Metastatic clear-cell renal carcinoma: an exceptional cause of ileocolonic intussusception in adults

Introduction: Intussusceptions in adults are rare, representing 1% to 5% of intestinal obstructions in this age group. This condition can be caused by benign and malignant lesions acting as lead points, the latter being the most frequent. Furthermore, the diagnosis is challenging due to the non-specific symptoms with variable duration. Case Presentation: A 43-year-old man, with a history of localized clear-cell renal carcinoma (ccRCC) treated 9 years earlier with a right radical nephrectomy, presented with bowel obstruction symptoms. An abdominal computed tomography scan showed an ileocolonic intussusception. Hence, the patient required a right hemicolectomy with ileotransverse anastomosis. The histopathological analysis showed a metastatic ccRC to the terminal ileum causing the intussusception. Discussion: Adult intussusceptions are rare. However, they should be considered in the differential diagnosis of patients with abdominal pain and symptoms of bowel obstruction. Metastases of renal cancer to the small bowel are uncommon and even more so in the form of intussusception. Definitive treatment must be tailored to the patient's condition and underlying cause. (AU)

Advances in colonic manometry in adults with colonic motility disorders / 中华胃肠外科杂志

In recent years, colonic manometry has been gradually introduced into clinical practice. It helps clinicians to gain a better understanding of the physiology and pathophysiology of colonic contractile activity in healthy adults and patients with colonic dysfunction. More and more patterns of colonic motility are being discovered with the help of colonic manometry. However, the clinical significance of these findings still needs to be further investigated. This review enhances our understanding of colonic motility and the current state of development and application of colonic manometry, as well as the limitations, future directions and potential of the technique in assessing the impact of treatment on colonic motility patterns, by analyzing and summarizing the literature related to colonic manometry.

Caracterización clínica y epidemiológica de los pacientes con cáncer de colon / Clinical and epidemiological characterization of patients with colon cancer

INTRODUCCIÓN. El cáncer de colon es una neoplasia del tubo digestivo considerada una de las más frecuentes en ambos sexos y que predomina en adultos mayores. OBJETIVO. Describir las características clínicas y epidemiológicas de los pacientes con cáncer de colon. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1 601 y muestra de 210 datos de Historias Clínicas Electrónicas de pacientes diagnosticados con cáncer de colon, atendidos por la Unidad de Oncología del Hospital de Especialidades Carlos Andrade Marín de la ciudad de Quito en el periodo enero de 2016 a diciembre de 2019. Criterios de inclusión: diagnóstico confirmado de Cáncer de Colon, edad igual o mayor a 18 años, y disponer de todos los datos clínicos requeridos en el estudio. Se utilizó el método de muestreo probabilístico con lo que se estimó una proporción para el estudio con un intervalo de confianza del 95%, un margen de error del 5% y una frecuencia esperada del 3%, de donde se obtuvo una muestra ajustada al 10% de pérdidas. El procesamiento de datos se realizó en los programas Microsoft Excel versión 16 y el Statistical Package for Social Sciences versión 24. RESULTADOS. La mayor presentación fue en adultos mayores de 50 años, con una relación 1:1 en cuanto a sexo, y en la procedencia, se ubicó mayoritariamente en la población de la región Sierra; las personas con una actividad económica de tipo profesional fueron las más afectadas; en lo que se refiere a los antecedentes se encontró mayor relación en los personales y dentro de estos los pólipos; no hubo relación con los antecedentes quirúrgicos ni familiares. El síntoma de debut más prevalente fue el dolor abdominal; la mayoría fueron sometidos a colonoscopia; predominó la lateralidad derecha y el tipo histológico principalmente identificado fue el adenocarcinoma. CONCLUSIÓN. No se observó relación estadísticamente significante entre estadíos, evolución y tratamientos instaurados, lo que pudo estar influenciado por el muestreo al azar; y que el 53,30% de los pacientes aún se encuentra en controles.

INTRODUCTION. Colon cancer is a neoplasm of the digestive tract considered one of the most frequent in both sexes and predominantly in older adults. OBJECTIVE. To describe the clinical and epidemiological characteristics of patients with colon cancer. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1 601 and sample of 210 data from Electronic Medical Records of patients diagnosed with colon cancer, attended by the Oncology Unit of the Hospital de Especialidades Carlos Andrade Marín of the city of Quito in the period January 2016 to December 2019. Inclusion criteria: confirmed diagnosis of Colon Cancer, age equal to or older than 18 years, and having all the clinical data required in the study. The probability sampling method was used with which a proportion was estimated for the study with a confidence interval of 95%, a margin of error of 5% and an expected frequency of 3%, from which a 10% loss adjusted sample was obtained. Data processing was performed in Microsoft Excel version 16 and Statistical Package for Social Sciences version 24. The greatest presentation was in adults over 50 years of age, with a 1:1 ratio in terms of sex, and in terms of origin, it was mainly located in the population of the Sierra region; people with a professional economic activity were the most affected; in terms of history, a greater relationship was found in personal history and within these, polyps; there was no relationship with surgical or family history. The most prevalent debut symptom was abdominal pain; the majority underwent colonoscopy; right laterality predominated and the histological type mainly identified was adestatistically significant relationship was observed between stages, evolution and treatment, which could be influenced by random sampling; and that 53,30% of the patients are still in controls.

