Caracterización sobre los pacientes operados de cáncer colorrectal tratados con quimioterapia adyuvante en Camagüey

Introducción: El cáncer colorrectal es un problema de salud creciente en el mundo, el aumento en la expectativa de vida de las poblaciones, el continuo mejoramiento de las técnicas de tamizaje y la búsqueda activa de casos, son las razones por las cuales cada año se informa un aumento en el número global de casos diagnosticados con cáncer. Objetivo: Caracterizar a los pacientes operados de cáncer colorrectal tratados con quimioterapia. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal, en pacientes atendidos en la consulta multidisciplinaria de cáncer colorrectal. El universo lo conformaron todos los pacientes que acudieron a consulta en ese período, la muestra a criterio de los autores la conformaron 55 pacientes tratados con quimioterapia adyuvantes por cáncer colorrectal. La fuente primaria de la investigación estuvo dada por la historia clínica. Resultados: En cuanto a la relación sexo y edad, se observó una mayor frecuencia del grupo de 70-79 años y en el sexo femenino. Según la localización topográfica existió predominio en colon sigmoides con 33 pacientes para un 60 % de la muestra estudiada. La variante histológica adenocarcinoma moderadamente diferenciado fue la de mayor presentación. Predominaron los pacientes en estadio IIIa de la enfermedad. El esquema de quimioterapia usado con mayor frecuencia fue el Folfox. Conclusiones: En la muestra, la mayoría de los pacientes estuvieron incluidos en el grupo etáreo entre 70-79 años de edad. La localización topográfica más frecuente fue el colon sigmoide y el tipo histológico, el adenocarcinoma moderadamente diferenciado. Predominaron los pacientes en el estadio IIIa y el tratamiento con quimioterapia adyuvante más utilizado fue el esquema de Folfox.

Introduction: Colorectal cancer is a growing health problem in the world, the increase in the life expectancy of populations, the continuous improvement of screening techniques and the active search for cases, are the reasons why an increase in the global number of cases diagnosed with cancer is reported each year. Objective: To characterize the patients operated on for colorectal cancer treated with adjuvant chemotherapy. Methods: An observational, descriptive, cross-sectional study was carried out in patients seen at the multidisciplinary colorectal cancer clinic. The universe was made up of all the patients who attended the consultation in that period, the sample at the authors' criteria was made up of 55 patients treated with adjuvant chemotherapy for colorectal cancer. The primary source of the investigation was given by the clinical history. Results: Regarding the relationship between sex and age, a higher frequency was observed in the group of 70-79 years and in the female sex. Regarding the topographic location, there was a predominance in the sigmoid colon with 33 patients for 60% of the sample studied. The moderately differentiated adenocarcinoma histological variant was the one with the highest presentation. Patients in stage IIIa of the disease were more frequent. The most frequently used chemotherapy regimen was Folfox. Conclusions: In the sample, most of the patients were included in the age group between 70-79 years of age. The most frequent topographic location was the sigmoid colon and the histological type was moderately differentiated adenocarcinoma. Patients in stage IIIa predominated and the most widely used adjuvant chemotherapy treatment was the Folfox regimen.

Sigmoid gallstone ileus: a challenging diagnosis

Gallstone ileus is a rare (1%­4%) complication of gallstone disease. Gallstones entering the gastrointestinal tract by penetration may cause obstruction at any point along their course through the tract; however, they have a predilection to obstruct the smaller-caliber lumen of the small intestine (80.1%) or stomach (14.2%). The condition is seen more commonly in the elderly who often have significant co-morbidities. Gallstone ileus causing large bowel obstruction is rare. We report the case of a 95-year-old woman who presented with a history of abdominal pain without fever, nausea, vomiting, or diarrhea. Computed tomography of the abdomen and pelvis with oral contrast revealed a high-density structure within the lumen of the distal sigmoid colon, initially suspected to be a foreign body. Medical management failed and surgical intervention was not possible. Autopsy revealed peritonitis and a rupture of the sigmoid colon at the site of a cylindrical stone found impacted in an area of fibrotic narrowing with multiple diverticula. A necrotic, thick-walled gallbladder had an irregular stone in its lumen that was a fracture match with the stone in the sigmoid. Adhesions, but no discrete fistula, were identified between the gallbladder and the adjacent transverse colon. The immediate cause of death was peritonitis caused by colonic perforation by the gallstone impacted at an area of diverticular narrowing. To our knowledge, such autopsy findings have not been previously reported.

