Tratamiento ambulatorio de la diverticulitis aguda no complicada / Outpatient Treatment of Acute Uncomplicated Diverticulitis

Introducción: La diverticulitis aguda es la complicación más frecuente de la enfermedad diverticular del colon y causa de ingresos hospitalarios. Su tratamiento ha sido evaluado en los últimos años y muestra una tendencia a limitar el tratamiento quirúrgico y potenciar el de tipo conservador. Objetivo: Realizar una revisión sobre la aplicabilidad, la seguridad y la eficacia del tratamiento ambulatorio de la diverticulitis aguda no complicada en pacientes seleccionados. Métodos: Se realizó una revisión bibliográfica en fuentes de información disponibles en las bases de datos SciELO, Medline (Pubmed), así como Google académico, donde se escogieron un total de 36 referencias. Desarrollo: Históricamente los pacientes diagnosticados de diverticulitis aguda han sido internados en centros hospitalarios para estudio y tratamiento dietético, antibiótico y analgésico. En los últimos años ha crecido la tendencia en el mundo a tratar estos pacientes de forma ambulatoria una vez comprobado que no se encuentra complicada, lo que ha demostrado con nivel de evidencia, que estos logran presentar una evolución favorable sin necesidad de ingreso, con menos gastos para el sistema de salud. Conclusiones: El tratamiento ambulatorio de la diverticulitis aguda no complicada no solo es eficaz y seguro, sino también aplicable en la mayoría de los pacientes, siempre que toleren la ingesta oral y dispongan de un entorno familiar adecuado(AU)

Introduction: Acute diverticulitis is the most frequent complication of diverticular colon disease and cause of hospitalizations. Its treatment has been assessed in recent years; there is a tendency to limit surgical treatment and promote conservative treatment instead. Objective: To review the applicability, safety and efficacy of outpatient treatment of acute uncomplicated diverticulitis in selected patients. Methods: A bibliographic review was carried out in sources of information available in the SciELO and Medline (Pubmed) databases, as well as in Google Scholar, by means of which a total of 36 references were selected. Development: Historically speaking, patients diagnosed with acute diverticulitis have been admitted to hospitals for study and dietary, antibiotic and analgesic treatment. In recent years, there has been a growing tendency worldwide to treat these patients on an outpatient basis once it has been proven that the condition is not complicated, which has shown, with level of evidence, that patients present a favorable evolution without the need for admission, with less expenses for the health system. Conclusions: Outpatient treatment of acute uncomplicated diverticulitis is not only effective and safe, but also applicable in most patients, given that they can tolerate oral intake and have an adequate family environment(AU)

Evaluation of the serrated lesions detection rate and its role as a colonoscopy quality criteria

Objectives: To evaluate the serrated lesion detection rate in colonoscopy at a specialized clinic and its role as quality criteria for endoscopic examination. Methods: This is an observational cross-sectional study with all patients that underwent colonoscopy between October 2018 and May 2019, performed by an experimented physician. A questionnaire was answered before the examination by the patient, and another questionnaire after the colonoscopy was answered by themedical team. All polyps identified were removed and sent to the same pathologist for analysis. Results: A total of 1,000 colonoscopies were evaluated. The average age of the patients was 58.9 years old, and most of them were female (60.6%). In 62.5% of the procedures, polyps were removed, obtaining a total of 1,730 polyps, of which 529 were serrated lesions, being 272 sessile serrated lesions (SSL). This data resulted in a serrated lesion detection rate (SDR) of 29.2%, and of 14% when considering only the SSL detection rate (SSLDR). The right colon had higher rates, with 22.3% SDR and 15.3% SSLDR. Screening colonoscopies also presented a higher serrated detection rate, of 20%, followed by diagnostics and follow-up exams. Smoking was the only risk factor associated with higher serrated detection rate. Conclusions: The serrated lesion detection rate is higher than the ones already previously suggested and the have the higher rates were stablished in the right colon and on screening exams. (AU)

Resultados terapéuticos en pacientes con traumas de colon y recto tratados con sutura primaria o colostomía / Therapeutic Results in patients with Colon and Rectal Traumas Treated with Primary Suture or Colostomy

