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Abstract Lower gastrointestinal bleeding (LGB) originates below the angle of Treitz and can result from vascular, inflammatory, neoplastic, or traumatic causes. This study analyzed the clinical and epidemiological profiles of LGB patients treated at Hospital Regional do Mato Grosso do Sul from 2017 to 2022, exploring the relationship between LGB etiology and colonoscopy performance. A retrospective analysis of 303 patients examined variables such as year of service, management approach, hospital stay, Oakland score, age, sex, and race. Most patients were hospitalized between 2018 and 2019, with hospitalization being the primary management strategy. The majority were male (59.4%), over 60 years old (55.1%), and mixed race (53.5%). The mean length of hospital stay was 10.6 days, and the average Oakland score was 20.28. Clinical findings showed 64.7% had no prior LGB history, with an average systolic blood pressure of 91.24 mmHg and a heart rate of 129.61 bpm. Colonoscopy revealed diverticular disease as the most common finding (39.6%), and the most frequent bleeding types were enterorrhagia (47.5%) and melena (37.0%). Significant associations were found between bleeding type, hemoglobin levels, and outcomes, with melena linked to lower hemoglobin levels and higher mortality. Colonoscopy results were also associated with outcomes, showing higher mortality in colitis patients. These findings emphasize the impact of clinical and demographic factors in LGB management and suggest further research into targeted interventions.

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Abstract Introduction The relationship between hypovitaminosis D and the development of inflammatory bowel disease (IBD) is well established in countries with high prevalence and incidence of IBD and low exposure to solar ultraviolet radiation. However, only some studies included emerging countries, which have an increasing prevalence of IBD and diverse climate and social conditions. Objective This cross-sectional study's purpose is to evaluate the prevalence of hypovitaminosis D and its relationship with IBD activity in patients treated at a reference service in an emerging country. Methods This study analyzed the medical records of 113 patients from June 2022 to August 2023. We collected data about sex, age, IBD diagnosis, vitamin D serum levels, fecal calprotectin, and IBD medication. We presented the descriptive data as absolute and relative frequencies. We looked for possible links between calprotectin and vitamin D in people with Crohn's disease (CD) and ulcerative colitis (UC). We used the Chi-square test of independence (when expected cell counts were greater than 5) and Fisher's exact test (when expected cell counts were less than 5). Results We diagnosed 78 patients with UC and 35 with CD. Serum vitamin D levels were less than 30 ng/dl in 57.1% of patients with CD and 57,7% of those with UC. There was no association between low vitamin D serum levels and fecal calprotectin. Conclusion The present study indicates a prevalence of low vitamin D serum levels in patients with IBD, but this finding does not have a significant relationship with disease activity.

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Abstract The use of CO2 lasers in surgical procedures is well-established in medicine; however, data are still scarce in coloproctology, especially regarding anal skin tags. Objectives To assess the degree of satisfaction, pain, and postoperative healing in patients undergoing outpatient clinic CO2 laser anal skin tag resection with topical and injectable local anesthesia and its complications. Methods Prospective collection of data on patients with anal skin tags operated at a private clinic in São Paulo with topical and injectable local anesthesia and use of CO2 laser. The need for intraoperative stitches, opioids, and corticosteroids was assessed, as well as patient satisfaction and level of pain based on the analogue pain scale. Results 39 patients were evaluated, of whom 36 (92.3%) were women. The main complaint was aesthetics (51.2%). The average healing time was 3.7 + 1.8 weeks, and the average pain was 2.4 + 2.7. Six patients required stitches due to bleeding, and the presence of stitches did not increase the healing time or the need for opioids. One patient presented with bleeding in the 1st postoperative period and needed reintervention in a surgical facility, 2 presented with fissures, and 12 with residual skin tags. Thirty-eight patients were satisfied. Conclusions Anal skin tag resection with topical and injectable local anesthesia and CO2 laser is an effective and safe procedure at an outpatient level. Its advantages are low levels of postoperative pain, rapid healing, and low rates of serious complications with a high degree of patient satisfaction.

