Mature Solid Teratoma of the Retroperitoneum Presenting as Sigmoid Colon Polyp with Lower Gastrointestinal Bleeding: A Case Report

Mature colonic teratomas are rare tumors and no case, to the best of our knowledge, has been reported from the African continent. In addition, some pedunculated teratomas in the colon have been treated by endoscopic polypectomy and classified as primary teratoma of the colon. We report a case of a distinct intra sigmoid pedunculated teratoma originating from the retroperitoneum of a 4-year-old African girl and we highlight the potential for misclassification of primary origin of endoscopically removed polypoid teratomas in the colon. CASE PRESENTATION: A 4-year-old black African female child who presented with abdominal pain and hematochezia. On clinical assessment, she was found to be anaemic and to have a sigmoid colon mass. At surgery, there was a mobile mass within the lumen of sigmoid colon and the mass was fixed to the retroperitoneum by a stalk of tissue. Pathologist's review of the resected sigmoid segment showed a pedunculated intra-sigmoid mass with the stalk traversing the wall of the colon. The mass was histologically proven a mature solid teratoma. CONCLUSION: This, to the best of our knowledge, is the first report of intra sigmoid teratoma from the African continent. It highlights the potential for misclassification of endoscopically resected colonic teratomas

Management of rectal stump leak following emergency Hartmann's procedure / Gerenciamento do vazamento do coto retal após o procedimento de emergência de Hartmann

ABSTRACT We report on the management of three cases of rectal stump leak and sepsis following urgent Hartmann's procedure for perforated sigmoid diverticulitis or large bowel obstruction. Two patients had significant risk factors for poor tissue healing. All patients developed features of sepsis and computer tomography scans demonstrated rectal stump leak with adjacent collections. All patients required reoperation for drainage and washout of abscess. An intraperitoneal catheter system was introduced together with drains in order to continue on the ward until tract was formed. There was no mortality and minimal morbidity. The key to management of rectal stump leak is the early and aggressive drainage of the associated collection and continued irrigation of the stump.

RESUMO Relatamos o tratamento de três casos de vazamento de coto retal e sepse após o procedimento de urgente de Hartmann para diverticulite sigmoide perfurada ou obstrução do intestino grosso. Dois pacientes apresentaram fatores de risco significativos para uma má cicatrização tecidual. Todos os pacientes desenvolveram características de sepse e tomografia computadorizada demonstraram vazamento de coto retal com coleções adjacentes. Todos os pacientes necessitaram de reoperação para drenagem e lavagem do abscesso. Um sistema de cateter intraperitoneal foi introduzido junto com os drenos para continuar na enfermaria até a formação do trato. Não houve mortalidade e morbidade mínima. A chave para o gerenciamento do vazamento de coto retal é a drenagem precoce e agressiva da coleta associada e a irrigação contínua do coto.

Fístula sigmoido-cervical secundaria a una enfermedad diverticular complicada / Sigmoido-cervical fistula due to diverticular disease

Resumen Introducción: Las fístulas secundarias a una enfermedad diverticular complicada son una indicación formal de cirugía electiva en el 4 a 23% de los casos. Caso Clínico: Se presenta el caso de una mujer de 52 años con antecedentes de una histerectomía subtotal por miomatosis uterina que consulta por cuadro de dolor abdominal en hipogastrio acompañado de fiebre de 4 días de evolución. La tomografía computada (TC) de abdomen y pelvis describe una diverticulitis complicada con absceso peridiverticular. Tratada con antibióticos con buena respuesta clínica consulta a los 3 meses en nuestro servicio por pérdida de material fecal por vagina. Nueva TC confirma la presencia de una colección perisigmoidea y engrosamiento de la pared vesical. La colonoscopía informa una estenosis franqueable a nivel de sigmoides y se constata salida de gases por vagina. La corrección quirúrgica electiva incluyó una sigmoidectomía abierta con traquelectomía en block, cierre de la cúpula vaginal y anastomosis colorrectal mecánica, con buena evolución posoperatoria, sin recidiva a los 12 meses de seguimiento. La fístula sigmoido-cervical es una complicación rarísima de la enfermedad diverticular complicada que puede ocurrir en pacientes sometidas a una histerectomía subtotal previa. Aunque el diagnóstico de la fístula es clínico, la colonoscopía y la TC permiten descartar otras etiologías. La resección radical del segmento afectado es el tratamiento estándar en pacientes aptos.

