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Abstract Purpose Right- and left-sided colorectal cancers (CRCs) have different clinical presentations and prognosis. These tumors arise from premalignant lesions, usually polyps, that can be resected during colonoscopy exams. Here, we aimed to assess the influence of polyp location on endoscopic and histopathological characteristics in women aged 60 years or over. Materials and Methods Single-center, retrospective study of 262 women aged ≥ 60 years with colonic polyps, examined at the University Hospital of Brasília, Brazil, from January 2019 to December 2023. All polyps found were analyzed individually regarding its endoscopic and histopathological characteristics. The data for right- and left-sided polyps were compared. Results A total of 510 polyps were studied, 282 in the left colon (LC) and 228 in the right colon (RC). In terms of morphology, polyps were predominantly sessile on both sides of the colon, and pedunculated polyps were more frequently observed in the LC (p = 0.087). Most of the polyps were ≥ 5 mm on both sides (p = 0.901). Regarding histopathology, 73.2% of polyps in the RC were tubular adenomas, versus 38.7% in the LC. Serrated adenomas had a 3.5% rate of occurrence in the RC and 2.1% in the LC. A total of 47.9% in the LC were hyperplastic, and 14.5% in the RC (p < 0.001) were hyperplastic. The LC tended to be more associated with absence of dysplasia (p < 0.001). Conclusion The RC was associated with tubular and serrated adenomas and with the presence of dysplasia, whereas the LC was associated with hyperplastic polyps.

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Abstract Objectives To evaluate the efficacy of the transperitoneal drains in reducing the onset of the postoperative intra-abdominal abscess and surgical-site infection (SSI) following emergency open appendectomy for complicated appendicitis. The study assessed whether utilization of drain was associated with adverse outcomes leading to prolonged hospital stay and increased healthcare expenditure. Materials and Methods This was a prospective randomized controlled trial conducted at the Nyangabgwe Referral Hospital, carried out from December 2022 to September 2023. The study included all patients aged 16-years-old and over, with complicated appendicitis, and who underwent emergency open appendectomy. Patients with uncomplicated appendicitis and those scheduled for laparoscopic appendectomy were excluded. Results Altogether, 263 participants were consented for the trial, of whom 128 were randomized into the drainage (DG), and 135 into the non-drainage (NDG) groups. A total of 118 patients (44.87%) developed postoperative SSI (DG: 81.35%; NDG: 18.64%; p = 0.001). The length of hospital stay (LOS) was found to be longer in patients with transperitoneal drains than those without (DG: 6 days; NDG: 4 days; p = 0.001). There were three patients (1.14%) who underwent relook laparotomies, two from the DG and one from the NDG (p = 0.304). There was no risk of postoperative intra-abdominal abscess formation between patients belonging to the DG (N = 128) and those in the NDG (N = 135; p < 0.0001). Overall, no mortality was registered in both study groups. Conclusion Routine placement of prophylactic transperitoneal drain in patients with complicated appendicitis who undergo emergency open appendectomy shows no statistical improvement over non-usage and, generally, does not avert the onset of postoperative SSI, ileus, or fecal fistula. Moreover, drain usage was linked to prolonged length of hospital stay and increased total healthcare expenditure.

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Abstract Objective To assess whether pelvic floor physiotherapy (PFPT) can reduce the risk of readmission with recurrent diverticulitis following an initial episode. Materials and Methods This is a retrospective analysis of patients admitted to hospital with acute diverticulitis who were followed up for a minimum of 2 years. Data on the episodes of diverticulitis, patient demographics and comorbidities, anorectal investigations and PFPT were collected and analyzed. Results A total of 50 consecutive patients were reviewed by a colorectal surgeon following an episode of acute diverticulitis. The rate of recurrent diverticulitis within 2-years was 20% in the group who received PFPT (PT) compared to 50% in the group who did not (NPT), and was found to be statistically significant (p = 0.041). The difference in rates of operative and radiological interventions for those with recurrent diverticulitis was not found to be statistically significant between the groups. Conclusion This retrospective cohort study demonstrates a potential benefit of PFPT in the prevention of recurrent diverticulitis. Based on these findings, a larger prospective randomized study is planned to corroborate and quantify this relationship.