Abordaje quirúrgico y evolución posoperatoria en reintervenciones de complicaciones en cirugía colorrectal laparoscópica, 15 años de experiencia / Surgical approach and postoperative clinical course in reinterventions for complications following laparoscopic colorectal surgery: 15 years of experience

Resumen Objetivo: Comparar tres abordajes quirúrgicos (abierto, laparoscópico y laparoscópico convertido) para el manejo de complicaciones posoperatorias en cirugía colorrectal electiva realizadas primariamente por vía laparoscópica. Materiales y Método: Este estudio de cohorte retrospectivo incluyó pacientes reoperados después de una cirugía colorrectal laparoscópica electiva, agrupándose según la vía de abordaje de reoperación: abierta (RVA), laparoscópica (RVL) y laparoscópica convertida (RVLC). Las variables estudiadas fueron: preoperatorias (edad, sexo, puntuación ASA, IMC, comorbilidades e historia quirúrgica); operatorias (causa de reoperación, latencia para reoperación, tiempo operatorio, cirugía realizada y causa de conversión); y posoperatorias (tránsito intestinal, días de hospitalización, días de UCI, complicaciones médicas, infección del sitio quirúrgico, evisceración, transfusión y mortalidad a los 30 días). Resultados: Sin diferencias significativas para las variables preoperatorias y operatorias. En cuanto a las variables posoperatorias, el grupo de reoperaciones por vía laparoscópica, tuvo menos días de hospitalización (p = 0,012), menos días de UCI (p = 0,001) y un tránsito intestinal más rápido para reaparición de gases, heces y retorno a dieta sólida (p = 0,008, p = 0,029, p = 0,030, respectivamente). No hubo diferencias significativas en la infección del sitio quirúrgico, la evisceración, las complicaciones médicas, la transfusión y la mortalidad. Discusión y Conclusión: Este estudio reveló una mejor evolución clínica posoperatoria en el grupo de reoperación laparoscópica, con menor estancia hospitalaria y en UCI, y reducción del íleo posoperatorio, sin aumento de la morbimortalidad. Por lo tanto, la reoperación laparoscópica en cirugía colorrectal podría ser el abordaje más adecuado en pacientes debidamente seleccionados.

Aim: To compare three approaches (laparoscopic, open, and conversion of laparoscopic approach) for the management of intra-abdominal surgical complications after elective laparoscopic colorectal surgery. Materials and Method: This was a retrospective cohort study including patients who required reoperation due to an intra-abdominal surgical complication after initial elective laparoscopic colorectal surgery. Patients were grouped according to the reoperation approach-laparoscopic reoperation, laparoscopic reoperation that required conversion to open surgery, and open reoperation. Pre-operative variables (age, gender, ASA score, BMI, comorbidities, and surgical history), operative variables (cause of reoperation, latency for reoperation, operative time, surgery performed, and cause of conversion), and post-operative variables (intestinal transit, hospital days, ICU days, medical complications, surgical site infection, evisceration, transfusion and 30-day mortality), were compared between groups. Results: There were no significant differences between groups among the pre-operative and operative variables. In terms of post-operative variables, the laparoscopic reoperation group, had fewer hospital days (p = 0.012), fewer ICU days (p = 0.001), and faster intestinal transit regarding gas, stool and return to solid diet (p = 0.008, p = 0.029 and p = 0.030, respectively). However, there were no significant differences in surgical site infection, evisceration, medical complications, transfusion, and mortality. Discussion and Conclusión: This study revealed better post-operative clinical course in the laparoscopic reoperation group, with shorter hospital and ICU stay, and reduced postoperative ileus, without increased morbidity or mortality. Laparoscopic reoperation for complications after elective laparoscopic colorectal surgery may therefore be the preferred approach.

Tratamiento multidisciplinario de la endometriosis profunda grave / Multidisciplinary treatment of severe deep endometriosis

Introducción: La endometriosis es una entidad clínica caracterizada por la presencia de tejido endometrial fuera del endometrio, siendo la afección rectocolónica más agresiva. Diseño: Retrospectivo de grupo único. Objetivos: Evaluar la factibilidad de las resecciones colorrectales, patología compleja que debe abordarse en forma multidisciplinaria y reportar los resultados obtenidos de más de 10 años de trabajo. Material y métodos: Estudio descriptivo y retrospectivo de una serie de casos. En el periodo comprendido entre 2005 y a principios de 2017, se evaluaron 29 pacientes. La evaluación se realizó en forma multidisciplinaria. Resultados: Hemos operado 171 endometriosis profundas. La edad media fue 34,04 años. Veintinueve necesitaron resección de colon, en 27 se realizó una resección anterior con anastomosis colorrectal y 2 sigmoidectomías. Las anastomosis fueron con sutura mecánica, 17 término-terminales colorrectales y 12 término-laterales. Veintiocho anastomosis fueron realizadas entre los 7 y 5 cm del margen anal, 1 fue realizada a 4 cm del margen anal. En este caso se confeccionó una colostomía transversa de protección. El tiempo operatorio medio fue 90 minutos (45-195). El índice de conversión fue del 15%. Las complicaciones fueron hemoperitoneo, fístula anastomótica e infecciones de piel. La estadía institucional la media fue de 5 días. Conclusiones: El tratamiento laparoscópico de esta enfermedad es factible, debido a la distorsión de la anatomía de la pelvis que esta genera, aunque las tendencias actuales enfatizan la necesidad del tratamiento de esta afección de forma mínimamente invasiva. (AU)