Introduction: Diverticular disease is complicated by fistulas in 4% to 23% of patients. Case Report: A woman 52 years-old previously operated on with parcial histerectomy was successfully treated with antibiotics due to diverticulitis complicated with an abscess. Three months later the patient presented with vaginal discharge of faeces. Computed tomography showed wall thickening of sigmoid colon and vesical wall. Colonoscopy exclude cancer and confirmed the exit of gas through vagina. En-bloc resection of the sigmoid colon with traquelectomy with primary anastomosis was performed. The postoperative course was good without recurrence after 12 months of follow up. Sigmoido-cervical fistula is a very rare benign fistula due to diverticular disease. Diagnosis is basically clinic, but tomography and colonoscopy are important to exclude other causes of fistulas. Radical surgery with primary anastomosis is the standard treatment.

Trombosis segmentaria sigmoidea consecuente a neoplasia maligna de colon. A propósito de un caso interesante / Sigmoid segmental thrombosis consequent to colon malignant neoplasia. On the purpose of a case

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.

ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.

Hormone treatment as first line therapy is safe and relieves pelvic pain in women with bowel endometriosis / O tratamento hormonal como terapia de primeira linha é seguro e melhora a dor pélvica em mulheres com endometriose intestinal

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.

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%.

Obstrucción colónica por cálculo / Colonic obstruction by gallstone

El íleo biliar es una rara complicación de la colelitiasis, que se caracteriza por presentar clínicamente una obstrucción intestinal mecánica intraluminal, secundaria a la impactación de un cálculo biliar en el tubo digestivo, debido a la existencia de una fístula bilio-entérica. El diagnóstico preoperatorio es difícil, ya que presenta síntomas y signos de obstrucción intestinal, los cuales son muy inespecíficos para sospechar un íleo biliar. El tratamiento de elección en el manejo del íleo biliar es el quirúrgico. Habitualmente se realiza una cirugía en dos tiempos, enterolitotomía como único gesto, sin embargo no hay una técnica quirúrgica definitiva estandarizada. Presentamos el caso de una paciente de 70 años que acude al Departamento de Urgencias con el diagnóstico clínico de obstrucción intestinal mecánica baja, de cuatro días de evolución, como consecuencia de un cálculo impactado en colon sigmoides.

Gallstone ileus is a rare complication of cholelithiasis, which is characterized by clinically presenting as an intraluminal mechanical intestinal obstruction secondary to the impaction of a gallstone in the digestive tract, due to the existence of a biliary-enteric fistula. The preoperative diagnosis is difficult, since it presents symptoms and signs of intestinal obstruction, which are very unspecific to suspect a Biliary Ileus. The treatment of choice in the management of gallstone ileus is surgery; usually is performed in two stages, whole lithotomy as the only gesture, however there is no standardized definitive surgical technique. We present the case of a 70-year-old patient, who attended the emergency department with the clinical diagnosis of low mechanical bowel obstruction, four days of evolution, as a result of a stone impacted in the sigmoid colon.

Chronic constipation leading to sigmoid colon volvulus in an adolescent

We report a case of one of the rare complications of constipation in an adolescent. The patient presented with acute abdominal symptoms and the radiographic images revealed a dilated twisted sigmoid colon. Rectal tube reduction was successful and subsequently, the patient underwent sigmoidectomy and uneventful recovery

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.

Oclusión intestinal por nudo ileosigmoideo / Intestinal occlusion by Ileosigmoid Knot

La oclusión intestinal es una causa frecuente de abdomen agudo quirúrgico. Dentro de sus múltiples casusas se encuentra el nudo ileosigmoideo, entidad rara en el mundo, pero puede verse con relativa frecuencia en algunas latitudes geográficas como Asia, Medio Oriente y otros países del continente africano. El objetivo de este trabajo es presentar cuatro casos de pacientes con oclusión intestinal por nudo ileosigmoideo en los hospitales Souro Sanu de Bobo Diulaso, Burkina Faso y Wa Regional Hospital, de Gana. Se intervinieron quirúrgicamente, se hizo resección en bloque de los segmentos ileales y sigmoideos gangrenados con anastomosis íleo-ascendente y colostomía de tipo Hartman. Los pacientes evolucionaron satisfactoriamente y luego de tres meses se restableció definitivamente el tránsito intestinal. Se realizó una revisión de la literatura(AU)

Intestinal occlusion is a frequent cause of surgical acute abdomen. Among its multiple causes are the ileosigmoid knot, a rare entity worldwide, which is relatively frequent in some geographic areas such as Asia, Middle East and Africa. The objective of this paper was to present four patients with intestinal occlusion due to ileosigmoid knot in Souro Sanu of Bobo Diulaso hospitals in Burkina Faso and Wa Regional Hospital in Ghana. They were operated on through block resection of gangrenous ileal and sigmoid segments with ascending ileoanastomosis and Hartrman-type colostomy. The patients recovered satisfactorily and three months later, the intestinal transfer was finally re-established. A literature review on the topic was made(AU)

Ileosigmoid Knot: A Rare Cause of Intestinal Obstruction.

