Rectum

Pudendal nerve terminal latency

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Q .PNTL prolonged in all the following except

a) Traumatic injury to anal sphincter

b) Prolonged labor

c) Long standing Rectal prolapse

d) Straining

Answer for premium members (Q4) 

The nerve latency is measured by an electrode which is worn on the finger. It stimulates the pudendal nerve and calculates the conduction time to the anal sphincter

Treatment of anal incontinence

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Q) Newest treatment for anal incontinence?
a. Sacral nerve stimulation
b. Artificial sphincter.
c. Repair of sphincter
d. Gluteus maximus graft

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Answer a)

Sacral nerve stimulation is the newest modality in treatment for anal incontinence. In it electrodes are placed via the sacral foramina. The nerve supply of anal sphincter is similar to lower extremity so their stimulation can lead to contraction of various foot muscles.

Others are all older methods

Shackelford page 1779

Colon Bleeding

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Q) True statement about  colonic bleeding:     More Questions on colon

a) Bleeding from diverticulitis is severe and often requires interventional procedures to stop it

b) In colitis risk of brisk bleeding is less and diarrhea is absent

c) In haemaorrhoids,  haemodynamic compromise is rare

d) Bleeding from angiodysplasia is always slight and managed endoscopically

Colon cancer surveillnace

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Q) CEA surveillance in normal person whose father and brother had colon cancer is helpful in 

a) CEA is highly sensitive in picking up the diagnosis of colon cancer

b) HIGH preoperative CEA is predictive of unresectability in colon cancer

c) Increase in CEA after surgery is indicative of tumor recurrence

d) CEA is present in normal colonic mucosa

Answer for premium members

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Q) 75 year old man complains of obstipation for 2 days. He has taken laxatives but continues to have worsening pain and distension associated with vomiting. He underwent b/l knee replacement  2 weeks back. He was on Inj fentanyl for pain control. He is on antihypertensives and lipid lowering agents for the past 15 years.

On examination  he is afebrile, oriented, pulse rate of 100 min/, BP 120/60 and abdomen is distended with mild tenderness. There are no signs of peritonitis, bowel sounds are sluggish.

TLC is 6,500, and  potassium is 3.2 . All other blood tests are normal. X ray abdomen and CT abdomen shows dilated large bowel loops and oral contrast upto splenic flexure.

What is the probable diagnosis

a) Ischemic colitis

b) CMV colitis

c) Colonic Pseudoobstruction

d) Caecal volvulus

Answer for premium members

Altemeier procedure

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📘 Theme: Rectal Prolapse

True about the Altemeier procedure?

A. It is proctosigmoidectomy with posterior levatoroplasty
B. Done in left lateral position
C. Recurrence rate can be as high as 50%
D. Altemeier was the first person to do it

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✅ Answer: A. It is proctosigmoidectomy with posterior levatoroplasty

Explanation:
The Altemeier procedure is a perineal rectosigmoidectomy (proctosigmoidectomy) performed for complete rectal prolapse. It is commonly combined with posterior levatoroplasty, which restores pelvic floor support and helps reduce recurrence.

Why the other options are incorrect:

  • B. The procedure is usually performed in the lithotomy position, not the left lateral position.
  • C. Reported recurrence rates are generally 10–30%; a recurrence rate of 50% is not considered typical.
  • D. Although the procedure bears Altemeier's name, he popularized and refined the operation rather than being the first to perform it.

Take-home Message:
Altemeier = Perineal rectosigmoidectomy + posterior levatoroplasty; performed in the lithotomy position; preferred perineal operation for complete rectal prolapse in elderly or high-risk patients.

Reference: Sabiston Textbook of Surgery, 22nd Edition, p. 1394.