864:
line. Redundant rectal and sigmoid wall is removed and the new edge of colon is reconnected (anastomosed) with the anal canal with stitches or staples. This procedure may be combined with levatorplasty, to tighten the pelvic muscles. A combined a perineal proctosigmoidectomy with anterior levatorplasty is also called an
Altemeier procedure. Levatorplasty is performed to correct levator diastasis which is commonly associated with rectal prolapse. Perineal rectosigmoidectomy was first introduced by Mikulicz in 1899, and it remained the preferred treatment in Europe for many years. It was Popularized by Altemeier. The procedure is simple, safe and effective. Continence levatorplasty may enhance restoration of continence (2/3 of patients). Complications occur in less than 10% of cases, and include pelvic bleeding, pelvic abscess and anastomotic dehiscence (splitting apart of the stitches inside), bleeding or leak at a dehiscence Mortality is low. Recurrence rates are higher than for abdominal repair, 16-30%, but more recent studies give lower recurrence rates. Additional levatorplasty can reduce recurrence rates to 7%.
890:. After reduction of the prolapse, a subcutaneous suture (a stitch under the skin) or other material is placed encircling the anus, which is then made taut to prevent further prolapse. Placing silver wire around the anus first described by Thiersch in 1891. Materials used include nylon, silk, silastic rods, silicone, Marlex mesh, Mersilene mesh, fascia, tendon, and Dacron. This operation does not correct the prolapse itself, it merely supplements the anal sphincter, narrowing the anal canal with the aim of preventing the prolapse from becoming external, meaning it remains in the rectum. This goal is achieved in 54-100% cases. Complications include breakage of the encirclement material, fecal impaction, sepsis, and erosion into the skin or anal canal. Recurrence rates are higher than the other perineal procedures. This procedure is most often used for people who have a severe condition or who have a high risk of adverse effects from general anesthetic, and who may not tolerate other perineal procedures.
873:
redundant length of bowel. The muscle layer that is left is plicated (folded) and placed as a buttress above the pelvic floor. The edges of the mucosal are then stitched back together. "Mucosal proctectomy" was first discussed by
Delorme in 1900, now it is becoming more popular again as it has low morbidity and avoids an abdominal incision, while effectively repairing the prolapse. The procedure is ideally suited to those patients with full-thickness prolapse limited to partial circumference (e.g., anterior wall) or less-extensive prolapse (perineal rectosigmoidectomy may be difficult in this situation). Fecal incontinence is improved following surgery (40%–75% of patients). Post operatively, both mean resting and squeeze pressures were increased. Constipation is improved in 50% of cases, but often urgency and tenesmus are created. Complications, including infection, urinary retention, bleeding,
1681:
a serious medical condition that requires the attention of a medical professional. However, in rosebud pornography, it is performed deliberately. Michelle Lhooq, writing for VICE, argues that rosebudding is an example of producers making 'extreme' content due to the easy availability of free pornography on the internet. She also argues that rosebudding is a way for pornographic actors and actresses to distinguish themselves. Repeated rectal prolapses can cause bowel problems and anal leakage and therefore risk the health of pornographic actors or actresses who participate in them. Lhooq also argues that some who participate in this form of pornography are unaware of the consequences.
391:
thickness external rectal prolapse (a complete rectal prolapse) by the orientation of the folds (furrows) in the prolapsed section. In full thickness rectal prolapse, these folds run circumferential. In mucosal prolapse, these folds are radially. The folds in mucosal prolapse are usually associated with internal hemorrhoids. Furthermore, in rectal prolapse, there is a sulcus present between the prolapsed bowel and the anal verge, whereas in hemorrhoidal disease there is no sulcus. Prolapsed, incarcerated hemorrhoids are extremely painful, whereas as long as a rectal prolapse is not strangulated, it gives little pain and is easy to reduce.
51:
1199:(paradoxical contraction of the pelvic floor during attempted defecation). The operation has been shown to improve rectal sensitivity and decrease rectal volume, the reason thought to create urgency. 90% of patients do not report urgency 12 months after the operation. The anal sphincter may also be stretched during the operation. STARR was compared with biofeedback and found to be more effective at reducing symptoms and improving quality of life.
602:
764:
external rectal prolapse. The factors that result in a patient progressing from internal intussusception to a full thickness rectal prolapse remain unknown. Defecography studies demonstrated that degrees of internal intussusception are present in 40% of asymptomatic subjects, raising the possibility that it represents a normal variant in some, and may predispose patients to develop symptoms, or exacerbate other problems.
324:(intra-rectal intussusception) is where the intussusception starts in the rectum, does not protrude into the anal canal, but stays within the rectum. (i.e. the intussusceptum originates in the rectum and does not extend into the anal canal. The intussuscipiens includes rectal lumen distal to the intussusceptum only). These are usually intussusceptions that originate in the upper rectum or lower
498:
205:. This infolding is perhaps best visualised as folding a sock inside out, creating "a tube within a tube". Another definition is "where the rectum collapses but does not exit the anus". Many sources differentiate between internal rectal intussusception and mucosal prolapse, implying that the former is a full thickness prolapse of rectal wall. However, a publication by the
238:(rectal internal mucosal prolapse, RIMP) refers to prolapse of the mucosal layer of the rectal wall which does not protrude externally. There is some controversy surrounding this condition as to its relationship with hemorrhoidal disease, or whether it is a separate entity. The term "mucosal hemorrhoidal prolapse" is also used.
1482:, about 7–10 cm from the anus. However, the area may of ulceration may be closer to the anus, deeper inside, or on the lateral or posterior rectal walls. The name "solitary" can be misleading since there may be more than one ulcer present. Furthermore, there is a "preulcerative phase" where there is no ulcer at all.
1664:(MPS) has now been recognized. It includes SRUS, rectal prolapse, proctitis cystica profunda, and inflammatory polyps. It is classified as a chronic benign inflammatory disorder. The unifying feature is varying degrees of rectal prolapse, whether internal intussusception (occult prolapse) or external prolapse.
228:(partial rectal mucosal prolapse) refers to prolapse of the loosening of the submucosal attachments to the muscularis propria of the distal rectummucosal layer of the rectal wall. Most sources define mucosal prolapse as an external, segmental prolapse which is easily confused with prolapsed (3rd or 4th degree)
1680:
Rosebud pornography and prolapse pornography (or rosebudding or rectal prolapse pornography) is an anal sex practice that occurs in some extreme anal pornography wherein a pornographic actor or actress performs a rectal prolapse wherein the walls of the rectum slip out of the anus. Rectal prolapse is
1315:
Mucosal prolapse can be differentiated from a full thickness external rectal prolapse (a complete rectal prolapse) by the orientation of the folds (furrows) in the prolapsed section. In full thickness rectal prolapse, these folds run circumferential. In mucosal prolapse, these folds are radially. The
763:
Some believe that internal rectal intussusception represents the initial form of a progressive spectrum of disorders the extreme of which is external rectal prolapse. The intermediary stages would be gradually increasing sizes of intussusception. However, internal intussusception rarely progresses to
1452:
Overactivity of the anal sphincter during defecation causes the patient to require more effort to expel stool. This pressure is produced by the modified valsalva manovoure (attempted forced exhalation against a closed glottis, resulting in increased abdominal and intra-rectal pressure). Patiest with
735:
The association with uterine prolapse (10-25%) and cystocele (35%) may suggest that there is some underlying abnormality of the pelvic floor that affects multiple pelvic organs. Proximal bilateral pudendal neuropathy has been demonstrated in patients with rectal prolapse who have fecal incontinence.
394:
The prolapse may be obvious, or it may require straining and squatting to produce it. The anus is usually patulous, (loose, open) and has reduced resting and squeeze pressures. Sometimes it is necessary to observe the patient while they strain on a toilet to see the prolapse happen (the perineum can
337:
An
Anatomico-Functional Classification of internal rectal intussusception has been described, with the argument that other factors apart from the height of intussusception above the anal canal appear to be important to predict symptomology. The parameters of this classification are anatomic descent,
4552:
Lehur PA, Stuto A, Fantoli M, Villani RD, Queralto M, Lazorthes F, et al. (November 2008). "Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial".
1147:
It is clear that there is a wide spectrum of symptom severity, meaning that some patients may benefit from surgery and others may not. Many procedures receive conflicting reports of success, leading to a lack of any consensus about the best way to manage this problem. Relapse of the intussusception
390:
Rectal prolapse may be confused easily with prolapsing hemorrhoids. Mucosal prolapse also differs from prolapsing (3rd or 4th degree) hemorrhoids, where there is a segmental prolapse of the hemorrhoidal tissues at the 3, 7 and 11 o'clock positions. Mucosal prolapse can be differentiated from a full
1183:
This operation aims to "remove the anorectal mucosa circumferentially and reinforce the anterior anorectal junction wall with the use of a circular stapler". In contrast to other methods, STARR does not correct the descent of the rectum, it removes the redundant tissue. The technique was developed
872:
This is a modification of the perineal rectosigmoidectomy, differing in that only the mucosa and submucosa are excised from the prolapsed segment, rather than full thickness resection. The prolapse is exposed if it is not already present, and the mucosal and submucosal layers are stripped from the
863:
The goal of
Perineal rectosigmoidectomy is to resect or remove the redundant bowel. This is done through the perineum. The lower rectum is anchored to the sacrum through fibrosis in order to prevent future prolapse. The full thickness of the rectal wall is incised at a level just above the dentate
829:
Recovery time following laparoscopic surgery is shorter and less painful than following traditional abdominal surgery. Instead of opening the pelvic cavity with a wide incision (laparotomy), a laparoscope (a thin, lighted tube) and surgical instruments are inserted into the pelvic cavity via small
509:
The true incidence of rectal prolapse is unknown, but it is thought to be uncommon. As most affected people are elderly, the condition is generally under-reported. It may occur at any age, even in children, but there is peak onset in the fourth and seventh decades. Women over 50 are six times more
790:
Surgery is often required to prevent further damage to the anal sphincters. The goals of surgery are to restore the normal anatomy and to minimize symptoms. There is no globally agreed consensus as to which procedures are more effective, and there have been over 50 different operations described.
743:
Sphincter function in rectal prolapse is almost always reduced. This may be the result of direct sphincter injury by chronic stretching of the prolapsing rectum. Alternatively, the intussuscepting rectum may lead to chronic stimulation of the rectoanal inhibitory reflex (RAIR - contraction of the
580:
Initially, the mass may protrude through the anal canal only during defecation and straining, and spontaneously return afterwards. Later, the mass may have to be pushed back in following defecation. This may progress to a chronically prolapsed and severe condition, defined as spontaneous prolapse
488:
It may be used to evaluate incontinence, but there is disagreement about what relevance the results may show, as rarely do they mandate a change of surgical plan. There may be denervation of striated musculature on the electromyogram. Increased nerve conduction periods (nerve damage), this may be
998:
Some believe that it represents the initial form of a progressive spectrum of disorders the extreme of which is external rectal prolapse. The intermediary stages would be gradually increasing sizes of intussusception. The folding section of rectum can cause repeated trauma to the mucosa, and can
777:
Surgery is thought to be the only option to potentially cure a complete rectal prolapse. For people with medical problems that make them unfit for surgery, and those who have minimal symptoms, conservative measures may be beneficial. Dietary adjustments, including increasing dietary fiber may be
630:
This theory was based on the observation that rectal prolapse patients have a mobile and unsupported pelvic floor, and a hernia sac of peritoneum from the Pouch of
Douglas and rectal wall can be seen. Other adjacent structures can sometimes be seen in addition to the rectal prolapse. Although a
588:
If the prolapse becomes trapped externally outside the anal sphincters, it may become strangulated and there is a risk of perforation. This may require an urgent surgical operation if the prolapse cannot be manually reduced. Applying granulated sugar on the exposed rectal tissue can reduce the
1791:(termed the intussuscipiens). What results is 3 layers of rectal wall overlaid. From the lumen outwards, the first layer is the proximal wall of the intussusceptum, the middle is the wall of the intussusceptum folded back on itself, and the outer is the distal rectal wall, the intussuscipiens.
838:
The perineal approach generally results in less post-operative pain and complications, and a reduced length of hospital stay. These procedures generally carry a higher recurrence rate and poorer functional outcome. The perineal procedures include perineal rectosigmoidectomy and
Delorme repair.
669:
Since most patients with rectal prolapse have a long history of constipation, it is thought that prolonged, excessive and repetitive straining during defecation may predispose to rectal prolapse. Since rectal prolapse itself causes functional obstruction, more straining may result from a small
479:
therapy. Decreased squeeze and resting pressures are usually the findings, and this may predate the development of the prolapse. Resting tone is usually preserved in patients with mucosal prolapse. In patients with reduced resting pressure, levatorplasty may be combined with prolapse repair to
126:
Rectal prolapse is generally more common in elderly women, although it may occur at any age and in either sex. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated. Most external prolapse cases can be treated successfully, often with a surgical procedure.
3807:
Renzi A, Talento P, Giardiello C, Angelone G, Izzo D, Di Sarno G (October 2008). "Stapled trans-anal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter
505:
Rectal prolapse is a "falling down" of the rectum so that it is visible externally. The appearance is of a reddened, proboscis-like object through the anal sphincters. Patients find the condition embarrassing. The symptoms can be socially debilitating without treatment, but it is rarely
920:
was first developed and became widespread. Degrees of internal intussusception have been demonstrated in 40% of asymptomatic subjects, raising the possibility that it represents a normal variant in some, and may predispose patients to develop symptoms, or exacerbate other problems.
1006:
Others argue that the majority of patients appear to have rectal intussusception as a consequence of obstructed defecation rather than a cause, possibly related to excessive straining in patients with obstructed defecation. Patients with other causes of obstructed defecation
744:
external anal sphincter in response to stool in the rectum). The RAIR was shown to be absent or blunted. Squeeze (maximum voluntary contraction) pressures may be affected as well as the resting tone. This is most likely a denervation injury to the external anal sphincter.
4198:
Gosselink MP, Adusumilli S, Harmston C, Wijffels NA, Jones OM, Cunningham C, Lindsey I (December 2013). "Impact of slow transit constipation on the outcome of laparoscopic ventral rectopexy for obstructed defaecation associated with high grade internal rectal prolapse".
3943:
Adusumilli S, Gosselink MP, Fourie S, Curran K, Jones OM, Cunningham C, Lindsey I (November 2013). "Does the presence of a high grade internal rectal prolapse affect the outcome of pelvic floor retraining in patients with faecal incontinence or obstructed defaecation?".
258:
Rectal prolapse and internal rectal intussusception has been classified according to the size of the prolapsed section of rectum, a function of rectal mobility from the sacrum and infolding of the rectum. This classification also takes into account sphincter relaxation:
103:
and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.
1464:(which should normally relax during defecation). The increased pressure forces the anterior rectal lining against the contracted puborectalis and frequently the lining prolapses into the anal canal during straining and then returns to its normal position afterwards.
3067:
381:
Patients may have associated gynecological conditions which may require multidisciplinary management. History of constipation is important because some of the operations may worsen constipation. Fecal incontinence may also influence the choice of management.
414:(swelling) of the distal rectal mucosa, and in 10-15% of cases there may be a solitary rectal ulcer on the anterior rectal wall. Localized inflammation or ulceration can be biopsied and may lead to a diagnosis of SRUS or colitis cystica profunda. Rarely, a
877:
dehiscence (opening of the stitched edges inside), stricture (narrowing of the gut lumen), diarrhea, and fecal impaction occur in 6-32% of cases. Mortality occurs in 0–2.5% cases. There is a higher recurrence rate than abdominal approaches (7-26% cases).
