Juliana Ferreira Martins

Postoperative topical analgesia of hemorrhoidectomy with policresulen and cinchocaine: a prospective and controlled study

OBJECTIVE To evaluate the effects of topical policresulen and cinchocaine in the postoperative pain behavior of open hemorrhoidectomy. METHODS We conducted a prospective, double-blinded, controlled study. The control group received the usual guidelines with oral medications. The topical treatment group received, in addition, the application of the ointment and was comprised of two subgroups (policresulen + cinchocaine, and placebo). Pain intensity was recorded with the visual analogue scale. RESULTS 43 patients were operated on: control group - n = 13, one excluded; placebo - n = 15; and policresulen + cinchocaine - n = 15. The mean age was 45.98 years and 37.2% were men. The average pain intensity was 4.09 (immediate postoperative), 3.22 (hospital discharge), 5.73 (day 1) , 5.77 (day 2), 5.74 (day 3), 5.65 (day 7), 5.11 (day 10), 2.75 (day 15) and 7.70 (first bowel movement), with no difference between groups in all periods. CONCLUSION This study showed no reduction in pain after hemorrhoidectomy with the use of topical policresulen and cinchocaine.

Análise das complicações tardias em operações anorretais: experiência de um serviço de referência em coloproctologia

INTRODUCTION: anorectal procedures consist 80% of surgical cases in colorectal surgery practice. The exact rate of long-term complications after anorectal surgery is unknown. This number is variable according to the medical centres and the type of procedures. OBJECTIVE: to evaluate the long-term complications secondary to anorectal procedures, as well as the risk factors that might be associated with these complications. METHOD: retrospective analysis, including anorectal procedures performed between January 2007 and July 2009. The characteristics analyzed were: sex, age, type of surgery, health system, long-term complications and reoperations performed. RESULTS: 430 patients submitted to 453 anorectal procedures were studied (54,4% female). Hemorrhoidectomy was the most common procedure (50,3% of all operations). The mean period of follow-up was 164,7 days and 102 long-term complications were identified, occurring in 22,52% of all procedures. Residual fissure in ano was the most frequent complication (54%, n=55). Only 38 patients needed reoperation (8,83% of all cases). There was no statistical significance between sex, age, health system and type of surgery in relation to the complications found. CONCLUSIONS: the long-term complication rate was 22,52%, with reoperations performed in 8,83% of all patients. There was no risk factor for long-term complications identified in this case series.

Necrose pelvi-perineal pós-radioterapia para câncer de próstata: relato de caso

Around 75% of the patients submitted to radiotherapy for prostate cancer will develop anorectal symptoms, such as fecal urgency, bleeding, rectal pain and tenesmus. Perineal necrosis is a very rare event in these cases. The purpose of this report is the description of a diffuse perineal necrosis due to radiotherapy for the treatment of prostate cancer. This is a report of a 77-year old male, submitted to radiotherapy with 70 Gy of pelvic radiation for prostate cancer treatment. He came to outpatient practice after 4 months with anorectal complaints. Further investigation revealed severe radiation proctitis, with a perineal wound and external anal sphincter damage. The patient was submitted to a loop transverse colostomy with extended perineal debulking due to diffuse necrosis of pelvic structures, such as prostate, pelvic floor muscles and anterior rectal wall. Hyperbaric oxygen therapy was started for the extended perineal wound, with success. Prevention is the key to avoid radiation damage in pelvic organs. Doses above 70 Gy are associated with high risk of associated pelvic complications. The treatment of diffuse perineal necrosis must be prompt and aggressive. Fecal diversion is mandatory in cases with extended sphincter destruction.

Procedimento de ladd para má rotação intestinal no adulto: relato de caso

abstraCt – Background – The differential diagnosis of the unconscious patient must always include hyperosmolar hyperglycemic non-ketotic hypothesis. Case report – A 22 year-old woman, ABO – O+ with history of fatigability and jaundice. Physical examination revealed a markedly jaundice patient. Fulminant hepatic failure was the diagnostic. Liver transplant was performed from a brain- dead cadaver donor with success. Arterial hepatic thrombosis was considered one week after liver transplant and confirmed with Doppler-US. The hepatic retransplant occurred without problems. After two days of liver transplant the serum glucose was 600 mg/dl and unconsciousness. Hyperosmolar coma was controlled and treated with succes for 48 h. The patient left the hospital after 30 days of liver transplantation without diabetes. Conclusion – Hyperosmolar coma is an rare event after liver transplant. The early recognition and treatment of this disorder should result in improvement of evolution. Headings – Liver transplantation. Hyperosmolar. Hyperglycemic.