RESUMEN Introducción: El trauma de abdomen tiene alta incidencia y con frecuencia afecta el colon y el recto, se aboga por el tratamiento mediante sutura primaria. Objetivo: Identificar diferencias en las características clínico-quirúrgicas y resultados terapéuticos de pacientes con lesiones traumáticas de colon y recto, tratados con sutura primaria y técnicas derivativas. Método: Se realizó un estudio multicéntrico descriptivo ambispectivo para determinar características clínico-quirúrgicas y resultados terapéuticos en pacientes con lesiones traumáticas de colon y recto en los hospitales Carlos J. Finlay, Joaquín Albarrán, Calixto García y Enrique Cabrera de La Habana, en el periodo 2010-2015. El universo estuvo conformado por todos los pacientes intervenidos quirúrgicamente por trauma de colon y/o recto. Resultados: La colostomía fue el proceder más frecuente (53,1 por ciento). Los pacientes en edades medias de la vida (promedio: 43,5 años), sexo masculino (71,4 por ciento), evolución hasta el tratamiento quirúrgico menor de 12 horas (73,4 por ciento); causadas por empalamientos y otros (49 por ciento) y heridas con arma blanca (38,8 por ciento). La magnitud del daño de colon y recto fue baja, con mayor afectación de colon izquierdo. La frecuencia de complicaciones graves y mortalidad fue alta en la colostomía. Conclusiones: La sutura primaria muestra mejores resultados terapéuticos y debe ser la técnica de elección en las lesiones traumáticas de colon y recto intraperitoneal(AU)

ABSTRACT Introduction: Abdominal trauma presents high incidence and often affects the colon and rectum; primary suture is the preferred treatment. Objective: To identify differences between the clinical-surgical characteristics and the therapeutic outcomes in patients with traumatic lesions of the colon and rectum, treated with primary suture and derivative techniques. Method: A multicentric, descriptive and ambispective study was carried out to determine the clinical-surgical characteristics and the therapeutic outcomes in patients with traumatic colon and rectal lesions in Carlos J. Finlay, Joaquín Albarrán, Calixto García and Enrique Cabrera Hospitals in Havana, in the period from 2010 to 2015. The study population was made up of all patients surgically intervened for colon and/or rectal trauma. Results: The colostomy was the most frequent procedure (53.1 percent). Patients in middle ages of life (average: 43.5 years), male sex (71.4 percent), evolution to surgical treatment under 12 hours (73.4 percent); caused by impalement and others (49 percent) and cutting wounds (38.8 percent). The magnitude of colon and rectum damage was low, with greater involvement of the left colon. The frequency of serious complications and mortality was high in the colostomy. Conclusions: Primary suture shows better therapeutic results and should be the technique of choice in traumatic lesions of the intraperitoneal colon and rectum(AU)

Uso de la colostomía en el tratamiento de lesiones traumáticas de colon y recto / Colostomy in the treatment of traumatic lesions of the colon and the rectum

Introducción: El trauma de abdomen tiene una incidencia que varía según las publicaciones, pero el colon y el recto son estructuras anatómicas generalmente comprometidas. Objetivo: Determinar las características clínico-quirúrgicas y los resultados terapéuticos en pacientes con lesiones traumáticas de colon y recto tratados con técnicas derivativas. Método: Se realizó un estudio descriptivo, retrospectivo y multicéntrico en hospitales clínico-quirúrgicos seleccionados de La Habana, desde 2010 hasta 2015. El universo estuvo conformado por todos los pacientes ingresados en las instituciones con trauma rectocolónico único o múltiple tratados quirúrgicamente por colostomía. Resultados: Los pacientes estudiados se caracterizaron por edades: jóvenes (menos de 30), sexo masculino (69,2 por ciento), evolución hasta el tratamiento quirúrgico mayor de 12 horas (46,2 por ciento); causadas por empalamientos y otros (53,8 por ciento) y heridas con arma blanca (23,1 por ciento). Se aplicaron principalmente las técnicas quirúrgicas de colostomía en asa y de Hartman. Tanto el tiempo quirúrgico como la estadía fueron prolongados. La frecuencia de complicaciones graves y la mortalidad fue alta. Los costos fueron elevados. Conclusiones: La colostomía aun es una alternativa quirúrgica viable, pero su selección debe estar basada en la evaluación individualizada de los casos y en los índices pronósticos(AU)

Introduction: Abdominal trauma has an incidence that varies, according to publications; but the colon and the rectum are generally compromised anatomical structures. Objective: To determine the clinical-surgical characteristics and the therapeutic results in patients with traumatic lesions of the colon and the rectum treated with derivative techniques. Method: A descriptive, retrospective and multicenter study was conducted in selected clinical-surgical hospitals in Havana, from 2010 to 2015. The total sample consisted of all patients admitted with single or multiple rectocolonic trauma and treated with colostomy. Results: The patients studied were characterized by age: young (less than 30), male (69.2 percent), evolution until surgical treatment over 12 hours (46.2 percent); caused by impalements and others (53.8 percent) and stab wounds (23.1 percent). The surgical techniques of loop colostomy and Hartman colostomy were applied, mainly. Both surgical time and stay were prolonged. The frequency of serious complications and mortality was high. The costs were high. Conclusions: Colostomy is still a viable surgical alternative, but its selection must be based on the individualized evaluation of the cases and the prognostic rates(AU)

