EPITHELIAL TUMORS 1. Aden° in ata The adenomata are the most important epithelial tumors in chill hood. They are benign polypoid tumors which consist mostly of loose connective tissue. Their surface is smooth and the submucosa and mus cular tissue take part in the tumor formation (Lexer). Besides the adenomata of the nasal mucous membranes we observe most frequently rectal polypi (polypositas recti).
Pathologic A n usually adhere to the sacral wall of the rectum near the anus as tumors from the size of a pea to that of a cherry. At first they have a broad base, but by the movements of the gut and the passage of the stools this is soon drawn out to a long pellicle, which will often even permit the velvety red round polypus to appear outside the anus during defecation. The structure of these polypi is almost always that of the true adenomata of the mucous membranes; rarely we find a fibrous admixture or base in children. According to their structure, they are tender, soft, and easily injured, with rich vasculariza tion, which explains the bleeding.
The polypi prefer the sacral wall of the rectum, where they are fre quently found in numbers. In the ampulla especially they may he found in clusters, their size varying from that of a grain of rice to that of a cherry and even larger. Closely related, histologically, are those cases in which the whole large intestine contains polypi (Schneider). But we must not confound these with angiomatous plaques, which latter are also found in the ampulla and are closer to the hemorrhoidal tissue.
According to Pieehaud heredity plays some ride in this condition.
Sympto.ns.— These usually appear only when the single tumors have grown to some size; usually more or less copious bleeding with defecation will send the parents to the physician.
There is increased straining caused by feeling something like a foreign body near the anus, which is intensified by the frequent injury to these small tumors, with hemorrhage, also pain from pulling on and irritation of the rectal wall. Furthermore are those difficulties with urination to be
mentioned which we observe in all painful affections in and around the rectum, called by the French tenesme vesical, and which we can easily understand from the close nervous and embryological relation between bladder and rectum. Every action of the sphincters is avoided, as these will rarely act separately owing to their anatomical position. This reflex retention may assume excessive degrees, so as to cause a suspicion even of severe affections in the genito-urinary system (see Pararectal Abscesses).
Diagnosis.—ThiS is usually easy. Bleeding from the rectum in the absence of a prolapsus or of a larger fissure or of (though in children we need hardly consider this) hemorrhoidal nodes, must make us think of polypi, which can frequently appear during defecation. Otherwise the examining finger can feel these on the sacral part of the rectum and a speculum will make inspection easy (Fig. 196).
Treatment. —Steady lengthening of the pedicle and its tearing through is a form of self-cure, but the disagreeable symptoms will soon demand an early removal of the source of the hemorrhage. We should avoid pulling on the polypus, as its tissue is very friable and it may reform from parts which are left behind.
After cleansing the ampulla we expose the polypus freely and ligate the pedicle as near as possible to the mucous membrane and then cut off the tumor. Polypi with a broad base should be circumcised and the mucous membrane carefully sewed up, on account of the danger of an infection of the par recta] tissues from the rectum. Before the opera tion we thoroughly clean out the bowels, and afterward give small doses of opium and a constipating diet, thus saving ourselves from having to pack the rectum, which is very disagreeable and not advisable in children on account of the continuous pressing.
Tumors situated higher up can be brought into view with the recto scope. In extensive pulypositas with numerous millet-seed tumors we Ftc. 196.