1243:
Symptom severity increases with the size of the prolapse, and whether it spontaneously reduces after defecation, requires manual reduction by the patient, or becomes irreducible. The symptoms are identical to advanced hemorrhoidal disease, and include:
807:. Procedures for rectal prolapse may involve fixation of the bowel (rectopexy), or resection (a portion removed), or both. Trans-anal (endo-anal) procedures are also described where access to the internal rectum is gained through the anus itself.
248:
of the rectal lining caused by repeated frictional damage as the internal intussusception is forced into the anal canal during straining. SRUS can be considered a consequence of internal intussusception, which can be demonstrated in 94% of cases.
5969:
5954:
1221:. It is different to an internal intussusception (occult prolapse) or a complete rectal prolapse (external prolapse, procidentia) because these conditions involve the full thickness of the rectal wall, rather than only the mucosa (lining).
1035:
is by telescoping of the intussusceptum, occluding the rectal lumen during attempted defecation. One study analysed resected rectal wall specimens in patients with obstructed defecation associated with rectal intussusception undergoing
521:
35% of women with rectal prolapse have never had children, suggesting that pregnancy and labor are not significant factors. Anatomical differences such as the wider pelvic outlet in females may explain the skewed gender distribution.
5515:
Levine DS, Surawicz CM, Ajer TN, Dean PJ, Rubin CE (November 1988). "Diffuse excess mucosal collagen in rectal biopsies facilitates differential diagnosis of solitary rectal ulcer syndrome from other inflammatory bowel diseases".
3717:
Bassotti G, Villanacci V, Bellomi A, Fante R, Cadei M, Vicenzi L, et al. (March 2012). "An assessment of enteric nervous system and estroprogestinic receptors in obstructed defecation associated with rectal intussusception".
434:
This investigation is used to diagnose internal intussusception, or demonstrate a suspected external prolapse that could not be produced during the examination. It is usually not necessary with obvious external rectal prolapse.
309:
The most widely used classification of internal rectal prolapse is according to the height on the rectal/sigmoid wall from which they originate and by whether the intussusceptum remains within the rectum or extends into the
751:
in rectal prolapse is by the chronic stretch and trauma to the anal sphincters and the presence of a direct conduit (the intussusceptum) connecting rectum to the external environment which is not guarded by the sphincters.
334:(intra-anal intussusception) is where the intussusception starts in the rectum and protrudes into the anal canal (i.e. the intussusceptum originates in the rectum, and the intussuscipiens includes part of the anal canal)
810:
Abdominal procedures are associated with lower risk of postoperative recurrence of the prolapse, compared with perineal procedures (6.1% vs 16.3% in patients who are younger than 65 years of age at the time of surgery).
649:
to show that rectal prolapse begins as a circumferential intussusception of the rectum, which slowly increases over time. The leading edge of the intussusceptum may be located at 6–8 cm or at 15–18 cm from the
221:
layer attachments, resulting in the separated portion of rectal lining "sliding" down. This may signify that authors use the terms internal rectal prolapse and internal mucosal prolapse to describe the same phenomena.
3320:
Portier G, Kirzin S, Cabarrot P, Queralto M, Lazorthes F (August 2011). "The effect of abdominal ventral rectopexy on faecal incontinence and constipation in patients with internal intra-anal rectal intussusception".
755:
The assumed mechanism of obstructed defecation is by disruption to the rectum and anal canal's ability to contract and fully evacuate rectal contents. The intussusceptum itself may mechanically obstruct the rectoanal
4108:
Gosselink MP, Adusumilli S, Gorissen KJ, Fourie S, Tuynman JB, Jones OM, et al. (December 2013). "Laparoscopic ventral rectopexy for fecal incontinence associated with high-grade internal rectal prolapse".
191:(rectal procidentia, full thickness rectal prolapse, overt rectal prolapse) is a full thickness, circumferential, true intussusception of the rectal wall which protrudes from the anus and is visible externally.
1030:
combined with internal intussusception (as 94% of SRUS patients have) were shown to have altered rectal wall biomechanics compared to patients with internal intussusception alone. The presumed mechanism of the
794:
Surgical approaches in rectal prolapse can be either perineal or abdominal. A perineal approach (or trans-perineal) refers to surgical access to the rectum and sigmoid colon via an incision around the anus and
470:
This investigation objectively documents the functional status of the sphincters. However, the clinical significance of the findings are disputed by some. It may be used to assess for pelvic floor dyssenergia,
1485:
Pathological specimens of sections of rectal wall taken from SRUS patients show thickening and replacement of muscle with fibrous tissue and excess collagen. Rarely, SRUS can present as polyps in the rectum.
2171:
Gouvas, N; Georgiou, PA; Agalianos, C; Tan, E; Tekkis, P; Dervenis, C; Xynos, E (February 2015). "Ventral colporectopexy for overt rectal prolapse and obstructed defaecation syndrome: a systematic review".
255:(MPS) is recognized by some. It includes solitary rectal ulcer syndrome, rectal prolapse, proctitis cystica profunda, and inflammatory polyps. It is classified as a chronic benign inflammatory disorder.
5480:
Blanco F, Frasson M, Flor-Lorente B, Minguez M, Esclapez P, GarcĂa-Granero E (November 2011). "Solitary rectal ulcer: ultrasonographic and magnetic resonance imaging patterns mimicking rectal cancer".
4726:
Halligan S, Nicholls RJ, Bartram CI (January 1995). "Evacuation proctography in patients with solitary rectal ulcer syndrome: anatomic abnormalities and frequency of impaired emptying and prolapse".
510:
likely to develop rectal prolapse than men. It is rare in men over 45 and in women under 20. When males are affected, they tend to be young and report significant bowel function symptoms, especially
1507:
in the muscle layers of the gut lining, and it can occur anywhere along the gastrointestinal tract. When it occurs in the rectum, some believe to be an interchangeable diagnosis with SRUS since the
6913:
1133:), then biofeedback retraining is indicated. Some researchers advise that internal intussusception be managed conservatively, compared to external rectal prolapse which usually requires surgery.
4334:
Dodi G, Pietroletti R, Milito G, Binda G, Pescatori M (October 2003). "Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation".
1538:
SRUS is commonly misdiagnosed, and the diagnosis is not made for 5–7 years. Clinicians may not be familiar with the condition, and treat for
Inflammatory bowel disease, or simple constipation.
232:(piles). However, both internal mucosal prolapse (see below) and circumferential mucosal prolapse are described by some. Others do not consider mucosal prolapse a true form of rectal prolapse.
150:
The different kinds of rectal prolapse can be difficult to grasp, as different definitions are used and some recognize some subtypes and others do not. Essentially, rectal prolapses may be:
5084:
Levine DS (January 1987). ""Solitary" rectal ulcer syndrome. Are "solitary" rectal ulcer syndrome and "localized" colitis cystica profunda analogous syndromes caused by rectal prolapse?".
462:
if there is a history of severe constipation. Continent prolapse patients with slow transit constipation, and who are fit for surgery may benefit from subtotal colectomy with rectopexy.
1471:), combined with repeated frictional trauma from the prolapsing lining, and exposure to increased pressure are thought to cause ulceration. Trauma from hard stools may also contribute.
1489:
SRUS is therefore associated and with internal, and more rarely, external rectal prolapse. Some believe that SRUS represents a spectrum of different diseases with different causes.
1649:
Surgery may be considered, but only if non surgical treatment has failed and the symptoms are severe enough to warrant the intervention. Improvement with surgery is about 55-60%.
995:
There are two schools of thought regarding the nature of internal intussusception, viz: whether it is a primary phenomenon, or secondary to (a consequence of) another condition.
5602:
van den Brandt-Grädel V, Huibregtse K, Tytgat GN (November 1984). "Treatment of solitary rectal ulcer syndrome with high-fiber diet and abstention of straining at defecation".
4155:
Boons P, Collinson R, Cunningham C, Lindsey I (June 2010). "Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation".
6091:
4629:
Ertem D, Acar Y, Karaa EK, Pehlivanoglu E (December 2002). "A rare and often unrecognized cause of hematochezia and tenesmus in childhood: solitary rectal ulcer syndrome".
3364:
Johansson C, Ihre T, Ahlbäck SO (December 1985). "Disturbances in the defecation mechanism with special reference to intussusception of the rectum (internal procidentia)".
855:. Alternatively, perineal procedures may be selected to reduce risk of nerve damage, for example in young male patients for whom sexual dysfunction may be a major concern.
136:
2145:
4017:
Felt-Bersma RJ, Tiersma ES, Stella MT, Cuesta MA (September 2008). "Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele".
3991:
1364:. SRUS can therefore be considered to be a consequence of internal intussusception (a sub type of rectal prolapse), which can be demonstrated in 94% of cases. It may be
4377:
Bassi R, Rademacher J, Savoia A (December 2006). "Rectovaginal fistula after STARR procedure complicated by haematoma of the posterior vaginal wall: report of a case".
6595:
1453:
SRUS were shown to have higher intra-rectal pressures when straining than healthy controls. SRUS is also associated with prolonged and incomplete evacuation of stool.
736:
This finding was shown to be absent in healthy subjects, and may be the cause of denervation-related atrophy of the external anal sphincter. Some authors suggest that
1172:
Complications include constipation, which is reduced if the technique does not use posterior rectal mobilization (freeing the rectum from its attached back surface).
1169:) in patients with rectal intussusception. The operation has been shown to have low recurrence rate (around 5%). It also improves obstructed defecation symptoms.
4242:
Samaranayake CB, Luo C, Plank AW, Merrie AE, Plank LD, Bissett IP (June 2010). "Systematic review on ventral rectopexy for rectal prolapse and intussusception".
987:
It has been observed that intussusceptions of thickness ≥3 mm, and those that appear to cause obstruction to rectal evacuation may give clinical symptoms.
206:
2617:
Guanziroli E, Veraldi S, Guttadauro A, Rizzitelli G, Frassani S (Aug 1, 2011). "Persistent perianal dermatitis associated with mucosal hemorrhoidal prolapse".
608:
showing a rectal wall with changes seen in rectal prolapse. There is a marked increase of fibrous tissue in the submucosa and fibrous tissue +/- smooth muscle
525:
Associated conditions, especially in younger patients include autism, developmental delay syndromes, and psychiatric conditions requiring several medications.
1603:
have all been used to diagnose and study SRUS. Some recommend biopsy as essential for diagnosis since ulcerations may not always be present, and others state
6190:
1467:
The repeated trapping of the lining can cause the tissue to become swollen and congested. Ulceration is thought to be caused by resulting poor blood supply (
638:, originating in the cul de sac of Douglas, may protrude from the anus (via the anterior rectal wall), this is a different situation from rectal prolapse.
6229:
700:
Some authors question whether these abnormalities are the cause, or secondary to the prolapse. Other predisposing factors/associated conditions include:
298:
4420:
Sciaudone G, Di Stazio C, Guadagni I, Selvaggi F (March 2008). "Rectal diverticulum: a new complication of STARR procedure for obstructed defecation".
3761:
Abendstein B, Petros PE, Richardson PA, Goeschen K, Dodero D (May 2008). "The surgical anatomy of rectocele and anterior rectal wall intussusception".
3674:
Dvorkin LS, Gladman MA, Scott SM, Williams NS, Lunniss PJ (July 2005). "Rectal intussusception: a study of rectal biomechanics and visceroperception".
976:
intussusceptions commonly give more severe symptoms of straining, incomplete evacuation, need for digital evacuation of stool, need for support of the
244:(SRUS, solitary rectal ulcer, SRU) occurs with internal rectal intussusception and is part of the spectrum of rectal prolapse conditions. It describes
3856:"Stapled transanal rectal resection for the surgical treatment of obstructed defecation syndrome associated with rectocele and rectal intussusception"
422:. Full length colonoscopy is usually carried out in adults prior to any surgical intervention. These investigations may be used with contrast media (
418:(tumour) may form on the leading edge of the intussusceptum. In addition, patients are frequently elderly and therefore have increased incidence of
283:
Rectal internal mucosal prolapse has been graded according to the level of descent of the intussusceptum, which was predictive of symptom severity:
2795:
Pescatori M, Quondamcarlo C (November 1999). "A new grading of rectal internal mucosal prolapse and its correlation with diagnosis and treatment".
6084:
1093:
or dynamic MRI defecography can demonstrate the abnormal folding of the rectal wall. Some have advocated the use of anorectal physiology testing (
684:
loss of the normal horizontal position of the rectum with lengthening (redundant rectosigmoid) and downward displacement of the sigmoid and rectum
623:
The precise cause is unknown, and has been much debated. In 1912 Moschcowitz proposed that rectal prolapse was a sliding hernia through a pelvic
1136:
As with external rectal prolapse, there are a great many different surgical interventions described. Generally, a section of rectal wall can be
1162:
This procedure aims to " the descent of the posterior and middle pelvic compartments combined with reinforcement of the rectovaginal septum".
6457:
2914:
2884:
2474:
2414:
2314:
1884:
3553:
Christiansen J, Hesselfeldt P, Sørensen M (May 1995). "Treatment of internal rectal intussusception in patients with chronic constipation".
740:
damage is the cause for pelvic floor and anal sphincter weakening, and may be the underlying cause of a spectrum of pelvic floor disorders.
819:
The abdominal approach carries a small risk of impotence in males (e.g. 1-2% in abdominal rectopexy). Abdominal operations may be open or
3908:
Goei R, Baeten C (January 1990). "Rectal intussusception and rectal prolapse: detection and postoperative evaluation with defecography".
1191:
Complications, sometimes serious, have been reported following STARR, but the procedure is now considered safe and effective. STARR is
5984:
5453:
Lokuhetty D, de Silva MV, Mudduwa L (December 1998). "Solitary rectal ulcer syndrome (SRUS) masquerading as a carcinomatous stricture".
5054:
Vora IM, Sharma J, Joshi AS (April 1992). "Solitary rectal ulcer syndrome and colitis cystica profunda--a clinico-pathological review".
1037:
395:
be seen with a mirror or by placing an endoscope in the bowl of the toilet). A phosphate enema may need to be used to induce straining.
4470:"Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures"
6670:
6077:
3631:
Dvorkin LS, Knowles CH, Scott SM, Williams NS, Lunniss PJ (April 2005). "Rectal intussusception: characterization of symptomatology".
3148:
Mellgren A, Schultz I, Johansson C, Dolk A (July 1997). "Internal rectal intussusception seldom develops into total rectal prolapse".
1761:
1716:
procidentia has a similar meaning to prolapse, referring to "a sinking or prolapse of an organ or part". It is derived from the Latin
1672:
Rectal prolapse affects less than 0.5% of the general population. It affects women more commonly, with a female to male ratio of 9:1.
1144:, or a combination of both methods. Surgery for internal rectal prolapse can be via the abdominal approach or the transanal approach.
7342:
7189:
1735:(infolding), especially referring to "the slipping of a length of intestine into an adjacent portion". It is derived from the Latin
1689:
Prolapse refers to "the falling down or slipping of a body part from its usual position or relations". It is derived from the Latin
1188:. Since, specialized circular staplers have been developed for use in external rectal prolapse and internal rectal intussusception.
670:
prolapse, with increasing damage to the anatomy. This excessive straining may be due to predisposing pelvic floor dysfunction (e.g.
2719:"The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases"
2405:
Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, Church JM, Garcia-Aguilar J, Roberts PL, Saclarides TJ, Stamos MJ (2007).
