Rectal ulcer due to Kayexalate deposition - an unusual case

SUMMARY Sodium polystyrene sulfonate (PSP) or Kayexalate is a cation-exchange resin, widely used in the management of hyperkalaemia due to renal disease. A rare, yet potentially dangerous, adverse event related to sodium polystyrene sulfonate use is intestinal mucosal injury, especially in the colon. The injury to the gastrointestinal mucosa can range from mild and superficial to wall necrosis and bowel perforation. The mechanism that leads to mucosal damage remains unclear. However, it is believed that sorbitol, commonly given to counteract PSP's tendency to cause constipation, may play an important role in the development of gastrointestinal injury. Other potential risk factors are uraemia or end-stage renal disease, hemodynamic instability, solid organ transplantation, postoperative status and concomitant opioid administration. The authors present a case of diarrhoea and haematochezia after the administration of PSP without sorbitol, in a patient with hyperkalaemia due to acute kidney injury, in the absence of other risk factors. A colonoscopy was performed and revealed a rectal ulcer which histological findings were suggestive of mucosal injury due to Kayexalate deposition. This case supports the concept that this widely used drug can itself, without sorbitol, cause injury to the gastrointestinal wall. Even though this is a rare adverse effect, the widespread use of this medication may put a large population at risk.

RESUMO O polistireno sulfonato de sódio (PSP) ou kayexalato é uma resina de troca iônica, amplamente usada no tratamento da hipercalemia associada à doença renal. Um efeito adverso raro, mas potencialmente grave, dessa terapêutica é a agressão à parede do trato gastrointestinal, principalmente ao nível do cólon, que pode ser ligeira e superficial ou culminar em necrose e perfuração intestinal. O mecanismo pelo qual o PSP lesa a mucosa intestinal não é totalmente conhecido. Contudo, pensa-se que o sorbitol, frequentemente administrado em simultâneo para contrabalançar o efeito obstipante do PSP, possa ter um papel preponderante no desenvolvimento de lesão gastrointestinal. Outros potenciais fatores de risco são a presença de uremia ou doença renal em estágio terminal, instabilidade hemodinâmica, pós-operatório, pós-transplante renal e a administração concomitante de opioides. Os autores descrevem um caso de diarreia e hematoquesias após a administração de PSP sem sorbitol, numa paciente com hipercalemia secundária a lesão renal aguda, sem outros fatores de risco para o desenvolvimento desse efeito adverso. A investigação etiológica com colonoscopia revelou a presença de uma úlcera retal, cujo estudo histológico foi compatível com lesão por deposição de cristais de kayexalato. Este relato incomum reforça o conceito de que este fármaco de uso frequente, mesmo na ausência de sorbitol, pode ser lesivo para a mucosa intestinal. Assim, e apesar de este ser um efeito adverso raro, a utilização difundida do PSP coloca uma vasta população em risco.

Características clínicas asociadas a colitis eosinofílica en lactantes con rectorragia persistente / Clinical features of Eosinophilic Colitis in infants with persistent rectal bleeding

The most common presentation of cow's milk protein allergy (CMP) in infants is known as eosinophilic colitis (EC). The aim of this study is to evaluate EC characteristics in infants evaluated with colonoscopy due to the presence of rectorrhagia. Patients and Methods: A retrospective case-control study. Left-sided colonoscopy records of infants with persistent rectal bleeding, conducted between January 2006 and March 2011, were reviewed. The cases corresponded to infants with rectal biopsy compatible with EC and controls with negative biopsy. Telephone questionnaires to parents were conducted, evaluating personal and family history. Results: Complete records were obtained in 61 (79%) of the 77 procedures. 33 (54%) of them were males. Examination average age was 6.3 ± 5.9 months. 25 (41%) patients had EC on their histology. Between cases and controls, no significant difference in gestational age, birth weight and gender, only regarding age at the time of rectal bleeding, were observed. There was also no difference in personal history regarding obstructive bronchitis, allergic rhinitis, family history of asthma, allergic rhinitis or other food allergies. Those who received artificial feeding did not presented greater risk of EC. The most common symptoms in the cases did not differ significantly from the controls. Conclusions: The prevalence of EC in the children studied was 40.9%. Our results show that there are groups of patients with persistent rectal bleeding in which there is no personal or family history that helps diagnosing EC. An endoscopic study could be considered in these patients to establish a correct diagnosis of this condition, avoid unnecessary diets and not to delay the detection of other diseases.

