Coloproctology

Introduction: Faecal incontinence (IF), with no consensual values of prevalence and varied clinical symptomatology, has a negative impact on quality of life of patients. The evaluation of quality of life (QoL) and the measurement of the effectiveness of treatments represent an asset in understanding this nosological entity. In this article, we intend to present a brief bibliographical review of specific measurement instruments of QoL for patients with IF. Methods: After a bibliographical research, three scales were selected. Whey were the Fecal Incontinence Quality of Life Scale (FIQL), the Manchester Health Questionnaire (MHQ) and the New Score for Fecal Incontinence (NSFI). For each one of them we performed an analysis with respect to socio-demographic data of the samples where they have been developed and initially tested and psychometric quality primary criteria. Results: There were five articles selected for review. Studied populations are predominantly female (74% to 100%), with ages varying between 49 and 61 years. The reliability of scales, was demonstrated with regard to high internal consistency (Cronbach’s alpha, α > 0.7) and reproducibility (not tested in NSFI), as well as the convergent validity, evidenced by a significantly positive correlation. Discussion and Conclusion: Reliable and valid scales, submitted to suitable translation and cultural validation have become a relevant and important additional tool in evaluating results of Qol of patients with FI. All questionnaires showed high psychometric criteria, but the NSFI, by its simplicity, can more easily be recommended in daily clinical practice.

Rectal prolapse represents full thickness protrusion of the rectum through the anal sphincter. Rarely, the prolapsed portion of the rectum can become neoplastic. The exact incidence of rectal prolapse although unknown, it is a rather rare entity. We hereby report a case of a rectal prolapse with neoplastic change. The present study report the case of a 58-year-old woman, without previous major diseases, diagnosed with a rectal prolapse. Eight months later she attended with evident prolapse towards the posterior quadrant of the anal margin with a polypoid lesion of approximately 5 cm × 5 cm. An altemeier's rectosigmoidectomy is executed. The histopathologic study reports a tubulovillous adenoma with high grade dysplasia.

Introducción El síndrome de descenso perineal, es un raro desorden en el cual, el diafragma pélvico y el músculo elevador del ano se disponen de tal forma que ocasionan una verticalización del eje anorrectal. Para el entendimiento de este hecho es importante comenzar con una revisión del conocimiento anatómico del diafragma pélvico así como del mecanismo de continencia rectal. El diafragma pélvico está constituido por el músculo elevador del ano, el cual esta compuesto por tres cuerpos musculares que a saber son: Puborrectal: extendiéndose desde la porción inferior de la sínfisis del pubis, en un trayecto anteroposterior descendente a ambos lados de la vagina y del recto se fusiona en la línea media posterior al recto inferior y porción superior del canal anal, brindando así gran soporte a la unión anorrectal al disponerse en forma de lazo en sus porciones posterolaterales. Pubococcigeo: se origina a 1,5 centímetros por fuera de la sínfisis del pubis, en un trayecto anteroposterior descendente, rodea los aspectos laterales de la uretra, vagina y recto, fusionándose en la línea media posterior, continuándose hasta su inserción final en el coxis. Esta fusión forma la placa elevadora sobre la cual descansa la vagina y el recto. Determinándose así un eje horizontal de soporte de la porción inferior de la vagina y el recto, como se muestra en las figuras siguientes. Ileococcigeo: se origina de las fascia del músculo obturador interno para luego insertarse en la porción inferior del sacro y coxis. La continencia rectal viene dada por la contracción del músculo elevador, el cual hala hacia arriba al hiato genital creando un ángulo de inclinación rectal que funciona como válvula. Ocurriendo así un reflejo recíproco y sinérgico en el esfínter externo impidiendo la defecación, a través del control neurológico a cargo del nervio pudendo proveniente de los segmentos S3 y S4 del plexo sacro.

Patients with hematologic malignancies are susceptible to serious complications due to immunosuppression. Neutropenic-related infection is one of the major causes of morbidity and mortality in this group of diseases. Febrile neutropenia is a common complication of the hematologic neoplasm itself or chemotherapy, and has worse prognosis if prolonged (lasting more than 7 days) or severe (neutrophil count below 500 cells per μL). Among the usual sites of infection, we highlight the neutropenic enterocolitis and perianal infection as gastrointestinal complications of greater interest to the colorectal surgeon. Although most cases respond to conservative treatment, a portion of patients will need surgery for complete recovery.