5893:
4599:
Mackle EJ, Parks TG (October 1986). "The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome".
799:(the area between the genitals and the anus). Abdominal approach (trans-abdominal approach) involves the surgeon cutting into the
7087:
3510:
Christiansen J, Zhu BW, Rasmussen OO, Sørensen M (November 1992). "Internal rectal intussusception: results of surgical repair".
2501:
Gupta PJ (2006). "Treatment of rectal mucosal prolapse with radiofrequency coagulation and plication--a new surgical technique".
1324:
5792:
Vaizey CJ, van den
Bogaerde JB, Emmanuel AV, Talbot IC, Nicholls RJ, Kamm MA (December 1998). "Solitary rectal ulcer syndrome".
585:
maneuvers). A chronically prolapsed rectal tissue may undergo pathological changes such as thickening, ulceration and bleeding.
7228:
6840:
6823:
6328:
6323:
6200:
3588:
Ihre T, Seligson U (Jul–Aug 1975). "Intussusception of the rectum-internal procidentia: treatment and results in 90 patients".
2149:
50:
6353:
3995:
1064:
The following conditions occur more commonly in patients with internal rectal intussusception than in the general population:
135:
7082:
7038:
6932:
6754:
1994:
1336:
1085:
Unlike external rectal prolapse, internal rectal intussusception is not visible externally, but it may still be diagnosed by
1073:
1027:
1000:
839:
Elderly, or other medically high-risk patients are usually treated by perineal procedures, as they can be performed under a
7293:
1019:
are coexistent in 11% of patients with internal intussusception. Symptoms of internal intussusception overlap with those of
2566:
Gaj F, Trecca A (July 2005). "Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey".
970:, apart from mild obstructed defecation. "interrupted defaecation" in the morning is thought by some to be characteristic.
7139:
1296:
Mucosal prolapse occurs when the results from loosening of the submucosal attachments (between the mucosal layer and the
197:(occult rectal prolapse, internal procidentia) can be defined as a funnel shaped infolding of the upper rectal (or lower
7048:
6567:
6175:
1784:
1776:
1301:
6262:
7379:
1526:
Complications are uncommon, but include massive rectal bleeding, ulceration into the prostate gland or formation of a
6158:
901:(rectal intussusception, internal intussusception, internal rectal prolapse, occult rectal prolapse, internal rectal
69:. Note circumferential arrangement of folds in full thickness prolapse compared to radial folds in mucosal prolapse.
6628:
6557:
5011:
Kang YS, Kamm MA, Nicholls RJ (1995). "Solitary rectal ulcer and complete rectal prolapse: one condition or two?".
1086:
2768:
Fleshman JW, Kodner IJ, Fry RD (December 1989). "Internal intussusception of the rectum: a changing perspective".
1210:(mucosal prolapse, anal mucosal prolapse) is a sub-type of rectal prolapse, and refers to abnormal descent of the
6901:
6857:
6810:
6616:
6234:
5205:"Acute hemorrhagic rectal ulcer syndrome: a new clinical entity? Report of 19 cases and review of the literature"
4517:
Boffi F (June 2008). "Retained staples causing rectal bleeding and severe proctalgia after the STARR procedure".
2444:
1623:
6927:
2174:
Colorectal disease : the official journal of the
Association of Coloproctology of Great Britain and Ireland
1356:. This increased pressure causes the anterior portion of the rectal lining to be forced into the anal canal (an
7384:
7247:
6562:
6520:
6333:
6208:
6195:
6136:
5995:
5647:"Behavioural therapy (biofeedback) for solitary rectal ulcer syndrome improves symptoms and mucosal blood flow"
662:
that this condition is essentially a full-thickness rectal intussusception, beginning about 3 inches above the
6165:
1441:
The condition is thought to be uncommon. It usually occurs in young adults, but children can be affected too.
475:
is a contraindication for certain surgeries, e.g. STARR), and these patients may benefit from post-operative
455:
7172:
6949:
6690:
6482:
6141:
338:
diameter of intussuscepted bowel, associated rectal hyposensitivity and associated delayed colonic transit:
501:
A severe example of complete (external) rectal prolapse. Note circumferential arrangement of mucosal folds.
107:
Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be
7252:
6976:
6959:
6369:
6343:
6219:
6170:
6131:
6109:
6101:
1772:, which can sometimes be a medical emergency. Rectal intussusception by contrast is not life-threatening.
1041:
398:
The perianal skin may be macerated (softening and whitening of skin that is kept constantly wet) and show
5119:
Beck DE (June 2002). "Surgical
Therapy for Colitis Cystica Profunda and Solitary Rectal Ulcer Syndrome".
3249:
681:
poor posterior rectal fixation, resulting in loss of posterior fixation of the rectum to the sacral curve
7184:
7092:
7053:
6981:
1805:
1381:
1232:
1090:
1032:
1008:
943:
917:
671:
655:
559:
511:
127:
Internal prolapses are traditionally harder to treat and surgery may not be suitable for many patients.
120:
7103:
6284:
3273:"Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis"
1195:
in patients with weak sphincters (fecal incontinence and urgency are a possible complication) and with
3069:
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease
7223:
7167:
6988:
6884:
6467:
6462:
6296:
6214:
6180:
3044:
848:
820:
581:
that is difficult to keep inside, and occurs with walking, prolonged standing, coughing or sneezing (
1377:
830:
incisions. Rectopexy and anterior resection have been performed laparoscopically with good results.
7317:
7127:
7020:
7003:
6964:
6937:
6889:
6732:
6709:
6702:
6651:
6623:
6545:
6540:
6535:
6452:
5973:
1639:
1596:
1137:
1094:
840:
659:
297:
3463:"Rectal intussusception in symptomatic patients is different from that in asymptomatic volunteers"
3271:
Pellino G, Fuschillo G, Simillis C, Selvaggi L, Signoriello G, Vinci D, et al. (March 2022).
2544:
7329:
7194:
7177:
7162:
7149:
7132:
6998:
6525:
6497:
6257:
6153:
6118:
5817:
5774:
5627:
5584:
5541:
5337:
5144:
5036:
4578:
4445:
4402:
4359:
4267:
4224:
4180:
4134:
3969:
3833:
3786:
3743:
3699:
3656:
3613:
3535:
3492:
3389:
3346:
3173:
3093:
2820:
2599:
2526:
1800:
1429:
1297:
1122:
1049:
1045:
981:
852:
748:
541:
116:
6633:
6431:
4061:"Controversy in the treatment of symptomatic internal rectal prolapse: suspension or resection?"
3063:
1148:
after treatment is a problem. Two of the most commonly employed procedures are discussed below.
711:
previous surgery (30-50% of females with the condition underwent previous gynecological surgery)
1615:
Although SRUS is not a medically serious disease, it can be the cause of significantly reduced
1508:
7307:
7288:
6661:
6035:
6006:
5914:
5869:
5809:
5766:
5725:
5676:
5619:
5576:
5533:
5497:
5462:
5435:
5386:
5329:
5285:
5254:"Massive rectal bleeding: rare presentation of circumferential solitary rectal ulcer syndrome"
5234:
5185:
5136:
5101:
5063:
5028:
4993:
4942:
4893:
4844:
4795:
4743:
4705:
4656:
4608:
4570:
4534:
4499:
4437:
4394:
4351:
4316:
4259:
4216:
4172:
4126:
4090:
4034:
3961:
3925:
3887:
3825:
3778:
3735:
3691:
3648:
3605:
3570:
3527:
3484:
3443:
3381:
3338:
3302:
3225:
3165:
3081:
3026:
2990:
2963:
2910:
2880:
2812:
2777:
2750:
2690:
2644:
2591:
2518:
2470:
2410:
2310:
2259:
2189:
1880:
1857:
1449:
The essential cause of SRUS is thought to be related to too much straining during defecation.
1157:
887:
419:
218:
74:
5559:
Bishop PR, Nowicki MJ (June 2002). "Nonsurgical Therapy for Solitary Rectal Ulcer Syndrome".
5164:"A benign rectal ulcer penetrating into the prostate--diagnosis by prostate-specific antigen"
4864:"Pathology of the rectal wall in solitary rectal ulcer syndrome and complete rectal prolapse"
2306:
1749:
1175:
The advantage of the laparoscopic approach is decreased healing time and less complications.
7354:
7274:
7269:
7259:
7121:
6993:
6921:
6739:
6646:
6641:
6571:
6530:
6338:
6303:
5859:
5851:
5801:
5756:
5715:
5707:
5696:"Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback"
5666:
5658:
5611:
5568:
5525:
5489:
5425:
5417:
5376:
5368:
5319:
5275:
5265:
5224:
5216:
5175:
5128:
5093:
5020:
4983:
4973:
4932:
4924:
4883:
4875:
4834:
4826:
4785:
4777:
4735:
4695:
4687:
4646:
4638:
4562:
4526:
4489:
4481:
4429:
4386:
4343:
4306:
4298:
4251:
4208:
4164:
4118:
4080:
4072:
4026:
3953:
3917:
3877:
3867:
3817:
3770:
3727:
3683:
3640:
3597:
3562:
3519:
3474:
3433:
3425:
3373:
3330:
3292:
3284:
3215:
3207:
3157:
3073:
2953:
2943:
2804:
2740:
2730:
2680:
2634:
2626:
2583:
2575:
2510:
2298:
2249:
2241:
2181:
1847:
1810:
1725:
1600:
1497:
1403:
1260:
1192:
1141:
905:
and rectal invagination) is a medical condition defined as a funnel shaped infolding of the
844:
778:
beneficial to reduce constipation, and thereby reduce straining. A bulk forming agent (e.g.
632:
545:
108:
66:
2017:
601:
7312:
7242:
7108:
7043:
7008:
6879:
6680:
6582:
6501:
6492:
6442:
6382:
6267:
6244:
3105:
2906:
2901:
1780:
1769:
1765:
1754:
1704:
1616:
1414:
1408:
1373:
1254:
1105:
Nonsurgical measures to treat internal intussusception include pelvic floor retraining, a
956:
947:
757:
568:
555:
459:
362:
Type 2M Narrowed internal lumen with associated rectal hyposensitivity or early megarectum
112:
79:
6069:
4285:
Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, Tuech JJ, et al. (October 2009).
1327:(examination under anesthesia) of anorectum and banding of the mucosa with rubber bands.
7349:
7264:
6818:
6791:
6656:
6591:
6587:
6477:
6447:
5864:
5839:
5720:
5695:
5671:
5646:
5430:
5405:
5381:
5356:
5280:
5253:
5229:
5204:
4988:
4961:
4937:
4912:
4888:
4863:
4839:
4814:
4790:
4765:
4700:
4675:
4494:
4469:
4311:
4286:
4085:
4060:
3882:
3855:
3438:
3413:
3297:
3272:
3220:
3195:
3072:. Vol. 187. Global Initiative for Chronic Obstructive Lung Disease. pp. 1–7.
2958:
2931:
2745:
2718:
2254:
2229:
1852:
1835:
1619:
for patients. It is difficult to treat, and treatment is aimed at minimizing symptoms.
1574:
1515:
1479:
1140:(removed), or the rectum can be fixed (rectopexy) to its original position against the
737:
613:
5978:
5180:
5163:
2932:"Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child"
1699:
7373:
7282:
7235:
7028:
6971:
6954:
6866:
6611:
6438:
6313:
6279:
6224:
5805:
5761:
5744:
5308:"Clinical presentation of and outcome for solitary rectal ulcer syndrome in children"
5097:
4911:
Brosens LA, Montgomery EA, Bhagavan BS, Offerhaus GJ, Giardiello FM (November 2009).
4582:
4302:
4271:
4255:
4184:
4168:
3731:
3687:
3334:
3119:
2685:
2668:
1627:
1584:
1553:
1248:
1166:
1126:
1114:
937:
804:
325:
198:
5778:
5588:
5341:
5148:
5040:
4962:"Solitary rectal ulcer syndrome presenting as polypoid mass lesions in a young girl"
4766:"Transrectal ultrasound study of the pathogenesis of solitary rectal ulcer syndrome"
4449:
4406:
4228:
3973:
3921:
3837:
3790:
3703:
3660:
3617:
3496:
3393:
3350:
2824:
2667:
Nonaka T, Inamori M, Kessoku T, Ogawa Y, Yanagisawa S, Shiba T, et al. (2011).
2603:
2530:
1307:. The section of prolapsed rectal mucosa can become ulcerated, leading to bleeding.
7157:
7069:
6942:
6845:
6796:
6781:
6776:
6772:
6685:
6510:
6426:
6318:
6308:
6274:
6046:
5821:
5631:
5545:
4363:
4138:
3747:
3539:
3177:
2669:"A case of rectal cancer arising from long-standing prolapsed mucosa of the rectum"
2299:
2245:
1732:
1604:
1580:
1461:
1420:
1365:
1290:
1270:
967:
930:
663:
646:
642:
551:
515:
436:
423:
315:
3461:
Dvorkin LS, Gladman MA, Epstein J, Scott SM, Williams NS, Lunniss PJ (July 2005).
760:, creating a blockage that straining, anismus and colonic dysmotility exacerbate.
617:
6000:
5493:
5324:
5307:
4122:
1834:
Hammond K, Beck DE, Margolin DA, Whitlow CB, Timmcke AE, Hicks TC (Spring 2007).
1360:). The lining of the rectum is repeatedly damaged by this friction, resulting in
1003:. However, internal intussusception rarely progress to external rectal prolapse.
7337:
7099:
7077:
6908:
6828:
6472:
6373:
6126:
6030:
1721:
1643:
1511:
features of the conditions overlap. Indeed, CCP is managed identically to SRUS.
1369:
1265:
1225:
902:
874:
705:
609:
476:
399:
17:
6011:
3077:
2514:
7113:
6786:
6764:
6409:
6348:
6057:
6052:
5963:
5572:
5220:
5132:
4739:
4566:
4530:
4485:
4433:
4390:
4347:
4076:
4030:
3821:
3774:
3644:
3566:
3288:
2579:
1588:
1397:
1361:
1353:
1349:
1286:
1185:
1016:
910:
651:
605:
444:
311:
245:
229:
202:
3007:
Essential Revision Notes in Surgery for Medical Students By Irfan Halim; p139
1541:
The thickened lining or ulceration can also be mistaken for types of cancer.
157:(complete), where all the layers of the rectal wall prolapse, or involve the
7063:
7033:
6896:
6874:
6727:
6578:
6552:
6414:
6404:
6291:
6252:
6185:
6041:
5662:
5270:
4928:
2735:
2630:
1631:
1559:
1316:
folds in mucosal prolapse are usually associated with internal hemorrhoids.
1224:
Mucosal prolapse is a different condition to prolapsing (3rd or 4th degree)
1068:
1053:
1020:
497:
440:
415:
314:. The height of intussusception from the anal canal is usually estimated by
214:
96:
5873:
5855:
5680:
5580:
5501:
5466:
5439:
5421:
5390:
5333:
5289:
5238:
5203:
Tseng CA, Chen LT, Tsai KB, Su YC, Wu DC, Jan CM, et al. (June 2004).
5140:
4997:
4978:
4946:
4781:
4691:
4660:
4642:
4574:
4538:
4503:
4441:
4398:
4355:
4320:
4263:
4220:
4176:
4130:
4094:
4038:
3965:
3891:
3829:
3782:
3739:
3695:
3652:
3488:
3447:
3429:
3342:
3306:
3211:
3085:
3030:
2967:
2948:
2816:
2754:
2694:
2648:
2595:
2522:
2263:
2193:
1861:
1713:
can refer to many different medical conditions other than rectal prolapse.