Ileosigmoid knotting also known as compound volvulus or double volvulus is a rare cause of intestinal obstruction. Here, we present a case of acute intestinal obstruction in shock. The patient was resuscitated taken up for an emergency exploratory laparotomy, which revealed a large volume of hemorrhagic fluid and dilated gangrenous loops of ileum and sigmoid. A loop of ileum had encircled the base of sigmoid to form a knot resulting in gangrene of both the ileum and the sigmoid colon. Resection of gangrenous ileum and sigmoid colon with ileo-ileal and colorectal anastomosis with a temporary diversion colostomy was done.

Vesicoenteric Fistula due to Bladder Squamous Cell Carcinoma

Vesicoenteric fistula is a rare complication of bladder squamous cell carcinoma. We report the case of a 70-year-old male who complained of painless, total gross hematuria. Abdominopelvic computed tomography (CT) revealed an approximately 2.7-cm lobulated and contoured enhancing mass in the bladder dome. We performed partial cystectomy of the bladder dome after transurethral resection of the bladder. The biopsy result was bladder squamous cell carcinoma, with infiltrating serosa histopathologically, but the resection margin was free. Postoperatively, follow-up CT was done after 3 months. Follow-up CT revealed an approximately 4.7-cmx4.0-cm lobulated, contoured, and heterogeneous mass in the bladder dome. A vesicoenteric fistula was visible by cystography. Here we report this case of a vesicoenteric fistula due to bladder squamous cell carcinoma.

Infecção do trato urinário de repetição por fístula enterovesical secundária a doença diverticular do cólon: um relato de caso / Recurrent urinary tract infection due to enterovesical fistula secondary to colon diverticular disease: a case report

INTRODUÇÃO: As fístulas enterovesicais (FEV) são comunicações patológicas entre a bexiga e as alças intestinais pélvicas. Trata-se de uma rara complicação decorrente de doenças inflamatórias e neoplásicas da pelve, além de casos resultantes de iatrogenia, e associa-se a altos índices de morbimortalidade. RELATO DO CASO: Trata-se de um paciente de 61 anos com um quadro de dor e distensão abdominal, vômitos, parada de eliminação de fezes e flatos. APP: Hipertenso, diabético, com antecedentes de disfunção vesical e infecções do trato urinário de repetição (ITUr) nos últimos três anos. Por meio da realização de ressonância magnética de abdômen e pelve, diagnosticou-se FEV associada à doença diverticular (DDC) do sigmoide. A conduta estabelecida consistiu em colectomia parcial com rebaixamento de colo e cistectomia parcial com colocação cirúrgica de cateter duplo jota à esquerda. DISCUSSÃO: Embora consista de afecção primária do trato digestivo, normalmente o paciente com DDC associada a FEV procura atendimento médico em decorrência de queixas do trato urinário. Nesse caso, a demora no diagnóstico fez com que a queixa principal fosse do trato digestivo e com antecedentes de queixas urinárias. CONCLUSÃO: Apesar de pouco frequente, a ocorrência de ITUr associada à DDC deve ser sempre considerada no diagnóstico diferencial das ITUr pela alta morbimortalidade.

INTRODUCTION: Enterovesical fistula are pathological connections between the bladder and pelvic intestinal segments. It consists of a rare complication of neoplastic and inflammatory pelvic disorders, in addition to iatrogenic or traumatic injuries, and correlates with both high morbidity and mortality indexes. CASE REPORT: Male patient, 61 years old, admitted at the hospital clinics featuring abdominal pain and distension, vomiting and fecal retention. Patient's pathological precedents include high blood pressure, diabetes mellitus, vesical dysfunction and recurrent urinary tract infection on the past three years. Magnetic resonance imaging of abdomen and pelvis revealed enterovesical fistula in association with colon diverticular disease of the sigmoid. Management of choice consisted of partial colectomy with bowel lowering and partial cystectomy with surgical double-J stent insertion. DISCUSSION: Although consisting of a gastrointestinal primary affection, patients with enterovesical fistula usually search for medical help charging urinary tract features. In this particular case, our patient was admitted with gastrointestinal symptoms, reasoned by diagnostic delay, as the patient had already attended at multiple centers with urinary symptoms. CONCLUSION: Despite being an unusual affection, recurrent urinary tract infection associated with colon diverticular disease must always be considered at differential diagnosis of recurrent urinary tract infection as it concurs with high morbidity and mortality.