Introduction: Endometriosis is a clinical entity characterized by the presence of endometrial tissue outside the endometrium, being the most aggressive rectocolonic condition. Design: Descriptive, retrospective case series study. Objective: Evaluate the feasibility of colorectal resections in this complex pathology that must be approached in a multidisciplinary way and report the results obtained from more than 10 years of work. Material and methods: In the period between 2005 and early 2017, 29 patients were evaluated in a multidisciplinary way. Results: One hundred and seventy-one patients were operated on for deep endometriosis, mean age 34 years. Twenty-nine patients required colon resection, 27 anterior resection and 2 sigmoidectomies. Seventeen end-to-end and 12 end- to- side stapled anastomoses were performed. Twenty-eight anastomoses were performed between 7 and 5 cm from the anal margin and one at 4 cm. In the latter, a protective transverse colostomy was made. The mean operative time was 90 (45-195) minutes. The conversion rate was 15%. Complications were hemoperitoneum, anastomotic fistula, and wound infections. The average hospital stay was 5 days. Conclusion: Laparoscopic treatment of this disease is feasible. Despite the distortion it generates in the anatomy of the pelvis, the current trend emphasizes the need for minimally invasive treatment. (AU)

Obesity and helicobacter pylori infection in adults with non specific colitis / Obesidade e infecção por Helicobacter pylori em adultos com colite inespecífica

ABSTRACT Background Non specific colitis is defined as inflammatory condition of the colon that when examined microscopically lacks any characteristic features of any specific form of colitis and is commonly seen in reports of colonoscopy biopsies. There are many factors that cause it like obesity and H pylori. Aim of the study To determine the association of obesity and H pylori as contributory factors to this disease. Patients and methods This is a case-controlled study was carried out in Al-Kindy College of Medicine from January 2017 to June 2018. Sixty individuals were included; forty of them had non specific colitis. The rest were healthy control group. Demographic information's were taken like age and sex. Anthropometric measurement like weight in kilograms (kg), height in meters (m), waist circumference in centimeters (cm), and body mass index was done. H pylori IgG was done to both groups. Results Study results indicated that this disease was more common with increasing age, there is a significant difference (p = 0.002) between patients (48.12 ± 1.50) and control group (41.00 ± 1.10) regarding age. BMI of the patients is significantly higher in patients group (29.21 ± 0.41; p = 0.000) than the control (22.23 ± 0.41). Patients with non specific colitis showed significant (p = 0.000) increased in H pylori infection 33 (82.5%) compared with control group 2 (10%). Conclusions Obesity and infection withH pylori may predispose to non specific colitis.

RESUMO Introdução Colite inespecífica é uma condição inflamatória do cólon que microscopicamente não apresenta características de qualquer forma específica de colite; é comumente observada em relatórios patológicos de biópsias de colonoscopia. Vários fatores podem causar colite inespecífica, dentre os quais obesidade e infecção por H. pylori. Objetivo do estudo Determinar o possível papel da obesidade e H. pylori como fatores contribuintes para esta doença. Pacientes e Métodos Este foi um estudo caso-controle, realizado na Al-Kindy College of Medicine entre janeiro de 2017 e junho de 2018. Um total de 60 indivíduos foram incluídos, 40 dos quais apresentavam colite inespecífica. Os demais foram incluídos no grupo de controles saudáveis. Foram coletadas informações demográficas, como idade e sexo. Medidas antropométricas, como peso (kg), altura (m), circunferência da cintura (cm) e índice de massa corporal, também foram coletadas. Nos dois grupos, foi feita serologia para H. pylori (IgG) Resultados Os presentes resultados indicaram que esta doença era mais comum entre pacientes de idade mais avançada; observou-se uma diferença significativa p = 0,002 entre os pacientes 48,12 ± 1,50 e o grupo controle 41,00 ± 1,10 quanto à idade. O IMC foi significativamente maior no grupo de pacientes 29,21 ± 0,41; p = 0,000 do que no grupo controle 22,23 ± 0,41. A infecção por H. pylori foi significamente mais frequentemente observada no grupo de pacientes (33; 82,5%) em comparação ao grupo controle (2; 10%; p = 0,000. Conclusões A obesidade e a infecção por H. pylori podem predispor à colite inespecífica.

