I. Objective
For ten patients with idiopathic fecal incontinence, we performed a plastic anal canal procedure developed by us (narrowing the anal canal lumen by widely reversing the internal anal sphincter muscle of the posterior wall of the anal canal anteriorly) and evaluated its beneficial effect on fecal incontinence.
II. Results
In 9 patients, the fecal incontinence was resolved, while symptoms were relieved in the other patient. In the anal canal pressure test, we examined the maximum resting pressure and maximum voluntary contraction pressure before and after the procedure in 6 patients, and found no significant difference. We performed the balloon proctogram in 8 patients. Comparison of the images before and after the procedure revealed that dilatation of the anal canal was suppressed in the patients during all the stages of resting, contracting, and bowel movement. Significant extension of the length of the anal canal was observed in the resting and contracting stages (p<0.05) . In these images, we confirmed that the tip of the coccyx moved by 5 mm or more during transition from the resting stage to the contracting or bowel movement stage in 7 of the 8 patients.

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Purpose: To evaluate the feasibility of CT colonography for preoperative examination of the proximal colon using a transanal drainage tube in patients with acute colon obstruction caused by colorectal cancer.
Materials and Methods: Ten patients who received initial treatment for acute malignant colon obstruction at our hospital between June 2004 and December 2008 were studied. In these patients, elective surgery was possible after transanal drainage tube insertion, and the colon on the oral side from the cancer lesion was examined using a drainage tube. Air was injected through the tube into the oral side of the colon, and CT colonography was assessed for the presence or absence of lesions on the oral side.
Results: The images of the oral side of the colon were good enough to allow adequate interpretation in 9 of the 10 patients. In the first patient, the visualization of the area near the lesion was somewhat fair, although the right side colon was well visualized. There were no complications associated with this examination.
Conclusions: The present preoperative examination using a transanal drainage tube was useful for determining the extent of intestinal resection when patients were not candidates for colonoscopy or barium enema examination.

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The use of a potent stimulant laxative in patients who complain of "constipation" can result in diarrhea in some cases. The present study (1) clarified the severity of the condition described by patients as "constipation" based on a questionnaire survey of healthy adult volunteers and large bowel transit times, and (2) assessed the use of a mild stimulant laxative in the management of constipation using large bowel transit time as an index. A total of 30 adult healthy female volunteers and 10 patients with constipation were used as subjects. The former group was given a questionnaire survey which included questions such as "Do you think that you are constipated?" and total colonic transit (TCT) time was measured. The latter group was administered casanthranol+docusate sodium (D.S.S.) combination therapy and large bowel transit time was measured before and after treatment. The subjects ingested radiopaque markers (Sitzmarks) on days 1, 2, and 3, and a plain abdominal X-ray was taken on days 4 and 7. The total large bowel transit time and segmental transit times (right side (RCT), left side (LCT), rectosigmoid colon (RsCT) ) were calculated using the method of Metcalf et al. (1) TCT in the group of patients (n=6) who had both subjective symptoms and constipation was 110.4 h, in the group of patients (n=12) who had subjective symptoms but not constipation was 40.8 h, and in the group of patients (n=12) who had neither subjective symptoms nor constipation was 15.0 h. Therefore, significant differences in TCT were seen among the groups. (2) Compared to baseline, TCT after treatment was shortened from 100.8 to 59.4 h, RCT and LCT were significantly shortened, and RsCT was increased. The change, however, was not significant. Compared to individuals who have no subjective symptoms, it was shown that the transit time in a subset of individuals who have subjective symptoms of constipation is longer, even though the layman's understanding of the term "constipation" does not coincide with the definition of constipation. It was also shown that, in some individuals, constipation can be satisfactorily controlled by moderately shortening the transit time and that it is not necessary for the transit time to be within the normal range. What is important is that a mild stimulant laxative be used initially and that treatment be commenced at a low dose.

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A 24-year-old woman was admitted with a diagnosis of rectal, vaginal and bladder rupture due to falling from a jet ski. Suturing was carried out as extensively as possible, and sigmoid colostomy with drainage of the retroperitoneal space was performed. The patient was referred to our hospital 3 months after the accident due to the absence of recto-anal function, with retained bladder function. Though defecography demonstrated complete incontinence due to poor retention of the contrast medium at rest, sphincter training was started because slight puborectal muscle contractions were identified and electromyographic contraction waves were detected in part of the injured sphincter. Two months later, an increase in the maximal voluntary pressure, elongation of contrast retention time and contractions of the puborectal muscle were observed. On ultrasonography, scarring had developed in the ruptured sphincter, and at 6 months after injury, anterior sphincteroplasty was performed. At 9 months, sphincteroplasty with an artificial fascia and posterior sphincteroplasty were performed. At 15 months, the parameters of the anorectal sphincter had improved as follows: contrast retention time increased to 2 min, maximal resting pressure of 20mmHg, maximal voluntary pressure of 90mmHg, rectal sensory threshold of 15ml, urge sensation volume of 35ml and maximum tolerated volume of 75ml. The stoma was closed at 17 months after colostomy, and at present, the patient is in good health with no signs of incontinence.

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Rectal benign lymphoid polyps mimic the histological findings of tonsils, and so are also called rectal tonsils. It is necessary to distinguish them from malignant lymphoma or carcinoid tumors.
A 7-year-old female was admitted to Sapporo Higashi Tokushukai Hospital with a rectal polyp prolapse. A biopsy was performed to excise the polyp, which was diagnosed as a rectal tonsil, and her discomfort symptoms were relieved.
Rectal tonsils are rare in Japan: only 3 have been reported including this case, which was the youngest child. Therefore, we report this case in detail here.

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Vaginal metastasis of colorectal cancer is exceedingly rare. We report a case of rectal cancer with metastasis to the vagina that was discovered two years after an operation for rectal cancer. A 77-year-old woman underwent low anterior resection for rectal cancer (Ra) and received chemotherapy. Two years after the operation, there were no symptoms but abdominal computed tomography (CT) showed para-aortic lymph node swelling. Furthermore, 18F-fluorodeoxy-glucose positron emission tomography (FDG-PET) detected para-aortic lymph nodes and vagina. Vaginal metastasis of rectal cancer was confirmed by immunohistochemical study. The patient underwent resection of the vaginal metastasis because the metastatic lesion showed progressive disease resistant to chemotherapy.

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Pneumatosis cystoides intestinalis (PCI) is rarely associated with ulcerative colitis (UC) . We describe two cases of PCI who underwent restorative proctocolectomy for UC.
Case 1: A 31-year-old female diagnosed with UC at 23 years of age and treated with steroids was admitted to our hospital for abdominal distention. Examination revealed PCI extending from the ascending to transverse colon. Symptoms were relieved by hyperbaric oxygen therapy. Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) was performed because UC was intractable despite prolonged steroid treatment. Microscopic findings of the resected specimen were empty cysts in the submucosal layer extending from the caecum to the descending colon.
Case 2: A 34-year-old male diagnosed with UC (left-side colitis) at 23 years of age and treated with steroids was admitted to our hospital for restorative proctocolectomy with IPAA because UC was intractable. Examination revealed PCI extending from the ascending colon to hepatic flexure. Microscopic findings of the resected specimen were empty cysts in the submucosal layer of the ascending colon. Further evaluation of case studies is needed to clarify the pathogenesis of PCI associated with UC.

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