1530:. Very rarely, cancer can arise on the section of prolapsed rectal lining.
5894:"Extreme Anal Porn's Shitty Consequences | VICE | United States"
5813:
5770:
5745:"Long-term clinical outcome of surgery for solitary rectal ulcer syndrome"
5729:
5623:
5537:
5189:
5105:
5067:
5032:
4897:
4848:
4830:
4799:
4747:
4709:
4612:
3929:
3872:
3609:
3574:
3531:
3385:
3229:
3194:
Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (December 1989).
3169:
2994:
2808:
2781:
678:
Abnormally low descent of the peritoneum covering the anterior rectal wall
6697:
6675:
6387:
5711:
4879:
4059:
Festen S, van Geloven AA, D'Hoore A, Lindsey I, Gerhards MF (June 2011).
2875:
Yamada T, Alpers DH, Kalloo AN, Kaplowitz N, Owyang C, Powell DW (2009).
1710:
1635:
1527:
1475:
1468:
1424:
1110:
1106:
977:
796:
779:
722:
718:
582:
573:
287:
first degree prolapse is detectable below the anorectal ring on straining
5946:
4764:
Van Outryve MJ, Pelckmans PA, Fierens H, Van Maercke YM (October 1993).
4651:
2587:
2139:
2137:
2135:
2133:
2131:
2129:
2127:
2125:
2123:
2121:
2119:
2117:
2115:
2113:
2111:
2109:
2107:
2105:
2103:
2101:
2099:
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2081:
2079:
2077:
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2071:
2069:
2067:
2065:
2063:
2061:
2059:
2057:
2055:
6749:
6515:
6419:
6391:
5615:
5529:
5024:
4212:
3957:
3601:
3523:
3377:
3161:
2639:
2185:
2053:
2051:
2049:
2047:
2045:
2043:
2041:
2039:
2037:
2035:
1815:
1568:
1457:
1196:
1130:
1012:
800:
472:
264:
5372:
2879:(5th ed.). Chichester, West Sussex: Blackwell Pub. p. 1725.
2717:
Abid S, Khawaja A, Bhimani SA, Ahmad Z, Hamid S, Jafri W (June 2012).
1988:
1986:
1984:
1982:
1980:
1978:
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1934:
1932:
1930:
1928:
1926:
1924:
1922:
1920:
1918:
1916:
7215:
6833:
6719:
5958:
4287:"STARR with Contour Transtar: prospective multicentre European study"
3479:
3462:
1914:
1912:
1910:
1908:
1906:
1904:
1902:
1900:
1898:
1896:
1788:
1592:
1548:
1345:
1304:
1214:
1211:
1118:
906:
635:
624:
210:
92:
5404:
Amaechi I, Papagrigoriadis S, Hizbullah S, Ryan SM (November 2010).
2445:"Internal Rectal Intussusception [Internal Rectal Prolapse]"
1728:, but rectal procidentia can also be a synonym for rectal prolapse.
1129:
or more severe FI), or paradoxical contraction of the pelvic floor (
518:). When children are affected, they are usually under the age of 3.
6665:
6395:
5840:"Evaluation, Diagnosis, and Medical Management of Rectal Prolapse"
4674:
Womack NR, Williams NS, Holmfield JH, Morrison JF (October 1987).
2981:
Turell R (April 1974). "Sexual problems as seen by proctologist".
1504:
1501:
600:
590:
496:
411:
296:
5406:"Solitary rectal ulcer syndrome mimicking rectal neoplasm on MRI"
2230:"Surgery for complete (full-thickness) rectal prolapse in adults"
1500:
in the rectum. Cystica profunda is characterized by formation of
1089:, while the patient strains as if to defecate. Imaging such as a
704:
pregnancy (although 35% of women who develop rectal prolapse are
5989:
4676:"Pressure and prolapse--the cause of solitary rectal ulceration"
3763:
International Urogynecology Journal and Pelvic Floor Dysfunction
1218:
1015:
also tend to have higher incidence of internal intussusception.
177:, where the whole circumference of the rectal wall prolapse, or
100:
6073:
1492:
Another condition associated with internal intussusception is
181:
if only parts of the circumference of the rectal wall prolapse
167:
if they protrude from the anus and are visible externally, or
5743:
Sitzler PJ, Kamm MA, Nicholls RJ, McKee RF (September 1998).
3196:"Defecography in normal volunteers: results and implications"
1496:(also known as CCP, or proctitis cystica profunda), which is
2438:
2436:
2434:
2432:
2430:
2428:
2426:
1331:
Solitary rectal ulcer syndrome and colitis cystica profunda
916:
This phenomenon was first described in the late 1960s when
5645:
Jarrett ME, Emmanuel AV, Vaizey CJ, Kamm MA (March 2004).
4913:"Mucosal prolapse syndrome presenting as rectal polyposis"
3243:
3241:
3239:
1646:
retraining to coordinate pelvic floor during defecation.
209:
stated that internal rectal intussusception involved the
1760:
Rectal intussusception is not to be confused with other
1544:
The differential diagnosis of SRUS (and CCP) includes:
1285:, is thought to be related to chronic straining during
1281:
The condition, along with complete rectal prolapse and
1165:
Rectopexy has been shown to improve anal incontinence (
654:. This proved an older theory from the 18th century by
489:
significant in predicting post-operative incontinence.
426:) which may show the associated mucosal abnormalities.
5162:
Gilrane TB, Orchard JL, Al-Assaad ZA (December 1987).
2870:
2868:
2866:
2864:
2862:
2860:
2858:
2856:
2854:
2467:
Advanced therapy in gastroenterology and liver disease
1056:, namely deficient recto-vaginal ligamentous support.
980:
during defecation, urgency, frequency or intermittent
27:
Protrusion of the walls of the rectum outside the body
5482:
European Journal of Gastroenterology & Hepatology
2852:
2850:
2848:
2846:
2844:
2842:
2840:
2838:
2836:
2834:
1622:
Stopping straining during bowel movements, by use of
544:, (50-80% of patients) which may simply present as a
5936:
5306:
Blackburn C, McDermott M, Bourke B (February 2012).
4960:
Saadah OI, Al-Hubayshi MS, Ghanem AT (August 2010).
4862:
Kang YS, Kamm MA, Engel AF, Talbot IC (April 1996).
3017:
Hampton BS (January 2009). "Pelvic organ prolapse".
1357:
1352:, caused by straining and increased pressure during
1282:
558:(a sensation of incomplete evacuation of stool) and
514:, or have a predisposing disorder (e.g., congenital
367:
Type 3: Internal-external recto-anal intussusception
7328:
7214:
7207:
7148:
7062:
7019:
6865:
6856:
6809:
6763:
6718:
6604:
6491:
6381:
6368:
6243:
6117:
6108:
6021:
5940:
5312:
Journal of Pediatric Gastroenterology and Nutrition
3250:"Rectal prolapse repair on Encyclopedia of Surgery"
2905:. Lippincott Williams & Wilkins. 2008. p.
2545:"Rectal Prolapse on Pittsburgh Colorectal Surgeons"
1652:Ulceration may persist even when symptoms resolve.
1121:to relieve constipation and straining. If there is
263:
Grade I: nonrelaxation of the sphincter mechanism (
73:
40:
35:
2900:
2400:
2398:
2396:
2394:
2392:
2390:
2388:
2386:
2384:
2382:
2380:
2378:
2376:
2374:
2372:
2370:
2368:
2366:
2364:
2362:
2360:
2358:
2356:
2354:
2352:
2350:
2348:
2346:
1995:"ASCRS core subjects: Prolapse andIntussusception"
1877:Rectal Prolapse: Diagnosis and Clinical Management
1779:section of rectal wall, which telescopes into the
1048:. One study concluded that intussusception of the
782:) or stool softener can also reduce constipation.
44:Complete rectal prolapse, external rectal prolapse
4463:
4461:
4459:
3414:"Functional disorders: rectoanal intussusception"
2344:
2342:
2340:
2338:
2336:
2334:
2332:
2330:
2328:
2326:
2018:"How stapled resection can treat rectal prolapse"
1607:as the investigation of choice to diagnose SRUS.
1184:from a similar stapling procedure for prolapsing
3143:
3141:
2292:
2290:
2288:
2286:
2284:
2282:
3189:
3187:
1460:, or non-relaxation/paradoxical contraction of
1456:More effort is required because of concomitant
184:present at rest, or occurring during straining.
99:to such a degree that they protrude out of the
61:. full thickness external rectal prolapse, and
5355:Umar SB, Efron JE, Heigh RI (September 2008).
5056:Indian Journal of Pathology & Microbiology
4054:
4052:
4050:
4048:
2407:The ASCRS textbook of colon and rectal surgery
1023:, indeed the 2 conditions can occur together.
342:Type 1: Internal recto-rectal intussusception
301:A. Normal anatomy: (r) rectum, (a) anal canal
290:second degree when it reached the dentate line
6085:
5561:Current Treatment Options in Gastroenterology
5121:Current Treatment Options in Gastroenterology
4150:
4148:
3849:
3847:
3802:
3800:
2496:
2494:
2492:
2490:
2488:
2486:
2223:
207:American Society of Colon and Rectal Surgeons
8:
6191:Esophagogastric junction outflow obstruction
5694:Vaizey CJ, Roy AJ, Kamm MA (December 1997).
3903:
3901:
2228:Tou S, Brown SR, Nelson RL (November 2015).
2221:
2219:
2217:
2215:
2213:
2211:
2209:
2207:
2205:
2203:
714:pelvic neuropathies and neurological disease
484:Anal electromyography/pudendal nerve testing
353:Type 2: Internal recto-anal intussusception
5013:International Journal of Colorectal Disease
4721:
4719:
3810:International Journal of Colorectal Disease
2797:International Journal of Colorectal Disease
2234:The Cochrane Database of Systematic Reviews
1179:Stapled trans-anal rectal resection (STARR)
1152:Laparoscopic ventral (mesh) rectopexy (LVR)
439:may demonstrate associated conditions like
293:third degree when it reached the anal verge
7211:
6862:
6378:
6230:Esophageal intramural pseudodiverticulosis
6114:
6092:
6078:
6070:
5937:
5357:"An interesting case of mistaken identity"
4966:World Journal of Gastrointestinal Oncology
1474:The site of the ulcer is typically on the
1235:(outlet obstruction). and rectal malodor.
1231:Rectal mucosal prolapse can be a cause of
49:
32:
5863:
5833:
5831:
5760:
5719:
5670:
5429:
5380:
5323:
5279:
5269:
5228:
5179:
5079:
5077:
4987:
4977:
4936:
4887:
4838:
4789:
4699:
4650:
4594:
4592:
4493:
4310:
4084:
4019:Gastroenterology Clinics of North America
3881:
3871:
3478:
3437:
3296:
3219:
2957:
2947:
2744:
2734:
2684:
2662:
2660:
2658:
2638:
2253:
1851:
5887:
5885:
5883:
5301:
5299:
4624:
4622:
3985:
3983:
3676:The American Journal of Gastroenterology
3555:Scandinavian Journal of Gastroenterology
3407:
3405:
3403:
2930:Saleem MM, Al-Momani H (December 2006).
886:This procedure can be carried out under
134:
4813:Madigan MR, Morson BC (November 1969).
4468:Pescatori M, Gagliardi G (March 2008).
2712:
2710:
2708:
2706:
2704:
2146:"Prolapse, Intussusception, & SRUS"
1836:"Rectal prolapse: a 10-year experience"
1826:
1630:intake (possibly included bulk forming
554:(20-50% of patients) also described as
4759:
4757:
4728:AJR. American Journal of Roentgenology
3101:
3091:
217:layers separating from the underlying
6458:Small intestinal bacterial overgrowth
1052:rectal wall shares the same cause as
1040:. They reported abnormalities of the
882:Anal encirclement (Thirsch procedure)
406:Proctoscopy/sigmoidoscopy/colonoscopy
146:. External (complete) rectal prolapse
7:
5915:"Procidentia on the Free Dictionary"
3124:The Lecturio Medical Concept Library
1413:Sensation of incomplete evacuation (
5844:Clinics in Colon and Rectal Surgery
3418:Clinics in Colon and Rectal Surgery
2547:. West Penn Allegheny Health System
2409:. New York: Springer. p. 674.
1038:stapled trans-anal rectal resection
803:and gaining surgical access to the
645:, In 1968 Broden and Snellman used
322:Recto-rectal (high) intussusception
273:Grade III: moderate intussusception
189:External (complete) rectal prolapse
142:. Internal rectal intussusception.
3720:Neurogastroenterology and Motility
3412:Weiss EG, McLemore EC (May 2008).
2983:New York State Journal of Medicine
2770:The Netherlands Journal of Surgery
1344:(SRUS, SRU), is a disorder of the
1228:, although they may look similar.
25:
7343:Spontaneous bacterial peritonitis
7190:Exocrine pancreatic insufficiency
5258:Saudi Journal of Gastroenterology
3518:(11): 1026–8, discussion 1028–9.
3019:Medicine and Health, Rhode Island
1251:causing staining of undergarments
7088:Secondary sclerosing cholangitis
5806:10.1046/j.1365-2168.1998.00935.x
5762:10.1046/j.1365-2168.1998.00854.x
5410:The British Journal of Radiology
5361:Case Reports in Gastroenterology
5215:(6): 895–903, discussion 903–5.
5209:Diseases of the Colon and Rectum
4555:Diseases of the Colon and Rectum
4303:10.1111/j.1463-1318.2008.01714.x
4256:10.1111/j.1463-1318.2009.01934.x
4169:10.1111/j.1463-1318.2009.01859.x
4111:Diseases of the Colon and Rectum
3732:10.1111/j.1365-2982.2011.01850.x
3688:10.1111/j.1572-0241.2005.41114.x
3633:Diseases of the Colon and Rectum
3590:Diseases of the Colon and Rectum
3512:Diseases of the Colon and Rectum
3366:Diseases of the Colon and Rectum
3335:10.1111/j.1463-1318.2010.02327.x
3150:Diseases of the Colon and Rectum
2902:"Professional Guide to Diseases"
2686:10.2169/internalmedicine.50.5924
1875:Altomare DF, Pucciani F (2007).
1743:- "action of undertaking", from
929:Internal intussusception may be
593:(swelling) and facilitate this.
410:These may reveal congestion and
332:Recto-anal (low) intussusception
303:B. Recto-rectal intussusception
276:Grade IV: severe intussusception
6329:Gastric antral vascular ectasia
6324:Portal hypertensive gastropathy
6201:Gastroesophageal reflux disease
5604:Digestive Diseases and Sciences
5518:Digestive Diseases and Sciences
3922:10.1148/radiology.174.1.2294538
2503:Scandinavian Journal of Surgery
1660:A group of conditions known as
1358:internal rectal intussusception
1283:internal rectal intussusception
1060:Comorbidities and complications
933:, but common symptoms include:
899:Internal rectal intussusception
894:Internal rectal intussusception
696:a patulous, weak anal sphincter
641:Shortly after the invention of
195:Internal rectal intussusception
7083:Primary sclerosing cholangitis
6933:Hepatic veno-occlusive disease
6755:Solitary rectal ulcer syndrome
5794:The British Journal of Surgery
5749:The British Journal of Surgery
4815:"Solitary ulcer of the rectum"
3992:"Prolapse and intussusception"
3467:The British Journal of Surgery
2305:. New York: Springer. p.