Chagasic megacolon in Venezuela - case report / Megacólon chagásico na Venezuela

ABSTRACT Chagasic megacolon is the second most frequent cause of manifestation of the digestive forms of Chagas disease (trypanosoma cruzi parasitosis), characterized by progressive pseudo-occlusive symptoms or chronic constipation, caused by an alteration in the functioning of the colonic wall musculature. In Venezuela, cases of chagasic disease reported in the past are referred to chagasic heart disease, this being the first documented case of chagasic megacolon. We broach herein a case of chagasic megacolon in which early diagnosis and prompt surgical treatment led to a successful outcome.

RESUMO O megacólon chagásico é a segunda causa mais frequente de manifestação das formas digestivas da doença de Chagas (parasitose do Trypanosoma cruzi), caracterizado por sintomas pseudo-oclusivos progressivos ou constipação crônica, causado por uma alteração no funcionamento da musculatura da parede do cólon. Na Venezuela, os casos da doença chagásica relatados no passado são referidos como doença cardíaca chagásica, sendo este o primeiro caso documentado de megacólon chagásico. Neste artigo, abordamos um caso de megacólon chagásico no qual o diagnóstico precoce e o tratamento cirúrgico imediato levaram a um resultado bem-sucedido.

Reporte de caso. Abdomen agudo nutricional en el adulto mayor: apendagitis epiploica / Case report. Acute nutritional abdomen in the elderly: epiloic appendagitis

Se presentó un paciente de sexo masculino de 71 años de edad que consultó por un cuadro compatible con abdomen agudo médico de comienzo brusco. Refirió antecedentes de diabetes mellitus tipo 2, obesidad, dislipemia e hipertensión arterial. Al examen físico se encontró: afebril, presión arterial (PA) 128/75 mmHg; a la palpación del abdomen se halló un abdomen globoso, blando, depresible, doloroso en ambas fosas iliacas, signo de Mc Burney negativo, sin signos de re-acción peritoneal, catarsis y diuresis conservadas. Se solicitó una tomografía computada (TC) abdominal con con-traste oral y endovenoso (EV). La TC informó, a nivel del sigma sobre el borde antimesentérico, una imagen nodular de densi-dad grasa con halo hiperintenso y alteración tomodensitometría de la grasa adyacente, además de imágenes diverticulares no complicadas. Con el cuadro clínico del paciente y los hallazgos tomográficos se arribó al diagnóstico de apendagitis epiploica. Se inició tratamiento conservador con abordaje nutricional.

Local treatment of colostomy prolapse with the MESH STRIP technique: A novel and highly efficient day hospital technique

OBJECTIVE: Stoma prolapse is an intussusception of the bowel through a mature stoma. It can be caused by increased intra-abdominal pressure, excessively mobile bowel mesentery and/or a large opening in the abdominal wall at the time of stoma formation. It occurs predominantly in loop stomas, and correction methods include conservative modalities, such as local reduction to the prolapsed bowel, or surgical treatment. The purpose of this study was to describe our experience with the treatment of colostomy prolapse using a novel mesh strip technique. METHODS: Between February 2009 and March 2018, ten consecutive male patients underwent correction of colostomy prolapse under local anesthesia by peristomal placement of a polypropylene mesh strip. Operation time, short- and long-term complications, and recurrence rates were recorded and analyzed. RESULTS: No postoperative complications, morbidity or mortality were observed. The median length of the prolapse ranged from 6-20 cm, and the median operative time was 30 minutes. The median duration of follow-up was 25 months (range, 12-89 months). No relapse, mesh strip extrusion, local infection or granuloma formation were found. CONCLUSION: A simple, fast, and low-cost operation under local anesthesia using a mesh strip is a valuable option to treat colostomy prolapse.

Hemicolectomía radical laparoscópica: opción de mínima invasión para el cáncer de colon / Laparoscopic radical hemicolectomy: minimally invasive option for colon cancer / Hemicolectomia radical laparoscópica: opcão minimamente invasiva para cãncer de cólon

Introducción. El cáncer de colon es una de las principales causas de morbimortalidad a nivel mundial. En Colombia se presentan cerca de 145,600 casos nuevos al año. Cada vez son más los reportes de este tipo de patologías intervenidas por vía laparoscópica, aunque son pocos en Colombia. El objetivo de este artículo es mostrar el abordaje de esta patología mediante un procedimiento mínimamente invasivo: la colectomía derecha por vía laparoscópica, el cual es poco utilizado en el país. Caso clínico. Paciente de 86 años que consulta por pérdida de peso, adinamia y dolor abdominal en flanco derecho. Presenta además anemia ferropénica y sangre oculta en materia fecal. Las endoscopias digestivas muestran lesión ulcerada vegetante de aspecto neoplásico a nivel del ciego. La biopsia revela adenocarcinoma infiltrante moderadamente diferenciado con áreas de necrosis. Se realiza una colectomía derecha por técnica laparoscópica. Se hace seguimiento con neoadyuvancia por parte de Oncología Clínica. Discusión. El adenocarcinoma es uno de los cánceres primarios más comunes en el colon. La resección quirúrgica es una excelente alternativa para el manejo y tratamiento de estos tumores. En Colombia, la mayoría de estas resecciones se realizan por vía abierta. La resección por vía laparoscópica es un método que demuestra similar eficacia, ofreciendo una disminución en la respuesta inflamatoria, con mejor control del dolor y limitaciones funcionales. Conclusiones. La colectomía por vía laparoscópica para resección de tumores de colon es un método seguro, eficaz y reproducible. Sin embargo, exige tecnología de alto costo y debe ser realizada por un grupo quirúrgico con habilidad y experiencia en sutura manual laparoscópica. Cómo citar: López-Gómez LE, Dominguez ­ Alvarado GA, D ́vera Camargo D, Lozano-Eslava LA, Martínez-Rojas PA. Hemicolectomía radical laparoscópica: opción de mínima invasión para el cáncer de colon. MedUNAB. 2020;23(2): 281-287. doi: 10.29375/01237047.3829

