Invaginación intestinal en el adulto secundaria a pólipo mesenquimatoso. Presentación de un caso / Intestinal invagination in adults secondary to mesenchymal polyp. Case presentation

RESUMEN Fundamento: La invaginación intestinal como causa de dolor abdominal es un motivo infrecuente de consulta en la edad adulta. Una lesión orgánica es la causante en el 90 % de los casos. Pueden ser lesiones malignas o benignas, y entre estas últimas se mencionan los lipomas de intestino delgado. Objetivo: Presentar el caso de una paciente con invaginación intestinal secundaria a pólipo mesenquimatoso. Presentación del caso: Paciente femenina de 47 años de edad, con antecedentes de dolor abdominal recurrente hacia fosa ilíaca derecha y cambios intermitentes en el hábito intestinal. En los estudios de imagen realizados se le diagnosticó una invaginación de intestino delgado, la cual se corroboró en el acto quirúrgico y mediante anatomía patológica que informó un pólipo mesenquimatoso (fibrolipoma) como causante. Conclusiones: La invaginación intestinal, aunque infrecuente, puede ser la forma de presentación de dolor abdominal recurrente en el adulto.

ABSTRACT Background: Intestinal invagination as a cause of abdominal pain is an infrequent reason for consultation in adulthood. An organic injury is the cause in 90 % of cases. They can be malignant or benign lesions, and among the latter, lipomas of the small intestine are mentioned. Objective: To present the case of a patient with intestinal invagination secondary to a mesenchymal polyp. Case presentation: A 47-year-old female patient with a history of recurrent abdominal pain towards the right iliac fossa and intermittent changes in bowel habit. In the imaging studies, an invagination of the small intestine was diagnosed which was corroborated in the surgical act and by pathological anatomy that reported a mesenchymal polyp (fibrolipoma) as the cause. Conclusion: Intestinal invagination, although infrequent, may be the form of presentation of recurrent abdominal pain in adults.

Malrotación intestinal en el adulto diagnosticado posterior a presentación del síndrome pospolipectomía en ciego: reporte de un caso / Intestinal malrotation in adults diagnosed after presentation of post polypectomy syndrome in the cecum: report of a case

RESUMEN La malrotación intestinal es una anomalía congénita de la rotación y fijación intestinal, diagnosticada de forma infrecuente en la edad adulta. Se presenta un caso de malrotación intestinal en un paciente adulto previamente asintomático con cambios en el hábito intestinal en los últimos 6 meses al que se le realiza una colonoscopia ambulatoria con la evidencia de un pólipo en el ciego, posterior a su resección presenta dolor abdominal agudo en fosa ilíaca izquierda que permite la realización de estudios imagenológicos que confirman el diagnóstico.

ABSTRACT Intestinal malrotation is a congenital anomaly of intestinal rotation and fixation, diagnosed infrequently in adulthood. We report the presence of intestinal malrotation in a previously asymptomatic adult patient with changes in bowel habit in the last 6 months after a colonoscopy is performed with evidence of a polyp in the cecum, after resection presenting acute abdominal pain in the left iliac fossa that allows imaging to confirm the diagnostic.

TAMIS: ¿Un nuevo estándar para el tratamiento de los pólipos de recto? Revisión de la bibliografía y reporte de nuestra experiencia / TAMIS: A new standard for the treatment of rectal polyps? Literature review and report our experience

La morbilidad y alteración de la calidad de vida asociadas a la resección anterior del recto y amputación abdominoperineal determinaron un gran interés en el desarrollo del abordaje transanal. En los últimos años se ha visto un marcado desarrollo tecnológico en los dispositivos disponible para este abordaje. La cirugía por vía transanal ofrece ventajas en cuanto a sus resultados y complicaciones cuando se la compara a la cirugía por vía abdominal. La cirugía transanal mini-invasiva surge como una alternativa de abordaje videoendoscópico del recto. La resección local por cirugía endoscópica para los pólipos grandes de recto se ha convertido en un nuevo estándar de tratamiento en la mayoría de los centros, obteniendo piezas no fragmentadas con una alta tasa de márgenes negativos. En el presente estudio realizamos una revisión sobre la aplicación de TAMIS (TransAnal Minimally Invasive Surgery) al tratamiento de los pólipos de recto. (AU)