Colecistectomizados, litiasis vesicular y ácidos biliares totales elevados en heces como factores de riesgo para lesiones colónicas / Cholecystectomized patients, vesicular lithiasis and elevated total bile acids in faces as risk factors for colon lesions

Introducción: Evidencias científicas avalan que niveles elevados de ácidos biliares en la luz intestinal se asocian con lesiones inflamatorias, premalignas y malignas de colon. Objetivo: Argumentar científicamente la condición de niveles elevados de ácidos biliares totales en heces, litiasis vesicular y colecistectomizado como factores de riesgo para lesiones de colon. Método: Se realizó una investigación analítica en el Instituto de Gastroenterología y el Centro Nacional de Cirugía de Mínimo Acceso desde 2002 hasta 2015. En el estudio se incluyeron adultos con sintomas digestivos bajos. Se desarrollaron dos momentos: la determinación del riesgo relativo de la presencia de lesiones colónicas diagnosticadas por endoscopía y la identificación por histología. Se utilizaron métodos estadísticos como la prueba chi cuadrado de Pearson, determinación del riesgo relativo, regresión logística, entre otros. Resultados: Se observó mayor probabilidad de presentar algún diagnóstico endoscópico e histológico positivo para todas las edades y sexo, en pacientes con niveles elevados de ácidos biliares totales en heces y los colecistectomizados. Los riesgos relativos comunes y más altos se relacionaron con adenomas tubulares de alto grado de displasia y tubulovellosos. Los diagnósticos más frecuentes fueron pólipos y adenomas. Conclusiones: Los resultados avalan que los niveles elevados de ácidos biliares totales en heces, la litiasis vesicular y estar colecistectomizado, constituyen factores de riesgo para lesiones de colon. Se recomienda incluir estas tres condiciones de riesgo en los programas de pesquisa para el cáncer colorrectal(AU)

Introduction: Scientific evidence supports that elevated levels of bile acids in the intestinal lumen are associated with inflammatory, premalignant and malignant lesions of the colon. Objective: To scientifically support the condition of elevated levels of total bile acids in faeces, vesicular and cholecystectomized lithiasis as risk factors for colonic lesions. Method: An analytical research was carried out in the Gastroenterology Institute and the National Center for Minimally-Invasive Surgery, from 2002 to 2015. The study included adults with low digestive symptoms. Two moments were developed: the determination of the relative risk for the presence of colonic lesions diagnosed by endoscopy and the identification by histologic study. Statistical methods were used, such as the Pearson chi-square test, the relative risk determination, logistic regression, among others. Results: Higher probability was observed for all ages and sexes to present a positive endoscopic and histological diagnosis, in patients with high levels of total bile acids in feces and in cholecystectomized patients. The common and higher relative risks were related to tubular adenomas of high degree of dysplasia and tubulovillous. The most frequent diagnoses were polyps and adenomas. Conclusions: The results support that high levels of total bile acids in faeces, vesicular lithiasis and being cholecystectomized constitute risk factors for colonic lesions. These three risk conditions are recommended to be included in screening programs for colorectal cancer(AU)

Complicações em colonoscopia: experiência uni-institucional com 8968 pacientes / Colonoscopy complications: experience with 8968 consecutive patients in a single institution

RESUMO Objetivo: avaliar a incidência, características epidemiológicas, diagnóstico e evolução dos pacientes que retornaram às unidades de pronto atendimento (UPA) do Hospital Albert Einstein em São Paulo/SP com sinais e sintomas sugestivos de complicações até 30 dias após realização de colonoscopia. Métodos: estudo retrospectivo uni-institucional de pacientes submetidos à colonoscopia em 2014 e que retornaram, em até 30 dias após o procedimento, a uma UPA. Resultados: foram realizadas colonoscopias em 8968 pacientes, dos quais 95 (1,06%) tiveram queixa relacionada à possível complicação. A maioria dos procedimentos foi realizada eletivamente. Complicações menores (dor abdominal inespecífica/distensão) foram frequentes (0,49%) e a maioria dos pacientes recebeu alta após consulta na UPA. Complicações graves foram menos frequentes: perfuração (0,033%), hemorragia digestiva baixa (0,044%) e obstrução intestinal (0,044%). A procura à UPA em menos de 24 horas após o procedimento associou-se a maior índice de colonoscopias normais (P=0,006), mais diagnóstico de febre (P=0,0003) e síndrome dispéptica (P=0,043) e menos diagnóstico de colite/ileíte (P=0,015). A presença de febre em pacientes atendidos na UPA associou-se ao diagnóstico de pólipos na colonoscopia (P=0,030). Conclusão: os dados do presente estudo corroboram as evidências de segurança do exame de colonoscopia e apontam para redução nos índices de complicações mais graves deste exame.

