Valdemir José Alegre Salles

Neoplasia no sítio da colostomia: relato de três casos e revisão da literatura

Carcinomas rarely occur at the site of a colostomy. Colostomies are risk for malignancy, just as in any other portion of the colon. If the initial resection was for cancer, then the risk of metachronous colon adenocarcinoma is significantly higher than for the general population. Metachronous colorectal carcinoma occurs from 0.1 to 3.6 percent of patients who undergo surgery for colorectal carcinoma and the recurrence of the primary bowel malignancy that necessitated the stoma may present with signs of bleeding or obstruction. We report three cases of this rare neoplasia occurring at the site of a colostomy, and we review the literature.

Complication related to colostomy orifice: intestinal evisceration

Intestinal evisceration at the site of a stoma is a rare event, with high morbimortality. Its clinical manifestation often occurs between the sixth and seventh days after surgery. The risk factors most frequently related to evisceration are: increased intra-abdominal pressure, digestive tract cancer surgery, emergency surgery and stomas in the surgical incision. The authors report the case of a male patient, aged 62, suffering from adenocarcinoma of the rectum with obstructive acute abdomen, who underwent loop transversotomy for decompression. On the fourth day after surgery, he had a bronchospasm crisis, with evisceration of ileum and colon through the colostomic hole. The association of some triggering factors, such as emergency surgery, colorectal malignant neoplasm, increased intra-abdominal pressure and technical failure of colostomy were decisive in the development of this rare peri-colostomy complication.

Influência da idade e da doença colorretal na imunocompetência cutânea peri-colostômica

Objective: describe the immunological response in the dermal layer of the peri-colostomic region. Method: Forty-one patients with colostomies realized over eight weeks previously, were included. For the analysis of the immunocellular response in the peri-colostomic dermal region, the values of Pan T lymphocytes, T lymphocytes - helper, T lymphocytes - cytotoxic, lymphocytes B, T lymphocytes - Natural Killer and macrophages. Results: Analysis of the immuno-cellular response showed that both in the benign colorectal disease as well as in the malignant one number of Pan T lymphocytes, T lymphocytes - helper, T lymphocytes - cytotoxic and macrophages were statistically significant relationship major than B Lymphocytes and T lymphocytes - Natural Killer. Analysis of the immuno-cellular response based on age, demonstrated that both the adult age bracket as well as the geriatric one, displayed a major number of Pan T lymphocytes, T lymphocytes - helper and macrophages, with their numerical value significantly than the B lymphocytes and the T lymphocytes - Natural Killer, beyond the T lymphocytes - cytotoxic with the B lymphocytes and the T lymphocytes - Natural Killer in the adult age. Conclusion: The presence of a colostomy promotes the development of an immuno-cellular response in the dermal layer of the peri-colostomy region that is composed of a major number of Pan T lymphocytes, T lymphocytes - helper, T lymphocytes - cytotoxic and macrophages.

Pneumatose cística intestinal

Pneumatosis cystoides intestinalis is an uncommon disease characterized by an accumulation of gas in the bowel wall, and has been associated with a variety of disorders and procedures. There is no specific history and physical or laboratory findings do not help to diagnose. The treatment conservative with hyperbaric oxygen is effective, and surgery is usually indicated when complications appear.

Hérnia de amyand

Amyands hernia is an extremely rare surgical event. It is characterized by the presence of acute appendix in an incarcerated inguinal hernia. Its clinical presentation varies, depending on the extent of appendicular inflammation. The authors report a case of Amyands hernia, in an 89 years-old male who had the diagnosis made intraoperatively.