En lactantes, la forma de presentación más común de la alergia a la proteína de la leche de vaca (PLV) es la colitis eosinofílica (CE). El objetivo de este trabajo es evaluar características clínicas asociadas a CE en lactantes evaluados con colonoscopía por la presencia de rectorragia. Pacientes y Método: Estudio caso-control, retrospectivo. Se revisaron registros de colonoscopía izquierda de lactantes con rectorragia persistente, realizadas entre Enero 2006 y Marzo 2011. Casos fueron lactantes con rectorragia y biopsia compatible con CE y controles aquellos con biopsia negativa. Se realizó un cuestionario vía telefónica a los padres, evaluándose antecedentes personales y familiares. Resultados: En 61 (79%) de 77 procedimientos se obtuvo registros completos. 33 (54%) eran hombres. Edad promedio del examen fue 6,3 ± 5,9 meses. 25 (41%) pacientes presentaron CE en la histología. Sin diferencia significativa en edad gestacional, peso de nacimiento ni sexo, pero si en edad de presentación de la rectorragia, entre casos y controles. Tampoco hubo diferencia en antecedentes personales de bronquitis obstructivas, rinitis alérgica, ni antecedentes familiares de asma, rinitis alérgica u otras alergias alimentarias. Quienes recibieron lactancia artificial no tuvieron mayor riesgo de CE. Los síntomas más frecuentes en los casos no se diferenciaron significativamente de los controles. Conclusión: La prevalencia de CE en los niños estudiados fue de 40,9%. Nuestros resultados muestran que hay grupos de pacientes con rectorragia persistente en los cuales no existen antecedentes de la historia familiar ni personal que permitan establecer el diagnóstico de CE. Es en estos pacientes en los cuales podría considerarse el estudio endoscópico para establecer un correcto diagnóstico de esta patología, evitar dietas innecesarias y no retrasar la detección de otras enfermedades.

Influence of patient age and colorectal polyp size on histopathology findings / Influência da idade do paciente e do tamanho dos pólipos colorretais nos achados histopatológicos

BACKGROUND: Colorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening. AIM: To assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size. METHODS: Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older. RESULTS: A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia. CONCLUSION: Polyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon. .

RACIONAL: O câncer colorretal é causa importante de morbimortalidade e pode desenvolver-se pela sequência adenoma-carcinoma. A videocolonoscopia é considerada método de escolha para rastreamento populacional para esta neoplasia. OBJETIVO: Avaliar as características de pólipos endoscopicamente ressecados em uma série consecutiva de pacientes submetidos à videocolonoscopia em um hospital universitário e comparar os achados histopatológicos de acordo com a idade do paciente e o tamanho dos pólipos. MÉTODO: Estudo retrospectivo transversal baseado na análise dos laudos de 1950 videocolonoscopias realizadas consecutivamente. Foram selecionados aqueles em que foram evidenciados pólipos no cólon ou reto. Procedeu-se a revisão dos prontuários para coleta de dados demográficos e da avaliação histopatológica dos espécimes. Foram comparados os achados relativos aos pólipos de até 0,5 cm com os acima de 0,6 cm. Posteriormente, foram comparados pólipos de até 1 cm com os acima de 1,1 cm. Em um terceiro momento foram realizadas comparações dos achados dos pólipos ressecados de pacientes com idade até 49 anos com aqueles retirados de pacientes acima de 50 anos. RESULTADOS: Foram ressecados pólipos colorretais em 224 dos 1950 exames avaliados (11,5%), com retirada total de 272 pólipos. Pólipos maiores de 1 cm tenderam a ser pediculados (p=0,000) e tiveram maior chance de apresentarem componente adenomatoso (p=0,001), componente viloso (p=0,000) e displasia (p=0,003). Os mesmos achados foram observados com ponto de corte de 0,5 cm. Pacientes com 50 anos ou mais apresentaram mais frequentemente pólipos sésseis (p=0,023) e localizados no cólon proximal (p=0,009). Não houve diferença significante entre os grupos em relação à histopatologia ...