Lower gastrointestinal bleeding as a result of fistula between the iliac artery and sigmoid colon in patient with advanced testicular cancer

Fistula between arteries and the gastrointestinal tract are a rare cause of gastrointestinal bleeding, but potentially fatal. The recognition and early treatment can modify the patient prognosis. We report a case of a patient with previous surgery for seminoma of cryptorchidic testicle, with massive lower gastrointestinal bleeding. We performed the diagnosis and surgical treatment of the fistula between left external iliac artery and sigmoid colon. The patient was successfully treated by external iliac artery ligation and left colectomy.

Manejo del vólvulo de sigmoides en tres hospitales integrales comunitarios de la misión médica cubana en Bolivia / Management of Sigmoid Volvulus in Three General Community Hospitals of the Cuban Medical Mission in Bolivia

Fundamento: el vólvulo de sigmoides es una emergencia que se presenta con frecuencia en los hospitales del área andina sudamericana. Representa más del 50 % de todas las obstrucciones intestinales y aún mantiene altos índices de mortalidad.Objetivo: caracterizar el manejo del vólvulo de sigmoides. Métodos: estudio descriptivo de los pacientes con vólvulo de sigmoides que acudieron a tres hospitales integrales comunitarios de la misión médica cubana en Bolivia desde junio de 2006 hasta junio de 2007 y fueron atendidos por cirugía general. Se analizaron las variables: edad, sexo, antecedentes patológicos, diagnóstico operatorio, tipo y clasificación de la cirugía, operación realizada, evolución, complicaciones, uso de antibiótico-profilaxis, ingreso en sala de cuidados intensivos. La información se obtuvo del expediente clínico, informe operatorio y un modelo recolector de datos. Resultados: el vólvulo de sigmoides se presentó con mayor frecuencia en el hospital de Yapacaní, departamento de Santa Cruz; predominó el grupo de edades de 55 a 64 años y el sexo masculino; la enfermedad de Chagas estuvo presente en la mayoría de los pacientes; entre los síntomas predominaron la distención, el dolor abdominal y la detención de heces fecales. La descompresión, desvolvulación y el tratamiento quirúrgico fue la conducta tomada en todos los casos, la colostomía de Rankin-Mikulicz fue la más utilizada. No se reintervinieron pacientes, ni existió mortalidad. Conclusiones: la descompresión, desvolvulación y el tratamiento quirúrgico fue la conducta tomada en todos los casos; la colostomía de Rankin-Mikulicz fue la más utilizada. La mayoría de los pacientes evolucionaron de forma satisfactoria.

Background: Sigmoid volvulus is an emergency that occurs very frequently in the South American Andean area hospitals. It accounts for over 50% of all intestinal obstructions and still retains high mortality rates. Objective: To characterize the management of sigmoid volvulus. Methods: A prospective and descriptive study was conducted including all patients with sigmoid volvulus who attended three general community hospitals of the Cuban medical mission in Bolivia from June 2006 to June 2007 and were treated trough general surgery. We analyzed the following variables: age, sex, medical history, surgical diagnosis, classification and type of surgery, surgery performed, evolution, complications, use of antibiotic-prophylaxis and admission to intensive care units. The information was obtained from medical records, operative reports and a data collector model. Results: Sigmoid volvulus occurred more frequently in the Yapacaní hospital, department of Santa Cruz; the predominant age group was that from 55 to 64 years old as well as the predominant sex was that of males. Chagas disease was detected in most of the patients studied. Among symptoms those that predominated were distension, abdominal pain and stool detention. Decompression, devolvulation and surgical treatment were the processes followed in all cases, being the Rankin-Mikulicz colostomy the most widely used. No patients underwent a second surgery, and there were no mortality rates. Conclusions: Decompression, devolvulation and surgical treatment were the processes followed in all cases, being the Rankin-Mikulicz colostomy the most widely used. Most patients had a satisfactory evolution.