2276:Altomare, Pucciani (2007) p.14
2246:10.1002/14651858.CD001758.pub3
1755:Merriam-Webster.com Dictionary
1731:Intussusception is defined as
1705:Merriam-Webster.com Dictionary
1342:Solitary rectal ulcer syndrome
1337:Solitary rectal ulcer syndrome
1074:Solitary rectal ulcer syndrome
1028:solitary rectal ulcer syndrome
1001:solitary rectal ulcer syndrome
270:Grade II: mild intussusception
242:Solitary rectal ulcer syndrome
111:(mucus coming from the anus),
1:
7140:Sphincter of Oddi dysfunction
5181:10.1016/s0016-5107(87)71703-9
4917:Journal of Clinical Pathology
2020:. Contemporary surgery online
1775:Intussusceptum refers to the
1384:(rectal outlet obstruction).
537:history of a protruding mass.
305:C. Recto-anal intussusception
201:) wall that can occur during
7049:Postcholecystectomy syndrome
6568:Intestinal pseudoobstruction
6176:Esophageal motility disorder
5494:10.1097/MEG.0b013e32834b0dee
5325:10.1097/MPG.0b013e31823014c0
5098:10.1016/0016-5085(87)90868-7
4519:Techniques in Coloproctology
4474:Techniques in Coloproctology
4422:Techniques in Coloproctology
4379:Techniques in Coloproctology
4336:Techniques in Coloproctology
4123:10.1097/DCR.0b013e3182a85aa6
2877:Textbook of gastroenterology
2568:Techniques in Coloproctology
2465:Bayless TM, Diehl A (2005).
1534:Diagnosis and investigations
1380:, incomplete evacuation and
851:, thus avoid the risks of a
533:Signs and symptoms include:
480:further improve continence.
443:, vaginal vault prolapse or
5838:Cannon JA (February 2017).
4601:Clinics in Gastroenterology
3854:Hasan HM, Hasan HM (2012).
2297:Zbar AP, Wexner SD (2010).
909:wall that can occur during
859:Perineal rectosigmoidectomy
666:and protruding externally.
7401:
7034:Gallstone / Cholelithiasis
6558:Functional colonic disease
6354:Zollinger–Ellison syndrome
5455:The Ceylon Medical Journal
5252:Yagnik VD (Jul–Aug 2011).
5168:Gastrointestinal Endoscopy
3078:10.1164/rccm.201204-0596PP
2515:10.1177/145749690609500307
1514:Electromyography may show
1334:
1155:
1087:digital rectal examination
708:) (have never given birth)
674:) and anatomical factors:
565:a feeling of bearing down.
6235:Acute esophageal necrosis
5573:10.1007/s11938-002-0043-9
5221:10.1007/s10350-004-0531-1
5133:10.1007/s11938-002-0045-7
4740:10.2214/ajr.164.1.7998576
4567:10.1007/s10350-008-9378-1
4531:10.1007/s10151-008-0412-z
4486:10.1007/s10151-008-0391-0
4434:10.1007/s10151-008-0389-z
4391:10.1007/s10151-006-0310-1
4348:10.1007/s10151-003-0026-4
4077:10.1007/s00464-010-1501-4
4031:10.1016/j.gtc.2008.06.001
3822:10.1007/s00384-008-0522-0
3775:10.1007/s00192-007-0513-7
3645:10.1007/s10350-004-0834-2
3567:10.3109/00365529509093309
3252:. Encyclopedia of Surgery
3064:"Definition and Overview"
2580:10.1007/s10151-005-0219-0
2469:. PMPH-USA. p. 521.
1662:Mucosal prolapse syndrome
1656:Mucosal prolapse syndrome
1638:), stool softeners (e.g.
747:The assumed mechanism of
576:and erratic bowel habits.
253:Mucosal prolapse syndrome
236:Internal mucosal prolapse
91:occurs when walls of the
57:
48:
6334:Gastric dumping syndrome
6209:Laryngopharyngeal reflux
6196:Diffuse esophageal spasm
1879:. Springer. p. 12.
1494:colitis cystica profunda
966:intussusceptions may be
493:Complete rectal prolapse
458:may be used to rule out
279:Grade V: rectal prolapse
6950:Alcoholic liver disease
6483:Bile acid malabsorption
6427:Peptic (duodenal) ulcer
5663:10.1136/gut.2003.025643
5271:10.4103/1319-3767.82592
4929:10.1136/jcp.2009.067801
3994:. ASCRS. Archived from
3289:10.1093/bjsopen/zrac018
2736:10.1186/1471-230X-12-72
2631:10.2310/6620.2011.11017
2148:. ASCRS. Archived from
2144:Madhulika G, Varma MD.
1208:Rectal mucosal prolapse
827:Laparoscopic procedures
456:Colonic transit studies
451:Colonic transit studies
6960:Hepatic encephalopathy
6344:Buried bumper syndrome
6275:Peptic (gastric) ulcer
6159:Mallory–Weiss syndrome
6102:human digestive system
5892:Lhooq M (2014-06-17).
5856:10.1055/s-0036-1593431
4979:10.4251/wjgo.v2.i8.332
4782:10.1136/gut.34.10.1422
4692:10.1136/gut.28.10.1228
4643:10.1542/peds.110.6.e79
3430:10.1055/s-2008-1075861
3212:10.1136/gut.30.12.1737
3051:. Parasites In Humans.
2949:10.1186/1471-2482-6-19
1042:enteric nervous system
717:high gastrointestinal
620:
502:
359:Type 2N Narrowed lumen
348:Type 1N Narrowed lumen
306:
147:
7185:Pancreatic pseudocyst
7054:Porcelain gallbladder
6166:Zenker's diverticulum
4831:10.1136/gut.10.11.871
3045:"Trichuris Trichiura"
2809:10.1007/s003840050218
1806:Obstructed defecation
1720:- "to fall forward".
1382:obstructed defecation
1233:obstructed defecation
1091:defecating proctogram
1033:obstructed defecation
944:obstructed defecation
687:long rectal mesentery
672:obstructed defecation
604:
560:obstructed defecation
512:obstructed defecation
500:
300:
138:
121:obstructed defecation
6989:Hepatorenal syndrome
6928:Budd–Chiari syndrome
6885:Autoimmune hepatitis
6710:Intestinal adhesions
6468:Short bowel syndrome
6297:Functional dyspepsia
6215:Esophageal stricture
6181:Nutcracker esophagus
5712:10.1136/gut.41.6.817
5422:10.1259/bjr/24752209
4880:10.1136/gut.38.4.587
3808:prospective study".
2723:BMC Gastroenterology
1564:infectious disorders
849:intravenous sedation
815:Abdominal procedures
386:Physical examination
161:layer only (partial)
7128:Choledocholithiasis
6999:Metabolic disorders
6965:Acute liver failure
6938:Portal hypertension
6890:Alcoholic hepatitis
6733:Radiation proctitis
6652:Mesenteric ischemia
6624:Gastroenterocolitis
6453:Blind loop syndrome
6263:Ménétrier's disease
6171:Barrett's esophagus
3873:10.5402/2012/652345
2152:on 14 December 2013
1840:The Ochsner Journal
1640:polyethylene glycol
1368:, but it can cause
1095:anorectal manometry
841:regional anesthetic
834:Perineal procedures
823:(keyhole surgery).
660:Albrecht von Haller
466:Anorectal manometry
7380:Colorectal surgery
7303:Undefined location
7294:Grynfeltt–Lesshaft
7195:Pancreatic fistula
7178:Pancreatic abscess
7133:Biliary dyskinesia
7104:Mirizzi's syndrome
6605:Large and/or small
6285:Dieulafoy's lesion
6154:Boerhaave syndrome
6022:External resources
5616:10.1007/bf01311251
5530:10.1007/bf01536986
5416:(995): e221–e224.
5025:10.1007/bf00341203
4291:Colorectal Disease
4244:Colorectal Disease
4213:10.1111/codi.12443
4201:Colorectal Disease
4157:Colorectal Disease
4065:Surgical Endoscopy
3998:on 24 January 2013
3958:10.1111/codi.12367
3946:Colorectal Disease
3602:10.1007/bf02587429
3524:10.1007/bf02252991
3378:10.1007/bf02554307
3323:Colorectal Disease
3162:10.1007/bf02055439
2186:10.1111/codi.12751
1801:Fecal incontinence
1758:. Merriam-Webster.
1724:usually refers to
1708:. Merriam-Webster.
1430:fecal incontinence
1392:Symptoms include:
1298:muscularis propria
1046:estrogen receptors
1009:outlet obstruction
982:fecal incontinence
853:general anesthetic
749:fecal incontinence
621:
542:fecal incontinence
529:Signs and symptoms
506:life-threatening.
503:
356:Type 2W Wide Lumen
345:Type 1W Wide lumen
307:
148:
117:fecal incontinence
7367:
7366:
7363:
7362:
7203:
7202:
6805:
6804:
6662:Bowel obstruction
6364:
6363:
6067:
6066:
5800:(12): 1617–1623.
5610:(11): 1005–1008.
5524:(11): 1345–1352.
5488:(12): 1262–1266.
5373:10.1159/000154816
4923:(11): 1034–1036.
4776:(10): 1422–1426.
4686:(10): 1228–1233.
4561:(11): 1611–1618.
4207:(12): e749–e756.
4117:(12): 1409–1414.
4025:(3): 645–68, ix.
3952:(11): e680–e685.
3206:(12): 1737–1749.
3120:"Cystic Fibrosis"
3062:Vestbo J (2013).
2916:978-0-7817-7899-2
2886:978-1-4051-6911-0
2679:(21): 2569–2573.
2673:Internal Medicine
2476:978-1-55009-248-6
2416:978-0-387-24846-2
2316:978-1-84882-755-4
1886:978-88-470-0683-6
1750:"Intussusception"
1423:, or more rarely
1396:Straining during
1158:Ventral rectopexy
888:local anaesthetic
868:Delorme Procedure
693:levator diastasis
690:a deep cul-de-sac
430:Videodefecography
420:colorectal cancer
219:muscularis mucosa
85:
84:
30:Medical condition
16:(Redirected from
7392:
7355:Pneumoperitoneum
7212:
7122:Common bile duct
7004:Wilson's disease
6994:Peliosis hepatis
6863:
6740:Proctalgia fugax
6647:Abdominal angina
6572:Ogilvie syndrome
6521:Pseudomembranous
6379:
6339:Gastric volvulus
6304:Pyloric stenosis
6115:
6100:Diseases of the
6094:
6087:
6080:
6071:
5938:
5927:
5926:
5924:
5922:
5911:
5905:
5904:
5902:
5901:
5889:
5878:
5877:
5867:
5835:
5826:
5825:
5789:
5783:
5782:
5764:
5755:(9): 1246–1250.
5740:
5734:
5733:
5723:
5691:
5685:
5684:
5674:
5642:
5636:
5635:
5599:
5593:
5592:
5556:
5550:
5549:
5512:
5506:
5505:
5477:
5471:
5470:
5450:
5444:
5443:
5433:
5401:
5395:
5394:
5384:
5352:
5346:
5345:
5327:
5303:
5294:
5293:
5283:
5273:
5249:
5243:
5242:
5232:
5200:
5194:
5193:
5183:
5159:
5153:
5152:
5116:
5110:
5109:
5086:Gastroenterology
5081:
5072:
5071:
5051:
5045:
5044:
5008:
5002:
5001:
4991:
4981:
4957:
4951:
4950:
4940:
4908:
4902:
4901:
4891:
4859:
4853:
4852:
4842:
4810:
4804:
4803:
4793:
4761:
4752:
4751:
4723:
4714:
4713:
4703:
4671:
4665:
4664:
4654:
4626:
4617:
4616:
4596:
4587:
4586:
4549:
4543:
4542:
4514:
4508:
4507:
4497:
4465:
4454:
4453:
4417:
4411:
4410:
4374:
4368:
4367:
4331:
4325:
4324:
4314:
4282:
4276:
4275:
4239:
4233:
4232:
4195:
4189:
4188:
4152:
4143:
4142:
4105:
4099:
4098:
4088:
4071:(6): 2000–2003.
4056:
4043:
4042:
4014:
4008:
4007:
4005:
4003:
3987:
3978:
3977:
3940:
3934:
3933:
3905:
3896:
3895:
3885:
3875:
3851:
3842:
3841:
3816:(10): 999–1005.
3804:
3795:
3794:
3758:
3752:
3751:
3726:(3): e155–e161.
3714:
3708:
3707:
3682:(7): 1578–1585.
3671:
3665:
3664:
3628:
3622:
3621:
3585:
3579:
3578:
3550:
3544:
3543:
3507:
3501:
3500:
3482:
3480:10.1002/bjs.4912
3458:
3452:
3451:
3441:
3409:
3398:
3397:
3361:
3355:
3354:
3317:
3311:
3310:
3300:
3268:
3262:
3261:
3259:
3257:
3245:
3234:
3233:
3223:
3191:
3182:
3181:
3145:
3136:
3135:
3133:
3131:
3116:
3110:
3109:
3103:
3099:
3097:
3089:
3059:
3053:
3052:
3041:
3035:
3034:
3014:
3008:
3005:
2999:
2998:
2978:
2972:
2971:
2961:
2951:
2927:
2921:
2920:
2904:
2897:
2891:
2890:
2872:
2829:
2828:
2803:(4–5): 245–249.
2792:
2786:
2785:
2765:
2759:
2758:
2748:
2738:
2714:
2699:
2698:
2688:
2664:
2653:
2652:
2642:
2614:
2608:
2607:
2563:
2557:
2556:
2554:
2552:
2541:
2535:
2534:
2498:
2481:
2480:
2462:
2456:
2455:
2453:
2451:
2440:
2421:
2420:
2402:
2321:
2320:
2304:
2294:
2277:
2274:
2268:
2267:
2257:
2240:(11): CD001758.
2225:
2198:
2197:
2168:
2162:
2161:
2159:
2157:
2141:
2030:
2029:
2027:
2025:
2013:
2007:
2006:
2004:
2002:
1990:
1891:
1890:
1872:
1866:
1865:
1855:
1831:
1811:Rectal discharge
1762:intussusceptions
1759:
1747:- "to take up".
1726:uterine prolapse
1709:
1601:electromyography
1573:mucus-producing
1498:cystica profunda
1404:rectal discharge
1261:rectal discharge
1203:Mucosal prolapse
1142:sacral vertebrae
845:local anesthetic
731:cystic fibrosis
647:cinedefecography
633:pouch of Douglas
546:mucous discharge
226:Mucosal prolapse
109:mucous discharge
67:mucosal prolapse
53:
33:
21:
18:Mucosal prolapse
7400:
7399:
7395:
7394:
7393:
7391:
7390:
7389:
7385:Rectal diseases
7370:
7369:
7368:
7359:
7324:
7313:Internal hernia
7199:
7144:
7109:Biliary fistula
7067:
7058:
7044:Adenomyomatosis
7039:Cholesterolosis
7015:
7009:Hemochromatosis
6880:Viral hepatitis
6852:
6801:
6759:
6745:Rectal prolapse
6714:
6681:Fecal impaction
6671:Intussusception
6634:Crohn's disease
6600:
6583:Toxic megacolon
6495:
6493:Large intestine
6487:
6432:Curling's ulcer
6385:
6383:Small intestine
6372:
6360:
6268:Gastroenteritis
6239:
6104:
6098:
6068:
6063:
6062:
6058:Rectal prolapse
6017:
6016:
5949:
5935:
5930:
5920:
5918:
5913:
5912:
5908:
5899:
5897:
5891:
5890:
5881:
5837:
5836:
5829:
5791:
5790:
5786:
5742:
5741:
5737:
5693:
5692:
5688:
5644:
5643:
5639:
5601:
5600:
5596:
5558:
5557:
5553:
5514:
5513:
5509:
5479:
5478:
5474:
5452:
5451:
5447:
5403:
5402:
5398:
5354:
5353:
5349:
5305:
5304:
5297:
5251:
5250:
5246:
5202:
5201:
5197:
5161:
5160:
5156:
5118:
5117:
5113:
5083:
5082:
5075:
5053:
5052:
5048:
5010:
5009:
5005:
4959:
4958:
4954:
4910:
4909:
4905:
4861:
4860:
4856:
4825:(11): 871–881.