A great interest has developed in implementing trans anal minimally invasive surgery for the treatment of rectal adenomas and early rectal tumors. It present advantages when compare to radical surgery and peace meal endoscopic resections. TAMIS delivers non-fragmented specimens with clear resection margin in the majority of the cases. Such good technical results are mirrored with a low recurrence rate when evaluating rectal adenomas. This is a review of the application of TAMIS for the treatment of rectal adenomas. (AU)

Eficacia y seguridad de la resección endoscópica en pacientes con pólipos colorrectales no pediculados grandes / Efficacy and safety of endoscopic resection in patients with large non-pedunculated colorectal polyps

Introducción: Los pacientes con pólipos colorrectales no pediculados grandes (PCNP-G) han sido tradicionalmente tratados quirúrgicamente. Los avances en la endoscopía terapéutica permiten que la resección endoscópica de estas lesiones pueda ser considerada como una alternativa a la cirugía. Objetivo: Evaluar la eficacia y seguridad de la resección endoscópica en pacientes con PCNP-G. Materiales y métodos: Cohorte prospectiva multicéntrica. Se incluyeron a todos los pacientes referidos para resección endoscópica de PCNP-G entre enero del 2012 y diciembre del 2015, seguidos hasta agosto del 2016. Se obtuvieron las tasas de resecciones exitosas, de recurrencia y de complicaciones. Se analizaron los factores predictivos asociados a resección no exitosa y a recurrencia. Resultados: Se incluyeron 107 pacientes con 115 PCNP-G. La tasa de resección exitosa fue de 92%. Las complicaciones más comunes fueron el sangrado (8,7%) y la perforación (2,6%). La tasa de recurrencia fue de 7%, todas tratadas endoscópicamente con éxito. Los factores predictivos de resección no exitosa fueron una medida >50 mm de la lesión resecada y la presencia de fibrosis; y el único factor predictivo de recurrencia fue una medida >50 mm del pólipo resecado. Conclusiones: La resección endoscópica de los PCNP-G es altamente eficaz y segura

Introduction: Patients with large non-pedunculated colorectal polyps (L-NPCP) have been traditionally treated with surgery. Advances in therapeutic endoscopy allow endoscopic resection of these lesions and can be considered as an alternative to surgery. Objective: To evaluate the efficacy and safety of endoscopic resection in patients with L-NPCP. Methods: A prospective multicentric cohort. All patients referred for endoscopic resection with L-NPCP between January 2012 and December 2015, followed until August 2016, were included. Rates of successful resection, recurrence and complications were obtained. Predictive factors associated with unsuccessful resection and recurrence were analyzed. Results: 115 L-NPCP in 107 patients were included. The rate of successful resection was 92%. The most common complications were bleeding (8.7%) and perforation (2.6%). The recurrence rate was 7%, all successfully treated with a new endoscopic session. Predictors of unsuccessful resection were a measure >50 mm of the lesion and the presence of fibrosis; and the only predictor of recurrence was a size of the polyp resected >50 mm. Conclusions: Endoscopic resection of L-NPCP is very efficacious and safe

Pancreatitis aguda debido a intususcepción gastroduodenal / Acute pancreatitis due to gastroduodenal intussusception

Introducción: Los pólipos gástricos adenomatosos son poco frecuentes y generalmente se encuentran en el examen endoscópico de rutina. La intususcepción gastroduodenal es una complicación poco frecuente de los pólipos gástricos y ha sido raramente descrita como una causa de pancreatitis aguda. Caso clínico: Presentamos el caso de un varón de 68 años el cual ingresa de urgencia con dolor abdominal, náuseas y vómitos catalogados en un inicio como pancreatitis aguda de etiología biliar; incidentalmente se descubre un pólipo gástrico pediculado intususceptado a duodeno como causa de la pancreatitis aguda. Se realizó tratamiento endoscópico de urgencia y tratamiento definitivo con cirugía abierta.

Introduction: Adenomatous gastric polyps are uncommon and are usually found in the routine endoscopic examination. Gastroduodenal intussusception is a rare complication of those gastric polyps and has rarely been described as a cause of acute pancreatitis. Case report: We present the case of a 68 year old man who admitted to emergency with abdominal pain, nausea and vomiting initially classified as acute biliary pancreatitis etiology; a pedunculated gastric polyp intussuscepted into duodenum as a cause of acute pancreatitis was incidentally discovered, emergency endoscopic treatment and definitive treatment with open surgery was performed.