Comportamiento del cáncer colorrectal en el Hospital Provincial Clínico Quirúrgico Docente Amalia Simoni / Behavior of colorrectal cancer Amalia Simoni Clinical Surgical Teaching Hospital

RESUMEN Fundamento: el intestino grueso se extiende desde el ciego hasta el orificio del ano. El colon es el segmento del sistema digestivo que con mayor frecuencia se ve afectado por tumores. Objetivo: describir el comportamiento del cáncer colorrectal. Métodos: se realizó un estudio observacional descriptivo de corte transversal. El universo fue 106 pacientes con diagnóstico de cáncer colorrectal. Se aplicó un muestreo no probabilístico al juicio, el mismo se conformó por 87 pacientes. La información se extrajo de las historias clínicas, registro de procederes e informes de estudio histológico. Resultados: la edad que predominó fue entre 60-69 años, el sexo femenino fue el más frecuente. Dominó el cambio en el hábito intestinal como manifestación clínica. Se acentuaron las localizaciones de rectosigmoide como la más afectada por los tumores. Los adenocarcinomas fueron los tipos anatomopatológicos que se destacaron. Conclusiones: predominaron los pacientes en el grupo de edades entre 60-69 años y del sexo femenino. La localización más frecuente de la tumoración de colon fue en el rectosigmoide. El tipo histológico de la lesión más frecuente fue el adenocarcinoma donde se halló en más de la mitad de los casos.

ABSTRACT Background: the large intestine extends from the cecum to the orifice of the anus. The colon is segment of the digestive system that with greater frequency is affected by tumors. Objective: to determine the behavior of colorectal cancer. Methods: a cross-sectional descriptive observational study was carried out. The universe was 106 patients with colon cancer diagnosis. The non-probabilistic sample was formed by the 87 patients who met, inclusion and exclusion criteria. The information was extracted from the medical records, procedure records and histologic studies. Results: the age that predominated was between 60-69 years, the female sex prevailed. The locations in the rectosigmoide were accentuated. The adenocarcinomas were the anatomical-pathological types that stood out. Conclusions: the group of ages between 60-69 years, of the female sex, predominated. The change in the habit intestinal was the clinical manifestation. The most frequent histological type of the lesion was the adenocarcinoma in more than half of the cases.

Perforación de colon sigmoides por espina de pescado: tratamiento combinado laparoscópico y endoscópico / Fishbone perforation of the sigmoid colon: combined laparoscopic and endoscopic treatment

La ingestión accidental de cuerpos extraños, más frecuentemente espinas de pescado, causa perforaciones intestinales en menos del 1 % de los casos; la alta morbimortalidad asociada con estas ha favorecido la búsqueda de alternativas frente a la cirugía convencional. El caso presentado muestra cómo el abordaje combinado secuencial laparoscópico y endoscópico, permite resolver con menor grado de agresión una perforación sigmoidea por cuerpo extraño

Accidental ingestion of foreign bodies, more frequently fishbones, causes intestinal perforations in less than 1% of cases. The associated high morbidity and mortality has lead to the search for alternatives to conventional surgery. The presented case shows how sequential approach, laparoscopic and endoscopic combined, allows a sigmoid perforation by a foreign body to be solved with a lower aggressive approach

Megacolon andino y vólvulo del sigmoides de la altura: Presentación de 418 casos entre 2008 - 2012 en el hospital C. Monge - Puno, Perú / Andean megacolon and sigmoid volvulus in the high altitude: Presentation of 418 cases between 2008 - 2012 at C. Monge Hospital, Puno, Peru

