Functional outcomes and quality of life in patients treated with laparoscopic total colectomy for colonic inertia.

PURPOSE: To assess the functional outcomes and quality of life in patients with laparoscopic total colectomy for slow-transit constipation (STC). METHODS: All patients undergoing laparoscopic colectomy with ileorectal anastomosis for colonic inertia at two referral centers were analyzed. Their preoperative, intraoperative and postoperative details were recorded with a one-year follow-up. Their quality of life was assessed using the SF-36 questionnaire. RESULTS: Between 2004 and 2007, 710 patients were evaluated. Eight female patients (1.1 %) fulfilled the criteria for STC without obstructive defecation syndrome. Their mean age was 38 years ± 15 (range from 22 to 62). The conversion rate was 12.5 %. The morbidity rate was 37.5 %, and mortality was nil. The preoperative abdominal pain was 6.6 ± 0.3 and had decreased to 3.6 ± 2.3 postoperatively (P = 0.008). At 1 year, the defecation frequency per week had increased from 0.84 ± 0.24 to 6.75 ± 3.4 (P = 0.001). Three patients developed nocturnal leakage (37.5 %). Eighty-eight percent of the patients recommend the procedure. All parameters of the SF-36 questionnaire had improved at the one-year follow-up examination. CONCLUSION: Laparoscopic colectomy for slow-transit constipation is safe and increased the number of evacuations per week. Although nocturnal leakage may occur, these patients experience improvements in their quality of life.

Lower Gastrointestinal Bleeding Associated With Variceal Hemorrhoidal Disease in a Patient With Pan-Colonic Varices.

Colonic varices are a rare condition primarily caused by portal hypertension associated with conditions such as cirrhosis or hepatocellular carcinoma. Idiopathic cases are even rarer, with less than 50 cases with a pan-colonic affection reported in the literature. Males are more commonly affected, with an average age of 41 years. Colonic varices can involve the entire colon in idiopathic cases and are often familial. Gastrointestinal bleeding is the main symptom, ranging from mild to life-threatening. Diagnosis is typically made through colonoscopy, which reveals dilated bluish vascular tracts. Treatment involves fluid IV resuscitation and controlling hemorrhage through various methods such as endoscopic procedures. Correction of the underlying cause is essential in cases of portal hypertension. Recurrent or unstable cases may require colon resection. On this occasion, we present the case of a female patient who experienced profuse lower gastrointestinal bleeding. The patient's colonoscopy revealed the presence of varices throughout the entire length of the colon, with the only recent bleeding site being in the hemorrhoidal tissue. Therefore, a hemorrhoidectomy was performed to carry out an effective and less invasive therapeutic procedure than a colectomy with an excellent postoperative evolution.

[Hereditary mixed polyposis syndrome. First report in Mexico]. / Síndrome de poliposis mixta hereditaria. Primer reporte en México.

OBJECTIVE: Report for first time in Mexico a case of hereditary mixed polyposis and review the literature. BACKGROUND: The hereditary mixed polyposis syndrome (HMPS) is an uncommon condition, distinguished by presence of a different histological pattern of polyps in digestive tract, clinically manifested by diarrhea, anemia and weight loss. CASE REPORT: Male patient, 38 years old, with familiar antecedent (dead sister) with polyps and gastric cancer. With history of a 1 year with bleeding and mucous diarrhea, and weight loss of a 28.6 pounds. Pale at physical examination, without abdominal signs. At blood test with hemoglobin of 9.7 g/dL, and colonoscopy with multiple polyps within colon and rectum, upper endoscopy with a big esophageal polyp and multiple polyps in gastric and duodenal lining smaller than 1 cm. Contrast study of intestine was normal. Histopathologic study of the polyps report mixed pattern of polyps: (hyperplasic-adenomatous, juvenile-adenomatous, adenoma-inflammatory-hyperplasic, hyperplasic-adenomatous with a high degree dysplasia); juvenile in esophagus, and hyperplasic in stomach and duodenum. Patient was undergone to totalproctocolectomy and reconstruction by "J" ileoanal pouch with good outcome, and endoscopic esophageal polypectomy, with actual surveillance.

[Acute appendicitis without Crohn's disease in a patient with inflammatory bowel disease. Case report]. / Apendicitis aguda sin enfermedad de Crohn en un paciente con inflamación intestinal. Informe de un caso.

BACKGROUND: Crohn's disease was described for the first time in 1932. The association of acute appendicitis with this disease is very rare and when the cecum is involved, risk of fistula is very high. CASE REPORT: We present the case of a 48-year-old female who had been diagnosed with Crohn's disease several months earlier. The patient complained of intense abdominal pain in the right lower quadrant and was treated medically without improvement. Thus, laparascopic surgery was decided upon. DISCUSSION: The appendix was affected in 12-16% of all patients with Crohn's disease who had intestinal resection. CONCLUSIONS: If the cecum is not affected, appendectomy using laparascopic procedure with soft tissue drainage is adequate.

Apendicitis aguda sin enfermedad de Crohn en un paciente con inflamación intestinal: informe de un caso / Acute appendicitis without Crohn's disease in a patient with inflammatory bowel disease: case report

BACKGROUND: Crohn's disease was described for the first time in 1932. The association of acute appendicitis with this disease is very rare and when the cecum is involved, risk of fistula is very high. CASE REPORT: We present the case of a 48-year-old female who had been diagnosed with Crohn's disease several months earlier. The patient complained of intense abdominal pain in the right lower quadrant and was treated medically without improvement. Thus, laparascopic surgery was decided upon. DISCUSSION: The appendix was affected in 12-16% of all patients with Crohn's disease who had intestinal resection. CONCLUSIONS: If the cecum is not affected, appendectomy using laparascopic procedure with soft tissue drainage is adequate.