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Abstract Introduction Colorectal cancer (CRC) is the third most frequently diagnosed cancer and the second leading cause of cancer-related fatalities worldwide, representing a major health concern. To improve outcomes, the early diagnosis of CRC is crucial; however, due to the nonspecific early symptoms, most CRC cases are detected at late stages. The circular RNA (circRNA) produced by the isoprenylcysteine carboxyl methyltransferase (IMCT) gene (circICMT), long intergenic non-protein coding RNA 908 ((LINC00908), and DEAD-box helicase 54 (DDX54) messenger RNA (mRNA) are promising biomarkers for the early diagnosis of CRC. Materials and Methods The present study involved 65 samples obtained from (non-metastatic and metastatic) CRC tissues and adjacent non-cancerous tissues as controls. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to assess the expression levels of circICMT, LINC00908, and DDX54 mRNA in these samples. Results The expression level of circICMT was significantly higher in metastatic CRC than in nonmetastatic CRC samples (p= 0.001). Both cancer groups exhibited significantly-elevated circICMT and significantly-lower LINC00908 expression levels compared to the non-cancerous tissues (p< 0.001 for both). A significant difference was also found between non-metastatic and metastatic CRC patients (p= 0.021). The results from the qRT-PCR analysis of DDX54 mRNA expression revealed significant overexpression in CRC tissues in relation to the adjacent non-cancerous tissues (p< 0.001), and no significant difference was detected between the two cancer groups. Conclusion The relative expression levels of circICMT, LINC00908, and DDX54 mRNA were able to differentiate patients with colorectal adenocarcinoma from healthy controls. However, only circICMT and LINC00908 could distinguish early-stage from metastatic cases. Therefore, these two markers may serve as potential biomarkers for discriminating early-stage from advanced colorectal cancer (CRC).

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Abstract Objective To assess the results of stapled hemorrhoidopexy in 50 patients diagnosed with symptomatic grade-II, -III, or -IV internal hemorrhoids followed up for about 3 months after surgery to assess the complications and recurrence of the hemorrhoids. Materials and Methods The present is a prospective study of 50 patients with grade II–IV internal hemorrhoids who underwent stapled hemorrhoidopexy at Dr. Vithalrao Vikhe Patil Foundation's Medical College and Hospital, Ahilyanagar, between May 2018 and October 2020. Eligible patients were selected after informed consent and thorough evaluation. Surgeries were done under spinal anesthesia using a 34-mm stapler. Postoperative assessments included pain, bleeding, urine retention, and recurrence, with follow-ups up to 12 weeks. Histopathology of the excised tissue was also performed. Results The study included 50 patients (mean age 46.38 years), with per rectum (PR) bleeding (64%) and prolapse (36%) as the main symptoms. Most patients had grade-II or -III hemorrhoids, and 82% were anemic. The mean operating time was 33.7 minutes with minimal blood loss (mean 20.7 ml). Postoperative pain decreased significantly by day 3, and no anal incontinence or stricture was observed. One patient (2%) had recurrence at 6 and 12 weeks. Conclusion The conclusion of our study is that stapled hemorrhoidopexy has excellent postoperative results, especially regarding postoperative pain, bleeding, anal incontinence, anal stricture and recurrence. It is safe, easy to learn, and highly effective in the management of symptomatic grade-II, -III, and -IV internal hemorrhoids.