Úlcera solitaria de recto / Solitary rectal ulcer

Introducción: La úlcera solitaria de recto es una entidad patológica crónica, benigna e infrecuente, que en general no se la considera entre los diagnósticos diferenciales de las patologías crónicas del recto. A menudo es subdiagnosticada. Las principales manifestaciones clinicas son: proctorragia, mucorrea, esfuerzo defecatorio y tenesmo. Objetivo: Evaluar las características clinicas de una patología infrecuente del recto, a partir de 3 casos clínicos. Lugar de aplicación: Institución privada. Pacientes y método: Se presentan 3 pacientes con diagnóstico anatomopatológico de úlcera solitaria de recto, entre 2003-2010, dos hombres y una mujer, con un promedio de edad de 53 años (rango 41-70 años). Resultados: La presentación clínica fue proctorragia, mucorrea, tenesmo, proctalgía y esfuerzo defecatorio. En los 3 pacientes la úlcera fue solitaria, dos en pared posterior y una en pared anterior del recto. El diagnostico se realizó por medio de la endoscopía, y biopsia de la lesión. Los 3 casos respondieron favorablemente al tratamiento médico. Conclusiones: La etiología es desconocida. Se la relaciona con trastornos de la defecación. La lesión no siempre es ulcerada ni solitaria. El diagnóstico se realiza por medio de colonoscopía y biopsia, debido a que presenta histología patognomónica. El tratamiento puede ser conservador o quirúrgico.

Introduction: Solitary rectal ulcer is a chronic, benign and infrequent entity, generally not considered in the differential diagnosis of chronic diseases of the rectum. It is often under­diagnosed. The main clinical manifestations include bloody stool, mucorrhea, straining and tenesmus. Objective: To asses the current behavior of a rare disease of the rectum, from 3 clinical cases. Point of application: Private institution. Patients and method: Three patients are presented with pathological diagnosis of solitary rectal ulcer, between 2003 - ­2010, two men and a woman, with an average age of 53 years (range 41-70 years). Results: The clinical presentation was bloody stool, mucorrhea. tenesmus, anal pain and straining. In all cases the ulcer was solitary; two in posterior wall and one in anterior wall of the rectum. The diagnosis was made by endoscopy and biopsy of the lesion. The 3 cases responded well to medical treatment. Conclusions: The etiology is unknown. It is related to defecation disorders. The lesion is not always ulcerated of solitary. Diagnosis is made by colonoscopy and biopsy, because it shows pathognomonic histology. Treatment can be conservative or surgical.

Pioderma gangrenoso de rápida evolución / Pyoderma gangrenosum rapidly evolving

Se presenta caso de mujer adulta con múltiples lesiones ampollosas de 1 semana de evolución, acompañada de fiebre. Presentaba antecedentes de rectorragias ocasionales desde hace varios años. La colonoscopía detectó la presencia de Enfermedad inflamatoria intestinal, que se confirmó con la anatomía patológica. La biopsia de piel fue compatible con pioderma gangrenoso. La paciente mejoró con prednisona y aziatropina.

A case report of adult female with multiple bullous lesions of 1 week duration, accompanied by fever. She had a history of occasional rectal bleeding for several years. The colonoscopy detected the presence of inflammatory bowel disease, which was confirmed by pathology. Skin biopsy was consistent with pyoderma gangrenosum. The patient improved with prednisone and aziatropina.

