Rectopexia laparoscópica con técnica de Orr-Loygue para el tratamiento del prolapso rectal / Laparoscopic Orr-Loygue rectopexy with mesh for the treatment of rectal prolapse

Introducción: Existen múltiples alternativas para el tratamiento quirúrgico del prolapso rectal mediante procedimientos de fijación, resección o combinados. Si bien el abordaje perineal evita el acceso a la cavidad peritoneal, se acompaña de una tasa de recidiva mayor en relación al abordaje abdominal. Descripción: Se presenta una paciente de 66 años, histerectomizada por vía laparotómica, con un prolapso rectal externo y reductible de 1 año de evolución, sin incontinencia fecal ni constipación. La endoscopia preoperatoria descartó patología colónica asociada. Abordaje laparoscópico en posición de Trendelenburg lateralizado a la derecha. Como es habitual en estos casos se observa la presencia de dolicosigma y fondo de saco de Douglas profundo y se evidencia también la cicatriz de la cesárea. El procedimiento comienza con la apertura peritoneal a nivel del promontorio y la movilización de la unión rectosigmoidea, identificando el uréter izquierdo. Se continua la disección circunferencial tras la apertura de la reflexión peritoneal hasta la altura de la cúpula vaginal. La rectopexia se realiza según la técnica de Orr-Loygue mediante la fijación de la malla por una parte a ambas caras laterales del recto y por otra al promontorio sacro con puntos de polipropileno 2-0, cuidando de no lesionar los vasos ilíacos y los uréteres. Finalmente se cierra la reflexión peritoneal con poliglactina para aislar las mallas protésicas del contenido visceral. La paciente tuvo una buena evolución postoperatoria, otorgándose el alta a las 48 h. Tras 8 meses de seguimiento se encuentra asintomática, con tránsito digestivo y continencia fecal sin alteraciones. Conclusión: El abordaje laparoscópico para el tratamiento del prolapso rectal es seguro y ofrece las ventajas de la cirugía mini-invasiva. La rectopexia con malla protésica es un procedimiento técnicamente desafiante, aunque con mejores resultados alejados. (AU)

Introduction: There are multiple alternatives for the surgical treatment of rectal prolapse through fixation, resection or combined procedures. Although the perineal approach avoids access to the peritoneal cavity, it is associated with a higher recurrence rate than the abdominal approach. Description: The video shows a 66-year-old female patient, hysterectomized by laparotomy, with a 1-year history of reduciblefull-thickness rectal prolapse, without fecal incontinence or constipation. Preoperative endoscopy ruled out associated colonic pathology. The laparoscopic approach is done with the patient placed in Trendelenburg and tilted to the right. As usual in these cases, the presence of dolichosigma and deep Douglas pouch is observed, as well as the cesarean section scar. The procedure begins with the peritoneal opening at the level of the promontory and the mobilization of the rectosigmoid junction, identifying the left ureter. Circumferential dissection is continued after opening the peritoneal reflection up to the level of the vaginal vault. Rectopexy is performed according to the Orr-Loygue technique by fixing the mesh to both lateral aspects of the rectum on one side and to the sacral promontory on the other side with 2-0 polypropylene interrupted sutures, taking care not to injure the iliac vessels and ureters. Finally, the peritoneum is closed with a running suture with polyglactin to isolate the prosthetic mesh from the visceral content. The patient had a good postoperative outcome and was discharged at 48 h. After 8 months of follow-up, she is asymptomatic and has normal colonic transit and fecal continence. Conclusion: the laparoscopic approach for the treatment of rectal prolapse is safe and offers the advantages of minimally invasive surgery. Prosthetic mesh rectopexy is a technically challenging procedure, although has better distant results. (AU)

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)

Lipoma de recto prolapsado e incarcerado: caso clínico y análisis de la literatura / Prolapsed and incarcerated rectal lipoma: case report and literature review / Prolapso e encarceramento de lipoma do reto: caso clínico e análise da literatura

Los lipomas colónicos son tumores benignos poco frecuentes, extremadamente raros a nivel rectal. A pesar de ello, ocupan el segundo lugar en frecuencia detrás de los pólipos adenomatosos. Aunque la mayoría de los lipomas colorrectales son asintomáticos y se descubren incidentalmente, en ocasiones pueden ser sintomáticos y determinar complicaciones agudas que requieren tratamiento quirúrgico de urgencia. Estas formas de presentación pueden confundirse con las del cáncer colorrectal, constituyendo un desafío diagnóstico y terapéutico. Presentamos el caso de una paciente que consultó en emergencia por una gran masa dolorosa de aparición aguda a nivel del ano, resultando ser un lipoma rectal prolapsado a través del canal anal.