ABSTRACT Objective: to evaluate the incidence, epidemiological characteristics, diagnosis and evolution of patients who returned to the emergency care units of the Albert Einstein Hospital in São Paulo/SP with signs and symptoms suggestive of colonoscopy complications up to 30 days after the procedure. Methods: we conducted a retrospective, uni-institutional study of patients submitted to colonoscopy in 2014 who returned to the Emergency department (ED) within 30 days after the procedure. Results: 8968 patients underwent colonoscopies, 95 (1.06%) of whom had complaints related to possible complications. Most of the procedures were elective ones. Minor complications (nonspecific abdominal pain/distension) were frequent (0.49%) and most of the patients were discharged after consultation at the ED. Severe complications were less frequent: perforation (0.033%), lower gastrointestinal bleeding (0.044%), and intestinal obstruction (0.044%). ED consultations in less than 24 hours after the procedure was associated with a higher index of normal colonoscopies (p=0.006), more diagnosis of fever (p=0.0003) and dyspeptic syndrome (p=0.043), and less diagnosis of colitis/ileitis (p=0.015). The observation of fever in patients treated at the ED was associated with the diagnosis of polyps at colonoscopy (p=0.030). Conclusion: the data corroborate the safety of the colonoscopy exam and points to a reduction in major complications rates.

Tratamiento conservador en perforaciones postpolipectomía colonica / Conservative treatment in colon postpolypectomy perforations

Introduccion: La videocolonoscopía es el principal método de diagnóstico, tratamiento y seguimiento en patologías colorectales. La perforación colónica en endoscopía terapeútica es una complicación infrecuente pero debe ser evaluada y tratada rapidamente cuando aparece ya que puede presentar una morbimortalidad elevada. Objetivo: Valorar resultado de tratamiento conservador no quirúrgico en perforaciones colónicas post polipectomía endoscópica. Materiales y Métodos: Se realizó un estudio retrospectivo observacional descriptivo sobre base de datos prospectiva en el Sanatorio del Salvador y en el centro privado Unidad Digestiva Baistrocchi de la ciudad de Córdoba, desde enero del año 2012 a diciembre del 2017. Resultados: Sobre un total de 1606 procedimientos intervencionistas, se presentaron 9 perforaciones. El síntoma más frecuente fue el dolor abdominal, seguido de distensión, defensa muscular, reacción peritoneal y fiebre. Se realizaron radiografía de abdomen y tomografía computada a todos los casos con diagnóstico presuntivo para corroborar los hallazgos clínicos. Se realizó internación, reposo gástrico, control estricto de parámetros clínicos y antibioticoterapia para flora colónica. Se analizó diariamente evolución decidiendo conducta a seguir. El tratamiento conservador fue satisfactorio en un 87% de los casos. Conclusión: La perforación colónica postpolipectomía es una complicación inevitable, de menor incidencia en especialistas entrenados. Conociendo los síntomas de presentación, realizando un correcto examen físico y seguimiento clínico puede realizarse tratamiento conservador exitoso en aquellos pacientes clínicamente estables y de riesgo moderado. (AU)

Background: Videocolonoscopy has become the main tool for diagnostic and treatment of colorrectal diseases. Perforation after therapeutic colonoscopy is an uncommon complication but it must be treated quickly beacause of it´s high rate of morbidity and mortality. Aims: To evaluate rate of success of non quirurgical treatment in postpolipectomy perforations. Methods: A retrospective observational study was performed over a prospective database of 11062 colonoscopy fulfilled between january 2012 and december 2017. Results: We had 9 perforations. The most common symptom was abdominal pain, followed by distension, peritonism and fever. All pacients with presumpitve diagnoses were studied with computed tomography and plain chest radiography. The management was conservative in all cases. The standard treatment was endovenous antibiotics, nil-by-mouth regimen, fluids and hospitalization in common floor. Conservative treatment was successful in 87% of our cases. Conclusions: postpolipectomy perforation is inevitable, nevertheless, has lower incidence in specialized physicians. Knowledge about symptoms and having a close follow up of potencial patients may allow us to improve rates of success in conservative management. (AU)

Colorectal injury by compressed air: the rule of conservative therapy / Lesão colorretal por ar comprimido: a regra da terapia conservadora

ABSTRACT We are reporting a case of colorectal injury caused by a jet of compressed air directed from a distance towards the anus. The patient mentioned that it happened accidentally while his colleague was cleaning his clothes using compressed air. The patient presented with acute abdominal pain and distension. A contrast CT study did not show any free air or leakage. The patient was treated conservatively, progressed well and was discharged from the hospital on the fourth day.

