The role of colonoscopy in young patients with rectal bleeding: a systematic review and meta-analysis.

PURPOSE: Anal bleeding is a frequent complaint in the coloproctological practice. Although usually associated with common anorectal disorders, it may represent a sign of an occult colorectal carcinoma. Our purpose was to evaluate the accuracy of the colonoscopy for detection of neoplastic lesions in patients under 50 years of age with rectal bleeding. METHODS: This systematic review and meta-analysis searched publications in PubMed, Web of Science, and Cochrane Library databases up to August, 2023. Cross-sectional and case-control studies including patients under 50 years with rectal bleeding evaluated by colonoscopy were included. Primary outcome was prevalence of neoplastic lesions (adenomas and adenocarcinomas). Secondary outcomes were prevalence of those lesions according to age and anatomic location. The study was registered on PROSPERO (CRD42021257859) on July 5, 2021. RESULTS: Nine studies comprising 4162 patients were analyzed. A total of 398 patients with adenomas and 40 patients with adenocarcinoma were identified. Prevalence of neoplastic lesions (adenomas and carcinomas) was 10%. In patients under 40 years, the prevalence of neoplastic lesions was 7% (6% of adenomas, 1% of carcinomas). Among patients aged 40-50 years the prevalence was 15%, 14%, and 1%, respectively. Most lesions (71%) were located distally to splenic flexure. CONCLUSION: About 10% of patients under 50 years with anal bleeding will have a neoplastic lesion detected through colonoscopy. The greatest benefit of the procedure is observed between 40 and 50 years. Almost 30% of the neoplastic lesions were found in the proximal colon and could not be detected without the performance of a complete colonoscopy.

Prolapso rectal completo / Complete Rectal Prolapse

Introducción: El prolapso rectal completo es la invaginación de las capas del recto a través del canal anal y su protrusión fuera de este. Su incidencia es de 2,5 por 100 000 habitantes con predominio en mujeres de edad avanzada. Es una afección de curso crónico y benigno, cuya presentación clínica y endoscópica es tan variable que puede confundirse con otras entidades como con el cáncer colorrectal. Objetivo: Presentar el caso de una paciente femenina, operada de prolapso rectal completo en la provincia de Cienfuegos. Presentación de caso: Se presenta una paciente femenina de 76 años de edad, blanca, de procedencia rural que acude a la consulta y refiere que lleva 12 días sin defecar. Además, presenta dolor, sangramiento rectal no activo y una masa que protruía a través de la región anal sugestiva al examen físico de un prolapso rectal completo. El tacto rectal confirma el diagnóstico. Se realiza reducción quirúrgica del prolapso por técnica de Delorme. Actualmente lleva 6 meses de operada con evolución favorable. Por lo poco frecuente de esta entidad se considera de interés científico su publicación. Conclusión: Esta entidad es poco común en el entorno médico, el gran cambio que causa en el nivel de vida de aquellos que la portan y sus complicaciones hace que requiera un tratamiento rápido y oportuno(AU)

Introduction: Complete rectal prolapse is the invagination of the rectal layers through the anal canal and its protrusion out of it. Its incidence is 2.5 per 100,000 inhabitants, predominantly in elderly women. It is a chronic and benign condition, whose clinical and endoscopic presentation is so variable that it can be confused with other entities, such as colorectal cancer. Objective: To present the case of a female patient who underwent surgery for complete rectal prolapse in the province of Cienfuegos. Case presentation: A 76-year-old female patient, white, from a rural area, came to the clinic and reported that she had not defecated for 12 days. In addition, she presents pain, nonactive rectal bleeding and a mass protruding through the anal region suggestive, on physical examination, of a complete rectal prolapse. Digital rectal examination confirmed the diagnosis. Surgical reduction of the prolapse was performed using the Delorme technique. She has undergone surgery for 6 months now, with favorable evolution. Due to the rarity of this entity, its publication is considered as scientifically interesting. Conclusion: This entity is uncommon in the medical environment. The great change that it causes in the living standards of those who carry it and its complications make it require a quick and timely treatment(AU)

Cs-131 prostate brachytherapy boost and effect of hydrogel rectal spacer on long-term patient-reported rectal bleeding and bowel quality of life.

