Marcelo Maia Caixeta de Melo

Terminal ileum of patients who underwent colonoscopy: endoscopic, histologic and clinical aspects

CONTEXT For the diagnosis of the diseases which affect the terminal ileum, the colonoscopy allows macroscopic evaluation and the performing of biopsies. Studies with criteria for the endoscopic and histological characterization of this segment are scarce and there are still some doubts about the need of biopsies in patients with normal ileoscopy. OBJECTIVE Study the terminal ileum of patients who underwent colonoscopy considering: endoscopic and histological correlation; agreement between results of the initial histological evaluation and slides review, and the chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea to show histological alterations. METHODS In a prospective study, 111 patients who presented smooth mucosa without enanthema in the endoscopic exam of the terminal ileum were selected. Biopsies of the ileal mucosa of such patients were performed, being the slides routinely examined and reviewed afterwards. RESULTS The correlation between patients with normal ileoscopy and ileum with preserved histological architecture was of 99.1%. The agreement between initial histological evaluation and slides review calculated by the Kappa test was 0.21. In patients with abdominal pain and/or chronic diarrhea, the chance of showing histological alterations was 2.5 times higher than the others. CONCLUSIONS The correlation between endoscopic and histological findings was high. The agreement between the initial histologic evaluation and slides review was not satisfactory. The chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea, showing histological alterations was higher in relation to the asymptomatic ones or with other symptoms, although the clinical importance of this datum was not evaluated.

Prevalence of rectoanal inhibitory reflex in chagasic megacolon

BACKGROUND Rectoanal inhibitory reflex is not always evident in patients with chagasic megacolon. This may be due to insufficient volumes of air used during insufflation for the manometric examination. AIMS To identify the volume of air necessary to induce rectoanal inhibitory reflex in patients with chagasic megacolon and to observe its prevalence in these individuals. METHODS Rectoanal inhibitory reflex in 39 patient with chagasic megacolon was studied by means of anorectal manometry using the balloon method. The balloon was insufflated using sequential volumes up to 300 mL to induce reflex. RESULTS Rectoanal inhibitory reflex was identified in 43.6% of the patients using a mean volume of 196 mL of insufflated air (standard error = 13.5). CONCLUSION Rectoanal inhibitory reflex can be induced in patients with chagasic megacolon when greater volumes of air are used.

Endoscopic aspects in the diagnosis of terminal ileum diseases

The ileum is approximately the most distal three-fifths of the small intestine and is responsible for the digestion and the absorption of foods. The diagnosis of diseases that affects this segment can be achieved by clinical evaluation and complementary examinations. Not only does ileocolonoscopy allow macroscopical analysis, but also enables biopsies to be carried out for histological evaluation. Only three publications about the description of the endoscopic characteristics of the terminal ileum have been found in the literature. Even so, there have not been found descriptions or classifications in publications that mentioned endoscopic aspect of the terminal ileum, being reported only as normal ileum. Therefore, this strengthens the idea of the lack of knowledge or the non-acceptance of these descriptions and these classifications by the scientific community. Endoscopic aspects of this segment when affected by several diseases vary from normal endoscopically ileum to cases when the macroscopical examination demonstrate specific features of these illnesses. In the present investigation, there are doubts about the need of biopsy of this segment in patients with normal ileoscopy. Moreover, few studies with criteria for macroscopical and microscopical characterization of the ileum were found.

Colorectal cancer and situs inversus totalis: case report.

Situs inversus totalis is a rare congenital condition that occurs in one out of 4000–20000 people, characterized by complete transposition of the thoracic and abdominal viscera1-14. In contrast, situs solitus is a term that refers to the normal arrangement of body organs. Any disposition of organs between these two extremes is designated by situs ambiguous, situs transversus or situs inversus partialis8. The etiologic nature of this anomaly is not known. This condition is typically associated with normal life expectancy unless a gastrointestinal or cardiac anomaly is present 2,8. The typical cardiac anomaly has from 3–5% incidence, is transposition of the great vessels, and 80% of these patients have a right sided aortic arch5. Other vascular anomalies are variation of celiac trunk and superior mesenteric artery4. There are also anomalies of the gastrointestinal system to include biliary tree atresia, duodenal atresia, preduodenal portal vein, colonic aganglionosis, malrotation of the intestine, polysplenia/asplenia, anular pancreas, diaphragmatic hernia and others4,5. Moreover, it may be associated with clinical syndromes, like Kartagener’s (situs inversus, chronic rhinosinusitis and bronchiectasias)14. This anomaly is not a premalignant condition. However, many cases of malignant neoplasms and situs inversus totalis have been reported, especially gastric cancer8. Association between colorectal cancer and situs inversus totalis is rare.

Linfoma primário de cólon: relato de caso

O linfoma colorretal primario e uma doenca rara (0.2 a 0.6% de todas as neoplasias colonicas), apresentando pior prognostico quando comparado com o linfoma gastrico primario ou com o adenocarcinoma do colon. E uma doenca com sintomatologia inespecifica, o que dificulta o diagnostico precoce. O objetivo deste relato e mostrar um caso de linfoma primario do colon, revisar criterios diagnosticos e tratamento.

CARCINOMA ESPINOCELULAR DE PADRÃO BASALOIDE EM MARGEM ANAL: RELATO DE CASO

Priscila Oliveira Cardoso a, Luciana Maria Pyramo Costa b, Mateus Sewastjanow Silva a, Marco Antônio Miranda Silveira b, Marina Varella Braga de Oliveira c, Jessica Gerundi Guimarães c, Andy Petroianu a a Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil b Instituto de Previdência dos Servidores do Estado de Minas Gerais (Ipsemg), Belo Horizonte, MG, Brasil c Hospital Alberto Cavalcanti (HAC), Fundação Hospitalar do Estado de Minas Gerais (Fhemig), Belo Horizonte, MG, Brasil

Intestinal obstruction caused by phytobezoar composed of jaboticaba seeds: case report and literature review

Bezoar is a cluster of swallowed and undigested material in the gastrointestinal tract which can cause intestinal obstruction. It has multiple subtypes and the phytobezoar (composed of vegetable fiber) is the most common. We report a patient admitted with intestinal obstruction caused by impaction of multiples seeds of jaboticaba in the rectum. The treatment included multiple enemas, laxatives and digital maneuvers and it was effective after four days. Only one similar report was found in the literature.