4812:
4811:
4807:
4763:
4762:
4755:
4725:
4724:
4717:
4673:
4672:
4668:
4628:
4627:
4620:
4607:(4): 985–1002.
4598:
4597:
4590:
4551:
4550:
4546:
4516:
4515:
4511:
4467:
4466:
4457:
4419:
4418:
4414:
4376:
4375:
4371:
4333:
4332:
4328:
4284:
4283:
4279:
4241:
4240:
4236:
4197:
4196:
4192:
4154:
4153:
4146:
4107:
4106:
4102:
4058:
4057:
4046:
4016:
4015:
4011:
4001:
3999:
3989:
3988:
3981:
3942:
3941:
3937:
3907:
3906:
3899:
3853:
3852:
3845:
3806:
3805:
3798:
3760:
3759:
3755:
3716:
3715:
3711:
3673:
3672:
3668:
3630:
3629:
3625:
3587:
3586:
3582:
3552:
3551:
3547:
3509:
3508:
3504:
3460:
3459:
3455:
3411:
3410:
3401:
3372:(12): 920–924.
3363:
3362:
3358:
3319:
3318:
3314:
3270:
3269:
3265:
3255:
3253:
3247:
3246:
3237:
3193:
3192:
3185:
3147:
3146:
3139:
3129:
3127:
3126:. 7 August 2020
3118:
3117:
3113:
3100:
3090:
3061:
3060:
3056:
3043:
3042:
3038:
3016:
3015:
3011:
3006:
3002:
2980:
2979:
2975:
2929:
2928:
2924:
2917:
2899:
2898:
2894:
2887:
2874:
2873:
2832:
2794:
2793:
2789:
2767:
2766:
2762:
2716:
2715:
2702:
2666:
2665:
2656:
2616:
2615:
2611:
2565:
2564:
2560:
2550:
2548:
2543:
2542:
2538:
2500:
2499:
2484:
2477:
2464:
2463:
2459:
2449:
2447:
2442:
2441:
2424:
2417:
2404:
2403:
2324:
2317:
2296:
2295:
2280:
2275:
2271:
2227:
2226:
2201:
2170:
2169:
2165:
2155:
2153:
2143:
2142:
2033:
2023:
2021:
2015:
2014:
2010:
2000:
1998:
1992:
1991:
1894:
1887:
1874:
1873:
1869:
1833:
1832:
1828:
1824:
1797:
1770:small intestine
1748:
1739:- "within" and
1698:
1687:
1678:
1670:
1658:
1624:correct posture
1617:quality of life
1613:
1587:, transrectal
1536:
1524:
1518:motor latency.
1447:
1439:
1409:Rectal bleeding
1390:
1374:rectal bleeding
1339:
1333:
1322:
1313:
1279:
1255:Rectal bleeding
1241:
1205:
1193:contraindicated
1181:
1160:
1154:
1103:
1083:
1062:
993:
957:Rectal bleeding
927:
896:
836:
817:
788:
775:
770:
599:
569:rectal bleeding
531:
495:
486:
468:
460:colonic inertia
453:
432:
408:
388:
379:
374:
304:
302:
175:circumferential
133:
113:rectal bleeding
89:rectal prolapse
80:General surgery
36:Rectal prolapse
31:
28:
23:
22:
15:
12:
11:
5:
7398:
7396:
7388:
7387:
7382:
7372:
7371:
7365:
7364:
7361:
7360:
7358:
7357:
7352:
7350:Hemoperitoneum
7347:
7346:
7345:
7334:
7332:
7326:
7325:
7323:
7322:
7321:
7320:
7315:
7310:
7299:
7298:
7297:
7296:
7291:
7278:
7277:
7272:
7267:
7262:
7257:
7256:
7255:
7250:
7239:
7238:
7233:
7232:
7231:
7220:
7218:
7209:
7205:
7204:
7201:
7200:
7198:
7197:
7192:
7187:
7182:
7181:
7180:
7175:
7170:
7165:
7154:
7152:
7146:
7145:
7143:
7142:
7137:
7136:
7135:
7130:
7117:
7116:
7111:
7106:
7097:
7096:
7095:
7090:
7085:
7074:
7072:
7060:
7059:
7057:
7056:
7051:
7046:
7041:
7036:
7031:
7025:
7023:
7017:
7016:
7014:
7013:
7012:
7011:
7006:
6996:
6991:
6986:
6985:
6984:
6979:
6969:
6968:
6967:
6962:
6952:
6947:
6946:
6945:
6940:
6935:
6930:
6918:
6917:
6916:
6906:
6905:
6904:
6894:
6893:
6892:
6887:
6882:
6871:
6869:
6860:
6854:
6853:
6851:
6850:
6849:
6848:
6838:
6837:
6836:
6831:
6821:
6819:Blood in stool
6815:
6813:
6807:
6806:
6803:
6802:
6800:
6799:
6794:
6792:Anal dysplasia
6789:
6784:
6779:
6769:
6767:
6761:
6760:
6758:
6757:
6752:
6747:
6742:
6737:
6736:
6735:
6724:
6722:
6716:
6715:
6713:
6712:
6707:
6706:
6705:
6695:
6694:
6693:
6683:
6678:
6673:
6668:
6659:
6657:Angiodysplasia
6654:
6649:
6638:
6637:
6636:
6626:
6621:
6620:
6619:
6608:
6606:
6602:
6601:
6599:
6598:
6592:Diverticulosis
6588:Diverticulitis
6585:
6576:
6575:
6574:
6565:
6555:
6550:
6549:
6548:
6543:
6538:
6533:
6528:
6523:
6513:
6507:
6505:
6489:
6488:
6486:
6485:
6480:
6478:Milroy disease
6475:
6470:
6465:
6460:
6455:
6450:
6448:Tropical sprue
6445:
6436:
6435:
6434:
6424:
6423:
6422:
6417:
6412:
6401:
6399:
6376:
6370:Lower GI tract
6366:
6365:
6362:
6361:
6359:
6358:
6357:
6356:
6346:
6341:
6336:
6331:
6326:
6321:
6316:
6311:
6306:
6301:
6300:
6299:
6289:
6288:
6287:
6282:
6272:
6271:
6270:
6265:
6260:
6249:
6247:
6241:
6240:
6238:
6237:
6232:
6227:
6222:
6217:
6212:
6206:
6205:
6204:
6198:
6193:
6188:
6183:
6173:
6168:
6163:
6162:
6161:
6156:
6146:
6145:
6144:
6139:
6134:
6123:
6121:
6112:
6110:Upper GI tract
6106:
6105:
6099:
6097:
6096:
6089:
6082:
6074:
6065:
6064:
6061:
6060:
6049:
6038:
6026:
6025:
6023:
6019:
6018:
6015:
6014:
6003:
5992:
5981:
5966:
5950:
5945:
5944:
5942:
5941:Classification
5934:
5933:External links
5931:
5929:
5928:
5906:
5879:
5827:
5784:
5735:
5706:(6): 817–820.
5686:
5657:(3): 368–370.
5637:
5594:
5567:(3): 215–223.
5551:
5507:
5472:
5461:(4): 241–242.
5445:
5396:
5367:(3): 308–313.
5347:
5318:(2): 263–265.
5295:
5244:
5195:
5174:(6): 467–468.
5154:
5127:(3): 231–237.
5111:
5092:(1): 243–253.
5073:
5046:
5003:
4972:(8): 332–334.
4952:
4903:
4874:(4): 587–590.
4854:
4805:
4753:
4715:
4666:
4618:
4588:
4544:
4525:(2): 135–136.
4509:
4455:
4412:
4385:(4): 361–363.
4369:
4342:(3): 148–153.
4326:
4297:(8): 821–827.
4277:
4250:(6): 504–512.
4234:
4190:
4163:(6): 526–532.
4144:
4100:
4044:
4009:
3979:
3935:
3916:(1): 124–126.
3897:
3843:
3796:
3769:(5): 705–710.
3753:
3709:
3666:
3639:(4): 824–831.
3623:
3596:(5): 391–396.
3580:
3561:(5): 470–472.
3545:
3502:
3473:(7): 866–872.
3453:
3424:(2): 122–128.
3399:
3356:
3329:(8): 914–917.
3312:
3283:(2): zrac018.
3263:
3235:
3183:
3156:(7): 817–820.
3137:
3111:
3102:|journal=
3054:
3036:
3009:
3000:
2989:(4): 697–698.
2973:
2922:
2915:
2892:
2885:
2830:
2787:
2776:(6): 145–148.
2760:
2700:
2654:
2625:(4): 227–229.
2609:
2574:(2): 163–165.
2558:
2536:
2509:(3): 166–171.
2482:
2475:
2457:
2422:
2415:
2322:
2315:
2301:Coloproctology
2278:
2269:
2199:
2163:
2031:
2008:
1892:
1885:
1867:
1825:
1823:
1820:
1819:
1818:
1813:
1808:
1803:
1796:
1793:
1697:- "to slide".
1693:- "forward" +
1686:
1683:
1677:
1674:
1669:
1666:
1657:
1654:
1612:
1609:
1578:
1577:
1575:adenocarcinoma
1571:
1565:
1562:
1556:
1551:
1535:
1532:
1523:
1520:
1516:pudendal nerve
1480:rectal ampulla
1446:
1443:
1438:
1435:
1434:
1433:
1427:
1418:
1411:
1406:
1400:
1389:
1386:
1378:rectal malodor
1335:Main article:
1332:
1329:
1321:
1318:
1312:
1309:
1278:
1275:
1274:
1273:
1268:
1263:
1257:
1252:
1240:
1237:
1204:
1201:
1180:
1177:
1156:Main article:
1153:
1150:
1102:
1099:
1082:
1079:
1078:
1077:
1071:
1061:
1058:
1026:Patients with
992:
989:
961:
960:
954:
951:
940:
926:
923:
895:
892:
835:
832:
816:
813:
787:
784:
774:
771:
769:
766:
738:pudendal nerve
733:
732:
729:
726:
715:
712:
709:
698:
697:
694:
691:
688:
685:
682:
679:
614:lamina propria
598:
595:
578:
577:
571:
566:
563:
549:
538:
530:
527:
494:
491:
485:
482:
467:
464:
452:
449:
431:
428:
407:
404:
387:
384:
378:
375:
373:
370:
369:
368:
365:
364:
363:
360:
357:
351:
350:
349:
346:
295:
294:
291:
288:
281:
280:
277:
274:
271:
268:
186:
185:
182:
172:
171:if they do not
162:
155:full thickness
132:
131:Classification
129:
83:
82:
77:
71:
70:
55:
54:
46:
45:
42:
38:
37:
29:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
7397:
7386:
7383:
7381:
7378:
7377:
7375:
7356:
7353:
7351:
7348:
7344:
7341:
7340:
7339:
7336:
7335:
7333:
7331:
7327:
7319:
7316:
7314:
7311:
7309:
7306:
7305:
7304:
7301:
7300:
7295:
7292:
7290:
7287:
7286:
7285:
7284:
7280:
7279:
7276:
7273:
7271:
7268:
7266:
7263:
7261:
7258:
7254:
7251:
7249:
7246:
7245:
7244:
7241:
7240:
7237:
7234:
7230:
7227:
7226:
7225:
7224:Diaphragmatic
7222:
7221:
7219:
7217:
7213:
7210:
7206:
7196:
7193:
7191:
7188:
7186:
7183:
7179:
7176:
7174:
7171:
7169:
7166:
7164:
7161:
7160:
7159:
7156:
7155:
7153:
7151:
7147:
7141:
7138:
7134:
7131:
7129:
7126:
7125:
7124:
7123:
7119:
7118:
7115:
7112:
7110:
7107:
7105:
7101:
7098:
7094:
7091:
7089:
7086:
7084:
7081:
7080:
7079:
7076:
7075:
7073:
7071:
7065:
7061:
7055:
7052:
7050:
7047:
7045:
7042:
7040:
7037:
7035:
7032:
7030:
7029:Cholecystitis
7027:
7026:
7024:
7022:
7018:
7010:
7007:
7005:
7002:
7001:
7000:
6997:
6995:
6992:
6990:
6987:
6983:
6980:
6978:
6975:
6974:
6973:
6972:Liver abscess
6970:
6966:
6963:
6961:
6958:
6957:
6956:
6955:Liver failure
6953:
6951:
6948:
6944:
6941:
6939:
6936:
6934:
6931:
6929:
6926:
6925:
6924:
6923:
6919:
6915:
6912:
6911:
6910:
6907:
6903:
6900:
6899:
6898:
6895:
6891:
6888:
6886:
6883:
6881:
6878:
6877:
6876:
6873:
6872:
6870:
6868:
6864:
6861:
6859:
6855:
6847:
6844:
6843:
6842:
6839:
6835:
6832:
6830:
6827:
6826:
6825:
6822:
6820:
6817:
6816:
6814:
6812:
6808:
6798:
6795:
6793:
6790:
6788:
6785:
6783:
6780:
6778:
6774:
6771:
6770:
6768:
6766:
6762:
6756:
6753:
6751:
6748:
6746:
6743:
6741:
6738:
6734:
6731:
6730:
6729:
6726:
6725:
6723:
6721:
6717:
6711:
6708:
6704:
6701:
6700:
6699:
6696:
6692:
6689:
6688:
6687:
6684:
6682:
6679:
6677:
6674:
6672:
6669:
6667:
6663:
6660:
6658:
6655:
6653:
6650:
6648:
6644:
6643:
6639:
6635:
6632:
6631:
6630:
6627:
6625:
6622:
6618:
6615:
6614:
6613:
6612:Enterocolitis
6610:
6609:
6607:
6603:
6597:
6593:
6589:
6586:
6584:
6580:
6577:
6573:
6569:
6566:
6564:
6561:
6560:
6559:
6556:
6554:
6551:
6547:
6544:
6542:
6539:
6537:
6534:
6532:
6529:
6527:
6524:
6522:
6519:
6518:
6517:
6514:
6512:
6509:
6508:
6506:
6503:
6499:
6494:
6490:
6484:
6481:
6479:
6476:
6474:
6471:
6469:
6466:
6464:
6461:
6459:
6456:
6454:
6451:
6449:
6446:
6444:
6440:
6439:Malabsorption
6437:
6433:
6430:
6429:
6428:
6425:
6421:
6418:
6416:
6413:
6411:
6408:
6407:
6406:
6403:
6402:
6400:
6397:
6393:
6389:
6384:
6380:
6377:
6375:
6371:
6367:
6355:
6352:
6351:
6350:
6347:
6345:
6342:
6340:
6337:
6335:
6332:
6330:
6327:
6325:
6322:
6320:
6317:
6315:
6314:Gastroparesis
6312:
6310:
6307:
6305:
6302:
6298:
6295:
6294:
6293:
6290:
6286:
6283:
6281:
6280:Cushing ulcer
6278:
6277:
6276:
6273:
6269:
6266:
6264:
6261:
6259:
6256:
6255:
6254:
6251:
6250:
6248:
6246:
6242:
6236:
6233:
6231:
6228:
6226:
6225:Megaesophagus
6223:
6221:
6218:
6216:
6213:
6210:
6207:
6202:
6199:
6197:
6194:
6192:
6189:
6187:
6184:
6182:
6179:
6178:
6177:
6174:
6172:
6169:
6167:
6164:
6160:
6157:
6155:
6152:
6151:
6150:
6147:
6143:
6140:
6138:
6135:
6133:
6130:
6129:
6128:
6125:
6124:
6122:
6120:
6116:
6113:
6111:
6107:
6103:
6095:
6090:
6088:
6083:
6081:
6076:
6075:
6072:
6059:
6055:
6054:
6050:
6048:
6044:
6043:
6039:
6037:
6033:
6032:
6028:
6027:
6024:
6020:
6013:
6009:
6008:
6004:
6002:
5998:
5997:
5993:
5991:
5987:
5986:
5982:
5980:
5976:
5975:
5971:
5967:
5965:
5961:
5960:
5956:
5952:
5951:
5948:
5943:
5939:
5932:
5916:
5910:
5907:
5895:
5888:
5886:
5884:
5880:
5875:
5871:
5866:
5861:
5857:
5853:
5849:
5845:
5841:
5834:
5832:
5828:
5823:
5819:
5815:
5811:
5807:
5803:
5799:
5795:
5788:
5785:
5780:
5776:
5772:
5768:
5763:
5758:
5754:
5750:
5746:
5739:
5736:
5731:
5727:
5722:
5717:
5713:
5709:
5705:
5701:
5697:
5690:
5687:
5682:
5678:
5673:
5668:
5664:
5660:
5656:
5652:
5648:
5641:
5638:
5633:
5629:
5625:
5621:
5617:
5613:
5609:
5605:
5598:
5595:
5590:
5586:
5582:
5578:
5574:
5570:
5566:
5562:
5555:
5552:
5547:
5543:
5539:
5535:
5531:
5527:
5523:
5519:
5511:
5508:
5503:
5499:
5495:
5491:
5487:
5483:
5476:
5473:
5468:
5464:
5460:
5456:
5449:
5446:
5441:
5437:
5432:
5427:
5423:
5419:
5415:
5411:
5407:
5400:
5397:
5392:
5388:
5383:
5378:
5374:
5370:
5366:
5362:
5358:
5351:
5348:
5343:
5339:
5335:
5331:
5326:
5321:
5317:
5313:
5309:
5302:
5300:
5296:
5291:
5287:
5282:
5277:
5272:
5267:
5263:
5259:
5255:
5248:
5245:
5240:
5236:
5231:
5226:
5222:
5218:
5214:
5210:
5206:
5199:
5196:
5191:
5187:
5182:
5177:
5173:
5169:
5165:
5158:
5155:
5150:
5146:
5142:
5138:
5134:
5130:
5126:
5122:
5115:
5112:
5107:
5103:
5099:
5095:
5091:
5087:
5080:
5078:
5074:
5069:
5065:
5062:(2): 94–102.