Sensibilidade da ecografia endorectal no estadiamento do cancro do recto: correlação com o estadiamento patológico / Sensitivity of endorectal ecography in the staging of rectal chancre: correlation with pathological staging

OBJECTIVO: Avaliar a sensibilidade da ecografia endorectal, em nossa experiência, no estadiamento do cancro do recto comparando com o resultado anatomopatológico. MATERIAL E MÉTODOS: Estudo retrospectivo, realizado entre Janeiro de 2005 e Agosto de 2009. Calculou-se a sensibilidade, a especificidade, o valor preditivo positivo e negativo para cada estadio T e N. Por meio da elaoração de curvas ROC avaliou-se a precisão do estadiamento ecoendoscópico e por meio do teste de McNemar comparou-se com o resultado anatomopatológico. RESULTADOS: Dos 112 doentes, 76 cumpriram os critérios de inclusão. Obtivemos uma eficácia de 75 a 97 por cento para uT e de 75 por cento para uN. Verificou-se sensibilidade, especificidade, valor preditivo positivo e negativo, respectivamente, de 63;98;92 e 89 por cento para uT1; 71;76;54 e 88 por cento para uT2; 67;81;73 e 76 por cento para uT3; 100;97;60 e 100 por cento para uT4; e 39;91;62 e 78 por cento para uN. As curvas ROC indicaram que a ecografia endorectal é um bom teste para o estadiamento do T e razoável para o N. O teste de McNemar revelou que não há diferenças significativas entre o estadiamento ecoendoscópico e anatomopatológico (p>0,05). CONCLUSÕES: Conclui-se que a ecografia endorectal é uma importante ferramenta no estadiamento do cancro do recto, apresentando boa correlação com o resultado anatomopatológico.

OBJECTIVE: This study aimed to evaluate endorectal ultrasound sensibility, in our experience, in rectal cancer staging comparing with pathologic result. METHODS: A retrospective study between January 2005 and August 2009. We calculated sensibility, specificity, positive and negative predictive value for T and N. Through ROC curves we evaluated endoscopic ultrasound accuracy and through McNemar test we compared it with the anatomopathological result. RESULTS: Of 112 patients, 76 met the inclusion criteria. We obtained an efficiency of 75 to 97 percent for uT and 75 percent in uN. There was a sensibility, specificity, positive and negative predictive value, respectively of 63, 98, 92 and 89 percent for uT1, 71 percent and 76, 54 and 88 for uT2, 67, 81; 73 and 76 percent for uT3, 100, 97, 60 and 100 percent uT4, and 39, 91, 62 and 78 percent for uN. The ROC curves indicated that endorectal ultrasound is a good test for T staging and reasonable for N staging. The McNemar test revealed no significant differences between endoscopic ultrasound and histological staging (p>0.05). CONCLUSIONS: We concluded that endorectal ultrasound is an important tool in rectal cancer staging, showing a good correlation with histopathological results.

Estudo comparativo entre MBI (FICE®) e a magnificação com índigo-carmin no diagnóstico diferencial de lesões neoplásicas e não-neoplásicas de cólon e reto / Comparative study between MBI (FICE®) and magnification chromoendoscopy with indigo carmine in the differential diagnosis of neoplastic and non-neoplastic lesions of the colorectum

CONTEXTO: O uso da cromoscopia virtual com sistema de imagem multibanda poderia auxiliar no diagnóstico in vivo de neoplasias colônicas. Objetivo - Avaliar a exatidão da magnificação associada à cromoendoscopia eletrônica ou com índigo-carmin na distinção entre lesões neoplásicas e não-neoplásicas do cólon e reto. MÉTODOS: Foram avaliadas prospectivamente 157 lesões colorretais em 75 pacientes. Empregou-se o sistema FICE® para a análise dos padrões de capilares, com a malha capilar negativa sendo considerada padrão de lesões não-neoplásicas, e a malha capilar positiva, o padrão das neoplasias. Após esta avaliação, ainda usando o sistema FICE®, o padrão de criptas foi definido conforme a classificação de Kudo. Por fim, instilou-se índigo-carmin à 0,8 por cento e outro estudo das criptas foi realizado. RESULTADOS: Entre as 157 lesões colorretais, classificou-se 116 como malha capilar positiva, sendo 115 confirmadas histologicamente como neoplasias. Já entre as 41 lesões com malha capilar negativa, 32 eram não-neoplásicas. A sensibilidade foi de 92,7 por cento, a especificidade de 97 por cento e a precisão de 93,6 por cento. Os padrões de criptas tipo I e II representaram as lesões não-neoplásicas e os tipos III-V, as neoplásicas. Com a utilização da cromoscopia eletrônica, observou-se sensibilidade de 94,4 por cento, especificidade de 97 por cento e precisão de 94,9 por cento. Já com o uso da magnificação associada ao índigo-carmin, a sensibilidade foi de 97,6 por cento, a especificidade de 93,9 por cento e a precisão de 96,8 por cento. CONCLUSÕES: Tanto a cromoendoscopia eletrônica, quanto o uso do índigo-carmin, associados à magnificação de imagens, apresentaram precisão elevada quanto ao diagnóstico histopatológico e não houve diferença estatística entre ambos os métodos.

