ABSTRACT
ABSTRACT Objective: To evaluate clinical features and complications in patients with bowel endometriosis submitted to hormonal therapy. Methods: Retrospective study based on data extracted from medical records of 238 women with recto-sigmoid endometriosis treated between May 2010 and May 2016. Results: Over the course of follow-up, 143 (60.1%) women remained in medical treatment while 95 (39.9%) presented with worsening of pain symptoms or intestinal lesion growth (failure of medical treatment group), with surgical resection performed in 54 cases. Women in the Medical Treatment Group were older (40.5±5.1 years versus 37.3±5.8 years; p<0.0001) and had smaller recto sigmoid lesions (2.1±1.9 versus 3.1±2.2; p=0.008) compared to those who had failed to respond to medical treatment. Similar significant reduction in pain scores for dysmenorrhea, chronic pelvic pain, cyclic dyschezia and dysuria was observed in both groups; however greater reduction in pain scores for dyspareunia was noted in the Surgical Group. Subjective improvement in pain symptoms was also similar between groups (100% versus 98.2%; p=0.18). Major complications rates were higher in the Surgical Group (9.2% versus 0.6%; p=0.001). Conclusion: Patients with recto-sigmoid endometriosis who failed to respond to medical treatment were younger and had larger intestinal lesions. Hormonal therapy was equally efficient in improving pain symptoms other than dyspareunia compared to surgery, and was associated with lower complication rates in women with recto-sigmoid endometriosis. Medical treatment should be offered as a first-line therapy for patients with bowel endometriosis. Surgical treatment should be reserved for patients with pain symptoms unresponsive to hormonal therapy, lesion growth or suspected intestinal subocclusion.
RESUMO Objetivo: Avaliar características clínicas e complicações em pacientes com endometriose intestinal submetidos ao tratamento hormonal. Métodos: Dados de prontuários de 238 pacientes com endometriose de retossigmoide tratadas entre maio de 2010 e maio de 2016 foram coletados para este estudo retrospectivo. Resultados: Durante o período de acompanhamento, 143 (60,1%) mulheres mantiveram tratamento clínico, enquanto 95 (39,9%) tiveram piora dos sintomas de dor ou aumento da lesão intestinal (grupo falha de tratamento clínico), sendo 54 submetidas ao tratamento cirúrgico. As mulheres no Grupo Tratamento Clínico eram mais velhas (40,5±5,1 anos versus 37,3±5,8 anos; p<0,0001) e tinham lesões intestinais menores (2,1±1,9 versus 3,1±2,2; p=0,008) em comparação ao grupo falha de tratamento clínico. Redução significativa e semelhante do escore de dor na dismenorreia, dor pélvica crônica, disquezia cíclica e disúria cíclica foi observada nos Grupos Tratamento Clínico e Cirúrgico. Dispareunia, no entato, teve uma redução maior no Grupo Cirurgia. A redução subjetiva dos sintomas dolorosos também foi semelhante entre os Grupos Clínico e Cirúrgico (100% versus 98,2%; p=0,18). O Grupo Tratamento Cirúrgico foi relacionado a uma maior taxa de complicações graves (9,2% versus 0,6%; p=0,001) em comparação ao Grupo Tratamento Clínico. Conclusão: Falha no tratamento clínico em pacientes com endometriose de retossigmoide foi observada em mulheres mais jovens que tinham lesões intestinais maiores. O tratamento clínico hormonal foi igualmente eficaz na melhora dos sintomas de dor, exceto dispareunia, em comparação ao tratamento cirúrgico em mulheres com endometriose intestinal, mas com menor taxa de complicações. O tratamento clínico deve ser oferecido como primeira opção em pacientes com endometriose intestinal, enquanto o tratamento cirúrgico deve ser reservado para pacientes sem melhora nos sintomas de dor com tratamento hormonal, progressão das lesões ou suspeita de suboclusão intestinal.