5061:
5057:
5050:
5047:
5042:
5038:
5034:
5030:
5026:
5022:
5018:
5014:
5007:
5004:
4999:
4995:
4990:
4985:
4980:
4975:
4971:
4967:
4963:
4956:
4953:
4948:
4944:
4939:
4934:
4930:
4926:
4922:
4918:
4914:
4907:
4904:
4899:
4895:
4890:
4885:
4881:
4877:
4873:
4869:
4865:
4858:
4855:
4850:
4846:
4841:
4836:
4832:
4828:
4824:
4820:
4816:
4809:
4806:
4801:
4797:
4792:
4787:
4783:
4779:
4775:
4771:
4767:
4760:
4758:
4754:
4749:
4745:
4741:
4737:
4733:
4729:
4722:
4720:
4716:
4711:
4707:
4702:
4697:
4693:
4689:
4685:
4681:
4677:
4670:
4667:
4662:
4658:
4653:
4648:
4644:
4640:
4636:
4632:
4625:
4623:
4619:
4614:
4610:
4606:
4602:
4595:
4593:
4589:
4584:
4580:
4576:
4572:
4568:
4564:
4560:
4556:
4548:
4545:
4540:
4536:
4532:
4528:
4524:
4520:
4513:
4510:
4505:
4501:
4496:
4491:
4487:
4483:
4479:
4475:
4471:
4464:
4462:
4460:
4456:
4451:
4447:
4443:
4439:
4435:
4431:
4427:
4423:
4416:
4413:
4408:
4404:
4400:
4396:
4392:
4388:
4384:
4380:
4373:
4370:
4365:
4361:
4357:
4353:
4349:
4345:
4341:
4337:
4330:
4327:
4322:
4318:
4313:
4308:
4304:
4300:
4296:
4292:
4288:
4281:
4278:
4273:
4269:
4265:
4261:
4257:
4253:
4249:
4245:
4238:
4235:
4230:
4226:
4222:
4218:
4214:
4210:
4206:
4202:
4194:
4191:
4186:
4182:
4178:
4174:
4170:
4166:
4162:
4158:
4151:
4149:
4145:
4140:
4136:
4132:
4128:
4124:
4120:
4116:
4112:
4104:
4101:
4096:
4092:
4087:
4082:
4078:
4074:
4070:
4066:
4062:
4055:
4053:
4051:
4049:
4045:
4040:
4036:
4032:
4028:
4024:
4020:
4013:
4010:
3997:
3993:
3986:
3984:
3980:
3975:
3971:
3967:
3963:
3959:
3955:
3951:
3947:
3939:
3936:
3931:
3927:
3923:
3919:
3915:
3911:
3904:
3902:
3898:
3893:
3889:
3884:
3879:
3874:
3869:
3865:
3861:
3857:
3850:
3848:
3844:
3839:
3835:
3831:
3827:
3823:
3819:
3815:
3811:
3803:
3801:
3797:
3792:
3788:
3784:
3780:
3776:
3772:
3768:
3764:
3757:
3754:
3749:
3745:
3741:
3737:
3733:
3729:
3725:
3721:
3713:
3710:
3705:
3701:
3697:
3693:
3689:
3685:
3681:
3677:
3670:
3667:
3662:
3658:
3654:
3650:
3646:
3642:
3638:
3634:
3627:
3624:
3619:
3615:
3611:
3607:
3603:
3599:
3595:
3591:
3584:
3581:
3576:
3572:
3568:
3564:
3560:
3556:
3549:
3546:
3541:
3537:
3533:
3529:
3525:
3521:
3517:
3513:
3506:
3503:
3498:
3494:
3490:
3486:
3481:
3476:
3472:
3468:
3464:
3457:
3454:
3449:
3445:
3440:
3435:
3431:
3427:
3423:
3419:
3415:
3408:
3406:
3404:
3400:
3395:
3391:
3387:
3383:
3379:
3375:
3371:
3367:
3360:
3357:
3352:
3348:
3344:
3340:
3336:
3332:
3328:
3324:
3316:
3313:
3308:
3304:
3299:
3294:
3290:
3286:
3282:
3278:
3274:
3267:
3264:
3251:
3244:
3242:
3240:
3236:
3231:
3227:
3222:
3217:
3213:
3209:
3205:
3201:
3197:
3190:
3188:
3184:
3179:
3175:
3171:
3167:
3163:
3159:
3155:
3151:
3144:
3142:
3138:
3125:
3121:
3115:
3112:
3107:
3095:
3087:
3083:
3079:
3075:
3071:
3070:
3065:
3058:
3055:
3050:
3046:
3040:
3037:
3032:
3028:
3024:
3020:
3013:
3010:
3004:
3001:
2996:
2992:
2988:
2984:
2977:
2974:
2969:
2965:
2960:
2955:
2950:
2945:
2941:
2937:
2933:
2926:
2923:
2918:
2912:
2908:
2903:
2896:
2893:
2888:
2882:
2878:
2871:
2869:
2867:
2865:
2863:
2861:
2859:
2857:
2855:
2853:
2851:
2849:
2847:
2845:
2843:
2841:
2839:
2837:
2835:
2831:
2826:
2822:
2818:
2814:
2810:
2806:
2802:
2798:
2791:
2788:
2783:
2779:
2775:
2771:
2764:
2761:
2756:
2752:
2747:
2742:
2737:
2732:
2728:
2724:
2720:
2713:
2711:
2709:
2707:
2705:
2701:
2696:
2692:
2687:
2682:
2678:
2674:
2670:
2663:
2661:
2659:
2655:
2650:
2646:
2641:
2636:
2632:
2628:
2624:
2620:
2613:
2610:
2605:
2601:
2597:
2593:
2589:
2585:
2581:
2577:
2573:
2569:
2562:
2559:
2546:
2540:
2537:
2532:
2528:
2524:
2520:
2516:
2512:
2508:
2504:
2497:
2495:
2493:
2491:
2489:
2487:
2483:
2478:
2472:
2468:
2461:
2458:
2446:
2439:
2437:
2435:
2433:
2431:
2429:
2427:
2423:
2418:
2412:
2408:
2401:
2399:
2397:
2395:
2393:
2391:
2389:
2387:
2385:
2383:
2381:
2379:
2377:
2375:
2373:
2371:
2369:
2367:
2365:
2363:
2361:
2359:
2357:
2355:
2353:
2351:
2349:
2347:
2345:
2343:
2341:
2339:
2337:
2335:
2333:
2331:
2329:
2327:
2323:
2318:
2312:
2308:
2303:
2302:
2293:
2291:
2289:
2287:
2285:
2283:
2279:
2273:
2270:
2265:
2261:
2256:
2251:
2247:
2243:
2239:
2235:
2231:
2224:
2222:
2220:
2218:
2216:
2214:
2212:
2210:
2208:
2206:
2204:
2200:
2195:
2191:
2187:
2183:
2180:(2): O34-46.
2179:
2175:
2167:
2164:
2151:
2147:
2140:
2138:
2136:
2134:
2132:
2130:
2128:
2126:
2124:
2122:
2120:
2118:
2116:
2114:
2112:
2110:
2108:
2106:
2104:
2102:
2100:
2098:
2096:
2094:
2092:
2090:
2088:
2086:
2084:
2082:
2080:
2078:
2076:
2074:
2072:
2070:
2068:
2066:
2064:
2062:
2060:
2058:
2056:
2054:
2052:
2050:
2048:
2046:
2044:
2042:
2040:
2038:
2036:
2032:
2019:
2012:
2009:
1996:
1989:
1987:
1985:
1983:
1981:
1979:
1977:
1975:
1973:
1971:
1969:
1967:
1965:
1963:
1961:
1959:
1957:
1955:
1953:
1951:
1949:
1947:
1945:
1943:
1941:
1939:
1937:
1935:
1933:
1931:
1929:
1927:
1925:
1923:
1921:
1919:
1917:
1915:
1913:
1911:
1909:
1907:
1905:
1903:
1901:
1899:
1897:
1893:
1888:
1882:
1878:
1871:
1868:
1863:
1859:
1854:
1849:
1845:
1841:
1837:
1830:
1827:
1821:
1817:
1814:
1812:
1809:
1807:
1804:
1802:
1799:
1798:
1794:
1792:
1790:
1786:
1782:
1778:
1773:
1771:
1767:
1763:
1757:
1756:
1751:
1746:
1742:
1738:
1734:
1729:
1727:
1723:
1719:
1714:
1712:
1707:
1706:
1701:
1696:
1692:
1684:
1682:
1675:
1673:
1667:
1665:
1663:
1655:
1653:
1650:
1647:
1645:
1641:
1637:
1633:
1629:
1628:dietary fiber
1625:
1620:
1618:
1610:
1608:
1606:
1602:
1598:
1594:
1590:
1586:
1585:sigmoidoscopy
1582:
1576:
1572:
1570:
1567:drug-induced
1566:
1563:
1561:
1558:inflammatory
1557:
1555:
1554:endometriosis
1552:
1550:
1547:
1546:
1545:
1542:
1539:
1533:
1531:
1529:
1522:Complications
1521:
1519:
1517:
1512:
1510:
1506:
1503:
1499:
1495:
1490:
1487:
1483:
1481:
1477:
1472:
1470:
1465:
1463:
1459:
1454:
1450:
1444:
1442:
1436:
1431:
1428:
1426:
1422:
1419:
1416:
1412:
1410:
1407:
1405:
1401:
1399:
1395:
1394:
1393:
1387:
1385:
1383:
1379:
1375:
1371:
1367:
1363:
1359:
1355:
1351:
1347:
1343:
1338:
1330:
1328:
1326:
1319:
1317:
1310:
1308:
1306:
1303:
1299:
1294:
1292:
1288:
1284:
1276:
1272:
1269:
1267:
1264:
1262:
1258:
1256:
1253:
1250:
1249:Fecal leakage
1247:
1246:
1245:
1238:
1236:
1234:
1229:
1227:
1222:
1220:
1216:
1213:
1209:
1202:
1200:
1198:
1194:
1189:
1187:
1178:
1176:
1173:
1170:
1168:
1167:fecal leakage
1163:
1159:
1151:
1149:
1145:
1143:
1139:
1134:
1132:
1128:
1127:fecal leakage
1124:
1120:
1116:
1115:suppositories
1112:
1108:
1107:bulking agent
1100:
1098:
1096:
1092:
1088:
1080:
1075:
1072:
1070:
1067:
1066:
1065:
1059:
1057:
1055:
1051:
1047:
1043:
1039:
1034:
1029:
1024:
1022:
1018:
1014:
1010:
1004:
1002:
996:
990:
988:
985:
983:
979:
975:
971:
969:
965:
958:
955:
952:
949:
945:
942:Sensation of
941:
939:
938:Fecal leakage
936:
935:
934:
932:
924:
922:
919:
914:
912:
908:
904:
900:
893:
891:
889:
884:
883:
879:
876:
870:
869:
865:
861:
860:
856:
854:
850:
846:
842:
833:
831:
828:
824:
822:
814:
812:
808:
806:
805:pelvic cavity
802:
798:
792:
785:
783:
781:
772:
767:
765:
761:
759:
753:
750:
745:
741:
739:
730:
727:
724:
720:
716:
713:
710:
707:
703:
702:
701:
695:
692:
689:
686:
683:
680:
677:
676:
675:
673:
667:
665:
661:
657:
653:
648:
644:
639:
637:
634:
628:
626:
619:
618:H&E stain
615:
611:
607:
603:
596:
594:
592:
586:
584:
575:
572:
570:
567:
564:
561:
557:
553:
550:
547:
543:
539:
536:
535:
534:
528:
526:
523:
519:
517:
513:
507:
499:
492:
490:
483:
481:
478:
474:
465:
463:
461:
457:
450:
448:
446:
442:
438:
429:
427:
425:
421:
417:
413:
405:
403:
401:
396:
392:
385:
383:
376:
371:
366:
361:
358:
355:
354:
352:
347:
344:
343:
341:
340:
339:
335:
333:
329:
327:
323:
319:
317:
313:
299:
292:
289:
286:
285:
284:
278:
275:
272:
269:
266:
262:
261:
260:
256:
254:
250:
247:
243:
239:
237:
233:
231:
227:
223:
220:
216:
212:
208:
204:
200:
196:
192:
190:
183:
180:
176:
173:
170:
166:
163:
160:
156:
153:
152:
151:
145:
141:
137:
130:
128:
124:
122:
118:
115:, degrees of
114:
110:
105:
102:
98:
94:
90:
81:
78:
76:
72:
68:
64:
60:
56:
52:
47:
43:
39:
34:
19:
7302:
7281:
7158:Pancreatitis
7120:
7070:biliary tree
6943:Nutmeg liver
6920:
6846:Hematochezia
6797:Pruritus ani
6782:Anal abscess
6777:Anal fistula
6773:Anal fissure
6744:
6686:Constipation
6640:
6511:Appendicitis
6319:Gastroptosis
6309:Achlorhydria
6148:
6137:Eosinophilic
6051:
6040:
6029:
6005:
5994:
5983:
5968:
5953:
5919:. Retrieved
5917:. Farlex Inc
5909:
5898:. Retrieved
5850:(1): 16–21.