RESUMO Descrevemos um caso de lesão colorretal causada por um jato de ar comprimido direcionado para o ânus, a certa distância. O paciente mencionou que o ocorrido foi acidental, enquanto um colega estava limpando suas roupas com ar comprimido. O paciente se apresentou com dores abdominais agudas e distensão. Um estudo de TC contrastado não demonstrou ar livre, nem vazamento. O paciente foi tratado conservadoramente, teve boa evolução e recebeu alta hospitalar no quarto dia.

Trauma de Cólon: experiência de um centro de referência em Porto Alegre/RS / Colon trauma: the experience of a reference center in Porto Alegre/RS

Introdução: As lesões de cólon são comuns em pacientes vítimas de trauma. Seu tratamento é bastante variável e muito discutido. Objetivo: Analisar a experiência com trauma de cólon de um centro de referência em trauma por aproximadamente 4 anos, avaliando o perfil dos pacientes, mecanismo de trauma, lesões, evolução e desfecho. Métodos: Estudo retrospectivo em que foram incluídos todos os pacientes com trauma de cólon no período de setembro de 2009 a dezembro de 2013. Resultados: Foram identificadas 101 vítimas com trauma de cólon, sendo 92 casos (91%) devido a trauma penetrante. Os ferimentos abdominais foram preponderantes (85,1%), seguidos por ferimentos em dorso em 15,8% e em transição toracoabdominal em 9,9%. Apenas 6,9% apresentavam-se com PAS < 90 mmHg e 23,8% com FC > 100 bpm na admissão. Noventa e nove por cento dos pacientes foram levados ao bloco cirúrgico para laparotomia exploradora imediatamente após o atendimento na sala de emergência. Setenta e três (72,3%) apresentaram lesões de outros órgãos abdominais associadas, a mais comum foi de intestino delgado (49,5%). A mortalidade da série foi de 1%, e as complicações mais frequentes foram a pneumonia em 16,8%, a infecção de ferida operatória em 11,9% e a infecção urinária em 7,9%. Conclusões: O diagnóstico e tratamento precoce das lesões de cólon são fundamentais para uma boa evolução e para prevenção das complicações, principalmente infecciosas, que são responsáveis pela morbidade e mortalidade nesses pacientes. Os dados apresentados estão de acordo com os encontrados na literatura atual(AU)

Background: Colon lesions are common in trauma patients. Their treatment is very variable and much discussed. Objective: To analyze the experience with colon trauma of a reference center for trauma for about 4 years, evaluating patient profile, mechanism of trauma, injury, evolution and outcome. Methods: A retrospective study which included all patients with colon trauma from September 2009 to December 2013. Results: A series of 101 victims with colon trauma were identified, of which 92 cases (91%) were due to penetrating trauma. Abdominal injuries were prevalent (85.1%), followed by back (15.8%) and thoracoabdominal transition (9.9%) injuries. Only 6.9% presented with SBP 100 bpm at admission. Ninety-nine percent of patients were taken to the operating room for exploratory laparotomy immediately after evaluation in the emergency room. Seventythree (72.3%) had associated injuries to other abdominal organs, the most common being small intestine (49.5%). The mortality in this series was 1%, and the most frequent complications were pneumonia in 16.8%, wound infection in 11.9%, and urinary infection in 7.9%. Conclusions: Early diagnosis and treatment of colon lesions are critical for a good outcome and prevention of complications, mainly infectious diseases, which are responsible for morbidity and mortality in these patients. The data presented are consistent with the current literature(AU)

Sutura primaria en lesiones traumáticas de colon y recto / Primary suture in colon and rectum traumatic lesions

Introducción: en la vida civil la tendencia actual en el tratamiento de las lesiones traumáticas de colon y recto es hacia el cierre primario, pero aún no existe consenso. Objetivo: identificar características y evolución de 36 pacientes con traumatismos de colon a los que se les practicó sutura primaria. Métodos: estudio descriptivo, de cohorte retrospectiva. Se estudiaron pacientes atendidos en hospitales docentes de la provincia de La Habana, desde noviembre de 2008 hasta enero de 2012, así como los factores relacionados con la ocurrencia de complicaciones y los costos. Los datos fueron tomados de la historia clínica y del informe operatorio, en cada hospital. La información fue procesada de forma automatizada (SPSS 15.0). Se utilizó análisis de distribución de frecuencias, y el test de homogeneidad para identificar las variables relacionadas con la ocurrencia de complicaciones. Resultados: la causa más frecuente de las lesiones fue el arma blanca (86,1 por ciento). Los factores relacionados con la ocurrencia de complicaciones fueron el agente causal y la severidad de las lesiones según la escala de Flint (p= 0,02 y p= 0,04). Los costos promedio por tiempo quirúrgico y estadía resultaron ser de: $ 1091,88 y $ 1250,82. Conclusiones: las principales complicaciones por empleo de sutura primaria en los hospitales docentes de La Habana fueron: infección del sitio quirúrgico y sangramiento postoperatorio, y los factores relacionados con ellas: el agente causal y la severidad de las lesiones. El empleo de la sutura primaria es una opción terapéutica que parece razonable y menos costosa que la colostomía(AU)