CONTEXT: Multiband imaging (MBI)/Fuji Intelligent Color Enhancement (FICE®) is a spectral image processing technology that helps in vivo diagnosis of colorectal neoplasias. OBJECTIVE: To compare the diagnostic accuracy of the magnification with either the electronic chromoendoscopy or indigo carmine dye in the differential diagnosis of neoplastic and non-neoplastic colorectal lesions. Methods - Seventy five patients with 157 colorectal lesions were prospectively evaluated. The capillary pattern, as well as the pit pattern according to the Kudo classification, of colorectal lesions were evaluated by means of the FICE® system. Absence and presence of meshed capillary networks were labeled as non-neoplastic and neoplastic lesions, respectively. Afterwards, indigo carmine 0.8 percent was instilled and a new evaluation of the pit pattern was carried out. RESULTS: One hundred and sixteen of the 157 lesions were classified as positive meshed capillary network, 115 of them were confirmed histologically as neoplasia. Other 32 lesions out of 41 with negative meshed capillary network were non-neoplastic. Sensitivity, specificity and accuracy were, respectively, 92.7 percent, 97 percent and 93.6 percent. Pit patterns I and II were confirmed as non-neoplastic lesions, and patterns III to V were confirmed as neoplasies. Sensitivity, specificity and accuracy for the electronic chromoendoscopy were, respectively, 94.4 percent, 97 percent and 94.9 percent. Meanwhile, the figures for the magnification with indigo carmine were, respectively, 97.6 percent, 93.9 percent and 96.8 percent. CONCLUSIONS: Both methods, either the MBI/FICE® system or the use of indigo carmine dye with magnification, achieved a high accuracy for the differential diagnosis between neoplastic and non-neoplastic colorectal lesions.

Afectación ganglionar en paciente con endometriosis profunda rectovaginal / Lymph node involvement in a patient with rectovaginal endometriosis

Se describe un raro caso de endometriosis rectovaginal con compromiso ganglionar en mujer de 33 años. La presencia de tejido endometrial en ganglios linfáticos pélvicos es rara y ha sido confirmada en la literatura en mujeres que han sido sometidas a cirugía por endometriosis. La presencia de endometriosis en los ganglios linfáticos pélvicos es muy improbable que surja de novo y sugiere extensión de la enfermedad.

A rare case of rectovaginal endometriosis with lymph node involvement is described in a 33-year-old patient. The presence of endometrial tissue in pelvic lymph nodes is rare and has been confirmed in the literature in subjects who underwent surgery for endometriosis. Involvement of pelvic lymph nodes by endometriosis seems unlikely to arise de novo and probably suggests lymphatic spread of the disease.

