Association of ano-rectal inflammatory bowel diseases with cases of fistula-in-ano-[a cross sectional hospital based study] at Al Thora Hospital, Al Beida

Incidence of Inflammatory bowel diseases at Libya is 0.9 to 3.6 / 100 000 population as per 2006 study. And extrapolated prevalence of Inflammatory bowel diseases at Libya is 11, 263 / 5.631.585 [1] Inflammatory bowel disease mainly constitute Crohn's disease, Ulcerative colitis, Intermediate colitis, and pouchitis. Perianal pathological problems are fairly frequent manifestation of Inflammatory bowel diseases. A study has been carried out at Al Thora Hospital, Al Beida, in last 5 years, from Jan 2005 to Dec 2009; about the association of ano-rectal Inflammatory bowel diseases with cases of fistula-in-ano

A randomized double-blind controlled trial comparing two forms of enema for flexible sigmoidoscopy.

OBJECTIVE: To compare bowel preparation quality and patient tolerance of two common enema solutions for flexible sigmoidoscopy. MATERIAL AND METHOD: Three hundred adults were randomized to receive a hypertonic sodium chloride or hypertonic sodium phosphate enema regime, each consisting of two enemas administered 60 and 30 min before the procedure. Patients completed surveys on preparation comfort. Patients and endoscopist were blinded to the preparation used During the procedure, the endoscopist took pictures of the mucosa and intraluminal content. All pictures were later evaluated by a single doctor who graded the quality of the preparation. RESULTS: There were no serious complications during or following the procedures. The preparation quality was rated as excellent or good by 76.9% of the hypertonic sodium chloride group and 72.9% of the hypertonic sodium phosphate group (p = 0.423). The hypertonic sodium chloride enema was associated with more abdominal discomfort (p = 0.018). CONCLUSION: Both enemas were safe for all patients with no statistical difference between the qualities of the two bowel preparations. Both preparations performed their bowel-cleaning function well and were suitable for the preparation of patients before flexible sigmoidoscopy. The less expensive hypertonic sodium chloride solution may be an option for hospitals where budgetary considerations are important.

Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population

BACKGROUND: Colonoscopy is the gold standard exam to investigate patients with colonic complaints. However, its availability is limited in developing countries. Sigmoidoscopy has been advocated as a first procedure in colorectal cancer screening strategies, in order to select those who need colonoscopy. AIM: To study the correlation between distal and proximal colonic neoplasias in symptomatic patients 50 years or older and patients 40 to 49 years old who underwent colonoscopy at a gastrointestinal endoscopy unit in 1999 and 2000 with the purpose to evaluate its role in a symptomatic population. METHODS: All colonoscopies performed in our Department in 1999-2000 were reviewed. The distal colon was defined as the colonic segment aboral to the splenic flexure. Advanced neoplasias were defined as adenomas larger than 10 millimeters and adenocarcinomas. RESULTS: Of the 2,701 colonoscopies retrieved, 1,125 were enrolled in this study. Prevalence rates for adenoma, advanced adenoma and carcinoma were 28.9 percent, 4.6 percent and 4 percent in the group of 830 patients 50 years or older (mean age 65 years, 491 women). The finding of one small (<10 mm) adenoma in the distal bowel doubled the likelihood of finding a proximal neoplasia (OR = 2.12, 95 percent CI, 1.27-3.54), and multiple (OR = 3.99, 95 percent CI, 1.72-9.28) or advanced (OR = 3.73, 95 percent CI, 1.81-7.7) adenomas increased this risk even further. Of the patients without adenoma or carcinoma in the distal colon, 1.93 percent had proximal advanced neoplasia. In the group of 40 to 49-year-old patients (n = 395; mean age 44.8 years, 208 women) the prevalence of adenomas (14.9 percent), advanced adenomas (3.4 percent), and carcinomas (1.7 percent) was lower. CONCLUSIONS: The likelihood of finding a proximal lesion is greater in patients with distal neoplasias. This likelihood is further increased when adenomas are multiple or larger than 10 mm. One out of 52 patients 50 years or older...

RACIONAL: A colonoscopia é o exame padrão-ouro na investigação de pacientes com sintomas intestinais baixos. Entretanto, sua disponibilidade é restrita em países com poucos recursos financeiros. OBJETIVO: Como a retossigmoidoscopia flexível tem sido defendida como o primeiro procedimento em estudos de rastreamento populacional para o câncer de cólon e reto, selecionando aqueles que necessitam colonoscopia, estudou-se a correlação entre a presença de neoplasias proximais e distais nos pacientes com idade entre 40 e 49 anos e naqueles com idade igual ou superior a 50 anos submetidos a colonoscopia, objetivando avaliar o papel deste exame segmentar em uma população sintomática. MÉTODOS: Todas as colonoscopias realizadas no Departamento de Coloproctologia do Complexo Hospitalar da Santa Casa de Porto Alegre, RS, no período de 2 anos, foram retrospectivamente estudadas. O cólon distal foi definido como o segmento colônico aboral à flexura esplênica. Neoplasias avançadas foram definidas como adenomas com tamanho superior a 1 cm ou adenocarcinomas. RESULTADOS: Das 2 701 colonoscopias realizadas naquele período, 1 125 foram incluídas no estudo. Destas, 830 foram feitas em pacientes com idade igual ou superior a 50 anos (média de idade de 65 anos, 491 mulheres) e a prevalência de adenomas, adenomas avançados e carcinoma foi 28,9 por cento, 4,6 por cento e 4 por cento, respectivamente. A presença de um adenoma pequeno (<1 cm) no cólon distal dobrou a probabilidade de coexistir uma neoplasia proximal (RC = 2.12, IC 1.27-3.54), sendo este risco maior quando os adenomas eram múltiplos (RC = 3.99, IC 1.72-9.28) ou avançados (RC = 3.73, IC 1.81-7.7). Entre os pacientes com o segmento colônico distal livre de adenomas ou carcinomas, 1,93 por cento apresentavam neoplasias proximais avançadas. No grupo de pacientes com idade entre 40-49 anos (n = 395; média de idade 44,8 anos, 208 mulheres), a prevalência de adenomas (14,9 por cento), adenomas avançados...