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Abstract Introduction Anorectal fistulas are chronic abnormal connections between the anal canal and perianal skin, often resulting from cryptoglandular infections. Despite advancements in surgical techniques, recurrence remains a significant challenge. Traditional methods like fistulotomy and seton placement show variable success rates, while newer sphincter-sparing approaches like IFTAK and LAFT offer promise. This study compares the efficacy of IFTAK and LAFT in managing trans-sphincteric fistulas. Methods This prospective study at Sir Sundar Lal Hospital, BHU, compared IFTAK and LAFT for managing trans-sphincteric fistula-in-ano. Forty-four patients were randomized into two groups (22 each). Patients underwent preoperative preparation, postoperative care, and follow-ups at regular intervals. Outcomes, including pain (VAS), healing, and recurrence, were analyzed statistically using SPSS. Results Group A (IFTAK) showed significantly lower recurrence rates (0% vs. 27.3%, p = 0.000) and superior healing of the fistulous tract compared to Group B (LAFT). Pain reduction, discharge, inflammation, and induration improved significantly in both groups (p < 0.001). However, Group A demonstrated faster pain reduction and better wound dryness at 45 and 60 days (p < 0.05). Hospital stays were shorter in Group A. Overall, IFTAK exhibited better clinical outcomes and fewer complications. Conclusion The study indicates that IFTAK is more effective than LAFT for managing trans-sphincteric fistulas, with no recurrences, better healing, and higher success rates, especially for posterior fistulas. LAFT offers less pain, and shorter hospital stays but has a higher recurrence rate. Combining IFTAK and LAFT may optimize outcomes, warranting further research.

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Abstract Introduction Intermittent fasting (IF) has gained popularity in recent years as a potential tool for promoting health and reducing disease risk. However, little research has been done on the impact of fluid restrictive IF on benign anorectal diseases. In this study, we aim to explore the effects of long periods of IF on conditions such as hemorrhoids and anal fissures, focusing on the potential role of other influencing factors. Materials and Methods This study utilized a cohort design to examine the changes in admissions for hemorrhoidal disease and anal fissure during Ramadan, a period of intermittent fasting with fluid restriction, compared to the remainder of the year. Patients admitted with these conditions between January 1, 2010, and December 31, 2019, were divided into two groups: the Ramadan group and the control (non-Ramadan) group. The primary endpoint of the study was to determine any significant differences in admissions between the two groups. Results The results showed that a total of 49,046 patients (0.68% of all admissions) were admitted with hemorrhoidal disease, and 33,480 patients (0.45%) with fissures were reviewed. Admissions for hemorrhoidal disease were significantly higher in the Ramadan group at 0.9%, compared to the control group (non-Ramadan) at 0.7% (p < 0.001). However, no increase was observed in the admittance rate for fissures between the two groups. Conclusion This study explores the potential connection between fluid restrictive IF and anorectal disease incidence, shedding light on this under-researched area. Findings suggest that extended periods of IF may increase the risk of hemorrhoidal disease, highlighting the need for clinicians and individuals adopting such regimes to consider related risk factors.

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Abstract Objectives We aimed to evaluate the Anastomotic Leak Risk Calculator in predicting the outcome of Colonic Anastomosis in right and left sided colonic surgeries at our institution from November 2022 to May 2024. We also evaluated the various variables which may predict the risk of leak pre-operatively and intra-operatively. Methods Patients who underwent colectomy on an emergency/elective basis were included and were followed for 30 days post operatively. Preoperative, intraoperative and post operative data was collected which was used to derive a risk score using the previously developed Anastomotic Leak Risk Calculator. Results The predictability of occurrence of Anastomotic leak (AL) in colonic surgeries by the Anastomotic Leak Risk Calculator has not been statistically significant. AL percentage in our study was 6.7%. The site of anastomosis significantly effects the probability of occurrence of anastomotic leak. The occurrence of intra operative complications have a significant effect on the preoperative and post-operative anastomotic leak risk score. There is a significant effect of AL on the duration of hospital stay post-surgery and the 30-day outcome of the patient. Conclusion An accurate assessment of the risk of anastomotic leak is crucial to tailor personalized treatment choices for patients. Various pre-operative and intraoperative factors must be carefully analyzed to decide the further course of action in every patient who requires colonic surgery.