Epidemiological aspects of endoscopic resections of colorectal polyps in patients at an endoscopy training center in the Santos region, Brasil / Aspectos epidemiológicos de las resecciones endoscópicas de los pólipos colo-rectales en un centro de entrenamiento de endoscopía en la región de Santos, Brasil

Introduction: Colorectal polyps are structures that project from the surface of the mucosal layer of the large intestine. They are classified as neoplastic or non-neoplastic. Early detection of pre-neoplastic lesions is important for preventing colorectal cancer. These can be resected so as to decrease the morbidity and mortality rates. Colonoscopy is the gold-standard procedure for diagnosing and resecting precursor lesions. Objective: To evaluate the epidemiological, endoscopic and histological aspects of endoscopic resection of lesions of the colon and rectum at a training center. Materials and method: A search was conducted in the database of our institution covering the period from January 2011 to July 2014. Cases that underwent endoscopic resection of polyps and/or colorectal lesions were selection. The following variables were defined: general data on the patients (age, gender and indication from the examination) and data on the polypoid lesion (number, histological type and topographic distribution). Results: 678 lesions were identified in 456 examinations. Regarding sex, 242 (53.1%) were female and 214 (46.9%) were male. The mean age was 64.54 years, with extremes of 5 and 94 years. The most frequent locations were the rectum (21%) and sigmoid (20%). Histologically, 34.7% were hyperplastic polyps and 58.9% were adenomatous polyps, of which 74.1% were tubular, 10.6% tubulovillous, 2% villous and 13% indeterminate; and 1.7% were adenocarcinomas. In 65.4% of the cases, the examination showed that only one polyps was present, while 34.6% had two or more lesions. Conclusion: In our clinic, with a mean of 250 examinations/month, the parameters evaluated were compatible with the results reported in the literature.

Introducción: Los pólipos colorrectales son estructuras que se proyectan en la superficie de la capa mucosa del intestino grueso. Son clasificados en neoplásicos y no neoplásicos. La detección precoz de lesiones preneoplásicas es relevante en la prevención del cáncer colorrectal. Pueden ser resecados y reducir los índices de morbimortalidad. La colonoscopia es el patrón de oro para el diagnóstico y resección de lesiones precursoras. Objetivo: Evaluar aspectos epidemiológicos, endoscópicos e histológicos relacionados a las resecciones endoscópicas de lesiones de colon y recto en un centro de entrenamiento. Matariales y métodos: Fue realizada una búsqueda en la base de datos de nuestra institución durante el período de enero de 2011 a julio de 2014. Se seleccionaron aquellos sometidos a las resecciones endoscópicas de pólipos y/o lesiones colorrectales. Las siguientes variables fueron definidas: datos generales de los pacientes (edad género e indicación del examen) y datos de la lesión polipoidea (número, tipo histológico, distribución topográfica). Resultados: Fueron identificadas 678 lesiones en 456 exámenes. Con relación al sexo, 242 (53,1 %) eran del género femenino y 214 (46,9 %) masculino. El promedio de edad fue de 64,54 años, con extremos de 5 y 94 años. La ubicación más frecuente fue en el recto (21 %) y sigmoide (20 %). Histológicamente, 34,7% eran pólipos hiperplásicos y 58,9% adenomatosos, siendo 74,1% tubulares, 10,6% tubulovellosos, 2% vellosos y 13% indeterminados y, 1,7% correspondieron a adenocarcinomas. En el 65,4% de los casos existía solamente un pólipo al hacer el examen, 34,6% presentaban dos o más lesiones. Conclusión: En nuestro trabajo, con un promedio de 250 exámenes/mes, los parámetros evaluados fueron compatibles a los resultados encontrados en la literatura.

TeleCondutas: pólipos colorretais / TeleGuides: colorectal polyps

Pólipos colorretais são pequenas protrusões da mucosa colônica e do reto, sendo a sua grande maioria de potencial maligno baixo (como os adenomas tubulares com displasia de baixo grau) ou nulo (como os pólipos hiperplásicos). Os pólipos que contêm potencial maligno ­ os adenomas ­ são a parte inicial da cascata de carcinogênese de 95% das neoplasias malignas colorretais e podem ser diagnosticados e removidos através da colonoscopia. Esta guia apresenta informação que orienta a conduta para casos de pólipos colorretais no contexto da Atenção Primária à Saúde, incluindo: classificação dos pólipos colorretais, avaliação dos pólipos colorretais, seguimento das lesões pré-malignas, manejo dos pólipos colorretais, colonoscopia - procedimento e cuidados, rastreamento e vigilância de câncer colorretal, encaminhamento para serviço especializado.