Introduction: In civilian life, the current trend in the treatment of colon and rectum traumatic lesions is for the primary closure, but there is still no consensus. Objective: to identify the characteristics and outcome of 36 patients with colon trauma colonist who underwent primary suture. Methods: A descriptive study of retrospective cohort was carried out; we studied patients treated in Havana Province teaching hospitals, from November 2008 to January 2012, as well as the factors related to the occurrence of complications and costs. Data were collected from the medical records and the operative report, in each of the hospitals. The information was processed in an automated system (SPSS 15,0). Analysis of frequency distribution and homogeneity test were used to identify variables related to the occurrence of complications. Results: The most frequent cause of injury was stab (86,1 percent). The factors related to the occurrence of complications and the severity of lesions were the causative agents, as measured by the Flint scale (p= 0,02 and p= 0,04). Average costs per surgical and stay time turned out to be: $ 1091,88 and $ 1250,82. Conclusions: The main complications from the use of primary suture in teaching hospitals of Havana are: surgical site infection and postoperative bleeding, and other factors related to them: the causative agent and the severity of lesions. The use of primary suture is a therapeutic option that seems to be reasonable and less expensive than the colostomy(AU)

Repair of post polypectomy colonic perforation by Endoclip: a case report / Reparo de perfuração de cólon pós-polipectomia por Endoclip: relato de caso

A 73-year-old woman was admitted to evaluate for iron deficiency anemia, increased serum creatinine, and ascites. Her colonoscopy revealed a polyp at the junction of sigmoid and descending colon, and after polypectomy, a 6 mm colonic perforation was seen. The perforation was detected by radiography and CT scan; and beside conservative management and antibiotics, her perforation was closed by using Endoclip. The patient was observed and discharged from hospital without any surgery 5 days later, and in follow-up there was no problem regarding perforation. (AU)

Mulher, 73 anos, internada para avaliação para anemia ferropriva, com aumento da creatinina sérica e ascite. A colonoscopia revelou um pólipo na junção dos colos sigmoide e descendente e, em seguida à polipectomia, foi observada uma perfuração de 6 mm no cólon, comprovada por radiografias e tomografia computadorizada. Além do tratamento conservador e da antibioticoterapia, a perfuração foi ocluída com Endoclip. A paciente ficou sob observação e recebeu alta do hospital sem qualquer cirurgia 5 dias mais tarde. Durante o seguimento, não foram observados problemas com relação à perfuração. (AU)

Incidence of retrorenal colon during percutaneous nephrolithotomy

Objective The aim of this study was to investigate retrorenal colon incidence in percutaneous nephrolithotomy (PNL) interventions made in our clinic. Materials and Methods Clinical data of 804 PNL patients, accumulated over a 7 year period (2006-2012), was surveyed. The patient files were reviewed retrospectively, and only those who had abdominal computed tomography (CT) images before PNL intervention were included in the study. In the CT images, the position of both the ascending and descending colon in relation to the right and left kidneys were evaluated. Results According to our hospital reports, 394 patients with CT images were included in the present study 27 patients (6.9%) had retrorenal colon, of which 18 (4.6%) were on the left side, 4 (1.0%) on the right side and 5 (1.3%) had bilateral retrorenal colons. Colonic perforation complication was seen only in two patients and the colonic perforation rate was 0.3%. These two cases had no CT images. Conclusions PNL, in the process of becoming the standard treatment modality, is a safe and reliable technique for renal stone treatment. Colonic injury should be taken into consideration during PNL interventions of the lower pole of the kidney (especially on the left side) due to the location of retrorenal colon. .

Effect of glutamine supplementation on left colon healing in rats with extrahepatic biliary obstruction

PURPOSE: To evaluate the influence of glutamine and obstructive jaundice on left colon healing in rats. METHODS: Sixteen male rats were allocated across four groups: LG - Common bile duct ligation followed by colotomy and bowel suture on postoperative day 7. Supplementation with glutamine 2% from day 4 after duct ligation until euthanasia. L - Common bile duct ligation followed by colotomy and bowel suture on postoperative day 7. No glutamine supplementation. M - Common bile duct manipulation followed by colotomy and bowel suture on postoperative day 7. No glutamine supplementation. MG - Common bile duct manipulation followed by colotomy and bowel suture on postoperative day 7. Supplementation with glutamine 2% from day 4 after duct manipulation until euthanasia. On the day of euthanasia, bursting pressure of the sutured bowel segment was measured and samples were collected for histopathological analysis. RESULTS: There were no differences in bursting pressure among groups : LG vs. M (110 ± 28 vs. 173 ± 12; p = 0.08). Groups L and MG were not different from group M (156 ± 12 and 118 ± 22. Glutamine supplementation was associated with less edema, polymorphonuclear lymphocyte infiltration, bacterial colonies, and abscess formation, as well as with increased collagen formation. CONCLUSION: Obstructive jaundice had no negative effect and glutamine supplementation had no positive effect on colonic scar strength in rats. .

