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Abstract: A 58-year-old patient presented to our department due to unexplained prolapse of a foreign body in the anus, and was diagnosed as rectal choroidal adenoma, a type of choroidal adenoma. After communicating with the patient and his family, we decided to take surgical treatment by transanal endoscopic microsurgery. Transanal endoscopic microsurgery has the advantages of endoscopic, microscopic, and minimally invasive surgery, so it is minimally invasive with good exposure, precise resection, and a low postoperative The patient was treated by transanal endoscopic microsurgery.
Basic information】Male, 58 years old
Disease Type】Choroidal adenoma of the rectum
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】February 2021
Treatment plan】Surgery (transanal endoscopic microsurgery)
Treatment Period】3 days of admission and 1 month of follow-up
Treatment effect] The patient’s tumor was removed successfully and the prognosis was good
I. Initial consultation
Two years ago, a foreign body came out of the anus during defecation without any obvious cause, and it was moist around the anus, so the patient could return it by hand. Since then, the patient began to have foreign bodies coming out of the anus after walking or coughing, and there was often mucus spillage. According to the patient’s condition, an anal finger examination revealed that there was a foreign body in the rectum, which was suspected to be a rectal mass, so the patient was admitted to the hospital for further examination.
II. Treatment history
After MRI examination, a soft polyp-like mass with a tip measuring 6.1×5.2x4cm in length was found in the rectum, and the distal edge was 7.5cm from the edge of the anus. Before surgery, transanal rectal manometry was performed to check the function of the patient’s anal sphincter and endorectal ultrasound was performed to determine the depth and stage of the tumor. After the size of the tumor and the proportion of the circumference of the intestinal cavity were clarified, and the location of the tumor was recorded in the form of a clock, carbon dioxide gas was injected into the patient’s intestinal cavity, and then the proctoscope was started after reaching the site of the patient’s tumor through the anus. The operation was performed with less bleeding and the procedure was relatively smooth, and the postoperative pathological examination confirmed the diagnosis of rectal villous adenoma.
(Pathology: rectal villous adenoma)
(MRI)
Treatment effect
After confirming the size and location of the tumor, the patient was treated with transanal endoscopic microsurgery, and the procedure was relatively smooth with little bleeding. Because carbon dioxide gas was injected into the intestinal cavity during the procedure, the patient had a slight flatulence after the surgery and needed to fast for 1 day, and could start eating liquid food after 24 hours. The patient had a transient fever after surgery, with a temperature fluctuating between 37.8°C and 38.5°C. No special treatment was given to the patient, and after 1 day, the patient’s temperature returned to normal on its own. In conclusion, through a series of active treatment, the patient recovered well after tumor removal, and the gastrointestinal motility and bowel function gradually returned to normal.
IV. Notes
We are glad that the patient’s symptoms have been improved after treatment, but we still need to pay attention to some care matters after surgery.
1. Patients should be reviewed every 2 months after discharge, and if any uncomfortable symptoms occur during the follow-up period, they should seek medical examination immediately to avoid delaying the diagnosis and treatment of the disease.
2. Although postoperative patients have the possibility of transient fever, diarrhea, or transient anal bleeding due to internal hemorrhoids or rectal incisions, there is usually no need to worry too much. If bleeding occurs, most of them can recover on their own; if they cannot recover, they need to see a doctor as soon as possible to stop the bleeding through medication.
3. Patients can start eating a liquid diet after 24 hours after surgery, after which they need to gradually transition to a normal diet. During the recovery period, they need to avoid intake of spicy, coarse and hard stimulating foods to prevent trauma to the rectal wound.
V. Personal insight
Rectal villous adenoma, also known as papillary adenoma, has the advantages of endoscopic, microscopic, minimally invasive surgery with good minimally invasive visualization, precise excision, and low postoperative recurrence rate. Transanal endoscopic micrographic surgery is a new procedure for the treatment of rectal villous adenoma, as was used in the patient in this article, and the patient had a smooth operation with minimal bleeding and a good prognosis during follow-up. In addition, patients should not be overly stressed after learning that they have rectal choriomeningeal adenoma. It is recommended that they actively cooperate with the doctor’s guidance, build confidence and face the disease squarely.