PURPOSE: This study evaluates long-term patient-reported bowel quality of life (QOL), rectal bleeding, and bleeding bother in patients with prostate cancer treated with external beam radiation therapy (EBRT) and Cesium-131 LDR brachytherapy (LDR-BT) boost with and without hydrogel rectal spacer. METHODS AND MATERIALS: This is a retrospective analysis of prostate cancer patients treated between 2007 and 2022 with 45 Gy EBRT followed by 85 Gy Cs-131 LDR-BT boost with or without hydrogel rectal spacer. Expanded Prostate Cancer Index Composite (EPIC) QOL questionnaires pre-treatment and at each follow-up were collected. Patient-reported rectal bleeding occurring more than "rarely" and bother from rectal bleeding occurring more than a "very small problem" were deemed clinically significant. Fisher's exact test was used to test the association of rectal spacer use and the incidence of clinically significant rectal bleeding and bleeding bother. Paired samples t-test was used to analyze mean bowel scores at each time point. RESULTS: Three hundred and forty-one patients were included in the analysis. The rectal spacer was used in 108 patients. Overall median follow-up was 48 months (IQR, 24-72), with a median follow-up of 24 months (IQR, 12-37.5) for the hydrogel group and 60 months (IQR, 36-84) for the non-hydrogel group. EPIC questionnaire response rates at median follow-up were 33% and 37% for the hydrogel and non-hydrogel groups, respectively. A clinically significant decrease in mean bowel domain scores was seen in the bowel bother domain at 6 and 12 months for patients who did not receive a rectal spacer. At the last follow-up of 60 months, the prevalence of clinically significant rectal bleeding and bleeding bother were 2.2% and 2.2%, respectively. The cumulative incidence of clinically significant long-term rectal bleeding was 2.8% and 18.9% in the hydrogel group and non-hydrogel group, respectively (Fisher's exact test, p < 0.0001). The cumulative incidence of clinically significant long-term bowel bother was 4.6% and 19.7% in the hydrogel group and non-hydrogel group, respectively (Fisher's exact test, p < 0.001). CONCLUSIONS: Use of hydrogel rectal spacer with EBRT and Cs-131 LDR-BT boost was significantly associated with a lower incidence of patient-reported rectal bleeding and bother from rectal bleeding, and better long-term bowel QOL. Cumulative incidence was 2.8% (hydrogel group) versus 18.9% (non-hydrogel group) and 4.6% (hydrogel group) versus 19.7% (non-hydrogel group) for clinically significant long-term rectal bleeding and long-term bleeding bother, respectively.

Proctocolite induzida por proteína alimentar - teste de provocação oral deve ser realizado para confirmar o diagnóstico de alergia ao leite de vaca em neonatos? / Induced proctocolitis - oral food challenge should be done to confirm the diagnosis of cow's milk allergy in neonates?

ABSTRACT Background: Suspicion of food protein-induced proctocolitis based on empirical understanding of rectal bleeding can lead to misdiagnosis. Objective: to verify clinical and evaluative characteristics of patients who presented neonatal rectal bleeding and were on a restricted cow's milk diet. Methods: A cross-sectional retrospective study included patients followed up in a tertiary care center, who presented rectal bleeding in the neonatal period. The analyzed data included gender, gestational age, type of delivery, use of antibiotics during the last trimester of pregnancy, use of parenteral nutrition before the first manifestation, use of mechanical ventilation, initial clinical manifestations associated with rectal bleeding, diet before the first manifestation, period of elimination diet, oral food challenge (OFC) results and symptoms presented in cases of positive OFC. Fisher's exact test and Mann-Whitney test were used to analyze the data. The level of significance was set to 5%. Results: Forty-two patients were selected: 30 preterm infants, 34 cesarean deliveries, 10 exclusively breastfed patients before rectal bleeding. Median age at OFC was 6.3 months old. Median of length of the elimination period before OFC was 5.9 months. OFC was negative in 33/42 (79%) patients and positive in 9/42 (21%). There was no association between OFC results and the evaluated data. The main symptom observed in patients with positive OFC was blood in stools. Conclusion: OFC was negative in most cases of suspected cow's milk allergy due to rectal bleeding in neonates, most of them with a history of prematurity.

RESUMO Contexto: A suspeita de proctocolite induzida por proteína alimentar (PCIPA) com base na compreensão empírica de sangramento retal pode levar a diagnósticos equivocados. Objetivo Verificar as características clínicas e evolutivas de pacientes que apresentavam sangramento retal neonatal e faziam uso de dieta restrita com leite de vaca. Métodos: Estudo transversal retrospectivo com pacientes acompanhados em um centro terciário, que apresentaram sangramento retal no período neonatal. Os dados analisados incluíram: sexo, idade gestacional, tipo de parto, uso de antibióticos no último trimestre da gravidez, uso de nutrição parenteral antes da primeira manifestação, uso de ventilação mecânica, manifestações clínicas iniciais associadas ao sangramento retal, dieta antes da primeira manifestação, período de dieta de eliminação, resultados do teste de provocação oral (TPO) e sintomas apresentados em casos de TPO positivo. O teste exato de Fisher e o teste de Mann-Whitney foram usados para analisar os dados. O nível de significância adotado foi de 5%. Resultados: Quarenta e dois pacientes foram selecionados: 30 prematuros, 34 partos cesáreos, 10 pacientes amamentadas exclusivamente antes do sangramento retal. A idade média na ocasião do TPO foi de 6,3 meses. A mediana da duração do período da dieta de eliminação antes do TPO foi de 5,9 meses. O TPO foi negativo em 33/42 (79%) pacientes e positivo em 9/42 (21%). Não houve associação entre os resultados do TPO e os dados avaliados. O principal sintoma observado em pacientes com TPO positivo foi sangue nas fezes. Conclusão: O TPO foi negativo na maioria dos casos de suspeita de alergia ao leite de vaca devido a sangramento retal em neonatos, a maioria deles com história de prematuridade.