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Abstract Objective To evaluate the characteristics of endometriosis lesions affecting the rectum, using three-dimensional (3D) endorectal ultrasound. Materials and Methods Retrospective, observational, cross-sectional study, with data obtained through the evaluation of electronic medical records of patients treated at the Coloproctology Service of the University Hospital of Universidade Federal do Maranhão (HU-UFMA). All patients assessed were referred for ultrasound evaluation of the rectum due to suspected lesions in another previous imaging study. Patients underwent 3D endorectal ultrasound examination from May 2017 to May 2024. The evaluated data included lesion location, degree of lesion depth in the rectal wall, longitudinal and axial length of the lesion, and its distance from the anal margin. Results The sample consisted of 69 patients with a total of 72 foci. All lesions found were in the anterior hemicircumference of the rectum. The most common location of the foci was the middle (25) and upper (27) recta, with 8 foci also found in the lower rectum. Six patients had foci in more than one segment. Of the 72 foci found, the majority (39) involved the muscularis propria of the rectum. Regarding the length of the longest axis of the lesion, in the longitudinal plane the average was 1.84 cm and in the axial plane the average was 1.86 cm. The lesions were on average 9.0 cm from the anal margin. Conclusion Intestinal endometriosis lesions predominate in the middle and upper recta, approximately 9.0 cm from the anal margin, and mostly involve the muscularis propria of the rectum.

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Abstract Background The Toileting Habit Profile Questionnaire – Revised (THPQ-R) assesses sensory integration differences in children experiencing toileting and defecation participation issues. Sensory integration disorders (SIDs) are frequent in children with functional defecation disorders (FDDs) and may affect participation in toileting routines, a key feature of conventional medical management. Understanding a child's SIDs and their impact on participation in toileting routines can contribute to more effective interventions. Objective To develop a translated and culturally adapted Turkish version of the THPQ-R for use in clinical practice and research. Materials and Methods The process of translating the THPQ-R and adapting the questionnaire for use in Turkey was performed following accepted guidelines. The analysis was performed using data gathered from the Turkish THPQ-R (TR-THPQ-R) to explore its reliability and validity. Results The TR-THPQ-R was found to be highly reliable, with a Cronbach alpha value of 0.833. The test–retest analysis determined that the scale measured reliably over a short period of time (p < 0.05) and discriminated adequately between children with and without FDDs (p < 0.05). The hyperreactivity items of the TR-THPQ-R correlated with the hyperreactivity items of the Sensory Processing Measure, supporting convergent validity. Conclusions Turkish clinicians and researchers have a tool to assess sensory hyperreactivity concerns in children with defecation disorders. This study paves the way for new research that focuses on the relationship between toileting participation, FDDs, and SIDs in this population.

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Abstract Neuroendocrine tumors (NETs) are rare malignancies originating from enterochromaffin cells, with up to 90% arising in the gastrointestinal tract. Those located in the mesentery are usually metastatic, and primary mesenteric NETs are exceedingly rare. We herein report the case of an 82-year-old man referred to general surgery after an incidental mesenteric mass detected on a fluorodeoxyglucose-positron emission tomography (18F-FDG PET-CT) scan performed for the evaluation of a pulmonary lesion. An abdominal computed tomography (CT) scan revealed a 30-mm mass in the mesentery, adjacent to the ileocolic vessels. The patient underwent exploratory laparoscopy and excision of the mass. A histopathological analysis confirmed a well-differentiated NET. The patient was started on octreotide therapy, which continues to date. At 24 months of follow-up, the patient remains asymptomatic. Given the rarity of primary mesenteric NETs and the predominance of metastatic lesions at this site, comprehensive exclusion of other potential primary-tumor sites is of utmost importance.

