{"paper_id":"df31696c-a567-4a27-9a2d-50f7fa3e75f7","body_text":"Abstract\nJ Coloproctol 2024;44(Suppl S1):S1 –S138.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141222\nE-poster\nANAL ADENOCARCINOMA IN A YOUNG MAN: CASE REPORT\nVanessa Bernardes Daniel 1, Roberta Denise Alkmin Lopes de\nLima1, Rayssa Sawan Mendonça 1, Karla Cristina Cintra 1,\nMaycon Lucas Sousa 1, Leonardo Mundin Porto 1, Miguel\nMiranda Vicentini1, Cláudio Henrique Reviriego Formigoni 1\n1Santa Casa de Misericórdia de Franca, Franca, Brasil\nCase presentation A 33-year-old male presented\nwith a three-year history of hematochezia, tenesmus, and\nanal prolapse. The condition progressed with worsening anal\nbleeding, requiring blood transfusion. He sought medical\nattention, and a colonoscopy revealed an arteriovenous mal-\nformation 2 cm above the pectinate line. Despite treatment,\nthe symptoms persisted, and the bleeding worsened. He was\nreferred to a specialized center with a provisional diagnosis of\nhemorrhoidal disease. A proctological examination under\nsedation was performed, revealing a bleeding, pedunculated\nlesion measuring 6 cm, located above the pectinate line. Local\nexcision of the lesion was performed. Histopathological anal-\nysis showed intramucosal adenocarcinoma associated with a\nvillous adenoma with high-grade dysplasia, with clear surgi-\ncal margins.\nDiscussion Primary adenocarcinoma of the anus is a\nrare disease accounting for only 5% –10% of anal canal malig-\nnancies. The presentation of this disease is generally late,\nwith a mean age of diagnosis at 59 years, possibly due to the\nassociated non-speci fic symptoms. Anal adenocarcinomas\ncan be subdivided into two types: (1) colorectal from the\nmucosa above the dentate line and (2) extramucosal from\nanorectal fistulas or anal glands. Given the challenges with\nclassification and the low number of cases overall, most of the\nliterature is limited to case reports or outcome-driven obser-\nvational studies. This case highlights the challenges of early\ndiagnosis of anal malignancies and the importance of imme-\ndiate evaluation of the anorectal region when recto-anal\nsymptoms, such as bleeding or mucus in the stool, are\nreported through digital rectal examination, sometimes\nneglected in medicine. The lesion presented a clinical picture\nsimilar to symptoms of hemorrhoidal disease, such as bleed-\ning and anal prolapse. Anal tumors can also be identi fied in\nroutine or diagnostic colonoscopy, even in asymptomatic\npatients.\nConclusion Due to delayed diagnosis, anal adenocar-\ncinomas often have a poor prognosis. Understanding the\npatient’s symptoms and performing a physical examination,\nsuch as a digital rectal exam, supports early diagnosis and\ntargeted treatment. This approach contributes to better\npatient outcomes and helps reduce the morbidity and mor-\ntality associated with the disease.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141705\nE-poster\nADENOCARCINOMA WITH SIGNET RING CELLS OF CECAL\nAPPENDIX IN A PATIENT WITH TRANSVERSE COLON\nDUPLICATION: CASE REPORT\nBrunna Vitória Gouveia Prado\n1, Lêda Telesi Castro 1, Marina\nStröher2, Mychelly de Sá Carvalho 1, João Roberto Fagundes\nJúnior1, Maria Luiza Marinho Vidigal 2, Gabrielle Quessada 1\n1Hospital Municipal Prof. Dr. Alípio Corrêa Netto, São Paulo, Brasil\n2Faculdade de Medicina do ABC, Santo André, SP, Brasil\nCase presentation Male, 56 years old, with abdomi-\nnal pain and distension, nausea and change in bowel habit\nwith watery diarrhea for 5 days. Epilepsy patient. No previous\nabdominal surgery. No family background. On examination,\nhe appeared dehydrated, abdomen distended and painful on\ndiffuse palpation, with signs of peritonitis. Empty rectal\nampule. Abdomen tomography requested, which showed\nan area of thinering and distortion of the path of the\nmesenteric vessels in the mesogastria, with air- fluid levels\nin colic segments upward, with the possibility of acute\nobstructive abdomen. Exploratory laparotomy indicated\nwith findings of tumor in the cecum and duplication in the\ntransverse colon. Right hemicolectomy and ileo-transtomic\nanastomosis performed. Patient with good evolution, dis-\ncharge on the 7th postoperative day. Anatomopathological\nstudy with findings of adenocarcinoma with signet ring cells\nin the cecal appendix and mesogastria. Presence of a 14 cm\ntubular fragment with mucosa of a usual colonic appearance,\nwith continuous light with the transverse colon, correspond-\ning to intestinal duplication.\nDiscussion Primary appendix neoplasms have a prev-\nalence of 0.5 to 1% of cases. Primary signet ring cell adeno-\ncarcinoma comprises 4% of them, with an overall survival of\nISSN 2237-9363. © 2025. The Author(s).\nThis is an open access article published by Thieme under the terms of the\nCreative Commons Attribution 4.0 International License, permitting copying\nand reproduction so long as the original work is given appropriate credit\n(https://creativecommons.org/licenses/by-nc-nd/4.0/).\nThieme Revinter Publicações Ltda., Rua Rego Freitas, 175, loja 1,\nRepública, São Paulo, SP, CEP 01220-010, Brazil\nTHIEME\nS1\nArticle published online: 2025-04-25\n\n18% in 5 years, the lowest when compared to mucinosal\nadenocarcinoma and others. In 93% of cases, it presents\nmetastases to adjacent areas. The intraoperative finding of\ntubular duplication of the transverse colon is a most common\ndiagnosis in childhood. It has its first description in the 18th\ncentury and can occur throughout the gastrointestinal tract,\neither in a spherical or tubular form, with tubular duplication\nbeing the rarest. This variation results from embryonic\ndevelopmental disturbances and may present with intussus-\nception, volvulus, and obstruction. It can be associated with\nmalignant neoplasms, most commonly adenocarcinoma.\nConclusion Adenocarcinoma with signet ring cells of\nthe appendix is a rare entity with a high mortality risk,\nrequiring differential diagnosis and histopathological study\nto ensure proper management and follow-up. In cases of\nintestinal duplication, due to its potential for complications,\nsurgical treatment is the preferred approach for symptomatic\npatients. An individualized assessment of each case is neces-\nsary to determine whether resection of only the duplicated\nsegment or an extended resection of additional segments is\nwarranted based on intraoperative findings.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138351\nE-poster\nADENOCARCINOMA OF THE ILEUM MIMICS CROHN ’S\nDISEASE – CASE REPORT\nCristina Calloni 1, Daniel de Barcellos Azambuja 2, Andreia\nAzevedo2, Bruna Oliveira Trindade 2, Fares Hassan Hamaoui 3,\nAlice Oliveira3\n1Universidade Feevale, Rio Grande do Sul, Brasil\n2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto\nAlegre, Brasil\n3Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil\nIntroduction Crohn’s Disease (CD) is characterized by\nepisodes of in flammation of the gastrointestinal tract with\nthe classic symptoms: abdominal pain, diarrhea, change in\nstool pattern and weight loss. These symptoms are equivalent\nin cases of intestinal neoplasia.\nMethod Study based on medical record analysis and\nbibliographic review with the objective of reporting the\nimportance of the differential diagnosis of ileal adenocarci-\nnoma in cases previously diagnosed with CD. Case report:\nFemale patient, 45 years old, started experiencing abdominal\npain in July 2022. Under investigation, she underwent colo-\nnoscopy with subsequent biopsy of fragments, but there was\nno assertive clari fication of the diagnosis, starting empirical\ntreatment for CD with corticosteroids associated with aza-\nthioprine (AZA). After 8 months of treatment, she presented\nsymptoms suggestive of intestinal sub-occlusion and com-\nputed tomography (CT) of the abdomen showed signi ficant\ncircumferential and irregular parietal thickening of the seg-\nment of the distal ileum, associated with in filtration of the\nadjacent adipose tissue, in addition to luminal narrowing.\nFindings that favor the clinical suspicion of in flammatory\nbowel disease (IBD), especially CD. As her condition pro-\ngressed, she underwent an ileocolectomy procedure with\nsubsequent referral of an anatomical piece to the pathology\ndepartment. During the study, the pathology identi fied\nmoderately differentiated adenocarcinoma of the distal seg-\nment of the ileum, with a usual tubular/intestinal pattern,\nulcer-infiltrating, ring-shaped, extending to the mesentery\nand free surgical margins. With satisfactory postoperative\nevolution, she maintained the clinical segment with chemo-\ntherapy according to protocol.\nDiscussion Neoplasia of the small intestine is rare\nwith an annual incidence of 2.1 cases in 100,000. Adenocar-\ncinoma is the second most common histological type, and its\nileal location makes this entity even less common. Symptoms\nin patients with CD are indistinguishable from those with\nadenocarcinoma. Thus, this fact tends to mask and delay the\ndiagnosis of malignancy. Around 10% of patients originally\ndiagnosed with IBD have a change in diagnosis after\nreevaluation.\nConclusion The discussed finding highlights not only\nthe heterogeneity of these diseases, but also the dif ficulty of\ncorrectly determining their diagnoses. In this context, sys-\ntematic monitoring is, therefore, necessary so that the condi-\ntion does not remain undetermined, interfering with the\npatients’ quality of life and thus reducing their problems.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138613\nE-poster\nRECTAL ADENOCARCINOMA AND PAPILLARY THYROID\nCARCINOMA IN A YOUNG ADULT WITH LYNCH SYNDROME\nMayara de Almeida Stefano 1, Guilherme Abreu Guerra 2,\nVanessa Siqueira Reis 3, Bruno Augusto Alves Martins 3, João\nBatista de Sousa 3, Romulo Medeiros de Almeida 3, Antônio\nCarlos Nóbrega dos Santos 3, Marccus Antônio Tolentino de\nJesus3\n1Universidade de Brasília, Brasília, Brasil\n2Centro Universitário de Brasília, Brasília, Brasil\n3Hospital Universitário de Brasília, Brasília, Brasil\nPresentation A 44-year-old woman treated at an\noutpatient clinic for hereditary colorectal cancer with a\ndiagnosis of Lynch Syndrome with a pathogenic variant in\nthe MSH6 gene. Family history of neoplasms with sisters\ndiagnosed with gastric and thyroid cancer at ages 36 and 35,\nrespectively. The patient presented with colonoscopy with an\nulcerative lesion occupying 50% of the circumference of the\nmiddle rectum and histopathology with well-differentiated\nadenocarcinoma. Magnetic resonance imaging demonstrated\ncT3N1M0 staging. She underwent chemoradiotherapy along\nthe lines of the “RAPIDO trial ”. Four months later, a recto-\nsigmoidoscopy was performed which showed an ulcerated\narea covered with fibrin, compatible with a partial response\nto neoadjuvant therapy. It also brings a biopsy report of a\nthyroid nodule with cytology compatible with papillary\ncarcinoma, chosen to be discussed later. The case was dis-\ncussed in a clinical session, and the decision was made to\nperform anterior resection of the rectum and endoscopic\nfollow-up. Proposed total hysterectomy and bilateral prophy-\nlactic adnexectomy, considering the incidence of gynecologi-\ncal cancer in patients with Lynch syndrome. The patient was\ndischarged and cleared for treatment of the papillary carci-\nnoma. Bowel continuity was restored, and the patient\nremains under outpatient follow-up.\nDiscussion Lynch syndrome is the leading cause of\nhereditary colorectal cancer (CRC), accounting for approxi-\nmately 3% of CRC cases and 2–3% of endometrial cancer cases.\nWith mutations in the MSH6 gene, the cumulative risk of\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS2\n\n\nendometrial cancer can reach 50%. The decision to perform a\ntotal hysterectomy and prophylactic salpingo-oophorectomy\nremains controversial; however, in this case, the option was\ndiscussed with the patient, as she had already completed her\nfamily and was undergoing surgery. Other commonly affected\nsites include the ovaries, stomach, brain, and prostate. Family\nhistory of malignancies must be assessed, with colorectal\ncancer screening starting at age 30 or 2 –5 years before the\nyoungest age of diagnosis in the family, repeated every three\nyears. Studies have shown that colonoscopy in these patients\nreduces disease mortality and adds an average of 14 quality-\nadjusted life years compared to unscreened individuals.\nConclusion Patient education about the disease is\ncrucial, given the high likelihood of developing neoplasms\nthroughout life. Attention to signs and symptoms indicative\nof disease in the primary sites should not be overlooked.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138081\nE-poster\nMUCINOUS AND SIGNET RING CELL RECTAL\nADENOCARCINOMA WITH ISOLATED BONE MARROW\nDISSEMINATION: A CASE REPORT\nJuanita Justina Ferreira da Silva 1, Beatriz Dias Rosa 1, Matheus\nWalerio Braido Arantes 1, Giovane Amui Fernandes 1, Gabriel\nOriani Melo1, Fernanda Garcia de Carvalho Pereira 1, Renata de\nSouza Guerra 1, Marcelo Maia Caixeta Melo 1\n1Faculdade de Medicina de São José do Rio Preto, São José do Rio\nPreto, Brasil\nCase Presentation A 56-year-old male, hypertensive,\nwas admitted to the emergency department of a tertiary\nhospital on 03/20/2023 with a one-month history of lower\nback pain radiating to the lower limbs, associated with\nasthenia, anorexia, hematochezia, and a 4 kg weight loss,\nwithout prior colonoscopy. On admission, moderate bicito-\npenia and elevated LDH were observed. A computed tomog-\nraphy (CT) scan revealed concentric thickening of the rectal\nwall with adjacent mesorectal fat densi fication and locore-\ngional lymph nodes, suggesting primary rectal neoplasia. On\nproctological examination, a fixed lesion with irregular mu-\ncosa was found on the anterolateral left wall of the rectum, 6\ncm from the anal margin. A colonoscopy was scheduled for\n04/05/2024 but was postponed due to clinical worsening and\nrefractory bicitopenia. On 04/05/2023, a bone marrow biopsy\nshowed extensive in filtration by mucinous adenocarcinoma\nwith signet-ring cells, low hematopoietic reserve, and grade 3\nreticulin fibrosis. Immunohistochemistry con firmed a colo-\nrectal primary site. After a multidisciplinary discussion, a\npalliative approach was chosen due to the refractory bicito-\npenia to transfusion measures (9 units of red blood cells and\n27 units of platelets during the entire hospitalization), as well\nas the mucinous subtype ’s poor response to chemotherapy.\nThe patient was discharged after 23 days of hospitalization\nfor outpatient follow-up but discontinued follow-up care.\nDiscussion Rectal cancer with isolated bone marrow\ndissemination is extremely rare, occurring in 0 –1.1% of\npatients. This type of dissemination can lead to hematologic\ndysfunction, with the most common symptoms being ane-\nmia, lower back pain, and a tendency to bleed, though this\ninitial presentation without changes in bowel habits is un-\ncommon. The main predictive factors for bone marrow\nmetastasis include the rectal origin of the tumor, signet-\nring cell characteristics, receipt of systemic chemotherapy,\npresence of pulmonary metastases, and higher tumor grade\nin patients with multiple metastatic sites. However, the\nassociation with isolated bone marrow metastasis has not\nbeen established. The prognosis is poor, regardless of treat-\nment, with a survival rate of 3 months in many cases.\nConclusion This case highlights the importance of\ninvestigating bicitopenia, with colorectal cancer being a\ndiagnostic consideration even in the absence of gastrointes-\ntinal symptoms.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141707\nE-poster\nRECTAL AND DUODENAL ADENOCARCINOMAS AFTER\nRESTORATIVE PROCTOCOLECTOMY IN A PATIENT WITH\nFAMILIAL ADENOMATOUS POLYPOSIS: A CASE REPORT\nCarla dos Santos Porto 1, Guinther Pedrosa Nogueira\nGoequing1, Luana Souza de Moraes Melo 1, Karina Mara Leitão\nMaia1, Vanessa Siqueira Reis2, Oswaldo de Moraes Filho2, Bruno\nAugusto Alves Martins 2, João Batista de Sousa 2\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nCase Presentation A 48-year-old woman with a\nfamily history of intestinal neoplasms and familial adenoma-\ntous polyposis (FAP) was diagnosed with FAP at the age of 27\nand underwent restorative proctocolectomy. However, 17\nyears after the surgery, she was diagnosed with duodenal\nadenocarcinoma and treated with duodenopancreatectomy.\nIn 2022, she was diagnosed with distal rectal adenocarcino-\nma and opted for local excision of the tumor, followed by\nchemotherapy and radiotherapy (CT/RT). Exome sequencing\nrevealed a pathogenic variant in the APC gene (c.532-1G >T),\nan autosomal dominant inheritance that may be associated\nwith FAP .\nDiscussion FAP is an autosomal dominant high-pen-\netrance disease characterized by the formation of numerous\nadenomas in the rectum and colon. Around 70-80% of cases\nhave family history. Therefore, screening is recommended\nstarting at age 12, and prophylactic surgical treatment is\nindicated from age 18. The disease is initially asymptomatic\nbut may progress with nonspeci fic symptoms and tumors.\nDue to the colorectal and extra-intestinal manifestations of\nFAP, as well as the possibility of developing cancers, prophy-\nlactic surgery is recommended. This may include restorative\nproctocolectomy with ileal reservoir, total colectomy with\nileorectal anastomosis, or total proctocolectomy with per-\nmanent ileostomy. In this case, the patient underwent restor-\native proctocolectomy, which involves excision of the colon\nand rectum. After rectal resection near the pelvic floor, 1 to 2\ncm of rectal mucosa is left, followed by the formation of an\nileal reservoir. During endoscopic follow-up, the patient\ndeveloped adenocarcinoma in the remaining rectal stump.\nDespite prophylactic resection, neoplasms can still develop in\nrare cases, highlighting the importance of endoscopic\nmonitoring.\nConclusion Restorative proctocolectomy is consid-\nered the gold-standard treatment for patients with more than\n20 polyps in the rectum. This case is significant as it illustrates\na rare occurrence in which the patient developed two\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S3\n\n\nmalignant neoplasms despite having undergone proctocolec -\ntomy, underscoring the importance of continued endoscopic\nsurveillance.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138304\nE-poster\nAGENESIS OF THE INFERIOR VENA CAVA IN A PATIENT\nUNDERGOING RESTORATIVE RECTOSIGMOIDECTOMY FOR\nCOLORECTAL CANCER: A CASE REPORT AND ITS SURGICAL\nIMPLICATIONS\nFernanda Garcia de Carvalho Pereira\n1, Matheus Walerio Braido\nArantes1, Leonardo Santos Viana 2, Renata de Souza Guerra 1,\nBeatriz Dias Rosa 1, Giovane Amui Fernandes 1, João Gomes\nNetinho1, Juanita Justina Ferreira da Silva 1\n1Faculdade de Medicina de São José do Rio Preto, São José do Rio\nPreto, Brasil\n2Faculdade de Medicina de Catanduva, Catanduva, Brasil\nCase Presentation A 50-year-old male presented\nwith asthenia, weight loss, and hematochezia, symptoms\nwhich he attributed to long-standing hemorrhoidal disease.\nOn physical examination, the abdomen was unremarkable,\nbut the patient had grade IV hemorrhoids, varicocele, and a\nlarge number of varicose veins in the lower limbs. A colonos-\ncopy revealed a vegetative lesion in the sigmoid colon, and\nhistopathology con firmed adenocarcinoma. A CT scan\nshowed thickening of the sigmoid colon and agenesis of the\ninferior vena cava (IVC), with collateral venous circulation in\nthe retroperitoneum, mesenteric varices, and perirenal vari-\nces. Due to these findings and the risk of bleeding, an open\nsurgical approach was chosen. Intraoperatively, the sigmoid\ntumor and intense collateral circulation in the retroperito-\nneum, along with mesenteric vessel engorgement, were\nobserved. The patient underwent rectosigmoidectomy, retro-\nperitoneal lymphadenectomy, and colorectal anastomosis.\nDespite careful retroperitoneal dissection, the surgery was\ncomplicated by higher-than-usual bleeding. The patient had a\ngood postoperative recovery. Histopathological analysis con-\nfirmed adenocarcinoma. The patient is currently undergoing\nadjuvant chemotherapy.\nDiscussion Malformations of the IVC are estimated to\noccur in 0.5% of the population. The most common include\nduplications of the IVC, left-sided positioning of the aorta,\ninterruption of one of its segments (infra-hepatic, pre-renal,\nrenal, or infrarenal), and, very rarely, IVC agenesis, with low\nprevalence in the literature. The etiology of agenesis is\ntypically embryological defects or intrauterine or perinatal\nthrombosis. This condition is usually asymptomatic but may\npresent with nonspeci fic symptoms such as abdominal pain\nor lead to chronic venous insuf ficiency and deep vein throm-\nbosis. Diagnosis is often incidental, found on imaging studies\nor during abdominal surgery. Although rare, IVC abnormali-\nties have signi ficant surgical implications and pose a major\nchallenge for surgeons. Preoperative diagnosis of such anom-\nalies allows the surgeon to plan the surgical approach and,\nthrough careful exposure and dissection of the anomalous\nvenous network, avoid severe iatrogenic injuries that could\nlead to massive bleeding and death.\nConclusion This case highlights the rare diagnosis of\nIVC agenesis discovered during colorectal cancer staging,\nwhich signi ficantly impacted the surgical planning and\nhelped avoid negative outcomes for the patient.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138252\nE-poster\nABDOMINOPERINEAL RESECTION OF THE RECTUM FOR LOW\nRECTAL GIST: A CASE REPORT\nCamila Nardi 1, Fernando Forghieri Silveira 1, Danilo Toshio\nKanno1, Luana Borges Segantine Martins 1, Naualy Cunha\nAlencar1, Carlos Augusto Real Martinez 1\n1Hospital Universitário São Francisco na Providência de Deus,\nBragança Paulista, SP, Brasil\nCase Report A 67-year-old woman with changes in\nbowel habits and tenesmus since 2015 was diagnosed with a\nlow rectal tumor and underwent transanal resection at\nanother institution, with the result being low-grade GIST.\nIn 2021, she returned to our clinic reporting tenesmus and\nhematochezia. She underwent a colonoscopy, which identi-\nfied a recurrence of the lesion. A pelvic MRI was performed,\nrevealing an expansive lesion in the rectum about 2 cm from\nthe anal verge, extending over 5.7 cm, involving the levator\nani muscle and posterior vaginal wall, with associated bilat-\neral external iliac and right obturator lymphadenopathy. A\nchest and abdominal CT scan showed no signs of distant\nmetastasis. Neoadjuvant therapy with imatinib for 2 years\nwas chosen. In 2023, a restaging MRI was performed, showing\npersistence of the lesion in the rectum but no associated\nlymphadenopathy. An extra-sphincteric abdominoperineal\namputation with resection of the posterior vaginal wall and\nterminal colostomy was performed. The procedure was com-\npleted without complications, and the patient was dis-\ncharged on the 10th postoperative day. She returned to the\nclinic with the result of the surgical pathology report showing\nlow-grade GIST, pT4apN0cM0, with free margins.\nDiscussion GIST, the most common mesenchymal\ntumor of the digestive tract, primarily affects adults, with\nthe most common locations being gastric (60-70%), small\nintestine (20-25%), and colorectal (5%). When located in the\nrectum, MRI provides greater bene fit for anatomical investi-\ngation and assessment of potential metastases. De finitive\ndiagnosis is made by biopsy and immunohistochemistry,\nwith over 95% of cases staining positively for CD117. The\ngoal of surgery is complete tumor removal and histological\nstudy of its characteristics, which will be used to determine\nadditional therapy. In cases where the tumor is surgically\nunresectable, treatment with Imatinib 400 mg/day should be\ninitiated, and it has been successfully used in the treatment of\nmetastatic GISTs for many years, with the potential for\ncomplete or partial remission.\nConclusion Despite the rarity of the tumor presenta-\ntion in this case, it is essential to disseminate knowledge on\nthe subject. In addition to describing a case of rectal GIST,\nwhich has a low incidence, this report also highlights the\nsuccess of using Imatinib as neoadjuvant therapy in an\nattempt to convert an unresectable tumor into a resectable\none, ultimately providing the opportunity for de finitive sur-\ngical treatment.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS4\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 137935\nE-poster\nANALYSIS OF HOSPITALIZATIONS DUE TO MALIGNANT COLON\nNEOPLASMS IN GOIÁS BETWEEN 2008 AND 2023\nVictor Cordeiro Simão 1, Pedro Eduardo da Costa Galvão 1,\nArthur Cordeiro Simão 1, Nayã Pereira Portilho 2, Gabriela Luz\nCastelo Branco de Souza1, Isabely Gelinski1, Mylena Santana de\nSena Araújo 1, Bruna Dell ‘acqua Cassão1\n1Universidade Federal de Goiás, Goiânia, Brasil\n2Pontifícia Universidade Católica de Goiás, Goiânia, Brasil\nIntroduction Malignant colon neoplasm is one of the\nleading causes of morbidity and mortality related to cancer\nworldwide. In Goiás, as in the rest of Brazil, the impact of this\ndisease on the healthcare system is signi ficant, reflected in a\nhigh number of hospitalizations. Understanding the epide-\nmiology of this pathology is crucial to guide public health\npolicies, develop preventive strategies, and improve the\nclinical management of patients in the region.\nObjective To qualitatively and quantitatively analyze\nhospitalizations due to malignant colon neoplasm in Goiás\nbetween 2008 and 2023.\nMethods This is a retrospective observational study\nbased on the DATASUS database, using the Health Data\nScience Platform (PCDaS), developed by the Institute for\nCommunication and Scienti fic and Technological Informa-\ntion in Health at FIOCRUZ, which allowed access to enriched\ndata from the SUS Hospital Information System (SIH/SUS) and\nthe analysis of hospitalizations for malignant colon neoplasm\n(ICD-10 C18) in Goiás between 2008 and 2023. A segmented\nregression (joinpoint) was performed to determine the trend\nin hospitalization rates.\nResults There were 11,192 hospitalizations between\n2008 and 2023 with a primary diagnosis of C18. The pre-\ndominant sex in the sample was male, with 5,779 (51.63%)\npatients. The most frequent age group was between 50 and 69\nyears, with 5,260 (47.0%) patients. The main surgical proce-\ndures performed were hemicolectomy (1,832) and appendec -\ntomy (1,670). Among the procedures performed during\nhospitalizations, 6,893 (61.75%) were of moderate complexi-\nty. The majority of hospitalizations were urgent, with 8,137\n(72.7%) cases. Furthermore, 1,183 hospitalizations resulted in\ndeath, of which 1,064 were urgent cases. The statistics\nshowed an increasing trend in hospitalizations.\nConclusion The high rate of urgent hospitalizations\nand the signi ficant number of deaths, particularly among\nthese hospitalizations, highlight the severity of the disease\nand the need for more effective interventions. The increasing\ntrend in hospitalizations suggests a rise in the incidence or\ndetection of malignant colon neoplasm, underscoring the\nimportance of prevention policies and early diagnosis. These\nfindings provide an important foundation for the formulation\nof public health strategies aimed at reducing morbidity and\nmortality associated with malignant colon neoplasm in Goiás.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 137762\nE-poster\nSQUAMOUS CELL CARCINOMA ASSOCIATED WITH CHRONIC\nHIDRADENITIS SUPPURATIVA: CASE REPORT AND\nLITERATURE REVIEW\nAndrey Salgado Moraes Filho 1, Giovanna Savoy Pazin 1, Livia\nMoreira Genaro1, Morgana Danubia Gomes de Souza Bonfitto2,\nPriscilla de Sene Portel Oliveira 3, Renata Ferreira Magalhães 4,\nMaria de Lourdes Setsuko Ayrizono 1, Raquel Franco Leal 1\n1Serviço de Coloproctologia, Departamento de Cirurgia, Faculdade\nde Ciências Médicas, Universidade Estadual de Campinas, Campinas,\nBrasil\n2Departamento de Anatomia Patológica, Gastrocentro, Faculdade de\nCiências Médicas, Universidade Estadual de Campinas, Campinas,\nBrasil\n3Pós-graduação em Ciências da Cirurgia, Faculdade de Ciências\nMédicas, Universidade Estadual de Campinas, Campinas, Brasil\n4Disciplina de Dermatologia, Departamento de Clínica Médica,\nFaculdade de Ciências Médicas, Universidade Estadual de Campinas,\nCampinas, Brasil\nIntroduction Hidradenitis Suppurativa (HS) is a\nchronic inflammatory disorder that affects the pilosebaceous\nunit, and Squamous Cell Carcinoma (SCC), also known as\nepidermoid carcinoma, may arise as a complication.\nCase Presentation A 58-year-old male, smoker,\nobese, and with type 2 diabetes, initially followed by the\ndermatology team for follicular occlusion syndrome mani-\nfested by HS, was referred to the coloproctology service due\nto the progression of a lesion in the perianal region near the\nHS lesions. On physical examination, an ulcerated, vegetative,\npainful, friable lesion was found in the right perianal region,\nconsistent with SCC in the HS scar. Pelvic MRI revealed a\nneoplastic tissue proliferation at the right anal margin mea-\nsuring 5.2 /C2 1.2 /C2 3.0 cm, with signs of neoplastic involve-\nment of the internal and external anal sphincters. A biopsy of\nthe lesion con firmed SCC (T3N1M0) in the HS scar. The\npatient underwent chemotherapy combined with radiother-\napy; however, lesions recurred. Due to this, abdominoper-\nineal amputation of the rectum was indicated. The patient\nremains under outpatient follow-up, disease-free for 2 years.\nDiscussion Studies have shown that patients with\nchronic HS have a higher risk of developing SCC, especially\nwhen the perineal and gluteal regions are involved, though\nthis is a rare occurrence. The standard protocol for SCC is\nchemoradiotherapy, aiming to preserve the anal sphincter by\navoiding surgical procedures. Surgical intervention is re-\nserved for cases that do not respond to chemoradiotherapy\nor for advanced cases where local resection alone is\ninsufficient.\nConclusion The reported case follows the epidemiol-\nogy of HS, mainly affecting males with chronic lesions in the\nperianal, gluteal, and perineal regions. These lesions can\nevolve severely and become refractory to non-invasive meas-\nures, requiring more aggressive surgery.