Argón plasma: respuesta terapéutica y calidad de vida en pacientes con proctitis actínica crónica hemorrágica / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: La proctitis actínica crónica hemorrágica (PACH) se presenta secundaria a la radioterapia pélvica. La coagulación con argón plasma (APC) es una terapéutica eficaz, segura, de fácil uso y relativo bajo costo. Objetivo: Describir la respuesta terapéutica a corto y largo plazo del APC en pacientes con PACH, así como evaluar la calidad de vida antes y después de la intervención. Material y Métodos: Estudio observacional, prospectivo de serie de casos en 46 pacientes con PACH, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso entre 2017 y 2020. Se emplearon medidas de resumen y comparación de medias (t de Student pareada) para la hemoglobina inicial y final, así como para los puntajes de calidad de vida aplicados antes y después de la intervención. Para determinar el tiempo libre de resangrado se utilizó l Método de Kaplan-Meier. Se estimó una significación menor a 0.05 para un intervalo de confianza de 95 por . Resultados: Se necesitó una media de 3,6 ± 2,394 sesiones de APC. La media de hemoglobina se incrementó 1,9 g/L. La respuesta terapéutica a corto plazo se observó en 100 por ciento de los pacientes y a largo plazo en 91,3 . La media de puntaje para la calidad de vida descendió en 12,065 puntos (p˂ 0,00), La percepción global percibida se incrementó en una media de 7.326 puntos (p˂ 0,00). Conclusiones: El APC tiene buena respuesta terapéutica a corto y largo plazo con pocas sesiones y bajo número de complicaciones, con mejoría de la calidad de vida de los pacientes(AU)

Introduction: Chronic hemorrhagic radiation proctitis (CHRP) appears secondary to pelvic radiotherapy. Argon plasma coagulation (APC) is an effective, safe, easy-to-use, and relatively inexpensive therapy. Objective: To describe the short- and long-term therapeutic response of APC in patients with CHRP, as well as to evaluate the quality of life before and after the intervention. Material and Methods: Observational, prospective case series study of 46 patients with CHRP, treated at the National Center for Minimally Access Surgery between 2017 and 2020. Summary measures and comparison of means (paired Student's t-test) were used for baseline and final hemoglobin, as well as for the quality of life scores applied before and after the intervention. The Kaplan-Meier method was used to determine the recurrence free time. A level of significance less than 0.05 was estimated for a 95 por ciento confidence interval. Results: A mean of 3,6 ± 2,394 APC sessions was required. The mean hemoglobin increased 1,9 g / L. Short-term therapeutic response was observed in 100 % of patients, and long-term in 91,3 por ciento. The mean score for quality of life decreased by 12,065 points (p˂ 0,00). The perceived global perception increased by a mean of 7,326 points (p˂ 0,00). Conclusions: APC has a good therapeutic response in the short and long term with few sessions and a low number of complications, with an improvement in the quality of life of the patients(AU)

Diffuse cavernous hemangioma of the rectum.

Diffuse cavernous hemangioma (DCH) is a rare benign vascular lesion. The rectosigmoid colon is the most common site of this disease. It affects mainly young adults. The most frequent symptom is chronic rectal bleeding which is painless, often begins in the infancy and sometimes is uncontrollable. Endoscopy is the diagnose method of choice and complete surgical excision with sphincter-saving procedure is the primary mode of treatment. A high index of suspicion and a correct diagnose is necessary. We present a 34-year-old male with a DCH of the rectum and anus who required an APR because of affection of dentate line.

El hemangioma cavernoso difuso (HCD) es un tumor vascular benigno raro. Su localización más habitual es el rectosigma. Se presenta en adultos jóvenes como rectorragia indolora y recurrente, que suele aparecer en la infancia y puede llegar a ser incontrolable. La endoscopia digestiva es el método diagnostico de elección. El único tratamiento eficaz consiste en la resección completa siendo deseable la realización de una técnica con conservación esfinteriana. Un alto índice de sospecha y un correcto diagnóstico son necesarios. Presentamos el caso de un varón de 34 años con un HCD del anorecto que requirió una resección abdominoperineal.

Salvage radiation therapy in prostate cancer: relationship between rectal dose and long-term, self-reported rectal bleeding.

PURPOSE: To quantify the relationship between the rectal dose distribution and the prevalence of self-reported rectal bleeding among men treated with salvage radiotherapy (ST) delivered by three-dimensional conformal radiotherapy (3DCRT) for prostate cancer. To use this relationship to estimate the risk of rectal bleeding for a contemporary cohort of patients treated with volumetric modulated arc therapy (VMAT) ST. METHODS AND PATIENTS: Rectal bleeding of any grade was reported by 56 (22%) of 255 men in a PROM-survey at a median follow-up of 6.7 years after 3DCRT ST. Treatment plan data were extracted and dose-response relationships for the rectal volumes receiving at least 35 Gy (V35Gy) or 63 Gy (V63Gy) were calculated with logistic regression. These relationships were used to estimate the risk of rectal bleeding for a cohort of 253 patients treated with VMAT ST. RESULTS: In the dose-response analysis of patients in the 3DCRT ST cohort, both rectal V35Gy and V63Gy were statistically significant parameters in univariable analysis (p = 0.005 and 0.003, respectively). For the dose-response models using either rectal V35Gy or V63Gy, the average calculated risk of rectal bleeding was 14% among men treated with VMAT ST compared to a reported prevalence of 22% for men treated with 3DCRT ST. CONCLUSIONS: We identified dose-response relationships between the rectal dose distribution and the risk of self-reported rectal bleeding of any grade in a long-term perspective for men treated with 3DCRT ST. Furthermore, VMAT ST may have the potential to decrease the prevalence of late rectal bleeding.