Intususcepción intestinal debido a un pólipo fibroide inflamatorio (tumor de vanek) / Intestinal intussusception due to an inflammatory fibroid polyp (vanek tumor)

La intususcepción en un adulto debe hacer sospechar un tumor (benigno o potencialmente riesgoso); el diagnóstico certero es crucial para el tratamiento adecuado del paciente1. Alrededor del 90% de estos casos se dan en el intestino delgado y colon, el 10% restante se originan en el estómago y en estomas creados quirúrgicamente2. En los adultos, aproximadamente 90% de los casos de intususcepción son secundarios a una lesión definible3. El tumor de Vanek o pólipo fibroide inflamatorio, se conoce como una lesión benigna, rara, de localización submucosa, no encapsulada, cuya ubicación puede darse a lo largo del tracto digestivo, siendo más común en el antro gástrico (80 %), aunque también se ha descrito en la unión gastroesofágica, duodeno, yeyuno, íleon y colon4.

Intussusception in an adult must make us suspect the presence of a tumor (benign or potentially dangerous) as the most frequent cause. Accurate diagnosis is of great importance in order to provide appropriate treatment and improve patient prognosis1. About 90% of these cases occur in the small intestine and colon, and the remaining 10% originate in the stomach and surgically created ostomas2. In adults, approximately 90% of cases of intussusception are secondary to a definable lesión3. The Vanek's tumor or inflammatory fibroid polyp (IFP) is a rare benign lesion of submucosal location, not encapsulated, that may be located throughout the digestive tract, being more common in the gastric antrum (80%), although it has also been described in the gastroesophageal junction, duodenum, jejunum, ileum and colon4.

A retenção da cápsula endoscópica e suas situações de risco: análise em 215 exames consecutivos e revisão das condutas de prevenção e tratamento / The retention of the endoscopic capsule and its risk situations: analysis in 215 consecutive exams and review of the prevention and treatment conduits

Introdução: lesões estenosantes do intestino delgado (ID), e suas neoplasias em especial, são patologias de difícil diagnóstico. A Cápsula Endoscópica (CE) representou notável avanço no reconhecimento das mesmas. Porém a retenção da CE nestas lesões estenosantes representa risco potencial que deve sempre ser evitado. Objetivo: efetuar uma revisão dos aspectos preventivos das situações em que a CE pode vir a ficar retida, das condutas terapêuticas quando a retenção ocorre e, principalmente, analisar, numa sequência de 215 exames com a CE, quais as situações que representaram risco de retenção e quais aquelas em que realmente houve a retenção. Casuística: 215 exames endoscópicos consecutivos do delgado com a cápsula foram objetos de análise. Material e Métodos: endoscopia digestiva alta (EDA) e colonoscopia (CO) foram os exames que todos os 215 pacientes efetuaram antes de se submeterem ao exame da CE. Diversas foram as indicações dos exames com a CE, mas 85% deles foram indicados por hemorragia digestiva de causa obscura (sangramento digestivo com EDA e CO negativas) ou anemia de causa a investigar. Nenhum paciente apresentava queixas ou sinais de suboclusão antes de efetuar o exame. A CE utilizada em todos os pacientes foi da marca GIVEN (Yokenan, Israel), modelos M2A e PillCam SB. Foi considerada retida a CE que, após três semanas da realização do exame, não havia sido eliminada, e exame radiológico comprovava sua presença no intestino delgado. Resultados: 141 lesões foram identificadas nestes 215 exames com a CE, sendo 112 delas no intestino delgado e 29 fora do delgado. Em 26,6% (37 casos) dos 112 casos com lesões no delgado, havia alterações que promoviam algum grau de estreitamento da luz do delgado, a saber: 10 casos de neoplasia maligna (3 linfomas, 2 adenocarcinomas, 2 casos de metástases de melanoma, 2 casos de tumor carcinoide e 1 tumor estromal ­ GIST), 8 casos de Doença de Crohn, 4 casos de úlcera/estenose por uso de AINES, 1 caso de enterite actínica e 14 casos de pólipos do delgado de diâmetro suficiente para promover algum grau de estreitamento luminar. Nestes 38 casos, em 5 deles (13,4%) a CE ficou retida: 2 casos de Doença de Crohn, 2 casos de estenose e úlcera por uso de AINES e 1 caso de enterite actínica. Conclusões: estreitamento do lúmen do intestino delgado pode ter diversas causas, algumas reversíveis outras não, algumas progressivas, outras estáveis, e muitas delas, dependendo de sua causa e de seu grau, podem promover a retenção da CE. As causas de retenção observadas nesta casuística vão ao encontro com as principais causas de retenção apresentadas na literatura e destaca-se o fato de que, dos 10 casos de neoplasia, em nenhum deles a CE ficou retida.

