Retrospective analysis of the elective tests of rigid proctosigmoidoscopy performed in the service of medical residency in Coloproctology of Hospital Santa Marcelina / Análise retrospectiva de exames eletivos de retossigmoidoscopia rígida realizadas no serviço de residência médica de Coloproctologia no Hospital Santa Marcelina

Introduction: Proctologic examination is a deeply intimate procedure which deals with a body area in which prejudices, taboos and constraints prevail, and may also relate to previous trauma; yet this procedure is of paramount importance for the investigation of patients with symptoms that foretell pathologies associated with distal colon, rectum and anus. Objectives: This study aimed to analyze all cases scheduled of rigid proctosigmoidoscopy performed by the Coloproctology Service, Hospital Santa Marcelina, in 8 of its 10 years of residency in the specialty. Materials and methods: We analyzed mean age, gender distribution, device's height of reach in relation to the anal verge, the percentage of abnormal tests stratified to perform, or not perform, anoscopy and proctosigmoidoscopy, and major diseases detected. Results: 844 rigid proctosigmoidoscopy procedures scheduled and performed by the Coloproctology Service, Hospital Santa Marcelina, between September 2006 and August 2014, were analyzed. The distribution was similar between genders and the mean age was 51.2 years. With respect to the device's height of reach from the anal verge, these values were stratified as follows: distance reached >15 cm, 10-15 cm, and <10 cm from the anal verge. Distances >15 cm from the anal verge were attained in 692 (82% of RR) tests, between 10 and 15 cm in 94 (11.1%) tests, and <10 cm in 58 (6.9%) tests. Conclusion: In this study, it was found that proctology examination and rigid proctosigmoidoscopy are mandatory procedures in cases of symptoms depending on these practices.

Introdução: O exame proctológico, apesar de profundamente íntimo e de lidar com área do corpo na qual imperam preconceitos, tabus e constrangimento, podendo inclusive relacionar-se a traumas prévios, é de suma importância para a investigação de pacientes com sintomas que predizem patologias associadas ao cólon distal, reto e ânus. Objetivos: Analisar todos os casos de retossigmoidoscopias rígidas realizadas de forma agendada pelo serviço de Coloproctologia do Hospital Santa Marcelina em 8 de seus 10 anos de residência médica na especialidade. Materiais e métodos: Analisou-se a média de idade, distribuição por sexo, altura de alcance do aparelho em relação à borda anal, percentagem de exames anormais com estratificação quando realizado ou não a anuscopia e retossigmoidoscopia e as principais doenças detectadas. Resultados: Foram avaliadas 844 retossigmoidoscopias rígidas realizadas pelo serviço de Coloproctologia do Hospital santa Marcelina, de forma agendada, entre setembro de 2006 e agosto de 2014. A distribuição foi semelhante entre os sexos e a média de idade foi de 51,2 anos. Com relação à altura em relação à borda anal, estratificou-se esses valores em maior que 15 cm, entre 10 e 15 cm da borda anal e alcance inferior a 10 cm da borda anal. Em 692 exames foi possível alcance superior a 15 cm da borda anal (82% das RR), em 94 (11,1%) entre 10 e 15 cm, e em 58 (6,9%) exames, abaixo de 10 cm. Conclusão Verificou-se em nosso estudo que o exame proctológico e a retossigmoidoscopia rígida são mandatório em casos de sintomatologia que assim o necessitem.

Colonoscopic Perforation; A 10-year Experience in Single General Hospital / 대한소화기학회지

BACKGROUND/AIMS: Colonoscopy is the principal method for diagnosis, treatment, and follow up of colorectal disease. The study aimed to assess the incidence, clinical features, and management of colonoscopic perforations at a local general hospital. METHODS: A retrospective review of patient record was performed for all patients with iatrogenic colonic perforation after sigmoidoscopy and colonoscopy between 1997 and 2007. RESULTS: In the 10-year period, 16,388 colonoscopic and sigmoidscopic procedure were performed. All 10 cases of procedure related colonic perforation were developed. Perforation occurred in 9 cases during therapeutic procedure; 5 cases due to polypectomy and 4 cases due to endoscopic submucosal dissection. Perforation occurred in one case during diagnostic procedure. CONCLUSIONS: Therapeutic procedure is a clear risk factor of colonic perforation. When colonic perforation occurs, we should be able to make early diagnosis. Early diagnosis can lead to a good treatment and can produce good prognosis with short hospital days.

Evaluación prospectiva de la seguridad y tolerancia de los procedimientos colonoscópicos en pacientes pediátricos / Prospective evaluation of safety and tolerance of colonoscopy in children

Background: Colonoscopy is a well established diagnostic and therapeutic procedure in pediatrics. Aim: To evaluate colon preparation alternatives for colonoscopy or sigmoidoscopy, type of sedation, clinical indications and findings. Patients and methods: Prospective study of 123 children referred for colonoscopy. Demographic data, type of colon preparation, sedation, type of endoscope and endoscopic results were obtained. The following day, a phone interview was carried out inquiring about duration, quality and adverse effects of the sedation and procedure. Results: Seventy one boys (58%) and 52 girls (42%) with a mean age of 6.7±4.4 years, were recruited. The main indication was lower gastrointestinal bleeding (71%). The different colon preparations produced elimination of clear liquid stools in 50%, non transparent liquid in 23%, semi liquid in 22% and solid in 6% of the patients. Most common side effects were abdominal distension (20%) and nausea (16.8%). The most commonly used drugs were midazolam (76%) and demerol (43%). The average duration of the procedure was 18.3 minutes (range: 4-50). The most common findings were rectal polyps (18.7%) and hemorrhagic colitis (14.6%). In 77% of cases, the sedation was considered very good or good. Colon visualization was described as very good (51%) or good (36%). Seventy three percent of children had complete amnesia. The most common adverse effect was vomiting (7.5%). Conclusion: Lower endoscopies are feasible procedures to carry out in children, in an ambulatory basis, with intravenous sedation and minimum adverse effects.

Bacteriemia transitoria post Proctosigmoidoscopía. / Transient Bacteriemia post Proctosigmoidoscopy.

En el presente trabajo se han estudiado 40 personas concurrentes al servicio de Gastroenterología del Hospital Hipólito Unanue. Se tomaron una muestra basal de sangre y muestras sucesivas al minuto, cinco, diez y quince minutos después de realizada la Proctosigmidoscopía, con jeringa y aguja descartable para cada muestra. El análisis de los hemocultivos demuestra que en todos los casos el hemocultivo basal, fue negativo, de los hemocultivos posteriores a la endoscopía, 5 casos correspondieron a Estafilococo Aureus, coagulasa negativo; un caso de Neisseria y un caso de Difteroide. De los 7 hemocultivos positivos, dos lo fueron en la segunda muestra, dos casos en la tercera y los tres restantes en la cuarta muestra. No hubo positividad en la quinta muestra. La positividad de los hemocultivos nos lleva a concluir que se presenta bacteriemia como posible complicación del exámen proctosigmoidoscópico, pero con la característica especial de ser transitoria, de corta duración, ya que se presenta sólo en los primeros minutos de realizado el examen, encontrándose la sangre, libre de bacterias, quince minutos después de la endoscopía.