Colonic lipomas are infrequent benign tumors, extremely rare at the rectum. Nevertheless, they follow in frequency polyp adenomas. Even though most colorectal lipomas are asymptomatic and incidental, they can occasionally be symptomatic and develop acute complications that require urgent surgical treatment. This form of presentation can be confounded with colorectal cancer, therefore impairing diagnosis and treatment. We present the case of a female patient who came to the emergency room with an acute painful mass through the anus, that resulted in a prolapsed rectal lipoma.

Os lipomas colônicos são tumores benignos pouco frequentes, extremamente raros no nível retal. Apesar disso, ocupam o segundo lugar em frequência atrás dos pólipos adenomatosos. Embora a maioria dos lipomas colorretais sejam assintomáticos e descobertos incidentalmente, às vezes eles podem ser sintomáticos e levar a complicações agudas que requerem tratamento cirúrgico de emergência. Essas formas de apresentação podem ser confundidas com as do câncer colorretal, constituindo um desafio diagnóstico e terapêutico. Apresentamos o caso de um paciente que consultou na sala de emergência por uma grande massa dolorosa de início agudo ao nível do ânus, que acabou por ser um lipoma retal prolapsado pelo canal anal.

Caracterización clínica, endoscópica, e histológica de pacientes pediátricos con pólipos colorectales atendidos en el Centro de Enfermedades Digestivas y el IHSS-HRN de 2021-2022 / Clinical, endoscopic, and histological characterization of pediatric patients with colorectal polyps attended at the center for digestive diseases and the IHSS-HRN from 2021-2022

Antecedentes: Los pólipos colorrectales son la causa más frecuente de hemorragia de tubo digestivo bajo no anemizante. Se presen- ta en el 3-4% de la población menor de 21 años. Objetivo: Describir las características clíni- cas, endoscópicas e histológicas de los pacien- tes pediátricos con pólipos colorrectales atendi- dos en el periodo enero del 2021- agosto 2022. Pacientes y metodología: Estudio descriptivo, ana- lítico, retrospectivo, de corte transversal, realizado en 93 pacientes que cumplían los criterios de inclu- sión. Se empleó muestreo no probabilístico a conve- niencia, utilizando un instrumento tipo formulario. Resultados: Predominó el sexo masculino, raza mes- tiza, edad entre 5-10 años y la procedencia urbana. El principal motivo de consulta fue el sangrado diges- tivo bajo, que junto al prolapso del pólipo fueron los dos síntomas gastrointestinales referidos. Endoscópica- mente lo más frecuente fue encontrar de 1-4 pólipos, de localización rectal, aspecto sésil. La polipectomía demostró ser un procedimiento seguro. El pólipo infla- matorio constituyó el reporte histológico más frecuente. * Médico Residente de tercer año de Pediatría, Escuela Universitaria de las Ciencias de la Salud, UNAH-VS ** Asesor Clínico ­Subespecialidad en Gastroenterología Pediátrica *** Asesor metodológico-Neumólogo pediatra, Máster en Investigación médica Correspondencia enviar a: Dr. Daniel Almazán, E-mail: dr.daniel.almazan@gmail.com Fecha de entrega: 20/09/2022 Fecha de aprobado 27/09/2022 Conclusiones: Los pólipos colorrectales deben ser el primer diagnóstico sospechado en pacientes pe- diátricos con sangrado digestivo bajo no asociado a diarrea ni estreñimiento. La referencia temprana al gastroenterólogo pediatra ayuda a la pronta me- joría de la calidad de vida del paciente; y encontra- mos que actualmente se realiza tardíamente. No se encontró relación estadísticamente significativa en- tre la edad, sexo, aspecto y diagnóstico del pólipo...(AU)

Factores de riesgo asociados a sepsis neonatal en pacientes en cuidados mínimos, de la unidad de cuidados intensivos neonatales / Risk factors associated with neonatal sepsis in minimum care, in the neonatal intensive care unith