Acute patient-reported bowel quality of life and rectal bleeding with the combination of prostate external beam radiation, low-dose-rate brachytherapy boost, and SpaceOAR.

PURPOSE: This study evaluates acute patient-reported bowel quality of life (QOL) and rectal bleeding in prostate cancer patients treated with combination external beam radiation (EBRT), low-dose-rate brachytherapy (LDR-BT), and SpaceOAR. MATERIALS AND METHODS: A retrospective review of prostate cancer patients treated with EBRT (45 Gy), cesium-131 LDR-BT (85 Gy), and SpaceOAR was conducted. Patient-reported acute (≤3 months after LDR-BT) bowel QOL and rectal bleeding was analyzed from Expanded Prostate Cancer Index Composite (EPIC) questionnaires. Five-point changes in mean bowel QOL scores were considered clinically significant. Clinically significant rectal bleeding was bleeding occurring more than "rarely" ("about half the time," "usually," or "always"), and clinically significant bleeding bother was considering bleeding a "small, moderate, or big problem." Outcomes were analyzed using descriptive statistics and paired t-tests. RESULTS: 69 patients were identified. Bowel summary, function, and bother scores clinically and significantly decreased 2 weeks after LDR-BT (79.9 ± 15.6, 80.5 ± 15.4, and 79.4 ± 18.1, respectively) compared with pre-EBRT scores (92.3 ± 9.1, 93.3 ± 9.0, and 92.6 ± 11.9, respectively) and pre-LDR-BT scores (91.1 ± 11.0, 91.6 ± 9.8, and 90.6 ± 13.3, respectively), but returned to clinical and statistical baseline pre-EBRT values at 3 months (88.7 ± 12.4, 88.8 ± 11.1, and 88.7 ± 14.5, respectively). The 3-month cumulative incidence of clinically significant rectal bleeding and bleeding bother was 4.35% and 2.90%, respectively. CONCLUSIONS: With combination EBRT, LDR-BT, and SpaceOAR, bowel QOL returned to the baseline 3 months after LDR-BT. Clinically significant rectal bleeding was <5%. Further followup will confirm if low acute rectal toxicity translates to reduced late toxicity.

Endoscopic management of massive rectal bleeding from a Dieulafoy's lesion: Case report.

BACKGROUND: Rectal Dieulafoy's lesions (DLs) are very rare; however, they can be life threatening when presented with massive hemorrhage. CASE SUMMARY: A 44-year-old female with medical history of chronic renal failure who was on renal replacement therapy presented with lower gastrointestinal hemorrhage. Physical examination revealed signs of hypovolemic shock and massive rectal bleeding. Complete blood count revealed abrupt decrease in hematocrit. After hemodynamic stabilization, an urgent colonoscopy was performed. A rectal DL was diagnosed, and it was successfully treated with two hemoclips. There were no signs of recurrent bleeding at thirty days of follow-up. CONCLUSION: Rectal DLs represent an unusual cause of lower gastrointestinal bleeding. Massive hemorrhage can increase the morbidity and mortality of these patients. Endoscopic management continues to be the reference standard in the diagnosis and therapy of these lesions. Thermal, mechanical (hemoclip or band ligation), or combination therapy (adrenaline injection combined with thermal or mechanical therapy) should be considered the first choice for treatment.

A prospective study of efficacy and safety of rubber band ligation in the treatment of Grade II and III hemorrhoids - a western Indian experience / Estudo prospectivo da eficácia e segurança da ligadura elástica no tratamento de hemorroidas de Grau II e III - uma experiência na Índia ocidental

ABSTRACT Background: Hemorrhoids are one of the most frequent diseases of the anal region with high prevalence involving all age groups. Multiple treatment options exist with none being perfect. Rubber band ligation of hemorrhoids is a non-operative treatment which can be performed on outpatient basis. Objective: The study was undertaken to determine efficacy of banding in treatment of Grade II and III hemorrhoids and to follow-up patients treated by banding to evaluate for symptomatic relief, recurrence and complications. Study design: A prospective, interventional study with clearance from the institutional ethics committee was undertaken over the period of 2 years in a tertiary referral center with a sample size of 60. Result: Out of 60 patients, 41 patients (68.30%) had Grade II and 19 patients (31.7%) had Grade III hemorrhoids. At first follow up, success rate for Grade II hemorrhoids was 85% (35/41) as compared to 21% (4/19) in Grade III. The unsuccessful 20 patients were re-banded, however only 2 of them responded to procedure. At the end of 6 weeks, 36 patients with Grade II hemorrhoids (88%) were cured. Failure rate was higher for Grade III hemorrhoids (68.42%, n = 13). Success rate was 86.6% for single hemorrhoid. There were no major complications. Anemia reverted significantly with successful band ligation. Conclusion: Rubber band ligation is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an outpatient procedure. It gives better results for Grade II and single hemorrhoids. Recurrence rate after successful band ligation is low.