Subject(s)
Humans , Female , Adult , Progestins/therapeutic use , Rectal Diseases/drug therapy , Sigmoid Diseases/drug therapy , Pelvic Pain/drug therapy , Contraceptives, Oral, Combined/therapeutic use , Endometriosis/drug therapy , Rectal Diseases/surgery , Sigmoid Diseases/surgery , Pain Measurement , Recombinant Fusion Proteins , Medical Records , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Pelvic Pain/surgery , Dysmenorrhea/drug therapy , Dyspareunia/drug therapy , Endometriosis/surgery , Chronic PainABSTRACT
Introducción: La úlcera solitaria de recto es una entidad patológica crónica, benigna e infrecuente, que en general no se la considera entre los diagnósticos diferenciales de las patologías crónicas del recto. A menudo es subdiagnosticada. Las principales manifestaciones clinicas son: proctorragia, mucorrea, esfuerzo defecatorio y tenesmo. Objetivo: Evaluar las características clinicas de una patología infrecuente del recto, a partir de 3 casos clínicos. Lugar de aplicación: Institución privada. Pacientes y método: Se presentan 3 pacientes con diagnóstico anatomopatológico de úlcera solitaria de recto, entre 2003-2010, dos hombres y una mujer, con un promedio de edad de 53 años (rango 41-70 años). Resultados: La presentación clínica fue proctorragia, mucorrea, tenesmo, proctalgía y esfuerzo defecatorio. En los 3 pacientes la úlcera fue solitaria, dos en pared posterior y una en pared anterior del recto. El diagnostico se realizó por medio de la endoscopía, y biopsia de la lesión. Los 3 casos respondieron favorablemente al tratamiento médico. Conclusiones: La etiología es desconocida. Se la relaciona con trastornos de la defecación. La lesión no siempre es ulcerada ni solitaria. El diagnóstico se realiza por medio de colonoscopía y biopsia, debido a que presenta histología patognomónica. El tratamiento puede ser conservador o quirúrgico.
Introduction: Solitary rectal ulcer is a chronic, benign and infrequent entity, generally not considered in the differential diagnosis of chronic diseases of the rectum. It is often underdiagnosed. The main clinical manifestations include bloody stool, mucorrhea, straining and tenesmus. Objective: To asses the current behavior of a rare disease of the rectum, from 3 clinical cases. Point of application: Private institution. Patients and method: Three patients are presented with pathological diagnosis of solitary rectal ulcer, between 2003 - 2010, two men and a woman, with an average age of 53 years (range 41-70 years). Results: The clinical presentation was bloody stool, mucorrhea. tenesmus, anal pain and straining. In all cases the ulcer was solitary; two in posterior wall and one in anterior wall of the rectum. The diagnosis was made by endoscopy and biopsy of the lesion. The 3 cases responded well to medical treatment. Conclusions: The etiology is unknown. It is related to defecation disorders. The lesion is not always ulcerated of solitary. Diagnosis is made by colonoscopy and biopsy, because it shows pathognomonic histology. Treatment can be conservative or surgical.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Rectal Diseases/diagnosis , Rectal Diseases/diet therapy , Rectal Diseases/pathology , Rectal Diseases/drug therapy , Rectal Diseases/therapy , Ulcer/diagnosis , Ulcer/drug therapy , Ulcer/therapy , Chronic Disease , Diagnosis, Differential , Endoscopy, Digestive System/methodsSubject(s)
Humans , Anus Diseases/complications , Anus Diseases/drug therapy , Anus Diseases/prevention & control , Rectal Diseases/drug therapy , Rectal Diseases/etiology , Rectal Diseases/prevention & control , Sexually Transmitted Diseases/drug therapy , Sexually Transmitted Diseases/prevention & control , Acquired Immunodeficiency Syndrome/complications , Anus Neoplasms/complications , Anus Neoplasms/mortality , Diagnosis, Differential , Quality of Life , Risk Groups , Sexual BehaviorABSTRACT
Tres peu de chirurgiens defendent la non-preparation du colon (ou du rectum). Cependant; a y regarder de plus pres; il apparait que les partisans de cette attitude prescrivent; tous; a un moment ou a un autre; a leur patient un regime et quelques sulfamides intestinaux. La plupart des auteurs ont utilise une preparation qu'on peut appeler classique et qui comporte un regime sans residus; des laxatifs et des lavements evacuateurs. [abstract terminated]
Subject(s)
Colonic Diseases/drug therapy , Colonic Diseases/surgery , Rectal Diseases/drug therapy , Rectal Diseases/surgeryABSTRACT
Cincuenta y nueve pacientes sometidos a cirugía colorrectal electiva recibieron preparación de colon por vía anterógrada y profilaxis antibiótica en dosis única con ceftriaxona y ornidazol. La preparación utilizada fue bien tolerada, obteniendo una adecuada limpieza del lumen intestinal y minimizando las alteraciones hidroelectrolíticas y del equilibrio ácido-base. No hubo sepsis ni complicaciones sépticas graves intraabdominales.