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S5\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138364\nE-poster\nCOLORECTAL CANCER AND PARANEOPLASTIC\nDERMATOMYOSITIS: CASE REPORT\nGabriela Fonseca Lopes 1, Lucas Faraco Sobrado 1, Diego\nFernandes Maia Soares 1, Guilherme Cutait de Castro Cotti 1,\nCaio Sergio Rizkallah Nahas 1, Carlos Frederico Sparapan\nMarques1, Ulysses Ribeiro Junior 1, Pedro Pastre Sponchiado 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nCase Presentation A 40-year-old male, previously\nhealthy, began oncological follow-up at a university hospital\nwith a report of a 40 kg weight loss, abdominal cramps, and\nanemia. During the clinical investigation, a non-metastatic,\nstenosing adenocarcinoma was identi fied in the right colon,\nwhich was impassable via colonoscopy. In the perioperative\nperiod, the patient developed muscle pain and weakness in\nthe scapular and pelvic girdles, a skin rash, and elevated\ncreatine kinase (CPK). This combination of signs and symp-\ntoms led to the suspicion of dermatomyositis as a paraneo-\nplastic syndrome, and a skin biopsy was performed on a\nlesion on the back of the hand. After evaluation by the\nrheumatology and neurology teams, preoperative immuno-\nglobulin treatment was administered, leading to an improve-\nment in the symptoms. The patient then underwent\nlaparoscopic right colectomy with D2 lymphadenectomy,\nwithout anastomosis due to his clinical condition.\nDiscussion Malignancies most commonly associated\nwith dermatomyositis include ovarian, lung, breast, pancreat-\nic, gastric, colon, and prostate cancers, as well as non-Hodgkin\nlymphomas. Dermatomyositis (DM) is generally considered a\nparaneoplastic syndrome, occurring predominantly in women\nand in 96% of cases associated with adenocarcinomas. This\nsyndrome typically regresses with the surgical treatment of\nthe underlying neoplasm but may reappear with recurrence of\nthe malignancy. The association between colorectal cancer and\ndermatomyositis is linked to a worse prognosis, with reported\nmortality in up to 85% of cases.\nConclusion In patients with dermatomyositis, it is\nessential to investigate underlying malignancies, as clinical\nsymptoms may be related to a paraneoplastic syndrome. In\nthis case report, the collaborative action of the multidisci-\nplinary team was crucial to the patient ’s treatment, from\ndiagnosis to oncological surgery, enabling the management\nof this complex and rare condition.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138343\nE-poster\nCOLORECTAL CANCER IN YOUNG PATIENTS IN THE BRAZILIAN\nUNIFIED HEALTH SYSTEM (SUS): A COMPARATIVE STUDY\nACROSS DIFFERENT REGIONS OF BRAZIL\nBruna Oliveira Trindade 1, Daniel de Barcellos Azambuja 1,\nDebora Tagliari2, Cristina Calloni 3\n1Universidade Federal de Ciências da Saúde de Porto Alegre, Porto\nAlegre, Brasil\n2Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil\n3Universidade Feevale, Rio Grande do Sul, Brasil\nIntroduction Colorectal cancer (CRC) ranks as the 4th\nmost common cancer in Brazil. Although traditionally diag-\nnosed after the sixth decade of life, an increasing percentage\nof cases is being identified in young patients under 50 years of\nage.\nObjective To evaluate the geographic and temporal\npatterns of young patients (20-49 years old) with CRC treated\nsurgically through the Uni fied Health System (SUS) in differ-\nent regions of Brazil.\nMethod The data from the “Oncology Panel” of Data-\nSUS was used to collect information on the number of CRC\npatients (considering ICD codes C18 to C21), geographic\ndistribution, gender, age group, and treatment initiation\ntime. The Brazilian regions were categorized into North,\nNortheast, Southeast, South, and Midwest. Statistical analysis\nwere performed using SPSS software.\nResults Between 2013 and 2023, 12,659 young\npatients underwent surgery for CRC in Brazil, with an in-\ncrease from 508 cases in 2013 to 1,807 cases in 2023. A\nstatistically significant growth was observed (p<0.001), and a\nstrong positive correlation was found between the number of\ncases and the years evaluated (Pearson correlation coefficient\n= 0.883). The age group of 40-49 years represented the largest\nproportion of cases (37.2%), while the 20-29 age group had\nthe smallest proportion (6.9%). All age groups showed sta-\ntistically signi ficant growth. Only 6.42% of patients were\noperated on more than 60 days after diagnosis. Regionally,\ngrowth patterns followed the national trend, with the South-\neast and South regions leading with 5,485 and 3,319 patients,\nrespectively, while the North region had 385 patients in the\nstudied period. The Northeast region was the only one that\ndid not show a high correlation between the number of cases\nand the years evaluated (Pearson correlation coef ficient =\n0.669), although it still showed statistically signi ficant\ngrowth (p = 0.024). The North region stood out with\n14.81% of patients undergoing surgery after 60 days from\ndiagnosis.\nConclusion The increase in CRC cases in young\npatients in Brazil may be related to technological advance-\nments and greater access to healthcare services. However,\nthere is a clear regional disparity. These findings emphasize\nthe need for public policies that promote equity in access to\nearly diagnosis and appropriate treatment of CRC in all\nregions of Brazil.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141083\nE-poster\nHEREDITARY NONPOLYPOSIS COLORECTAL CANCER (HNPCC)\n- CASE REPORT\nEster Mesquita Henriques da Silva1, Paulo Victor Alves Tubino1,\nCalil Salomao Abud Neto 1\n1Escola Superior de Ciências da Saúde, Brasília, Brasil\nCase Presentation A 25-year-old female patient, with\nno comorbidities, was admitted to a tertiary unit reporting\naltered bowel habits and reduced stool volume. She disclosed\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS6\n\n\na family history of colorectal cancer, including her mother\ndiagnosed at 38 years, an uncle diagnosed at 54 years, and\ntwo cousins diagnosed at 40 and 32 years, all on the maternal\nside. A colonoscopy revealed a vegetative lesion in the splenic\nflexure, ulcerated with areas of necrosis, causing approxi-\nmately 80% luminal narrowing, rendering the lesion impass-\nable. Contrast-enhanced abdominal computed tomography\nshowed a segmental annular wall thickening at the splenic\nflexure, signi ficantly narrowing the intestinal lumen, with\nassociated densi fication of the pericolic fat plane, without\nsignificant thickening of the left laterocoronal fascia, and an\nextension of approximately 7.0 cm. On physical examination,\nthe abdomen was slightly distended, with no palpable mass.\nThe histopathological diagnosis of the splenic flexure lesion\nconfirmed invasive adenocarcinoma. Considering the diag-\nnosis of Hereditary Nonpolyposis Colorectal Cancer (HNPCC),\nthe patient underwent a total colectomy with terminal\nileorectal mechanical anastomosis and retroperitoneal\nlymphadenectomy without complications. The postoperative\nperiod was uneventful, and histopathological analysis of the\nsurgical specimen revealed invasive adenocarcinoma with\nstaging of pT3; pN0, with 42 lymph nodes evaluated. Immu-\nnohistochemistry (IHC) results were positive for CDX2, CK20,\nCK7, chromogranin, synaptophysin, and CD56. The patient\nwas referred to oncology for joint follow-up.\nDiscussion HNPCC is characterized by reduced or\nabsent activity of mismatch repair (MMR) proteins. Its diag-\nnosis is predominantly clinical, relying on detailed assess-\nment of a positive family history and the use of Amsterdam\ncriteria, with genetic testing less commonly applied in clinical\npractice. This genetic syndrome is associated with a higher\nincidence of metachronous and synchronous tumors com-\npared to sporadic colorectal cancer, often necessitating total\ncolectomy as the treatment for patients diagnosed with\nHNPCC.\nConclusion Characterizing the clinical-epidemiologi-\ncal aspects is crucial for clinical suspicion and early diagnosis\nof hereditary nonpolyposis colorectal cancer, enabling effec -\ntive family monitoring and appropriate treatment.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141755\nE-poster\nMETASTATIC ANAL CANAL SQUAMOUS CELL CARCINOMA\n(SCC) TO THE LIVER: CASE REPORT\nRodrigo Gomes da Silva 1, Fernanda Sophya Leite Cambraia 1,\nLara Floresta Neves Gonçalves 1, Jherlley Antonio Bazon\nMendes1, Vitor Gonzaga Giancotti 1, Lucas Crepaldi Carvalho\nNery1, José Henrique Paiva Rodrigues 1, Cleo Gonçalves\nTrindade Ribeiro1\n1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo\nHorizonte, Brasil\nCase Presentation A 43-year-old female patient pre-\nsented with complaints of painful defecation, tenesmus, and\nnarrow stools. She had no comorbidities or relevant family\nhistory. Physical examination revealed a vegetative, ulcerated\nlesion in the right anorectal ring. Colonoscopy identi fied a\nneoplastic lesion in the distal rectum and anal canal, measur-\ning 4 cm, and histopathology confirmed poorly differentiated\nsquamous cell carcinoma (SCC). Staging included abdominal\nand thoracic CT scans, which showed no metastases, while\npelvic MRI revealed thickening of the distal rectum, meso-\nrectal fat invasion, and enlarged lymph nodes. The patient\nwas referred for treatment with the Nigro protocol (chemo-\nradiation). Post-treatment MRI revealed hepatic lesions and\nrectal involvement beyond the muscularis propria. Physical\nexamination identified a hardened lesion 3 cm from the anal\nverge. Biopsy con firmed SCC with atypia suggesting HPV\ninfection. A PET scan showed uptake in the anal canal and\nliver lesion.\nRestaging Confirmed persistent/recurrent SCC with\nliver metastasis. Due to insuf ficient response to chemothera-\npy, abdominoperineal resection of the rectum and left hepa-\ntectomy were performed. Histopathology revealed SCC\ninfiltrating up to the vaginal mucosa, with clear margins,\nand 1 of 17 lymph nodes affected (T4aN1M1). The patient is\ncurrently under outpatient follow-up with imaging control.\nDiscussion SCC of the anal canal is rare, accounting\nfor less than 2% of gastrointestinal tract cancers, and strongly\nassociated with HPV. Up to 30% of cases may be asymptom-\natic, with rectal bleeding as the most common symptom in\n45% of cases. Other symptoms include pain, tenesmus, and\nincontinence. Prevention and screening involve HPV vaccina-\ntion and diagnostic tools such as high-resolution anoscopy\nand anal Pap smears, although no standardized screening\nprogram exists. Staging should assess the primary tumor ’s\nspread and locoregional disease, utilizing pelvic MRI, transa-\nnal ultrasound, and abdominal/thoracic CT scans. Data on\nchemotherapy for metastatic SCC cases with complete resec -\ntion is limited. Following the failure of the standard treat-\nment, a multidisciplinary and individualized approach was\nadopted.\nConclusion Until the 1980s, abdominoperineal resec -\ntion was the standard treatment, associated with high mor-\nbidity and permanent stoma rates. The Nigro protocol (1974)\ndemonstrated ef ficacy with combined chemoradiation and\nhas become the current standard of care. Metastatic disease is\ngenerally managed with systemic chemotherapy, but meta-\nstasectomy may improve overall survival in selected cases.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138357\nE-poster\nROBOTIC SURGERY VS. LAPAROSCOPIC SURGERY IN RIGHT\nCOLECTOMY: A COMPARATIVE CASE ANALYSIS IN AN\nINSTITUTION\nCristina Calloni 1, Daniel de Barcellos Azambuja 2, Andreia\nKayser Cardozo2, Bruna Oliveira Trindade 2\n1Universidade Feevale, Rio Grande do Sul, Brasil\n2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto\nAlegre, Brasil\nIntroduction Colorectal cancer is one of the most\ncommon cancer types. With advancements in surgical tech-\nniques, right colectomy can be performed using laparoscopic\nor robotic approaches. Both methods offer speci fic bene fits,\nbut the choice of the ideal technique remains debated. This\nstudy retrospectively compares clinical outcomes, including\noperative time, hospital stay duration, and patient quality of\nlife, in right colectomy performed using both techniques.\nObjective To conduct a comparative analysis of right\ncolectomy performed via robotic and laparoscopic\napproaches, evaluating clinical outcomes such as lymph\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S7\n\n\nnodes resected, hospital stay duration, and postoperative\nbowel function recovery time, aiming to identify signi ficant\ndifferences between the techniques.\nResults Twenty surgical procedures were analyzed,\nincluding 10 laparoscopic and 10 robotic surgeries. The\naverage patient age was 63.1 years, with a balanced gender\ndistribution between the two groups. Most tumors were\nlocated in the ascending colon (9 cases), followed by the\nhepatic flexure (3 cases) and the cecum (8 cases). The average\nnumber of resected lymph nodes was similar between the\napproaches, with 19 nodes for the laparoscopic method\n(standard deviation of 11) and 20 for the robotic method\n(standard deviation of 8). The average hospital stay duration\nwas six days for the laparoscopic approach (standard devia-\ntion of 4) and five days for the robotic approach (standard\ndeviation of 1). The greater variability in the laparoscopic\nprocedure was attributed to one case with postoperative\ncomplications. The average time to the resumption of bowel\nfunction was 3.5 days for laparoscopy (standard deviation of\n1.5) and three days for robotics (standard deviation of 1).\nRegarding operative time, the robotic approach demonstrat-\ned longer surgery durations.\nConclusion The results indicate that both surgical\ntechniques are equivalent in terms of clinical ef ficacy. The\nchoice between robotic and laparoscopic surgery should\nconsider factors such as the surgeon ’s experience, resource\navailability, and patient preferences. While robotic surgery\noffers technological advantages, including enhanced preci-\nsion, integrated 3D visualization, and improved dexterity, its\nhigh cost may limit its adoption. Therefore, it can be conclud-\ned that there are no signi ficant differences in direct clinical\nbenefits between the laparoscopic and robotic techniques for\nright colectomy.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 137690\nE-poster\nSURGICAL CYTOREDUCTION OF PERITONEAL METASTASIS\nDUE TO RIGHT COLON ADENOCARCINOMA IN A PATIENT\nWITH LYNCH SYNDROME – CASE REPORT\nAugusto Zbonik Mendes\n1, Henrique de Andrade Ferreira Pinto1,\nIlson Geraldo dos Santos 1, Diogo Viana Abreu 1, Mario Inácio\nCarneiro Neto1, Guilherme de Almeida Santos 1, Jennyfer Kellen\nLázaro da Rocha 1, Lais Campos Soares 2\n1Santa Casa de Belo Horizonte, Belo Horizonte, Brasil\n2Universidade Professor Edson Antônio Velano, Belo Horizonte, Brazil\nCase Presentation A 36-year-old male underwent a\nright colectomy for acute appendicitis in December 2022. The\nbiopsy revealed colon adenocarcinoma, with immunohis-\ntochemistry showing microsatellite instability and loss of\nMLH1 and PMS2 repair protein expression, con firming a\ndiagnosis of Lynch Syndrome. The patient received chemo-\ntherapy cycles (5-Fluorouracil and leucovorin) and was re-\nferred to the colorectal team due to a large, expansive\nperitoneal lesion in the right iliac fossa. The lesion measured\n8.5 /C2 7 /C2 9 cm, with no cleavage plane from adjacent intesti-\nnal loops and the psoas muscle. There was an unclear cleavage\nplane involving a small portion of the right common iliac\nartery, affecting less than 30% of its circumference, and\nanother peritoneal lesion near the umbilical scar. A joint\ncolorectal and vascular surgery approach was performed,\nachieving complete cytoreduction of the right iliac fossa\nlesion. The procedure included a segmental enterectomy\nwith primary anastomosis, partial resection of the psoas\nmuscle, and resection of umbilical peritoneal metastasis.\nThere was no vascular invasion, and the surgery was com-\npleted without complications. The patient showed good\npostoperative progress, being discharged on the sixth day\nof hospitalization. Follow-up revealed decreased CEA levels\nand no signs of recurrence.\nDiscussion Lynch Syndrome is the most common\nhereditary condition linked to colorectal cancer. Identifying\nthese patients is crucial due to the more than 80% lifetime risk\nof colorectal cancer, often diagnosed at advanced stages, as in\nthe case presented. Peritoneal metastases signi ficantly re-\nduce overall survival and are associated with a poor prognosis\nin 30-40% of cases. In selected patients, surgical cytoreduc -\ntion, either alone or combined with HIPEC, can improve\noncological outcomes. This approach should consider the\nperitoneal carcinomatosis index (PCI) and the feasibility of\ncomplete cytoreduction. In the presented case, the presence\nof a limited number of lesions, despite their large size,\nallowed for a successful surgical approach.\nConclusion Even in patients with advanced disease\nand peritoneal metastases, if the PCI is below 20 and complete\ncytoreduction is achievable, surgical intervention should be\nconsidered as a de finitive management strategy. This ap-\nproach can improve oncological outcomes, increasing surviv-\nal and quality of life for affected patients.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138311\nE-poster\nTOTAL COLECTOMY IN A PATIENT WITH THREE\nSYNCHRONOUS COLORECTAL TUMORS: A CASE REPORT\nFernanda Garcia de Carvalho Pereira\n1, Juanita Justina Ferreira\nda Silva 1, Matheus Walerio Braido Arantes 1, Lucas Garcia de\nCarvalho Pereira 2, Renata de Souza Guerra 1, Giovane Amui\nFernandes1, Beatriz Dias Rosa 1, João Gomes Netinho 1\n1Faculdade de Medicina de São José do Rio Preto , São José do Rio\nPreto, Brasil\n2Universidade Federal de Minas Gerais, Brasil\nCase Report A 63-year-old woman presented with\nabdominal pain, diarrhea, and hematochezia. Physical exam-\nination showed no abnormalities. Initial CEA level was 32. CT\nscan revealed thickening in the descending colon and a\nhepatic nodule suggestive of a secondary implant. Colonos-\ncopy showed a vegetating lesion in the sigmoid and descend-\ning colon, preventing the passage of the scope. The patient\nunderwent total colectomy with ileorectal anastomosis and\nhepatic metastasectomy. The pathological examination con-\nfirmed 3 synchronous tumors (lesions in the sigmoid colon,\ndescending colon, and a polyp in the ascending colon), all\nadenocarcinomas with mucinous areas. Immunohistochem-\nistry showed microsatellite stability and a KRAS gene muta-\ntion. The patient is currently under follow-up and receiving\nadjuvant therapy.\nDiscussion Synchronous colorectal cancer refers to\nthe presence of simultaneous tumors in a patient at initial\npresentation. The prevalence is 3.5%, and the occurrence of 3\nor more tumors is rare. Literature reports a higher prevalence\nof synchronous tumors in males and elderly patients. There is\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS8\n\n\nalso a tendency for greater involvement of the ascending\ncolon and mucinous pathology. Risk factors include in flam-\nmatory bowel disease, Lynch syndrome, and familial adeno-\nmatous polyposis, as well as genetic and molecular factors\nsuch as microsatellite instability and mutations in BRAF,\nKRAS, and p53 genes. Preoperative diagnosis is often chal-\nlenging. Complete colonoscopy is frequently hindered due to\nobstructive tumors. CT scans have good sensitivity. Virtual\ncolonoscopy, MRI, and PET scans can be useful, especially\nwhen the colonoscopy is incomplete or if synchronous lesions\nare suspected. Treatment should consider tumor location,\nstaging, and the patient ’s general condition. Studies recom-\nmend total colectomy to resect potentially undiagnosed\nlesions and prevent metachronous tumors. However, others\nrecommend traditional surgery to preserve the colon. In the\npresented case, a rare occurrence of 3 synchronous colorectal\ntumors was observed. The patient had only the KRAS gene\nmutation as a risk factor. The preoperative colonoscopy\nidentified two lesions, with the third lesion diagnosed only\nin the pathological examination.\nConclusion This case highlights the importance of\nstudying clinical and molecular risk factors in the pathophys-\niology of synchronous colorectal lesions, as well as discussing\nthe diagnosis and particularities of treatment, which remain\ncontroversial.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138205\nE-poster\nTOTAL COLECTOMY IN ONCOLOGICAL PATIENTS:\nEPIDEMIOLOGICAL STUDY ON THE CENTRAL-WEST REGION\nBETWEEN 2018 AND 2023\nMaria Luiza Ferreira da Costa 1, João Veríssimo da Silva Neto 1,\nFabiana Silva Delmondes 1, Ana Carolina da Costa Ferreira 2,\nAline Guimarães Sant ‘ana1, Milton Sant ‘ana de Freitas Filho 1\n1Universidade Estadual de Goiás, Brasil\n2Universidade Federal de Minas Gerais, Belo Horizonte, Brasil\nIntroduction Total colectomy is characterized by the\ncomplete removal of the intraperitoneal colon, and its indi-\ncation ranges from complications of in flammatory bowel\ndiseases to the presence of familial adenomatous polyposis\n(FAP) and colon cancer (CC).\nObjectives To determine the number of hospitaliza-\ntions for total colectomy in an oncological context; analyze\nthe average hospitalization cost and average hospital stay for\nthis procedure; and identify risk factors for the development\nof colonic neoplasia and their relationship to prevention.\nMethod A retrospective epidemiological study was\nconducted, evaluating hospitalizations, average hospitaliza-\ntion cost, and average hospital stay for total colectomy in\noncology in the states of the Central-West Region (CO) from\n2018 to 2023. Data were collected from the SUS Hospital\nInformation System and the Oncology Panel-BRASIL by the\nDepartment of Information Technology of the Uni fied Health\nSystem (SUS), accessed through the Health Information\nTabulator.\nResults Between 2018 and 2023, 6448 cases of colon\ncancer were treated in CO, 47.5% of which were treated\nsurgically. Goiás (GO) had the highest number of treatments\n(2706), followed by Mato Grosso do Sul (MS) (1287), Mato\nGrosso (MT) (1234), and the Federal District (DF) (1221).\nDuring this period, 143 hospitalizations for total colectomy\ndue to oncological reasons were recorded, with 62 in DF, 47 in\nGO, 26 in MS, and 8 in MT. The average hospitalization cost\nwas R$ 9082 in MS, R$ 9707 in MT, R$ 9977 in GO, and R$ 9231\nin DF. The average hospital stay was 10.2 days in MS, 9.5 days\nin MT, 7.25 days in GO, and 9.5 days in DF. Risk factors for\ndeveloping CC include genetic, environmental, and lifestyle\nfactors such as alcohol consumption, obesity, hypertension,\nand diabetes.\nConclusion Approximately half of the colon cancers\nwere treated surgically, with only 2% requiring total colec -\ntomy. The average hospitalization cost was around R$ 9000,\nwith GO having the highest cost and the shortest hospital\nstay. Modifiable risk factors are associated with an increased\nnumber of colon cancers, and delayed diagnosis is linked to\nadvanced staging and the need for invasive measures like\ntotal colectomy. The improvement of public policies on\nlifestyle changes and colon cancer screening exams contrib-\nutes to a reduction in incidence and early diagnosis, thereby\nreducing the need for total colectomy and public expenditure\non this procedure.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138257\nE-poster\nDIFFICULTY IN DIFFERENTIAL DIAGNOSIS BETWEEN\nGYNECOLOGICAL AND PROCTOLOGICAL TUMORS – CASE\nSERIES\nR. F. F. Hudari 1, Flávia Balsamo 1, Sandra Di Felice Boratto 1,\nMarcella Conz Rodrigues 1, Guiherme Garcia Hudari 1, Sergio\nHenrique Couto Horta 1, Eduardo Vidal de Holanda 1, Lynardo\nJose Fernandes Tavares 1\n1Centro Universitário Faculdade de Medicina do ABC, Santo André, SP,\nBrasil\nCase Presentations Case 1: Female, 75 years old,\nreports abdominal pain and changes in bowel habits. Colo-\nnoscopy showed an ulcerative-in filtrative lesion 22 cm from\nthe anal verge, histopathology indicating poorly differentiat-\ned squamous cell carcinoma (SCC). Staging cT3N2M0. The\npatient developed a subintestinal obstruction and was indi-\ncated for loop transverse colostomy. Abdominal MRI sug-\ngested the primary neoplasia originated in the sigmoid. The\npatient underwent exploratory laparotomy and left oopho-\nrectomy due to peritoneal carcinomatosis. The diagnosis of\nhigh-grade papillary serous ovarian carcinoma was con-\nfirmed by immunohistochemistry. The patient is currently\nundergoing chemotherapy and scheduled for cytoreductive\nsurgery by gynecology. Case 2: Female, 28 years old, presents\nwith abdominal pain. Colonoscopy showed a vegetative\nlesion 8 cm from the anal verge. Abdominal and pelvic CT\nand MRI revealed a tumor in the left adnexal region, rectum,\nand sigmoid, cT4bN2bM1a. The patient underwent total\nhysterectomy, bilateral salpingo-oophorectomy, segmental\nenterectomy, mechanical latero-lateral anastomosis, sigmoi-\ndectomy, terminal colostomy, left ureter resection, and re-\nsection of tumor implants in the sacral region. Colonoscopy\nhistopathology showed no evidence of the primary site. The\npatient was referred to oncology and died 2 months after\ndiagnosis. Case 3: Female, 73 years old, with abdominal pain,\nenterorrhagia, and weight loss. Colonoscopy showed a lesion\n13 cm from the anal verge. Abdominal and pelvic CT showed a\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S9\n\n\nlesion in the uterine area in contact with the rectum and\nsecondary involvement. Rectal biopsy con firmed invasive\nulcerated colorectal carcinoma. The patient is under follow-\nup with gynecology and oncology.\nDiscussion Complex pelvic lesions in women can\noriginate from various anatomical structures and have a\nbroad range of possible diagnoses. Most of these masses\nare of ovarian origin, and MRI is useful for diagnostic differ-\nentiation. When colorectal tumors are suspected, immuno-\nhistochemistry is required. Colorectal SCC is rare (0.025-0.1\nper 1,000 colon cancers), its clinicopathological character-\nistics are unclear, and its prognosis may be worse than that of\nadenocarcinoma.\nConclusion Differential diagnosis of pelvic masses is\nnecessary for appropriate patient treatment. Early detection\nis crucial for favorable prognosis. Three cases initially sus-\npected of coloproctological neoplasms were presented,\nwhere the complexity of the advanced lesions hindered\ndiagnosis. However, after investigation, the cases were con-\nfirmed to be gynecological tumors.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138149\nE-poster\nLARGE CARCINOID TUMOR OF THE CECUM: CASE REPORT\nPierre Rodrigues Bernardino 1, Isabella da Silva Idelfonso 1, José\nRoberto Violatti Filho 1, Amanda Karolyne Batista Ferreira 1,\nCarlos Eduardo Oliveira Sodero 1\n1Universidade Federal do Triângulo Mineiro, Uberaba, Brasil\nCase Presentation FFS, female, 60 years old. The\npatient presented with a 4-year history of colicky pain\nassociated with severe abdominal distension of a progressive\nnature. She developed constipation, with bowel movements\nevery 10 days, characterized by dry stools, in addition to\nanorexia, asthenia, and a 13 kg weight loss over the last 2\nmonths. Upon admission, she underwent colonoscopy, which\nrevealed a vegetative lesion in the cecum with smooth,\nyellowish areas and other rough, hyperemic areas. The histo-\npathological examination (HE) of the lesion con firmed a\ncarcinoid tumor (neuroendocrine), without adenomas. The\npatient underwent laparoscopic right hemicolectomy with-\nout complications, and no metastatic foci were found. The\nspecimen sent for histopathological analysis revealed a grade\nI neuroendocrine carcinoma, multifocal, with the largest\nfocus measuring 6x3 cm, staging MpT2pN1. The patient\nwas referred to clinical oncology for follow-up.\nDiscussion Carcinoid tumors are indolent neoplasms\nof the diffuse neuroendocrine cellular system and are typi-\ncally diagnosed late. Previously considered rare, this pathol-\nogy is increasingly prevalent with advancements in\ndiagnostic technologies such as computed tomography and\ncolonoscopy. The symptoms are nonspeci fic, complicating\nthe diagnosis. Initial manifestations are often associated with\nsubocclusive syndromes, which are related to the tumor’s size\nand location in the gastrointestinal tract, and may progress to\nabdominal pain, asthenia, anorexia, and weight loss, as\nobserved in the patient’s progression. Despite the low growth\nrate and metastasis rate, carcinoid tumors should be surgi-\ncally resected. Tumors larger than 2 cm are rare and are often\nassociated with lymph node and hepatic metastases, which\nconfer a worse prognosis, making adjuvant therapy\nnecessary.\nConclusion The patient presented with lesions that\ndiffered from the usual prevalence, with the increased size of\nthe lesion conferring greater severity, a higher chance of\nmetastasis, and a worse prognosis. Nevertheless, the patient\nhad a favorable outcome during outpatient follow-up, with\nremission of obstructive symptoms.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141709\nE-poster\nACUTE KIDNEY INJURY IN THE POSTOPERATIVE PERIOD OF\nELECTIVE COLORECTAL SURGERY: EVALUATION OF THE\nINFLUENCE OF AGE\nLeonardo Menezes Guarda1, Gabriela Portal Monteiro1, Yasmin\nGóis de Mello1, Isaac José Felippe Corrêa Neto1, Laercio Robles1\n1Santa Marcelina\nIntroduction Life expectancy has signi ficantly in-\ncreased from the last century to the present due to advances\nin science, vaccination, medical care, and better lifestyles.\nBetween 1990 and 2019, global life expectancy rose from 64\nto 72.8 years. With an aging population, diseases such as\ncolorectal cancer are more prevalent, especially among the\nelderly, increasing postoperative challenges, with acute kid-\nney injury (AKI) being one of the most frequent\ncomplications.\nObjective To analyze risk factors related to acute\nkidney injury in the postoperative period of elective colorec -\ntal surgeries in patients over 65 years of age. Additionally, to\noutline the socioeconomic, clinical-surgical, and laboratory\nprofile of the study population.\nMethod A clinical, observational, longitudinal, pro-\nspective, and analytical study with a quantitative approach. It\nwas conducted through the analysis of electronic medical\nrecords of patients who underwent colorectal surgery at a\nTeaching Hospital in São Paulo (SP), Brasil.