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Abstract Introduction Colorectal cancer is the third leading cause of cancer-related mortality in Brazil. Proper staging is crucial for the management of patients with rectal cancer, as the implemented therapies may result in implications for the prognosis and quality of life. The therapeutic armamentarium has evolved over time, highlighting the importance of magnetic resonance imaging (MRI) in preoperative evaluation. This study aims to assess the correlation between clinical staging by MRI and pathological staging in individuals with rectal cancer. Methods Cross-sectional observational study in patients diagnosed with rectal cancer from the Colorectal Surgery Department at the University Hospital of Brasília. Demographic data and clinical and pathological staging were analyzed. The degree of agreement and reliability between the clinical and pathological staging results was assessed by the Kappa (k) and weighted Kappa (wk) tests. Results Seventy-six patients were studied. Fair agreement was observed for T staging between clinical T and pathological T, being stronger for T3. In patients who underwent neoadjuvant therapy prior to surgery, the reliability was slight, while without neoadjuvant therapy, it was moderate. There was slight agreement between clinical and pathological stages for N staging, which was more substantial in patients without neoadjuvant therapy. Conclusion This study highlights the importance of MRI in the preoperative staging of rectal cancer but emphasizes the need to consider other aspects before defining the treatment plan.

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Abstract Introduction Appendicular intussusception is the invagination of the appendix into the cecum. Endometriosis is the presence of endometrial tissue outside the uterine cavity, and it has a variable clinical picture, presenting as acute appendicitis or intestinal obstruction due to intussusception. The aim of the present paper is to report a case of cecal appendix intussusception secondary to endometriosis, since this is an extremely rare condition and there are few studies on the subject in the literature. Case Report We herein report the case of a 37-year-old female patient with deep endometriosis and abdominal pain in the right iliac fossa associated with menstruation. There was an intraluminal formation in the cecum, in the appendicular ostium. Magnetic resonance imaging showed foci compatible with ectopic endometrium in the uterus, rectum, and sigmoid colon. The cecal appendix was enlarged. Resection of the terminal ileum and cecum was performed, and the surgical specimen led to the diagnosis of appendicular intussusception and endometriosis of the cecal appendix. Discussion In adults, the most common etiologies of appendicular intussusception are endometriosis, mucocele, carcinoid tumors, and adenocarcinomas. In patients with endometriosis, involvement of the cecal appendix is infrequent. The definitive diagnosis is established by analyzing the surgical specimen, and imaging tests play a limited role in ruling out malignancies. Laparoscopic cecectomy is usually chosen, preserving the ileocecal valve. Hormone suppression therapy can prevent the recurrence of intestinal endometriosis. Conclusion Appendicular intussusception, although an infrequent pathology, is an occurrence that requires surgical treatment and, in patients with endometriosis, it is important to include this hypothesis in the differential diagnosis.

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Abstract Gastrointestinal stromal tumor (GIST) is a rare condition that originates in the cells of Cajal and constitutes the most frequent type of malignant mesenchymal tumors in the gastrointestinal tract. Although their incidence is low, GISTs are most common in the stomach and small intestine, although they can occur in other areas, such as the rectum. Although no specific risk factor has been identified, certain genetic conditions such as neurofibromatosis type I increase the likelihood of developing a GIST. Symptoms may vary depending on the location of the tumor and include early satiety, abdominal distention, gastrointestinal disturbances, and bleeding. The diagnosis is usually made incidentally during radiologic or endoscopic studies and is confirmed by immunohistochemistry studies that identify mutations in cluster of differentiation 117 (c-KIT) and platelet-derived growth factor receptor kinase alpha (PDGRF-α) receptors. These tumors are resistant to conventional chemotherapy and radiotherapy. Management of the disease preferably involves surgical resection, aiming for complete removal of the tumor. Prognosis after surgery depends on the size of the tumor and its mitotic activity. Periodic follow-up with imaging tests is recommended for several years after resection. In advanced cases, treatment may include therapy with imatinib, a tyrosine kinase inhibitor that has demonstrated efficacy in GISTs. Primary resistance to treatment can be a challenge, and in advanced rectal tumors, several surgical options can be considered, although resection can be difficult due to the location of the tumor and its adherence to the pelvic floor. Despite curative resection, recurrence and distant metastasis, especially to the liver, are major concerns, with a reduced median survival in patients with advanced disease.