RESUMO Background: As hemorroidas são uma das doenças mais frequentes da região anal, com alta prevalência envolvendo todas as faixas etárias. Existem várias opções de tratamento, sendo que nenhuma é perfeita. A ligadura elástica de hemorroidas é um tratamento conservador que pode ser realizado em ambulatório. Objetivo: O estudo foi realizado para determinar a eficácia da ligadura no tratamento de hemorroidas de Grau II e III e para acompanhamento dos pacientes tratados por ligaduras para avaliar o alívio sintomático, a recorrência e as complicações. Design do estudo: Estudo prospectivo e intervencionista com liberação do comitê de ética institucional foi realizado durante o período de 2 anos em um centro de referência terciário com um tamanho de amostra de 60. Resultado: Dos 60 pacientes, 41 (68,30%) apresentaram hemorroidas de Grau II e 19 (31,7%) de Grau III. No primeiro seguimento, a taxa de sucesso para hemorroidas de grau II foi de 85% (35/41), em comparação com 21% (4/19) no Grau III. Os 20 pacientes sem sucesso foram novamente submetidos a ligadura, mas apenas 2 deles responderam ao procedimento. Ao final de 6 semanas, 36 pacientes com hemorroidas de Grau II (88%) foram curados. A taxa de falha foi maior para as hemorroidas de grau III (68,42%, n = 13). A taxa de sucesso foi de 86,6% para hemorroida única. Não houve grandes complicações. A anemia reverteu significativamente com ligadura elástica bem-sucedida. Conclusão: A ligadura elástica é um método simples, seguro e eficaz para o tratamento de hemorroidas sintomáticas de segundo e terceiro graus, como procedimento ambulatorial. Ela promove melhores resultados para hemorroidas de Grau II e únicas. A taxa de recorrência após ligadura elástica bem-sucedida é baixa.

Outpatient application of formalin for chronic rectal bleeding after prostate irradiation: a quasi-experimental study.

PURPOSE: The aim of this quasi-experimental study is to evaluate a novel technique for an outpatient application of formalin for chronic rectal bleeding after prostate irradiation. METHODS: This is a quasi- experimental clinical trial developed between January 2010 and July 2015, including 35 patients with chronic radiation rectitis (CRP) due to a previous prostate radiation course. The study's eligibility was (1) completed external beam radiation therapy for prostate carcinoma >6 months previously, (2) rectal bleeding, defined as a frequency of >1× per week and/or needing of blood transfusions, and (3) diagnosis of chronic proctitis at colonoscopy. The 5% formalin application was performed by a custom applicator, which requires neither anesthesia nor sigmoidoscopy. The endpoint of the study was bleeding cessation and hemoglobin level. RESULTS: The onset of bleeding due to chronic rectitis was 12 months (6-36). During a median follow-up of 24 months, the rate of overall efficacy was 94%. The sustained complete response in 1 and 2 years was 80% and 73%, respectively. The Hb mean pre- and post-treatment differed significantly (12.2 vs 14.4, p = 0.0001). The rates of blood transfusion differed significantly, pre- and post-treatment (17% vs 5.7%, p = 0.031). CONCLUSION: The technique is very effective and safe, resulting to a significant improvement of hemoglobin levels and quality of life scores. Further studies are warranted to compare this technique with other treatment options for chronic radiation-induced rectal bleeding.

Caracterización de pacientes con colitis ulcerosa atendidos en centro de nivel terciario / Characterization of patients with ulcerative colitis treated at tertiary center

Introducción: la colitis ulcerosa es una afección de la sociedad moderna y su frecuencia en los países desarrollados ha ido en aumento desde mediados del siglo XX. Objetivo: caracterizar a pacientes con colitis ulcerosa. Métodos: se realizó un estudio descriptivo de corte transversal a 176 pacientes, con una edad media de 41,1 ± 14,5 años y colitis ulcerosa, atendidos en el Instituto de Gastroenterología desde enero 2011 hasta diciembre 2012. Resultados: se halló predominio del sexo femenino y el color de la piel blanca, mayor número de pacientes no fumadores y localización de la colitis hacia zona más distal del colon. Los síntomas más frecuentes fueron las diarreas con flemas y el sangrado rectal; mientras que las estenosis y el cáncer, al nivel de colon, y las alteraciones articulares y hepatobiliares, al nivel extracolónico, resultaron las complicaciones predominantes. El tratamiento medicamentoso más utilizado fue azulfidina, mesalazina y prednisona, por vía oral. Las causas más frecuentes de tratamiento quirúrgico fueron la estenosis y el cáncer colorrectal; las de muerte, el cáncer colorrectal y el colangiocarcinoma. Conclusiones: la colitis ulcerosa requiere especial atención por un equipo multidisciplinario y la familia, a partir del conocimiento de la enfermedad y sus complicaciones(AU)

Introduction: ulcerative colitis is a pathology of the modern society, and its frequency in developed countries has been growing since the middle of twenty century. Objective: characterize patients with ulcerative colitis. Methods: a transversal study was conducted in 176 patients with ulcerative colitis who are treated at Gastroenterology Institute from January 2011 to December 2012. Results: predominance of females and white skin color subjects was found, as well as higher number of nonsmoking subjects, the most frequent location of colitis was toward the distal colon area. The most common symptoms were diarrhea with mucus and rectal bleeding; but stenosis and cancer at colon level, joint disorders and hepatobiliary at extracolonic level were the predominant complications. The most widely used drug treatment was Azulfidine, mesalazine and prednisone orally. The most common causes of surgical treatment were stenosis and colorectal cancer. The most common cause death were colorectal cancer and cholangiocarcinoma. Conclusions: ulcerative colitis require special care by a multidisciplinary team and family, from knowledge of the disease and its complications(AU)