\nResults Thirty patients who underwent elective colo-\nrectal surgery were analyzed. The average age was 70.4 years\n(range 66-85 years), with 53.3% female and 46.6% ex-smokers\nor active smokers. The main comorbidity was Systemic\nArterial Hypertension (63.3%), followed by Diabetes Mellitus\n(23.3%), Dyslipidemia (16.6%), Hypothyroidism (10%), Heart\nFailure (6.6%), and Chronic Kidney Disease (3.3%). The major-\nity of patients (73.2%) had adenocarcinoma of the rectum and\nsigmoid. Approximately 33.3% of the patients developed AKI.\nNo significant association was observed between the devel-\nopment of AKI and the following variables: age, body mass\nindex, volume infused during surgery, surgical time, and\nperformance status.\nConclusion The non-use of angiotensin-converting\nenzyme inhibitors prior to surgery was the only factor related\nto the development of AKI in the postoperative period.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS10\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138292\nE-poster\nLEIOMYOSARCOMA OF THE RIGHT COLON: A CASE REPORT\nCristiane Koizimi Martos Fernandes 1, Fábio Lopes de Queiroz 1,\nArtur Duarte e Duarte 1, Letícia Brandão Castro 1, Letícia\nBrandão Castro1, Marina Barbabela Grisolia de Oliveira 1,\nVinícius Avelar Palhares 1, Eduardo de Carvalho Barbosa 1\n1Hospital Fellcio Rocho, Belo Horizonte, Brasil\nCase Presentation A 38-year-old male patient, post-\nrenal transplant from a living donor in 2009 due to type 1\ndiabetes mellitus, presented with weight loss. A colonoscopy\nperformed on 07/27/2022 revealed a pedunculated, lobulated,\nand voluminous lesion covered with fibrin, approximately\n50mm in diameter, occupying about 70% of the intestinal\nlumen. Tattooing and biopsy of the lesion were performed.\nThe pathological result showed a fusocellular neoplasm with\nfocal moderate atypia and a low mitotic index. The patient was\nthen subjected to right colectomy via laparoscopy on 08/11/\n2022. The pathological examination was consistent with a\nproliferative fusocellular colon lesion, predominantly affecting\nthe submucosa, with extension to the mucosa and ulceration of\nthe adjacent epithelium. One mitosis per 5mm² was identified.\nSurgical margins were free of disease. Twenty-nine lymph\nnodes were examined, all without signs of involvement.\nImmunohistochemistry revealed preserved histone H3 and\nfocal smooth muscle actin positivity. The patient experienced\nmultiple perioperative and postoperative complications, in-\ncluding latex anaphylaxis and anastomotic fistula. He under-\nwent further surgical treatment and later ileocolostomy\nclosure in 2023. Since then, there has been no disease recur-\nrence, with clinical improvement and significant weight gain.\nDiscussion Intestinal leiomyosarcomas are rare, ac -\ncounting for approximately 0.1% of cases of malignant neo-\nplasms in the colon. These tumors originate from the\nmuscular layer of the intestinal wall or the muscularis\nmucosa. Some cases are asymptomatic, and the diagnosis is\noften an incidental finding during preventive screening\nexams. Diagnosis is based on clinical examination, supported\nby imaging, endoscopic evaluations, and pathology with\nimmunohistochemistry. The recommended treatment is sur-\ngical resection of the affected intestinal segment. No estab-\nlished chemotherapy regimen exists due to the low incidence\nof the pathology and its limited impact on prognosis. Thefive-\nyear survival rate for tumors smaller than 5 centimeters,\nwithout metastases, and well-differentiated is around 50%.\nConclusion Malignant tumors derived from intestinal\nmuscle are rare, emphasizing the importance of preventive\ncolon exams for early detection. Histological and immuno-\nhistochemical confirmation of the lesion is essential to deter-\nmine the appropriate treatment, which should preferably be\nsurgical.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138344\nE-poster\nANAL MELANOMA: CASE REPORT\nIsabela de Oliveira Miranda 1, Maíra Leticia Schwaab 2, Giulia\nLuiza Cecconello2, Emanuella Roberta Ina Cirino 2, Renato\nVismara Ropelato2, Alexandra Damasio Todescatto 2, Paulo\nGustavo Kotze2\n1Universidade Federal de Pelotas, Pelotas Brazil\n2Hospital Universitário Cajuru, Curitiba, Brasil\nA 67-year-old white female with chronic kidney dis-\nease and grade III obesity was referred to a coloproctologist\ndue to hematochezia, pain, pruritus, and progressive anal\nprotrusion over 8 months. Upon anal inspection, a vegetative,\nulcerated, friable lesion with necrotic areas, irregular borders,\nand apparent infiltration into deeper layers was found on the\nleft posterior-lateral anal edge, measuring approximately 4cm\ncranio-caudally. On palpation, a lesion with the same charac -\nteristics was felt up to 3cm from the anal edge. A colonoscopy\nperformed 3 months earlier showed colonic diverticula and an\nerosive anal plica. Pelvic magnetic resonance imaging revealed\nan expansive, lobulated lesion in the posterior anal canal\nmeasuring 56x30mm, with an oval-shaped inguinal lesion\non the left side measuring 25x19mm. The patient underwent\npartial excision of the lesion, with histopathology and immu-\nnohistochemistry confirming the diagnosis of anal canal mel-\nanoma, with positive S100 and MELAN-A markers. Two\nmonths after diagnosis, the patient passed away at an external\noncology service. Anal melanoma is the third most common\nsite for mucosal melanoma and the primary site in the\ngastrointestinal tract. It is more frequent in white women,\nwith an average age of 55 years. At diagnosis, more than 60% of\npatients have metastases, a situation often due to tumor\naggressiveness and delayed diagnosis caused by nonspeci fic\nsymptoms resembling benign anorectal diseases. Anoscopy\ncan help evaluate the “ABCDE” of melanoma, but lesions\ngenerally appear polypoid, ulcerated, and range from 1 to 6\ncm. A definitive diagnosis is made by biopsy with immunohis-\ntochemistry, showing positive markers such as S100 and\nMELAN-A. For loco-regional and distant staging, positron\nemission tomography (PET) is superior to contrast-enhanced\ncomputed tomography due to the multiple lymphatic drainage\nareas in the region. Treatment involves local excision or\nabdominoperineal amputation, often with adjuvant therapies\nsuch as chemotherapy, radiation, and more recently, immuno-\ntherapy. The prognosis is poor, with a 5-year survival rate of\napproximately 20%. This case report supports the epidemiolo-\ngy of anal mucosal melanoma and emphasizes the importance\nof thorough anorectal evaluation for early diagnosis of this\naggressive tumor.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 137796\nE-poster\nCUTANEOUS METASTASIS IN A PATIENT WITH COLORECTAL\nCANCER: A CASE REPORT\nBruna Oliveira1, Lívia Oliveira 1, Barbara Tannús Valadão 1,\nReginaldo Rodrigues do Prado 1, Meriella Furlan Carneiro 1,\nMariane Tonin Jatobá 1, Ulisses Marques Cardoso 1, Larissa\nGanança Buosi 1\n1Hospital Sao Francisco Ribeirão Preto, Ribeirão Preto, Brasil\nCase Presentation A male patient, E.A.M.G., 59 years\nold, sought medical attention in November 2022, reporting\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S11\n\n\nbright red blood in his stool and weight loss. A colonoscopy\nwas requested, revealing an ulceroin filtrative lesion in the\nmid-rectum, affecting 50% of the circumference. Histopatho-\nlogical examination (HE) showed a well-differentiated ulcer-\noinvasive adenocarcinoma of the rectum. Tumor staging\nshowed no distant metastasis. He was referred to oncology\nand underwent neoadjuvant chemoradiotherapy, followed by\na rectosigmoidectomy with primary anastomosis and loop\ntransverse colostomy. During the surgery, no metastasis was\nobserved, and HE revealed no angiolymphatic or perineural\nneoplastic invasion, with clear circumferential and distal\nsurgical margins (pT2 pN0). In November 2023, the patient\nreturned, reporting a lesion in the perianal region. On physi-\ncal examination (PE), a single 4 cm, purple, painless, and\nmobile nodule was observed perianally. The lesion was\nexcised, and HE con firmed moderately differentiated ulcer-\nated adenocarcinoma in the skin at the anal margin. There\nwas no neoplastic invasion, angiolymphatic, or perineural\ninvolvement, and surgical margins were free, with the closest\nmargin being 3 mm.\nDiscussion Colorectal cancer (CRC) is the fourth most\ncommon malignancy globally and the most frequent in the\ngastrointestinal tract (GIT). The general incidence of cutane-\nous metastases from gastrointestinal malignancies is 5.3%,\nand most of these metastases are located near the primary\ntumor site. The mechanisms for the occurrence of cutaneous\nmetastases have not been de finitively established, but they\nmay appear through the peritoneal cavity or the lymphatic\nand hematologic systems. Iatrogenic implantation during\nsurgery is rare. Metastatic carcinoma appears as violet or\nskin-colored, firm, freely movable, painless nodules, which\ncan be solitary or multiple. They are mainly classi fied as\nadenocarcinoma, squamous cell carcinoma, and undifferen-\ntiated carcinoma. Local wide excision of the cutaneous meta-\nstatic lesion is the preferred treatment option, and in\nextensive cases, the treatment is palliative.\nConclusion Cutaneous metastases from CRC are a rare\nmanifestation, making it crucial to evaluate cutaneous lesions\nin patients with a history of CRC. Therefore, there is a need for\nphysicians to educate and train patients on skin examina-\ntions, detecting any changes, and early reporting of any\ncutaneous alterations, especially in individuals with a history\nof visceral malignancy. By promoting a comprehensive un-\nderstanding of this phenomenon, physicians can contribute\nto better detection, intervention, and care for individuals\nwith a history of CRC.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138334\nE-poster\nMETASTASIS OF RECTAL ADENOCARCINOMA MIMICKING\nHPV LESIONS\nEduardo Vidal de Holanda\n1, Sandra Di Felice Boratto 1, Isabela\nPereira Blanco1, Anelise Stachewski Russo 1, Sergio Henrique\nCouto Horta1, Juliana Giangiardi Batista 1, Raphaella Assis Alves\nJanuário1, Flavia Balsamo 1\n1Faculdade de Medicina do ABC, Santo André, Brasil\nCase Presentation A 71-year-old male presented to\nthe coloproctology outpatient clinic of a tertiary hospital\nafter being referred from the emergency department due\nto an anoperineal abscess and suspected genital lesions from\nHuman Papillomavirus (HPV). He complained of painful\nperianal protrusion, bleeding during bowel movements for\none year, weight loss of 12 kg over the same period, as well as\nscrotal warts and painless inguinal nodules. His medical\nhistory included an anoperineal fistula for 30 years, requiring\ntwo surgeries. Undergoing oncological investigation in an\nexternal service, a colonoscopy revealed an ulcerovegetative\nlesion in the rectosigmoid, occupying 80% of the lumen, and\nhistopathology confirmed adenocarcinoma. On proctological\nexamination, multiple verrucous, in filtrative lesions with\ncentral ulceration were observed on the scrotum, perineum,\nand right groin, in addition to bilaterally enlarged,fibroelastic\ninguinal lymph nodes. A retoscopy showed normal mucosa\nup to 12 cm from the anal margin, where a polypoid,\ninfiltrative lesion with friable, bleeding tissue was observed,\noccupying 50% of the rectal lumen up to 16 cm from the anal\nmargin. Additional exams indicated in filtration of the mes-\norectal fat, pelvic wall, and right spermatic vein. Histopathol-\nogy of the verrucous lesions con firmed adenocarcinoma.\nGiven the presence of high rectal tumor metastasis to the\nskin, an initial plan for resection and Hartmann colostomy,\nfollowed by systemic chemotherapy, was proposed. However,\nafter discussing the palliative nature of the surgery due to the\ncutaneous metastasis, the patient and family opted for palli-\native chemotherapy.\nDiscussion Cutaneous metastasis of colorectal ade-\nnocarcinoma is rare, with the abdominal wall being the most\ncommon site. It occurs through hematogenous and lymphatic\ndissemination and usually manifests late after the surgical\nresection of the primary tumor. The prognosis is poor, and the\naverage survival for patients after the appearance of cutane-\nous lesions ranges from 3 to 18 months.\nConclusion This case aims to discuss possible differ-\nential diagnoses for cutaneous metastases from colorectal\nadenocarcinomas. A high level of clinical suspicion is required\nfor diagnosing metastatic skin lesions, as when present,\ncutaneous metastasis is a standalone poor prognostic factor\nfor oncology.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138309\nE-poster\nBREAST METASTASIS OF RECTAL ADENOCARCINOMA\nNatália Ferreira Cardoso de Oliveira 1, Fernanda Belotti\nFormiga1, Luisa Fernandes Bassoi 1, Vilmar Marques de\nOliveira1, Louisie Galantini Lana de Godoy 1, Maria Antonieta\nLongo Galvão Silva 1, Luis Eduardo Silva Móz 1, Fang Chia Bin 1\n1Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo,\nBrasil\nCase Presentation A 42-year-old woman presented\nwith colicky abdominal pain, abdominal distension, and\naltered bowel habits, including constipation. During the\ninvestigation, she was diagnosed with high rectal adenocar-\ncinoma, subocclusive, with a large, solitary hepatic metasta-\nsis. A 3 cm breast nodule was also diagnosed. Due to\nsubocclusive symptoms, the patient underwent a rectosig-\nmoidectomy, and histological analysis revealed a poorly\ndifferentiated adenocarcinoma with a mucinous component,\npT4aN2a, with free margins and immunohistochemical stud-\nies showing no alterations in repair proteins. She started\nchemotherapy with 5-fluorouracil and oxaliplatin, when the\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS12\n\n\nbreast nodule fistulized to the skin. A core biopsy was\nperformed, suggesting triple-negative invasive ductal carci-\nnoma. Chemotherapy was switched to carboplatin and pacli-\ntaxel, and the patient underwent mastectomy with regional\nlymphadenectomy. The histological study con firmed meta-\nstatic gastrointestinal carcinoma, with free margins and\nregional lymph node involvement. Eight months after the\ncolorectal surgery, the patient developed local recurrence,\nincreased hepatic metastasis, new breast metastasis, and\nsuspected cutaneous metastasis. She is currently receiving\npalliative chemotherapy.\nDiscussion Breast metastasis from colorectal adeno-\ncarcinoma is extremely rare. Primary tumors most commonly\nassociated with breast metastasis include contralateral breast\ncancer, leukemia, melanoma, lymphoma, ovarian cancer, lung\ncancer, and stomach cancer. The literature reports only 49\ncases of colorectal metastasis on the breast, all with poor\nprognosis and, in some cases, dif ficult diagnosis. Since both\nbreast and colorectal tumors are the most common neo-\nplasms in the female population, the suspicion of a second\nprimary tumor is inevitable. Treatment is challenging, as\nmetastases often occur on multiple sites, indicating that\nthe disease is systemic and progresses rapidly.\nConclusion Breast metastasis from colorectal adeno-\ncarcinoma is extremely rare. Diagnosis requires cooperation\nbetween the surgeon and pathologist to avoid unnecessary\naggressive procedures and provide the best therapeutic\napproach.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138126\nE-poster\nMUCOCELE OF THE APPENDIX: A CASE REPORT\nAntonio Lopes Muritiba Neto1, Edmundo Guilherme de Almeida\nGomes1, Lais Maria Pinto Almeida 1, Gustavo Capitulino Araujo\nSantos1, Benicio Luiz Bulhões Barros Paula Nunes 1\n1Santa Casa de Misericordia de Maceió, Alagoas, Brasil\nCase Presentation MJS, a 67-year-old male, was\nreferred to the coloproctology outpatient clinic due to ab-\ndominal pain for several months, without changes in bowel\nhabits, bleeding, pruritus, or weight loss. On physical exami-\nnation, a palpable mass was noted in the hypogastrium.\nColonoscopy revealed a polyp (polypectomy), and abdominal\nultrasound showed an oval lesion to the right of the bladder. A\nsubsequent pelvic MRI showed an expansive, oval lesion with\nlobulated contours, hypointense on T1, hyperintense on T2,\nand peripheral contrast enhancement, measuring approxi-\nmately 7.9 /C2 4.3 /C2 5.0 cm, possibly corresponding to an\nappendiceal mucocele. As a result, a right colectomy was\nperformed without complications. Intraoperatively, the le-\nsion had a cleavage plane with the bladder and involved the\ndistal ileum. The pathological examination indicated a low-\ngrade mucinous neoplasm of the cecal appendix with mod-\nerate atypia, con fined to the appendiceal mucosa, with free\nsurgical margins, and no involvement of the colon or ileum.\nLymph nodes were also free of neoplasia (0/30). Pathological\nstaging: pTis, pN0. The patient, 60 days after surgery, is\nrecovering well, with preserved bowel habits, no complaints,\nand no indication for adjuvant treatment. Awaiting immuno-\nhistochemical results of the surgical specimen.\nDiscussion Mucocele is the term used to describe the\ngelatinous tumor of the vermiform appendix, occurring due\nto the abundant production of mucus in the lumen or chronic\nobstruction, leading to its accumulation. It is a rare condition\nthat affects 0.1-0.4% of the population and presents in three\ntypes: Type I, benign; Type II, mucinous cystadenoma, cov-\nered by neoplastic epithelium; and Type III, appendiceal\ncystocarcinoma, a malignant and aggressive neoplasm. Its\ntreatment is surgical: appendectomy for Types I and II, and\nright colectomy for Type III. In cases of diagnostic uncertainty\nor tumor invasion, or in the case of larger tumors, colectomy\nis preferred. It is crucial not to rupture the structure during\nspecimen removal to prevent disease dissemination to the\nperitoneum—risk of pseudomyxoma peritonei.\nConclusion The presented case highlights what is\nexpected of an appendiceal mucocele: diagnosis through\nincidental finding and nonspecific abdominal pain. Therefore,\nunderstanding the pathology and its nuances in the presence\nof clinical suspicion is essential, as it can lead to negative\noutcomes if diagnosed late or managed inappropriately.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 132899\nE-poster\nMALIGNANT COLON NEOPLASIA IN THE LEGAL AMAZON: A\n10-YEAR PROFILE\nVinícius Sussuarana Rocha 1, Raimundo Rocha Neto 1, Vítor\nAugusto Ribeiro Oliveira 1, Anna Cristina Pires da Luz Dória 1,\nMarcos Zuqueto Farias 1, Prisco de Paiva Bezerra Segundo 1,\nRaimundo Nonato Ribeiro de Oliveira Júnior 1, Iuri Silva Sena 1\n1Universidade Federal do Amapá, Macapá, Brasil\nIntroduction Colorectal cancer (CRC) is a signi ficant\ncause of global morbidity, associated with risk factors such as\nadvanced age, low socioeconomic status, obesity, sedentary\nlifestyle, smoking, excessive alcohol consumption, and an\nunbalanced diet.\nObjectives To analyze the epidemiological pro file of\nhospitalizations for malignant colon neoplasms from 2013 to\n2023 in the states of the Legal Amazon region.\nMaterials and Methods A descriptive study was\nconducted using data from the Hospital Information System\n(SIH/SUS), obtained through the Department of Informatics\nof the Unified Health System (DATASUS). The study analyzed\nhospitalizations and deaths due to malignant colon neo-\nplasms from 2013 to 2023 in the states of Acre, Amapá,\nAmazonas, Maranhão, Mato Grosso, Pará, Rondônia, Roraima,\nand Tocantins. The variables observed included age groups\n(under 1 year to 80 years or older), as well as male and female\ngenders and race/ethnicity.\nResults Over 10 years, there were a total of 23,970\nhospitalizations for malignant colon neoplasms, representing\nan increase of approximately 58.3%. The number of hospital-\nizations ranged from 1,811 cases in 2013 to 2,867 in 2023,\nwith the lowest number recorded in 2015 (1,713 cases) and\nthe highest in 2023 (2,867 cases). The state with the highest\nnumber of hospitalizations was Mato Grosso (9,048 cases),\nwhile Acre had the lowest (322 cases). During the same\nperiod, there were 2,014 deaths related to malignant colon\nneoplasms, ranging from 150 in 2013 to 268 in 2023. Mato\nGrosso had the highest incidence of deaths (510), while\nAmapá had the lowest (30). The female population accounted\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S13\n\n\nfor 11,891 hospitalizations, while the male population\naccounted for 12,079, representing approximately 50.3% of\ntotal hospitalizations. The most affected age group was 50 to\n59 years (6,025 cases), and the least affected was under 1 year\n(36 cases). Regarding race/ethnicity, the mixed-race popula-\ntion had the highest number of cases (15,594), followed by\nthe Indigenous population, with only 28 cases.\nConclusion The increase in hospitalizations may re-\nflect better case reporting and access to healthcare services.\nThe predominance of the mixed-race population can be\nexplained by its demographic representation in the studied\nregions. The most affected age group is related to prolonged\nexposure to risk factors and the aging process. Despite the\nrising incidence among women, cases are more prevalent in\nmen, possibly due to anatomical, hormonal, and behavioral\ndifferences.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 137663\nE-poster\nINTESTINAL OBSTRUCTION DUE TO SIGMOID COLON GIST – A\nCASE REPORT\nLuiza da Silva Barbosa1, Denise Moreira de Araújo1, Laís Silva do\nNascimento1, Jéssica Lins Bonfatti 1, Luciana Bessa Rosas 1,\nGabriela Santos Silva1, Bruno Coelho Jardim1, Ana Luisa de Arêa\nLesão Alves1\n1Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil\nCase Presentation R.V.S.N., 58 years old, presented to\nthe emergency room with a 4-day history of abdominal pain,\nabsence of bowel movements, and vomiting. Physical exami-\nnation revealed abdominal distension and diffuse tenderness\nupon palpation. An abdominal CT scan showed signi ficant\ndistension of the small intestine and descending colon with\nadjacent fat stranding. A large multiloculated solid-cystic\nlesion measuring 15 cm at its largest diameter was identified,\ncausing upstream obstruction. The liver and lungs showed no\nlesions suggestive of metastasis. The patient underwent\nexploratory laparotomy, revealing a stenosing tumor of the\nsigmoid colon. A Hartmann ’s procedure was performed, and\nthe surgical specimen was sent for biopsy. Pathological\nexamination revealed a moderately cellular mesenchymal\nneoplasm with an immunohistochemical pro file consistent\nwith a gastrointestinal stromal tumor (GIST). Clinical follow-\nup was chosen, with no need for adjuvant therapy.\nDiscussion GISTs account for approximately 0.1–3% of\ncolorectal cancers. They originate from Cajal cells and plurip-\notent stem cells of the mesenchyme. Histologically, they\nexhibit spindle-shaped cells and are positive for the CD117\nand CD34 antigens in 60 –70% of cases. GISTs are most\ncommon in the 6th and 7th decades of life and affect both\nsexes equally. They grow slowly and are often incidental\nfindings. Common symptoms include hematochezia and\nabdominal pain. GISTs can metastasize to the liver and\nperitoneum, though lymph node involvement is rare. Diag-\nnosis is typically made via colonoscopy. CT and MRI are used\nfor staging and to assess surgical resectability. Surgery is the\ntreatment of choice, with at least a 1 cm margin required.\nLymphadenectomy is unnecessary. Imatinib can be used as\nadjuvant therapy for incomplete surgical resections and\nmetastatic disease, reducing recurrence risk. It is also\nemployed as neoadjuvant therapy for initially unresectable\ntumors to reduce their size. Recurrence and metastasis occur\nin up to 50% of cases.\nConclusion Despite the low incidence of GISTs in the\ncolon and rectum, they should be considered as differential\ndiagnoses in cases of intestinal obstruction. GISTs respond\nwell to Imatinib in combination with surgical resection.\nEncouraging colorectal cancer screening through colonosco-\npy is vital for early diagnosis and better prognoses.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141513\nE-poster\nEPIDEMIOLOGICAL PROFILE OF MALIGNANT NEOPLASM OF\nTHE COLON IN GOIÁS OVER THE LAST FIVE YEARS\nGustavo Hayasaki Vieira1, Milena Almeida Barbosa1, Giovana de\nOliveira Araújo1, Rafaella Rodrigues de Freitas Vieira 1, Isabela\nMaciel Mesquita1, Samira Dionísio Maia 1, Gustavo Cartaxo de\nSousa Melo1, Valentina Melo Rosa Centofanti 1\n1Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brasil\nIntroduction Malignant neoplasm of the colon is the\nthird most common type of tumor worldwide, accounting for\napproximately 10% of all cases. It is the second leading cause\nof cancer-related deaths, presenting symptoms such as diar-\nrhea, constipation, blood in stool, abdominal pain, and low\niron levels. Given its high morbidity and mortality rates,\ndetermining the epidemiological pro file of this disease is\nessential, particularly in the state of Goiás, where there is a\nlack of studies in this Brazilian region.\nObjective To describe the epidemiological pro file of\nmalignant neoplasm of the colon in the state of Goiás\nbetween 2018 and 2023.\nMethodology This is a descriptive, retrospective, and\nquantitative study based on data from the Hospital Informa-\ntion System (SIH/SUS) accessed through the Department of\nInformatics of the Unified Health System (DATASUS). The data\npertain to malignant neoplasm of the colon over the last five\nyears in patients from Goiás. Filters applied included: ICD-10\nMorbidity List (malignant neoplasm of the colon), hospital-\nizations, race/ethnicity, gender, age group, available period\n(January 2018 to December 2023), and year of processing.\nData were tabulated and analyzed using Excel. The study\nadheres to the ethical guidelines of Resolution 466/12 of the\nNational Health Council.\nResults Over the analyzed years, 5,350 hospitaliza-\ntions due to malignant neoplasm of the colon were recorded\nin Goiás. The most affected ethnicity was mixed-race indi-\nviduals, representing 58.2% of cases (n=3,116). The disease\nwas more prevalent in men, accounting for 51.2% of hospital-\nizations (n=2,741), and among individuals aged 60-69 years,\nwho represented 23.72% (n=1,269). Notably, 2023 had the\nhighest number of hospitalizations, totaling 1,304 cases, with\na progressive increase in cases over the years. From 2018 to\n2023, there was an approximately 82.85% increase in hospi-\ntalizations, indicating a rising trend in the incidence of this\ntype of cancer. Regarding mortality, a total of 558 deaths were\nrecorded. The age group with the highest number of deaths\nwas individuals aged 60-69 years (n=148).\nConclusion The analysis revealed that the most vul-\nnerable pro file for colon cancer includes men, mixed-race\nindividuals, and those aged 60-69 years. Furthermore, there\nwas a progressive increase in cases over the studied period,\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS14\n\n\nhighlighting the urgent need for effective strategies for\nprevention, screening, and treatment to combat malignant\nneoplasm of the colon in Goiás.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138331\nE-poster\nEPIDEMIOLOGICAL PROFILE OF PATIENTS HOSPITALIZED FOR\nMALIGNANT NEOPLASM OF THE COLON IN A PUBLIC\nHOSPITAL IN THE LOWER AMAZON REGION BETWEEN 2020\nAND 2022\nMaristella Rodrigues Nery da Rocha\n1, Marco Daniel Bentes\nBatista Júnior1, Luis Arthur Pereira Junior 1, Ana Paulina Santos\nde Souza 1, Thiago de Lima Lopes 1, josé Pedro Siviero\nMuczinski1, Humberto Vinícius Maciel Guimarães 1\n1Universidade do Estado do Pará, Pará, Brasil\nIntroduction Colon cancer is one of the leading\nmalignant neoplasms of the gastrointestinal tract and poses\na significant public health challenge due to its high morbidity\nand mortality rates. The increasing number of cases in Brazil\nis linked to inadequate lifestyle and dietary habits, such as\nobesity and sedentary behavior. In the northern region,\nparticularly in the Lower Amazon, factors such as the geo-\ngraphic distance from urban centers and limited access to\nearly detection exams in fluence clinical outcomes of cancer\npatients. Recently, the COVID-19 pandemic may have exacer-\nbated these challenges. This study aims to improve public\nhealth strategies and enhance the quality of life for patients in\nSantarém.\nObjective To analyze the epidemiological pro file of\npatients hospitalized for colon cancer who progressed to\ndeath in a public hospital in Santarém between 2020 and\n2022.\nMethodology This is an epidemiological study based\non an observational, descriptive design with a quantitative\napproach. The data were extracted from the Hospital Infor-\nmation System (SIH/SUS) database concerning the mortality\nof patients hospitalized with colon cancer in a public hospital\nin the Lower Amazon region, Santarém, Pará, from 2020 to\n2022. Sociodemographic variables such as sex, age group, and\nethnicity were analyzed alongside clinical variables, includ-\ning the number of hospitalizations per year. The data were\norganized and analyzed using Microsoft Excel 2021.\nResults Based on information from SIH/SUS, 114\npatients were hospitalized for malignant colon neoplasm\nduring the study period: 46 in 2020, 30 in 2021, and 38 in\n2022. Of these, 12% progressed to death. Women of mixed\nethnicity (parda) accounted for the highest number of cases,\ntotaling 54. The mortality rate relative to hospitalizations was\n10% in 2020, peaked at 23% in 2021, and signi ficantly de-\ncreased to 5.2% in 2022. Regarding hospitalizations by age\ngroup, individuals aged 50 –59 years were the most affected\n(33 cases). However, in terms of mortality, the 60 –69 age\ngroup had the highest rate.\nConclusion The epidemiological pro file of colon can-\ncer mortality in the Lower Amazon region from 2020 to 2022\nis characterized by elderly women aged 60–69 years of pardo\nBrazilians.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 137586\nE-poster\nEPIDEMIOLOGICAL PROFILE OF COLORECTAL CANCER IN THE\nNORTHERN REGION FROM 2014 TO 2023\nBárbara Alessandra Solano Silva 1, Rosa Helena de Figueiredo\nChaves1, Louise Araújo Jassé Santos1, Letícia Gabrielle Machado\nGóes1, Hugo Ferreira Mendes 2, Renan Antonio Corrêa\nMedeiros3, Iago André Rocha Cardoso 1\n1Centro Universitário do Pará, Belém, Brasil\n2Universidade do Estado do Pará, Pará, Brasil\n3Centro Universitário Metropolitano da Amazônia, Belém, Brazil\nIntroduction Colorectal cancer is a malignant neo-\nplasm affecting the large intestine, particularly the colon and\nrectum. It is the third most common cancer worldwide and\nholds notable importance for Brazil, being the second most\nfrequent cancer in women and the third in men. Thus,\ncontinuous screening for this cancer in the Northern region\nis essential to reduce morbidity and mortality rates in one of\nthe areas most affected by it.