Pacientes jovens com doenças anais : é recomendada a realização de colonoscopia?

Introdução: A incidência de câncer colorretal vêm diminuindo na população acima dos 50 anos, possivelmente pelo emprego do rastreamento nesta faixa etária. Por razões ainda desconhecidas, as taxas desta neoplasia têm aumentado em pacientes jovens. Apesar deste aumento de incidência, as diretrizes atuais não definem a abordagem diagnóstica ideal nos pacientes com menos de 50 anos que consultam por doenças orificiais benignas, cenário comum no dia a dia do coloproctologista. Objetivo: Avaliar a prevalência de alterações em colonoscopias de pacientes com menos de 50 anos de idade que consultam por doenças anais. Método: Estudo observacional, prospectivo e unicêntrico. Foram realizadas colonoscopias nos pacientes com menos de 50 anos de idade atendidos por doenças anais benignas. Resultado: Foram incluídos 200 pacientes e 39% deles apresentaram alterações na colonoscopia. A prevalência de adenomas no grupo foi de 18% (15,5% em pacientes com menos de 40 anos e 19,5% nos pacientes com 40 a 49 anos). Um paciente foi diagnosticado com câncer colorretal e em outro foi indicada colectomia pela presença de adenoma não ressecável à colonoscopia. Conclusão: Nosso estudo encontrou uma prevalência de adenomas maior do que a relatada em estudos prévios com população de mesma faixa etária. Acreditamos que a indicação de colonoscopia no grupo jovem com doenças orificiais seja uma oportunidade de prevenção, interrompendo a cadeia de eventos que levará à formação dos tumores colorretais.Introduction: The incidence of colorectal cancer has been decreasing in the population over 50 years, possibly by the uptake of screening in this age group. The rates of this neoplasm have increased in young patients. The reasons for this are not fully understood. Despite this increased incidence, the current guidelines do not define the ideal diagnostic approach in patients under 50 years who are referred for benign anal diseases, a common scenario in the coloproctologist's daily life. Objective: To evaluate the prevalence of alterations in colonoscopies of patients under 50 years of age who consult for anal diseases. Method: Observational, prospective and unicentric study. Colonoscopies were performed in patients less than 50 years of age who were attended by benign anal diseases. Outcome: 200 patients were included and 39% of the patients presented changes in colonoscopy. The prevalence of adenomas in the group was 18% (15.5% in patients younger than 40 years and 19.5% in patients 40-49 years old). One patient was diagnosed with colorectal cancer and in another colectomy was indicated for the presence of unresectable adenoma at colonoscopy. Conclusion: Our study found a higher prevalence of adenomas than reported in previous studies with the same age group. We believe that the indication of colonoscopy in the young group with orifice diseases is an opportunity for prevention, interrupting the chain of events that will lead to the formation of colorectal tumors

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

Purpose: To investigate if fluorescein fluorescent test can predict dehiscence in a model of ischemic colonic anastomosis in rats. Methods: This experimental controlled trial randomly assigned 55 rats to four groups. Anastomoses were performed in non-ischemic colon segments (control group) and in ischemic colon segments measuring 1, 2 or 3 cm long (groups 1, 2 and 3, respectively). Fluorescein was injected and the tissues were examined under ultraviolet light. Seven days later, a second-look surgery was performed to check for the presence or absence of anastomosis dehiscence. Results: Twenty-four rats presented anastomotic dehiscence during the second-look surgery. Reticular and nonfluorescent patterns were significantly associated with the occurrence of anastomotic dehiscence. Fluorescein fluorescence had a sensitivity of 95.8%, specificity of 89.2%, positive predictive value of 88.4%, negative predictive value of 96.2%, and accuracy of 92.3% to predict anastomotic dehiscence. Conclusion: Fluorescein fluorescent test can accurately predict leak in a model of ischemic colonic anastomosis in rats