Introduction. Colon cancer is one of the main causes of morbimortality in the world. Colombia counts near 145,600 new cases per year. The reports of laparoscopic intervention in this pathology are growing, but in Colombia there is little recent work on the matter. The aim of this article is to show how this pathology can be addressed through a minimally invasive procedure, laparoscopic right colectomy, which is not frequently used in the country. Clinical case. An 86-year-old patient consults due to weight loss, adynamia and abdominal pain on right side. Iron-deficiency anemia and hidden blood in feces was reported. The digestive endoscopies show the presence of a vegetant and ulcerated lesion of neoplastic appearance in the cecum. A biopsy revealed a moderately differentiated, invasive adenocarcinoma with areas of necrosis. A laparoscopic right colectomy is conducted. Definitive report of moderately differentiated and ulcerated, invasive, mucinous adenocarcinoma, with lesion up to the serous membrane. Follow up is conducted with neoadjuvant therapy by the Clinical Oncology service. Discussion. Adenocarcinoma is one of the most common primary cancers in the colon. Surgical still an excellent alternative for the management of this kind of tumor. In Colombia, the majority of these resections are carried out by open surgery. However, laparoscopic resection is a method that offers similar outcomes to the traditional procedure, while providing a reduction in the inflammatory response, with better pain control and control of functional limitations. Conclusions. Laparoscopic colectomy for the resection of colonic tumors is a safe, effective and reproducible method. However, it requires high-cost technology and it must be conducted by a surgical team skilled and experienced in manual laparoscopic suturing.Cómo citar: López-Gómez LE, Dominguez ­ Alvarado GA, D ́vera Camargo D, Lozano-Eslava LA, Martínez-Rojas PA. Hemicolectomía radical laparoscópica: opción de mínima invasión para el cáncer de colon. MedUNAB. 2020;23(2): 281-287. doi: 10.29375/01237047.3829

Introdução. O câncer de cólon é uma das principais causas de morbimortalidade em todo o mundo. Na Colômbia, há uma incidência aproximada de 145,600 casos novos por ano. Na Colômbia existam poucos trabalhos recentes sobre este tipo de procedimentos. O objetivo deste artigo é mostrar a abordagem de o adenocarcinoma de cólon, através de um procedimento minimamente invasivo: a colectomia direita pela via laparoscópica, pouco utilizada no país. Caso clínico. Paciente de 86 anos que apresenta perda de peso, adinamia e dor abdominal no flanco direito, anemia ferropriva e sangue oculto nas fezes. As endoscopias digestivas evidenciam a presença de uma lesão ulcerada vegetante com aparência neoplásica no nível do ceco. A biópsia revelou adenocarcinoma infiltrante moderadamente diferenciado com áreas de necrose. As imagens de extensão mostram um efeito de massa intraluminal ao nível do ceco com adenomegalia pericecal. Realizou-se uma colectomia direita laparoscópica. Relato definitivo de adenocarcinoma mucinoso infiltrante moderadamente diferenciado e ulcerado, com comprometimento da serosa. O serviço de Oncologia Clínica fez o acompanhamento neoadjuvante. Discussão. O adenocarcinoma é um dos cânceres primários mais comuns no cólon. A ressecção cirúrgica continua sendo uma excelente alternativa para a gestão e tratamento deste tipo de tumores. Na Colômbia, a maioria dessas ressecções é realizada pela via aberta. A ressecção pela via laparoscópica é um método que oferece ressecções semelhantes às do procedimento tradicional, apresentando diminuição da resposta inflamatória, com melhor controle da dor e das limitações funcionais. Conclusão. A colectomia pela via laparoscópica para ressecção de tumores de cólon é um método seguro, eficaz e reprodutível. No entanto, requer tecnologia de alto custo e deve ser realizada por um grupo cirúrgico com habilidade e experiência em sutura manual laparoscópica. Cómo citar: López-Gómez LE, Dominguez ­ Alvarado GA, D ́vera Camargo D, Lozano-Eslava LA, Martínez-Rojas PA. Hemicolectomía radical laparoscópica: opción de mínima invasión para el cáncer de colon. MedUNAB. 2020;23(2): 281-287. doi: 10.29375/01237047.3829

Could the intestinal epithelial alterations promoted by roux-en-y gastric bypass explain higher tendency for colonic diseases in bariatric patients? / As alterações epiteliais intestinais promovidas pelo bypass em y-de-roux podem explicar maior tendência a doenças colônicas em pacientes bariátricos?