\nObjective To analyze the epidemiological pro file of\ncolorectal cancer in the Northern region from 2014 to 2023.\nMethodology This is a retrospective, quantitative,\ncross-sectional, and descriptive study using secondary data\nfrom the Department of Information Technology of the\nUnified Health System (DATASUS). The variables were ana-\nlyzed using descriptive statistics, focusing on male and female\npatients diagnosed with colorectal cancer in the Northern\nregion of Brazil between 2014 and 2023. Variables include the\nnumber of patients diagnosed by state, month, year, sex, and\nage.\nResults and Discussion A total of 18,178 cases were\nreported during the analyzed period. The highest number of\ncases was recorded in 2023, with 2,575 cases. Regarding sex,\nfemales slightly predominated, accounting for 51.36% of\ncases. Mixed-race individuals (parda) represented the major-\nity, with 71.03% of cases, followed by white individuals at\n12.36%, which can be attributed to the region ’s demographic\ncomposition. The age group above 60 years stood out with\n45.48% of cases, which aligns with the increased cancer risk\nassociated with aging. Among the states, Pará reported the\nhighest number of cases, accounting for 27.38% of the total,\nfollowed by Rondônia with 23.75%. The higher prevalence in\nPará may be related to lower socioeconomic indices.\nConclusion The epidemiological analysis of colorectal\ncancer aligns with patterns described in the literature, re-\nvealing a significant number of cases in the Northern region.\nThe findings show no signi ficant differences between sexes\nbut highlight disparities among racial groups, states, and age\ngroups, with higher prevalence among mixed-race individu-\nals, the state of Pará, and the elderly. Despite advancements in\nmedical science, the incidence of this disease remains high.\nTherefore, planning health policies and actions aimed at\nreducing these numbers and improving health indicators in\nthe affected region is imperative.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S15\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 137583\nE-poster\nEPIDEMIOLOGICAL PROFILE OF DEATHS IN WOMEN IN\nBRAZIL DUE TO COLORECTAL CANCER FROM 2013 TO 2022\nBárbara Alessandra Solano Silva 1, Rosa Helena de Figueiredo\nChaves1, Monyque Pinheiro Charchar 1, Rayane Calandrini de\nAzevedo1, Sávio Roberto Silva Costa 2, Karine Alves Ribeiro 1,\nLucas da Silva Vinagre 3\n1Centro Universitário do Pará, Belém, Brasil\n2Universidade do Estado do Pará, Pará, Brasil\n3Universidade Federal do Pará, Belém, Brasil\nIntroduction Colorectal cancer (CRC) is the third\nmost frequent malignant neoplasm worldwide, originating\nin the colon, rectum, or parts of the large intestine. It is often\ndiagnosed at advanced stages, contributing to a high mortali-\nty rate. In Brazil, according to the National Cancer Institute,\nthe estimated incidence in women in 2020 was 20,470 cases.\nThus, analyzing the mortality pro file of this cancer in the\nfemale population of the country is essential.\nObjective To analyze the epidemiological pro file of\ndeaths due to CRC in women in Brazil from 2013 to 2022.\nMethodology This is an ecological, cross-sectional,\nquantitative, and descriptive study based on secondary data\nfrom the Department of Informatics of the Uni fied Health\nSystem (DATASUS) on deaths caused by colorectal cancer in\nwomen in Brazil from 2013 to 2022. The variables were\nanalyzed using descriptive statistics and included deaths by\nregion, age, race, education level, and marital status.\nResults and Discussion During the analyzed period,\nBrasil reported 96,033 deaths from CRC in women. The\nhighest rates were recorded in 2022 (11,156 cases). Among\nthe regions, the Southeast had the highest number of cases\n(52,155), while the North had the lowest (3,419), likely due to\nthe Southeast’s predominantly female population. Regarding\nrace, white women were the most affected, with 60,695 cases,\nand widowed women accounted for the majority (31,093\ncases). The analysis of educational attainment revealed\nhigher mortality among those with 1-3 years of schooling.\nIn terms of age, individuals aged 80 years or older were the\nmost affected (24,311 cases), which may be attributed to\ncellular aging, excessive exposure to mutagenic factors, and a\ndecline in natural immunity.\nConclusion The data analysis revealed that 2022 had\nthe highest number of female deaths due to CRC, with\nprevalence in the Southeast region, among white, widowed\nwomen with low education levels. These findings are linked\nto higher exposure to risk factors and the greater number of\nreported cases in this population. Despite advancements in\nhealthcare, high mortality rates from CRC persist. Thus,\nincreased investment in health policies and actions aimed\nat reducing these rates is necessary.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138242\nE-poster\nPYODERMA GANGRENOSUM AS A PARANEOPLASTIC\nSYNDROME OF TRANSVERSE COLON ADENOCARCINOMA\nLuis Henrique Alves de Queiroz Campos 1, Natália Ferreira\nCardoso de Oliveira 1, Vitória Vicentin Giordano 1, Nadine\nGomes de Souza 1, Luis Eduardo Silva Móz 1, John Verrinder\nVeasey1, Fernanda Bellotti Formiga 1, Fang Chia Bin 1\n1Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo,\nBrasil\nCase Presentation A 58-year-old male, hypertensive\nand diabetic, presented with a non-healing leg ulcer of 4\nmonths’ duration. A biopsy of the lesion identi fied neutro-\nphilic ulcerative dermatitis consistent with pyoderma gan-\ngrenosum (PG). Oral corticosteroid therapy was initiated but\nresulted in lesion progression. The patient also exhibited\nchronic anemia and a weight loss of approximately 15 kg\nduring this period, without gastrointestinal symptoms. Diag-\nnostic investigation included a colonoscopy, which revealed a\nvegetative lesion in the proximal transverse colon. Biopsy\nconfirmed adenocarcinoma. Staging via abdominal MRI\nshowed diffuse liver metastases, and the carcinoembryonic\nantigen (CEA) level was 954.85 mcg/L. Systemic chemothera-\npy, local wound care, and corticosteroid maintenance were\nrecommended.\nDiscussion PG is an ulcerative condition often asso-\nciated with autoimmune systemic in flammatory diseases,\nsuch as rheumatoid arthritis and in flammatory bowel dis-\nease. Less commonly, it can present as a paraneoplastic\nsyndrome, most frequently associated with hematologic\nmalignancies. However, there are reports of PG linked to\nsolid tumors, with breast cancer being the most common,\nfollowed by gastrointestinal and colorectal cancers (predom-\ninantly rectal and sigmoid tumors). To date, no cases have\nbeen reported of PG associated with transverse colon adeno-\ncarcinoma. Paraneoplastic PG ulcers typically appear before\nthe cancer diagnosis and have a clinical course parallel to the\nmalignancy, with the dermatological lesion expected to\nimprove with cancer treatment.\nConclusion Colorectal carcinoma should be consid-\nered a differential diagnosis in patients with PG, particularly\nthose without known autoimmune diseases or who do not\nrespond to speci fic treatment. In such cases, colonoscopy\nshould be included in the etiological investigation.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 137680\nE-poster\nEXTRAMEDULLARY PLASMA CELL MYELOMA IN THE\nRECTUM: A DIAGNOSTIC CHALLENGE. CASE REPORT\nMarília Fernandes Gualberto de Galiza 1, Jéssica Siebra Macário\nde Brito1, Joana de Souza Simões 1, Luan Leal Oliveira 1, Marcus\nVinícius Castro de Oliveira Lopes 1, Tereza Vilma Sobreira\nAlexandre1, Amanda Rafaella Ferreira de Jesus1, Erodilho Sande\nMota1\n1Hospital Geral Roberto Santos, Bahia, Brasil\nCase Presentation CALS, 40 years old, male, was\nadmitted to the emergency department presenting with\nanorectal bleeding, altered bowel habits, and a 15 kg weight\nloss over the past year, associated with asthenia, left hemi-\nparesis, and dysarthria. He denies comorbidities. Admission\nexams revealed a history of ischemic stroke, as well as\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS16\n\n\nconcentric thickening and stenosis in the distal rectum and\nanal canal, with lymph node involvement, suggesting neo-\nplasia. During the pandemic, the patient lost follow-up with\nthe Coloproctology team. Several endoscopic exams with\nbiopsies were performed, all negative for neoplasia. A transa-\nnal biopsy was performed, along with immunohistochemis-\ntry, which revealed rectitis and chronic in flammatory\nprocesses. The patient continued to experience worsening\nsymptoms and general health, including weight loss, diar-\nrhea, intense proctalgia, and anorectal bleeding, requiring\nblood transfusions. Abdominoperineal amputation was rec -\nommended for diagnosis and treatment guidance, as com-\nplementary exams suggested neoplastic involvement.\nDespite initial reluctance, due to the persistent clinical con-\ndition, the patient agreed to undergo the procedure after 6\nmonths. In 2024, he underwent abdominoperineal amputa-\ntion (APA). The pathology report showed extramedullary\nplasmacytoma (EMP) in the rectum, with clear margins and\nthree affected pelvic lymph nodes.\nDiscussion Plasmacytoma is a rare disease, affecting\nthe upper aerodigestive tract in 80% of cases, and gastroin-\ntestinal involvement is rare. It is more common in males, with\nincidence increasing with age, typically around 60 years old.\nIt is histopathologically con firmed by the presence of mono-\nclonal plasma cell in filtration outside the bone marrow. The\ndiagnosis is based on finding a monoclonal tumor in an\nextramedullary site, excluding multiple myeloma (MM). As\nwith diagnosis, treatment is a challenge. Due to the tumor ’s\nradiosensitivity, radiation therapy (RT) is central to treat-\nment. Surgery may be considered as a first-line treatment to\navoid the long-term impact of RT, although it is frequently\nperformed for recurrent tumors. Adjuvant chemotherapy\nremains controversial.\nConclusion Extramedullary plasmacytoma can be the\nfirst indication of a plasma cell neoplasm, and its progression\nto multiple myeloma occurs in up to 30% of cases after the\ninitial diagnosis. Its prognosis is related to the tumor location\nand lymph node involvement. It should be considered as a\ndifferential diagnosis in abdominal tumors.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141712\nE-poster\nFAMILIAL ADENOMATOUS POLYPOSIS: A CASE REPORT\nWilson Júnior Pereira da Silva 1, Ana Beatriz Lopes 1, Maria\nBeatriz Souza Nascimento1, Talita Melo Nunes Caldas1, Vanessa\nSiqueira Reis2, Marccus Antônio Tolentino de Jesus 2, Bruno\nAugusto Alves Martins 2, João Batista de Sousa 1\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nCase Presentation A twelve-year-old boy was diag-\nnosed with familial adenomatous polyposis shortly after his\nfather passed away from colorectal cancer. At age fifteen, he\ndeveloped cancer of the descending colon and underwent\nsubtotal colectomy with ileorectal anastomosis. At seven-\nteen, a biopsy con firmed rectal adenocarcinoma, leading to\nproctectomy with a J-pouch ileal reservoir and protective\nileostomy, which was closed six months later. At twenty-six,\nhe developed synchronous adenocarcinomas in the proximal\njejunum and ileal reservoir, necessitating resection of the\nileal pouch, segmental enterectomy of the proximal jejunum,\nand creation of a new ileal pouch. At thirty, he presented with\na duodenal tumor with liver metastasis, both treated with\nchemotherapy. He succumbed to the disease at thirty-two\nyears of age.\nDiscussion Familial adenomatous polyposis is an\nautosomal dominant hereditary syndrome characterized by\nmultiple colorectal adenomatous polyps. Screening should\nbegin at the age of twelve, and patients should undergo\nprophylactic surgery. Prophylactic treatment is recom-\nmended by age eighteen to prevent progression to cancer,\nas untreated adenomatous polyps in the colon and rectum\nevolve into invasive carcinoma. Treatment options include\nrestorative proctocolectomy with an ileal pouch, total colec -\ntomy with ileorectal anastomosis, or total proctocolectomy\nwith de finitive ileostomy in cases of incontinence or distal\nrectal cancer. Even after surgery, tumors may develop in the\nremaining intestinal segments and the ileal pouch, requiring\ncontinuous monitoring.\nConclusion Young individuals with familial adeno-\nmatous polyposis are at an increased risk of developing\ncancer before the end of adolescence, as seen in this case.\nGiven the patient ’s young age, the rectum was preserved;\nhowever, despite close follow-up, it progressed to rectal\ncancer and, unfortunately, he passed away at a young age.\nPostoperative surveillance is critical, regardless of the type of\nsurgery performed, due to the cumulative risk of developing\npolyps and carcinoma over time.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141670\nE-poster\nPRESERVATION OF COLORECTAL ANASTOMOSIS AFTER\nDEHISCENCE USING VACUUM THERAPY – CASE REPORT\nGiovana Moreira Minchillo1, Rodrigo Moises de Almeida Leite 1,\nVictor Edmond Seid 1, Lucas Soares Gerbasi 1, Sergio Eduardo\nAlonso Araujo 1, Rafael Vaz Pandini 1, Erika Borges 1, Francisco\nTustumi1\n1Hospital Israelita Albert Einstein, São Paulo, Brasil\nCase Presentation The case involves J.C.L., a 58-year-\nold male patient with hypertension and diabetes. He was\ndiagnosed with high rectal adenocarcinoma, stage T3bN1\nbased on MRI, with no distant metastases. Surgical treatment\nwas indicated, and a robotic -assisted low anterior resection\nwith partial mesorectal excision, protective ileostomy, and\ncavity drainage was performed. Postoperatively, the patient\nexperienced a slow recovery, presenting with prolonged\nmetabolic ileus during hospitalization. On the 5th postoper-\native day, the drain showed fecaloid discharge. Abdominal CT\nrevealed signs of colorectal anastomotic dehiscence on the\nposterior wall with a 20mL adjacent collection. Considering\nthe patient’s stable clinical condition and the diverted intes-\ntinal transit, conservative treatment was chosen. This includ-\ned antibiotic therapy and the installation of transanal vacuum\ntherapy. Rectoscopy revealed an 80% dehiscence in the colo-\nrectal anastomosis. A continuous suction tube at 125mmHg\nwas placed inside the recess, with the system exit via the anal\nroute. After five days, there was significant improvement and\ntissue granulation, prompting a replacement and continua-\ntion of the vacuum system for an additional seven days. At the\nend of this period, control endoscopy showed resolution of\nthe anastomotic disruption. Three weeks after vacuum\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S17\n\n\ntherapy removal, the anastomosis was intact and patent, with\nno signs of stenosis. Six months after the initial surgery,\nintestinal continuity was restored with the closure of the\nprotective ileostomy.\nDiscussion Postoperative complications in colorectal\nsurgeries are a signi ficant topic of concern. Among them,\nanastomotic fistulas and dehiscences are the most feared.\nVacuum-assisted therapy is a relatively new approach for\ntreating colorectal anastomotic dehiscences. It involves the\nuse of a negative pressure system to promote better healing,\nsecretion drainage, vascularization, and stimulation of\nhealthy tissue growth at the site.\nConclusion This case report demonstrates that, in\nselected cases, vacuum therapy can yield satisfactory out-\ncomes, allowing the preservation of colorectal anastomosis\nand reducing the need for surgical re-intervention in oncolo-\ngy patients.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141745\nE-poster\nPREVALENCE OF EXTRA-INTESTINAL LESIONS IN PATIENTS\nWITH FAMILIAL ADENOMATOUS POLYPOSIS\nMariana Trotta Villar 1, Luna Vitória Gondim Ferreira 1, Laura\nTrotta Villar1, Vanessa Siqueira Reis 2, Marccus Antônio\nTolentino de Jesus 2, Romulo Medeiros de Almeida 2, Bruno\nAugusto Alves Martins 2, João Batista de Sousa 1\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nIntroduction Familial adenomatous polyposis (FAP)\nis a hereditary genetic condition with an autosomal dominant\ninheritance pattern, predisposing individuals to colorectal\ncancer and a wide range of extra-intestinal manifestations. In\naddition to colorectal polyps, FAP can affect the entire\ngastrointestinal tract and other organs, including the stom-\nach, duodenum, small intestine, thyroid, adrenal glands,\npancreas, and pituitary gland. Benign extra-intestinal man-\nifestations include sebaceous cysts, lipomas, osteomas,\nclubbed fingers, dental abnormalities, and desmoid tumors.\nMalignant manifestations encompass periampullary, bile\nduct, gastric, ileal, thyroid, adrenal, and central nervous\nsystem tumors. Early diagnosis and identi fication of these\ncomplications are crucial for effective disease management\nand improved patient quality of life.\nObjective The objective of this study was to analyze\nthe prevalence and types of extra-intestinal manifestations in\nFAP patients treated at a university hospital.\nMethodology A retrospective analysis of medical\nrecords was conducted for patients diagnosed with FAP\nwho were treated at the coloproctology outpatient clinic of\nthe University Hospital between 1992 and 2024. Data col-\nlected included patient age, sex, and the presence of extra-\nintestinal manifestations at diagnosis or during follow-up.\nThese manifestations were categorized as dental-bone\nlesions, desmoid tumors, duodenal tumors, sebaceous cysts,\nbrain tumors, and mandibular osteomas.\nResults The analysis included 72 patients with FAP, of\nwhom 15 (20.8%) presented with at least one extra-intestinal\nmanifestation. The most common manifestations were den-\ntal-bone lesions, found in 9 patients (12.5%), desmoid tumors\nin 3 patients (4.2%), and duodenal tumors in 3 patients (4.2%).\nOther manifestations included mandibular osteomas in 2\npatients (2.7%), sebaceous cysts in 1 patient (1.38%), and\nbrain tumors in 1 patient (1.38%).\nConclusion The results of this study indicate that\nextra-intestinal manifestations are relatively common in\npatients with FAP. Dental-bone lesions, desmoid tumors,\nand duodenal tumors were the most frequent manifestations.\nThese findings underscore the need for a proactive clinical\napproach to identify and manage extra-intestinal complica-\ntions associated with FAP, contributing to improved disease\nmanagement and patient quality of life.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 136556\nE-poster\nLATE TUMOR PROGRESSION: SYSTEMIC METASTASIS AND\nPERINEAL RECURRENCE AFTER ABDOMINOPERINEAL\nRESECTION OF THE RECTUM\nBruna Meirelles Carregaro 1, Denis Galhera 2, Guilherme\nMarques2, Pedro Magalhaes 2, Iana Saran Faine 1, André Luigi\nPincinato1, Anderson da Costa Lino Costa 3, Fernanda Bellotti\nFormiga1\n1Serviço de Coloproctologia do Hospital Heliópolis, São Paulo, Brasil\n2Universidade de São Caetano do Sul, Medicina, Brasil\n3Serviço de Patologia do Hospital Heliópolis, São Paulo, Brasil\nCase Presentation A 63-year-old male with stage II/III\nmid-rectal adenocarcinoma underwent neoadjuvant therapy\nin 2014 (5- fluorouracil and 5.4 Gy) achieving a complete\nclinical response. An organ-preservation protocol was fol-\nlowed for 18 months, after which a bleeding lesion was\nidentified during rectoscopy, con firming tumor regrowth.\nThe patient underwent abdominoperineal resection (APR)\nin 2016, with pathology showing ypT1N0. He remained under\noncological follow-up without complications until 2022 (six\nyears post-APR) when hepatic metastases developed. Seg-\nmentectomy (segments VII/VIII) was performed, followed by\nadjuvant therapy (capecitabine). Subsequently, a subcutane-\nous 1 cm perineal nodule appeared near the surgical scar,\ncausing mild pain. Initially, clinical observation was chosen,\nbut the lesion demonstrated slow growth and increasing local\npain. In 2023, MRI and PET-CT revealed hypermetabolism\n(SUVmax = 10.4) at the perineal surgical scar. The nodule was\nsurgically excised, and histopathology con firmed tubulovil-\nlous adenocarcinoma in fibroadipose tissue, with clear\nmargins.\nDiscussion Local recurrence following surgical resec -\ntion of rectal adenocarcinoma occurs in 3% to 35% of cases\nwithin five years. After APR, recurrence can present as\npelviperineal, pelvic, or perineal. Perineal recurrence, al-\nthough rarely described in isolation, can often be detected\nduring physical examination. Neoadjuvant therapy plays an\nundeniable role in reducing local recurrence rates. However,\nboth classical and total neoadjuvant therapies have shown\nlate systemic and local recurrences, the pathological mecha-\nnism of which remains unde fined. Surgical resection of\nsystemic and local progression can achieve curative out-\ncomes, emphasizing the importance of adequate oncological\nfollow-up. In this case, the patient showed a good response to\nneoadjuvant therapy, achieving complete clinical response,\nenabling organ preservation. It is known that 30% of patients\nexperience tumor regrowth, primarily within the first two\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS18\n\n\nyears of post-treatment. The rarity of this case lies in the\nprolonged interval of both systemic and perineal recurrence\n(more than five years), with successful curative resections\nand histological con firmation.\nConclusion Prolonged and adequate oncological fol-\nlow-up after multimodal treatment for rectal adenocarcino-\nma appears to be the best strategy to improve disease-free\nsurvival, as late recurrence is increasingly being documented.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138595\nE-poster\nRECTOSIGMOIDECTOMY WITH TME AFTER TEO, IN A PATIENT\nWITH A LESION MEETING HIGH-RISK CRITERIA\nJoão Pedro Pinto Cordeiro de Miranda Coutinho 1, Marcos\nVinícius de Araújo Denadai 1, Felipe Daldegan Diniz 1, Luís\nGustavo Capochin Romagnolo 1, Rodrigo Giacomini Bregeiro 1,\nCarlos Augusto Rodrigues Véo 1\n1Hospital de Amor de Barretos, São Paulo, Brasil\nCase Presentation A 62-year-old female patient pre-\nsented to an oncological reference service with a colonoscopy\nshowing a 20 mm polypoid lesion, with an eroded surface\ncovered by fibrin and irregular microvascularization in the\ndistal rectum, near the first Houston valve, with histopatho-\nlogical findings of intramucosal adenocarcinoma. Staging\nexams, including MRI, reported an apparent sessile lesion\non the anterior wall of the rectum, 6.5 cm from the anal\nmargin, measuring 1.5 cm in length, with no suspicious\nlymph nodes in the mesorectum and no apparent invasion\nof the submucosa. A transanal resection using the TEO\nplatform was initially chosen. The histopathological report\nshowed low-grade invasive adenocarcinoma extending into\nthe submucosa, Haggitt level 4, with a submucosal invasion\nthickness of 5 mm (about two-thirds of the submucosa),\nangiolymphatic invasion present, and intermediate tumor\nbudding, classified as pT1, with no microsatellite instability.\nDue to the presence of high-risk factors in the histopathology,\nadditional surgery was planned, and the patient underwent a\nrectosigmoidectomy with total mesorectal excision and a\nprotective ileostomy via robotic surgery. The pathology of\nthis procedure showed no residual neoplasia in the colon\nwall, however 2 out of 30 mesorectal lymph nodes were\naffected by neoplasia, and the patient was referred for adju-\nvant oncological treatment.\nDiscussion The use of platforms for resection of rectal\ntumors is a valid option for sparing patients with early lesions\nfrom more extensive surgeries, with total mesorectal exci-\nsion, as long as the tumor size and location allow for an R0\nresection. This procedure should be preceded by thorough\nstaging with pelvic MRI or endorectal ultrasound to assess the\ntumor’s depth in the rectal wall and to check for lymph node\ninvolvement. Histopathological predictive factors for lymph\nnode involvement include submucosal invasion, differentia-\ntion grade, lymphovascular and/or perineural invasion, and\ntumor budding. The risk of lymph node metastasis in T1\ntumors is between 6.3% and 10%. Transanal endoscopic\nresection of rectal tumors can be both diagnostic and cura-\ntive, depending on the lesion ’s histopathology.\nConclusion This case highlights the importance of\nproper analysis of the histopathological study following a TEO\nresection, as, despite the correct indication for local resection,\nhigh-risk factors were present, resulting in undetected lymph\nnode invasion on imaging exams.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141742\nE-poster\nONCOLOGICAL TRANSABDOMINAL AND TRANSANAL\nRECTOSIGMOIDECTOMY VIA ROBOTIC-ASSISTED SURGERY\nAryssa Anielli Sakai 1, Artur Cury Féres 1, João Paulo Slongo 1,\nVanessa Foresto Machado 1, Marley Ribeiro Feitosa 1, José\nJoaquim Ribeiro da Rocha 1, Rogério Sera fim Parra1, Omar\nFéres1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nSão Paulo, Brasil\nCases Presentation First case: A 54-year-old male\npatient with low rectal adenocarcinoma located 3 cm from\nthe anal verge, classi fied as cT2 cN2a cM0, underwent neo-\nadjuvant therapy according to the RAPIDO TRIAL protocol.\nUpon follow-up evaluation, the lesion remained in filtrative\nand hardened, starting 4 cm from the anal verge and extend-\ning 4 cm cephalically. He underwent robotic -assisted transa-\nnal and transabdominal rectosigmoidectomy, with specimen\nremoval via the anterior abdominal wall, colorectal anasto-\nmosis 2 cm from the anal verge stapled endoanal, and loop\ntransverse colostomy on the left flank. Postoperatively, he\nexperienced partial anastomotic dehiscence with retro-rectal\nabscess formation. Surgical drainage was performed via\nendoluminal access on postoperative day 24. Following\nthis, he had a good clinical recovery with no evidence of\nsurgical complications or disease recurrence during the 3-\nmonth follow-up. Second case: A 63-year-old male with a\nhistory of mid-rectal adenocarcinoma, located 7 cm from the\nanal verge, initially underwent transanal resection of the\nlesion (TAR). Due to pT3 stage disease, preoperative MRI\nshowed evidence of lymph node involvement in the meso-\nrectum, and post-TAR imaging revealed pre-sacral lymph-\nadenopathy. Chemoradiotherapy with radiosensitizing\nagents was initiated. During the second year of clinical-\nradiological follow-up, local recurrence was observed, and\ntotal mesorectal excision was indicated. The patient under-\nwent robotic -assisted transanal and transabdominal recto-\nsigmoidectomy, with specimen removal via transanal\napproach, mechanical colorectal anastomosis, and loop\ntransverse colostomy, without complications. The patient is\ncurrently under outpatient follow-up with no evidence of\nsurgical complications or neoplastic recurrence.\nDiscussion Post-neoadjuvant middle rectal tumors\noften require a combined transabdominal and transanal\napproach to achieve resection and low anastomosis with a\nprotective stoma. In these cases, we show the use of robotic\nsurgery for the abdominal component and the use of a\nproctoscope developed in our service for the anal component,\nwhich easily accesses this type of patient.\nConclusion Transabdominal and transanal resection\nis an effective therapeutic option for post-neoadjuvant mid-\ndle rectal tumors with low colorectal anastomosis, and\nrobotic surgery may be a good option for the abdominal\ncomponent.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S19\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141137\nE-poster\nROBOTIC VERSUS LAPAROSCOPIC LOW ANTERIOR\nRESECTION: RESULTS FROM A PROSPECTIVE COHORT STUDY\nRodrigo Moisés de Almeida Leite 1, Giovana Moreira Minchillo 1,\nAna Sarah Portilho 1, Rafael Vaz Pandini 1, Francisco Tustumi1,\nLucas Soares Gerbasi 1, Victor Edmond Seid 1, Sergio Eduardo\nAlonso Araujo 1\n1Hospital Israelita Albert Einstein, São Paulo, Brasil\nIntroduction The Robotic approach in Low Anterior\nResection (LAR) for the Surgical Treatment of Rectal cancer\nmay be associated with improved postoperative outcomes,\nsuch as shorter recovery time and reduced incidence of\npostoperative complications. However, longer operative\ntimes and higher costs may also be associated when com-\npared to laparoscopic approach. We analyzed a single sur-\ngeon prospective database comparing postoperative and\nintraoperative outcomes of LAR between robotic and laparo-\nscopic approaches.\nMethods We built a prospective cohort study includ-\ning laparoscopic and robotic LAR for the treatment of low and\nmiddle rectal cancer. Summary of outcomes include: - Total\nOperative Time (in minutes); - Length of in-hospital stay (in\ndays); - Incidence of Anastomotic Leak ; - Rate of unplanned\nconversions to open surgery; - Rate of any postoperative\nsurgical complication. The statistical analysis was conducted\non STATA 18 Standard Edition. 101 cases (66 robotic and 35\nlaparoscopic) were included for analysis. Robotic approach\nwhen compared to laparoscopy was associated with: - No\nincrease in operative time (median 197 minutes {IQR 180-\n240} vs 200 minutes {IQR 180-240}. p 0.628) - Signi ficant\nreduction in length of in-hospital stay (5 days vs 3 days), p\n0.025 - Significant reduction in unplanned conversions (4.54%\nvs 20%), p 0.010 - Signi ficant reduction in postoperative\ncomplications (RR 0.38, 95%CI {0.17-0.86}, p 0.018). No\nbenefit was observed regarding anastomotic leak.\nResults In this prospective, single center, cohort\nstudy, robotic approach in LAR with TME was associated\nwith a shorter in-hospital stay, reduced conversions and\npostoperative complications without increase in operative\ntime when compared to laparoscopy.