar epithelia overlying transitional epithelium in men, and with squamous metaplastic epithelia in women. The size of the wall and outside diameter of the ducts in fistulous tracts, which were found to have no differences between males and females, were significantly greater than those in hemorrhoidal tissues. The size of inside diameter of the duct in fistulous tracts in males was significantly greater than in females. It is presumed that the spread of infection through the anal glands corresponds to the enlarged ducts lined with columnar epithelia and inflammation faded by closing of the duct lumen reconstructed with squamous metaplasia.

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Factors Affecting Recurrence after Surgical Excision for Perianal Warts

T. Toyonaga, M. Matsushima, R. Katori, T. Takahashi, K. Kiryu, N. Soga ...

2006 Volume 59 Issue 5 Pages 259-264
Published: 2006
Released on J-STAGE: June 05, 2009

DOIhttps://doi.org/10.3862/jcoloproctology.59.259

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We review 122 patients of perianal warts who underwent surgical excisions between 2000 and 2004 inMatsushima hospital, to evaluate the outcome of surgical excision and the risk factors of postoperative recurrence.Clinical symptoms were feeling of lumps, itching, pain, bleeding and discharge. The perianal lesions were simple in 13 patients, sporadic in 48, multiple in 20, velvet-shaped in 13, comb-shaped in 17, and cauliflower-like in 6. Warts invaded the anal canal in 43%, and the vulva or the penis in 15%. Surgical excisions were performed under local anesthesia in 25 patients and under spinal anesthesia in 97.
Postoperative complications such as prolonged wound healing, anal fissure and pruritis ani occurred in 16%. Local recurrence occurred within 6 months in 48% except one case. Multiple perianal lesions, presence of anal canal lesion and bleeding were significant risk factors of postoperative recurrence. It seemed that surgical resection for perianal warts is a good first choice, but recurrence occurs frequently, and postoperative follow-up for at least six months with adequate informed consent and guidance on sexual intercourse is required.

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Combined Radical Retropubic Prostatectomy and Abdominoperineal Resection for Locally Invasive Squamous Cell Carcinoma of the Anal canal

J. Minohata, T. Hirai, K. Komori, Y. Kanemitu, T. Kato

2006 Volume 59 Issue 5 Pages 265-269
Published: 2006
Released on J-STAGE: June 05, 2009

DOIhttps://doi.org/10.3862/jcoloproctology.59.265

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A case of locally advanced squamous cell carcinoma of the anal canal who underwent combined radical retropubic prostatectomy and abdominoperineal resection is reported. A 68-year-old male was diagnosed as squamous cell carcinoma of the anal canal, with prostate invasion. At first external irradiation was given (40Gy), but he had a persistent tumor after irradiation. Then, he underwent combined radical prostatectomy and abdominoperineal resection. An anastomotic leakage between the bladder neck and the urethra occurred but since the anastomotic leakage healed, the patient has voided satisfactorily except for nocturnal incontinence which has gradually decreased over time.

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Squamous Cell Carcinoma In Situ of the Anal Canal with Human Papillomavirus (HPV) 16 infection-Report of a Case

S. Nakatani, T. Takiue

2006 Volume 59 Issue 5 Pages 270-275
Published: 2006
Released on J-STAGE: June 05, 2009

DOIhttps://doi.org/10.3862/jcoloproctology.59.270

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A 65-year old woman was referred to our hospital because of hematochezia. Colonoscopy revealed a flat elevated lesion, 15mm in diameter, that was reddish with contact-bleeding, at the dentate line on the posterior wall of the lower rectum (Rb) to the anal canal. Detailed observation by a closed view after indigo carmine dye spraying clearly demonstrated a villous surface structure and remarkable vessel overgrowth making a tumor that varied in size and shape. Transanal resection was performed under spinal anesthesia. The final histological diagnosis of the resected lesion was poorly differentiated squamous cell carcinoma in situ. The polymerase chain reaction (PCR) method detected human papilloma virus (HPV) 16, which is thought to be one of the most oncogenic HPV types.

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Laparoscopic Total Proctocolectomy with Creation of Ileostomy for a 77-year-old Patient of Steroid Therapy Resistance Ulcerative Colitis: A Case Report

K. Kobayashi, S. Koide, M. Morimoto, H. Miyai, T. Shibata, T. Hayakawa ...

2006 Volume 59 Issue 5 Pages 276-281
Published: 2006
Released on J-STAGE: June 05, 2009

DOIhttps://doi.org/10.3862/jcoloproctology.59.276

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A 77-year-old man who suffered from diarrhea and body weight loss visited our hospital on March 28, 2005. He was diagnosed as ulcerative colitis by colonoscopy, so oral administration of methalazine was started, but it was not effective. He admitted to the department of internal medicine in our hospital and prednisolone was administered, but this was not effective, either. Leucocytoapheresis therapy was tried two times, but in spite of this therapy, the patient's condition continued to worsen. Cytomegalo viral antigen was negative, so he was diagnosed as steroid therapy resistance ulcerative colitis, and laparoscopic total proctocolectomy and end ileostomy were performed on June 1, 2005. Post-operative course and self stoma care were excellent, and he was discharged from our hospital 18 days after the operation.
The operative procedure is not definitive for elderly patients of ulcerative colitis. The ileal pouch operation is suitable for ulcerative colitis patients, but the anal function of elderly patients is low, and it is not clear whether the pouch operation is good or not for patients older than seventy years old. We selected laparoscopic total proctocolectomy and end ileostomy for this patient in view of post-operative quality of life and anal function disorder. It is difficult to choose the operative procedure for elderly patients of ulcerative colitis.

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[title in Japanese]

2006 Volume 59 Issue 5 Pages 282-292
Published: 2006
Released on J-STAGE: June 05, 2009

DOIhttps://doi.org/10.3862/jcoloproctology.59.282

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[title in Japanese]

2006 Volume 59 Issue 5 Pages 293-307
Published: 2006
Released on J-STAGE: June 05, 2009

DOIhttps://doi.org/10.3862/jcoloproctology.59.293

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