Approaches and Treatment of Intussusception, Volvulus, Rectal Prolapse, and Functional Disorders of the Colon, Rectum, and Anus

Jason S. Mizell, MD, FACS, FASCRS

I would like to thank Dr. Steele for inviting me to participate as a guest editor for this issue of Clinics in Colon and Rectal Surgery. This issue focuses on two broad categories of diseases that are complicated, frequently misdiagnosed, and commonly misunderstood—anatomic abnormalities of the small bowel and colon, and functional disorders of the colon, rectum, and anus. Not only are these diseases extremely debilitating for patients but they are also some of the most challenging and complex for the colorectal surgeon. Additionally, lack of a comprehensive understanding of their workup and treatment can lead to poor outcomes, patient harm, and surgeon frustration. This issue provides current data regarding etiologies, evaluation, workup, and medical and surgical management of these difficult and perplexing problems.

Dr. Kapadia from the University of Iowa has provided an extensive review of volvulus in the small intestine and colon, and medical and surgical repair of each when appropriate.

Drs. Ivatury and Holubar from Dartmouth-Hitchcock Medical Center describe in depth the etiology, diagnosis, and treatment of intussusception in the pediatric and adult population, including a detailed description of open and laparoscopic treatments of this complex disease.

Rectal prolapse is covered extensively by a team of colorectal surgeons. Dr. Cannon from the University of Alabama at Birmingham describes the etiology, methods of diagnosis, and medical therapy for rectal prolapse. Drs. Joubert and Laryea from the University of Arkansas for Medical Sciences (UAMS) describe abdominal approaches for surgical repair of rectal prolapse, giving a thorough review of emerging therapies and data regarding mesh repair of prolapse. Dr. Barfield from Our Lady of the Lake Physicians Group in Baton Rouge, Louisiana, completes the section with a description of perineal approaches for rectal prolapse.

The remainder of the issue switches gears from anatomic abnormalities to functional disorders of the rectum, anus, and pelvic floor. These topics can be quite perplexing, but the authors have done an outstanding job describing a clear method for evaluation and management of these difficult problems.

Drs. Tillou and Poylin from Beth Israel Deaconess Medical Center begin this section with a detailed evaluation of the data that can be used to guide evaluation and treatment of colonic inertia.

Drs. Fabrizio, Alimi, and Kumar from the Medstar Georgetown University Hospital and Virginia Mason Medical Center were challenged with the difficult and tedious task of reviewing the data regarding methods of evaluation of the causes of obstructed defecation. Details regarding tools for physiologic testing and imaging are covered at length.

The often poorly understood and somewhat controversial topic of rectoanal intussusception and its clinical implications is reviewed by Drs. Blaker and Anandam from the University of Texas Southwestern Medical Center.

Dr. Mustain from UAMS gives a thorough review of the anatomy of the pelvic floor, along with etiologies for why rectoceles develop. The symptomatology of rectoceles, their role in obstructed defecation syndrome, their workup, and finally detailed treatment options are described for this often overtreated anatomic abnormality.

Finally, Drs. Payne and Grimm from the University of South Alabama Medical Center describe the frequently misunderstood and difficult problems of paradoxical puborectalis contraction and increased perineal descent (IPD). Details of dyssynergia are well described along with newer modalities for evaluation of IPD.

I would like to sincerely thank all of the contributors for their hard work in contributing to this issue of the Clinics in Colon and Rectal Surgery. Editing this issue and working with these outstanding physicians has been a very rewarding experience. Their sacrifice, research, and efforts have provided an in-depth resource for physicians who aim to treat these complex and debilitating disorders.