5847:
5843:
5797:
5793:
5787:
5752:
5748:
5738:
5703:
5699:
5689:
5654:
5650:
5640:
5607:
5603:
5597:
5564:
5560:
5554:
5521:
5517:
5510:
5485:
5481:
5475:
5458:
5454:
5448:
5413:
5409:
5399:
5364:
5360:
5350:
5315:
5311:
5261:
5257:
5247:
5212:
5208:
5198:
5171:
5167:
5157:
5124:
5120:
5114:
5089:
5085:
5059:
5055:
5049:
5019:(2): 87–90.
5016:
5012:
5006:
4969:
4965:
4955:
4920:
4916:
4906:
4871:
4867:
4857:
4822:
4818:
4808:
4773:
4769:
4734:(1): 91–95.
4731:
4727:
4683:
4679:
4669:
4652:11424/245594
4634:
4630:
4604:
4600:
4558:
4554:
4547:
4522:
4518:
4512:
4477:
4473:
4428:(1): 61–63.
4425:
4421:
4415:
4382:
4378:
4372:
4339:
4335:
4329:
4294:
4290:
4280:
4247:
4243:
4237:
4204:
4200:
4193:
4160:
4156:
4114:
4110:
4103:
4068:
4064:
4022:
4018:
4012:
4000:. Retrieved
3996:the original
3949:
3945:
3938:
3913:
3909:
3863:
3860:ISRN Surgery
3859:
3813:
3809:
3766:
3762:
3756:
3723:
3719:
3712:
3679:
3675:
3669:
3636:
3632:
3626:
3593:
3589:
3583:
3558:
3554:
3548:
3515:
3511:
3505:
3470:
3466:
3456:
3421:
3417:
3369:
3365:
3359:
3326:
3322:
3315:
3280:
3276:
3266:
3254:. Retrieved
3203:
3199:
3153:
3149:
3128:. Retrieved
3123:
3114:
3068:
3057:
3048:
3039:
3022:
3018:
3012:
3003:
2986:
2982:
2976:
2939:
2935:
2925:
2895:
2876:
2800:
2796:
2790:
2773:
2769:
2763:
2726:
2722:
2676:
2672:
2622:
2618:
2612:
2588:11573/576276
2571:
2567:
2561:
2549:. Retrieved
2539:
2506:
2502:
2466:
2460:
2448:. Retrieved
2406:
2300:
2272:
2237:
2233:
2177:
2173:
2166:
2154:. Retrieved
2150:the original
2022:. Retrieved
2011:
1999:. Retrieved
1876:
1870:
1846:(1): 24–32.
1843:
1839:
1829:
1774:
1753:
1744:
1740:
1736:
1733:invagination
1730:
1717:
1715:
1703:
1694:
1690:
1688:
1679:
1671:
1668:Epidemiology
1661:
1659:
1651:
1648:
1621:
1614:
1605:defecography
1595:, anorectal
1581:Defecography
1579:
1543:
1540:
1537:
1525:
1513:
1493:
1491:
1488:
1484:
1478:wall of the
1473:
1466:
1462:puborectalis
1455:
1451:
1448:
1440:
1421:constipation
1391:
1366:asymptomatic
1341:
1340:
1323:
1314:
1295:
1291:constipation
1280:
1271:Pruritus ani
1242:
1230:
1223:
1217:through the
1207:
1206:
1190:
1182:
1174:
1171:
1164:
1161:
1146:
1135:
1123:incontinence
1104:
1084:
1063:
1025:
1005:
997:
994:
986:
973:
972:
968:asymptomatic
964:Recto-rectal
963:
962:
953:Pelvic pain.
931:asymptomatic
928:
918:defecography
915:
898:
897:
885:
881:
880:
871:
867:
866:
862:
858:
857:
837:
826:
825:
821:laparoscopic
818:
809:
793:
789:
776:
773:Conservative
762:
754:
746:
742:
734:
721:loads (e.g.
699:
668:
664:dentate line
643:defecography
640:
629:
622:
587:
579:
552:constipation
532:
524:
520:
516:anal atresia
508:
504:
487:
469:
454:
437:Defecography
433:
424:barium enema
409:
397:
393:
389:
380:
336:
331:
330:
321:
320:
316:defecography
308:
282:
257:
252:
251:
241:
240:
235:
234:
225:
224:
194:
193:
188:
187:
178:
174:
168:
164:
158:
154:
149:
143:
139:
125:
106:
88:
86:
62:
58:
7338:Peritonitis
7100:Cholestasis
7078:Cholangitis
7021:Gallbladder
6909:Fatty liver
6829:Hematemesis
6811:GI bleeding
6617:Necrotizing
6546:Lymphocytic
6541:Collagenous
6536:Microscopic
6473:Steatorrhea
6374:Enteropathy
6220:Inlet patch
6142:Herpetiform
6127:Esophagitis
6031:MedlinePlus
4480:(1): 7–19.
2936:BMC Surgery
2640:10281/62853
2443:Marzouk D.
1787:section of
1722:Procidentia
1685:Terminology
1676:Pornography
1644:biofeedback
1370:rectal pain
1266:Rectal pain
1226:hemorrhoids
1186:hemorrhoids
1017:Enteroceles
903:procidentia
875:anastomotic
706:nulliparous
656:John Hunter
610:hyperplasia
540:degrees of
477:biofeedback
400:excoriation
230:hemorrhoids
41:Other names
7374:Categories
7330:Peritoneal
7308:Incisional
7229:Congenital
7173:Hereditary
7150:Pancreatic
7114:Haemobilia
6787:Hemorrhoid
6765:Anal canal
6703:Infectious
6691:Functional
6526:Ulcerative
6410:Duodenitis
6349:Gastrinoma
6053:Patient UK
6007:DiseasesDB
5921:14 October
5900:2020-08-31
5264:(4): 298.
4637:(6): e79.
4631:Pediatrics
3990:Donald K.
3866:: 652345.
3256:16 October
3248:Sherk SD.
3025:(1): 5–9.
2619:Dermatitis
2551:15 October
2156:13 October
2024:14 October
2016:Kiran RP.
2001:14 October
1822:References
1764:involving
1700:"Prolapse"
1591:, mucosal
1589:ultrasound
1560:granulomas
1509:histologic
1437:Prevalence
1398:defecation
1362:ulceration
1354:defecation
1350:anal canal
1287:defecation
974:Recto-anal
911:defecation
843:, or even
652:anal verge
606:Micrograph
445:enterocele
312:anal canal
246:ulceration
215:submucosal
203:defecation
123:symptoms.
7318:Richter's
7275:Spigelian
7270:Obturator
7260:Umbilical
7093:Ascending
7064:Bile duct
6897:Cirrhosis
6875:Hepatitis
6858:Accessory
6728:Proctitis
6579:Megacolon
6553:Dysentery
6463:Whipple's
6415:Jejunitis
6405:Enteritis
6292:Dyspepsia
6253:Gastritis
6186:Achalasia
6119:Esophagus
6042:eMedicine
4583:207073118
4272:205531685
4185:205531441
3910:Radiology
3104:ignored (
3094:cite book
2729:(1): 72.
1745:suscipere
1741:susceptio
1718:procidere
1632:laxatives
1611:Treatment
1597:manometry
1528:stricture
1320:Treatment
1311:Diagnosis
1300:) of the
1101:Treatment
1081:Diagnosis
1069:Rectocele
1054:rectocele
1021:rectocele
768:Treatment
441:cystocele
372:Diagnosis
179:segmental
97:prolapsed
75:Specialty
7248:Indirect
7243:Inguinal
6977:Pyogenic
6922:Vascular
6698:Diarrhea
6676:Volvulus
6642:Vascular
6581: /
6570: /
6531:Ischemic
6498:Appendix
6388:Duodenum
6258:Atrophic
6132:Candidal
6047:med/3533
5874:28144208
5779:46533721
5681:14960517
5589:25736970
5581:12003716
5502:21971372
5467:10355182
5440:20965892
5391:21490861
5342:27955947
5334:22266488
5290:21727744
5239:15129312
5149:38880216
5141:12003718
5041:13503102
4998:21160895
4947:19861563
4661:12456946
4575:18642046
4539:18545877
4504:18512007
4450:19607242
4442:18512015
4407:20997835
4399:17115306
4356:14628157
4321:19175625
4264:19438880
4229:22097353
4221:24125518
4177:19486104
4131:24201396
4095:21140169
4039:18794001
3974:30806620
3966:23890098
3892:22577584
3838:20362023
3830:18654789
3791:25614599
3783:18074069
3740:22188470
3704:21774948
3696:15984985
3661:21148803
3653:15785903
3618:13534724
3497:36285327
3489:15898121
3448:20011408
3394:36592501
3351:25684257
3343:20497199
3307:35390136
3277:BJS Open
3086:22878278
3049:Whipworm
3031:19248418
2968:17194301
2825:21170092
2817:10647634
2755:22697798
2695:22041358
2649:21781642
2604:19519510
2596:16007353
2531:23227666
2523:17066611
2264:26599079
2194:25186920
1993:Kim DG.
1862:21603476
1795:See also
1777:proximal
1711:Prolapse
1636:psyllium
1634:such as
1476:anterior
1469:ischemia
1432:(rarely)
1425:diarrhea
1415:tenesmus
1388:Symptoms
1239:Symptoms
1138:resected
1111:psyllium
1050:anterior
978:perineum
948:tenesmus
925:Symptoms
797:perineum
786:Surgical
780:psyllium
723:Whipworm
719:helminth
627:defect.
583:Valsalva
574:diarrhea
556:tenesmus
416:neoplasm
169:internal
165:external
7289:Petit's
7265:Femoral
7168:Chronic
6982:Amoebic
6750:Anismus
6516:Colitis
6443:Coeliac
6420:Ileitis
6392:Jejunum
6245:Stomach
6149:Rupture
6001:D012005
5865:5179269
5822:2831853
5814:9876062
5771:9752869
5730:9462216
5721:1891593
5672:1773992
5632:2833491
5624:6092015
5546:7754839
5538:2460300
5431:3473720
5382:3075189
5281:3133995
5230:7177015
5190:2450805
5106:3536653
5068:1483723
5033:7636379
4989:2999680
4938:2853932
4898:8707093
4889:1383120
4849:5358578
4840:1553062
4800:8244113
4791:1374554
4748:7998576
4710:3678951
4701:1433454
4613:3536217
4495:2778725
4364:8408754
4312:2774156
4139:8094564
4086:3098348
3930:2294538
3883:3346690
3748:2148155
3610:1149581
3575:7638574
3540:9443258
3532:1425046
3439:2780198
3386:4064851
3298:8989040
3230:2612988
3221:1434461
3178:6337533
3170:9221859
3130:11 July
2995:4523440
2959:1785387
2782:2694021
2746:3444426
2255:7073406
1997:. ASCRS
1853:3096348
1816:Anismus
1783:of the
1569:colitis
1458:anismus
1402:Mucous
1259:Mucous
1197:anismus
1131:anismus
1013:anismus
1011:) like
801:abdomen
625:fascial
612:in the
473:anismus
377:History
326:sigmoid
265:anismus
211:mucosal
199:sigmoid
159:mucosal
7283:Lumbar
7253:Direct
7236:Hiatus
7216:Hernia
7068:Other
6834:Melena
6720:Rectum
6203:(GERD)
6036:001132
5990:176780
5896:. VICE
5872:
5862:
5820:
5812:
5777:
5769:
5728:
5718:
5679:
5669:
5630:
5622:
5587:
5579:
5544:
5536:
5500:
5465:
5438:
5428:
5389:
5379:
5340:
5332:
5288:
5278:
5237:
5227:
5188:
5147:
5139:
5104:
5066:
5039:
5031:
4996:
4986:
4945:
4935:
4896:
4886:
4847:
4837:
4798:
4788:
4746:
4708:
4698:
4659:
4611:
4581:
4573:
4537:
4502:
4492:
4448:
4440:
4405:
4397:
4362:
4354:
4319:
4309:
4270:
4262:
4227:
4219:
4183:
4175:
4137:
4129:
4093:
4083:
4037:
4002:8 July
3972:
3964:
3928:
3890:
3880:
3836:
3828:
3789:
3781:
3746:
3738:
3702:
3694:
3659:
3651:
3616:
3608:
3573:
3538:
3530:
3495:
3487:
3446:
3436:
3392:
3384:
3349:
3341:
3305:
3295:
3228:
3218:
3176:
3168:
3084:
3029:
2993:
2966:
2956:
2942:: 19.
2913:
2883:
2823:
2815:
2780:
2753:
2743:
2693:
2647:
2602:
2594:
2529:
2521:
2473:
2450:8 July
2413:
2313:
2262:
2252:
2192:
1883:
1860:
1850:
1789:rectum
1785:distal
1642:, and
1593:biopsy
1549:polyps
1346:rectum
1305:rectum
1302:distal
1215:mucosa
1212:rectal
1119:enemas
1109:(e.g.
999:cause
907:rectal
636:hernia
119:, and
93:rectum
7208:Other
7163:Acute
6914:MASLD
6867:Liver
6841:Lower
6824:Upper
6666:Ileus
6502:Colon
6396:Ileum
6211:(LPR)
6012:11189
5979:569.1
5964:K62.3
5818:S2CID
5775:S2CID
5628:S2CID
5585:S2CID
5542:S2CID
5338:S2CID
5145:S2CID
5037:S2CID
4579:S2CID
4446:S2CID
4403:S2CID
4360:S2CID
4268:S2CID
4225:S2CID
4181:S2CID
4135:S2CID
3970:S2CID
3834:S2CID
3787:S2CID
3744:S2CID
3700:S2CID
3657:S2CID
3614:S2CID
3536:S2CID
3493:S2CID
3390:S2CID
3347:S2CID
3174:S2CID
2821:S2CID
2600:S2CID
2527:S2CID
1781:lumen
1766:colon
1737:intus
1505:cysts
1502:mucin
1445:Cause
1277:Cause
991:Cause
847:with
758:lumen
597:Cause
591:edema
412:edema
95:have
6596:SCAD
5996:MeSH
5985:OMIM
5974:9-CM
5923:2012
5870:PMID
5810:PMID
5767:PMID
5726:PMID
5677:PMID
5620:PMID
5577:PMID
5534:PMID
5498:PMID
5463:PMID
5436:PMID
5387:PMID
5330:PMID
5286:PMID
5235:PMID
5186:PMID
5137:PMID
5102:PMID
5064:PMID
5029:PMID
4994:PMID
4943:PMID
4894:PMID
4845:PMID
4796:PMID
4744:PMID
4706:PMID
4657:PMID
4609:PMID
4571:PMID
4535:PMID
4500:PMID
4438:PMID
4395:PMID
4352:PMID
4317:PMID
4260:PMID
4217:PMID
4173:PMID
4127:PMID
4091:PMID
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