Introduction: stenosing Injury of small intestine (ID), and their tumors in particular, are difficult to diagnose diseases. Endoscopic capsule (EC) represented notable advance in the recognition of same. However the EC in these stenosing lesions represents a potential risk that should always be avoided. Objective: to carry out a review of the preventive aspects of the situations where the EC could be retained, the therapeutical when retention occurs, and, mainly, to analyze, in a sequence of 215 cases with the EC, which the situations that represented retention risk and what those in which really happened to retention. Series: endoscopic examinations of 215 consecutive exams with the capsule were objects of analysis. Material and methods: upper gastrointestinal Endoscopy (UGE) and colonoscopy (CO) were the tests that all 215 patients effected before undergoing the examination. Several were the indications of the exam with the EC, but 85% of them were nominated by obscure cause gastrointestinal bleeding (digestive bleeding with UGE and CO negative) or to investigate cause anemia. No patient presented complaints or sub-oclusion signs before the exam. The EC used in all patients was of the mark GIVEN (Yokenan, Israel), M2A models and PillCam SB .Was considered retained the EC that, after three weeks of the completion of the examination, had not been eliminated, and radiological examination proved their presence in the small intestine. Results: 141 lesions were identified in these exams with 215 EC, 112 of them in the small intestine and 29 out of small intestine. In 26.6% (37 cases) of 112 cases with injuries in small intestine, there were changes that were promoting some degree of narrowing of the light of small intestine, namely: 10 cases of malignant neoplasm (3 adenocarcinomas , 2 lymphomas, 2 cases of metastasis of melanoma, 2 cases of carcinoid tumor and 1 stromal tumor-GIST), 8 cases of Crohn's disease, 4 cases of ulcer/stenosis by use of NSAIDS, 1 case of Actinic enteritis and 14 cases of polyps of small intestine of a suitable diameter to promote some degree of narrowing luminary. In these 38 cases, in 5 of them (13.4%) the EC was retained: 2 cases of Crohn's disease, 2 cases of stenosis and ulcers by use of NSAIDS and 1 case of Actinic enteritis. Conclusions: Narrowing of the lumen of the small intestine can have several causes, some not, some other reversible progressive other stable, and many of them, depending on their cause and their degree, can promote EC retention. The causes of observed retention in this series meet with the main causes of retention presented in the literature and highlights the fact that the 10 cases of neoplasia, in none of them the EC was retained.

Inflammatory cloacogenic polyp: a rare kind of benign polyp to be cured with endoscopic and/or surgical removal / Pólipo cloacogênico inflamatório: um raro tipo de pólipo benigno a ser curado por remoção endoscópica e/ou cirúrgica

Abstract Background Inflammatory cloacogenic polyp is a very rare kind of benign polyp which occurs in the anal transitional zone and lower rectum. These polyps arise in association with various conditions (e.g., internal hemorrhoids, diverticulosis, colorectal tumors, and Crohn's disease) in which mucosal injury is the underlying pathogenic mechanism. Case report A 24-year-old male patient applied to emergency department with bloody defecation for a month. A polyp that is 1.5 cm in size had been observed at rectum and anal verge junction during colonoscopy, pathological diagnosis was inflammatory cloacogenic polyp. Thereupon, colonoscopic polypectomy was performed as the malignant transformation possibility. Conclusion Polyps of the anorectal junction with inflammatory appearance might be inflammatory cloacogenic polyps with malignant transformation potential that must be treated by endoscopic removal or surgery and followed up routinely with colonoscopic surveillance.

