Abstract Introduction Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results The mean patient age was 28.85 (range, 18–44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25–40) and 54.5 (range, 45–65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes.
{"title":"Surgical Outcome of Modified Karydakis Flap and Modified Limberg Flab in the Management of Sacroccygeal Pilonidal Disease: A Comparative Study","authors":"Yasser Baz, Y. Orban, M. Ezzat","doi":"10.1055/s-0042-1759740","DOIUrl":"https://doi.org/10.1055/s-0042-1759740","url":null,"abstract":"Abstract Introduction Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results The mean patient age was 28.85 (range, 18–44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25–40) and 54.5 (range, 45–65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"42 1","pages":"335 - 339"},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47325760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mrabti, A. Sair, A. Benhamdane, T. Addajou, R. Berrida, S. Sentissi, I. Koti, F. Rouibaa, A. Benkirane, H. Seddik
Abstract Objective To evaluate the prevalence of polyps and their treatments. Materials and Method This is a retrospective study conducted in our department over 20 years and 3 months between January 2000 and March 2021. All patients with colorectal polyps who underwent endoscopic resection were included. We evaluated the resection techniques and the management of complications. Results The total number of patients was 273, with a mean age of 57.26 ± 14.058 (18–90) and a M/W sex ratio of 2. The prevalence was 3.35% and the mean number of polyps was 1.33 ± 0.69. The most frequent symptoms were rectal bleeding (23.5%) and constipation (12.1%). The median size was 6 mm (4–12 mm). The left colonic location was the most frequent site (43%). All polyps were classified according to the Paris classification, with a predominance of sessile polyps in 45.75%, followed by pedunculated polyps, representing 42.4%. Endoscopic resection was performed either by biopsy forceps, polypectomy, or mucosectomy in 30.2%, 27.4%, and 25.4% of cases, respectively. Our study noted immediate bleeding in 1.5% of cases, and no perforations or late complications. All complications were treated endoscopically, and no patient required blood transfusion or surgical intervention. Conclusion Endoscopic resection of rectocolic polyps is the ideal treatment for these lesions. In our department, the prevalence was 3.35%, the most used resection techniques were forceps resection and polypectomy, and the complication rate was 1.5%.
{"title":"Sporadic Rectocolic Polyps Prevalence and Management","authors":"S. Mrabti, A. Sair, A. Benhamdane, T. Addajou, R. Berrida, S. Sentissi, I. Koti, F. Rouibaa, A. Benkirane, H. Seddik","doi":"10.1055/s-0042-1757773","DOIUrl":"https://doi.org/10.1055/s-0042-1757773","url":null,"abstract":"Abstract Objective To evaluate the prevalence of polyps and their treatments. Materials and Method This is a retrospective study conducted in our department over 20 years and 3 months between January 2000 and March 2021. All patients with colorectal polyps who underwent endoscopic resection were included. We evaluated the resection techniques and the management of complications. Results The total number of patients was 273, with a mean age of 57.26 ± 14.058 (18–90) and a M/W sex ratio of 2. The prevalence was 3.35% and the mean number of polyps was 1.33 ± 0.69. The most frequent symptoms were rectal bleeding (23.5%) and constipation (12.1%). The median size was 6 mm (4–12 mm). The left colonic location was the most frequent site (43%). All polyps were classified according to the Paris classification, with a predominance of sessile polyps in 45.75%, followed by pedunculated polyps, representing 42.4%. Endoscopic resection was performed either by biopsy forceps, polypectomy, or mucosectomy in 30.2%, 27.4%, and 25.4% of cases, respectively. Our study noted immediate bleeding in 1.5% of cases, and no perforations or late complications. All complications were treated endoscopically, and no patient required blood transfusion or surgical intervention. Conclusion Endoscopic resection of rectocolic polyps is the ideal treatment for these lesions. In our department, the prevalence was 3.35%, the most used resection techniques were forceps resection and polypectomy, and the complication rate was 1.5%.