Antecedentes: La sepsis neonatal representa un desa- fío para los Servicios de Neonatología en el mundo, a pesar de los avances en estudios diagnósticos y te- rapia antimicrobiana, más del 46% de las muertes en menores de 5 años corresponden al periodo neo- natal, y dentro de ese porcentaje 15% es por sepsis. Objetivo: Caracterizar los factores de riesgo aso- ciados a sepsis neonatal en los recién nacidos ingre- sados en UCIN (Unidad de Cuidados Intensivos), en área de Cuidados Mínimos del Instituto Hondu- reño de Seguridad Social, de enero a junio del 2022. Pacientes y Metodología: Estudio cuantitativo con un alcance descriptivo, se estudiaron a 100 neonatos con el diagnóstico de sepsis neonatal ingresados en UCIN en área de cuidados mínimos, muestreo no probabilísti- co a conveniencia, con revisión de expedientes clínicos y aplicación de consentimiento informado a padre y/o tutor. Resultados: El 57% tenían entre 1 ­ 24 horas de vida al ingreso, 65.0% de género masculino, un 93.0% de raza mestiza y un 7% de raza negra. El 83.0% de las madres eran primigestas, con antecedente de infección urinaria en un 70.0% durante el tercer trimestre de ges- tación y el 15.5% con antecedente de infecciones vagi- nales. Un 7.8% con ruptura prematura de membranas, 3.9% corioamnionitis, 6.49% fiebre intraparto y 10.0% con infecciones respiratorias maternas. La fiebre fue el signo de sepsis predominante en todos los pacientes.Conclusiones: Madre entre 26-35 años, ser primípara, tener menos de tres controles prenatales durante su ges- tación se consideran factores de riesgo para sepsis neo- natal con una relación estadísticamente significativa ...(AU)

Prolapso rectal completo procedimiento de Delorme / Complete rectal prolapse Delorme procedure / Procedimento completo de prolapso retal Delorme

Introducción: el prolapso rectal es una invaginación del recto que produce su exteriorización a través del ano. Se denomina completo cuando está constituido por todo el espesor de la pared rectal. En su incidencia están vinculados factores como el sexo femenino, los pacientes añosos y el parto. Etiopatogenia: es multifactorial, se plantean varias teorías. Entre ellas, un fondo de saco peritoneal recto vaginal o recto vesical anormalmente profundo, la falta de fijación normal del recto a su lecho, la consecuencia de una invaginación idiopática de la parte superior del recto y un estado de relajación y atonía de la musculatura del suelo de la pelvis y del canal anal. Caso Clínico: mujer, 64 años. Prolapso rectal completo por debilidad de la musculatura del piso pélvico y canal anal. Se plantean la valoración diagnóstica y exámenes paraclínicos preoperatorios. Se describe el procedimiento de Delorme como solución técnica a su prolapso rectal. Se destaca que la paciente evolucionó favorablemente. Conclusiones: el objetivo del tratamiento es solucionar el prolapso y restaurar la función anorrectal sin provocar efectos nocivos. El prolapso que presenta esta paciente es multifactorial e incluye el conjunto de las siguientes anomalías, afecta a las mujeres de edad avanzada y multíparas, está exteriorizado permanentemente y forma parte de una enfermedad degenerativa difusa del periné. El mismo fue solucionado según el procedimiento de Delorme. La evolución de la paciente fue satisfactoria, no se objetivaron complicaciones ni recidiva en el post operatorio precoz o alejado.

Introduction: rectal prolapse is an invagination of the rectum that produces its exteriorization through the anus. It is called complete when it is constituted by the whole thickness of the rectal wall. Factors such as female sex, elderly patients and childbirth are linked to its incidence. Etiopathogenesis: it is multifactorial, and several theories have been put forward. Among them, an abnormally deep peritoneal rectal vaginal or rectal vesical fornix, the lack of normal fixation of the rectum to its bed, the consequence of an idiopathic invagination of the upper part of the rectum and a state of relaxation and atony of the muscles of the pelvic floor and the anal canal. Case report: female, 64 years old. Complete rectal prolapse due to weakness of the pelvic floor muscles and anal canal. The diagnostic evaluation and preoperative paraclinical examinations are presented. The Delorme procedure is described as a technical solution to her rectal prolapse. It is emphasized that the patient evolved favorably. Conclusions: The goal of treatment is to resolve the prolapse and restore anorectal function without causing harmful effects. The prolapse presented by this patient is multifactorial and includes all of the following anomalies, affects elderly and multiparous women, is permanently externalized and is part of a diffuse degenerative disease of the perineum. It was solved according to the Delorme procedure. The patient's evolution was satisfactory, no complications or recurrence were observed in the early or distant postoperative period.

