Volvulus, Prolapse, Intussusception, and Functional Disorders

I would like to thank Dr. Beck for inviting me to participate as a Guest Editor for this issue of Clinics in Colon and Rectal Surgery. The subject matter-volvulus, prolapse, intussusception, and functional disorders-incorporates a potpourri of important and sometimes misunderstood, as well as misdiagnosed topics in colon and rectal surgery. Lack of a fundamental knowledge of the evaluation, diagnosis, and subsequent treatment options for the spectrum of these functional conditions can lead to devastating outcomes for the patient. Each of the authors provides a concise and informative update on their respective subject matter.

Drs. John Marks and Elsa Valsdottir, from the Marks Colorectal Surgical Associates and the Lankenau Hospital and Institute for Medical Research, have submitted an excellent review of volvulus both in the pediatric and adult population. In their review, they also address the role of laparoscopy for the condition.

The treatment of rectal prolapse from both the abdominal and perineal approaches and a detailed outline of the evaluation of patients with prolapse is addressed by Drs. Anthony Vernava and Bashar Safar from Physicians Regional Medical Center and Cleveland Clinic Florida.

Dr. Mari Madsen, from Cedars-Sinai Medical Center, describes the recognized perineal repairs for rectal prolapse and provides a critical review of the published literature.

Dr. Sue Cera, from Physicians Regional Medical Center in Naples, Florida addresses the topic of intestinal intussusception. She provides a thorough summary of the pathophysiology in both pediatric and adult patients, accompanied by a detailed evaluation of treatment options and controversies.

The remainder of the issue is dedicated to functional disorders of the anorectum with a focus on constipation; all of the contributing authors of these articles are based at the Cleveland Clinic Florida. Dr. Paula Denoya reviews the components of the anorectal physiology laboratory and the evaluation of constipation. Drs. Eric Weiss and Elisabeth McLemore detail the evaluation and treatment of rectoanal intussusception with attention given to both surgical and noninvasive management options.

Dr. G. Willy Davila and Dr. Roger Lefevre bring a different perspective to the treatment of rectocele. The urogynecological evaluation tools are presented as well as the multiple different surgical approaches.

Drs. Steven Wexner and Ron Landmann provide the reader with a complete understanding of the paradoxical puborectalis contraction and increased perineal descent, both functional disorders that are difficult to manage. Treatment strategies are provided that will ultimately prove helpful to any physician who manages patients with these conditions.

The debilitating condition of colonic inertia is reviewed by Drs. Juan Nogueras and Jared Frattini. Epidemiology and pathophysiology, as well as management options are discussed. The authors critically evaluate surgical and nonsurgical treatments and present a concise treatment algorithm, which provides the reader with a safe and reliable approach to treating these patients.

I would like to personally thank all of the contributors to this issue of Clinics in Colon and Rectal Surgery. Their efforts have provided a useful reference for the evaluation and treatment of these complex functional and anatomic disorders.