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Abstract Introduction Intestinal tuberculosis (ITB) presents with clinical features that often mimic malignant or inflammatory diseases. Diagnosis is established through a combination of endoscopic, radiological, and pathological findings. Case A 76-year-old woman presented with acute, diffuse abdominal pain. Computed tomography (CT) of the abdomen revealed subocclusion due to wall thickening at the ileocecal transition. A colonoscopy biopsy showed ulcerated granulomatous lesions, with negative results for AFB. Enterography suggested the possibility of a neoplastic disease. Due to the subocclusion, the patient underwent a segmental right ileocolectomy and ileocolostomy with a double-barrel stoma. Histopathological analysis of the resected specimen, including frozen section examination, confirmed ITB. Conclusion The diagnosis of ITB is challenging due to its clinical, endoscopic, radiologic, and histopathologic features, which overlap with neoplasms and inflammatory bowel disease. Therefore, establishing an appropriate therapeutic approach requires the integration of multiple diagnostic findings.

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Abstract Objective This study explores the role of DNA mismatch repair (MMR) deficiency (dMMR) in colorectal cancer (CRC). We review how it influences the development of cancer, how it is diagnosed, and the latest treatments available, including how patients with dMMR respond to specific therapies differently than others. Methods We conducted a thorough review of current research, focusing on studies that address how dMMR affects people with colorectal cancer. We excluded studies on animals or cases that weren't directly relevant to human colorectal cancer. The focus was on how new knowledge and treatments change patient care. Results Around 15% of colorectal cancer cases involve dMMR, which is often linked to Lynch Syndrome and specific genetic changes. Patients with dMMR tend to have better outcomes in the early stages of cancer but respond poorly to traditional chemotherapy. However, these patients show significant improvement with immunotherapy, especially treatments targeting immune checkpoint proteins. Advances in diagnostic tools like microsatellite instability (MSI) testing and next-generation sequencing are helping doctors identify these cases earlier and choose better treatment options. Conclusions Recognizing dMMR in colorectal cancer is crucial for deciding the best treatment plan. Immunotherapy is proving to be particularly effective for these patients, and as diagnostic methods improve, we expect even better outcomes, especially for those with a hereditary risk like Lynch Syndrome.

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Abstract Introduction This study explores the efficacy of Rubber Band Ligation (RBL) as a treatment for symptomatic occult prolapse in a single outpatient center, proposing it as a viable alternative to traditional surgical methods. The research aims to assess patient outcomes, complication rates, and overall satisfaction with RBL, providing insights into its potential as a less invasive treatment option. Occult prolapse, often underdiagnosed, can significantly impact a patient's quality of life. Traditional surgical treatments, while effective, come with higher risks and longer recovery periods. This study investigates the use of RBL, a minimally invasive procedure commonly used for hemorrhoid treatment, as an alternative for addressing symptomatic occult prolapse. Methods A retrospective analysis was conducted on patients diagnosed with symptomatic occult prolapse at a single outpatient center. These patients underwent RBL treatment over a defined period. Data on patient demographics, symptoms, procedure details, and follow-up outcomes were collected and analyzed. The primary endpoints included symptom relief, complication rates, and patient satisfaction. Results The study included 186 patients with a mean age of 48.3 years. Symptom relief was achieved in about 80% of patients post-RBL, with a minor complication rate of 9%. Common complications included minor bleeding and discomfort, which were manageable with conservative measures. Results confirmed it is effective until 1 year with a low rate of complications and could be offered conservative treatment for mucosal prolapse.

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Abstract Objective This study aims to evaluate the utilization of colorectal cancer (CRC) screening in Monmouth County, NJ, and to compare tumor stages between patients diagnosed through screening and those presenting with symptoms. The role of nurse navigators in enhancing screening adherence and patient care was also examined. Material and Methods A retrospective chart review was conducted on 118 patients diagnosed with CRC at Jersey Shore University Medical Center (JSUMC) between January 2020 and July 2021. Data collected included initial symptoms, hemoglobin levels, age at diagnosis, screening history, cancer stage, nurse navigator involvement, and 24-month survival. Results Among patients diagnosed by symptoms (n = 83), 40% were diagnosed with Stage IV CRC versus 14% for screened patients. Of the screened patients (n = 15), 86% were alive 24 months post-diagnosis compared to 67% of symptomatic patients. Notably, 73% of all patients had never undergone CRC screening, indicating a significant gap in adherence to recommended guidelines. Only 25% of patients were assigned a nurse navigator, suggesting limited utilization of this support. Conclusions The findings demonstrate that CRC screenings were underutilized, contributing to a higher incidence of advanced-stage diagnoses and lower survival rates among symptomatic patients. Enhancing public awareness about the importance of screening, along with expanding the role of nurse navigators, may significantly improve patient outcomes and reduce the burden of advanced colorectal cancer.