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141125\nE-poster\nROBOTIC VS OPEN SURGERY FOR SIMULTANEOUS RESECTION\nOF COLORECTAL CANCER AND LIVER METASTASES: A\nSYSTEMATIC REVIEW AND META ANALYSIS\nBruna Oliveira Trindade 1, Antônio Nocchi Kalil 2, Fares Hassan\nHamaoui2, Cristina Calloni 3, Daniel de Barcellos Azambuja 2\nPatrícia Marcolin4\n1UFCPSA\n2Santa Casa de Porto Alegre, Porto Alegre, Brasil\n3Universidade Feevale, Rio Grande do Sul, Brasil\n4Universidade Federal da Fronteira Sul, Santa Catarina, Brazil\nIntroduction For patients with resectable colorectal\nliver metastases (CLM), surgery offers the best long-term\nsurvival and potential cure. Synchronous resection is pre-\nferred, but while colorectal surgeries are often laparoscopic,\nminimally invasive CLM resections are not yet standard. The\nemergence of robotic surgery introduces new possibilities,\nbut its impact on surgical outcomes compared to traditional\nopen surgery is still debated, with various studies providing\nconflicting results. To address this uncertainty, we conducted\na systematic review and meta-analysis to compare the surgi-\ncal outcomes of robotic versus open simultaneous resections\nfor colorectal cancer and liver metastases.\nMethods A comprehensive search of PubMed,\nEmbase, and Cochrane databases was conducted to identify\nstudies comparing robotic and open surgery for simultaneous\nresection of colorectal cancer and liver metastases. The\nprimary outcomes were (1) operative time; (2) anastomotic\nleakage; (3) bile leakage; (4) blood loss; and (5) postoperative\nhospital stays. Heterogeneity was examined with I2 statistics.\nOdds ratios (ORs), mean Differences (MD) and their 95%\nconfidence intervals (CIs) were computed with the use of a\nrandom-effects model.\nResults From a total of 582 studies, we included 5\nstudies with 1,696 patients, of whom 165 (9.73%) underwent\na robotic surgery approach. The blood loss (MD -87.48; 95% CI\n[-103.76, -71.21]; p < 0.0001), postoperative hospital stays\n(MD -2.23; 95% CI [-2.96,-1.51]; p < 0.0001) were statistically\nsignificant lower in patients treated by robotic platform. On\nthe other hand, operative time was higher in the open surgery\ngroup (MD 48.87; 95% CI [21.23,76.50]; p=0.0005). Anasto-\nmotic leakage (OD 1.66; 95% CI [0.65,4.26]; p=0.29) and bile\nleakage (OR 0.57; 95% CI [0.57,3.98]; p=0.57) did not show a\nstatistically significant difference between the groups.\nConclusion This comprehensive systematic review\nand meta-analysis provides evidence that robotic approaches\nyield improved outcomes for patients undergoing simulta-\nneous resection of colorectal cancer and liver metastases.\nNew studies are needed to evaluate new outcomes.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138296\nE-poster\nSARCOMA INTESTINAL EM DOIS\nSEGUIMENTOS INTESTINAIS\nSIMULTÂNEOS: RELATO DE CASO\nIntestinal Sarcoma in Two Simultaneous Intestinal\nSegments: Case Report\nRaphaella Assis Alves Januário 1, Juliana Giangiardi Batista 1,\nEduardo Vidal de Holanda 1, Rafaela Fonseca Falcão Hudari 1,\nFlávia Balsamo1, Sérgio Henrique Couto Horta 1, Laís Yumi\nTakaoka1, Sandra Di Felice Boratto 1\n1Centro Universitário Faculdade de Medicina do ABC, São Paulo,\nBrasil\nCase Presentation A 71-year-old male patient pre-\nsented with abdominal pain, hematochezia, and a 15 kg\nweight loss over 4 months. He was referred to a tertiary\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS20\n\n\nhospital in Greater São Paulo, where enterotomography\nrevealed irregular segmental parietal thickening with a neo-\nplastic appearance in the proximal jejunal loop, beginning\nabout 10 cm after the Treitz angle, extending 10 cm, and signs\nof fistulization extending into another jejunal loop, approxi-\nmately 80 cm from the Treitz angle, with 4.0 cm of involve-\nment. There was also thickening in the ileal loop in the right\nhypogastrium, measuring 4.0 cm, without mesenteric\nlymphadenopathy. Following staging, the patient underwent\nexploratory laparotomy requiring 3 enterectomies and the\ncreation of 3 enteroenterostomies: the first 4 cm from the\nTreitz angle, the second 70 cm from the Treitz angle, and the\nthird at the site of the ileal tumor resection. The patient had a\ngood postoperative recovery and was discharged on the 6th\npostoperative day. Histopathological examination revealed\npoorly differentiated malignant neoplasia with ulceration in\nboth resected lesions, and immunohistochemistry (IHC) was\nconsistent with angiosarcoma due to the following positive\nmarkers: CD-34, CD-31, ERG, Factor VIII, and FL1.\nDiscussion Sarcomas are a rare and heterogeneous\ngroup of malignant mesenchymal tumors that account for\nless than 1% of all adult malignant neoplasms. The histopath-\nological spectrum of sarcomas is broad, presumably because\nthe embryonic mesenchymal cells from which they arise have\nthe capacity to differentiate into skeletal and smooth muscle,\nadipose tissue, and fibrous tissue, among others. The reported\nincidence is between 10 and 15 cases per million inhabitants\nper year. Symptoms may include weight loss, intestinal\nsubocclusion, and hematochezia, if the tumor is intestinal.\nTreatment is surgical, and the diagnosis of sarcoma is retro-\nspective, as it is made through IHC, which detects tumor cells\npositive for vascular markers such as CD31 and Factor VIII.\nConclusion The incidence of intestinal sarcoma is\nrare, and its diagnosis is made through immunohistochemical\nresults after resection. Therefore, treatment, when possible,\nshould be surgical, similar to other intestinal neoplasms. It is\nimportant to pay attention to the pathological results and\nrequest immunohistochemistry for differentiation.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141153\nE-poster\nTRANSVERSE COLON SCHWANNOMA: A CASE REPORT\nBárbara Adeline Ramalho Faro1, Maurício Prado Ribeiro2, Paulo\nFigueiredo Barreto Neto2, André Luiz Santos 2, Hernan Augusto\nCenturion Sobral 2, Gustavo Henrique de Souza Maranhão 1\n1Universidade Tiradentes, Alagoas, Brasil\n2Hospital São Lucas, São Paulo, Brasil\nCase Presentation A 39-year-old woman was referred\nfor a colonoscopy following the identi fication of an image in\nthe transverse colon during an abdominal contrast-enhanced\nCT scan. She denied changes in bowel habits, nausea, vomit-\ning, fatigue, or weight loss. Physical abdominal examination\nrevealed no pain, masses, or signs of peritoneal irritation.\nProctological and laboratory exams were unremarkable. Co-\nlonoscopy identi fied a nodular, extramucosal lesion in the\nproximal transverse colon, measuring 30 mm and occupying\n¼ of the intestinal lumen. Total abdominal CT suggested a\nlesion in the proximal transverse colon, indicative of intesti-\nnal tuberculosis or gastrointestinal stromal tumor (GIST). The\npatient underwent a right partial colectomy with D2\nlymphadenectomy via laparoscopy. Surgical pathology con-\nfirmed a Schwannoma in the colonic wall, measuring 2.5 cm\nwith clear margins. Immunohistochemistry demonstrated\ndiffuse S100 expression, supporting the diagnosis.\nDiscussion Schwannomas are benign mesenchymal\ntumors caused by the excessive proliferation of Schwann cells\nin nerve sheaths. They can occur anywhere in the body, most\ncommonly in the stomach and small intestine, but findings in\nthe transverse colon are extremely rare. These tumors are\ntypically observed between the fifth and eighth decades of\nlife, making this case particularly unique. There remains\ncontroversy in the literature regarding the treatment ap-\nproach for intestinal schwannomas. Several studies suggest\nthe malignant potential of colonic schwannomas is minimal,\nand pathological parameters, such as mitotic rate and tumor\nsize, appear to have little prognostic signi ficance. Complete\nsurgical resection seems to be the treatment of choice due to\nthe preoperative diagnostic uncertainty and excellent long-\nterm outcomes. Tumor recurrence is generally associated\nwith incomplete surgical margins.\nConclusion This report presents a rare case of intes-\ntinal schwannoma and aims to contribute to the scienti fic\ncommunity by detailing the evolution and management of\nthe treatment based on updated bibliographical references.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141725\nE-poster\nTREATMENT OF PELVIC COLLECTION AFTER\nRECTOSIGMOIDECTOMY WITH SELF-EXPANDING LUMINAL-\nAPPOSING METAL STENT: CASE REPORT\nAryssa Anielli Sakai1, Artur Cury Féres1, Matheus Couto Furtado\nAlbuquerque1, João Paulo Slongo 1, José Joaquim Ribeiro da\nRocha1, Marley Ribeiro Feitosa 1, Rogério Sera fim Parra1, Omar\nFéres1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nSão Paulo, Brasil\nCase Presentation A 59-year-old female patient with\nrectosigmoid adenocarcinoma (T3 N2 M1) underwent ab-\ndominal rectosigmoidectomy with a descending-colon-to-\nrectum mechanical anastomosis and a loop transverse colos-\ntomy. She was readmitted four days post-discharge with\ncomplaints of fever and cessation of stool output from the\nstoma. A CT scan revealed a pelvic abscess. Despite abdominal\npain, she remained in good general condition, clinically\nstable, and without signs of peritonitis. A transrectal ultra-\nsound-guided drainage via endoscopic ultrasound (EUS) was\nchosen. Colonoscopy identi fied a partial anastomotic dehis-\ncence associated with a 6.5 /C2 4.0 cm pelvic collection poste-\nrior to the rectum, confirmed by EUS. A lumen-apposing self-\nexpanding metal stent (LAMS) Hot Axios® was placed to\ndrain the abscess, resulting in immediate evacuation of the\ncollection. Follow-up CT scans showed a reduction in abscess\nsize. The patient experienced a satisfactory clinical course,\nand the stent was removed via colonoscopy after two weeks.\nAt six months of follow-up, no complications or reinterven-\ntions were required.\nDiscussion The selection of LAMS for the drainage of\npelvic collections post-colorectal surgery is based on its\nability to provide effective and immediate evacuation while\nminimizing complications associated with traditional\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S21\n\n\nmethods, such as percutaneous or open drainage. The Hot\nAxios® system simpli fies the procedure by eliminating the\nneed for guidewires and dilators, enhancing practicality.\nThough recent studies are limited, they emphasize the safety\nand ef ficacy of this alternative approach in selected cases,\nshowing reduced hospitalization times, lower complication\nrates, and fewer subsequent interventions.\nConclusion This case demonstrates the successful\napplication of LAMS in managing a pelvic collection post-\nrectosigmoidectomy, highlighting its effectiveness as a safe\nand minimally invasive therapeutic method. This favorable\nclinical outcome supports the use of transluminal endoscopic\ntechniques as a valuable option for treating complex postop-\nerative abdominopelvic complications, particularly in\npatients with therapeutic limitations. The experience under-\nscores the importance of personalized treatment strategies\nand advanced technologies to improve outcomes in patients\nwith challenging clinical scenarios.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141717\nE-poster\nBILATERAL KRUKENBERG TUMOR IN A PATIENT WITH\nCROHN’S DISEASE: CASE REPORT\nMariana Geraldi Rodrigues 1, Rosane Louzada Machado 1,\nEduardo de Paula Vieira 1, Fernanda Scelza Gianotti 1\n1Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brasil\nCase Presentation A 39-year-old female patient with\nstenosing ileocolonic Crohn’s disease since 2004 presented in\n2022 with nausea, postprandial fullness, and diarrhea. Colo-\nnoscopy revealed stenosis in the descending colon and sig-\nmoid. CT enterography identi fied an 11 cm stricture at the\nhepatic flexure. She underwent right ileocolectomy with\nileostomy. Histopathology showed mixed colonic adenocar-\ncinoma (40% signet ring cells). Chemotherapy with XELOX\nwas initiated but switched to bFOL due to toxicity. Six months\nlater, carcinoembryonic antigen levels increased, and a cystic\nmass was detected in the supravesical region. PET-CT sug-\ngested ovarian implantation. In 2023, she underwent right\nsalpingo-oophorectomy, and histopathology con firmed me-\ntastasis of colorectal adenocarcinoma. Treatment included\nchemotherapy with 5-FU þ Irinotecan, followed by total hys-\nterectomy and prophylactic left salpingo-oophorectomy in\n2024. PET-CT detected residual lesions, which were treated\nwith radiotherapy. Genetic testing revealed no mutations in\nKRAS, NRAS, or BRAF. Palliative chemotherapy with Irinote-\ncan and Cetuximab was initiated.\nDiscussion In Brazil, colorectal cancer (CRC) is the\nsecond most common cancer in women and the third in men.\nPatients with Crohn ’s disease (CD) have a 2- to 6-fold in-\ncreased risk of developing CRC, which accounts for 10–15% of\ndeaths in in flammatory bowel diseases. CRC associated with\nCD tends to affect younger individuals and is often diffuse,\nextensive, multifocal, and located in the right colon. Kruken-\nberg tumors (KT) are ovarian metastases, typically from\ngastrointestinal cancer. Approximately 76% of KTs originate\nfrom the stomach and 11% from the colorectum. Immuno-\nstaining for CK20 and CK7 helps distinguish ovarian metas-\ntases from primary ovarian neoplasms; colorectal tumors are\nCK20 positive and CK7 negative. Up to 30% of ovarian malig-\nnancies are metastatic, affecting younger women with a\nmedian survival of 19–27 months. KTs from colorectal cancer\nhave a better prognosis when unilateral. Prophylactic oopho-\nrectomy is recommended post-menopause and may be con-\nsidered pre-menopause to reduce the risk of metachronous\nmetastasis and primary ovarian cancer.\nConclusion This report highlights the importance of\nCRC screening and prevention in patients with in flammatory\nbowel disease, emphasizing the complex management of\nassociated ovarian metastases. Prophylactic oophorectomy\nis recommended to improve prognosis and survival, particu-\nlarly in premenopausal women and in cases with synchro-\nnous microscopic metastases.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 138150\nE-poster\nLOCALLY INVASIVE DESMOID TUMOR: CASE REPORT\nPierre Rodrigues Bernardino 1, Isabella da Silva Idelfonso 1, José\nRoberto Violatti Filho 1, Amanda Karolyne Batista Ferreira 1,\nCarlos Eduardo Oliveira Sodero 1, Luciano Ricardo Pelegrinelli 1\n1Universidade Federal do Triângulo Mineiro, Minas Gerais, Brazil\nCase Presentation DCP, male, 36 years old. The\npatient reported progressive right hypochondrial pain over\nthe past 30 days. A computed tomography (CT) scan revealed\nan oval, voluminous mesenteric mass measuring approxi-\nmately 10 cm, occupying the right hypochondrium and flank.\nThe mass exhibited mixed density, was contiguous with the\ndistal ileum, displaced the ascending colon at the hepatic\nflexure, and showed intimate relations with the second and\nthird portions of the duodenum, the superior mesenteric\nartery, and the inferior vena cava, causing compression.\nEndoscopy and colonoscopy results were unremarkable.\nThe patient underwent exploratory laparotomy, con firming\nfindings consistent with the CT. Tumoral dissection involved\nthe duodenal portions, pancreatic head, inferior mesenteric\nartery, and inferior mesenteric vein. A right colectomy was\nperformed with the creation of a double-barrel stoma. His-\ntopathological and immunohistochemical analysis confirmed\na diagnosis of desmoid fibromatosis, with nuclear beta-\ncatenin expression. The patient developed a cutaneous mu-\ncosal fistula, which resolved favorably. A subsequent intesti-\nnal transit reconstruction was performed without\ncomplications.\nDiscussion Desmoid tumors, also known as deep\nfibromatosis, are locally aggressive tumors originating from\nfibroblasts in musculoaponeurotic tissues. They are non-\nmalignant, incapable of metastasis, but highly invasive local-\nly, potentially compressing adjacent structures and causing\norgan dysfunction. The etiology is uncertain, and these\ntumors are rare, with an incidence of 2 –4 cases per million\npeople annually, accounting for about 0.03% of all neoplasms.\nThey are more prevalent in adult women. Histologically, they\nconsist of spindle cells forming spiral bundles, and 67 –80%\nshow immunoreactivity to beta-catenin. Clinical manifesta-\ntions vary depending on the site of involvement. Due to their\nhigh recurrence rate and potential invasion of vital structures,\nmanagement can be challenging. Imaging is critical for diag-\nnosis, determining lesion size, and assessing anatomical\nrelationships. Surgical intervention is the preferred thera-\npeutic approach when feasible. Complications may include\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS22\n\n\nintestinal obstructions, fistula formation, hemorrhages, and\nintestinal perforations.\nConclusion This case is remarkable not only for the\ntumor’s rarity but also for the patient ’s demographic pro file\nand the extent of the lesion. Regular follow-up is essential\ngiven the high likelihood of recurrence. The management of\nsuch cases requires specialized diagnostic tools and a well-\ntrained surgical team to ensure optimal treatment and care.\nCâncer do Cólon/Reto/Ânus\nColon/Rectal/Anus Cancer\nID – 141718\nE-poster\nNEUROENDOCRINE TUMOR MIMICKING CROHN’S DISEASE: A\nCASE REPORT\nCamille Moreira Baptista da Silva1, Beatriz da Costa Rossi Ramos\nde Carvalho 1, Luna Vitória Gondim Ferreira 1, Igor Torres da\nSilveira Mendes1, Vanessa Siqueira Reis 2, Marccus Antônio\nTolentino de Jesus2, Bruno Augusto Alves Martins2, João Batista\nde Sousa 1\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nCase Presentation A 43-year-old male patient pre-\nsented with recurrent episodes of colicky abdominal pain and\nintermittent abdominal distension over the past four years,\ninitially diagnosed as Crohn ’s disease. He was on prednisone\n40 mg/day and azathioprine 100 mg/day, scheduled to begin\nbiological therapy with infliximab. Laboratory tests showed a\nC -reactive protein level of 2.98 mg/dL and fecal calprotectin of\n553 μg/g. Colonoscopy revealed a thickened mucosa in the\nterminal ileum, with vascular pattern obliteration but no\nerosions or ulcers. Entero-CT showed focal, asymmetric wall\nthickening in an ileal loop segment in the right iliac fossa,\nmeasuring 5.0 cm, causing angulation of the intestinal seg-\nment and significant luminal narrowing. This led to upstream\nileal distension with fecaloid material, suggesting partial\nintestinal obstruction. Prominent mesenteric lymph nodes\nwere noted, the largest measuring 2.0/C2 1.0 cm. A review of CT\nimages raised suspicion of a primary small bowel neoplasm.\nThe patient underwent segmental enterectomy with primary\nanastomosis without complications. He experienced signi fi-\ncant clinical improvement, with cessation of prior episodes of\npartial intestinal obstruction. Histopathological analysis\nrevealed a well-differentiated, low-grade neuroendocrine\ntumor (NET) of the small intestine, pT2N1, located in the\nileum, measuring 2.5 /C2 1.5 cm, invading the muscularis\npropria, with clear margins and angiolymphatic invasion.\nImmunohistochemistry showed Ki-67 positivity in 1%.\nDiscussion Neuroendocrine tumors (NETs) are rare\nneoplasms with nonspeci fic presentations and slow growth,\noften excluded from the initial differential diagnosis. Most\nNETs of the jejunum and ileum are non-functioning tumors\nbut may exhibit hepatic metastases and carcinoid syndrome.\nAt diagnosis, these tumors are typically >2 cm, involving the\nmuscularis propria with regional lymph node metastases.\nClinical manifestations include abdominal pain, intestinal\nobstruction, diarrhea, weight loss, and bleeding. Surgical\nintervention remains the treatment of choice whenever\nfeasible.\nConclusion This case highlights the importance of\nconsidering differential diagnoses in patients with suspected\nCrohn’s disease. In this instance, careful reassessment of the\nclinical history and complementary examinations was criti-\ncal in revising the initial diagnosis.\nColoproctologia experimental\nExperimental Coloproctology\nID – 141797\nE-poster\nCOMBINATION OF LIFT AND FILAC FOR THE TREATMENT OF\nCOMPLEX ANAL FISTULA: CASE REPORT\nRejane Corrêa Furtado 1, Ricardo Everton Dias Mont ‘alverne1,\nBenjamin Ramos de Andrade Júnior1, Tainah Cristina Saboya de\nQueiroz Colares1, Ramiro Rolim Neto 1, Thiago Costa Maia 1,\nGabriel Lopes Ponte Prado 1, Breno Moreira Viana Mendonça\nBrito1\n1Santa Casa da Misericórdia de Fortaleza, Fortaleza, Brasil\nCase Presentation A 62-year-old male patient with\ncoronary artery disease and hypertension presented with a\none-year history of anal discharge. A colonoscopy revealed\npurulent discharge from an internal opening, prompting a 3D\nEndoanal Ultrasound, which documented a complex trans-\nsphincteric anorectal fistula involving 77% of the external\nanal sphincter. The patient expressed a strong preference for\npreserving continence and opted for a sphincter-preserving\ntechnique. The patient underwent the Ligation of Intersphinc -\nteric Fistula Tract (LIFT) procedure combined with the FiLaC\n(Fistula Tract Laser Closure) technique for the external tract. A\nradial fiber with a 1470-nanometer diode laser was used,\ndelivering energy at 100 joules/cm. The patient experienced\nan uneventful early postoperative period without complaints.\nHowever, on the 30th postoperative day, purulent discharge\nwas noted from the surgical wound, which was managed with\noral antibiotics. Currently, the patient is asymptomatic, with\ncomplete resolution of the anorectal fistula.\nDiscussion Various surgical options are available for\ntreating anorectal fistulas, particularly complex cases where\nrecurrence rates and the risk of postoperative incontinence\nremain significant challenges. In this context, the increasing\ninterest in novel therapies, such as diode laser application,\ncombined with multiple techniques, represents a promising\napproach for managing anorectal fistulas while preserving\nsphincter function.\nColoproctologia experimental\nExperimental coloproctology\nID – 138151\nE-poster\nEFFECTS OF PLATELET-RICH FIBRIN APPLIED TO COLORECTAL\nSUTURES IN RATS\nFábio Henrique de Oliveira 1, Guilherme Couto dos Santos 1,\nLuciana Xavier Pereirq, Fernanda Elias Rabelo, Vinicius Silva\nBelo, Lucas Silva de Oliveira, Antônio Lacerda- filho\n2\n1Universidade Federal de São João del-Rei, São João del-Rei, Brasil\n2Universidade Federal de Minas Gerais, Belo Horizonte, Brasil\nIntroduction The most feared complication in intes-\ntinal surgery is anastomotic dehiscence, which is closely\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S23\n\n\nrelated to impaired healing and can occur in 2% to 15% of\noperated patients. This complication is associated with high\nmorbidity and mortality rates, negatively impacts surgical\noutcomes, increases hospital costs, and worsens the progno-\nsis in oncological cases. Several factors can in fluence the\nhealing of colonic anastomoses, such as poor nutritional\nstatus. The application of biomaterials, such as platelet-rich\nfibrin (PRF), has been extensively studied due to its significant\nproperties in tissue healing and restoration. The potential\nbeneficial effects of PRF on intestinal healing motivated this\nstudy.\nObjective To evaluate the effects of PRF on the healing\nof intestinal sutures in rats.\nMaterials and Methods Forty rats were divided into\nfour groups. Two groups were fed a standard diet and\nconsidered well-nourished (Groups I and II). The other two\ngroups were fed a cornmeal-based diet, which is low in\nprotein, and considered malnourished (Groups III and IV).\nAll animals underwent cecostomy and cecorrhaphy. Groups II\nand IV had their sutures overlaid with a human PRF mem-\nbrane. The following parameters were assessed: animal\nweight, mortality, site of rupture, rupture pressure, collagen\nconcentration, and reticulin concentration at the suture line.\nResults The use of PRF did not in fluence mortality,\nrupture pressure, or rupture sites in well-nourished animals.\nIn malnourished animals, a signi ficant difference was ob-\nserved in the rupture site (p=0.038) and reticulin concentra-\ntion (p=0.040) when PRF was used. While no differences were\nnoted in rupture pressures, there was a trend toward in-\ncreased collagen concentration in malnourished animals that\nreceived the PRF membrane.\nConclusion The use of PRF did not influence healing in\nwell-nourished rats. In malnourished animals, its application\nfavored healing and allowed the colonic suture to demon-\nstrate greater resistance than the colonic wall during rupture\npressure testing and rupture site evaluation.\nColoproctologia experimental\nExperimental coloproctology\nID – 141733\nE-poster\nHIGH-FLOW ILEOSTOMY: WHAT IS THE COST OF\nCONVENTIONAL TREATMENT (EXCLUSIVE TPN) COMPARED\nTO DISTAL ENTERAL RENUTRITION WITH PARTIAL\nPARENTERAL NUTRITION? A CASE REPORT\nGian Francisco de Macedo Almeida\n1, Ruth Avernias Lopes de\nAvila2, Rafael Rodrigues Leite 2, David de Faria Soares\nRodrigues2, Alexandre Brindeiro de Amorim Filho 2, Háira\nDelvair Nogueira Ramos 2, Camilla de Sales Brito 2, Karina\nQueiroz Cruz Almeida 2\n1Hospital Universitário Alcides Carneiro, Campina Grande, Brasil\n2Universidade Federal de Campina Grande, Campina Grande, Brasil\nNutritional management is crucial in surgical\npatients, especially in cases of complications from high-\noutput enterostomies. Malnutrition and electrolyte imbal-\nances are associated with worse prognoses, with direct\nimplications for surgical management. Nutritional interven-\ntion can be enteral, partial parenteral nutrition (PPN), or total\nparenteral nutrition (TPN). In cases of high-output enteros-\ntomies, exclusive TPN may be used. This case describes a 66-\nyear-old patient who underwent rectosigmoidectomy for\nneoplasia. They developed an abscess and perforation of\nthe small intestine on the 10\nth postoperative day (POD),\nrequiring enterectomy, ileostomy, and mucosal fistula. Pro-\ngressing to high-output enterostomy, unresponsive to clinical\ntreatment, the decision was made to perform ef fluent rein-\nfusion, along with prehabilitation measures and the use of\nPPN. In 14 days, the patient was fit for intestinal transit\nreconstruction, discharged with an exclusive oral diet after 7\ndays, and achieved normalization of the digestive tract,\nregaining 10 kg by the 30th POD. The aim is to describe the\ncosts of PPN associated with ef fluent reinfusion versus TPN\n(hypothetical case). Energy needs were calculated by the\nnutrition department, prescribing 550 kcal daily via Olimel\nN4E (approximately 35% of the needs). One bag of Olimel N4E/\nday was prescribed for 14 days at a cost of R$ 2,515.38. This\nsupplement is used exclusively for PPN and administered via\na peripheral line. Additionally, ascorbic acid (R$1.33) and B\ncomplex vitamins (R$2.34) were used daily, totaling R$51.38.\nThese would also be prescribed for TPN. If exclusive TPN were\nperformed, Olimel N7E (R$290.00/unit) and Olimel N9E (R\n$210.00/unit) would be used. For 1,833 kcal/day, 2 bags/day of\nTPN would be required. Thus, over 14 days, the cost would be\nR$8,120.00 with Olimel N7E and R$5,880.00 with Olimel N9E.\nAdditionally, central venous access would be required, cost-\ning R$36.89. Therefore, the total cost of PPN was R$2,566.76,\nwhile TPN would cost up to R$8,120.00, an increase of 316%.\nWe did not consider the risks and side effects inherent to\nexclusive TPN, such as electrolyte, glycemic, and immunolog-\nical disturbances, as well as the risks of central venous access.\nThus, the technique of distal enteral re-nutrition, combined\nwith PPN and prehabilitation measures, allowed reconstruc -\ntion to be performed in a shorter time and with potentially\nreduced complications, proving to be a safe and cost-effective\nprocedure.\nColoproctologia experimental\nExperimental coloproctology\nID – 141070\nE-poster\nIMPACT OF DISTAL ENTERAL RENUTRITION THERAPY ON\nWEIGHT GAIN IN A PATIENT WITH HIGH-OUTPUT ILEOSTOMY\n- A CASE REPORT\nGian Francisco de Macedo Almeida\n1, David de Faria Soares\nRodrigues2, Rafael Rodrigues Leite 2, Alexandre Brindeiro de\nAmorim Filho 2, Ruth Avernias Lopes de Avila 2, Háira Delvair\nNogueira Ramos 2, Camila de Sales Brito 2, Karina Queiroz Cruz\nAlmeida3\n1Hospital Universitário Alcides Carneiro, Campina Grande, Brasil\n2Universidade Federal de Campina Grande, Campina Grande, Brasil\n3Universidade de Pernambuco, Recife, Brasil\nHigh-output ileostomies, especially those involving\nthe small intestine, can impair patients ’ quality of life and\nresult in electrolyte disturbances, particularly when they\nprogress to high-output states1,2,3 Thus, intestinal transit\nreconstruction becomes an alternative to improving these\npatients’ quality of life and clinical status. However, achieving\nan optimal nutritional state is essential for surgical treat-\nment, as preoperative malnutrition is associated with poorer\nprognoses and severe postoperative complications4. Preha-\nbilitation therapies can reduce postoperative complications\nby up to 50%5, along with other measures. This study aims to\nreport the effect of ileostomy content reinfusion therapy in\nthe preoperative period of intestinal transit reconstruction.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS24\n\n\nThe present work is an analytical case report that seeks to\nassess the impact of reinfused ileostomy content volume on\nweight gain in a patient with high-output ileostomy. The\nanalysis was performed using RStudio version 4.4.0, testing\nthe correlation between reinfused volume and weight, and\nbetween reinfused volume and BMI, using Pearson ’s correla-\ntion test. The case involves a 66-year-old male diagnosed with\ncolorectal cancer, initially undergoing rectosigmoidectomy\nand colectomy of the descending colon. Subsequently, the\npatient underwent exploratory laparotomy with enterec -\ntomy, ileostomy, and mucosal fistula creation due to a cavi-\ntary abscess involving the small intestine. Thirty-two days\nafter the last surgery, the patient returned to the service with\nmalnutrition, accompanied by asthenia, tremors, and anorex-\nia. During hospitalization, partial parenteral nutrition was\ncombined with reinfusion of ileostomy content through the\nmucosal fistula for 14 days. The ileostomy had an output\ngreater than 1000 mL/day. A signi ficant correlation was\nobserved between reinfused volume and weight gain (p-\nvalue = 0.01805) and BMI (p-value = 0.01801). Considering\nthe importance of preoperative nutritional therapy in surgi-\ncal patients, particularly oncological and malnourished indi-\nviduals, reinfusion therapy proved effective in this case. It\nfacilitated weight gain and allowed for subsequent intestinal\ntransit reconstruction without postoperative complications.