Objetivo: El presente estudio describe el manejo médico y quirúrgico del vólvulo de sigmoides debido a dolicomegacolon andino en un hospital a una altitud mayor a 3000 msnm. Material y métodos: Estudio descriptivo, observacional, transversal de 418 pacientes con diagnóstico de vólvulo de sigmoides; admitidos inicialmente por cuadros de obstrucción intestinal, en el Hospital de Juliaca Carlos Monge - Puno, Perú, durante el periodo 2008-2012. Los datos fueron procesados a través del programa SPSS versión 21. Resultados: Se registraron 418 pacientes, la media de edad fue de 60 años, rango 18-89 años, con una proporción hombre/mujer de 3,5/1. El manejo no quirúrgico se hizo en 64 (15,4%), el tratamiento empleado fue de enema salino 20 casos 31% y sonda rectal 44 (69%), se presentó recurrencia en 27 pacientes (45%), los cuales tuvieron cirugía con resección anastomosis primaria, de estos la mortalidad correspondió a 8 pacientes (30%). De los 354 pacientes sometidos a manejo quirúrgico de emergencia 325 fueron sometidos a sigmoidectomia con anastomosis primaria (92%), mientras 29 tuvieron colostomía a lo Hartmann (8%), la morbilidad para ambos procedimientos fue de 52 casos (14,7%), la mortalidad para ambos procedimientos fue de 45 casos (12,7%). Conclusiones: El vólvulo sigmoides debido a megacolon andino tuvo una edad media de 60 años. El 15,4% tuvo manejo no quirúrgico, la tasa de recurrencia fue de 45%, mortalidad de 30%. El 84,7% tuvo manejo quirúrgico; el 92% tuvo resección anastomosis primaria y 8% colostomía a lo Hartmann, la morbilidad fue de 14,7% y la mortalidad de 12,7%.

Objective: The present study describes the medical and surgical management of sigmoid volvulus due to Andean dolicomegacolon in a hospital at an altitude above 3000 m. Material and methods: A descriptive, observational, crosssectional study of 418 patients diagnosed with sigmoid volvulus; Admitted initially due to intestinal obstruction, in the Hospital of Juliaca Carlos Monge. Puno-Perú, during the period 2008-2012. The data were processed through the SPSS software version 21. Results: A total of 418 patients were enrolled, the mean age was 60 years, range 18-89 years, and the male/female ratio was 3.5/1. Nonsurgical management was done in 64 (15.4%), the treatment used was saline enema 20 cases (31%) and rectal catheter 44 (69%), recurrence was present in 27 patients (45%), who had surgery with primary anastomosis resection, of which the mortality corresponded to 8 patients (30%). Of the 354 patients undergoing emergency surgical management, 325 were submitted to sigmoidectomy with primary anastomosis (92%), while 29 had Hartmann's colostomy (8%), the morbidity for both procedures was 52 cases (14.7%), Mortality for both procedures was 45 cases (12.7%). Conclusions: In patients with sigmoid volvulus due to Andean megacolon the mean age was 60 years. The 15.4% had non-surgical management, the recurrence rate was 45%, and mortality 30%. Patients with surgical management was 84.7%, from this group; 92% had primary anastomosis resection and 8% Hartmann colostomy, morbidity was 14.7% and mortality was 12.7%.

Ultrasound value in diagnosis of deep infiltrating endometriosis in rectosigmoid: Meta-analysis / 中国医学影像技术

Objective To explore the diagnostic value of comparing enhanced transvaginal ultrasound (E-TVS),none enhanced transvaginal ultrasound (TVS),and transrectal ultrasound (TRS) in preoperative detection of deep infiltrating endometriosis (DIE) in the rectosigmoid by Meta-analysis.Methods The literatures published from January 1990 to June 2016 were searched.The information of literatures were selected and evaluated.The included data was statistically analyzed by Meta-disc 1.4 software.Results Totally 25 literatures were enrolled.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio were 0.92,0.96,16.64,0.09,227.95 for E-TVS,0.83,0.97,16.95,0.17,112.97 for TVS,0.94,0.96,14.43,0.08,208.72 for TRS,respectively.Area under the curve were 0.980 4,0.966 3,0.979 0,respectively.Conclusion Diagnostic value of the three ultrasonography in preoperative detection of DIE in the rectosigmoid are E-TVS,TRS,TVS.E-TVS can be used as the preferred method of ultrasonic diagnosis of DIE in the rectosigmoid.

Comparative study of collagen deposition in the colon wall of patients operated for sigmoid diverticular disease

PURPOSE: To investigate the deposition of collagen in the colon wall of patients with sigmoid diverticulitis.METHODS: Samples of sigmoid tissue from 15 patients (disease group), seven men and eight women aged 37-77 years who underwent surgery for the treatment of diverticulitis, were selected. For the control group, specimens from five patients, three men and two women aged 19-58 years undergoing emergency surgery for sigmoid trauma were selected. These subjects had no associated diseases. The histological study of the surgical specimens was performed by staining with hematoxylin-eosin and picrosirius and using a histochemical method for collagen quantification.RESULTS: Collagen deposition in the colon wall in terms of area (F), glandular epithelium (E) and total area was significantly higher in the disease group compared to control (p=0.003, p=0.026 and p=0.010, respectively). The collagen volume fraction (F fraction) and muscle tissue (M fraction) were also significantly higher compared to control (p=0.044 and p=0.026, respectively). The muscle (M area) and volume fraction of glandular epithelium (E fraction) did not differ significantly between the two groups, (p=0.074 and p=1.000, respectively).CONCLUSION: In this study, collagen deposition in the colon wall of the patients operated for sigmoid diverticulitis was higher compared to patients without the disease.