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"42 1","pages":"290 - 295"},"PeriodicalIF":0.0,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44225936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keila Marcia Ferreira Macedo, A. L. L. Souza, F. M. Almeida, Nayara Tamillis Gonçalves Cruz Costa, Wagna Maria Araújo Oliveira, Maria Alves Barbosa, E. Oliveira
Introduction The relationship between obesity and physical activity is still unknown in specific groups, such as people living with ostomies. Objective To assess the prevalence of obesity and the level of physical activity in ostomized individuals. Methods A cross-sectional study with a population of ostomized patients in two hospitals of a Brazilian city. Obesity was assessed by the Body Mass Index (BMI) and physical activity, by the International Physical Activity Questionnaire. Results The study included 148 patients (55.4% of men [82]), with a mean age of 58.5 (±17.8) years, with 56.1% (83) of the sample aged 60 or older. Colostomies were identified as definitive in 67.6% (100), there were 28 cases (18.9%) of obesity, 67 (45.3%) overweight patients, and 31 (20.9%) subjects were underweight. Sedentary lifestyle was identified in 40.5% (60) of the participants. The mean BMI was significantly higher in men (25.9 ± 5.1), and a higher proportion of men were overweight (28; 34.1%); the underweight group had a greater proportion of women (20; 30.3%). An association between physical inactivity and underweight (p = 0.003) was found. Conclusion Most patients with ostomies, especially colostomies, are men over 60 years of age who are overweight or obese. In general, underweight individuals are more sedentary.
{"title":"Obesity and Physical Activity in Ostomized Patients","authors":"Keila Marcia Ferreira Macedo, A. L. L. Souza, F. M. Almeida, Nayara Tamillis Gonçalves Cruz Costa, Wagna Maria Araújo Oliveira, Maria Alves Barbosa, E. Oliveira","doi":"10.1055/s-0042-1754381","DOIUrl":"https://doi.org/10.1055/s-0042-1754381","url":null,"abstract":"\u0000 Introduction The relationship between obesity and physical activity is still unknown in specific groups, such as people living with ostomies.\u0000 Objective To assess the prevalence of obesity and the level of physical activity in ostomized individuals.\u0000 Methods A cross-sectional study with a population of ostomized patients in two hospitals of a Brazilian city. Obesity was assessed by the Body Mass Index (BMI) and physical activity, by the International Physical Activity Questionnaire.\u0000 Results The study included 148 patients (55.4% of men [82]), with a mean age of 58.5 (±17.8) years, with 56.1% (83) of the sample aged 60 or older. Colostomies were identified as definitive in 67.6% (100), there were 28 cases (18.9%) of obesity, 67 (45.3%) overweight patients, and 31 (20.9%) subjects were underweight. Sedentary lifestyle was identified in 40.5% (60) of the participants. The mean BMI was significantly higher in men (25.9 ± 5.1), and a higher proportion of men were overweight (28; 34.1%); the underweight group had a greater proportion of women (20; 30.3%). An association between physical inactivity and underweight (p = 0.003) was found.\u0000 Conclusion Most patients with ostomies, especially colostomies, are men over 60 years of age who are overweight or obese. In general, underweight individuals are more sedentary.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49480453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
João Henrique Sendrete de Pinho, L. Riscado, Marcos Paulo Moreira Sales, Gabriel Seixa de Souza, Abner Ramos de Castro, Cristiane de Souza Bechara
Abstract Objective To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results We were able to build a simulator and a colonoscope with a total amount of R$ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students.
