Manifestaciones extraintestinales en rectocolitis úlcerativa: a propósito de un caso / Extraintestinal manifestations in ulcerative proctocolitis: a case report

La colitis ulcerativa (CU) forma más común de la enfermedad inflamatoria intestinal (EII),¹ es una enfermedad crónica que cursa con inflamación recurrente no controlada del colon,² caracterizada por ulceración de la mucosa, sangrado rectal, diarrea y dolor abdominal.³ Un tercio de los pacientes pueden desarrollar una manifestación extraintestinal.4,5 En la CU estas manifestaciones suelen estar relacionadas con la actividad de la enfermedad.5,6 Presentamos un caso clínico de una paciente con CU quien presenta manifestaciones extraintestinales cutáneas, oculares y en mucosa bucal, con resolución de las mismas posterior a tratamiento médico

Ulcerative colitis (UC) the most common form of inflammatory bowel disease (IBD),¹ is a chronic disease that causes uncontrolled recurrent inflammation of the colon,² characterized by mucosal ulceration, rectal bleeding, diarrhea and abdominal pain.³ A third of patients may develop extraintestinal manifestation.4,5 In UC these manifestations are often associated with disease activity.5,6 We present a case of a patient with UC who presented extraintestinal cutaneous, ocular and oral mucosa, with resolution of the same post-treatment

Análise da qualidade de vida pós-operatória em pacientes com reservatório ileal por retocolite ulcerativa / Quality of life of patients with ulcerative colitis after ileal pouch-anal anastomosis

A proctocolectomia total com reservatório ileal (RI) é a cirurgia mais utilizada em portadores de retocolite ulcerativa (RCUI), porém, trata-se de procedimento de grande porte, que implica em derivação intestinal temporária e elevada morbidade. A experiência adquirida ao longo do tempo evidenciou a ocorrência de várias complicações como distúrbios evacuatórios e a inflamação do reservatório ou bolsite, que podem influenciar negativamente a qualidade de vida do paciente e se contrapor às expectativas iniciais. Objetivo: avaliar a qualidade de vida pós-operatória de pacientes com RI por RCUI. Casuística e métodos: Foram avaliados 31 pacientes operados pela mesma equipe (Grupo de Coloproctologia- FCM/UNICAMP) há pelo menos 1 ano. Empregou-se questionário de avaliação inicial dirigido elaborado pelos autores com o intuito de caracterizar a população e identificar sua satisfação com a cirurgia e questionário específico validado em português para investigação da qualidade de vida após cirurgia de RI (IBDQ), composto por 32 questões que abrangem quatro dimensões: sintomas intestinais, sintomas sistêmicos, aspectos sociais e aspectos emocionais. Cada questão dentro de cada um dos domínios aferidos tem sete alternativas de respostas. Cada opção de resposta vale seu próprio número em pontos, sendo 1 pior qualidade de vida e 7 a melhor. Verificou-se assim, o total de pontos obtidos em cada domínio. Foram avaliados os percentuais com pontuação máxima e mínima para cada item avaliado. Considerou-se resultado satisfatório para as pontuações 5, 6 e 7, regular 4 e insatisfatório valores de 1 a 3.

Restorative proctocolectomy with Ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis (UC), however, involves temporary ileostomy and high morbidity. The acquired experience over time showed the occurrence of various complications, such as, evacuation disturbances and the inflammation of the pouch or pouchitis, which can influence negatively the patients' quality of life (QoL) and as opposed to when compared to the initial expectations. Aim: To evaluate quality of life of patients with UC after IPAA. Patients and Methods: Thirty one patients were evaluated and underwent surgery by the same team with at least one year follow-up after surgery. An initial questionnaire was used for evaluation. It had been elaborated by qualified personnel with the purpose to characterize the patients and to identify their satisfaction with the surgery. A second questionnaire, specifically validated in Portuguese, was used to investigate the QoL after IPAA. It has 32 questions which covered four areas: intestinal and systemic symptoms, plus social and emotional aspects. Each question has seven possible answers. Each answer option has its own value; one represented the worse QoL and seven the best. For classification purposes five to seven points were considered satisfactory, four regular and one to three unsatisfactory. For quantitative analysis, the interval between the minimum and maximum punctuation of each domain were divided by 3, thus considering for physical domain scores between 46 to 54,99 as unsatisfactory, 55 to 62,99 regular, 63 to 70 satisfactory; for systemic domain, 8 to 17,99 unsatisfactory, 18 to 26,99 regular, 27 to 35 satisfactory; for social aspects, 10 to 18,33 unsatisfactory, 18,34 to 26,67 regular and 26,68 to 35 satisfactory; e for emotional aspects, 22 to 42,66 unsatisfactory, 42,67 to 63,32 regular and 63,33 to 84 satisfactory.

Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5 percent). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8 percent) 1 year after ileal pouch-anal anastomosis, 9 (14.8 percent) after 3 years, 13 (21.3 percent) after 5 years, and 16 (26.2 percent) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up

Complicaciones rectosigmoideas en el tratamiento radiante del cáncer ginecológico / Rectosigmoid complications in radiation treatment of gynecological cancer

Antecedentes: La radioterapia mediante irradiación intracavitaria y externa solas o asociadas a cirugía o quimioterapia es considerada el tratamiento de elección del cáncer ginecológico. Las dosis radiantes efectivas que se requieren para tratar adecuadamente procesos neoplásicos es lindante con aquellas toleradas por los tejidos circundantes. Objetivos: Analizar las complicaciones rectosigmoideas relacionadas al tratamiento radiante del cáncer ginecológico. Diseño: Trabajo retrospectivo. Población: Se presentan 55 pacientes con complicaciones rectosigmoideas del tratamiento radiante por cáncer ginecológico tratados durante junio 1990 a junio 1999. Método: El tratamiento radiante se implementó en 27 pacientes (49 por ciento), 17 casos por cáncer de cuello uterino y los restantes 10 por cáncer de endometrio. A la radioterapia, en 28 casos se le asoció cirugía (Op. de Wertheim Meigs) con diagnóstico de: cáncer de cuello uterino en 9 casos, cáncer de endometrio en 17 y de ovario en 2 casos. La dosis radiante utilizada osciló entre los 4500 y 13200 cGy. Resultados: Se presentaron complicaciones tempranas en 21 casos (38,2 por ciento) y las tardías ocurrieron en 34 pacientes (68,8 por ciento). Estas fueron fistulosas en 15 casos, hemorrágicas en 7 casos, obstructivas en 10 y ulcerativas en 2 casos. Se implementó tratamiento médico en 27 casos (49 por ciento), tratamiento quirúrgico en 31 pacientes (56,4 por ciento) todos ellos con complicaciones tardías. La morbilidad quirúrgica fue de 58 por ciento y la mortalidad cercana al 40 por ciento. Conclusiones: Consideramos un llamado de atención a las indicaciones del tratamiento radiante para que se tomen todas las medidas preventivas para reducir la frecuencia de sus severas complicaciones. Es necesario un manejo artesanal de cada paciente por el radioterapeuta evitando la estandarización del proceso.

Tratamiento quirúrgico de la proctocolitis ulcerosa idiopática

En un período de 18 años se ha intervenido quirúrgicamente seis pacientes por Proctocolitis Ulcerosa Idiopática lo que representa sólo el 7.5% de los enfermos controlados por esta afección en el Departamento de Gastroenterología del Hospital G. Fricke. Este bajo porcentaje de indicación operatoria se atribuye en general tanto al rechazo de la ileostomía como al temor de una disfunción sexual. Se mencionan las indicaciones operatorias al igual que se analizan las alternativas quirúrgicas, urgentes y electivas, estimando que la cirugía debe plantearse más frecuente y precozmente que hasta la fecha, en nuestro medio. Dentro de las alternativas quirúrgicas de urgencia destacan la colectomía total para el megacolon tóxico y la Pamproctocolectomía en caso de hemorragia masiva. En la cirugía eletiva resalta la Panproctocolectomía con ileostomía definitiva tipo Brooke, como la operación consagrada, para los casos más complicados, como son los pacientes que hemos operado. Sin embargo, una elección a su debido tiempo y apropiada de los pacientes permitirá mejorar su calidad de vida mediante las nuevas operaciones de proctocolectomía restauradora, lo mismo que una técnica meticulosa reducirá al mínimo las disfunciones sexuales. Se finaliza describiendo los aspectos técnicos y complicaciones post operatorias específicas más importantes de las Panproctocolectomía clásica