Introdução: O prolapso retal é uma invaginação do reto que resulta em sua externalização através do ânus. É chamado completo quando consiste de toda a espessura da parede retal. Fatores como sexo feminino, pacientes mais velhos e parto estão ligados a sua incidência. Aetiopatogênese: é multifatorial, e várias teorias foram apresentadas. Estes incluem um fórnix peritoneal rectovaginal ou retal vesical anormalmente profundo, a falta de fixação normal do reto em seu leito, a conseqüência da invaginação idiopática da parte superior do reto e um estado de relaxamento e atonia dos músculos do assoalho pélvico e do canal anal. Relato de caso: mulher, 64 anos de idade. Prolapso retal completo devido à fraqueza dos músculos do assoalho pélvico e do canal anal. São apresentados a avaliação diagnóstica e os exames paraclínicos pré-operatórios. O procedimento Delorme é descrito como uma solução técnica para seu prolapso retal. Observa-se que o paciente evoluiu favoravelmente. Conclusões: O objetivo do tratamento é resolver o prolapso e restaurar a função anorretal sem causar efeitos nocivos. O prolapso apresentado por esta paciente é multifatorial e inclui todas as seguintes anomalias, afeta mulheres idosas e multíparas, é externalizado permanentemente e faz parte de uma doença degenerativa difusa do períneo. Foi tratado de acordo com o procedimento Delorme. A evolução do paciente foi satisfatória, não foram observadas complicações ou recidivas no período pós-operatório precoce ou distante.

Homeopathic treatment of rectal prolapse in a kitten: a case report

Rectal prolapse be either partial or incomplete in nature and is defined as double layer evagination of the rectum through the anal canal. The common associated causations which can be seen in kittens are severe endoparasitism, enteritis, and associated tenesmus (Fossum, 2002). Rectal prolapse is the one of the most encountered surgical conditions involving the rectum in all domestic animal species (Tyagi and Singh, 1993). Surgical intervention is the most common treatment methodology adopted but however, in cases where surgery is not indicated, required, not opted by the owner, becomes a challenge to treat. Therefore, finding alternative therapies for clinical management is the need of hour. The objective of this study is to report successful management of rectal prolapse in a 5-month-old kitten having 4 episodes of prolapse in five days. The homeopathic medicines used in this case were Sepia 200C and Ruta g. 200C. The patient revealed a favourable response by 2nd day of the treatment and complete healing was observed on 7th day. This therapeutic protocol used was conclusive and it re-established the normal intake of food and energy level. Hence, homeopathic treatment can be considered as an alternative therapy for clinical management of rectal prolapse in a Felines and Canines.

Use of rectal tissue for reconstruction of an anogenital cleft in a juvenile dog with recurrent rectal prolapse.

CASE DESCRIPTION: A 4-month-old 4.2 kg sexually intact female mixed-breed dog was evaluated for rectal and vesicular tenesmus, intermittent rectal prolapse, fecal incontinence, and an anogenital cleft. CLINICAL FINDINGS: Rectal prolapse and an anogenital cleft were confirmed on physical examination. Results of a CBC and serum biochemical analysis were within respective reference ranges, and abdominal ultrasonography revealed no abnormalities. Urinalysis revealed evidence of a urinary tract infection. TREATMENT AND OUTCOME: An H-perineoplasty was performed and the prolapse was reduced. The repair partially dehisced and was repaired (with concurrent reduction of a recurrent rectal prolapse) but dehisced again. There was limited tissue available for additional reconstruction. In another surgical procedure, the rectum was allowed to prolapse, the most dorsal 40% of the prolapsed rectal tissue was resected, and the rectal tissue margin and skin in this region were apposed. The remaining rectal tissue flap was folded ventrally, and the lateral margins of the aborad aspect were sutured to the dorsolateral vestibular mucosa. In a subsequent surgery, 2.5 to 3 cm of the rectal tissue flap was excised. The remainder was used to create ventral margins for the rectum and vestibular mucosa. The perineal skin between the anus and dorsal vulvar commissure was closed. The patient experienced mild cutaneous partial dehiscence of the repair that healed by second intention. Over an 18-month follow-up period, some fecal incontinence persisted, but straining resolved and urinary tract infection did not recur. CLINICAL RELEVANCE: For the dog of this report, the use of rectal mucosa in surgical repair of an anogenital cleft provided an acceptable clinical outcome.