{"title":"Low-cost Colonoscopic Simulator and Colonoscope to Train Basic Skills in Colonoscopy during Undergraduate Studies","authors":"João Henrique Sendrete de Pinho, L. Riscado, Marcos Paulo Moreira Sales, Gabriel Seixa de Souza, Abner Ramos de Castro, Cristiane de Souza Bechara","doi":"10.1055/s-0042-1757774","DOIUrl":"https://doi.org/10.1055/s-0042-1757774","url":null,"abstract":"Abstract Objective To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results We were able to build a simulator and a colonoscope with a total amount of R$ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"42 1","pages":"296 - 301"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43553739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Hiraki, Toshiya Tanaka, Mika Koga, Daisuke Miura, E. Sadashima, Hirofumi Sato, S. Mitsumizo, K. Kitahara
Objective Postoperative nausea and vomiting (PONV) is a frequent complication following colorectal surgery. The present study investigated the risk factors for PONV after colorectal cancer surgery. Methods A retrospective study of 204 patients who underwent surgery for colorectal cancer was conducted. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with PONV. Results The overall incidence of postoperative nausea (PON) and postoperative vomit (POV) was 26.5% (54/204), and 12.3% (25/204), respectively. The univariate analysis showed that female gender (p < 0.001), no current alcohol drinking habit (p = 0.003), and no stoma creation (p = 0.023) were associated with PON. Postoperative vomit was significantly correlated with female gender (p = 0.009), high body mass index (p = 0.017), and right-sided colon cancer (p = 0.001). The multivariate logistic regression analysis revealed that female gender (odds ratio [OR]: 4.225; 95% confidence interval [CI]: 2.170–8.226; p < 0.001) was an independent risk factor for PON. A high body mass index (OR: 1.148; 95%CI: 1.018–1.295; p = 0.025), and right-sided colon cancer (OR: 3.337; 95%CI: 1.287–8.652; p = 0.013) were independent risk factors for POV. Conclusion Our findings suggest that female gender for PON and a high body mass index and right-sided colon cancer for POV are risk factors after colorectal cancer surgery. An assessment using these factors might be helpful for predicting PONV.
{"title":"A Clinical Risk Analysis of Postoperative Nausea and Vomiting After Colorectal Cancer Surgery","authors":"M. Hiraki, Toshiya Tanaka, Mika Koga, Daisuke Miura, E. Sadashima, Hirofumi Sato, S. Mitsumizo, K. Kitahara","doi":"10.1055/s-0042-1748837","DOIUrl":"https://doi.org/10.1055/s-0042-1748837","url":null,"abstract":"\u0000 Objective Postoperative nausea and vomiting (PONV) is a frequent complication following colorectal surgery. The present study investigated the risk factors for PONV after colorectal cancer surgery.\u0000 Methods A retrospective study of 204 patients who underwent surgery for colorectal cancer was conducted. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with PONV.\u0000 Results The overall incidence of postoperative nausea (PON) and postoperative vomit (POV) was 26.5% (54/204), and 12.3% (25/204), respectively. The univariate analysis showed that female gender (p < 0.001), no current alcohol drinking habit (p = 0.003), and no stoma creation (p = 0.023) were associated with PON. Postoperative vomit was significantly correlated with female gender (p = 0.009), high body mass index (p = 0.017), and right-sided colon cancer (p = 0.001). The multivariate logistic regression analysis revealed that female gender (odds ratio [OR]: 4.225; 95% confidence interval [CI]: 2.170–8.226; p < 0.001) was an independent risk factor for PON. A high body mass index (OR: 1.148; 95%CI: 1.018–1.295; p = 0.025), and right-sided colon cancer (OR: 3.337; 95%CI: 1.287–8.652; p = 0.013) were independent risk factors for POV.\u0000 Conclusion Our findings suggest that female gender for PON and a high body mass index and right-sided colon cancer for POV are risk factors after colorectal cancer surgery. An assessment using these factors might be helpful for predicting PONV.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45197040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maruska Dib Iamut, M. Lacerda, Mário Araújo Júnior, J. Macedo, E. Klumb
Abstract Patients with systemic lupus erythematosus have a higher incidence of neoplasms associated with human papillomavirus infections, such as those that affect the vulva, the vagina, and the cervix; however, little is known about the frequency of anal cancer among these patients. Although there are recommendations for screening for this cancer in immunosuppressed individuals, it is possible that this procedure is not strictly followed. We describe the case of a 47-year-old woman with systemic lupus erythematosus who was treated with immunosuppressants and developed advanced anal squamous cell carcinoma after adequate treatment and healing of a high-grade cervical squamous intraepithelial lesion. Five years after the completion of the anal cancer treatment, the patient presented with cystic hepatic lesions that were histopathologically confirmed to be metastatic squamous cell carcinoma. This report aimed to highlight the need for anal cancer screening in patients with lupus, particularly if there was a history of cervical cytopathological alterations.
