Local treatment of colostomy prolapse with the MESH STRIP technique: A novel and highly efficient day hospital technique

OBJECTIVE: Stoma prolapse is an intussusception of the bowel through a mature stoma. It can be caused by increased intra-abdominal pressure, excessively mobile bowel mesentery and/or a large opening in the abdominal wall at the time of stoma formation. It occurs predominantly in loop stomas, and correction methods include conservative modalities, such as local reduction to the prolapsed bowel, or surgical treatment. The purpose of this study was to describe our experience with the treatment of colostomy prolapse using a novel mesh strip technique. METHODS: Between February 2009 and March 2018, ten consecutive male patients underwent correction of colostomy prolapse under local anesthesia by peristomal placement of a polypropylene mesh strip. Operation time, short- and long-term complications, and recurrence rates were recorded and analyzed. RESULTS: No postoperative complications, morbidity or mortality were observed. The median length of the prolapse ranged from 6-20 cm, and the median operative time was 30 minutes. The median duration of follow-up was 25 months (range, 12-89 months). No relapse, mesh strip extrusion, local infection or granuloma formation were found. CONCLUSION: A simple, fast, and low-cost operation under local anesthesia using a mesh strip is a valuable option to treat colostomy prolapse

Is there a higher frequency of dysplasia and anal infection by the human papillomavirus in patients with Crohn\'s disease?

O objetivo deste estudo foi comparar a frequência de displasia e infecção pelo papilomavírus humano (HPV) no canal anal de pacientes com doença de Crohn (DC) a um grupo controle, utilizando a citologia por esfregaço e a detecção viral por reação em cadeia da polimerase (PCR) seguida de hibridização, avaliar se há correlação do uso de imunossupressores e manifestação anal da doença com essas frequências, além de estabelecer se há concordância entre os dois métodos utilizados. Inicialmente, foram selecionados dois grupos: portadores de DC e outro de indivíduos hígidos (grupo controle). Todos os indivíduos foram submetidos à coleta de citologia anal por esfregaço com duas escovas e uma terceira que foi preservada em meio líquido para PCR. As lâminas foram classificadas de acordo com a classificação de Bethesda em: normal, células escamosas atípicas de significado indeterminado (ASCUS), lesão intraepitelial escamosa de baixo grau (LSIL) e lesão intraepitelial escamosa de alto grau (HSIL). A análise da PCR foi considerada como positiva ou negativa e os tipos 16 e de alto risco oncogênico foram identificados no primeiro grupo. Dados como uso de imunossupressores e presença da manifestação anal da DC foram considerados nas subanálises. Como resultado, 117 pacientes foram submetidos a coleta de citologia anal e detecção viral do HPV pela PCR. O grupo controle foi formado por 54 indivíduos e o DC por 63 (32 sem uso de imunossupressor e 31 em uso destas medicações). ASCUS e LSIL representaram respectivamente 25,9% e 22,2% dos pacientes controle e 28,6% e 39,7% dos DC, não havendo diferença estatisticamente significativa entre os grupos. HPV foi identificado em 14,8% dos pacientes do grupo controle e 27% dos pacientes com DC pela PCR, sendo predominantemente de alto risco nos dois grupos. A análise dos subgrupos DC sem e com o uso de imunossupressores também não apresentou diferença estatística entre as frequências encontradas pela PCR. A manifestação anal da DC se correlacionou inversamente com a frequência de HPV pela detecção viral, isto é, pacientes com comprometimento inflamatório anal apresentaram menor prevalência de PCR positiva. O coeficiente Kappa, utilizado para comparar a citologia anal por esfregaço e PCR, foi 0,068 na casuística total, denotando baixa concordância. Este estudo permite concluir que na amostra estudada não houve diferença entre displasia e infecção anal pelo HPV na comparação entre pacientes controle e DC. O uso de imunossupressores não influenciou este resultado, no entanto a manifestação anal da DC foi inversamente proporcional a positividade na PCR. Há baixa concordância entre citologia anal por esfregaço e detecção viral do HPV pela PCR seguida de hibridização na amostra estudadaThe aim of this study is to compare the frequency of dysplasia and anal infection by human papillomavirus (HPV) between two groups, one of patients with Crohn´s disease (DC) and another one with healthy individuals (control group). The study used the anal cytology and the polymerase chain reaction (PCR) followed by hybridization. In addition, this study evaluate association with the use of immunosuppressant and the anal phenotype of the inflammatory bowel disease and establish if there is agreement between the both methods. From all individuals, three anal samples collected by brushes were obtained; the first two were used to the cytology and the third to PCR. Bethesda classification was applied in cytology evaluation (normal, atypical squamous cells of undetermined significance (ASCUS), low-grade intraepithelial lesion (LSIL) and high-grade (HSIL). The PCR analysis were classified in positive or negative and the first was evaluated according presence of types 16 and high oncogenic risk virus.117 patients were enrolled in this study, the control group had 54 individuals e DC had 63 (32 without using immunosuppressant and 31 with it). ASCUS and LSIL represented respectively 25,9% and 22,2% of control group and 28,6% and 39,7% of DC (differences statistically insignificant). HPV was identified in 14,8% of controls individuals and 27% from DC group using the PCR. The high oncogenic risk type was prevalent in both groups. The analysis of the subgroups DC with and without immunosuppressant did not show differences in PCR frequencies. The anal manifestation of DC was inversely proportional to the HPV frequency by PCR; therefore, anal manifestation may play a protective role. The Kappa coefficient, used to compare the agreement between two methods was 0,068, meaning low level of agreement. In conclusion, there was no difference in frequencies of dysplasia and viral infection between the two main groups. The use of immunosuppressant did not change the results, although the anal inflammatory disease was inversely proportional to the frequency of HPV infection. There was no agreement between the two different methods applied in this populatio

Preoperative embolization of a cavernous hemangioma of the rectum

Colorectal cavernous hemangioma is a rare benign vascular neoplasia that may be found in any segment of the colon and cause recurrent and painless rectal bleeding. Standard treatment of rectal hemangioma consists of resection of the affected segment followed by coloanal anastomosis. Massive bleeding during the operation is the most feared complication, especially during extensive resection or reoperation. The authors describe a preoperative embolization of a rectal hemangioma with Onyx-18(r) and microspheres, in a 49-year-old patient with successful prevention of uncontrolled hemorrhage during surgery