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Re: Recurrent rectoceleFrom: Atkinson, Samuel M (ATKINSONS@ECU.EDU)Fri Dec 1 14:54:27 2006
Had a patient years ago with an abscess in the recto-vaginal septum middle third. Multiple courses of antibiotics were necessary as the abccess waxed and waned. Having never seen such an abscess in this location, and with negative proctoscopy, I began to "listen to the patient and let her tell me what was going on," I received your same answer.I advised her to desist, whereupon I was further informed her wealthy lover paid very dearly for the privilege. Still somewhat naive, and thinking this was an abusive relationship, I was further informed that she too also found this pleasurable. thus I informed her the problems woud persist. I suspect your patient began rectal IC shortly after your repair and thus the failure of your surgery was the consequence, not your technigue. Recently, Paraiso, Walters et al reported in their Cleveland Clinic Newsletter data that has been accepted for publication in which they compared site specific repairs to mesh repairs to classical repairs. They found no ststistical difference in cures or recurrence. There is concern about reports of rectal erosion with mesh. I would not do any repeat repair with any technique in this patient, even if you get an oath from her that she will give up "Fudge Packing".. (She will fall off the wagon!). The nice thing about Military Service and active duty dependents and MD's is that you or her husband will PCS shortly! Irecommend she use enemas for her defecatory problems. They may also be pleasurable as I understand was one of the services available in the bath houses in SF during the rsrly AIDS epidemic. sAm ob-gy n-l@obgyn.net on behalf of Elrod, Darryl G Maj 48 MDOS/SGOBO Sent: Thu 11/30/2006 3:21 AM To: Multiple recipients of list OB-GYN-L Subject: Recurrent rectocele. I figured I'd change the tone of the conversation to something along the clinical lines. 35 yo G4P4 with TVH/abdominal paravaginal repair/Burch/McCalls and a posterior repair with perineorrhaphy about a year ago presents back for recurrent rectocele symptoms. Although not as bad as before surgery, she still feels the need to splint with bowel movements and has increased pressure rectally. On exam there is still a significant bulge in the posterior vagina. On rectal exam, the sphincter feels intact, the posterior vaginal wall can be brought nearly to the hymen (better than before her last surgery when I could bring it past the hymen). The anterior vagina and the cuff are well suspended. I don't feel anything that would make me concerned for an enterocele and the upper half of the vagina there feels to be good support. Endoanal ultrasound shows a normal internal and external sphincter. Under normal circumstances I wouldn't be to concerned about either tackling this repair myself or sending her to a urogyn to repair. However, I got one of those turn the head, get red with embarrassment looks from her. I questioned what that was for and got 'do you think this might have something to do with liking anal sex???' Turns out, she likes it enough to not really want to be without it for any lengthy period of time. Oddly enough, I can't seem to find much literature at all on management of recurrent rectocele and none on risk of recurrent rectocele with anal sex. Any thoughts on a) if this would be enough to undo a perfectly good posterior repair (probably) b) if you repaired it again, how long would you prescribe nil per anus (6 months???) c) would you tackle this yourself or refer? Thanks, Glen //SIGNED// D. Glen Elrod, Maj., USAF, MC Obstetrician/Gynecologist Chief of Obstetrics 48 MDOS/SGOBO RAF Lakenheath, England Telephone DSN: 314-226-8130 Comm: +44 (0) 1638 52 8130 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer.
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