Asymptomatic Perforated Appendicitis Presenting as a Subepithelial Sigmoid Colon Lesion at Screening Colonoscopy / 대한내과학회지

Acute appendicitis is common in all age groups. Although many patients with acuteappendicitis present with migrating abdominal pain, the initial presentation can be atypical and nonspecific. Unusual manifestations can lead to diagnostic delay, which is associated with increased morbidity and mortality. Colonoscopic findings suggestinga diagnosis of asymptomatic appendicitis include hyperemia and bulging at the appendiceal orifice area with surrounding mucosal edema, and drainage of pus from the appendiceal orifice. We report a case of asymptomatic perforated appendicitis and periappendiceal abscess that presented as a subepithelial sigmoid colon lesion at screening colonoscopy. On colonoscopy, a subepithelial lesion with pustular drainage surrounded by hyperemic mucosa was seen at the sigmoid colon. Computed tomography revealed appendicitis and a periappendiceal abscess with adjacent sigmoid colon wall thickening. The patient underwent an appendectomy, with a final diagnosis of a perforated appendicitis with a periappendiceal abscess.

Comparative study on laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment transfer / 中华妇产科杂志

Objective To study the clinical effect of laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment.Methods From January 2004 to December 2009,105 cases undergoing laparoscope-assisted vaginoplasty using a vascularized pedicled intestinal flap were studied retrospectively.Operation time,blood loss in operating,bowel movement after operation,postoperation hospital duration,side effect,and artificial vagina were compared between two surgical management.Results The vaginoplasty were preformed successfully in all 105 cases.There were 48 patients treated by aparoscopeassisted ileal vaginoplasty and 57 patients treated by laparoscope-assisted sigmoid colon vaginoplasty.The values of the operation time [(141 ±22) minutes versus (159 ± 18) minutes,P =0.000],blood loss in operating [(42 ±6) ml versus (83 ± 14) ml,P =0.000],bowel movement after operation (36 ±9) hours versus (68 ±8)hours(P =0.000),and postoperation hospital duration [(9.8 ±2.0) days versus (11.1 ± 1.3) days,P =0.004] in the sigmoid colon vaginoplasty group were longer or higher than those in ileal vaginoplasty group (P ＜ 0.05).No intraoprative complication occurred.There were four postoperative complications:2 cases with intestinal obstruction in sigmoid colon vaginoplasty group,1 case with urethral orifice stenosis and 1 case with vaginal-rectal fistula in ileal vaginoplasty group.At follow-up of 6-62 months,all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length.Vaginal discharges resembled a milky white water or mucus without odour.Fifty-five patients with sexual intercourse reported satisfactory results.Six patients complained vaginal stenosis:5 patients in ileal vaginoplasty group and 1 patient in sigmoid colon vaginoplasty group.Conclusions Laparoscope-assisted vaginoplasty using pedicled ileum or sigmoid colon segment are both the effective ways in forming vagina.The latter management takes more time and blood loss while operating,yet the incidence of vaginal opening contracture appeared to be decreasing trend.

Application of circular anastomotic stapler for sigmoid colostomy in laparoscopy abdominoperineal resection / 重庆医学

Objective To evaluate the value of circular anastomotic stapler for sigmoid colostomy in laparoscopy abdominoperi-neal resection .Methods 62 patients of low colorectal cancer treated in our hospital from October 2010 to February 2013 was retro-spectively analyzed .All the patients were treated by laparoscopy abdominoperineal resection ,34 patients received sigmoid colostomy with circular anastomotic stapler(group A) ,and the other 28 patients received sigmoid colostomy with conventional suturing tech-niques(group B) .The medical records including operation time ,the time of return of bowl function ,postoperative hospital stay and postoperative complication rate were analysed statistically .Results All patients received the operations successfully .No conversion to open procedure and no operative death occured in two groups .The result of statistical analysis showed that in group A ,the opera-tion time ,the time of return of bowl function ,postoperative hospital stay time were shorter than group B ,and the rate of edema of sigmoid in group A were lower than group B(P<0 .05) .Conclusion The application of circular anastomotic stapler for sigmoid co-lostomy in LAPR is a safe ,effective and minimally invasive technique ,which can shorten operation time ,postoperative hospital stay and reduce the related complications of colostomy .