Solitary rectal ulcer syndrome: a clinicopathological study of 13 cases

Solitary rectal ulcer syndrome [SRUS] is a rare disorder that has a wide spectrum of clinical presentation and variable endoscopic findings. To further characterize the clinical and pathological features, a retrospective, hospital-based clinicopathological study was conducted. All cases of SRUS diagnosed at Farwania Hospital, Kuwait, between 2002 and 2007 were retrieved from the computerized filing system. The histological slides were reviewed by two authors to confirm the diagnosis. Immunohistochemical stain for smooth muscle actin [SMA] was performed. The clinical files were reviewed for clinical features and endoscopic findings. Thirteen cases were identified: 8 males and 5 females. The age range was 15-85. Rectal bleeding, constipation, and abdominal pain were the most common presenting symptoms and were seen, either alone or in various combinations, in 12 of the 13 cases. Rectal ulceration was the most common endoscopic finding, being seen in 9 of thel3 cases; 3 of these cases had multiple ulcerations. Two patients had rectal polyps, with one of them having multiple polyps. The histological examination revealed surface serration, fibromuscular obliteration of the lamina propria, and crypts' distortion in all the cases. Seven of the cases had diamond crypts. Ectatic mucosal vessels were a common finding. Positivity for SMA in the lamina propria was seen in all examined cases. SRUS is a rare disorder and only 13 cases were diagnosed in Farwania hospital over a 6-year period. The clinical presentation of our patients was variable. The presence of polyps and multiple ulcerations on endoscopy is further evidence that SRUS is a misnomer. Surface serration, fibromuscular obliteration, and crypts' distortion are the most characteristic features. The presence of diamond crypts is an additional diagnostic feature

A tale behind the rectum.

Tailgut cysts, also called benign retrorectal hamartomas, are uncommon developmental cysts found behind the rectum. Here, we present a rare case of a tailgut cyst associated with uterine anomaly, sacral and vertebral anomalies and vascular duplication, in a young lady who presented with constipation and infertility.

Colitis diverticular: caso clínico y revisión de literatura / Diverticular colitis disease: case report and review of literature

Estudios recientes han descrito en el sigmoides una colitis segmentaria que compromete el área peridiverticular, la cual respeta el resto del colon y recto. Esta enfermedad es similar a la colitis ulcerosa en su cuadro clínico, apariencia endoscópica e histológica, sin embargo, por definición respeta la mucosa rectal y el colon proximal al sigmoides. Se han descrito casos de progresión de colitis segmentaria a colitis ulcerosa.

Recent articles have described a segmental colitis involving an area of diverticulosis at the sigmoid colon level, but sparing the rest of bowel. This disease is similar to ulcerative colitis in its clinical presentation and endoscopic and histologic appearance, however by definition does not involve the rectum or proximal colon. Few cases have been reported in which there was progression from segmental colitis to typical chronic ulcerative colitis.

Hallazgos endoscópicos en pacientes con sangrado digestivo bajo, estudiados en el servicio de endoscopia cirugía hospital Escuela Oscara Danilo Rosales Arguello (Heodra), León - Nicaragua, 2002- 2006 / Discoveries endoscópicos in patient with having bled digestive bleat, studied in the service of endoscopia surgery hospital School Oscar Danilo Rosales Arguello (Heodra), León - Nicaragua, 2002 - 2006

Se realizo un estudio descriptivo de serie de casos, en le departamento de cirugía general en el servicio de endoscopia del Hospital Escuela Oscar Danilo Rosales Arguello (HEODRA), a los pacientes que acudieron a consulta a este centro en el servicio de emergencia con sangrado digestivo bajo y a quienes se les realizo colonoscopía en el servicio de endoscopia entre enero a diciembre del 2002 al 2005, a un total de 102 pacientes. La edad más frecuente encontrada en ambos sexos fue mayor de 50 años con un 68.6 porciento, seguido de los de 40-44 años con 7.8 por ciento, no hubo diferencia importante en cuanto al sexo. Los hallazgos endoscópicos más frecuente encontrado fue hemorroides en un 25 por ciento de los casos seguidos, las cuales en el 70 por ciento eran de I y II grado, seguido de la enfermedad divericular con un 20 por ciento, de los cuales el 75 por ciento eran del colon izquierdo y sólo en el 25 por ciento de los casos se observó sangrado activo; en cambio el cáncer se presentó en un 10 por ciento, de los cuales la mitad se trató de adenocarcinoma, no encontrando ningún hallazgo en 14 por ciento de los casos. Las formas de presentación clínica de los pacientes estudiados fue hematoquezia sola en un 46 por ciento, seguido de rectorragia con 30 por ciento y la combinación de hematoquezia y melena en 10. 7 por ciento. Del total de pacientes dos tercios presentaban algún factor de sangrado digestivo bajo, de los cuales el 27. 4 por ciento tenian más de un factor como asociaciuón de Aines, alcohol, tabaco entre otros y en el 18 por ciento tomaban AINES únicamente. Sólo 35 pacientes tenían antecedente de sangrado digestivo previo al estudio, de los cuales el 80 por ciento se trato de SDB