Resumo Experiência Pólipos cloacogênicos inflamatórios constituem um tipo muito raro de pólipo benigno, com ocorrência na zona de transição anal e reto baixo. Esses pólipos surgem em associação com diversos distúrbios (p. ex., hemorroidas internas, diverticulose, tumores colorretais, e doença de Crohn) nos quais a lesão à mucosa é o mecanismo patogênico subjacente. Relato de caso Paciente, gênero masculino, 24 anos, compareceu ao serviço de emergência com defecação sanguinolenta com duração de um mês. Durante a colonoscopia, foi observado um pólipo medindo 1,5 cm de diâmetro no reto e na junção da borda anal; foi estabelecido um diagnóstico patológico de pólipo cloacogênico inflamatório. Subsequentemente, foi realizada polipectomia colonoscópica, diante do potencial de transformação maligna. Conclusão Pólipos da junção anorretal com aspecto inflamatório podem ser pólipos cloacogênicos inflamatórios com potencial para transformação maligna, devendo ser tratados por remoção endoscópica ou cirúrgica e monitorados periodicamente com vigilância colonoscópica.

Is there a link between upper gastrointestinal polyps and colonic polyps? A retrospective study from a Turkish cohort / Existe conexão entre pólipos gastrointestinais proximais e pólipos colônicos? Estudo retrospectivo de uma coorte turca

OBJECTIVE: To investigate the incidence and associated demographical and clinical factors related to lower GI polyps and neoplasms in patients with upper GI polyps and neoplasms. METHODS: We investigated 99 patients who had upper GI polyps and neoplasms and who were screened with colonoscopy: the following data were collected: demographical and clinical data consisting of age, sex, smoking status, presence of H. pylori infection, placement of upper GI polyps or neoplasms, presence of gastric atrophy, usage of proton pump inhibitors (PPI), presence of lower GI polyp or neoplasm, type of colon polyp, pathological grade of colon polyp. The patients were grouped according to having/not having lower GI polyps and neoplasms; data was compared between groups. RESULTS: Smoking rate was significantly higher in patients with lower GI polyps and neoplasms (χ2: 4.35, p: 0.03). Furthermore, there was a signifant association between presence of lower GI polyps and neoplasms vs. smoking (OR: 2.44 CI: 1.01-5.84, p: 0.04). CONCLUSIONS: Patients with upper GI polyps and neoplasms who are smokers should be considered as candidates for having lower GI polyps and neoplasms and should be screened and followed more carefully. Additionally, we believe that large sampled and prospective studies are needed to higligt the association between upper GI polyps and presence of lower GI polyps and neoplasms.

OBJETIVO: investigar a incidência, demografia associada e fatores clínicos relativos a pólipos e neoplasias gastrointestinais distais em pacientes com pólipos e neoplasias do trato gastrointestinal superior. MÉTODOS: Foram investigados 99 pacientes que apresentaram pólipos ou neoplasias gastrointestinais superiores selecionados através de colonoscopia: os seguintes dados foram coletados: dados demográficos e clínicos consistentes em idade, sexo, tabagismo, presença de infecção por H. pylori, a presença de pólipos ou neoplasias gastrointestinais proximais, presença de atrofia gástrica, uso de inibidores da bomba de prótons (IBP), presença de pólipo ou neoplasia gastrointestinal distal, tipo de pólipo de cólon, grau patológico de pólipo de cólon. Os pacientes foram agrupados de acordo com ter/não ter pólipos ou neoplasias distais; os dados foram comparados entre os grupos. RESULTADOS: A taxa de tabagismo foi significativamente maior nos pacientes com pólipos e neoplasias distais (χ2: 4.35, p: 0,03). Além disso houve uma associação significante entre a presença de pólipos e neoplasias distais e tabagismo (OR: 2,44 CI: 1,01-5,84, p: 0,04). CONCLUSÕES: Os pacientes fumantes com pólipos e neoplasias do trato gastrointestinal superior devem ser considerados candidatos a pólipos e neoplasias distais e devem ser rastreados e seguidos com mais cuidado. Adicionalmente, grandes amostras e estudos prospectivos são necessários para esclarecer a associação entre pólipos gastrointestinais superiores e a presença de pólipos e neoplasias gastrointestinais distais.

Síndrome de Peutz- Jeghers. Presentación de cinco casos / Peutz Jeghers syndrome. Report of five cases

El Síndrome de Peutz Jeghers (SPJ) es caracterizado por pólipos hamartomatosos gastrointestinales y pigmentación mucocutánea característica, tiene alto riesgo de resecciones intestinales debido a isquemia secundaria e intususcepción. El riesgo de cáncer digestivo es nueve veces más que en la población general. Reportamos cinco pacientes con diagnóstico de SPJ, tres casos presentaron intususcepción intestinal, un caso hemorragia digestiva alta y el quinto caso falleció con neoplasia pancreática...

