Intestinal intussusception and occlusion caused by small bowel polyps in the Peutz-Jeghers syndrome. Management by combined intraoperative enteroscopy and resection through minimal enterostomy: case report.

UNLABELLED: The Peutz-Jeghers syndrome is a hereditary disease that requires frequent endoscopic and surgical intervention, leading to secondary complications such as short bowel syndrome. CASE REPORT: This paper reports on a 15-year-old male patient with a family history of the disease, who underwent surgery for treatment of an intestinal occlusion due to a small intestine intussusception. DISCUSSION: An intra-operative fiberscopic procedure was included for the detection and treatment of numerous polyps distributed along the small intestine. Enterotomy was performed to treat only the larger polyps, therefore limiting the intestinal resection to smaller segments. The postoperative follow-up was uneventful. CONCLUSION: We point out the importance of conservative treatment for patients with this syndrome, especially those who will undergo repeated surgical interventions because of clinical manifestation while they are still young.

[Villous and tubulovillous adenomas of the colon and rectum. Results in 30 patients]. / Adenomas vilosos e túbulo-vilosos do cólon e reto. Resultados observados em 30 casos.

UNLABELLED: Colorectal adenomas precede carcinomas as much as they become larger and present villous histology. Since colonoscopic polypectomy cannot remove all polyps, surgical options include local resection as well as segmental colectomy. Significant morbidity and high recurrence rates may occur following individual and polyp-related characteristics. This paper focuses the clinical aspects of colorectal tubulo-villous adenomas and the results of the surgical treatment. PATIENTS AND METHODS: Hospital charts from 30 patients who underwent surgical treatment of colorectal tubulovillous adenomas between 1980 and 1997 were retrospectively reviewed. RESULTS: Rectal bleeding, urgency and mucus discharge were the most frequent clinical findings. Proctologic examination (digital and rigid rectosigmoidoscopy) diagnosed the lesion for the majority of cases. Seventy per cent of the polyps were in the distal rectum and 60% were larger than 4 cm. Transanal resection was the surgical option for one half of the patients and segmental colectomy for the other. Fourty-two per cent of the polyps that were considered benign as result of preoperative biopsy showed malignant transformation when the whole polyp was examined. Recurrence rate was 26.7% and 6.7% for patients who underwent local resection and segmental colectomy respectively. Postoperative complication rate was similar for the two surgical groups. CONCLUSIONS: Recurrence may occur frequently after standard local resection. Preoperative biopsy examination has no role for the diagnosis of malignant transformation. Office proctologic examination diagnoses majority of colorectal polyps that may be elected for surgical resection.

[Chronic anal fissure: results of the surgical treatment of 220 patients]. / Fissura anal crônica: resultados do tratamento cirúrgico em 220 doentes.

Since results from non-surgical procedures designed for treatment of chronic anal fissure are still controversial, sphincterotomy remain as the "state of the art" therapy for this condition. In a retrospective basis, the authors intend to review results from treatment of chronic anal fissure in 220 patients who underwent surgical procedure between 1984 and 1995. Data from chart review included age, sex, location of the lesion at the canal anal, associated anorectal disease, delivered surgical technique and complications. Seventy per cent of the patients were male. Mean age was 37.1 years. Fissure was located at the posterior midline in 86.1%. Associated anorectal conditions occurred in 41.4%. Fissurectomy plus posterior sphincterotomy was the treatment of choice in 84.1%. Complications occurred in 5 (2.3%) cases. There were no incontinent patients. Mean follow-up was 2.6 years. The authors conclude that partial internal anal sphincter section produces excellent results in treatment of chronic anal fissure. Posterior sphincterotomy may persist effective and safe since continence impairment was not identified in the present study.