Rectal malakoplakia presenting as a mass ad fistulous tract in and renal transplant patient

Malakoplakia [MK] is a rare, chronic inflammatory disorder with characteristic morphologic features. It most commonly involves urogenital organs but can affect any organ system in the body. Gastrointestinal tract is the second common site of involvement. It commonly occurs in nontransplant patients but transplant patients are also vulnerable to it. We present a case report of a forty year old male renal transplant patient, who received a kidney from his brother with 1 haplotype and 4 antigen match. He was on regular post transplant follow up with stable graft function. Fifteen months post transplant he presented with the complaint of painful defecation, a swelling in the perianal region and inability to sit down properly. Biopsy examination showed malakoplakia with characteristic Michaelis-Gutmann bodies. Culture of the tissue grew E Coli. Immunosuppression therapy was curtailed and patient was started on ciprofloxacin 500mg OD for 6 months. The lesions regressed completely after six months of the above therapy and the patient became completely symptoms free

Spontaneous fulminant gangrene of distal colon and rectum

A case of a young female is reported who presented with acute abdomen and peritonitis. Emergency laparotomy revealed fulminant gangrene of descending colon and upper third of rectum. Two-stage procedure was carried out as transverse colostomy and subsequent colorectal anastomosis two months later

Affecçöes colorretais em portadores da síndrome da imunodeficiência adquirida e suas manifestaçöes endoscópicas / Colorectal diseases in AIDS patients and its endoscopic findings

Com a finalidade de se estabelecer as principais afecçoes colorretais observadas em pacientes portadores da síndrome da imunodeficiência adquirida com sintomas intestinais e verificar as alteraçoes endoscópicas relacionadas, foi analisada uma série de 236 colonoscopias realizadas em 186 pacientes. A colonoscopia foi sempre acompanhada de biopsias, mesmo quando nao havia alteraçoes endoscópicas. O diagnóstico mais freqüente foi colite pelo citomegalovírus identificado em 64 exames (27,1 por cento) e se apresentou caracteristicamente com padrao inflamatório ulcerativo. O segundo achado em freqüência foi o Cryptosporidium sp. observado em 31 exames (13,1 por cento), relacionando-se o processo inflamatório sem ulceraçoes. Outros patógenos observados com menor freqüência foram: Mycobacterium sp., Histoplasma capsulatum, Herpes simplex, Isospora sp. Giardia sp., Candida sp. e Campilobacter sp.. As afecçoes neoplásicas foram diagnosticadas em 10 exames (4,2 por cento) e representadas principalmente pelo sarcoma de Kaposi. Os autores concluem que: 1. as afecçoes colorretais mais freqüentes em portadores da AIDS (CMV e Cryptosporidium sp.) apresentam, na maioria das vezes, aspecto colonoscópico característico que podem sugerir diagnóstico; 2. a realizaçao de biopsias é fundamental: a) para confirmaçao diagnóstico; b) para realizaçao do diagnóstico quando da ausência de alteraçoes endoscópicas; c) para identificar a eventual concomitância de patógenos.