The Peutz Jeghers Syndrome (PJS) is characterized by gastrointestinal hamartomatous polyps and mucocutaneous pigmentation, are at high risk of bowel resections because ischemia secondary to intussusception. The risk of gastrointestinal cancer is nine more than the general population. We report five patients diagnosed with SPG, four had intestinal intussusception, one upper gastrointestinal bleeding and one died with pancreatic neoplasia...

Pólipo fibroide inflamatorio gástrico: presentación de un caso clínico patológico y revisión de la literatura / Inflammatory fibroid polyp of the gastrointestinal tract: clinical case and review of the literature

A case report of a 67 year old female presenting upper gastrointestinal symptoms characterized by epigastric pain and nausea. Her endoscopic examination reveals the presence of a polypoid submucosal lesion measuring 5 mm in diameter. Biopsies were reported as inflammatory fibroid polyp. Clinical pathological aspects, immunohistochemical findings, differential diagnosis and described new genetic alterations associated with this lesion are discussed.

Se presenta caso de paciente mujer de 67 años con sintomatología digestiva alta caracterizada por epigastralgia y náuseas. Su examen endoscópico muestra la presencia de lesión solevantada submucosa de 5 mm de diámetro. Las biopsias revelan la presencia de pólipo fibroide inflamatorio. Se discuten los aspectos clínico-patológicos, inmunohistoquímicos, diagnóstico diferencial y nuevas alteraciones genéticas descritas, asociadas a esta lesión.

Intususcepción íleo-ileal secundaria a un pólipo fibrinoide inflamatorio / Ileoileal intussusception secondary to inflammatory fibrinoid polyp

Introducción. El pólipo fibrinoide inflamatorio es una lesión inflamatoria no neoplásica que se presenta especialmente en el estómago, aunque puede ocurrir en cualquier parte del tubo digestivo, en donde puede ocasionar episodios de intususcepción y obstrucción intestinal. Presentación del caso. Se presenta el caso de una mujer de 49 años de edad, con un cuadro clínico de una semana de evolución consistente en episodios intermitentes de dolor abdominal, distensión abdominal y emesis. Ingresó a urgencias de la Clínica CES de Medellín, donde se le practicó una tomografía de abdomen que mostró una invaginación intestinal en el íleon, por lo que se programó para una laparotomía exploratoria. Se encontró una intususcepción secundaria a una lesión polipoide que ocupaba la luz del íleon, se resecó el segmento comprometido y se hizo una anastomosis látero-lateral, sin complicaciones. El estudio anatomo-patológico y la inmunohistoquímica confirmaron el diagnóstico de pólipo fibrinoide inflamatorio. Conclusión. El pólipo fibrinoide inflamatorio es una entidad poco frecuente, benigna, que al presentarse en el íleon puede causar intususcepción y obstrucción intestinal. Los estudios imaginológicos proporcionan hallazgos indirectos. Sin embargo, su diagnóstico definitivo se logra con los estudios anatomo-patológico y de inmunohistoquímica después la resección quirúrgica completa, la cual es curativa en la inmensa mayoría de los casos.Palabras clave: enfermedades intestinales; pólipos intestinales; neoplasias intestinales; obstrucción intestinal.

Introduction: Inflammatory fibrinoid polyp is a non-neoplastic inflammatory lesion, which occurs especially at gastric level, but may also occur anywhere in the gastrointestinal tract, where it can cause episodes of intussusceptions and intestinal obstruction. Case report: We report the case of a 49 year old woman with clinical presentation of one week of evolution consisting in episodes of intermittent abdominal pain, abdominal distension and emesis. She presented at the emergency department of Clinica CES (Medellín, Colombia), where a CT scan of the abdomen reported ileal intussusception. At exploratory laparotomy an intussusception secondary to a polypoid lesion that occupied the ileal lumen was found, and resection of the involved segment and anastomosis were performed without complications. Pathology and immunohistochemistry study confirmed the diagnosis of Inflammatory fibrinoid polyp. Conclusion: The inflammatory fibrinoid polyp is a rare, benign entity that when located in the ileum may cause intussusception and intestinal obstruction. Imagening studies exhibit indirect findings. However, definitive diagnosis is made with pathology and immunohistochemistry studies followimg complete surgical resection, which is curative in the majority of cases.