Síndrome de úlcera rectal solitaria en niños: Reporte de 3 casos

El síndrome de la úlcera rectal solitaria es una entidad benigna poco común cuyos síntomas más frecuentes son la rectorragia y el dolor anal. Los hallazgos anatomopatológicos son típicos. Se suele evidenciar engrosamiento de la mucosa, elongación y distorsión de las glándulas, una lámina propia edematosa con gran cantidad de colágena y engrosamiento de la muscularis mucosae. El diagnóstico se realiza mediante endoscopia con toma de biopsias. Se suele localizar preferentemente en la cara rectal anterior y/o lateral, aunque hasta un 30% de las lesiones son múltiples, existiendo casos de afectación del colon sigmoide y descendente. El Síndrome de úlcera rectal solitaria es muy raro en niños y la mayoría de revisiones en este grupo se limitan a descripción de casos. Se presentan tres casos con las características de este síndrome y lo infrecuente de su presentación en edades pediátricas.

Solitary rectal ulcer syndrome is an uncommon benign condition characterized by rectal bleeding, passage of mucus, and pain. Histological features are well established as obliteration of the lamina propia by fibrosis and smooth-muscle fibers extending from a thickened muscularis mucosa to the lumen. Diagnosis can usually be made on sigmoidoscopy, and biopsies should always be taken. Ulceration is not universally present, and polypoid, non-ulcerated lesions and erythematous areas are also seen. The lesion or lesions are most often found on the anterior or anterolateral wall of the rectum, although they can also be located in the left colon and be more extensive or even circumferential. Lesions are multiple in 30 percent of cases. The solitary rectal ulcer syndrome is very rare in children and most of revisions in this group are limited to case description. Three cases with the characteristics of this rare syndrome and its presentation in pediatric patients are presented.

Aplicación de formalina al 4 para el tratamiento de la rectitis actínica hemorragia refractaria: variantes, técnicas y resultados / Application of formalin to 4 for the treatment of actinic rectitis refractory hemorrhage: variants, techniques and results

Introducción: Varios tratamientos se utilizan para la rectitis actínica hemorrágica, entre ellos corticoides, sucralfato, mezalasina y distintas variantes de cauterización endoscópica, aunque ninguno puede considerarse de elección. En este contexto, la aplicación local de formalina al 4% ha demostrado ser efectiva y segura cuando han fracasado otros tratamientos conservadores. Objetivo: Comunicar nuestra experiencia en el tratamiento de la rectitis actínica sangrante con formalina, describiendo las variantes técnicas de su aplicación y los resultados. Diseño: Observacional retrospectivo. Lugar de aplicación: Hospital público de la Ciudad de Buenos Aires. Pacientes y Método: Se revisaron registros hospitalarios de 10 pacientes (7 mujeres) de edad promedio 61,1±15,6 (rango 28-81) años, con rectitis sangrante posterior a radioterapia pelviana. La dosis osciló entre 7400 y 8000 cGy y el sangrado comenzó en promedio 7,2±3,1 (rango 2-12) meses luego de finalizada la misma. Todos los pacientes presentaban anemia y habían recibido uno o más tratamientos conservadores previos sin respuesta, tres de los cuales habían requerido transfusiones. La terapia con formalina se realizó con dos modalidades: Grupo I: hisopo embebido en formalina al 4% a ph 7 puesto en contacto con la superficie sangrante durante 1-2 minutos. Grupo II: instilación de un volumen de 100-200 ml, en bolos de 30-40 ml por área sangrante, mantenidos en contacto durante 30-60 segundos con posterior aspiración y lavado con solución fisiológica entre los bolos y al final del procedimiento. La respuesta fue considerada completa cuando el sangrado cesó por completo o sólo hubo esporádicas y escasas pérdidas hemáticas, que no requirieron ningún tratamiento. La respuesta parcial se definió como la mejoría en frecuencia y magnitud del sangrado que no requirió otra terapia agresiva. Resultados: Se trataron 10 pacientes (Grupo I: 8 y Grupo II: 2)... (TRUNCADO)...

Background: Several treatments are used for radiation-induced hemorrhagic proctitis, among these corticosteroids, sucralfate, mezalasina, and cauterization endoscopic variants, but none can be considered of choice. With varying results are described. In this context, the local application of 4% formalin has proven to be effective and safe when other conservative treatments have failed. Objective: To report on our experience in the treatment of radiation-induced hemorrhagic proctitis, describing the technical variants of its implementation and results. Design: Observational retrospective study. Setting: Public Hospital of the City of Buenos Aires. Patients and Methods: Hospital records of 10 patients (7 women), average age 61.1 ± 15.6 (range 28-81) years, with radiation-induced hemorrhagic proctitis after pelvic radiotherapy were reviewed. The doses ranged from 7400 to 8000 cGy and the bleeding started on average 7.2 ± 3.1 (range 2-12) months after it ended. All patients had anemia and had received one or more previous conservative treatments with no response, and three of them had required transfusions. Formalin therapy was performed in two ways: Group I: swab with 4% formalin at pH 7 in contact with the bleeding surface for 1-2 minutes. Group II: instillation of a volume of 100-200 ml, in 30-40 ml bolus by bleeding area, maintained in contact with that area for 30-60 seconds, with subsequent aspiration and washing with saline solution between the boluses and the end of the procedure. Treatment response was considered complete when the bleeding stopped completely or there was sporadic and limited blood loss not merequiring any treatment. Partial response was defined as improvement in the frequency and magnitude of bleeding not requiring other aggressive therapy... (TRUNCATED)...