Endometriose retal: relato de um caso / Rectal endometriosis: report of a case

Os autores relatam um caso de uma paciente portadora de sangramento retal cíclico, coincidindo com períodomenstrual, que iniciou um mês após histerectomia. Ao exame apresentava lesäo vegetante no reto e diagnóstico foi realizado após segunda biópsia, quando o exame histopatológico revelou a presença de tecido endometrial. O enema opaco era normal. A paciente apresentou, inicialmente, melhora do quadro com tratamento clínico. Posteriormente foi submetida à intervençäo cirúrgica devido à recidiva da sintomatologia

Maladie de buschke-lowenstein ano-rectale [a'propos de 5 cas]

The authors report a series of 5 cases of Buschke Lowenstein's anorectal tumors. In one case the tumor degenerated. The treatment consists in a surgical exercise associated with an electro coagulation. Radiotherapy is indicated in one case of dysplasia and in the case of degeneracy. Evolution is good in the three cases seen in consultation with, in one single patient, five years' recoil. 20 cases are collected in medical literature till 1989 and 42 cases reported in English literature till 1994. These cases are comparatively studied with our series. Key words: Condyloma acuminatum, Buschke Lowenstein's anorectal disease. Excision, Electro coagulation Radiotherapy

Traumatismo colorectal en el Hospital Regional Honorio Delgado de Arequipa, 1 de julio 1985 al 30 de junio de 1995

Se estudian retrospectivamente 74 historias clínicas de pacientes con traumatismo colorectal, operados en el Hospital Regional Honorio Delgado de Arequipa. Las edades fluctuaron entre 7 a 56 años, siendo más frecuente entre 10 y 29 años, la relación de hombre y mujeres fue 8:1. El 54 por ciento de los pacientes, fueron intervenidos quirúrgicamente entre las 6 horas de ocurrido el trauma, siendo el arma blanca la que ocasionó el mayor número de lesiones, seguida del arma de fuego y los traumatismos cerrados de abdomen, ocasionados por accidentes de tránsito. El diagnóstico de los pacientes se ha basado, fundamentalmente en la clínica. El tratamiento inicial consistió en el reemplazo urgente de la volemia, sangre y antibióticos cuando fue necesario. La anestesia más utilizada fue la general inhalatoria y la incisión preferida resulto la mediana. En os hallazgos operatorios, el segmento más traumatizado fue el sigmoides y el colon transverso y lesiones asociadas de intestino delgado, hígado, bazo, vejiga. La operación de elección fue la sutura primaria, cuando técnicamente es posible, la colostomía proximal descompresiva y exteriorización son usados cuando hay lesiones amplias de colon o el estado genertal del paciente es precario. El lavado y/o drenaje de la cavidad peritoneal se efectuó en el 88 por ciento de los pacientes. La cirugía colorectal de urgencia, es evidentemente séptica, de ahí que se presentó un alto porcentaje de complicaciones, siendo la infección de herida operatoria la más frecuente. En el presente estudio los factores de riesgo como edad, shock, antibióticos usados en el pre-operatorio, demora de la operación, agente etiológico, procedimiento operatorio, localización de la lesión y lesiones asociadas no influyen en las complicaciones estudiadas(p>0.05). La mortalidad fue de 10.81 por ciento, siendo la septicemis la causa de muerte más frecuente. La estadía hospitalaria fue sumamente prolongada

Schistosomiasis and colorectal carcinoma in Egypt

This work was carried out to throw light on the etiological importance of schistosomiasis in colorectal and the predictive value of some tumor markers TMs [CEA and CA19-9] in these tumors detection. It included 10 patients with sole colorectal carcinoma [group I], 10 others with colorectal cancer and schistosomiasis [group II], 15 with late intestinal schistosomiasis [group III] and 10 with early schistosomal colitis [group IV], in addition to 10 normal healthy controls [group V]. Results suggested that, it seems time to keep in mind the association between colorectal cancer and S. mansoni particularly in long standing infections. Sole determination of CEA and/or CA19-9 is not enough for diagnosis of colorectal carcinoma. Screening of high risk groups using these markers would require longer follow up along with histopathological study. Furthermore, it could be postulated that the primary role of these TMs in cancer colon and rectum might be assessment of complete tumor excision as well as postoperative surveillance of patients at risk of recurrence