Infestação por miíase em prolapso retal: relato de caso e revisão de literatura

INTRODUCTION: myiasis is an infection of human tissues with dipterous fly larvae. It is commonly located in human skin, however, it is described in natural orifices. This condition is treated by mechanical extraction of larvae associated with damaged tissue ressection. OBJECTIVE: case report of a patient with myiasis infection of rectal prolapse, emphasizing its incidence, symptoms and treatment options. CASE REPORT: L.C.S., a 36-year-old male, with rectal prolapse complaints for one year, with bad sanitary conditions. Proctological examination revealed rectal prolapsed with necrosis areas affected by myiasis. Larvae remotion was realized with necrotic tissue resection. A loop-sigmoid colostomy was performed due to extensive perineal wound and internal sphincter damage. CONCLUSIONS: rectal prolapse with myiasis infection is rare, and must have prompt diagnosis and treatment. A simple perineal examination is essential. We emphasize continous health education and basic hygiene measures for the population.

Análise da prevalência de entidades coloproctológicas nos pacientes idosos do serviço de coloproctologia de um hospital universitário

INTRODUCTION: It is expected that in 2020, elderly people will reach 13% of the Brazilian population. This involves epidemiologic and medical concerns. There is few data in the literature regarding colorectal and anal diseases in this population. OBJECTIVE: to compare data about colorectal and anal conditions in elderly people (older than 60 years) with younger patients, including associated diseases, surgical procedures and complications. METHOD: The charts of the patients of the outpatient colorectal unit were retrospectively reviewed. They were divided in two groups: older than 60 years (group I) and younger than 60 years (controls, group II). RESULTS: 1126 patients were included in this study. 19,36% were older than 60 years. The average number of complaints in the group I was 1,21. Abdominal pain, constipation, diarrhea and positive fecal occult blood test were more frequent in the elderly. Anorectal complaints were more prevalent in the control group. The more prevalent conditions in group I, with statistical significance, were: diverticular disease, colorectal polyps and colorectal cancer. In group I, 58,36% had associated diseases. There was no statistical significance between the groups regarding surgical procedures and complications. CONCLUSIONS: Colonic diseases were more prevalent in the elderly group. They had more associated diseases compared with younger patients. There was no statistical difference between the groups regarding surgical treatment and complications.

Análise de custos entre a raquianestesia e a anestesia venosa com propofol associada ao bloqueio perianal local em operações anorretais

BACKGROUND: Approximately ninety percent of anorectal surgical procedures are performed in ambulatory basis. The choice of a proper anesthetic technique is important to achieve shorter hospital stay and low costs. Theres no evidence in the literature that an ideal type of anesthesia for these procedures exists. AIM: To compare the costs of patients operated with spinal anesthesia (0,5% bupivacaine) with combined anesthesia (propofol and local perineal block with 2% lidocaine and 0,5% bupivacaine) in anorectal surgical procedures. METHODS: Data from 99 patients submitted to anorectal operations were retrospectively analyzed. They were divided in two groups: 50 patients were operated with spinal anesthesia (group I) and 49 with combined anesthesia (group II). The type of operation, the time of hospital stay, the time of anesthetic and surgical procedure and the costs were analyzed. RESULTS: There were no significant differences between the studied groups regarding the type of operation, gender, age and complications. The time of anesthetic and surgical procedures was 53,1 minutes in group I and 44,08 minutes in group II (P=0,034). The average time of hospital stay was 19,68 hours in group I and 7,08 hours in group II (P<0,0001). The average cost of the procedures was R

Sacrococcygeal hernia: a challenge for the coloproctologist

296,49 in group I and R

Complication Rates After Bowel Resections for Crohnʼs Disease: A Brazilian Single-Center Comparison Between Laparoscopic And Conventional Surgery: P-110

280,27 in group II (P=0,73). CONCLUSIONS: Anorectal procedures with combined anesthesia (propofol and local perineal block) had similar costs than those with spinal anesthesia. There was a lower time of anesthetic and surgical procedures and shorter hospital stay in the combined anesthesia group.

Análise do número de linfonodos em espécimes de ressecções colorretais por neoplasia entre a cirurgia aberta e videolaparoscópica

Sacrococcygeal hernia consists of the protrusion of abdominal and pelvic structures through the sacrococcygeal region, an uncommom complication of coccygectomy and sacral coccygectomy. Its surgical treatment is based on perineal hernia repair, by means of abdominal, perineal or abdominoperineal access. Perineal (local or sacrococcygeal) access avoids the laparotomy morbidity and is indicated to patients that are not exposed to radiation or those who had not undergone oncological surgery, allowing local tissue to reconstruct, as in myocutaneous advancement flaps, associated or not to prosthetic mesh, because of the low complication rates and favourable outcomes. The aim of this article is to report the case of a female patient who had undergone sacral coccygectomy due to refractory coccygodynia and developed a symptomatic sacrococcygeal hernia. She underwent polytetrafluoroethylene mesh herniorrhaphy followed by soft tissue closure and gluteal myocutaneous V-Y advancement flap. The authors emphasize technical details and the difficulty of the procedure itself. After three years of follow-up, no recurrence was found.