Heterotopia gástrica como causa de sangrado del tubo digestivo bajo / Gastric heterotopia as a cause of lower gastrointestinal bleeding

Se comunica un caso de heterotopia gástrica en rectosigmoides con sangrado rectal como manifestación clínica, por lo que se efectuó la revisión bibliográfica del tema. Caso: Varón de 21 años de edad con rectorragia de una semana de evolución. Durante el estudio del caso se tomaron biopsias de lesiones ulceradas en mucosa rectal, que fueron enviadas para su estudio histopatológico. Resultados: En la muestra recibida se observaron fragmentos entremezclados de mucosa de colon y mucosa gástrica de tipo oxíntico (fúndica) cuyos adenómeros se hallaban en estrecha relación con las criptas de Lieberkühn. Conclusión: La heterotopia gástrica es un hallazgo infrecuente, más aún cuando se observa en segmentos muy apartados en el colon distal. Suele acarrear un curso indolente y benigno, sin embargo, en ocasiones conlleva ciertas malformaciones asociadas o complicaciones derivadas de la misma actividad secretora fisiológica del tejido ectópico. Raramente puede experimentar malignización.

We report a case of gastric heterotopia in the rectum and sigmoid colon clinically presented as rectal bleeding; a review of the literature on the topic is also presented. Case: Twenty-one-year-old male who had experienced rectal bleeding for one week. biopsies from ulcerated lesions in the rectum were taken and sent forward for histopathological assessment. Results: In the sample received, fragments of colon mucosa and oxyntic (fundus) gastric mucosa, which adenomeres were closely related to the crypts of Lieberkuhn. Conclusion: Gastric heterotopia is an unusual finding, even less common when it is located in distant segments of the distal colon. Although usually being a condition with an indolent and benign evolution, it may also produce certain malformations o complications, consequence of the same secretory activity of the ectopic tissue. It rarely becomes a malignant disease.

Melanoma anorrectal primario: una causa infrecuente de rectorragia en el adulto mayor / Primary anorectal melanoma: an uncommon source of rectal bleeding in the elderly

El melanoma anorrectal primario es un tumor maligno muy infrecuente y con un pobre pronóstico. Se presenta un paciente de 66 años con rectorragia, en el cual el diagnóstico de melanoma anorrectal se efectuó por colonoscopia e histología. Se trató mediante una resección abdominoperineal. Se efectúa revisión de la literatura.

Primary anorectal melanoma is a very rare malignant tumor, with poor prognosis. A 66 years old man presenting with rectal bleeding is reported. The diagnosis of anorectal melanoma was confirmed by colonoscopy and histological findings. An abdominoperineal resection was performed. A review of the literature is presented.

Pyoderma gangrenosum and ulcerative colitis in the tropics / Pioderma gangrenoso e colite ulcerativa nos trópicos

Pyoderma gangrenosum is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration. There may be rapidly enlarging, painful ulcers with undermined edges and a necrotic, hemorrhagic base. Disorders classically associated with pyoderma gangrenosum include rheumatoid arthritis, inflammatory bowel disease, paraproteinemia and myeloproliferative disorders. There have been some reports of the occurrence of pyoderma gangrenosum in Africa, and in Nigeria, but only one specifically reported pyoderma gangrenosum in association with ulcerative colitis. We report on a 45-year-old man who presented with pyoderma gangrenosum associated with ulcerative colitis; the second report in Nigeria. The skin lesions were managed with daily honey wound dressings. Oral dapsone and prednisolone were started. The frequency of the bloody diarrhea decreased, and was completely resolved by the second week after admission. The ulcers also showed accelerated healing. The goal of therapy is directed towards the associated systemic disorder, if present.

Pioderma gangrenoso é uma rara forma de inflamação dermatológica, caracterizada por ulceração progressiva e recorrente da pele. Pode ocorrer rápida formação de úlceras dolorosas expansivas, com bordas solapadas e base necrótica e hemorrágica. Condições classicamente associadas com pioderma gangrenoso incluem artrite reumatóide, doença inflamatória intestinal, paraproteinemia e doenças mieloproliferativas. Existem alguns relatos da ocorrência de pioderma gangrenoso na África e na Nigéria, mas apenas um relato específico da associação de pioderma gangrenoso e colite ulcerativa. Os autores relatam o caso de um homem de 45 anos que apresentou pioderma gangrenoso associado a colite ulcerativa, sendo este o segundo relato na Nigéria. As lesões de pele foram tratadas com curativos diários de mel. Foram utilizadas dapsona e prednisona via oral. A freqüência de diarréia sanguinolenta diminuiu e se resolveu completamente até a segunda semana após a admissão. As úlceras também mostraram rápida cicatrização. A meta do tratamento deve abordar também a doença sistêmica associada, quando presente.

