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Am J Gastroenterol. 1997 Oct;92(10):1879-83.
Colonic and anorectal function in constipated patients with anorexia nervosa.

Chun AB, Sokol MS, Kaye WH, Hutson WR, Wald A.

Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA.

OBJECTIVES: Many patients with eating disorders complain of severe constipation. Previous studies have suggested that constipation in patients with anorexia nervosa may be associated with slow colonic transit. However, it is unclear whether a refeeding program will alter colonic transit in these patients. The aim of this study was to investigate colorectal function by measuring colonic transit and anorectal function in anorexic patients with constipation during treatment with a refeeding program. METHODS: We prospectively studied 13 female patients with anorexia nervosa who were admitted to an inpatient treatment unit and compared them to 20 previously studied, age-matched, healthy female control subjects. Patients underwent colonic transit studies using a radiopaque marker technique and anorectal manometry measuring anal sphincter function, rectal sensation, expulsion dynamics, and rectal compliance. Patients were studied both early (< 3 wk) and late (> 3 wk) in their admission. We restudied two patients who had slow colonic transit. All patients also underwent structured interviews. RESULTS: Four of six patients studied within the first 3 wk of their admission had slow colonic transit, defined as > 70 h (108.0 +/- 17.0 h, mean +/- SEM), on initial evaluation. In contrast, none of the seven patients studied later than 3 wk into their admission had slow colonic transit. Two of the four patients with slow transit were restudied later in their admission and were found to have normal transit times. Rectal sensation, internal anal sphincter relaxation threshold, rectal compliance, sphincter pressures, and expulsion pattern were normal in all subjects. CONCLUSIONS: Despite complaints of severe constipation, colonic transit is normal or re

Zhonghua Nei Ke Za Zhi. 1996 Mar;35(3):172-4.
[A clinical and pathological analysis of 20 cases of lymphal follicular rectitis]

[Article in Chinese]

Liang H, Wu P, Fan K.

Department of Gastroenterology, General Hospital of PLA, Beijing.

Lymphal follicular rectitis (LFR) recognized in recent years is a kind of benign lesion localizing in rectum. The lack of specific clinical and endoscopic manifestation causes the difficulty in its diagnosis. It was easily confused with ulcerative rectitis, even there were some cases which were misdiagnosed malignant rectal lymphoma. A retrograde analysis was made in our study in the 176 cases of pathologically diagnosed chronic rectitis between January 1993 and July 1994 in our hospital. Among the 176 cases, 20 were certain to be LFR (2 formerly diagnosed, 18 confirmed in the retrograde study). Endoscopic manifestations are as following: (1) granuliform proliferation, eminence and roughness can be seen in rectal mucosa with hyperemia, edema and vague vessels. The lesion is either diffused or localized. (2) single or multiple smooth polypoid apperances can be observed in rectal mucosa, which are 0.2-0.4 cm in diameter, and its pathological characteristics under microscope are: obvious lymphal follicular hyperplasia in the mucosa. A protecting zone and clear reactive germinal center in the hyperplastic follicules, coalescence of follicules occupying more than half of the lamina propria, a large amount of lymphocytes, some are in karyokinesis phase, some infiltrate the mucosa musculis and vessels proliferation in the hyperplastic lymphal tissue, scattered plasma cells, no neutrophil, no eosinophil and no abscess, which is quite different from ulcerative rectitis. Clinical manifestations of the group include: 7 intermittent hematochezia, 4 abdominal pain associated with alternative constipation and diarrhea, 2 mucous stool, 1 tenesmus, 1 pyohemofecia, 2 abdominal distension and 6 asymptomatic. From our study, the diagnosis of LFR mainly depends on its endoscop

Obstet Gynecol. 1997 Dec;90(6):974-7.
The efficacy and complications of laparoscopic presacral neurectomy in pelvic pain.

Chen FP, Soong YK.

Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.

OBJECTIVE: To evaluate the efficacy and complications of laparoscopic presacral neurectomy in pelvic pain. METHODS: We reviewed records of 655 patients receiving laparoscopic conservative surgery and laparoscopic presacral neurectomy for diagnoses including adenomyosis with dysmenorrhea (n = 55), moderate and severe endometriosis with dysmenorrhea (n = 127), minimal and mild endometriosis with dysmenorrhea (n = 208), primary dysmenorrhea (n = 99), and chronic pelvic pain with or without pathologic disease (n = 166). Pain relief was evaluated at least 12 months postoperatively. RESULTS: Pain relief was evaluated in 527 patients. Significant pain relief (no pain or mild pain requiring no medication) was found in 22 (52%) of 42 women with adenomyosis, in 75 (73%) of 103 with moderate to severe endometriosis with dysmenorrhea, in 123 (75%) of 164 with minimal to mild endometriosis with dysmenorrhea, in 64 (77%) of 83 with primary dysmenorrhea, and in 84 (62%) of 135 with chronic pelvic pain. There were four major complications (0.6%) that required further surgery, including injury of the right internal iliac artery (n = 1) and chylous ascites (n = 3). Three cases (0.5%) had laceration of the middle sacral vein controlled during laparoscopy. In addition, 485 (74%) of the 655 patients complained of constipation after laparoscopic presacral neurectomy, which was relieved easily by medication. CONCLUSION: Presacral neurectomy can be performed safely and efficiently by laparoscopy and is a valuable alternative treatment for pelvic pain.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9397114&dopt=Abstract constipation laxative colon cleansing

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