Outcome of Fecal Incontinence in Patients with Rectal Prolapse Undergoing the Altemeier Procedure with or without Posterior Levatorplasty / Desfecho de incontinência fecal em pacientes com prolapso retal submetidos ao procedimento de Altermeier com ou sem levatorplastia posterior

Abstract Objective To compare the fecal incontinence status of patients submitted to theAltemeier procedure with or without posterior levatorplasty. Materials and Methods Medical records of the patients who underwent the Altemeier procedure at Shahid Faghihi Hospital (in Shiraz, Iran) from 2014 to 2018 were retrospectively studied. Patients older than 17 years of age who underwent the Altemeier procedure due to complete rectal prolapse were considered. In some cases, the operation was performed with posterior levatorplasty. Rectal prolapse due to collagen or connective tissue disorders, anal/sacral anomalies, immunodeficiency, history of rectal surgery, and pelvic radiotherapy were the exclusion criteria of the present study. In addition to the demographics (including age, gender, and body mass index), the fecal incontinence status of each case was determined through theWexner scale preoperatively and 12 months after the surgery. The incontinence scores were then compared against the baseline values of the two groups of patients: those with and those without posterior levatorplasty. The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, US), software, version 21. Results In total, 53 patients (17 men and 36 women) with a mean age of 55.23 ± 18.24 years were analyzed. The comparison of the pre- and postoperative scores on theWexner scale between the two groups revealed no statistically significant difference (p >0.05). Conclusion Posterior levatorplasty during the Altemeier procedure did not result in significant improvement of the fecal incontinence outcome of the patients.

Resumo Objetivo Comparar o status de incontinência fecal de pacientes após o procedimento de Altemeier com e sem levatorplastia posterior. Materiais e métodos Os prontuários médicos dos pacientes submetidos ao procedimento de Altemeier no Shahid Faghihi Hospital (em Shiraz, Irã) entre 2014 e 2018 foram avaliados retrospectivamente. Pacientes com idade superior a 17 anos submetidos ao procedimento de Altemeier devido a prolapso retal completo foram considerados. Em alguns casos, a operação foi realizada com levatorplastia posterior. Prolapso retal devido a distúrbios de colágeno ou do tecido conjuntivo, anomalias anais/sacrais, imunodeficiência, histórico de cirurgia retal, e radioterapia pélvica foram os critérios de exclusão deste estudo. Além dos dados demográficos (incluindo idade, sexo, e índice de massa corporal), o status da incontinência fecal de cada caso foi determinado por meio da escala de Wexner antes e doze meses após a cirurgia. Então, as pontuações de incontinência foram comparadas aos valores de referência dos dois grupos de pacientes: com e sem levatorplastia posterior. A análise estatística foi feita usandose o programa Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, EUA), versão 21. Resultados No total, 53 pacientes (17 homens e 36 mulheres) com idade média de 55.23 ± 18.24 anos foramavaliados. A comparação entre os grupos das pontuações na escala de Werner no pré e pós-operatório não revelou diferença estatisticamente significativa (p>0.05). Conclusão Levatorplastia superior durante o procedimento de Altemeier não resultou em melhora significativa do desfecho da incontinência fecal dos pacientes.

Prolapso peniano em tartaruga-verde (Chelonia mydas) / Penile prolapse in green sea turtle (Chelonia mydas)

A ocorrência de prolapso peniano em repteis é observada tanto em quelônios terrestres, quanto em squamatas, porém há a escassez de relatos em tartarugas marinhas documentados até o momento. Desta forma, objetivou-se relatar o processo de reabilitação de uma tartaruga-verde (Chelonia mydas) com prolapso peniano, de modo a nortear procedimentos clínicos e terapêuticos que possam propiciar maior sucesso na reabilitação destes animais. Uma tartaruga-verde (C. mydas), adulto, macho, foi resgatada no dia 02 de maio de 2020 na praia de Muriú, Ceará Mirim, Rio Grande do Norte, Brasil. O espécime encontrava-se ativo, responsivo, com bom escore corpóreo, hidratação moderada, presença de prolapso peniano com mucosa associada hiperêmica e parte necrosada, além disso, encontrava-se com a nadadeira anterior esquerda amputada. O animal recebeu suporte terapêutico à base de analgésicos, antibióticos, anti-inflamatórios, polivitamínicos e fluidoterapia. Foram realizados procedimentos cirúrgicos para remoção total do úmero e redução mecânica do prolapso peniano. Após 50 dias de reabilitação o animal teve alta médica e foi reintroduzido de volta ao mar. Conclui-se que o protocolo utilizado, tanto na reabilitação, quanto no tratamento conservativo do prolapso peniano mostrou-se eficaz na redução do edema, evitando assim a recidiva do prolapso.

