ABSTRACT
Introducción: la incontinencia fecal es más frecuente en mujeres, principalmente por la relación con el trauma obstétrico. Los factores que favorecen estas lesiones obstétricas han sido estudiados ampliamente; la Norma Oficial Mexicana ha cancelado el uso rutinario de la episiotomía media en los partos. Los objetivos de esta investigación fueron determinar la frecuencia de lesiones al esfínter anal e incontinencia fecal en mujeres primíparas sin episiotomía media, así como los factores maternos, obstétricos y del recién nacido que pudieran predisponer a estas lesiones. Material y métodos: se estudiaron primíparas atendidas en el periodo de mayo de 2002 a mayo de 2004, de cualquier edad, sanas, con embarazos a término no complicados. Se realizó interrogatorio de incontinencia, examen clínico y ultrasonido endoanal previos al parto, y se repitió el procedimiento seis semanas después del parto. Se utilizó χ2 para análisis estadístico. Resultados: de 122 pacientes, se eliminaron 62 (22 por cesárea y 40 por no acudir al seguimiento). Se observó incontinencia posparto en 14 pacientes (23 %), menor en 13 (22 %) y mayor en una (1.6 %), lesión a esfínteres en siete (12 %), lesiones ocultas en tres (5 %), incontinencia sin lesión a esfínteres en 10 (71 %) y lesión advertida al canal de parto en 45 (75 %). Conclusiones: hallamos alto índice de lesiones del esfínter anal en primíparas sin episiotomía de rutina, con menor índice de lesiones graves e incontinencia fecal mayor. Hubo probable relación de las lesiones con el tamaño y peso del producto, duración del segundo periodo del parto, lesión advertida y experiencia de quien atiende (no demostrado estadísticamente en este estudio).
BACKGROUND: Fecal incontinence is more frequent among women, mainly because of obstetrical trauma. The factors that induce these lesions have been widely studied. The Mexican Official Medical Regulations cancelled the routine use of episiotomy during vaginal delivery, taking into account many of these studies. We undertook this study to determine the frequency of anal sphincter lesions and fecal incontinence in primiparous women without episiotomy and related these lesions to maternal, obstetrical and newborn factors that could predispose to the origin of these lesions. METHODS: Primiparous women attended between May 2002 and May 2004, of any age, healthy, with uncomplicated term pregnancies were included. Before labor, a clinical examination, incontinence questionnaire and anal ultrasound were performed and the procedure was repeated 6 weeks after labor. Maternal, delivery and newborn factors were evaluated and compared in cases with fecal incontinence or anal sphincter lesions. Chi square test was utilized for categorical variables. RESULTS: We studied a total 122 patients, 62 were excluded (22 required Cesarean section and 40 failed to attend follow-up). Of these, postpartum incontinence was reported in 14 (23%) (minor in 13, 22%) and major in 1, 1.6%), sphincter lesion in 7 (12%), occult lesion in 3 (5%); incontinence without sphincter lesion in 10 (71%), and adverted partum canal lesion in 45 (75%). CONCLUSIONS: We found a high incidence of anal sphincter lesions in primiparous women without routine episiotomy but a reduced incidence of severe lesions and major fecal incontinence. There is a probable relation of lesions with newborn birthweight and height, duration of 2nd partum period, adverted lesion and attending physician (not statistically demonstrated).
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adolescent , Adult , Anal Canal/injuries , Episiotomy , Fecal Incontinence/etiology , Puerperal Disorders/etiology , Birth Weight , Body Height , Body Weight , Anal Canal , Cephalometry , Cervix Uteri/injuries , Obstetric Labor Complications/epidemiology , Fecal Incontinence/epidemiology , Labor Stage, First , Labor Stage, Second , Mexico , Parity , Term Birth , Time Factors , Puerperal Disorders/epidemiologyABSTRACT
BACKGROUND: Fecal incontinence is more frequent among women, mainly because of obstetrical trauma. The factors that induce these lesions have been widely studied. The Mexican Official Medical Regulations cancelled the routine use of episiotomy during vaginal delivery, taking into account many of these studies. We undertook this study to determine the frequency of anal sphincter lesions and fecal incontinence in primiparous women without episiotomy and related these lesions to maternal, obstetrical and newborn factors that could predispose to the origin of these lesions. METHODS: Primiparous women attended between May 2002 and May 2004, of any age, healthy, with uncomplicated term pregnancies were included. Before labor, a clinical examination, incontinence questionnaire and anal ultrasound were performed and the procedure was repeated 6 weeks after labor. Maternal, delivery and newborn factors were evaluated and compared in cases with fecal incontinence or anal sphincter lesions. Chi square test was utilized for categorical variables. RESULTS: We studied a total 122 patients, 62 were excluded (22 required Cesarean section and 40 failed to attend follow-up). Of these, postpartum incontinence was reported in 14 (23%) (minor in 13, 22%) and major in 1, 1.6%), sphincter lesion in 7 (12%), occult lesion in 3 (5%); incontinence without sphincter lesion in 10 (71%), and adverted partum canal lesion in 45 (75%). CONCLUSIONS: We found a high incidence of anal sphincter lesions in primiparous women without routine episiotomy but a reduced incidence of severe lesions and major fecal incontinence. There is a probable relation of lesions with newborn birthweight and height, duration of 2nd partum period, adverted lesion and attending physician (not statistically demonstrated).
Subject(s)
Anal Canal/injuries , Episiotomy , Fecal Incontinence/etiology , Puerperal Disorders/etiology , Adolescent , Adult , Anal Canal/diagnostic imaging , Birth Weight , Body Height , Body Weight , Cephalometry , Cervix Uteri/injuries , Fecal Incontinence/epidemiology , Female , Humans , Infant, Newborn , Labor Stage, First , Labor Stage, Second , Mexico , Obstetric Labor Complications/epidemiology , Parity , Pregnancy , Puerperal Disorders/epidemiology , Term Birth , Time Factors , UltrasonographyABSTRACT
Colon and rectum hemangioma is a rare disease, and even more so when it presents as cavernous subtype; few of these hemangioma have been confirmed by pathology reports. The main presentation of this disease is observed by transrectal painless bleeding; other manifestations are less frequent. Diagnosis implies high index of suspicion and proper diagnostic workup; this entity has been frequently misdiagnosed as other more common entities. We present the case of a 15-year-old female patient with a cavernous hemangioma of the sigmoid colon; her principal complaint was abdominal pain. Diagnosis was suspected due to the finding of phleboliths in plain abdominal film and diagnostic findings in colonoscopy. The patient was treated by means of segmental resection of the colon and experienced a satisfactory postoperatory recovery. According to the literature, these hemangiomas originate from embryologic sequestrations of mesodermal tissue, while clinically they usually present between the ages of 5 and 25 years, most commonly with painless transrectal bleeding and less frequently with intestinal obstruction, tenesmus, urgency, abdominal pain or mass, and anemia. The majority of these hemangiomas are localized in rectosigmoid region of the colon and may infiltrate surrounding tissues; 26-50% show phleboliths in plain abdominal film. Colonoscopy is considered by many authors the best diagnostic tool; angiography, computed tomography (CT) scan and scintigraphy may be also useful. The only effective treatment of this disease is complete surgical resection, for which there have been many proposals regarding best method and approach.