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Abstract Introduction Breast cancer metastasis to the gastrointestinal tract represents an important cause of mortality associated with this neoplasm. Its diagnosis is challenging due to the nonspecific nature of the clinical symptoms and the time interval that usually elapses between the primary disease and recurrence. We herein report a case of colonic metastasis secondary to breast carcinoma. Case Presentation A 68-year-old woman with a history of right-breast invasive ductal carcinoma, clinical stage IIIA (grade T2N2M0 in the Tumor, Node, Metastasis [TNM] classification), triple-negative, had been treated in 2015 with mastectomy and axillary lymph-node dissection, followed by adjuvant chemotherapy and radiotherapy. In 2020, recurrence of the disease was documented in the right supraclavicular and axillary lymph nodes, managed with multiple cytotoxic regimens and local radiotherapy. During the tenth year of follow-up, an abdominal computed tomography (CT) scan was performed due to changes in stool consistency, which revealed thickening of the cecum and ascending colon. Colonoscopy showed a stenosing lesion at the ileocecal valve, impassable with the endoscope. Staging studies revealed no other secondary lesions. Given the imminent risk of intestinal obstruction, a laparoscopic right hemicolectomy with complete mesocolic excision was performed. The immunohistochemical analysis confirmed high-grade triple-negative breast metastasis (Ki-67 of 80%, extensive lymphovascular invasion, 12/31 positive nodes). The postoperative evolution was favorable, with hospital discharge on the fourth day. Conclusion In patients with suspected breast cancer recurrence, restaging studies are mandatory to rule out oncologic involvement in different organs. The gold standard for diagnosis is based on biopsy of the suspicious lesion, along with basic staining and immunohistochemical markers, which enable the confirmation of the origin of the neoplastic involvement and its tumor biology. Maintaining a high index of diagnostic suspicion is essential for early detection and the establishment of appropriate treatment, contributing to improved patient prognosis.

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Abstract Langerhans-cell histiocytosis (LCH) is a rare disorder characterized by the proliferation of Langerhans cells, which originate in the bone marrow. It presents in two main clinical forms: single system LCH (SS-LCH), when the disease involves a single organ or system, and multisystem LCH (MS-LCH), which follows an acute, progressive, and disseminated course, characterized by the proliferation of Langerhans cells which originate from multiple organs or systems, including the lungs, bones, liver, spleen, bonemarrow, skin, central nervous and mucous membranes. Mortality is often associated with complications such as chronic obstructive pulmonary disease, secondary primary neoplasms, sepsis, hemorrhagic syndromes, and bone marrow failure. Although rare in adults, the initial presentation of MS-LCH may involve the perianal region. We herein report the case of a 38-year-old man with initial perianal involvement of MS-LCH, refractory to treatment with vinblastine, prednisone, cytarabine, and cladribine, who ultimately died from sepsis due to bone marrow failure. Additionally, we conducted a literature review using the keywords perianal histiocytosis, anal histiocytosis, and perineal histiocytosis on the PubMed, SciELO, and LILACS databases.

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Abstract Introduction Rectal anastomotic stricture (RAS) is a significant complication following rectal resection. Several techniques have been proposed for its management. However, treating complete strictures remains challenging. Objective To describe a simple, safe, and effective technique for the treatment of complete RAS using a circular stapler under ileocolonoscopic guidance. Materials and Methods A 43-year-old man underwent laparoscopic anterior resection of the rectum for a 7 cm serrated adenoma located 10 cm from the anal verge. The anastomosis was created 8 cm from the anal verge, and a protective loop ileostomy was fashioned. Histopathological analysis revealed a sessile serrated adenoma confined to the mucosa with foci of intramucosal carcinoma (TisN0). At 2 years postoperatively, delayed follow-up due to the COVID-19 pandemic revealed a complete RAS. Computed tomography (CT) with contrast administered through both the ileostomy efferent loop and the rectum demonstrated a short (< 1 cm) stricture at the anastomosis. The patient underwent transanal correction using a single-port system, assisted by colonoscopy through the ileostomy efferent loop. After circumferential stricturoplasty, a 31 mm circular stapler was used to perform reanastomosis under colonoscopic guidance. The patient had an uneventful recovery and was discharged on postoperative day 1. The ileostomy was closed after 45 days, and the patient presented only minimal symptoms of low anterior resection syndrome. Conclusion: Transanal stricturoplasty followed by circular stapler reanastomosis under endoscopic guidance appears to be a safe, simple, and effective approach for managing complete benign RAS. This technique may be considered in cases refractory to endoscopic dilation, in the place of redo surgery.