ABSTRACT Background: Intestinal diversions have revolutionized the treatment of morbid obesity due to its viability and sustained response. However, experimental studies suggest, after these derivations, a higher risk of colon cancer. Aim: To analyze the histological and immunohistological changes that the jejunojejunal shunt can produce in the jejunum, ileum and ascending colon. Method: Twenty-four male Wistar rats were randomly divided into two groups, control (n=12) and experiment (n=12) and subdivided into groups of four. Nine weeks after the jejunojejunal shunt, segmental resection of the excluded jejunum, terminal ileum and ascending colon was performed. Histological analysis focused on the thickness of the mucosa, height of the villi, depth of the crypts and immunohistochemistry in the expression of Ki-67 and p53. Results: Significant differences were found between the experiment and control groups in relation to the thickness of the mucosa in the jejunum (p=0.011), in the ileum (p<0.001) and in the colon (p=0.027). There was also a significant difference in relation to the height of the villus in the ileum (p<0.001) and the depth of the crypts in the jejunum (p0.001). The results indicated that there is a significant difference between the groups regarding the expression of Ki-67 in the colon (p<0.001). No significant differences were found between the groups regarding the expression of Ki-67 in the jejunum and ileum. In the P53 evaluation, negative nuclear staining was found in all cases. Conclusion: The jejunojejunal deviation performed in the Roux-in-Y gastrojejunal bypass, predispose epithelial proliferative effects, causing an increase in the thickness of the mucosa, height of the villi and depth of the crypts of the jejunum, ileum and ascending colon.

RESUMO Racional: As derivações intestinais revolucionaram o tratamento da obesidade mórbida pela sua viabilidade e resposta sustentada. Porém, estudos experimentais sugerem, após estas derivações, risco maior de câncer de cólon. Objetivo: Analisar as alterações histológicas e imunoistológicas que a derivação jejunojejunal possa produzir no jejuno, íleo e cólon ascendente. Método: Foram utilizados 24 ratos Wistar machos randomicamente divididos em dois grupos, controle (n=12) e experimento (n=12) e subdivididos em grupos de quatro. Nove semanas após a derivação jejunojejunal procedeu-se a ressecção segmentar do jejuno excluso, íleo terminal e cólon ascendente. Análise histológica focou na espessura da mucosa, altura dos vilos, profundidade das criptas e a imunoistoquímica na expressão do Ki-67 e p53. Resultados: Foram encontradas diferenças significativas entre os grupos experimento e controle em relação à espessura da mucosa no jejuno (p=0,011), no íleo (p<0,001) e no cólon (p=0,027). Também houve diferença significativa em relação à altura dos vilos no íleo (p<0,001) e profundidade das criptas no jejuno (p<0,001). Os resultados indicaram que existe diferença significativa entre os grupos em relação à expressão do Ki-67 no cólon (p<0,001). Não foram encontradas diferenças significativas entre os grupos em relação à expressão do Ki-67 no jejuno e no íleo. Na avaliação do P53, foi encontrada coloração nuclear negativa em todos os casos. Conclusão: O desvio realizado na derivação gastrojejunal em Y-de-Roux, predispõem efeitos proliferativos epiteliais, causando aumento da espessura da mucosa, altura dos vilos e profundidade das criptas do jejuno, íleo e cólon ascendente.

Asociación entre desenlaces clínicos y cumplimiento del protocolo de recuperación mejorada después de la cirugía (ERAS) en procedimientos colorrectales: estudio multicéntrico / Association between clinical outcomes and compliance with the Enhanced Recovery After Surgery (ERAS) protocol in colorectal procedures: A multicenter study

Introducción. Los protocolos de recuperación mejorada después de cirugía se han diseñado como una innovación en salud tras demostrarse que la mejora en los dispositivos médicos y la depuración de técnicas alcanzaron la meseta en disminución de complicaciones. Con estas estrategias de la medicina perioperatoria, en cirugía colorrectal se reducen la morbilidad y estancia hospitalaria. El objetivo del estudio fue evaluar si la tasa de adherencia al programa de recuperación mejorada después de la cirugía (ERAS) está asociada con los resultados quirúrgicos. Métodos. Estudio multicéntrico, observacional, retrospectivo de cohorte (2015-2019), en cinco hospitales latinoamericanos certificados por la sociedad ERAS. Se calculó la incidencia de complicaciones quirúrgicas durante el posquirúrgico inmediato (30 días) y la duración de la estancia hospitalaria. Se utilizaron análisis bivariado y regresión logística multivariada para evaluar los factores asociados con la tasa de complicaciones. Resultados. Fueron incluidos en el estudio 648 pacientes en cinco hospitales ERAS, con edad promedio de 61 años y mayor porcentaje de hombres (51 %). El cumplimiento global al protocolo ERAS fue de 75 % y la estancia promedio de 6,2 días (mediana: 4 días). Se tuvo un cumplimiento óptimo del protocolo ERAS (igual o mayor al 80 %) en 23,6 % de los pacientes. Se documentó fuga de la anastomosis en 4 %, complicaciones infecciosas en 8,4 %, íleo en 5,7 %, reingreso en 10,2 % y mortalidad de 1,1 %. El análisis multivariado mostró que los niveles de adherencia óptima al protocolo ERAS reducen significativamente la aparición de complicaciones como fuga de la anastomosis (OR 0,08; IC95% 0,01-0,48; p=0,005) y complicaciones infecciosas (OR 0,17; IC95%0,03-0,76; p=0,046).Discusión. Los resultados sugieren que un cumplimiento del programa ERAS mayor al 80 % se asocia a menor frecuencia de complicaciones en pacientes con cirugía electiva colorrectal