Influence of patient age and colorectal polyp size on histopathology findings / Influência da idade do paciente e do tamanho dos pólipos colorretais nos achados histopatológicos

BACKGROUND: Colorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening. AIM: To assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size. METHODS: Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older. RESULTS: A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia. CONCLUSION: Polyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon. .

RACIONAL: O câncer colorretal é causa importante de morbimortalidade e pode desenvolver-se pela sequência adenoma-carcinoma. A videocolonoscopia é considerada método de escolha para rastreamento populacional para esta neoplasia. OBJETIVO: Avaliar as características de pólipos endoscopicamente ressecados em uma série consecutiva de pacientes submetidos à videocolonoscopia em um hospital universitário e comparar os achados histopatológicos de acordo com a idade do paciente e o tamanho dos pólipos. MÉTODO: Estudo retrospectivo transversal baseado na análise dos laudos de 1950 videocolonoscopias realizadas consecutivamente. Foram selecionados aqueles em que foram evidenciados pólipos no cólon ou reto. Procedeu-se a revisão dos prontuários para coleta de dados demográficos e da avaliação histopatológica dos espécimes. Foram comparados os achados relativos aos pólipos de até 0,5 cm com os acima de 0,6 cm. Posteriormente, foram comparados pólipos de até 1 cm com os acima de 1,1 cm. Em um terceiro momento foram realizadas comparações dos achados dos pólipos ressecados de pacientes com idade até 49 anos com aqueles retirados de pacientes acima de 50 anos. RESULTADOS: Foram ressecados pólipos colorretais em 224 dos 1950 exames avaliados (11,5%), com retirada total de 272 pólipos. Pólipos maiores de 1 cm tenderam a ser pediculados (p=0,000) e tiveram maior chance de apresentarem componente adenomatoso (p=0,001), componente viloso (p=0,000) e displasia (p=0,003). Os mesmos achados foram observados com ponto de corte de 0,5 cm. Pacientes com 50 anos ou mais apresentaram mais frequentemente pólipos sésseis (p=0,023) e localizados no cólon proximal (p=0,009). Não houve diferença significante entre os grupos em relação à histopatologia ...

Intususcepción intestinal por pólipo fibroide inflamatorio en una anciana / Small bowel intussusception and Vanek's tumor in an elderly woman

El pólipo fibroide inflamatorio es un tumor benigno poco frecuente del tubo digestivo, descripto por Vanek en 1949. Son lesiones de etiología desconocida, originadas en la submucosa. Están formadas por células mononucleares y mesenquimatosas con citoplasma fusocelular, con una importante proporción de eosinófilos. Sus síntomas son variables, dependiendo de su localización, y son una r ara causa de intususcepción intestinal en adultos. Presentamos el caso de una mujer de 82 años, que sufrió una rara intususcepción de intestino delgado, originada en un pólipo fibroide inflamatorio.

Inflammatory fibroid polyps are non-frequent benign lesions, described by Vanek in 1949, originated in the sub mucosa of the gastrointestinal tract. They have an uncertain origin and they are formed of fibroblastic and mesenchymal proliferations with an important eosinophilic proportion. Depending on where are they localized, could present different type of symptoms. The inflammatory fibroid polyps are one of the rare benign conditions causing intestinal intussusception in adults.We present the case of a 82 years old woman, who presented an intestinal intussusception due to an inflammatory fibroid polyp localized in the small bowel.

Giant ileal inflammatory fibroid polyp: a rare cause of intestinal intussusception

Ileal inflammatory fibroid polyp is a rare non-neoplastic lesion of the gastrointestinal tract. Intussusception caused by an inflammatory fibroid polyps is uncommon. The authors report a case of a 75 year-old female patient presenting with ileal obstruction due to intussusception of a polypoid lesion. The patient underwent surgical treatment and histopathology confirmed the diagnosis. (AU)

Os pólipos fibroides inflamatórios são raras lesões não neoplásicas do trato gastrointestinal e a intussuscepção devido a essa entidade é incomum. Os autores relatam um caso de paciente do sexo feminino, 75 anos, que apresentou obstrução ileal devido a uma intussuscepção por lesão polipoide. A paciente foi submetida a tratamento cirúrgico, sendo diagnosticado pólipo fibroide inflamatório do íleo. (AU)