Manejo actual de las lesiones colorectales traumáticas / Current management of traumatic colo-rectal injuries

El tratamiento de las lesiones traumátcas del colon ha experimentado cambios importantes durante los últmos años, que nos han permitdo ofrecermejores opciones al manejo de éste tpo de trauma y por consiguiente un mejor “confort” para el paciente que, en el pasado, tenía que soportar losefectos indeseables de una cirugía derivatva como la colostomía, y luego someterse a una segunda intervención para su tratamiento defnitvo contodos los riesgos que esto conlleva. Aún existen controversias que están relacionadas con el tempo de evolución principalmente en cuanto al tratamientoprimario retrasado, presencia de shock, lesiones asociadas y grado de contaminación que podrían estar relacionadas con incremento en latasa de morbilidad y mortalidad. Hemos hecho una revisión crítca de la literatura relacionada con estos tópicos que nos ofrecen un mejor panoramade las mejores opciones de tratamiento utlizando una mejor evidencia y en consecuencia ofrecer recomendación adecuada debido a que aún existeincertdumbre acerca de su seguridad.

During recent years, colon injury treatment has experimented important changes that allow us to ofer beter optons for treatng this trauma andconsequently a beter “comfort” for the patents who, in the past, had to deal with the undesirable efects of a derivatve surgery like colostomy, andthen had a second interventon for their defnitve treatment with all the risks that it takes. There are stll controversies related with evoluton tme,mainly concerned the delayed primary treatment, shock presence, associated injuries and contaminaton grade, that could be related with increase ofmorbidity and mortality rates. A critcal literature review related with those topics has been done, that ofers a beter scene of the top treatment choicesusing beter evidence and consequently, ofers an appropriate recommendaton, because there is stll uncertainty about its safety.

A Case of Successful Endoscopic Clipping for Iatrogenic Colon Perforation Induced by Peritoneal Catheter Insertion / 대한소화기학회지

Advanced cancer patients with refractory ascites often do not respond to conventional treatments including dietary sodium restriction, diuretics, and repeated large volume paracentesis. In these patients, continuous peritoneal drainage by an indwelling catheter may be an effective option for managing refractory ascites with a relative low complication rate. Peritoneal catheter-induced complications include hypotension, hematoma, leakage, cellulitis, peritonitis, and bowel perforation. Although bowel perforation is a very rare complication, it can become disastrous and necessitates emergency surgical treatment. Herein, we report a case of a 57-year-old male with refractory ascites due to advanced liver cancer who experienced iatrogenic colonic perforation after peritoneal drainage catheter insertion and was treated successfully with endoscopic clipping.

Manifestaciones extraintestinales en rectocolitis úlcerativa: a propósito de un caso / Extraintestinal manifestations in ulcerative proctocolitis: a case report

La colitis ulcerativa (CU) forma más común de la enfermedad inflamatoria intestinal (EII),¹ es una enfermedad crónica que cursa con inflamación recurrente no controlada del colon,² caracterizada por ulceración de la mucosa, sangrado rectal, diarrea y dolor abdominal.³ Un tercio de los pacientes pueden desarrollar una manifestación extraintestinal.4,5 En la CU estas manifestaciones suelen estar relacionadas con la actividad de la enfermedad.5,6 Presentamos un caso clínico de una paciente con CU quien presenta manifestaciones extraintestinales cutáneas, oculares y en mucosa bucal, con resolución de las mismas posterior a tratamiento médico

Ulcerative colitis (UC) the most common form of inflammatory bowel disease (IBD),¹ is a chronic disease that causes uncontrolled recurrent inflammation of the colon,² characterized by mucosal ulceration, rectal bleeding, diarrhea and abdominal pain.³ A third of patients may develop extraintestinal manifestation.4,5 In UC these manifestations are often associated with disease activity.5,6 We present a case of a patient with UC who presented extraintestinal cutaneous, ocular and oral mucosa, with resolution of the same post-treatment