Anemia severa causada por Necator americanus: reporte de un caso / Severe anemia caused by Necator americanus: case report

En climas templados, yungas (zona intermedia entre valle y trópico) y trópico, prevalecen dos parásitos hematófagos: Necator americanusy Ancylostoma duodenale, responsable de una anemia crónica, que lleva a los niños a tener niveles tan bajos de Hb, que a veces sonconsiderados incompatibles con la vida; rara vez originan sangrado agudo severo.Describimos el caso de un niño, de seis meses de edad, procedente de Coroico (Nor Yungas) con disentería inicial, misma que luego secomplica con melenas y rectorragia de sangre rutilante que origina una hipovolemia severa, rayana en el choque. Sometido a exploraciónquirúrgica por persistencia del sangrado, previo gammagrafía para descartar un divertículo de Meckel, no se halla el sitio de sangradopor lo que se realiza laparotomía exploratoria y posteriormente una endoscopía, identifi cándose en duodeno foco de sangrado originadopor parásitos, que por su morfología se asume que se trate de Necator americanus. Con este diagnóstico, recibe transfusiones para suestabilizar su hipovolemia y Mebendazol, con buena evolución, remisión del sangrado de tubo digestivo, y buena tolerancia a la alimentación.El “sangrado agudo” por uncinarias, es excepcional, hecho que justifi ca la presentación del caso y permite realizar un recordatorio breve delos mecanismos responsables de ello...

In temperate climate, yungas (intermediate zone between valley and tropical lowland), two blood sucking parasites are prevalent: Necator americanus and Ancylostoma duodenale, responsible for chronic anaemia in children that causes extremely low Hb levels sometimesconsidered as incompatible with life; only in rare cases acute bleeding occurs.We describe the case of a six months old child stemming from Coroico (Nor Yungas) initially with dysentery that becomes complicated by melaena and rectal bleeding originating severe hypovolaemia bordering on shock. After gammagraphy in order to exclude Meckel’s diverticle, the child was submitted to surgical exploration, where no source of bleeding could be found, therefore an explorative laparotomy was performed and later on an endoscopy, where the source of bleeding was identifi ed in the duodenum as caused by the parasite Necator Americanus. With this diagnose, blood transfusions were administered to the child in order to stabilize the hypovolaemia and Mebendazol was given. The evolution was good, the bleeding stopped and feeding was well tolerated.Acute bleeding caused by hook worms is exceptional; therefore we present this case as a short reminder of the responsible mechanisms.

Colitis ulcerosa inespecífica como causa de hemorragia digestiva baja: caso pediátrico a propósito de diagnóstico diferencial y manejo / Nonspecific ulcerative colitis as a cause of lower gastrointestinal bleeding: a pediatric case purpose differential diagnosis and management

Se describe el caso clínico de una niña, de dos años y cuatro meses de edad, que consulta por rectorragia severa, luego de una disentería. La colonoscopía realizada a las tres horas del sangrado, reveló úlceras en todo el colon y el estudio histopatológico describe una colitis ulcerativa crónica en fase activa; es manejada solo condieta, probióticos y ceftriaxona, con mejoría del cuadro clínico. Dos colonoscopías de control muestran rectosigmoiditis inespecifica, con franca remisión de las úlceras. La estadística de colitis ulcerosa(CU) registrada en el Instituto Gastroenterológico Boliviano Japonés de La Paz, donde también se realizan todos los estudios endoscópicos del Hospital del Niño, muestra que el caso expuesto corresponde a la niña de menor edad reportada en nuestro medio hasta la fecha de la presente divulgación, aun que está descrita en laliteratura internacional la CU en lactantes de meses de edad (2). Esta circunstancia, junto a la remisión sin el uso de drogas específicas para la CU de la enfermedad inflamatoria intestinal (EII), obligan aplantear el diagnóstico diferencial con otras entidades que originan hemorragia digestiva baja con úlceras colónicas. Lo anterior, junto a los hallazgos endoscópico e histopatológico que inicialmente sugerían una CU como parte de la EII, la remisión progresiva consolo medidas dietéticas a perfilado el diagnóstico fi nal de una colitis ulcerosa inespecífica que amerita diagnósticos diferenciales por su evolución y por la rectorragia importante que ocasionó, por lo que el autor considera la justificación de esta publicación.

We describe the case of a 2 years and 4 months old girl who was admitted to the hospital for severe bleeding from the rectum after dysentery. Colonoscopy made three hours after the bleeding showed ulcers throughout the colon and the histopathologic exam described an active phase of chronic ulcerative colitis. The treatment is only diet, probiotics and ceftriaxone and the child’s state improves. Two control colonoscopies show an unspecific rectosigmoiditis with a clear remission of the ulcers. Statistics of ulcerative colitis (CU)recorded in the Instituto Gastroenterológico Boliviano Japonés of La Paz, where all the endoscopic studies of the Children’s Hospital are carried out, shows that the present case corresponds to the youngest girl ever reported until now, even though in the international literature, CU is described in babies of only months of age (2). This fact together with the remission of the infl ammatory intestinal disease (EII) without use of CU specifi c drugs, make it necessary to think of differential diagnoses with other diseases with colon ulcers that cause bleedings of the lower gastrointestinal tract. The above together with the endoscopic and histopathologic fi ndings that initially suggested a CU as part of the EII, the progressive remission with only dietetic measures, has drawn the fi nal diagnose of an unspecifi c ulcerative colitis that needs differential diagnosis due to its evolution and the important bleeding that it caused. For these reasons, the author considers this publication justifi ed.