Study on gasless-laparoscopic vaginoplasty using sigmoid colon segment / 中华妇产科杂志

Objective To study the clinical effect of gasless-laparoscopic vaginoplasty using sigmoid colon segment.Methods Clinical data of 119 cases undergoing laparoscopic or gasless-laparoscopic vaginoplasty using a vascularized pedicled sigmoid colon segment in Beijing Anzhen Hospital from January 2007 to December 2010 were reviewed retrospectively.Those patients were classified into 57 cases with laparoscopic sigmoid colon vaginoplasty and 62 cases with gasless-laparoscopic sigmoid colon vaginoplasty.The operation time,blood loss in operating,bowel movement after operation,postoperation hospital duration,side effect,and artificial vagina were compared between laparoscopic and gasless-laparoscopic group.Results The vaginoplasty were preformed successfully in 119 cases.The mean operation time of were (159 ± 18) min in laparoscopic group and (146 ± 17) min in gasless-laparoscopic group,respectively,which reached statistical difference (P ＜0.01).The blood loss in operating were (83 ± 14) ml and (86 ± 13)ml,bowel movement after operation were (68 ± 8) hours and (68 ± 11) hours,and postoperation hospital duration were (11.1 ± 1.3) days and (11.4 ± 1.9) days respectively in laparoscopic group and gasless-laparoscopic group.No significant difference were found in the blood loss in operating,bowel movement after operation,and postoperation hospital duration between two groups (P ＞ 0.05).No intraoperative complication occurred.There were two cases with incomplete adhesive intestinal obstruction at 15-20 days postoperatively,which one was in laparoscopic group and one was in gas-less laparoscopic group.At 6-50 months of following up (median time 12 months),all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length.Vaginal discharges resembled a milky white water or mucus without odour.Eighty-five patients with sexual intercourse reported satisfactory feeling.One patients complained vaginal stenosis in laparoscopic group.Conclusion Gasless-laparoscopic vaginoplasty using sigmoid colon segment is an alternative feasible and practical treatment.

Expression of protein gene product 9.5, vasoactive intestinal peptide and neuropeptide Y in the mucosa of the neovagina after sigmoid colon vaginoplasty / 中华妇产科杂志

Objective To investigate re-innervation in the neovaginal mucosa of patients underwent sigmoid colon vaginoplasty in treatment of Mayer-Rokitansky-Kistner-Hauser Syndrome (MRKHS).Methods Biopsies in the upper third of the posterior neovagina were taken in 20 patients treated by sigmoid colon vaginoplasty at 1, 2 and 3 years after surgery, respectively. Protein gene product 9. 5 ( PGP 9. 5 ),vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) were detected by immunohistochemical method and compared with those in intact sigmoid colon mucosa. Results ( 1 ) Density of nerve fiber:abundant distribution of PGP 9. 5 nerve fibers were observed in the mucosal muscle layer, submucosa, and smooth muscle layer of the neovagina. The nerve fibers of VIP and NPY immunoreactivity were mainly distributed around blood vessels and in the smooth muscles. In the neovagina, the density of nerve fibers of PGP 9. 5 of 17 ± 6 were much more than VIP of 2. 9 ± 1.0 and NPY of 2. 5 ± 0. 8 significantly ( P ＜ 0. 05 ).( 2 ) Expression of PGP 9. 5 in neovagina: at 1 year after surgery, PGP 9. 5 positive expression of 14 ± 4 was significantly lower in the neovagina than 28 ± 7 in the intact sigmoid colon( P ＜ 0. 05 ). However, after 2 to 3 years, its expression displayed an upgrade tendency in the neovagina and was significantly higher at the 3 year postoperatively than that at the 1 years postoperatively ( 22 ± 7 vs. 14 ± 4, P ＜ 0. 05 ). The changes were much more obvious in submucosa. (3) The expression of VIP and NPY in neovagina: at 1 year after surgery, VIP and NPY positive nerve fibers were also decreased in the neovagina when compared with those in the intact sigmoid colon ( 2. 3 ± 0. 7 vs. 5.3 ± 1.4, P ＜ 0. 05; 2.5 ± 1. 1 vs. 5.5 ± 1.1, P ＜ 0. 05 ) . At 2 to 3 years after surgery, the positive VIP fiber showed initially decreased and subsequently increased tendency. The density of VIP of 3.7 ± 0. 7 in the neovagina at 3 years postoperatively was higher than 2. 3 ±0. 7 at 1 years postoperatively (P ＜ 0. 05 ). No significant up-regulation was observed in NPY-positive expression in the neovagina within 3 years after operation. Conclusions Distribution of sensory PGP 9. 5,VIP and NPY immunoreactive nerve fibers was similar to the pattern observed within the intact sigmoid colon wall. The number of nerve fibers in the neovagina decreased after surgery and then increased subsequently within 3 years after surgery.