{"title":"Anal Cancer in Systemic Lupus Erythematosus Patients is a Neglected Condition","authors":"Maruska Dib Iamut, M. Lacerda, Mário Araújo Júnior, J. Macedo, E. Klumb","doi":"10.1055/s-0042-1760220","DOIUrl":"https://doi.org/10.1055/s-0042-1760220","url":null,"abstract":"Abstract Patients with systemic lupus erythematosus have a higher incidence of neoplasms associated with human papillomavirus infections, such as those that affect the vulva, the vagina, and the cervix; however, little is known about the frequency of anal cancer among these patients. Although there are recommendations for screening for this cancer in immunosuppressed individuals, it is possible that this procedure is not strictly followed. We describe the case of a 47-year-old woman with systemic lupus erythematosus who was treated with immunosuppressants and developed advanced anal squamous cell carcinoma after adequate treatment and healing of a high-grade cervical squamous intraepithelial lesion. Five years after the completion of the anal cancer treatment, the patient presented with cystic hepatic lesions that were histopathologically confirmed to be metastatic squamous cell carcinoma. This report aimed to highlight the need for anal cancer screening in patients with lupus, particularly if there was a history of cervical cytopathological alterations.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"43 1","pages":"052 - 055"},"PeriodicalIF":0.0,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47579092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Zoonotic pox infections have emerged as an intriguing new problem in infectious medicine in addition to the wellknownpox infections.1 There is a significant hazard to public health due to the spread of monkey pox throughout Europe.2 Zoonosis is thought to be the root cause of the resurgence of this odd pox disease.1 An increase in the number of reported cases across many nations has startled the medical community. Currently, human-to-human transmission is being watched. The medical community’s attention has been piqued by an increasing number of documented incidents in several nations.2 Monkeypox typically manifests as a fever and vesicular skin rash. Diarrhea and dysphagia are two uncommon clinical manifestations of the disease.3,4 The unusual presentation, which is challenging to identify, may be the initial presentation. In the present article, we want to talk about the earliest manifestations of monkeypox. Regarding the current epidemic scenario in Europe, homosexual males are the main groups affected, and skin lesions in the genitalia and anus are widespread. It may be difficult to notice the skin lesion because it may not present in other parts of the body. Regarding the protological issue, proctitis is additionally described as a clinical manifestation of monkeypox.5 Proctitis cases typically present lesions in the anus and genitalia as well as a history of anal sex. Finally, monkeypox patients frequently have thrombocytopenia.6 Melena or bleeding per anus may therefore be a clinical issue with monkeypox.
{"title":"Proctological Manifestation of Monkeypox","authors":"R. Mungmunpuntipantip, V. Wiwanitkit","doi":"10.1055/s-0042-1754385","DOIUrl":"https://doi.org/10.1055/s-0042-1754385","url":null,"abstract":"Dear Editor, Zoonotic pox infections have emerged as an intriguing new problem in infectious medicine in addition to the wellknownpox infections.1 There is a significant hazard to public health due to the spread of monkey pox throughout Europe.2 Zoonosis is thought to be the root cause of the resurgence of this odd pox disease.1 An increase in the number of reported cases across many nations has startled the medical community. Currently, human-to-human transmission is being watched. The medical community’s attention has been piqued by an increasing number of documented incidents in several nations.2 Monkeypox typically manifests as a fever and vesicular skin rash. Diarrhea and dysphagia are two uncommon clinical manifestations of the disease.3,4 The unusual presentation, which is challenging to identify, may be the initial presentation. In the present article, we want to talk about the earliest manifestations of monkeypox. Regarding the current epidemic scenario in Europe, homosexual males are the main groups affected, and skin lesions in the genitalia and anus are widespread. It may be difficult to notice the skin lesion because it may not present in other parts of the body. Regarding the protological issue, proctitis is additionally described as a clinical manifestation of monkeypox.5 Proctitis cases typically present lesions in the anus and genitalia as well as a history of anal sex. Finally, monkeypox patients frequently have thrombocytopenia.6 Melena or bleeding per anus may therefore be a clinical issue with monkeypox.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48913986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse. Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions. Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse. Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system. Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.
