Is there a precise correlation between the lengths of the peritoneal reflection and the middle rectal valve?

Introduction: Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma. Objectives: To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity. Design: We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery. Results: We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32). Conclusion: There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries. (AU)

Perforated acute abdomen in a patient with COVID-19: an atypical manifestation of the disease / Abdome agudo perfurativo em paciente com COVID-19: uma manifestação atípica da doença

Abstract Introduction: The Coronavirus belongs to a family of RNA viruses that can cause respiratory infection, with the possibility of gastrointestinal manifestations in approximately 5-50% of the cases. Objective: To report a surgical case with a diagnosis of COVID-19 that developed acute perforated abdomen and pneumothorax. Case report: This was an 80-year-old female patient with respiratory symptoms, with dry cough and fever and diffuse abdominal pain with signs of peritonitis. She had leukocytosis, kidney dysfunction and an increase in D-dimer with positive PCR for COVID. Computed tomography of the chest and abdomen showed pneumothorax on the right and extensive pneumoperitoneum. Conclusion: The presentation of COVID-19 with severe pulmonary and abdominal complications requires specialized and emergency treatments, but it has high mortality rates.

Resumo Introdução: O coronavírus pertence a uma família de vírus RNA que pode causar infecção respiratória com possibilidade de manifestações gastrintestinais em torno de 5% a 50% dos casos. Objetivo: Relatar caso operado com diagnóstico de COVID-19 e evolução com abdome agudo perfurativo e pneumotórax. Relato do caso: Paciente do sexo feminino de 80 anos com sintomas respiratórios com tosse seca e febre e dor abdominal difusa com sinais de peritonite. Apresentava leucocitose, disfunção renal e aumento de D-dímero com PCR positivo para COVID. Tomografia computadorizada de tórax e abdome demonstrando pneumotórax à direita e extenso pneumoperitônio. Conclusão: A apresentação do COVID-19 com sérias complicações pulmonar e abdominal requer tratamentos especializados e em regime de emergência, entretanto com altas taxas de mortalidade.