Use of defatted flaxseed meal reduces precancerous colon lesions in C57BL/6 mice

PURPOSE: To investigate the hemopreventive effect of defatted flaxseed meal in C57BL/6 mice after induction of precancerous colon lesions with 1.2-dimethylhydrazine (DMH). METHODS: Thirty-six 12-week-old C57BL/6 mice were divided into three treatment groups(n=12 in each group): (1) diet with 10% defatted flaxseed meal; (2) diet with defatted flaxseed meal and precancerous colon lesions induced by DMH; and (3) precancerous colon lesions induced by DMH, without defatted flaxseed meal. The incidence of aberrant crypt foci (ACF), oxidative processes, expression of tumor suppressor proteins and cyclins, as well as the profile of short-chain fatty acids (SCFA) in animal feces were investigated in the presence and absence of DMH. RESULTS: The rats consuming defatted flaxseed meals showed lesions with lower multiplicity and a reduced incidence of lesions. No changes in the expression of tumor suppressor proteins and those involved in cell cycle control were detected. CONCLUSION: Defatted flaxseed meal protected the distal colon of mice from precancerous lesions.

Utilidad de la cromoscopia virtual computarizada en la detección de lesiones planas colorectales / Computerized virtual chromoscopy utility in flat colorectal lesions

Las lesiones planas están asociadas con mayor frecuencia a la presencia de carcinoma invasor superficial. La magnificación endoscópica permite el análisis detallado de la superficie mucosa de lesiones sospechosas y predecir, por sus características morfológicas, si son lesiones benignas o malignas, permitiendo decidir conducta terapéutica al momento del estudio. Los tumores de diseminación lateral de colon y recto, son lesiones >10mm con bajo eje vertical extendidas lateralmente a lo largo de la pared luminal. Okamoto describe dos grupos: tipo granular, endoscópicamente numerosos nódulos de color homogéneo en comparación con mucosa colónica circundante; tipo plano, lesiones con superficie plana en ausencia de formación de gránulos nodulares. Establecer utilidad de la cromoendoscopia virtual computarizada y magnificación (FICE) para la determinación de las lesiones detectadas en estudios de video colonoscopia; decidir en el momento del procedimiento, la conducta a seguir. Se utilizó el modelo de clasificación de Paris en las lesiones colorectales detectadas. Estudio retrospectivo y descriptivo en pacientes que acudieron a una consulta de centro privado, en el período Enero 2009-Marzo 2012, realizándoles video colonoscopia con FICE, con equipo Fujinon EPX-4400, por un mismo endoscopista. Se revisaron 1298 video colonoscopias, 269 casos con lesiones planas en colon de los cuales 17 (6.31%) fueron lesiones tipo II (diseminación lateral); 9 del sexo femenino (52.94%) y 8 masculino (47.05%); 7 fueron lesiones IIa no granular (41.17%), 7 IIa granular (41.17%), 2 IIc no granular (11.76%) y 1 IIc granular (5.88%). En relación a la ubicación 5 casos (29.41%), en transverso; 4 casos (23.52%) tuvieron resección endoscópica y 13 casos (76.47%) fueron referidos para resolución quirúrgica de los cuales, histológicamente: 7 fueron tubulovellosos (41,18%) y 1 de estos presentó displasia de alto grado y los 6 restantes de bajo grado....

The flat lesions are associated with a high incidence of invasive superficial carcinoma; the endoscopic magnification allows a more detailed evaluation of the superficial lesions and can predict if they will be or not malignant, allowing to take a therapeutic decision at the moment of the videocolonoscopy. These tumours are lesions no more than 10 mm, whit a low vertical axis wich extents laterally along the lumen of the colon. Okamoto describes two groups: Granular type Endoscopically are numerous nodules with the same color compared with the surrounding colonic mucosae; and the Flat type which are flat lesions without presence of nodules. To establish the utility of the virtual computerized chromoendoscopy and magnification (FICE)® in the evaluation of lesions detected in videocolonoscopies performed and in order to take a therapeutic decision. We used the Paris model for the classification of the colorectal lesions encountered at the time of the colonoscopy. We performed a retrospective and descriptive study in patients who evaluated in a private office between January 2009-March 2012, a videcolonoscopy with FICE® using a videocolonoscope Fujinon EPX 4400 ® all studies were performed by the same operator. 1298 videocolonoscopies were performed, 269 cases with flat lesions, 17 (6.31%) were lesions type II (lateral spread), 9 were females (52,94%) and 8 males (47,05%), 7 were lesions type IIa, non granular (41,17%), 7 IIa granular (41,17%), 2 IIc non granular (11,76%), and 1 IIc granular (5,88%), 5 cases (29,41%) were located in transverse colon, 4 (23,52%) were successfully removed endoscopically , and 13 (76,47) were referred for surgical treatment, in relation with the histopathology: 7 were tubulovillous (41,18%), and 1 associated with high degree dysplasia and 6 low degree dysplasia. Our study demonstrates, the usefulness of the FICE® in the detection of flat lesions and permits obtain samples for biopsy and make therapeutic decisions