\nAdditionally, it reduced the risks and costs associated with\nprolonged parenteral nutrition, as highlighted in other\nstudies3,4,6.\nColoproctologia experimental\nExperimental coloproctology\nID – 138347\nE-poster\nVIDEO-ASSISTED NECROSECTOMY IN OMENTAL NECROSIS –\nA CASE REPORT\nCristina Calloni\n1, Bruna Oliveira Trindade 2, Daniel de Barcellos\nAzambuja2, André Bigolin 2, Fares Hassan Hamaoui 3, Mateus\nParisotto3\n1Universidade Feevale, Ribeirão Preto, Brasil\n2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto\nAlegre, Brasil\n3Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brasil\nIntroduction Video-assisted retroperitoneal\nnecrosectomy (VAN) involves the insertion of a drainage\ntube via a transperitoneal approach to perform lavage and\ndebridement of the necrotic area. This procedure is widely\nused and established in cases of necrotizing pancreatitis with\nsatisfactory outcomes.\nMethod A study based on medical record analysis and\nliterature review aimed at describing a case of omental\ninfarction resolved uniquely by video-assisted necrosectomy.\nCase Report A 52-year-old male patient with dysli-\npidemia presented a single episode of lower gastrointestinal\nbleeding in December 2023. A computed tomography (CT)\nscan of the abdomen showed a thickened area in the splenic\nflexure of the colon with in filtration of adjacent fat, and a\ncolonoscopy with biopsy fragments was performed. The\nsubsequent histopathological report indicated poorly differ-\nentiated adenocarcinoma. Further staging exams showed no\nsignificant changes. In January 2024, the patient underwent\nrobotic left colectomy with satisfactory progress and was\ndischarged on the 3rd postoperative day. However, 8 days\nlater, the patient returned with fever and abdominal pain.\nNew exams revealed ischemia and omental necrosis, initially\ntreated conservatively with antibiotics, followed by CT-guid-\ned puncture for the placement of a pigtail drain to evacuate\nthe collection in the necrotic area. After two months of\nconservative management without complete improvement\nand the inability to start chemotherapy due to septic con-\nditions, the decision was made to perform video-assisted\nnecrosectomy, which resulted in signi ficant improvement\nand enabled the possibility of chemotherapy.\nDiscussion The choice of an additional procedure, in\nthis case, video-assisted debridement, depends on the loca-\ntion of the collection relative to adjacent organs, availability\nof methods and technologies, time of presentation, appear-\nance of the content, and the patient ’s clinical condition.\nConclusion VAN proved to be potentially effective\nand feasible, and it can be implemented in cases of omental\nnecrosis, even though its indication is more firmly estab-\nlished in pancreatic necrosis. As a minimally invasive proce-\ndure, it offers rapid recovery, avoids conventional procedures,\nand allows surgeons who are not fully skilled to achieve\nclinical resolution with lower risks.\nColoproctologia experimental\nExperimental coloproctology\nID – 138158\nE-poster\nAORTIC VASCULAR PROSTHESIS IN ILEOSTOMY RESCUE -\nPREVENTING REINTERVENTION IN COMPROMISED\nABDOMEN: A CASE REPORT\nMariana Maiolino de Olival\n1, Juliana Chaves Brandão1, Leonardo\nMachado de Castro1, Rodrigo Rocha Rodrigues1, Camila Tobias\nQueiroz1, Ana Luiza de Oliveira Nelaton 1, Rodrigo Rego Lins 1,\nPaulo Cesar de Castro Junior 1\n1Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brasil\nCase Presentation MRHM, 62 years old, female,\nunderwent right colectomy and primary anastomosis in\nAugust 2023 due to a colon lesion. She developed an anasto-\nmotic fistula on the 7th postoperative day, requiring reoper-\nation and creation of a terminal ileostomy and mucousfistula.\nIn September 2023, an exploratory laparotomy was per-\nformed due to an intra-abdominal abscess, resulting in a\nnew ileostomy and closure of the mucous fistula. She was\ntransferred to a university hospital in October 2023 for the\ntreatment of persistent abdominal collection, peristomal\ndermatitis, and infection of surgical wounds. The collection\nwas resolved by radiological intervention; however, the\npatient progressed with partial collapse of the ileostomy,\nleading to subcutaneous contamination and a fistula to the\nsurgical wound. An exceptional measure was adopted by\nattaching an aortic vascular prosthesis to the ileostomy to\nextend its length and reduce subcutaneous contamination.\nAfter 8 days of hospitalization, there was significant improve-\nment, and the patient was discharged. Follow-up showed\ncomplete wound healing and resolution of dermatitis. In\nNovember 2023, the prosthesis was removed, revealing a\nflat ileostomy, well-fixed to the skin. MRHM is being followed\nby the proctology team.\nDiscussion The creation of ileostomies, although\ncommon, can present signi ficant complication rates. Gener-\nally performed in complex surgeries or reoperations, various\ncomplications are associated with it, with risk factors\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S25\n\n\nincluding tensioned tissues, poor vascularization, and im-\nproper positioning, as well as factors such as obesity and\npatient malnutrition. These complications directly affect\nsurvival and quality of life due to infections, dermatitis,\npain, dif ficulty in pouch attachment, prolonged hospitaliza-\ntions, and others. Even with necessary care, complications\nmay occur, requiring creative management by the surgeon. In\nthe case presented, an uncommon technique proved highly\neffective, accelerating peristomal healing, reducing local in-\nfection, and signi ficantly improving the patient ’s quality of\nlife, with reduced pain and pouch change frequency, which\nwas also re flected in her clinical and laboratory\nimprovement.\nFinal Considerations In selected and complex cases\nof retraction and collapse of stomas, the implementation of a\nvascular prosthesis can be an interesting alternative measure\nto optimize pouch attachment and reduce contamination and\nlocal dermatitis.\nDoença Diverticular\nDiverticular disease\nID – 141708\nE-poster\nPROGNOSTIC FACTORS IN COMPLICATED DIVERTICULITIS AT A\nTEACHING HOSPITAL IN SÃO PAULO\nIsaac José Felippe Corrêa Neto\n1, Gabriela Portal Monteiro 1,\nYasmin Góis de Mello1, Laercio Robles1, Allison de Lucena Silva1\n1Hospital Santa Marcelina, São Paulo, Brasil\nIntroduction Acute diverticulitis (AD) occurs in ap-\nproximately 15% of individuals with diverticular disease,\nbeing more common after the 6th decade of life and in\nmale patients. Around 12% of these patients will present\nwith complicated AD, and the treatment for cases with\npurulent or fecal peritonitis is typically surgical.\nObjective To evaluate the epidemiological data of\npatients with complicated acute diverticulitis presenting\nwith purulent and/or fecal peritonitis who underwent surgi-\ncal treatment at a teaching hospital.\nMethods This is a retrospective, clinical-observation-\nal study with a quantitative cohort approach, based on the\nanalysis of electronic medical records from a teaching hospi-\ntal in São Paulo, SP, Brasil.\nResults Eighteen patients with Hinchey 3 and 4\ndiverticulitis who underwent emergency surgery were ana-\nlyzed. The overall mean age was 54.9 years (ranging from 24\nto 80), with 61.1% being male, and most patients had an ASA 3\nanesthetic risk (72.2%). Among those with postoperative\ncomplications, the mean age was 58.9 years, and among\nthose without complications, it was 47 years. Fourteen\npatients (77.7%) had comorbidities, of which 73.3% had\nHinchey 3 AD and 100% had Hinchey 4 AD. Thirteen patients\n(72.2%) had C -Reactive Protein (CRP) levels greater than or\nequal to 250 mg/dL, and 88.8% showed leukocytosis.\nConclusion A higher incidence of complicated AD\nwith purulent or fecal peritonitis was observed in older\nindividuals, male patients, those with chronic diseases, those\nshowing signs of peritonitis upon admission physical exami-\nnation, and those with elevated leukocyte and C -reactive\nprotein levels.\nDoença Diverticular\nDiverticular disease\nID – 137821\nE-poster\nHOSPITALIZATIONS FOR DIVERTICULAR DISEASE IN BRAZIL\nBETWEEN 2008 AND 2023: A QUALITATIVE AND\nQUANTITATIVE ANALYSIS\nVictor Cordeiro Simão 1, Mylena Santana de Sena Araújo 1,\nGabriela Luz Castelo Branco de Souza 1, Nayã Pereira Portilho 2,\nArthur Cordeiro Simão 1, Isabely Gelinski 1, Bruna Dell ‘acqua\nCassão1, Pedro Eduardo da Costa Galvão 1\n1Universidade Federal de Goiás, Goiânia, Brasil\n2Pontifícia Universidade Católica de Goiás, Goiânia, Brasil\nIntroduction Diverticular disease can become a se-\nvere condition, responsible for over 24,645 deaths in Brazil\nbetween 2008 and 2022. Understanding the pro file of hospi-\ntalization rates within the Uni fied Health System (SUS) for\nthis condition is crucial for assessing its impact and planning\nhealthcare actions.\nObjective To conduct a quantitative and qualitative\nassessment of hospitalizations for diverticular disease in\nBrazil during the period from 2008 to 2023.\nMethods A retrospective observational study ana-\nlyzed the time series of hospitalization rates for Diverticular\nDisease of the Intestine (ICD-10 K57) in Brazil between 2008\nand 2023. Data were obtained from DATASUS, and rates were\ncalculated per 100,000 inhabitants. Trend analysis was con-\nducted using segmented linear regression (joinpoint). Meas-\nures such as Annual Percent Change (APC) and Average\nAnnual Percent Change (AAPC) were used to evaluate trends\nover the period, considering 95% Con fidence Intervals (CI).\nResults During the period, 129,512 hospitalizations\nwere identi fied, with 114,648 (88.52%) cases occurring as\nemergencies. The national hospitalization rate ranged from\n2.75 (in 2008) to 5.53 (in 2023). Nationally, there was an\nincreasing trend in hospitalization rates (AAPC 4.72), with\nhigher rates observed in females (AAPC 5.13) and in the 40 –\n59 age group (AAPC 3.48). A stationary trend was noted\nbetween 2018 and 2021 (APC -1.06; 95% CI: -3.52 to 2.76).\nThe South region showed the highest growth in hospitaliza-\ntion rates (AAPC 4.88), followed by the Southeast (AAPC 4.42).\nThe North, Northeast, and Central-West regions had higher\nAAPC values among females. The 40 –59 age group showed\nthe highest AAPC values in the Central-West and Northeast\nregions and was the only age group with a growing trend in\nthe Central-West. The 20–39 age group had the highest AAPC\nvalues in the Southeast and South regions.\nConclusion The quantitative analysis of hospitaliza-\ntion data for diverticular disease revealed a growing trend,\nparticularly in emergency admissions. Qualitative analysis\nhighlighted that the increase in hospitalizations was concen-\ntrated among females aged 40 –59 in the southernmost\nmacroeconomic regions. This underscores the urgency of\npublic health policies that address regional and gender-\nspecific dynamics, which are essential for tackling the rise\nin hospitalizations for diverticular disease in the country.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS26\n\n\nDoença Diverticular\nDiverticular disease\nID – 141728\nE-poster\nPYODERMA GANGRENOSUM IN DIVERTICULAR DISEASE\nWITH ACUTE EXACERBATION\nHeloisa G Mussnich1, Débora Oliveira Hutten1, Déborah Guedes\nMussnich1, Jonatas Sthift 1, Denise Pelisolli Fattore 1, Daniela\nCerqueira Koppe1, Eliana de Almeida Oliveira 1, Ana Maria S.\nGarcia1\n1Hospital Moinhos de Vento, Porto Alegre, Brasil\nCase Presentation An 81-year-old female patient\nwith a dermatological diagnosis of pyoderma gangrenosum\npresented with a skin lesion on the left pre-tibial region. After\nexcluding inflammatory bowel disease (IBD) and malignan-\ncies, she was treated with immunosuppressive therapy (cor-\nticosteroids and mycophenolate) with good disease control.\nEight months after the onset of the dermatological condition,\nthe patient developed anemia, elevated C -reactive protein,\nabdominal pain, and rectal bleeding. Abdominal computed\ntomography showed marked thickening of the sigmoid,\ndescending colon, and upper rectum walls, with a well-\norganized thick-walled hydroaerial pelvic collection measur-\ning approximately 25.3 cm³. This collection was near the\nsigmoid colon and demonstrated fistulous tracts originating\nfrom the upper rectum and distal sigmoid, converging in the\nmesorectum. Suspicion of IBD resurfaced, necessitating dif-\nferential diagnosis with complicated acute diverticulitis.\nClinical optimization was performed, including blood trans-\nfusion, parenteral nutrition, cessation of immunosuppres-\nsants, continuation of low-dose corticosteroids, and\nconsultation with a specialized IBD team. After two weeks,\nthe patient underwent laparoscopic rectosigmoidectomy\nwith protective ileostomy. During surgery, the sigmoid colon\nwas found to befirmly adhered to the pelvis, with a contained\nabscess that released purulent material upon dissection. Two\nmonths post-surgery, the ileostomy was reversed without\ncomplications, and the histopathological examination of the\nresected specimen con firmed a diagnosis of colonic divertic -\nular disease with acute exudative in flammation (diverticuli-\ntis), ruling out IBD. The pyoderma lesion completely healed\nfollowing the second surgery.\nDiscussion Pyoderma gangrenosum is an autoim-\nmune dermatological condition often associated with other\nautoimmune disorders and malignancies. The patient ’s co-\nlonic in flammation, abscess, and fistulas raised concerns\nabout a possible association with IBD. However, the manage-\nment approach, regardless of etiology, was deemed surgical\nin this case.\nConclusion This case report highlights the potential\nrole of chronic in flammatory processes (in this instance,\ncolonic diverticular disease) in perpetuating pyoderma gan-\ngrenosum. The resolution of diverticulitis led to the complete\nhealing of the dermatological lesion, underscoring the im-\nportance of addressing underlying in flammatory conditions\nin the management of pyoderma gangrenosum.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141180\nE-poster\nSURGICAL TRAINING IN INFLAMMATORY BOWEL DISEASES:\nEVALUATION OF SERVICES ACCREDITED BY THE BRAZILIAN\nSOCIETY OF COLOPROCTOLOGY\nDaniel de Castilho da Silva 1, Gilmara Pandolfo Zabot, Carlos\nHenrique Marques dos Santos, Sinara Monica de Oliveira Leite,\nJuliana Ranalli Rinaldi, Cristina Flores, Abel Botelho Quaresma,\nIdblan Carvalho de Albuquerque 2\n1Hospital Santa Catarina, São Paulo, Brasil\n2Hospital Heliópolis, São Paulo, Brasil\nIntroduction Surgery plays a crucial role in the\ntreatment of patients diagnosed with in flammatory bowel\ndisease (IBD), even with advancements in pharmacological\ntherapies. However, the training of coloproctology residents\nin the surgical treatment of IBD patients remains insufficient,\nhighlighting the need for this study.\nObjective To evaluate surgical training in IBD within\nthe services accredited by the Brazilian Society of Coloproc -\ntology (SBCP).\nMethodology Final year coloproctology residents\ncompleted an electronic questionnaire sent via email. The\nsurvey included 28 closed-ended questions designed to as-\nsess the participants ’ knowledge and practices related to the\nsurgical management of IBD, as well as the pro file of insti-\ntutions, residents, and faculty members.\nResults The evaluation revealed that, despite an ade-\nquate number of coloproctology residency programs in Brazil\n(61 in total), the number of residents and faculty members\naffiliated with the SBCP as full members and the Brazilian\nOrganization for Crohn ’s Disease and Ulcerative Colitis\n(GEDIIB) is very limited.\nConclusion Given the increasing incidence of IBD in\nBrazil and globally, the findings of this study warrant careful\nconsideration. The results highlight de ficiencies in the surgi-\ncal training of medical professionals and weak ties with\neducational organizations specializing in IBD surgical treat-\nment. Consequently, graduates from coloproctology residen-\ncy programs in Brazil demonstrate insuf ficient theoretical\nand practical, particularly surgical, training for managing\nthese patients.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 137364\nE-poster\nEMERGENCY SURGICAL APPROACH FOR ABDOMINAL\nTRAUMA IN A PATIENT WITH CROHN ’S DISEASE: CASE\nREPORT AND LITERATURE REVIEW\nGiovanna Savoy Pazin 1, Mayara Marina Sousa Senzano 1,\nAlexandre Foratto 1, Isabella Colombani 1, Claudio Saddy\nRodrigues Coy1, Maria de Lourdes Setsuko Ayrizono 1 Gustavo\nPereira Fraga1, Raquel Franco Leal 1\n1Universidade Estadual de Campinas, Campinas, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S27\n\n\nIntroduction Crohn’s disease (CD) is a chronic, recur-\nrent in flammatory condition that primarily affects the gas-\ntrointestinal tract and can present with multiple\ncomplications, such as abscesses, fistulas, and perforations.\nAbdominal blunt trauma can more easily predispose to\nlacerations and perforations in areas affected by the disease.\nCase Presentation A 29-year-old male was brought to\nthe emergency department of a tertiary university hospital\nafter a high-impact automobile accident. In the initial treat-\nment, a chest drain was performed for right-sided pneumo-\nthorax, maintaining hemodynamic stability. The patient then\nunderwent a CT scan of the abdomen, revealing pneumo-\nperitoneum and thickening of the small intestine loops. The\npatient had a prior diagnosis of Crohn ’s disease with loss of\nfollow-up, along with a history of alcohol and tobacco use. An\nexploratory laparotomy was indicated, where a jejunal loop\nperforation and several areas of stenosis and in flammation\ndistal to the perforation were identi fied. A segmental enter-\nectomy was performed, and the afferent and efferent loops\nwere buried, with a vacuum peritoneostomy created due to\ninstability. The patient stabilized and underwent reoperation\n48 hours later, with an 8 cm enterectomy, creation of a right\njejunostomy 1 meter from Treitz ’s angle, and a mucosal\nfistula on the left with a 2.5 meter distal loop. He was\nhospitalized for 30 days post-surgery for nutrition and stabi-\nlization. He underwent surgery for intestinal transit recon-\nstruction by the Coloproctology team, with identification of 8\nareas of intestinal stenosis, Meckel ’s diverticulum, and in-\nflammatory patterns with some areas of remission in the\nsmall intestine. Intestinal reconstruction was performed with\na manual isoperistaltic side-to-side anastomosis, as well as\nHeineke-Mikulicz stenoplasties and balloon dilation for some\nof the stenoses. The postoperative evolution was without\ncomplications. After discharge, he continued ambulatory\nfollow-up, remaining asymptomatic, and was reintroduced\nto immunobiologics for the treatment of Crohn ’s disease.\nConclusion This is a rare case of blunt abdominal\ntrauma in a patient with Crohn ’s disease. The surgical man-\nagement of traumatic intestinal injuries in these patients is\ncontroversial in literature. Thus, the management of this\npatient may offer a new perspective on care and attention\nto minimize the morbidity and mortality associated with\nthese conditions.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138305\nE-poster\nAPPROACH TO GIANT CYSTIC LESION IN CROHN ’S DISEASE\nUSING THE MODIFIED KRASKE PROCEDURE\nRodolfo Dahlem Melo 1, Cristiane Jacomini 1, Antonio Balestrim\nFilho1, Vanessa Foresto Machado 1, Rogério Sera fim Parra1,\nMarley Ribeiro Feitosa 1, Omar Féres 1, José Joaquim Ribeiro da\nRocha1\n1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil\nCase Presentation A 45-year-old woman with ileo-\ncolonic Crohn ’s disease for 17 years, using certolizumab\n(discontinued in fliximab 13 years ago due to anaphylactic\nreaction), previously underwent multiple abdominal surger-\nies due to enteric and colonic fistulas. She presented with a\npalpable abdominal mass, abdominal pain, and foul-smelling\nsecretion from the anus. An investigation with pelvic MRI\nrevealed an expansive formation of 17 cm extending from the\npelvis to the mesogastrium, predominantly to the left, with\nT2 hypersignal and no post-contrast enhancement, of un-\nknown etiology. Due to a history of previous laparotomies\nand intestinal fistulas, the decision was made to use the\nKraske incision for a transperineal approach to the pelvic\nlesion under investigation. Intraoperatively, the cystic con-\ntent was dark liquid, and there was glandular tissue inside,\nsuspected to be ovarian tissue. Cytology of the surgery\nshowed cystic, hemorrhagic, and benign fluid. The patient\nrecovered satisfactorily and was discharged on the second\npostoperative day. The pathological examination of the lesion\nrevealed ovarian tissue, diagnosing a left ovarian corpus\nluteum cyst.\nDiscussion The perineal approach is an option for\nretrorectal tumors, low perineal lesions, and cases where\nconventional laparotomy access is dif ficult. Due to the loca-\ntion and, primarily, the size of the lesions, some complica-\ntions from the posterior approach may be observed, such as\nperforation of the neoplastic lesion, rectal perforation, and\nvascular and nerve damage. However, this approach has\nacceptable complication rates, short hospital stays, and quick\nrecovery. The main complications of the approach are rec -\ntocutaneous fistulas, urinary dysfunction, and neurological\nissues.\nConclusion The posterior approach using the modi-\nfied Kraske procedure can be used for giant pelvic lesions and\nyields acceptable results, making it a viable option for select-\ned patients.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141634\nE-poster\nADENOCARCINOMA OF THE ILEUM OCCURRING AT THE SITE\nOF ILEOSTOMY CLOSURE AFTER ILEAL-ANAL POUCH\nCREATION FOR ULCERATIVE COLITIS\nGabriela da Costa 1, Jorge Benjamin Fayad 1, Kelly Cavallini 1,\nGabriel Oliveira Septimio 1, Claudia Maria Vale Joaquim Falbo\nDomingos1, Jayna Martins Neno Rosa 1, Martina Gutierrez\nGalhardo1\n1Hospital Federal de Ipanema, Rio de Janeiro, Brasil\nCase Presentation A 55-year-old female patient with\nIdiopathic Ulcerative Colitis (IUC) since 1995. After 15 years\nof disease and clinical intractability, she underwent total\nproctocolectomy with ileo-anal pouch formation in three\nstages. In 2023, after multiple medical consultations over a\nperiod of 2 months, she was admitted for hospitalization due\nto hypogastric pain near the surgical scars, where the skin\nhad a rock-like appearance, associated with fever and nausea.\nAn abdominal CT scan revealed a mixed collection located\nanteriorly to the pelvis. A pouchoscopy and contrast exami-\nnation of the pouch showed no abnormalities. Percutaneous\ndrainage of the pelvic collection was performed with a Pigtail\ncatheter, initially draining purulent secretion. She then de-\nveloped intestinal obstruction and underwent exploratory\nlaparotomy, which identi fied a collection in the abdominal\nwall, stenosis of the small intestine at the previous ileostomy\nclosure site, fistulized to the abdominal wall, and intense\nfibrosis. An enterectomy of the previous ileo-ileal anastomo-\nsis was performed, with primary anastomosis and resection\nof the entero-cutaneous fistulous tract. Histopathological\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS28\n\n\nexamination diagnosed moderately differentiated adenocar-\ncinoma in the ileal segment, with perforation into the visceral\nperitoneum and fistulous tract, invading connective-adipose\ntissue and skeletal muscle.\nDiscussion Among gastrointestinal neoplasms, only\n2-3% originate from the small intestine, making them ex-\ntremely rare. Their diagnosis is often delayed due to nonspe-\ncific symptoms, presenting as an acute complication. A\nCanadian study demonstrated that only 16% of small intestine\nadenocarcinomas occurred in the ileum. A Swedish study\nanalyzed 142,008 patients with In flammatory Bowel Disease\n(IBD) for the prevalence of small intestine tumors. Of these,\n59.8% had Ulcerative Colitis (UC), and only 21 patients\npresented adenocarcinoma of the small intestine associated\nwith UC. Among the UC patients, it was found that extensive\ndisease had a 2.7 times greater risk of small bowel adenocar-\ncinoma. The highest risk was among patients diagnosed with\nIBD before the age of 40, as in the case of the reported patient.\nConclusion Studies on this subject suffer from biases\ndue to small sample sizes and short follow-up periods.\nTherefore, case reports are effective for gathering more\nreliable statistics in the future.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138326\nE-poster\nCOLON AGENESIS IN A PATIENT WITH SEVERE PERINEAL\nCROHN’S DISEASE\nEduardo Vidal de Holanda 1, Fernanda Belz dos Santos 1,\nGuilherme Melchior Maia Lopes 1, Lorena Menezes Gadotti 1,\nJaques Waisberg1, Sandra Di Felice Boratto 1, Marcella Conz\nRodrigues1, Raphaella Assis Alves Januário 1\n1Faculdade de Medicina do ABC, Santo André, Brasil\nCase Presentation A 30-year-old female was admit-\nted to a tertiary hospital with a perianal abscess associated\nwith hyperemia and the discharge of purulent secretion from\nthe vaginal canal. She had a history of Crohn ’s disease, being\nfollowed at another service, and had used adalimumab,\ndiscontinuing treatment 6 years prior. She also had depres-\nsion and anxiety. She denied any previous surgeries. Upon\nexamination, there were hardened circumferential plicomas\nand multiple anorectal and rectovaginal fistulas. The abdo-\nmen was soft and painless, without scars. She was diagnosed\nwith severe perineal abscessed Crohn ’s disease. MRI showed\nsoft tissue edema adjacent to the anal canal, with multiple\nperianal fistulas, an irregular collection on the right, and a\nposterior collection extending to the coccyx, maintaining a\nfistula communicating with the posterior wall of the anal\ncanal. Abdominal and pelvic CT revealed diffuse densification\nof the perirectal fat, indicating in flammation and infection.\nShe underwent two perineal approaches, with drainage of\ncollections, the largest on the right, and placement of five\nsilicone drains. After resolving the septic condition, she had\ndifficulty healing the surgical wound due to signi ficant fecal\nincontinence. A decision was made for a diverting transverse\ncolostomy. During surgery, it was found that all colon seg-\nments were absent, with the ileum located 270 cm distal to\nthe Treitz angle, medianized at the level of the promontory,\nand covered with hypertrophic mesenteric tissue. A diverting\nileostomy was then performed.\nDiscussion Colon agenesis is a rare finding in medical\nliterature, with most reported cases involving newborns with\nassociated gastrointestinal and cardiac malformations. One\nform of presentation is the “colon pouch syndrome,” charac -\nterized by the partial or complete replacement of the colon by\na dilated terminal ileum, often with an associated urogenital\nfistula.\nConclusion The patient described in this case had a\nprior diagnosis of Crohn ’s disease made at another tertiary\ncenter in São Paulo and had previously received immunobio-\nlogical therapy. A complete investigation was assumed to\nhave been done, and the patient con firmed it at the onset of\nclinical manifestations, but follow-up exams were lost. This\ncase highlights not only the rarity of the disease found but\nalso the unusual age range, the association with in flammato-\nry bowel disease, and the diagnostic failure over years of\nmonitoring for Crohn ’s disease.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141693\nE-poster\nABDOMINOPERINEAL RESECTION OF THE RECTUM WITH\nENLARGEMENT IN A CASE OF COMPLEX PERINEAL CROHN ’S\nDISEASE WITH DELAYED HEALING\nRafael Andrade Cruz\n1, Vinícius Miranda Baroni 1, Bárbara\nMáximo Nascimento1, Artur Cury Féres 1, Marley Ribeiro\nFeitosa1, Rogério Sera fim Parra1, José Joaquim Ribeiro da\nRocha1, Omar Féres 1\n1Faculdade de Medicina de Ribeirão Preto, São Paulo, Brasil\nCase Presentation A 26-year-old male patient, diag-\nnosed with Crohn ’s Disease (Montreal A2L2B3p), presented\nto the coloproctology outpatient clinic 7 years ago with\ncomplaints of perineal pain, colic, and diarrhea with mucus.\nHe was treated with azathioprine, immunobiologics, and\nmultiple perianal surgeries, but did not achieve complete\nperineal healing. After 5 years of follow-up, he developed\nrectal stenosis and extensive anal fibrosis with an open and\npurulent wound. Abdominoperineal resection of the rectum\nwas indicated. Postoperatively, the patient had delayed and\ninefficient healing of the perineal wound, largely due to his\nsystemic conditions, especially nutritional issues. He under-\nwent 35 sessions of hyperbaric oxygen therapy (HBOT),\nresulting in partial healing. During this period, the disease\nrecurred in the transverse colon, leading to another colec -\ntomy with terminal ileostomy and perineal resuture. An\nadditional 14 sessions of HBOT were performed, with good\nhealing and disease control. After healing, the patient gained\n33 kg in weight over 6 months.\nDiscussion Crohn’s Disease affects various regions of\nthe gastrointestinal tract, but the most challenging compli-\ncations arise when it involves the perianal region. Despite\nvarious adjunctive treatments and local surgical interven-\ntions, there is a signi ficant risk of developing irreversible\nanorectal fibrosis and subsequent rectal amputation, which\ncan occur in up to 15% of patients, as seen in this case. What\nstood out the most, however, was the prolonged and ineffec -\ntive healing of the postoperative wound due to the patient ’s\nmalnutrition, requiring a total of 49 HBOT sessions, as well as\nthe recurrence of the disease and the need for another\ncolectomy. This was a high-complexity case that ultimately\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S29\n\n\nresulted in satisfactory outcomes and improved the patient ’s\nquality of life.\nConclusion This case illustrates the most challenging\ncomplications of Crohn ’s Disease in its perianal form and\nemphasizes the importance of continuous monitoring and\nfrequent adjustments in the therapeutic plan, adapting to the\ndisease’s progression and the patient’s individual response to\ntreatment.