Civilian rectal trauma: the surgical challenge

Using the Department of Surgery, Radiology, Anaesthesia and Intensive Care's operative database and information from the Trauma Registry for patients presenting after 1998, a retrospective study of patients seen between the period 1992 and 2002 was done at the University Hospital of the West Indies with the objective of determining the treatment and outcome of patients with a diagnosis of rectal trauma. Over the 10-year period, 45 patients were seen with this diagnosis. Eighty-two per cent of the cases were males, with a mean age of 29.8 years (range 16-70 years) while the eight female patients had a mean age of 36.8 years. Low velocity gunshot wounds accounted for 64 of the entire group and for 78 in males. Six of the eight cases seen in females were iatrogenic occurring during gynaecological operations. Sixty-three per cent of rectal injuries were associated with other injuries with the genitourinary system most commonly involved The majority (83) were diagnosed preoperatively by visualization of the rectal wound or the presence of blood on proctosigmoidoscopy. All the patients had peri-operative antibiotics and diversion with a proximal sigmoid colostomy. Fifteen per cent of cases had presacral drain insertion. Distal rectal washout was not used. There were no deaths. Seventy-three per cent of patients had closure during the period under review at an average time of 8.5 months after initial surgery. The other 27 after an average of 23 months did not have documented closure. The mainstay of treatment for civilian rectal trauma remains diverting sigmoid loop colostomy, despite its morbidity, and peri-operative antibiotics

Lymphocytic immuno-phenotype and expression of epidermal growth factor receptor in intestinal schistosomiasis

Schistosomiasis is an endemic disease in Egypt performing major health and subsequently economic problems. Schistosomiasis generates a range of host immune responses that may contribute to the pathogenesis of this disease. In this study immunologic response and reparative potentiality of intestinal mucosa following infection have been evaluated Fortey patients with manifestations of active intestinal schistosomiasis were selected by positive rectal snip for this study and compared to 10 negative control patients. sigmoidoscopic biopsies were obtained and conducted for histopathologic examination, immunohistochemistry study of CD4+, CD8+ and epidermal growth factor receptor [EGFr], and feulgen stain to evaluate DNA content of glandular epithelium, using CAS200 image analyzer system. All bilharzial biopsies demonstrated lymphocytic infiltration intermixed with eosinophils and bilharzial ovae were detected in 12 biopsies. Positive CD4+ lymphocytes were observed in 35 cases [88.2%] with focal or diffuse distribution [25 and 10 cases respectively]. Seven cases were CD8+ positive [17.5%]. In 18 biopsies [47%], epidermal growth factor receptor was expressed by glandular and brush border epithelium. These cases demonstrated proliferative diploid histogram represented S-phase pattern of DNA distribution. The EGFr expression was conelated well with presence of bilharzial ovae, ulcerated epithehum and positive CD4+ lymphocytes. In conclusion, the expression of EGEr is stimulated by antigenisity released from ovae and cytokines of the activated T cells, to participate in mucosal healing process through DNA synthesis and adaptation to the presence of infection

Sigmoidopexy (tube sigmoidostomy) as definitive surgical procedure for sigmoid volvulus.

BACKGROUND: Volvulus of the sigmoid colon is associated with high mortality and high recurrence rate following nonoperative decompression of the colon. Therefore definitive surgery is required for its management. AIM: To evaluate the outcome following sigmoidopexy (tube sigmoidostomy) as a definitive surgical procedure to prevent recurrence of disease. METHODS: Seventeen patients with sigmoid volvulus who presented with features of large gut obstruction were studied; 12 patients underwent elective and 5 underwent emergent exploratory laparotomy. Malecot catheter fixed to the sigmoid colon and abdominal wall acted as fixator for the colon and rent for drainage of fecal matter. RESULTS: Sigmoidostomy started functioning the day following surgery and the stoma remained patent for approximately 12 days, although discharge started decreasing by the 5th postoperative day. No recurrence was noted over a period of 18 (5) months (range 13-23). CONCLUSIONS: Tube sigmoidostomy is an alternative effective procedure to prevent recurrence of sigmoid volvulus in patients who present without gangrene.

Comparison of three bowel preparation for sigmoidoscopy

The efficacy of three lower bowel preparations in 96 patients undergoing rigid sigmiodoscopy was studied. The maximal length of insertion and clarity of view were assessed in each group and compared to patients without bowel preparation. Blood per rectum and diarrhoea were the main indications for sigmoidoscopy. The maximal insertion of the instrument was similar for all groups and the rectosigmoid junction was examined in the majority. The clarity of view was good in 71 per cent of patients receiving Fleet enema, 68 per cent of those receiving Dulcolax micro-enema, 36 per cent in the Dulcolax suppository and 16 per cent in the group without bowel preparation. There were no adverse effects or complications arising from bowel preparation or sigmoidoscopy. Bowel preparation significantly improves the number of satisfactory sigmoidoscopic examinations, and the use of simple disposable enemas is safe and effective.

Synchronous and hetachronous carcinoma of the colon

The presence of one malignant growth of the colon does not exclude the presence of a second one in the same organ. Preoperative sigmoidoscopic and radiologic examination should be done in all cases to exclude the presence of double lesions. A careful 6-monthly follow-up should be made in all cases with colorectal cancer