Introduction. Enhanced Recovery After Surgery (ERAS) protocol has been designed as an innovation in health after demonstrating that the improvement in medical devices and the refinement of techniques reached the plateau in reducing complications. With these strategies of perioperative medicine, in colorectal surgery morbidity and hospital stay are reduced. The aim of the study was to evaluate whether the rate of adherence to the ERAS protocol is associated with surgical outcomes.Methods. Multicenter, observational, retrospective cohort study (2015-2019), in five Latin American hospitals certified by the ERAS Society. The incidence of surgical complications during the immediate postoperative period (30 days) and length of hospital stay were calculated. Bivariate analyzes and multivariate logistic regression were used to assess factors associated with complication rates.Results. 648 patients were included in the study in five ERAS hospitals, with an average age of 61 years and a higher percentage of men (51%). Overall compliance with the ERAS protocol was 75% and the average stay was 6.2 days (median: 4 days). There was optimal compliance with the ERAS protocol (equal to or greater than 80%) in 23.6% of the patients. Anastomotic leak was documented in 4%, infectious complications in 8.4%, ileus in 5.7%, readmission in 10.2%, and mortality in 1.1%. Multivariate analysis showed that optimal adherence levels to the ERAS protocol significantly reduce the appearance of complications such as anastomotic leakage (OR 0.08; 95%CI 0.01-0.48; p=0.005) and infectious complications (OR 0.17; 95%CI 0.03-0.76; p=0.046).Discussion. The results suggest that compliance with the ERAS program greater than 80% is associated with a lower frequency of complications in patients with elective colorectal surgery

Korean Children and Adolescents with Crohn's Disease Are More Likely to Present with Perianal Fistulizing Disease at Diagnosis Compared to Their European Counterparts / 대한소아소화기영양학회지

Fístulas colónicas de origen diverticular / Colonic fistulas of diverticular origin

INTRODUCCIÓN: La enfermedad diverticular de colon sigmoides representa la principal causa de fistulización del colon a órganos vecinos. OBJETIVO: Describir variables clínicas y terapia quirúrgica de esta entidad. MATERIALES Y MÉTODO: Revisión retrospectiva de los casos de fístulas colónicas de origen diverticular (FCD) operados en forma electiva en un centro terciario. RESULTADOS: En un periodo de 30 años se realizó cirugía resectiva por una FCD en 49 pacientes. Los órganos más afectados fueron la vejiga en 33 casos (68%) y la vagina en 6 (12%). La cirugía efectuada fue la sigmoidectomía en 48 casos (5 con una ileostomía de protección) y una operación de Hartmann. La vía de abordaje fue laparoscópica en 4 pacientes y la morbilidad global de la serie fue 20%, sin mortalidad. Con un seguimiento promedio de 87 meses (extremos 16-178) no hubo casos de recidiva de la fístula. CONCLUSIONES: La FCD representa el 26% de los casos intervenidos por una enfermedad diverticular de colon sigmoides, lo que probablemente refleja un diagnóstico tardío. La fístula colovesical (FCV) es la fístula más común por esta causa y en la mitad de los casos tienen una presentación silenciosa. Las fístulas colovaginales ocurren en mujeres histerectomizadas. La cirugía resectiva del colon en pacientes con riesgo normal es la cirugía estándar con buenos resultados a corto y largo plazo. La cirugía laparoscópica es factible y segura especialmente en los casos de FCV.

BACKGROUND: Fistula formation is a well-known complication of diverticular disease (FCD). AIM: Determine the clinical presentation and surgical management of this kind of fistulas. MATERIALS AND METHODS: Retrospective revision of all consecutive scheduled cases operated on in a terciary public centre in a thirty-years period. RESULTS: Forty-nine patients with a segmental resection of sigmoid colon were analized. Colovesical fistulas were the most common type (n = 33), followed by colovaginal (n = 6). Resection with anastomosis was performed in 48 cases and Hartmann type operation in one. Laparoscopic procedure was made in 4 cases without conversion. Complication rate was 20% and two patients were reoperated on, without mortality in this series. Follow up showed no case of recurrence. CONCLUSIONS: FDC represent 26% of cases operated on in our series. Colovesical fistula is the most common type, followed by colovaginal fistula in histerectomized women. Resection and primary anastomosis should be the treatment of choice in average risk patients with acceptable morbidity and good long-term results. Laparoscopic approach is safe, specifically in patients with colovesical fistulas.

Tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal / Surgical treatment of deep pelvic endometriosis with colorectal involvement

INTRODUCCIÓN: En la endometriosis el compromiso intestinal afecta hasta al 12% de las pacientes, comprometiendo al recto y a la unión rectosigmoidea en el 90% de los casos. OBJETIVO: Describir la experiencia del equipo de Coloproctología y Ginecología de Clínica Alemana de Santiago en el tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal. MATERIAL Y MÉTODOS: Estudio retrospectivo a partir de la base de datos de pacientes con endometriosis tratados entre enero del año 2015 y abril de 2018. Los criterios de inclusión fueron pacientes con clínica de endometriosis pélvica profunda, que tuviesen compromiso colorrectal y hayan sido tratados con shaving rectal, resección discoide o resección segmentaria. Se revisaron fichas clínicas electrónicas, protocolos operatorios y biopsias definitivas. RESULTADOS: Se reclutaron 25 pacientes con una mediana de edad de 35 años. El síntoma principal de consulta fue dismenorrea y el síntoma digestivo más frecuente fue disquecia. En 8 pacientes se realizó un shaving rectal, en 7 una sigmoidectomía, en 9 una resección discoide y en 1 paciente una tiflectomía. La complicación posoperatoria reportada fue la hemorragia digestiva baja en 4 pacientes (Clavien-Dindo I y IIIa). Con una mediana de seguimiento de 13 meses, a la fecha 3 pacientes se les ha diagnosticado algún tipo de recidiva. CONCLUSIÓN: Es importante que la cirugía a realizar, garantice una morbilidad y recurrencia baja. Los resultados en nuestro centro son alentadores, lo que nos hace creer que el tratamiento quirúrgico podría ser una buena alternativa en la endometriosis pélvica profunda con compromiso colorrectal.

INTRODUCTION: In endometriosis, intestinal involvement affects up to 12% of patients, compromising the rectum and the rectosigmoid junction in 90% of cases. AIM: Describe the experience of the Coloproctolgy and Gynecology Team of the Clínica Alemana de Santiago in the surgical treatment of deep pelvic endometriosis with colorectal involvement. MATERIAL AND METHODS: Retrospective study based on the database of patients with endometriosis treated between January 2015 and April 2018. The inclusion criteria were patients with deep pelvic endometriosis clinic, who had colorectal involvement and who had been treated with rectal shaving, discoid resection or segmental resection. Electronic clinical records, operative protocols and definitive biopsies were reviewed. RESULTS: Twenty-five patients with a median age of 35 years were recruited. The main symptom of consultation was dysmenorrhoea and the most frequent digestive symptom was dyschezia. In 8 patients a rectal shaving was performed, in 7 a sigmoidectomy, in 9 a discoid resection and in 1 patient a tiflectomy. The only reported post-operative complication was low gastrointestinal bleeding in 4 of the 25 patients (Clavien-Dindo I and IIIa). A median follow-up of 13 months was achieved, to date 3 patients have been diagnosed with some type of recurrence. CONCLUSION: It is important that the surgery to be performed guarantees low morbidity and recurrence. The results in our center are encouraging, which makes us believe that surgical treatment could be a good alternative in deep pelvic endometriosis with colorectal involvement.

A novel simplified scoring system for predicting mortality in emergency colorectal surgery: prediction model development

ABSTRACT BACKGROUND: Despite advances in surgical approaches, emergency colorectal surgery has high mortality and morbidity. OBJECTIVE: We aimed to create a simple and distinctive scoring system, for predicting mortality among patients undergoing emergency colorectal surgery. DESIGN AND SETTING: Prediction model development study based on retrospective data-gathering. METHODS: Patients who underwent emergency colorectal surgery between March 2014 and December 2016 at a single tertiary-level referral center were included in our study. Patient demographics, comorbidities, type of surgery, etiology and laboratory and radiological findings were collected retrospectively and analyzed. A new clinical score (named the Numune emergency colorectal resection score) was constructed from the last logistic regression model, in which one point was assigned for the presence of each predictive factor. RESULTS: 138 patients underwent emergency colorectal surgery. These comprised 64 males (46.4%) and 74 females (53.6%), with a mean age of 64 years. Multivariate analysis revealed that blood urea nitrogen level > 65 mg/dl (odds ratio, OR: 8.03; 95% confidence interval, CI: 2.16-15.77), albumin level < 0.7 ­mg/­dl (OR: 4.43; 95% CI: 1.96-14.39) and American Society of Anesthesiologists score ≥ 3 (OR: 3.47; 95% CI: 0.81-9.18) were associated with postoperative complications. The Numune score was graded from I to III. The risk of mortality was found to be 63.2% in the group with grade III, which accounted for 35.2% of the subjects. There were 37 postoperative deaths. CONCLUSIONS: Surgeons need scoring systems, especially to predict postoperative mortality. We propose the Numune emergency colorectal resection score for emergency surgical procedures as a practical, usable and effective system for predicting postoperative morbidity.