Objetivo: Confirmar la congruencia entre los diagnósticos Clínico e Imagenológico a través de la
Ecodefecografía en pacientes con Síndrome de Defecación Obstruida (SDO). Métodos:
Investigación de nivel descriptivo, cuantitativa, no experimental. La observación fue retrospectiva
de carácter transversal. Se incluyeron pacientes de la Unidad de Coloproctología del I. A.
Hospital Universitario de Caracas, con diagnóstico de SDO. Se utilizó el Programa Estadístico
SPSS (Statistical Package for Social Sciences), con el cual se tabularon y calcularon los
estadísticos descriptivos y relaciones estadísticas entre los elementos observados. Se incluyeron
cuarenta y un pacientes (41), de sexo femenino, con diagnóstico de SDO y con el estudio de
Ecodefecografía 3D. Resultados: En la esfera del SDO de los pacientes incluidos en el estudio,
la patología de mayor frecuencia fue el Anorrectocele, seguido por la Intususcepción Rectoanal y
el Prolapso Mucoso, tanto por examen físico como por Ecodefecografia 3D. Coinciden 29 casos
en el diagnóstico de Anorrectocele, sin diferenciar el grado y 2 en la de Intususcepción
Rectoanal. El diagnóstico al Examen Físico en nuestra serie fue congruente en un 99% con los
hallazgos en la Ecodefecografía. Conclusión: Se comprobó una correlación positiva
estadísticamente significativa entre el diagnóstico clínico y Ecodefecográfico en el Anorrectocele.

Впервые предложена схема стратификации аноректальной дисфункции у пациентов после «низкой»
резекции прямой кишки, которая апробирована у 32 пациентов с формированием «илеоасцендоцекального
неоректум». Показано, что данный способ позволяет достичь хороших функциональных результатов и
высокого качества жизни в ранние сроки после операции. Предложенная схема доказала эффективность
и показала возможность получения объективных и унифицированных данных об аноректальной
дисфункции после низкой резекции прямой кишки.

Background Fistula-in-ano is one of the most common clinical condition encountered in a surgical outpatient department. Many treatment modalities have been described with variable outcomes but gold standard surgical treatment is yet to be agreed upon. The aim of the present study is to evaluate the treatment outcomes of ligature of intersphincteric fistula tract (LIFT) technique in the treatment of simple and complex fistula-in-ano with the primary objective of recurrence rate and broad objective of other postoperative complications during the period of study and after long-term follow-up. Methods It is a retrospective study of prospectively collected data from the patients who have been operated for fistula-in-ano using the LIFT technique at our institute from February 2018 to March 2020 and followed-up until September 2020. Results A total of 56 patients with fistula-in-ano were treated with the LIFT procedure during the study period, of which 20 patients had simple fistula and 36...

Introduction Colorectal cancer is the 4th commonest cancer in the world. Studies had shown different tumor behavior depending on the site, pathology and stage. However the characters of Egyptian colon cancer patients are not well addressed. Method Computerized registry of a tertiary cancer hospital in Egypt was searched for colon cancer cases. Demographic, pathologic and treatment data were collected and analyzed using SPSS program. Results About 360 colon cancer patients attended our center in the last 12 years. Tumor characters showed great diverse from that of developed countries, with especially different prognosis and survival. Conclusion Egyptians have unique tumor characters and behavior, and different compliance with treatment regimens. Multicenter prospective studies, as well as evolving Egyptian treatment guidelines are needed to address this.

Primary epiploic appendagitis (PEA) is a seldom reported disease caused by spontaneous torsion of one or more epiploic appendices. The aim of this study is to describe two cases of PEA reviewing the main aspects of the diagnosis and treatment of disease. Case report: Case 1) Male patient, 55 years old, obese, with abdominal right iliac fossa (RIF) pain for two days. Abdominal examination showed pain on palpation in the RIF with rebound tenderness. Abdominal computed tomography identified lobulated lesion in the cecum, measuring 4.5 cm in diameter, which was suggestive of PEA or early neoplasm of the colon wall. The laparoscopic assessment confirmed the diagnosis of PEA and the appendix was removed. The patient had a satisfactory outcome, being discharged on the second postoperative day. Case 2) Female patient, obese, 47 years old, with abdominal pain for six days, with sudden RIF onset. She had pain at palpation with rebound tenderness. Acute diverticulitis was suspected and patient...