Hemipelvectomia externa ampliada para tratar adenocarcinoma de sigmóide / Extended external hemipelvectomy for sigmoid adenocarcinoma treatment

Surgery is the most effective way of treating a locally advanced colorectal carcinoma and an extended en bloc resection is necessary to achieve the best overall survival rate. In this rare case, a multi-visceral resection was performed along with the entire lower left limb and left iliac bone for a sigmoid carcinoma. The T4N0M0 (B3) tumor involved the left iliac vessels, left pelvic wall, small bowel and both rectus muscles, besides presenting with a skin fistula. A Hartmann colostomy was also performed. Chemotheraphy was interrupted because of toxicity. The patient is free of disease after 38 months. There are very few cases that describe an extended hemipelvectomy as part of a colorectal carcinoma treatment.

Neocolpoplastia com alça exclusa de sigmóide / Neocolpoplasty with excluded sigmoid segment

Introdução: O emprego de alças intestinais para tratamento de agenesia de vagina remontaao início do século vinte, porém tem sido pouco popularizado. Método: Os autores apresentamsete casos em que a neocolpoplastia foi realizada com o emprego de alça exclusa desigmóide, transposta através do fundo de saco de Douglas, por incisão peritoneal, e alojadaem um túnel dissecado entre o reto e a bexiga. A extremidade inferior foi suturada ao intróitovaginal com incisão quebrada em V, e a extremidade superior fechada em fundo cego, ousuturada ao redor do colo uterino telescopado através dela, quando o útero estava presente.Resultados: A evolução é de três a dez anos. A técnica foi executada em três casos comausência de vagina associada à agenesia de útero, um caso de síndrome adrenogenital comatresia de vagina associada a útero infantil, e três casos de agenesia de vagina com presençade útero funcional. O útero foi preservado, com seu colo dentro da neovagina, permitindomenstruações normais em dois deles. Discussão: Não foram necessários, nem indicados,dilatações ou uso de moldes no período pós-operatório. Os resultados foram bons e o índicede complicações pequeno. As vaginas permitem penetração fácil. São amplas, profundas eelásticas, com lubrificação e aspecto visual normais. Conclusão: A neocolplastia mostrouseuma técnica viável com baixo índice de complicação, principalmente estenoses.

Introduction: The use of intestinal loops for treatment of vaginal agenesis remounts to thebeginning of XX century; however it has been little popularized. Methods: The authorspresent seven cases wherein the neocolpoplasty has been realized with the use of excludedsigmoid loop, transposed trough the bottom of Douglas sack by peritoneal incision andaccommodated in a dissected tunnel between the rectum and the bladder. The inferiorextremity was sutured to the vaginal introit with incision in V, and the superior extremityclosed in a blind bottom, or sutured around of the telescoped uterine cervix trough her, whenthe uterus was present. Results: The evolution is from three to ten years. The techniquewas executed in three cases with vagina absence associated to the uterus agenesis, onecase of adrenogenital syndrome with the vagina atresia associated to an infantile uterus,and three cases of vaginal agenesis with the presence of functional uterus. The uterus waspreserved with his lap inside of the neovagina, allowing normal menstruation in two ofthem. Discussion: Weren’t necessary, not even indicated, dilations or use of molds in thepostoperative period. The results were good and the index of complications was small.The vaginas allow easy penetration. They are ample, deep and elastic, with lubrication andnormal visual aspect. Conclusion: The neocolpoplasty show it to be a viable techniquewith low complication index, mainly estenoses.