The occurrence of penile prolapse in reptiles has been observed both in terrestrial turtles and squamates. However, there are few reports of penile prolapse in sea turtles published to date. This study aimed at reporting the rehabilitation process of a green sea turtle (Chelonia mydas) with penile prolapse, in order to guide clinical and therapeutic measures that can provide greater success in the rehabilitation of these animals. An adult male green sea turtle (C. mydas) was rescued on May 2, 2020 at Muriú beach, Ceará Mirim, Rio Grande do Norte, Brazil. The specimen was active and responsive, with a good body score and moderate hydration, and showed the presence of penile prolapse with associated hyperemic mucosa and necrosis. It also had the left anterior fin amputated. The animal received therapeutic support based on antibiotics, analgesics, anti-inflammatories, multivitamins, and fluid therapy. The surgical procedure for the complete removal of the humerus and mechanical reduction of penile prolapse was performed. After 50 days of rehabilitation, the animal was discharged and was reintroduced back to the sea. It is concluded that the protocol used was effective in reducing edema, thus preventing the recurrence of prolapse, both in rehabilitation and in the conservative treatment of penile prolapse

Prolapso peniano em tartaruga-verde (Chelonia mydas) / Penile prolapse in green sea turtle (Chelonia mydas)

A ocorrência de prolapso peniano em repteis é observada tanto em quelônios terrestres, quanto em squamatas, porém há a escassez de relatos em tartarugas marinhas documentados até o momento. Desta forma, objetivou-se relatar o processo de reabilitação de uma tartaruga-verde (Chelonia mydas) com prolapso peniano, de modo a nortear procedimentos clínicos e terapêuticos que possam propiciar maior sucesso na reabilitação destes animais. Uma tartaruga-verde (C. mydas), adulto, macho, foi resgatada no dia 02 de maio de 2020 na praia de Muriú, Ceará Mirim, Rio Grande do Norte, Brasil. O espécime encontrava-se ativo, responsivo, com bom escore corpóreo, hidratação moderada, presença de prolapso peniano com mucosa associada hiperêmica e parte necrosada, além disso, encontrava-se com a nadadeira anterior esquerda amputada. O animal recebeu suporte terapêutico à base de analgésicos, antibióticos, anti-inflamatórios, polivitamínicos e fluidoterapia. Foram realizados procedimentos cirúrgicos para remoção total do úmero e redução mecânica do prolapso peniano. Após 50 dias de reabilitação o animal teve alta médica e foi reintroduzido de volta ao mar. Conclui-se que o protocolo utilizado, tanto na reabilitação, quanto no tratamento conservativo do prolapso peniano mostrou-se eficaz na redução do edema, evitando assim a recidiva do prolapso.(AU)

The occurrence of penile prolapse in reptiles has been observed both in terrestrial turtles and squamates. However, there are few reports of penile prolapse in sea turtles published to date. This study aimed at reporting the rehabilitation process of a green sea turtle (Chelonia mydas) with penile prolapse, in order to guide clinical and therapeutic measures that can provide greater success in the rehabilitation of these animals. An adult male green sea turtle (C. mydas) was rescued on May 2, 2020 at Muriú beach, Ceará Mirim, Rio Grande do Norte, Brazil. The specimen was active and responsive, with a good body score and moderate hydration, and showed the presence of penile prolapse with associated hyperemic mucosa and necrosis. It also had the left anterior fin amputated. The animal received therapeutic support based on antibiotics, analgesics, anti-inflammatories, multivitamins, and fluid therapy. The surgical procedure for the complete removal of the humerus and mechanical reduction of penile prolapse was performed. After 50 days of rehabilitation, the animal was discharged and was reintroduced back to the sea. It is concluded that the protocol used was effective in reducing edema, thus preventing the recurrence of prolapse, both in rehabilitation and in the conservative treatment of penile prolapse(AU)