La miasis es el daño causado por las larvas de dípteros ciclorrafos en el hombre o los animales, cuando se alimentan de tejidos vivos o muertos, produciendo la invasión y destrucción tisular. Se describen los siguientes factores de riesgo: las úlceras de exposición y las hemorroides, infecciones bacterianas de las heridas o cavidades naturales, la mala higiene personal, relacionados con tareas de campo de cría de animales, comportamientos asociados con el alcoholismo como la insensibilidad y la costumbre de dormir al aire libre, la ingesta de alimentos contaminados y sin condiciones de higiene adecuadas. Es común en las áreas tropicales de América Central y del Sur. Presentamos caso clínico de miasis en una fluxión hemorroidal cuyo paciente refiere haber dormido al aire libre se extrajeron las larvas y se manejó de forma ambulatoria con tratamiento médico con evolución clínica satisfactoria. Palabras Claves:miasis; larvas; hemorroides Title Myasis in hemorrhoidal fluxion. Report of a case Abstract Myiasis is the damage caused by larvae of dipterous ciclorrafos in man or animals, when they feed on living or dead tissues, causing invasion and tissue destruction. The following risk factors are described: exposure ulcers and hemorrhoids, bacterial infections of natural wounds or cavities, poor personal hygiene, related to animal husbandry tasks, behaviors associated with alcoholism such as insensitivity and custom of sleeping outdoors, intake of contaminated food and without proper hygiene conditions. It is common in the tropical areas of Central and South America. We report a clinical case of myiasis in a hemorrhoidal fluxion the patient reporting having slept in the open air, the larvae were extracted and managed on an outpatient basis with medical treatment with satisfactory clinical evolution Key Word Myasis; larvae; hemorrhoids Miasis en fluxión hemorroidal. A propósito de un caso ++VITAE Academia Biómedica Digital

BACKGROUND: Defecography is the gold standard for assessing functional anorectal disorders but is limited by the need for a specific radiologic environment, exposure of patients to radiation, and inability to show all anatomic structures involved in defecation. Echodefecography is a 3-dimensional dynamic ultrasound technique developed to overcome these limitations.

Проведено проспективное рандомизированное исследование 30 пациентов с хроническим геморроем 3-4-й ста-
дий. Основная группа (n=15) – выполнена геморроидэктомия ультразвуковым скальпелем, контрольная (n=15) –
стандартная геморроидэктомия по Миллигану-Моргану. Применение гармонического скальпеля привело к до-
стоверному снижению продолжительности операции, интраоперационной кровопотери, интенсивности болевого
синдрома в раннем послеоперационном периоде, что улучшило качество жизни оперированных и сократило про-
должительность реабилитационного периода

Objective: This study aims to determine changes in the proportions of types I and III collagen in hemorrhoids and to verify the sliding anal canal lining theory. Patients and method: The study is focused on a sample of 17 patients, 9 females and 8 males (age range: 30–70 years), with grade III and grade IV hemorrhoids. Tissue from 4 fetuses (age: 16 weeks of gestation) was used as control sample. All the participants gave their informed consent. Samples were gathered in 2014. All patients underwent open hemorrhoidectomy by using the technique described by Milligan and Morgan, published in Lancet journal in 1937. The hemorrhoid samples were stained with hematoxylin–eosin for the histologic study to confirm the hemorrhoidal tissue diagnosis. The picrosirius red staining protocol was used after the histologic analysis. The method used for image processing is described in the text. Images were imported to the Image Tool for Windows software. The same process was used on the embryonic tissue. Data resulting from the analysis of images were processed using STATISTICA, a software for statistical analysis. Results: When compared, it was found that the two tissues presented very different values, with hemorrhoids containing the highest type III collagen values. Conclusion: Our results seem to imply that hemorrhoids have a larger proportion of type III collagen than fetal tissue. They also suggest a possible age-related deterioration of the tissue.

Please cite this article in press as: Sardiñas C, et al. Mechanical technology effect in the treatment of anorectocele using transanal repair of rectocele and full rectal mucosectomy with one circular stapler procedure. J Coloproctol (Rio J). 2017. http://dx.