{"title":"Doppler Ultrasound Testing Suggests Hemorrhoids in Females may be a Consequence of Impaired Blood Flow Associated with Pelvic Organ Prolapse","authors":"T. Enache, Diana-Elena Soare","doi":"10.1055/s-0042-1754383","DOIUrl":"https://doi.org/10.1055/s-0042-1754383","url":null,"abstract":"\u0000 Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse.\u0000 Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions.\u0000 Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse.\u0000 Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system.\u0000 Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42618656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Lemanski, Anna Laura Duro Barp, Gabriela Kohl Hammacher, Martina Estacia Da Cas, Cristine Moratelli Wink, A. P. D. S. Voloski, A. Pasqualotti, Cristiane da Silva Rodrigues de Araújo
Introduction Streptococcus gallolyticus belongs to the Streptococcus bovis complex, and it is a common bacterium colonizing the gastrointestinal tract. Its presence in the blood may suggest an underlying pathology such as a colonic neoplasm. We report herein a case of S. bovis bacteremia in an apheresis platelet donor, review similar cases in the literature, and suggest a flowchart for the management of similar cases in other blood donation centers. Case Presentation A 61-year-old subject presented to a Hemotherapy Service to make an apheresis platelet donation. On quality control testing, S. gallolyticus was identified in hemoculture, and the donor was called back for follow-up. At first, a new hemoculture was requested, and the patient was referred to the outpatient department of infectious diseases to further investigate pathologies associated with S. gallolyticus. A subsequent colonoscopy investigation evidenced a polypoid structure in the ascending colon. Pathology reported the resected specimen as a low-grade tubular adenoma. Conclusion Isolation of S. bovis in blood products requires further investigation and should be managed with precision by Hemotherapy Services. A standard protocol for the management of asymptomatic patients with S. bovis positive hemoculture, with the requests of a new blood culture, a colonoscopy, and an echocardiogram is crucial, as it may ensure early diagnosis and reduce morbidity and mortality.
{"title":"Streptococcus gallolyticus Bacteremia Detected in Apheresis Platelets and Its Link to Colonic Neoplasms","authors":"F. Lemanski, Anna Laura Duro Barp, Gabriela Kohl Hammacher, Martina Estacia Da Cas, Cristine Moratelli Wink, A. P. D. S. Voloski, A. Pasqualotti, Cristiane da Silva Rodrigues de Araújo","doi":"10.1055/s-0042-1754384","DOIUrl":"https://doi.org/10.1055/s-0042-1754384","url":null,"abstract":"Introduction Streptococcus gallolyticus belongs to the Streptococcus bovis complex, and it is a common bacterium colonizing the gastrointestinal tract. Its presence in the blood may suggest an underlying pathology such as a colonic neoplasm. We report herein a case of S. bovis bacteremia in an apheresis platelet donor, review similar cases in the literature, and suggest a flowchart for the management of similar cases in other blood donation centers.\u0000 Case Presentation A 61-year-old subject presented to a Hemotherapy Service to make an apheresis platelet donation. On quality control testing, S. gallolyticus was identified in hemoculture, and the donor was called back for follow-up. At first, a new hemoculture was requested, and the patient was referred to the outpatient department of infectious diseases to further investigate pathologies associated with S. gallolyticus. A subsequent colonoscopy investigation evidenced a polypoid structure in the ascending colon. Pathology reported the resected specimen as a low-grade tubular adenoma.\u0000 Conclusion Isolation of S. bovis in blood products requires further investigation and should be managed with precision by Hemotherapy Services. A standard protocol for the management of asymptomatic patients with S. bovis positive hemoculture, with the requests of a new blood culture, a colonoscopy, and an echocardiogram is crucial, as it may ensure early diagnosis and reduce morbidity and mortality.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42081230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isaac José Felippe Corrêa Neto, Juliana Lazzarini Pizzo, Amanda Gambi Robles, Leonardo Mauri, L. Robles
