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• W2032131176 abstract "I T is the purpose of this paper to caII attention to two facts: (I) That bIood discovered in the sigmoid and upper rectum on initia1 proctoscopic examination may originate at or near the mucocutaneous Iine and be carried proximaIIy by retrograde filling, reverse peristaIsis or by the passage of the examining instrument and (2) that serious rectal hemorrhage may originate at or near the mucocutaneous Iine. During proctoscopic examination in some patients it has been observed that a bIue, green or orange colored materia1 may be seen on the mucosa as high as the 23 cm. level. Such patients give a history of having used a so-called hemorrhoida suppository a few hours prior to the examination. Since a suppository upon insertion lies just above the mucocutaneous line, the colored materia1 is carried proximaIIy by a physioIogic mechanism. PresumabIy, this process is a reverse peristaIsis. To confirm this observation commercial, socaIIed hemorrhoida suppositories were inserted in twenty patients, who were then asked to return in one hour. Proctoscopic examination was then carried out. The examination was done in an uninverted position to avoid the effect of gravity, and the Iower rectum was swabbed until clean to avoid carrying the coIored material proximaIIy with the proctoscope. In ten patients the coIored materia1 was found in the rectum and sigmoid; in three it stained the recta1 mucosa up to the rectosigmoid where a feca1 mass was encountered; in four the discoIoration was confined to the ampuIIa by fecal materia1, and in three the partiaIIy meIted suppository was found just above the mucocutaneous line. These resuIts seem to indicate that a reverse peristaIsis may be invoIved. A group of ten patients were examined one hour after the insertion of IO cc. of whoIe bIood into the rectum. During the waiting period they were asked to sit or stand, but not to recline in order to avoid the effect of gravity. On proctoscopic examination the Iower rectum was swabbed unti1 cIean and then the bowe1 was examined proximaIIy. In seven cases smaI1 amounts of Iight and dark bIood, cIotted or streaked, were found up to the 23 cm. Ievel. In three cases fecal materia1 in the ampuIIa blocked any retrograde flow. From this preliminary study it wouId seem that bIood aIso may be carried proximally by reverse peristaIsis. Another group of ten patients, each with bleeding internal hemorrhoids, were asked to have their bowel movement in the of&e Iavatory. They were examined within the next thirty minutes. In seven patients there was no blood found in the rectum aIthough six of these passed some bIood with the bowe1 movement. In three patients small amounts of bloodwere seen in the ampuIIa. After cIeaning away this bIood, proctoscopic examination was continued, and in one case bIood was seen at the 20 cm. IeveI. These results may indicate that in a smaI1 but definite percentage of patients with bleeding interna hemorrhoids, some residua1 bleeding occurs after defecation. This may pass unnoticed by the patient or appear as a dark stain on the dista1 end of the next feca1 passage. The proctoscope may aIso carry blood proximaIIy. The hoIIow tip of the instrument may pick up the bIood below and deposit smaI1 amounts of it aIong the mucosa to the 23 cm. level. This bIood may originate, as above described, from digita examination in hemorrhoids, but most commonIy from sIight injury to the anterior bowe1 waI1 by the obturator of the anoscope or proctoscope. The bIeeding from such injury may be slight and unnoticed. The obturator of the anoscope may scratch the mucosa, and being Ionger than the examining part of the instrument cause a IittIe bIeeding which is not seen during anoscopic examination. The proctoscope is then passed and before its obturator is withdrawn the proxima1 end of the instrument may have passed over the site of the injury and have picked up a IittIe blood. The bIood may remain unseen unti1 the instrument is rotated, or a cotton appIicator is" @default.
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• W2032131176 date "1954-11-01" @default.
• W2032131176 modified "2023-09-27" @default.
• W2032131176 title "Retrograde rectal hemorrhage" @default.
• W2032131176 doi "https://doi.org/10.1016/0002-9610(54)90263-9" @default.
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