[ sigmoid diverticulitis]

The sigmoid diverticulitis is the most common complication of diverticulosis of the colon. The remaining questions concern the current risk factors for recurrence after a first acute episode, radiological asking immediately upon suspicion of diverticulitis and therapeutic management including the indications of surgical treatment, what to conduct and its principles. Literature review. Risk factors of recurrence are: persistent or recurrent diverticulitis, abscess, stenosis and / or fistula. Abdominal CT is recommended in all patients clinically suspected diverticulitis of the colon. Treatment of acute diverticulitis is medical. The emergency surgical treatment depends on the stage of Hinchey. Stage I: In case of failure of medical treatment, resection-anastomosis in an emergency time delay to be proposed. Stage II: a percutaneous drainage followed by resection-anastomosis in 1 time. Stage III: surgery in emergency sigmoid colectomy based on. Stage IV: Hartmann procedure is the procedure of reference. Prophylactic colectomy is proposed in the case of presence of risk factors of recurrence. Comparison with other literature review were allowed to find that ultrasound made by an experienced radiologist could replace abdominal CT, and for stage III and IV Hinchey, laparoscopic resection can be performed with an immediate restoration of digestive continuity in well selected patients

Expressão de mediadores neurotróficos e pró-inflamatórios na endometriose de reto e sigmoide / Expression of neurotrophic and inflammatory mediators in rectosigmoid endometriosis

OBJETIVO: Avaliar a expressão de mediadores neurotróficos (NGF, NPY E VIP) e pró-inflamatórios (TNF-α) em fragmentos de reto e sigmoide comprometidos por endometriose. MÉTODOS: Foram selecionadas 24 pacientes submetidas ao tratamento cirúrgico de endometriose de reto e sigmoide com técnica de ressecção segmentar, seguido de anastomose mecânica término-terminal, com grampeador circular, no período de janeiro de 2005 a dezembro de 2007. Neste estudo incluímos mulheres no menacme que se submeteram a tratamento cirúrgico por endometriose profunda infiltrativa com acometimento do reto e sigmoide, atingindo o nível da camada muscular, submucosa ou mucosa. Para o grupo de estudo foram utilizados 24 fragmentos de reto e sigmoide com endometriose confirmada histologicamente, sendo um fragmento de cada uma das 24 pacientes selecionadas. Para o grupo controle, utilizou-se um fragmento da margem distal da ressecção, denominado anel de anastomose, de cada uma das 24 pacientes selecionadas e incluídas no estudo. As amostras foram agrupadas em blocos de Tissue Micro Array (TMA) e submetidas à reação imunoistoquímica para avaliar a expressão do fator de necrose tumoral alfa (TNF-α), do fator de crescimento neural (NGF), do neuropeptídeo Y (NPY) e do peptídeo intestinal vasoativo P (VIP), e posterior análise semiquantitativa da imunomarcação por meio da leitura da densidade ótica relativa (DO). RESULTADOS: Observou-se maior densidade ótica relativa da imunomarcação para TNF-α e NGF no grupo de estudo (amostras com endometriose intestinal), DO= 0,01, respectivamente, para as duas proteínas (p<0,05), em relação aos controles sem endometriose. Não houve diferença estatística na densidade ótica da imunomarcação do NPY e VIP. CONCLUSÃO: Identificou-se o aumento da imunomarcação dos anticorpos TNF-α e NGF em fragmentos de reto e sigmoide comprometidos por endometriose em relação aos controles livres da doença. Não identificamos diferença estatística na imunomarcação das proteínas NPY e VIP.

PURPOSE: To evaluate the expression of neurotrophic (NGF, NPY and VIP) and pro-inflammatory (TNF-α) mediators in the rectum and sigmoid fragments compromised by endometriosis. METHODS: Twenty-four patients were selected to undergo surgical treatment of endometriosis of the rectum and sigmoid colon with a segmental resection technique, followed by end-to-end anastomosis with a circular stapler from January 2005 to December 2007. The study included premenopausal women who underwent surgical treatment for deep endometriosis infiltrating the rectum with involvement of the rectum and sigmoid, reaching the level of the muscle layer, submucosa or mucosa. Twenty-four rectum and sigmoid fragments with histologically confirmed endometriosis, one from each of the 24 selected patients, were used for the study group. For the control group, we used a fragment of the distal resection margin called anastomosis ring from each of the 24 patients enrolled in the study. Samples were grouped into Tissue Micro Array (TMA) blocks and subjected to immunohistochemistry to evaluate the expression of tumor necrosis factor alpha (TNF-α), nerve growth factor (NGF), neuropeptide Y (NPY) and P vasoactive intestinal peptide (VIP), followed by semiquantitative analysis of immunostaining by reading the relative optical density (OD). RESULTS: There was higher optical density relative to TNF-α immunostaining and NGF in the study group (samples with intestinal endometriosis), DO=0.01, for the two proteins, respectively (p<0.05), compared to controls without endometriosis. There was no statistically significant difference in the optical density of immunostaining of NPY and VIP. CONCLUSION: We identified increased immunostaining of TNF-α antibodies and fragments of NGF in the rectum and sigmoid compromised by endometriosis compared to disease-free controls. We did not identify any statistical difference in immunostaining of NPY and VIP proteins.