Ghost ileostomy release down: our initial experience

Background: Many publications describe the advantages of the creation of ghost ileostomy (GI) to prevent the need for formal covering ileostomy in more than 80% of carcinoma rectum patients. However, none of the papers describes exactly how to ultimately remove the GI in these 80% of patients in whom it doesn't need formal maturation. Aim: To describe and evaluate the ghost ileostomy release down (GIRD) technique in terms of feasibility, complications, hospital stay, procedure time etc. in patients with low anterior resection/ultra-low anterior resection (LAR/uLAR) with GI for carcinoma rectum. Method: The present was a prospective cohort study of patients with restorative colorectal resections with GI for carcinoma rectum, Postoperatively the patients were studied with respect to ease and feasibility of the release down of GI and its complications. The data was collected, analyzed and inference drawn. Results: A total of 26 patients needed the GIRD and were included in the final statistical analysis of the study. The procedure was done between 7th to 16th postoperative days (POD) and was successful in all patients without the need of any additional surgical procedure. None of the patients required any local anesthetic injection or any extra analgesics. The average time taken for procedure was 5-minutes and none of the patients had any significant difficulty in GI release. There were no immediate postprocedure complications. Conclusion: The GIRD technique is a simple, safe, and quick procedure done around the 10th POD that can easily be performed by the bedside of patient without the need of any anesthesia or additional analgesics. (AU)

Metástasis rectal de carcinoma urotelial de vejiga resecado / Rectal metastasis of a resected urothelial bladder cancer

Resumen Se presenta el caso de una paciente con antecedentes de carcinoma urotelial de vejiga de alto grado con compromiso secundario ganglionar y óseo, la cual presentó cuadro de hematoquecia, tenesmo y dolor rectal un año después de su cirugía oncológica. La resonancia magnética de abdomen y pelvis, demos tró una lesión sólida rectal de 5 cm de longitud que estenosaba la luz y atravesaba el peritoneo, a 6 cm del margen anal. La anatomía patológica de dicha lesión, informó una metástasis urotelial a nivel del recto inferior en concordancia con el antecedente de la paciente. Este caso identifica una evolución atípica de carcinomas uroteliales (CU), destacando una ruta inusual de metástasis a distancia. Los CU pueden, en raras ocasiones, hacer metástasis rectales, generalmente en casos avanzados o recurrentes de la enfermedad. Al ser escasa la bibliografía disponible sobre dicho tema, cabe destacar la importancia de mantener un alto índice de sospecha en pacientes con antecedentes de carcinoma urotelial y síntomas urinarios/rectales (dolor y tenesmo rectal, dolor suprapúbico, incontinencia urinaria y fecal).

Abstract We present the case of a female patient with a history of high-grade urothelial carcinoma of the bladder with secondary lymph node and bone involvement, who presented with hematochezia, tenesmus and rectal pain one year after her oncological surgery. The abdomen and pelvis magnetic resonance image showed a 5 cm solid rectal lesion that stenosed the lumen and crossed the peritoneum, 6 cm away from the anal margin. The histology of this lesion reported an urothelial metastasis at the level of the lower rectum according to the patient's history. This case identifies an atypical evolution of urothelial carcinomas (UC), highlighting an unusual route of distant metastasis. UC can, on rare occasions, metastasize to the rectum, usually in advanced or recurrent cases of the disease. As the literature available on this topic is scarce, it is crucial to highlight the importance of maintaining high suspicion in patients with a history of urothelial carcinoma and urinary/rectal symptoms (rectal pain and urgency, suprapubic pain, urinary and fecal incontinence).