Introduction Chronic constipation (CC) is a highly prevalent disease in Western society. Chronic constipation can have a different etiology in patients who underwent a cesarean section and result from postoperative stress and metabolic response to trauma, analgesic agents, immobilization, and dietary restrictions. Chronic constipation may also occur due to puerperium-related psychological changes and to the stretching and weakening of the perineal and abdominal muscles after childbirth. Objectives The present study analyzes intestinal transit restoration after a cesarean section and the influence of osmotic laxative agents. Methods The present prospective, nonrandomized sample study used the ROME III questionnaire and the Bristol stool scale in adult women who underwent a cesarean section. We divided the subjects into 2 groups, each with 30 patients, to compare the effect of the prophylactic administration of an osmotic laxative. Results We evaluated 60 randomly-chosen pregnant women from the Obstetrics ward of Hospital Santa Marcelina, São Paulo, SP, Brazil, from October 2019 to March 2020. Their mean age was 26.8 years old, and the mean gestation time was 37.95 weeks. Ten patients (16.7%) presented with constipation before the cesarean section, and 38 (63.3%) had a bowel movement after the procedure. However, in 84.2% of these patients, the usual stool consistency worsened. After the cesarean section, 46.7% of the women who did not receive laxative agents had a bowel movement, compared with 80% of those who did (p = 0.0074). Conclusion Some factors, including those related to the procedure, may hamper intestinal transit restoration after a cesarean section. Osmotic laxative agents can facilitate transit restoration with no negative effects in this group of patients.
{"title":"Does Prophylactic Use of Postcesarean Section Laxatives Favor Bowel Movements?","authors":"Isaac José Felippe Corrêa Neto, Juliana Lazzarini Pizzo, Amanda Gambi Robles, Leonardo Mauri, L. Robles","doi":"10.1055/s-0042-1754382","DOIUrl":"https://doi.org/10.1055/s-0042-1754382","url":null,"abstract":"\u0000 Introduction Chronic constipation (CC) is a highly prevalent disease in Western society. Chronic constipation can have a different etiology in patients who underwent a cesarean section and result from postoperative stress and metabolic response to trauma, analgesic agents, immobilization, and dietary restrictions. Chronic constipation may also occur due to puerperium-related psychological changes and to the stretching and weakening of the perineal and abdominal muscles after childbirth.\u0000 Objectives The present study analyzes intestinal transit restoration after a cesarean section and the influence of osmotic laxative agents.\u0000 Methods The present prospective, nonrandomized sample study used the ROME III questionnaire and the Bristol stool scale in adult women who underwent a cesarean section. We divided the subjects into 2 groups, each with 30 patients, to compare the effect of the prophylactic administration of an osmotic laxative.\u0000 Results We evaluated 60 randomly-chosen pregnant women from the Obstetrics ward of Hospital Santa Marcelina, São Paulo, SP, Brazil, from October 2019 to March 2020. Their mean age was 26.8 years old, and the mean gestation time was 37.95 weeks. Ten patients (16.7%) presented with constipation before the cesarean section, and 38 (63.3%) had a bowel movement after the procedure. However, in 84.2% of these patients, the usual stool consistency worsened. After the cesarean section, 46.7% of the women who did not receive laxative agents had a bowel movement, compared with 80% of those who did (p = 0.0074).\u0000 Conclusion Some factors, including those related to the procedure, may hamper intestinal transit restoration after a cesarean section. Osmotic laxative agents can facilitate transit restoration with no negative effects in this group of patients.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47975370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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