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138191\nE-poster\nABDOMINOPERINEAL AMPUTATION DUE TO CROHN ’S\nDISEASE: CASE SERIES\nBárbara Máximo Nascimento 1, Maria Eduarda Pequeno da\nCosta Reis1, Bárbara Neuber Fonseca 1, Artur Cury Féres 1,\nMarley Ribeiro Feitosa 1, Rogério Sera fim Parra1, José Joaquim\nRibeiro da Rocha 1, Omar Féres 1\n1Faculdade de Medicina de Ribeirão Preto, São Paulo, Brasil\nIntroduction Crohn’s Disease (CD) affects various\nregions of the gastrointestinal tract. The most challenging\ncomplications occur when CD affects the perianal region,\nwhich is associated with a reduced quality of life for the\npatient. Although there are different treatments, there is a\nsignificant risk of progression to irreversible anorectal fibro-\nsis and consequent abdominoperineal amputation (AP),\nwhich can occur in up to 15% of cases.\nObjective To analyze the prevalence and clinical-\nlaboratory characteristics related to perianal CD in patients\nundergoing AP in a public tertiary hospital service, as well as\nto understand the postoperative evolution and complications\nof these patients.\nMethods This is a retrospective study of data collect-\ned from medical records of patients who underwent AP\nbetween 2000 and 2024 due to perianal CD. The Chi-square\ntest was used to analyze the heterogeneity of frequency\ndistribution in the studied cohort.\nResults In the analyzed period, considering all\npatients who underwent AP (n=479), it was observed that\nonly 3.96% (19 patients) were due to Crohn ’s disease. Among\nthem, the majority were female (63.2%), with a mean age of\n39 /C6 11.3 years and a mean BMI of 23.7 /C6 5.1 when undergo-\ning total proctectomy. The average time interval from diag-\nnosis to amputation was 13.8 /C6 6.7 years. Only one patient\nhad never undergone surgery, and all others had previous\nperianal interventions, with fistulotomy (77.7%) being the\nmost frequent. Of the total, 73.7% already had a prior ostomy.\nOnly one death was associated with the procedure, and in 3\ncases, malignancy was found in the surgical specimen. Com-\nparatively, it was observed that the presence of anemia and\nhypoalbuminemia did not affect the complication rates.\nThere was no statistical difference in complication rates in\npatients using corticosteroids (0% vs. 47.1%; p=0.48), azathi-\noprine (33.3% vs. 43.8%; p=1.00), and immunobiologics (45.5%\nvs. 37.5%; p=1.00). Similarly, no differences were observed in\npatients who had been previously ostomized (42.9% vs.\n40.0%; p=1.00).\nConclusion Despite therapeutic advances in CD,\nperianal involvement with consequent amputation remains\nan important outcome in the disease ’s progression. Although\ndelayed by other therapeutic alternatives, it still occurs early\nand involves factors related to both the patient’s prior history\nand postoperative factors, which were analyzed in this study.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141296\nE-poster\nEPIDEMIOLOGICAL ANALYSIS OF HOSPITALIZATIONS FOR\nCROHN’S DISEASE AND ULCERATIVE COLITIS IN THE\nGERIATRIC POPULATION: A BRAZILIAN OVERVIEW OF THE\nLAST DECADE\nGustavo Hayasaki Vieira1, Milena Almeida Barbosa1, Giovana de\nOliveira Araújo1, Rafaella Rodrigues de Freitas Vieira 1, Isabela\nMaciel Mesquita1, Samira Dionísio Maia 1, Valentina Melo Rosa\nCentofanti1, Gustavo Cartaxo de Sousa Melo 1\n1Pontifícia Universidade Católica de Goiás, Goiânia, Brazil\nIntroduction Inflammatory bowel diseases (IBD),\nincluding Crohn ’s disease (CD) and ulcerative colitis (UC),\nare conditions that cause signs such as in flammation of the\ngastrointestinal tract and abdominal pain. CD predominates\nbetween the ages of 15-35 and, secondarily, among the\nelderly. Thus, considering the IBD incidence in the geriatric\npopulation and the lack of studies for this age group in Brazil,\nit is essential to conduct an epidemiological analysis of this\ngroup.\nObjective To analyze the epidemiological pro file of\nhospitalizations of elderly Brazilian patients for Crohn ’s dis-\nease and ulcerative colitis between 2013 and 2023.\nMethod This is a descriptive, retrospective, and quan-\ntitative study based on the Hospital Information System (SIH/\nSUS), through the Department of Information and Informatics\nof the Unified Health System (DATASUS), referring to Crohn’s\ndisease and ulcerative colitis over the last ten years, for\npatients in Brazil. The filters used were ICD-10 morbidity\nlist (Crohn ’s disease and ulcerative colitis), hospitalizations,\nrace/ethnicity, gender, age group, average hospital stay, avail-\nable period (January 2013 to December 2023), and processing\nyear. The data were tabulated in Excel and analyzed using R\n4.40 software with RStudio 2024.04.1 þ 748. The study\nadheres to the ethical guidelines of Resolution 466/12 from\nthe National Health Council.\nResults The total number of hospitalizations in these\nten years was 10,034. The Southeast region led the number of\nhospitalizations (50.6%), while the North region had the\nlowest number (4.5%). The age group with the most hospital-\nizations was 60-69 years (51.3%) and was mostly urgent\n(83.2%). The female sex was more affected (57.3%), and the\npredominant ethnicity was white, with 45.7% of the total. The\ndata indicate an increase in hospitalizations for CD over the\nyears, with 2023 having the most hospitalizations (n¼1,290),\nwhile the lowest record was in 2013 (n ¼70). The Northeast\nregion had the highest average length of hospital stay (n ¼8).\nConclusion The results highlight the importance of\npublic health strategies for early diagnosis and effective\nmanagement of CD and UC, aiming to reduce emergency\nhospitalizations and improve the quality of life for geriatric\npatients. Additionally, the regional variation in hospitaliza-\ntions and length of stay suggests that health policies tailored\nto local speci fics are vital to addressing the challenges\npresented by the disease in Brazil.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS30\n\n\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141078\nE-poster\nRARE PRESENTATION OF CROHN ’S DISEASE: CUTANEOUS\nMETASTASIS\nCamila Vieira Chiquetti 1, Giulia Candida Ribeiro Garnes 2,\nBárbara Érnica Zeferino 1, Carlos Henrique Marques dos\nSantos1, Carlos Otavio da Silva Ribeiro 1, Odinilson Almeida\nFonseca1, Luiz Carlos Takita 2\n1Hospital Regional do Mato Grosso do Sul, Campo Grande, Brasil\n2Universidade Estadual do Mato Grosso do Sul, Campo Grande, Brasil\nCase Presentation A 23-year-old male patient, diag-\nnosed with Crohn ’s Disease six years ago, presented with\nperianal fistulas confirmed by colonoscopy and histopathol-\nogy. He was treated with infliximab and azathioprine, achiev-\ning partial improvement with incomplete healing. After one\nyear, his treatment was optimized due to worsening perianal\nlesions, including anal fissures, ulcerated perianal lesions,\nand fistulous openings, consistent with perianal Crohn ’s\nDisease. He developed ulcerated lesions in the intergluteal\nfold, bilateral inguinal folds, and scars from external perianal\norifices, requiring debridement and hyperbaric oxygen ther-\napy. The patient underwent 26 sessions of hyperbaric oxygen\ntherapy over two months, showing improvement but no\ncomplete healing, leading him to discontinue due to costs.\nHe had a partial response to other therapies, needing cortico-\nsteroids for stabilization. One year later, he was hospitalized\nwith abscesses and ulcerated lesions in the perianal, penile,\nand inguinal regions (Figure 1). He underwent drainage and\nbiopsy, which showed epithelioid granulomas, Langhans-\ntype giant cells, and microabscesses in glandular crypts,\nindicating active Crohn ’s Disease and metastatic Crohn ’s\n(Figure 2). Due to treatment refractoriness, hyperbaric oxy-\ngen therapy and biologic therapy (in fliximab plus ustekinu-\nmab) were indicated. The patient showed improvement in\nthe lesions, weight gain, and quality of life, though complete\nhealing had not yet occurred at follow-up (Figure 3).\nDiscussion Metastatic Crohn ’s Disease is character-\nized by granulomatous skin lesions with histology similar to\nintestinal tissue. Its pathophysiology is not well understood,\nbut studies suggest a correlation between abnormal T-cell\nresponses in the intestinal mucosa that migrate to the skin as\nthe disease progresses, leading to exposure to skin antigens\nand lesion formation. Due to its rarity, treatment requires a\ncomplex approach depending on the severity, generally\ninvolving high-dose steroids, followed by anti-TNF inhibitors\nlike infliximab, and in refractory cases, therapy optimization\nwith ustekinumab and hyperbaric oxygen therapy. In this\ncase, a combination of two biologics was used, an off-label\ntherapy, which yielded satisfactory results for the patient.\nConclusion Metastatic Crohn ’s Disease is a rare and\nsevere condition requiring prompt intervention and ongoing\nstudies on treatments and their effectiveness. Thus, case\ndescriptions, outcomes, and the applicability of therapeutic\napproaches are of paramount importance.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 137921\nE-poster\nASSESSMENT OF QUALITY OF LIFE IN PATIENTS WITH\nULCERATIVE COLITIS UNDERGOING TOTAL\nPROCTOCOLECTOMY WITH ILEAL RESERVOIR: A CROSS-\nSECTIONAL COHORT STUDY IN A BRAZILIAN REFERRAL\nCENTER\nIsrael Geraldo Silva\n1, Sandro da Costa Ferreira 1, Cintia Maura\nCaseiro Nigro1, Omar Féres 1, Marley Ribeiro Feitosa 1, José\nJoaquim Ribeiro da Rocha 1, Rogerio Sera fim Parra1\n1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil\nIntroduction and Objectives Restorative proctoco-\nlectomy with ileoanal anastomosis (IPAA) is the procedure of\nchoice when colectomy is necessary for ulcerative colitis (UC)\nrefractory to medical treatments. However, IPAA may be\nassociated with signi ficant morbidity and impact on the\npatient’s quality of life (QoL). This study aimed to report\nQoL, long-term satisfaction with surgery, and post-IPAA\nfunctional outcomes in a referral center for In flammatory\nBowel Diseases (IBD) in Brazil.\nMethods A standardized questionnaire was adminis-\ntered to patients with UC who underwent IPAA surgery from\nMarch to August 2023, assessing QoL and bowel function.\nParameters included daily bowel movements, fecal inconti-\nnence, diaper dependency, use of antidiarrheal medications,\nfecal urgency, social limitations, fatigue, impact on sexual life,\nand work capacity.\nResults Twenty-eight patients completed the ques-\ntionnaires (female, n=19, 67.9%, average age 44.8/C6 10.2 years).\nPatients reported an average of 6.0 /C6 1.8 bowel movements\nper day, with 27 (96.4%) experiencing diarrhea. Diapers were\nnot required in most cases (22, 78.6%), with nocturnal bowel\nmovements reported by most (24, 85.7%). Fecal urgency was\ncommon (17, 60.7%), with 21 patients (75%) requiring antidi-\narrheal medication. After surgery, patients reported fatigue\n(27, 96.4%), impact on sexual life (18, 64.3%), social and work\nchallenges (22, 78.6%), and embarrassment about their health\ncondition (21, 75%). Overall, 22 patients (78.6%) were satis-\nfied with the procedure.\nConclusion Despite high long-term satisfaction with\nIPAA, patients experienced negative effects on bowel habits\nand QoL. Thesefindings may inform strategies to improve QoL\nfor future IPAA patients.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141700\nE-poster\nBACTERIOPHAGES IN THE TREATMENT OF INFLAMMATORY\nBOWEL DISEASE\nMatheus Amorim Grigorio 1, Raphael Vinicius Mendes Abreu 1,\nSacha da Silva Faria 2, Luiza Camapum Fernandes Ribeiro 2, Ana\nJulia Faria Ramos 3, Lucas Adati Taira 1, Leandro Adati Taira 4,\nEduardo Henrique Lacoski Santos 5\n1Centro Universitário do Planalto Central Apparecido dos Santos,\nBrasília, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S31\n\n\n2Universidade Evangélica de Goiás, Anápolis, Brasil\n3IMEPAC, Araguari, Brasil\n4Centro Universitário Presidente Antônio Carlos, Juiz de Fora, Brasil\n5Pontifícia Universidade Católica, Curitiba, Brasil\nIntroduction Inflammatory Bowel Disease (IBD) is a\nchronic condition with increasing incidence, caused by the\ninteraction of environmental, genetic, and immunological\nfactors, resulting in persistent in flammation in the intestine.\nIntestinal dysbiosis, an imbalance in the microbiota, is fre-\nquently associated with the development and worsening of\nIBD symptoms. Current therapies, such as aminosalicylates\nand immunosuppressants, may have side effects and are not\nalways effective for all patients.\nObjective This scoping review aims to summarize\nscientific evidence on the use of bacteriophages, viruses\nthat infect speci fic bacteria, as a promising therapeutic\nalternative in the treatment of IBD.\nMethodology A scoping review was conducted to\nmap and summarize the existing knowledge on the use of\nbacteriophages in IBD. The search covered the SciELO and\nPubMed databases, using the descriptors “bacteriophage”\nand “inflammatory bowel disease ” in combination with the\nBoolean operator “AND.” The search period covered 2018 to\n2023, including articles published in Portuguese and English.\nThe selection of studies was based on relevance to the topic\nand methodological quality, prioritizing original articles,\nsystematic reviews, and case studies.\nDiscussion The research revealed the potential of\nbacteriophages in controlling intestinal dysbiosis, modulat-\ning the microbiota, and reducing inflammation. The ability of\nbacteriophages to target drug-resistant bacteria makes them\nan attractive alternative in the context of increasing antimi-\ncrobial resistance. Additionally, bacteriophage therapy\nappears to be a personalized and controlled option, with\npromising results in preliminary studies. The safety and\nefficacy of bacteriophages have been demonstrated in various\nareas, such as food safety and animal health, reinforcing their\ntherapeutic potential in IBD.\nConclusion The use of bacteriophages in the treat-\nment of IBD emerges as a promising alternative, with the\npotential to control intestinal dysbiosis, reduce in flamma-\ntion, and improve patients’ quality of life. Continued research\nin this area is essential to establish effective and safe treat-\nment protocols, opening new perspectives for IBD\nmanagement.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141679\nE-poster\nLATE PATHOLOGICAL DISTENSION OF ILEAL POUCH: CASE\nREPORT\nBruna Bueno Biondi\n1, Daniel Teixeira de Alencar 1, Magaly\nGemio Teixeira1\n1Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brasil\nMale patient, 48 years old, with severe universal\nulcerative colitis. Symptoms began in 1994. Due to clinical\nintractability, the patient underwent total proctocolectomy\nwith ileal pouch and loop ileostomy in 2007, with closure of\nthe ileostomy in the same year. In 2009, the patient developed\nanal stenosis and underwent surgical dilation. In the same\nyear, he had an episode of subocclusion and underwent\nexploratory laparotomy for adhesiolysis. In 2017, the patient\ndeveloped a perianal fistula but refused surgical treatment.\nBiologic therapy with Adalimumab was started. In 2021,\nintestinal transit showed a normal-appearing ileal pouch.\nIn 2023, the patient reported mild abdominal distension and\na sensation of fullness, with an average of 2 bowel movements\nper day. An enteric MRI was performed, showing an increase\nin the ileal pouch with proximal dilation, without any ob-\nstructive factors. The patient developed a symptomatic inci-\nsional hernia. During the intraoperative procedure, prolapsed\ndilated small bowel loops were identified. The ileal pouch was\nlarge (40 /C2 20 cm), with proximal dilation and no points of\nobstruction. The intraoperative proctological examination\nshowed adequately patent pouch-anal anastomosis. As no\nobstruction points were identi fied, only the pouch was\nemptied, and the incisional hernia was corrected. No justi fi-\ncation for the late pathological dilation of the ileal pouch was\nfound. There was no relation to the anal pouch-anastomosis\nstenosis, as it occurred 15 years earlier and was resolved. The\nimaging exam in 2021 showed a normal pouch. In 2023, the\npatient presented frustrating symptoms, leading to an imag-\ning exam that already demonstrated pouch dilation, and due\nto improvement with symptomatic treatment, no interven-\ntion was made. It was not possible to diagnose what caused\nthe dilation, and there was no consensus on the approach, as\ndespite the dilation, the patient remained oligossympto-\nmatic. Over the years, during the late follow-up of patients\nwith ileal pouches, more frequent complications such as\npouchitis and less frequent ones such as total ileal pouch\nprolapse, fecaloma with the need for emptying, and now\nidentified pathological dilation of the pouch, have been\nrecognized. No reports of ileal pouch dilation without ob-\nstructive factors were found in the literature. Even after years\nof satisfactory evolution in these patients, attention must be\ngiven to these rare and late complications.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138359\nE-poster\nABSCESSED DIVERTICULITIS AS A DIFFERENTIAL DIAGNOSIS\nOF INFLAMMATORY BOWEL DISEASE – CASE REPORT\nCristina Calloni 1, Daniel de Barcellos Azambuja 2, Vivian Koch 3\n1Universidade Feevale, Ribeirão Preto, Brasil\n2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto\nAlegre, Brasil\n3Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brasil\nInflammatory bowel disease (IBD) is characterized by\nepisodes of inflammation in the gastrointestinal tract caused\nby an abnormal immune response to the micro flora, with\nCrohn’s Disease (CD) and Ulcerative Colitis (UC) being the\nmain representatives. This study is based on medical record\nanalysis and a literature review. A 68-year-old female patient,\nwith a previous history of obesity, was hospitalized in 2021\ndue to an episode of intestinal bleeding. She underwent a\ncolonoscopy, which showed luminal stenosis of the sigmoid\ncolon with inability to progress endoscopically, in addition to\ninflammatory characteristics, leading to a diagnosis of UC.\nAfter the investigation, treatment with In fliximab (IFX) com-\nbined with Azathioprine (AZA) was started, but the response\nand disease control were inadequate, prompting\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS32\n\n\noptimization of the IFX therapy. However, the stenosis per-\nsisted in follow-up exams performed in 2022 and 2023. In\n2024, surgical management of the lesion was chosen after\nconsidering the possibility of neoplastic involvement, al-\nthough the prolonged course of the disease was not sugges-\ntive of malignancy. The resected specimen was sent to\npathology and diagnosed with an abscessed diverticulitis,\nan unexpected finding. Diverticular disease can present\nsignificant complications, such as in flammation (diverticuli-\ntis), abscesses, fistulas, and thickening, conditions that may\nalso resemble a presentation of IBD. Therefore, surgical\nchoice, both for diagnostic con firmation and therapy, should\nbe individualized. Around 3% to 10% of patients with colon\ninflammation exhibit overlapping clinical and pathological\nfeatures, making differentiation dif ficult, and approximately\n10% of patients initially diagnosed with IBD (either CD or UC)\nmay have their diagnosis changed upon re-evaluation. The\ndiscussed finding highlights not only the heterogeneity of\nthese diseases but also the challenge of determining their\ndiagnoses correctly. In this context, systematic monitoring is\nessential to prevent the condition from remaining undeter-\nmined, impacting the quality of life of patients and reducing\ntheir complications.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141713\nE-poster\nCOMPLICATED COLONIC CROHN ’S DISEASE WITH INTRA-\nABDOMINAL HYPERTENSION AND TOXIC MEGACOLON WITH\nSIGMOIDOSTOMY AS A COLON PRESERVATION STRATEGY: A\nCASE REPORT\nJordana Martins Américo de Souza\n1, Gersino Perin Ribeiro 1,\nJean Luca Alves 1, João Paulo Slongo 1, Jackeline Kalinoski 1,\nTaiane Costa Santana 1, Daniele Ximenez 1, André Pereira\nWestphalen1\n1Hospital Universitário do Oeste do Paraná, Cascavel, Brasil\nCase Presentation A 40-year-old male patient, diag-\nnosed with Crohn ’s Disease (CD) 6 years ago, Harvey Brad-\nshaw Index (HBI - 8), was hospitalized due to hypersensitivity\nto the infusion of in fliximab after the second dose of the\ninduction phase, presenting with rash, tachycardia, and fever,\nrequiring intensive care unit admission. Managed with anti-\nbiotic therapy and corticosteroids, the patient developed\nprogressive abdominal distention due to toxic megacolon\n(TM) and was referred for surgical intervention due to\ncompartment syndrome and failure of decompressing colo-\nnoscopy. The first approach involved exploratory laparotomy\nand Barker peritoneostomy. The patient was re-operated on\nthree days later for abdominal wall closure and a loop\nsigmoidostomy. The first dose of adalimumab was adminis-\ntered five days after the procedure, with clinical improve-\nment and disease control, continuing with outpatient follow-\nup and no further hospitalizations.\nDiscussion TM is the dilation of part or the entire\ncolon ( > 6 cm), accompanied by toxemia, manifesting as\nabdominal distension, pain, and signs of sepsis. It is one of the\nmost feared complications of ulcerative colitis and can also\noccur in CD. It has high mortality rates, particularly when it\nculminates in compartment syndrome, and surgical treat-\nment with partial or total colectomy is the treatment of\nchoice. Colectomy is the resection of a segment or the entire\ncolon, indicated in various pathologies but considered espe-\ncially in emergencies, as a surgery with high morbidity and\nmortality. It can be associated with complications such as\nfistulas, bleeding, strictures, malabsorption syndromes, and\nincreased hospitalization time. Loop sigmoidostomy involves\nopening a region of the sigmoid colon and exteriorizing it\nthrough the abdominal wall, decompressing the colon and\npreserving the segment, with the possibility of later assessing\nintestinal reconstruction. Following surgical intervention,\nclinical treatment with biologics should be associated to\ncontrol the underlying disease.\nConclusion In this case, loop sigmoidostomy was\nchosen as the treatment for TM to decompress the segment\nwithout resecting it, as a strategy for intestinal preservation\nand lower morbidity and mortality. The prior creation of\nperitoneostomy to resolve compartment syndrome, com-\nbined with clinical treatment with adalimumab, contributed\nto the success of the treatment, with no decompensations or\ncomplications from CD or new hypersensitivity reactions.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141721\nE-poster\nCROHN’S DISEASE AND CUTANEOUS FISTULA: CASE REPORT\nRoberta Oliveira Raimundo Borsato 1, Tales Alvarenga Lopes e\nSilva2, Daniella Coelho Vandanezi Sobreira 2, Marina Tambasco\nFreire Vicente1, Ludymilla Ribeiro Bordoni de Oliveira 1,\nAlexandre Siles Vargas Júnior 1, Debora Francielle Dias 1\n1Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de\nFora, Brasil\n2Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil\nCase Presentation A 62-year-old woman presented\nwith purulent secretion from a spontaneous opening in the\nright iliac fossa (RIF) for the past 3 months, associated with\nfever episodes, refractory to antimicrobial therapy. She had a\nhistory of right ileocolectomy 28 years ago for the treatment\nof an enterocutaneous fistula, at which time she was diag-\nnosed with Crohn ’s disease (CD). She was on vedolizumab\ntreatment. Abdominal enterography revealed a posterolater-\nal enterocutaneous fistula near the iliac portion of the\niliopsoas muscle. After adequate nutritional support and\ncorrection of anemia, the patient underwent exploratory\nlaparotomy – multiple adhesions and blocked perforation\nof the sigmoid colon, firmly adhered to the retroperitoneum\non the right side, where an abscess adjacent to the psoas\nmuscle was found, with a fistulous tract leading to the\nabdominal wall. A Hartmann ’s sigmoidectomy and abdomi-\nnal cavity drainage were performed. The postoperative peri-\nod was uneventful.\nDiscussion CD can affect any part of the gastrointes-\ntinal tract (GIT), manifesting with in flammatory, stenosing,\nor penetrating phenotypes. Around 14% to 26% of patients\ndevelop fistulous processes. Of these, 24% will develop enter-\nenteric or enterocolonic fistulas, and only 6% will develop\nenterocutaneous or colocutaneous fistulas. The occurrence of\ntwo or more fistulas happens in less than one-third of cases\nand indicates severe CD. Fistula diagnosis requires contrast-\nenhanced imaging for better anatomical definition. The treat-\nment of CD with the penetrating phenotype requires a\nmultidisciplinary approach that integrates pharmacological\nand, sometimes, surgical therapies, along with nutritional\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S33\n\n\nsupport. The goal is to control in flammation, promote heal-\ning, and prevent sepsis, which is the main factor associated\nwith morbidity and mortality. The treatment of immunolog-\nical dysregulation includes biologic drugs, immunosuppres-\nsors, and corticosteroids. In the case of enterocutaneous or\ncolocutaneous fistulas, surgical intervention is performed in\n75% to 85% of cases and aims to restore GIT continuity, ensure\nproper coverage of the soft tissues surrounding the intra-\nabdominal content, and close the external opening. Intestinal\nloop fistulas are treated surgically only if symptomatic, which\noccurs in about 6% of cases.\nConclusion This case illustrates the complexity of\nmanaging fistulas associated with CD, highlighting the\nneed for a personalized multidisciplinary approach, especial-\nly in patients with severe disease.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141677\nE-poster\nCROHN’S DISEASE IN A FEMALE PATIENT: CASE REPORT\nMaria Fernanda Almeida Miranda 1, Vinícius da Cruz Silva 1,\nGustavo Lima Guilherme 1, Camila Alves dos Santos 1, Letícia\nRuth Valente de Oliveira 1, João Lopes 1, Mateus Silva Campos 1,\nJacqueline Jessica de Marchi 1\n1Universidade Federal do Mato Grosso, Cuiabá, Brasil\nCase Presentation A 45-year-old woman with a\nhistory of tuberculosis, endometriosis, and stroke, diagnosed\nwith Crohn ’s Disease (CD) since 1998. Previous treatments\nincluded corticosteroids, 5-aminosalicylic acid, in fliximab,\nazathioprine, adalimumab, and 70 sessions of hyperbaric\noxygen therapy. After 25 years of treatment, total proctoco-\nlectomy and terminal ileostomy were performed, with peria-\nnal complications and colon stenosis. In 2020, intravenous\nvedolizumab was chosen due to its selective action and safety,\nachieving remission of the disease. In 2024, the patient\nswitched to the subcutaneous form of vedolizumab, present-\ning with occult blood in the stool, bleeding from the ileos-\ntomy, pain, and abdominal distension. Ferripoly maltose and\ncarboxymaltose iron were administered, and an enteroradi-\nology scan revealed segmental wall thickening of the ileum\nnear the gallbladder with partial stenosis, as well as in the\nright iliac fossa with signi ficant stenosis. The patient was\nreturned to intravenous vedolizumab, and the disease en-\ntered latency again.\nDiscussion CD affects 3 out of 100,000 people, pri-\nmarily between the second and third decades of life. It is a\nchronic inflammation that can affect any part of the gastro-\nintestinal tract, with a higher frequency in the ileum, colon,\nand perianal region. Diagnosis involves clinical, laboratory,\nradiological, histopathological, and endoscopic data. The\nanatomopathological analysis may reveal segmental or skip\nlesions, deep ulcers, stenotic areas, and fistulas. Treatment is\nbased on the disease activity phase, location, medications\nalready used, and adverse effects. In severe cases, both\nsurgical and pharmacological treatments are used, as in the\ncase described, including terminal ileostomy, total proctoco-\nlectomy, and vedolizumab. The vedolizumab protocol begins\nwith an intravenous induction phase, followed by intrave-\nnous or subcutaneous maintenance. Currently, there is insuf-\nficient data to determine if dose escalation bene fits patients\nwith a diminished response in subcutaneous maintenance,\nwhich is why induction and maintenance are indicated\nintravenously.\nFinal Comments CD is a chronic disorder that causes\nsignificant morbidity, presenting in a variable manner with\nperiods of activity and remission. Surgical intervention may\nbe a therapeutic option but does not result in a cure.\nTherefore, longitudinal monitoring of CD patients is essential\nto adjust treatment as the disease progresses and to improve\nprognosis.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141630\nE-poster\nPERIANAL FISTULIZING CROHN ’S DISEASE IN REMISSION:\nWHAT HAPPENS TO THE FISTULA AFTER REMOVAL OF THE\nSETON?\nIdblan Carvalho de Albuquerque\n1, Iana Faine Saran 1, Bruna\nMeirelles Carregaro 1, Janaina Giotti 1, Andre Luigi Pincinato 1,\nFernanda Bellotti Formiga 1, Pedro Piassaroli de Abreu 1\n1Hospital Heliópolis, São Paulo, Brasil\nIntroduction The surgical treatment of perianal fis-\ntulizing Crohn’s disease (PCD) initially involves abscess drain-\nage, seton placement, and in very severe cases, intestinal\ndiversion. After scheduled surgeries to control the damage in\nconjunction with biological therapy, and in the presence of\nperianal remission, the surgical team may perform proce-\ndures such as fistulotomy, mucosal advancement, LIFT, or\nVAFT with the goal of treating the fistula. In this context,\nremoval of the seton without any definitive treatment may be\na therapeutic option.\nObjective To evaluate the evolution of the anorectal\nfistula in fistulizing Crohn’s disease after seton removal.\nMethod This study was conducted through a review\nof medical records containing information about seton re-\nmoval during the last surgery for the treatment of PCD\nbetween 12/2021 and 03/2024. The demographic data stud-\nied included age, sex, and Montreal classi fication. The num-\nber of surgical procedures up to the surgery for seton removal\nwas quanti fied. Patients with fistulas of other etiologies or\nthose lost to follow-up were excluded.\nResults During the study period, 47 patients were\noperated on due to PCD, of which 19 underwent seton\nremoval and curettage of the fistula tract. The average age\nwas 32 years, with a predominance of male patients (58%).