Doença de Hodgkin do sigmoide: relato de caso / Hodgkin´s Disease of sigmoid: a case report

Doença de Hodgkin no cólon é uma afecção rara. Relata-se um caso de Doença de Hodgkin extranodal com acometimento de sigmoide, cuja confirmação diagnóstica somente foi realizada após a cirurgia de ressecção tumoral e estudo imunohistoquímico.

Hodgkin disease of the colon is rare. We report a case of extranodal Hodgkin's disease involving the sigmoid which diagnosis was confirmed only after tumor resection and immunohistochemical study.

Valor do enema de bário com duplo contraste no diagnóstico da endometriose do reto e sigmóide / Double-contrast barium enema in the diagnosis of intestinal deeply infiltrating endometriosis

OBJETIVO: avaliar a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo do enema de bário com duplo contraste (EBDC) para o diagnóstico da endometriose do reto e sigmóide. MÉTODOS: estudo transversal prospectivo que incluiu 37 pacientes com quadro clínico suspeito de endometriose profunda. As pacientes foram submetidas ao EBDC de acordo com a técnica padrão descrita na literatura. Em seguida, foram submetidas à laparoscopia. Os exames foram realizados e seus resultados e imagens foram interpretados e comparados com base na avaliação histológica. A análise estatística foi realizada pela análise de associação (teste do χ2) e análise de concordância (teste de Kappa). RESULTADOS: a média de idade das pacientes estudadas foi de 35,8±4,4 anos (faixa de 28 a 48 anos), sendo 85,6 por cento brancas e 14,4 por cento negras. A endometriose profunda foi confirmada por laparoscopia e pelo exame histológico em todas as pacientes estudadas. A endometriose intestinal foi confirmada histologicamente em 27 mulheres (72,9 por cento). O EBDC demonstrou sinais radiológicos sugestivos de infiltração intestinal por endometriose em 24 mulheres (64,9 por cento) e ausência de sinais em 13 mulheres (35,1 por cento). A sensibilidade do método foi de 87,5 por cento, especificidade de 53,8 por cento, valor preditivo positivo de 77,8 por cento e valor preditivo negativo de 70 por cento. Dentre os 24 exames anormais, 16 (43,2 por cento) apresentaram imagem radiológica do tipo espícula, 16 (43,2 por cento) apresentavam imagem compatível com estenose e quatro (10,8 por cento) o duplo contorno. CONCLUSÕES: o EBDC apresenta elevada sensibilidade e elevado valor preditivo positivo no diagnóstico da endometriose do reto e sigmóide. As imagens radiológicas do tipo espícula e estenose apresentam elevada sensibilidade e valor preditivo positivo para a infiltração intestinal por endometriose.

PURPOSE: to evaluate the sensitivity, specificity, positive and negative predictive value of double contrast barium enema (DCBE) for the diagnoses of rectum and sigmoid endometriosis. METHODS: prospective transversal study including 37 patients with suspicion of deep endometriosis. Patients were submitted to DCBE, according to the standard technique described in the literature, and then, to laparoscopy. The results of laparoscopy and the DCBE images were interpreted and compared, based on the histological evaluation. Statistical analysis was done by association (χ2 test) and agreement analyses (Kappa's test). RESULTS: patients' average age was 35.8±4.4 years old (age group from 28 to 48 years), 85.6 percent of them being white and 14.4 percent, black women. Deep endometriosis was confirmed by laparoscopy and histological exam in all the studied patients. Intestinal endometriosis was confirmed by histological exam in 27 women (72.9 percent) of them. DCBE demonstrated suggestive radiologic signs of intestinal infiltration by endometriosis in 24 women (64.9 percent) and no signs in 13 women (35.1 percent). The method sensitivity was 67.5 percent, specificity 53.8 percent, positive predictive value, 77.8 percent and negative predictive value, 70 percent. Among the 24 abnormal exams, 16 (43.2 percent) presented radiologic speculum-type image, 16 (43.2 percent), an image compatible with stenosis, and four (10.8 percent), double contour. CONCLUSIONS: the DCBE presents high sensitivity and high positive predictive value, in the diagnosis of the rectum and sigmoid endometriosis. Radiologic images speculum and stenosis-type present high sensitivity and positive predictive value for the intestinal infiltration by endometriosis.