\nPatients underwent an average of three surgical procedures\n(ranging from two to seven) from seton placement to remov-\nal. The average duration of seton placement was 13.6 months\n(ranging from two to 36 months). The majority of patients\n(13) had only one fistula tract. Fistula obliteration occurred in\n69%, while 21% showed an epithelialized and asymptomatic\nfistula. Recurrence of in flammatory activity in the fistula\ntract was diagnosed in 10% of patients within six months of\nseton removal.\nConclusion In this study, seton removal was effective,\nallowing fistula tract obliteration in 69% of patients. Only 10%\nof patients showed recurrence of inflammatory activity in the\nfistula tract within six months after the seton removal\nsurgery. This is considered an appropriate therapeutic option\nfor patients who have achieved perianal remission.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS34\n\n\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141685\nE-poster\nINFLAMMATORY BOWEL DISEASE IN THE ELDERLY: CLINICAL\nASPECTS AND EPIDEMIOLOGY\nSandro da Costa Ferreira 1, Rogerio Sera fim Parra1, Lílian Rose\nOtoboni Aprile1, Juarez Roberto de Oliveira Vasconcelos1, Artur\nCury Féres1, Omar Féres1, José Joaquim Ribeiro da Rocha 1, Luiz\nErnesto de Almeida Troncon 1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\nIntroduction Inflammatory bowel disease (IBD) is\ngenerally associated with young adults. However, a signi fi-\ncant proportion of new IBD cases are diagnosed in older\nindividuals as the incidence of IBD increases and our popula-\ntion ages. Older patients with IBD comprise two groups:\nthose with a new diagnosis (late-onset IBD > 60 years) and\npatients with juvenile or adult-onset IBD who have reached\nadvanced age. Older patients with IBD present a signi ficant\nchallenge due to the limited speci fic studies and character-\nistics inherent to this population, such as polypharmacy,\ncomorbidities, and frailty.\nObjectives To evaluate the clinical and epidemiologi-\ncal aspects of patients with late-onset IBD in comparison to\npatients diagnosed at younger ages ( <60 years).\nMethods A retrospective analysis of data from patients\nwith late-onset IBD and younger-onset IBD, randomized in a\n1:2 ratio based on sex, disease location, and phenotype of\nCrohn’s disease (CD) and ulcerative colitis (UC), and year of\ndiagnosis, followed from January 2001 to December 2021.\nDisease severity, therapies, clinical and endoscopic remission,\nsurgeries, comorbidities, and deaths were assessed.\nResults A total of 63 patients with late-onset IBD\n(57.1% female, mean age: 72.00 /C6 6.4 years, 52.4% UC) were\nincluded. Lower use of immunomodulators [CD (36.7% vs.\n70.0%; p=0.0020), UC (15.2% vs. 45.6%; p=0.003)] and biologi-\ncal agents [CD (50.0% vs. 75.0%; p=0.020), UC (12.1% vs. 33.8%;\np=0.003)] was signi ficantly observed in patients with late-\nonset IBD compared to those with younger-onset IBD. Greater\ndisease severity was observed in patients with CD diagnosed\nat younger ages (66.7%; p=0.006). Higher frequency of comor-\nbidities (92.06% vs 31.25%; p <0.0001) and deaths (7.9% vs\n0.7%; p=0.0015) were observed in patients with late-onset\nIBD compared to those with younger-onset IBD. No significant\ndifferences were observed regarding clinical and endoscopic\nremission, use of corticosteroids and aminosalicylates, and\nsurgery (p >0.05).\nConclusion Older patients with IBD have substantial\ncomorbidities, higher mortality, and lower use of immuno-\nmodulators and biological agents compared to younger\npatients with IBD. Further studies in this speci fic population\nare needed.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 133370\nE-poster\nEFFECT OF RVD2 ON EXPERIMENTAL COLITIS IS ASSOCIATED\nWITH THE ACTIVATION OF THE ANTI-INFLAMMATORY\nCYTOKINE IL10\nLívia Bitencourt Pascoal 1, Fábio Henrique Mendonça Chaim 1,\nBruna Biazon Palma 1, Bruno Lima Rodrigues 1, Marina Moreira\nde Castro1, Luiz Roberto Lopes 1, João José Fagundes 1, Raquel\nFranco Leal1\n1Universidade Estadual de Campinas, Campinas, Brasil\nIntroduction New therapeutic strategies targeting\nthe inflammatory process are being proposed for in flamma-\ntory bowel diseases (IBD), as clinical failure remains a chal-\nlenge in managing these patients. Recent studies have\nhighlighted the role of specialized pro-resolving lipid medi-\nators (SPMs) in the active resolution of chronic inflammation.\nThis study aimed to investigate how the effect of Resolvin D2\n(RvD2) on dextran sodium sulfate (DSS)-induced experimen-\ntal colitis occurs.\nMethod An experimental model was conducted using\nmale C57BL/6J mice and IL10 knockout (KO) animals. Follow-\ning the induction of DSS-induced experimental colitis, ani-\nmals were subdivided and treated with RvD2 or anti-TNF α.\nThe metabolic phenotype and in flammatory profile of these\nanimals were assessed through real-time PCR, ELISA, CBA\nmultiplex, and histology. The study was approved by the\nAnimal Use Ethics Committee.\nResults A reduction in colon length and progressive\nweight loss were observed in the IL10 KO groups with DSS-\ninduced experimental colitis (p < 0.0001) and in the IL10 KO\ngroup with DSS-induced experimental colitis treated with\nRvD2 (p < 0.0001) compared to the non-colitic IL10 KO group.\nIL10 KO mice with DSS-induced experimental colitis and IL10\nKO mice treated with RvD2 developed severe colitis charac -\nterized by weight loss by day 11 of exposure (p < 0.05). The\nmice exhibited soft to liquid stools with blood, which, along\nwith weight variation, increased the Disease Activity Index\nand colon shortening. Additionally, signi ficant increases in\nIL1B were observed in colon samples from IL10 KO mice with\nDSS-induced colitis, regardless of RvD2 treatment (p < 0.05).\nSignificant increases in IL6 (p < 0.01) and IL17 (p < 0.05) were\nobserved in the IL10 KO DSS group, alongside a reduction in\ninterferon-gamma (p < 0.05) when compared to the non-\ncolitic IL10 KO group. None of the evaluated cytokines\ndecreased signi ficantly in IL10 KO DSS mice treated with\nRvD2 compared to untreated ones.\nConclusion IL10 KO animals did not exhibit a signi fi-\ncant reduction in pro-in flammatory cytokines following\nRvD2 treatment, demonstrating that the bene ficial effect of\nthis mediator on experimental colitis occurs via IL10.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 137991\nE-poster\nREAL-WORLD EVIDENCE OF THE USE OF IMMUNOBIOLOGICS\nIN CROHN’S DISEASE IN THE STATE OF GOIÁS FROM 2018 TO\n2023: AN OPEN RETROSPECTIVE COHORT STUDY\nVictor Cordeiro Simão 1, Pedro Eduardo da Costa Galvão 1,\nArthur Cordeiro Simão 1, Nayã Pereira Portilho 2, Gabriela Luz\nCastelo Branco de Souza 1, Mylena Santana de Sena Araújo 1,\nIsabely Gelinski1, Bruna Dell ‘acqua Cassão1\n1Universidade Federal de Goiás, Goiânia, Brasil\n2Pontifícia Universidade Católica de Goiás, Goiânia, Brazil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S35\n\n\nIntroduction The use of immunobiologicals in the\ntreatment of Crohn’s Disease has shown significant impact in\nreducing complications, hospitalizations, and surgical inter-\nventions. Therefore, understanding the implementation of\nthis treatment is essential to guide health planning actions.\nObjective To analyze real-world data on the use and\nimplementation of immunobiologicals for the treatment of\nCrohn’s Disease in Goiás, from 2018 to 2023.\nMethods An open retrospective cohort study was\nconducted using data from DATASUS databases. Extraction,\nTransformation, and Load (ETL) algorithms were applied to\ntwo databases from the Brazilian Uni fied Health System ’s\nOutpatient Information System (SIA/SUS) —Ambulatory Pro-\ncedures and Medication Authorizations. Data from January\n2018 to December 2023 in Goiás were analyzed, based on\nrecords of health resource utilization by individual patients\nwith Crohn’s Disease. This approach allowed for a description\nand analysis of outpatient treatment regimens with immu-\nnobiologics in Goiás.\nResults A total of 625 patients were included in the\ncohort during the study period. The majority of patients were\nmale (63.7%). The average age of patients was 35.3 years\n(Standard Deviation /C6 14.9), with the predominant age group\nbeing 20–39 years, comprising 347 (50%) patients. Infliximab\nwas observed as the primary immunobiologic used, with its\nusage increasing from 92.9% to 95.3% of patients. A total of\n441,687 units of in fliximab were dispensed during the study\nperiod, while 1,232,551 units were approved, averaging\n205,426 units annually. The mean annual cost was R$\n3,343,455.41, with a total expenditure of R$ 20,060,732.50.\nConclusion The data highlights the predominant use\nof infliximab for treatment and the prevalence of young male\npatients, underscoring the need for speci fic interventions for\nthis group. Furthermore, the considerable financial invest-\nment involved emphasizes the importance of targeted health\nplanning aimed at optimizing resources and achieving better\nclinical outcomes for patients with Crohn ’s Disease.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141799\nE-poster\nSOCIODEMOGRAPHIC FACTORS RELATED TO MORTALITY\nRATE AND DEATHS DUE TO INFLAMMATORY BOWEL DISEASE\nIN BRAZIL\nTalita Alves Harrop 1, Vinícius Sussuarana Rocha 1, Kauê\nMagalhães Castro dos Santos1, Gisele Rocha Lopes1, Ravi Cabral\nGabriel1, Raimundo Rocha Neto 1, Carolline Alves Ibiapino 1,\nPaulo de Oliveira Neto 1\n1Universidade Federal do Amapá, Macapá, Brasil\nIntroduction Inflammatory Bowel Disease (IBD)\nencompasses a group of chronic illnesses, with Ulcerative\nColitis (UC) and Crohn ’s Disease (CD) being the most promi-\nnent. Despite its association with potentially fatal complica-\ntions, Brasil faces a scarcity of data on its morbidity and\nmortality.\nMethod This descriptive cross-sectional study uti-\nlized 2022 data from the Mortality Information System (SIM)\nfor CD and UC, and the Brazilian Institute of Geography and\nStatistics (IBGE). The mortality rate (MR) was calculated as\nthe ratio of deaths to the population for each year in the\nseries, multiplied by 100,000.\nObjective To determine the MR for IBD in Brazil based\non key sociodemographic variables.\nResults In 2022, 555 deaths from IBD were recorded\nin Brazil, corresponding to a general mortality rate of 0.273.\nThe North (MR ¼0.115) and Northeast (MR ¼0.188) regions\nhad the lowest rates, 57.8% and 31.0% lower than the national\nrate, respectively. In contrast, the South (MR ¼0.367) and\nSoutheast (MR ¼0.326) regions exceeded the national MR\nby 34.4% and 19.4%, respectively, while the Central-West\nshowed a rate similar to the national average (0.276). Regard-\ning gender, female mortality (n¼299, MR¼0.285) was slightly\nhigher than male mortality (n ¼256, MR¼0.259), with only a\n2.6% variation. Concerning ethnicity, both absolute numbers\nand MR indicated a predominance among the White popula-\ntion (n ¼330, MR ¼0.373). The Yellow race had the second-\nhighest MR (0.235) despite having the lowest number of\ndeaths (n ¼2). Other racial groups had rates below the na-\ntional average: Brown (n ¼173, MR ¼0.187), Black (n ¼38,\nMR¼0.183), and Indigenous (n ¼2, MR ¼0.162). Finally, mor-\ntality was proportional to the age group. The lowest rate was\nobserved in children aged 5 –9 years (0.014), surpassing the\nnational average in the 45 –49 age group (0.285) and increas-\ning exponentially thereafter, peaking at ages 75 –79 (1.09)\nand 80 þ years (2.46). These figures were 3.9 and 9 times\nhigher, respectively, than the national MR.\nConclusion Due to the lack of systematic registration\nof diagnosed IBD cases in Brazil, analyzing mortality rates is a\ncritical factor in estimating its incidence across sociodemo-\ngraphic variables. This evaluation revealed higher mortality\nrates in the South and Southeast regions, among the White\nand elderly populations, with a slight predominance in\nfemales.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141650\nE-poster\nSIGMOID-SPINAL FISTULA IN A PATIENT WITH CROHN ’S\nDISEASE - CASE REPORT\nGersino Perin Ribeiro1, Joao Paulo Slongo1, Jackeline Kalinoski1,\nTaiane Costa Santana 1, Ana Carolina Quadros 1, Jean Luca\nAlves1, Daniele Ximenez 1, André Pereira Westphalen 1\n1Hospital Universitário do Oeste do Paraná, Cascavel, Brasil\nBNF, a 22-year-old female, was diagnosed with\nCrohn’s Disease (CD) in 2022 through colonoscopy and enter-\notomography, showing stenosing involvement of the distal\nileum and sigmoid. She started immunobiological therapy\nwith in fliximab in February 2023 and, in August, presented\nwith abdominal pain and complaints of bilateral sacroiliac\npain, mainly on the left, with neuropathic pain and reduced\nmobility of the left lower limb, with suspected sacroiliitis\nsecondary to Crohn ’s Disease. An MRI of the lumbosacral\nspine and CT of the abdomen were requested, revealing a\nfistulous tract from the sigmoid toward the sacrum, with a\nspinal collection and paravertebral extension posterior to the\nL5-S1 vertebral foramen, with heterogeneous collections.\nDue to the complication of a spinal fistula and the develop-\nment of septic shock, the decision was made to perform\nlaparotomy with a Maylard transverse incision. The surgery\nrevealed a fistula in the terminal ileum and sigmoid with\nretroperitoneal abscess extension on the left, requiring seg-\nmental enterectomy with double-barrel ileostomy and\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS36\n\n\nrectosigmoidectomy with terminal colostomy. The patient\nreceived antibiotic therapy and corticosteroids, with good\npostoperative recovery, improvement in the infectious con-\ndition, and resolution of neurological symptoms. Ambulato-\nrily, the in fliximab dose was optimized to 5mg/kg every 4\nweeks after corticosteroid tapering. She underwent recon-\nstruction of the bowel in February 2024 with colorectal\nanastomosis and subsequent endoscopic dilation of the\nanastomosis. In May 2024, a double-barrel ileostomy enter-\noanastomosis was performed. She continues to show good\nclinical progress with optimized in fliximab therapy, achiev-\ning clinical and endoscopic control of the disease, with an IHB\nof 1 point and no anastomotic recurrence. Crohn’s Disease, by\nits transmural nature, combined with the variability in the\ndistribution of the affected intestinal segment, can lead to\nfistula formation, with the most common types being enter-\novesical, enterocutaneous, enterovaginal, and enteroenteric.\nIn the case described, a spinal fistula was observed, requiring\nurgent surgical intervention due to intense pain, sepsis,\nimpaired lower limb mobility, and risk of meningitis. This\ncase highlights the potential complications caused by fistulas\nin CD, presenting atypically with diagnostic complexity that\nmay resemble extra-intestinal symptoms, requiring the med-\nical team to have a high level of suspicion and experience in\nmanaging CD and using anti-TNF agents for disease control.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141636\nE-poster\nIS THERE A BENEFIT TO USING INDIRECT CALORIMETRY IN\nOUTPATIENT PATIENTS WITH CROHN ’S DISEASE?\nRaissa José de França Carvalho 1, Maria Carolina Gonçalves\nDias1, Celso Ricardo Fernandes de Carvalho 1, Marcelo\nRodrigues Borba1, Carlos Frederico Sparapan Marques 1, Carlos\nWalter Sobrado Junior 1, Carolina Bortolozzo Graciolli Facanali 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nIntroduction Patients with Crohn’s disease (CD) may\npresent with nutritional deficits. Symptoms such as diarrhea,\nmalabsorption, and an increased resting energy expenditure\n(REE) can lead to greater weight loss, resulting in secondary\nprotein-energy malnutrition. Assessing energy needs is part\nof the therapeutic management, as both overfeeding and\nunderfeeding negatively impact nutritional status. Although\nindirect calorimetry (IC) is the gold standard for quantifying\nenergy needs in critically ill patients, it is rarely performed in\npractice, and alternatives such as formula-based methods are\nused. There is inconsistent evidence on the use of IC in\noutpatient patients and the relationship between total ener-\ngy expenditure (TEE) and disease activity. Furthermore, the\nagreement between methods, with IC plus 20% (responsible\nfor diet-induced thermogenesis and daily energy expendi-\nture) and the TEE estimated by the Pocket Formula (PF) in CD,\nled to the study.\nObjective To evaluate the agreement of REE measured\nby IC plus 20% with TEE calculated by PF and to investigate the\nrelationship between energy expenditure and disease activi-\nty, as well as other clinical and laboratory variables.\nMethod A cross-sectional, single-center study in\nadult patients with CD. REE measurements using IC and PF\nwere conducted simultaneously. Laboratory exams, socio-\ndemographic data, anthropometric assessments, and clinical\nactivity evaluations using the Harvey Bradshaw index were\ncollected. Statistical analyses were performed (5%\nsignificance).\nResults A total of 100 patients participated in the\nstudy. The mean age was 42.6 years, with 49% being male.\nMen had higher TEE than women (p<0.0001). PF showed low\nagreement with IC (CCI <0.4). A statistically signi ficant in-\nverse correlation was found between TEE and both age and\nage at diagnosis (r=-0.217 and r=-0.244 respectively; p<0.05).\nThe difference in energy expenditure between methods was\ninversely correlated with age, BMI, and age at diagnosis (r <-\n0.5 and p <0.05). No relationship was found between energy\nexpenditure and disease activity.\nConclusion The findings highlight the need for nutri-\ntional health monitoring in individuals with CD. Greater\nattention should be given to men and younger individuals,\nas they have higher energy expenditure. Although TEE is not\nrelated to disease activity, the use of IC, even in outpatient\npatients, is essential for proper nutritional management.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138682\nE-poster\nIMPACT OF SEXUAL SATISFACTION, ANXIETY, AND\nDEPRESSION IN PATIENTS WITH INFLAMMATORY BOWEL\nDISEASE: AN OBSERVATIONAL STUDY IN A REFERENCE\nCENTER\nRoberta Mesquita Gomes da Silva 1, Sandro da Costa Ferreira 1,\nCintia Maura Caseiro Nigro1, Omar Féres1, José Joaquim Ribeiro\nda Rocha1, Daniela Oliveira Magro 2, Claudio Saddy Rodrigues\nCoy2, Rogerio Sera fim Parra1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\n2Faculdade de Ciências Médicas de Campinas, Campinas, Brasil\nIntroduction Inflammatory bowel diseases (IBD) are\nconditions associated with a negative impact on quality of\nlife, especially during active disease and in critically ill\npatients. However, even patients in remission may experi-\nence a reduced quality of life due to depressive or anxious\nsymptoms. There are few national studies on the psychologi-\ncal factors affecting IBD patients and the assessment of sexual\nfunction in these individuals.\nObjective To evaluate the psychological pro file of\npatients with active and inactive IBD by applying validated\nquestionnaires on anxiety/depression and sexuality.\nMethods Validated instruments (questionnaires)\nwere applied to assess sexuality (male and female sexual\nquotient), anxiety, and depression (Beck Scales – Beck Anxi-\nety Inventory and Beck Depression Inventory, respectively) in\nIBD patients at a Brazilian reference center for IBD. Variables\nrelated to gender, age, disease type, disease activity, and prior\nsurgeries were collected. The study was approved by the\nResearch Ethics Committee and registered in the Brazilian\nPlatform.\nResults A total of 161 patients were included (Crohn’s\nDisease [CD], n=90, 55.9%; White, n=126, 78.3%; employed,\nn=107, 66.6%; average age 38.2 years; active disease, n=96,\n56.9%; deep remission, n=41, 25.5%). There were no differ-\nences in age (p=0.659), age at diagnosis (p=0.466), or disease\nduration (p=0.531) between patients with CD and Ulcerative\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S37\n\n\nColitis (UC), indicating that the groups were homogeneous.\nOverall, anxiety and depression were present in 65 (40.4%)\nand 72 (44.7%) patients, respectively. Women experienced\nsignificantly more sexual performance/satisfaction im-\npairment than men (65.7% vs. 34.1%, p=), regardless of\nwhether the disease was active or in remission. When\ncomparing IBD types, women with UC had a signi ficantly\ngreater negative impact on sexual performance/satisfaction\n(85.7% vs. 57.1%, p=0.028) than women with CD. Among men,\nthe negative impact on sexual performance/satisfaction was\nsimilar between UC and CD (28.6% and 46.6%, p=0.766).\nPerianal disease, prior surgeries, or disease activity did not\nhave statistical significance in relation to anxiety, depression,\nor sexuality rates.\nConclusion Anxiety and depression affected more\nthan 40% of patients with IBD. Women experienced a greater\nnegative impact on sexuality compared to men. Women with\nUC had the highest negative impact on sexuality.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138225\nE-poster\nAMERICAN CUTANEOUS LEISHMANIASIS IN A PATIENT WITH\nCROHN’S DISEASE UNDER BIOLOGICAL THERAPY WITH ANTI-\nTNF-ALPHA\nIsabella da Silva Idelfonso 1, Pierre Rodrigues Bernardino 1, José\nRoberto Violatti Filho 1, Amanda Karolyne Batista Ferreira 1,\nEmerson Abdulmassih Wood da Silva 1\n1Universidade Federal do Triângulo Mineiro, Uberaba, Brasil\nIntroduction Patients with Crohn’s disease (CD) may\npresent with nutritional deficits. Symptoms such as diarrhea,\nmalabsorption, and an increased resting energy expenditure\n(REE) can lead to greater weight loss, resulting in secondary\nprotein-energy malnutrition. Assessing energy needs is part\nof the therapeutic management, as both overfeeding and\nunderfeeding negatively impact nutritional status. Although\nindirect calorimetry (IC) is the gold standard for quantifying\nenergy needs in critically ill patients, it is rarely performed in\npractice, and alternatives such as formula-based methods are\nused. There is inconsistent evidence on the use of IC in\noutpatient patients and the relationship between total ener-\ngy expenditure (TEE) and disease activity. Furthermore, the\nagreement between methods, with IC plus 20% (responsible\nfor diet-induced thermogenesis and daily energy expendi-\nture) and the TEE estimated by the Pocket Formula (PF) in CD,\nled to the study.\nObjective To evaluate the agreement of REE measured\nby IC plus 20% with TEE calculated by PF and to investigate the\nrelationship between energy expenditure and disease activi-\nty, as well as other clinical and laboratory variables.\nMethod A cross-sectional, single-center study in\nadult patients with CD. REE measurements using IC and PF\nwere conducted simultaneously. Laboratory exams, socio-\ndemographic data, anthropometric assessments, and clinical\nactivity evaluations using the Harvey Bradshaw index were\ncollected. Statistical analyses were performed (5%\nsignificance).\nResults A total of 100 patients participated in the\nstudy. The mean age was 42.6 years, with 49% being male.\nMen had higher TEE than women (p<0.0001). PF showed low\nagreement with IC (CCI <0.4). A statistically signi ficant in-\nverse correlation was found between TEE and both age and\nage at diagnosis (r=-0.217 and r=-0.244 respectively; p<0.05).\nThe difference in energy expenditure between methods was\ninversely correlated with age, BMI, and age at diagnosis (r <-\n0.5 and p <0.05). No relationship was found between energy\nexpenditure and disease activity.\nConclusion The findings highlight the need for nutri-\ntional health monitoring in individuals with CD. Greater\nattention should be given to men and younger individuals,\nas they have higher energy expenditure. Although TEE is not\nrelated to disease activity, the use of IC, even in outpatient\npatients, is essential for proper nutritional management.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 128602\nE-poster\nMONITORING SERUM INFLIXIMAB LEVELS IN CROHN ’S\nDISEASE PATIENTS: COMPARISON BETWEEN TWO TESTS\nRenato Lazarin Ricci 1, Luis Eduardo Miami Gomes 1, Livia\nMoreira Genaro 1, Marina Moreira de Castro 1, Michel Gardere\nCamargo1, Ligiana Pires Corona 1, Maria de Lourdes Setsuko\nAyrizono1, Raquel Franco Leal 1\n1Universidade Estadual de Campinas, Campinas, Brasil\nIntroduction The treatment of Crohn ’s disease (CD)\nhas increasingly relied on the use of biological agents. Safe\nand accessible tests have led to the active implementation of\ntherapeutic drug monitoring in clinical practice. Several\ncommercially available assays exist to detect serum levels\nof infliximab (IFX). Understanding and comparing the differ-\nent methods of serum IFX level measurement is important for\nclinical practice.\nObjective To compare two distinct tests for detecting\nserum IFX levels in patients with Crohn ’s disease (CD).\nMethod This is a prospective, observational, cross-\nsectional study. Seventy-five patients receiving maintenance\ntherapy with IFX, aged between 18 and 60 years, were\nselected. Participants were allocated into the disease activity\n(CDA) or remission (CDR) groups. Disease activity was de-\nfined by endoscopic or radiological criteria. Serum IFX levels\nwere measured by enzyme-linked immunosorbent assay\n(ELISA) and lateral flow rapid test. Differences between test\nresults within the measurement range were evaluated by the\nWilcoxon test, Passing-Bablok regression, and Bland-Altman\nmethod.\nResults A signi ficant difference was observed (p <\n0.001) in the median results between the two tests (2.27\nfor Promonitor [IQR: 1.36 –4.27] vs. 4.0 for Quantum Blue\n[IQR: 1.7–6.9]). The CUSUM test showed a linear relationship\nbetween the two measures, making the Passing-Bablok\nmethod applicable (p > 0.20). The serum IFX concentrations,\nwithin the measurement range, assessed in 27 patients with\nCD for each method, showed higher values for the rapid test\nthan for ELISA. The two IFX level tests had moderate agree-\nment (r = -0.6758; p < 0.001). The Passing-Bablok regression\nintercept did not signi ficantly differ from 0 (-0.018; 95% CI\n-0.489 to 0.420), but the slope was less than 1 (0.589; 95% CI\n0.454 to 0.766), indicating a proportional difference between\nthe two tests. Additionally, a Bland-Altman test was per-\nformed to further compare and establish the level of agree-\nment between the two assays. This analysis revealed\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS38\n\n\nmoderate agreement between the two assays, with only one\nvalue outside the con fidence interval.\nConclusion Although the tests showed a statistically\nsignificant association, they cannot be considered inter-\nchangeable, especially at higher IFX levels. Therefore, it is\nideal for patients to be monitored using the same assay.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138164\nE-poster\nMORTALITY DUE TO INFLAMMATORY BOWEL DISEASE:\nCOMPARATIVE PATTERN BETWEEN THE NORTHEAST AND\nOTHER REGIONS OF BRAZIL\nLidiane Gomes Bandeira 1, Vitor Caiaffo Brito 1\n1Universidade Federal de Pernambuco, Recife, Brasil\nIntroduction Inflammatory bowel diseases (IBD) are\ncharacterized by chronic in flammation of the intestines of\nunclear etiology. IBD occurs worldwide and represents a\npublic health problem, impairing quality of life with increas-\ning mortality outcomes.\nObjective To compare mortality rates due to IBD in\nthe Northeast of Brazil between 2012 and 2022 with other\nregions of the country.\nMethods This is an observational, cross-sectional,\nretrospective, and descriptive epidemiological study based\non secondary data collected from the DATASUS platform\nusing the Health Information Tabulator (TABNET) for the\nyears 2012–2022. The study analyzed the number of deaths,\nethnicity, gender, and age group of patients by region.\nResults In the period analyzed, there were 49,948\ndeaths due to IBD in Brazil. The Northeast accounted for the\nhighest number of cases (18,901), followed by the Southeast\n(16,837) and South (6,219). The Northeast had a higher\nnumber of female deaths (10,229) compared to males\n(8,676), with similar patterns in other regions, except for\nthe North, where male deaths predominated. Regarding age\ngroup, the mortality pattern increased from 20 years onward\nfor both the Northeast and other regions, with a peak for\nindividuals over 80 years old. In this age group, the Southeast\nsurpassed the Northeast with 7,850 deaths compared to\n7,608. For the age range from infancy to 19 years, mortality\nwas predominantly for infants under 1 year old in all regions,\nwith the Northeast leading with 1,988 cases. Concerning\nethnicity, higher mortality was observed among mixed-\nrace individuals, followed by whites in the Northeast, North,\nand Central-West. However, in the South and Southeast, the\npattern was reversed, with whites predominating, followed\nby mixed-race individuals.\nConclusion The Northeast was responsible for the\nhighest number of IBD-related deaths in Brazil during the\nanalyzed period, with an increasing pattern of cases in the\nother regions, particularly from the age of 20. In terms of\ngender, the Northeast followed the trend of other regions, with\nhigher mortality in females, except in the North. For age group,\nmortality among those over 80 years old was higher compared\nto other age groups, with the Southeast surpassing the North-\neast in this regard. Regarding ethnicity, the Northeast followed\nthe pattern of the North and Central-West, with a predomi-\nnance of mixed-race individuals followed by whites, unlike the\nSouth and Southeast, where this pattern was reversed.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 137644\nE-poster\nTHE USE OF CANNABINOID DERIVATIVES AS A POTENTIAL\nTHERAPEUTIC IN INFLAMMATORY BOWEL DISEASES\nEloisa Possimoser Negri1, Vitória Foleto1, Thalia Ely Cervejeira1,\nVitor Cavalli1, Lais Pedot Faris 1, José Rodoolfo Hildebrando\nAlves Leite2, Weverton Fernandes de Lima Souza 1\n1Uninassau Vilhena, Vilhena, Brazil\n2Universidade Federal de Mato Grosso, Cuiabá, Brasil\nIntroduction Inflammatory Bowel Disease (IBD) is\nthe chronic in flammation of the colon mucosa and portions\nof the small intestine and rectum. It presents abdominal pain,\ndiarrhea, and weight loss. It is related to Ulcerative Colitis\n(UC) or Crohn’s Disease (CD). UC is an in flammation affecting\nvariable extensions of the colon. CD is characterized by\ntransmural and discontinuous involvement along the gastro-\nintestinal tract. The perpetuation of IBD increases the risk of\ncolorectal cancer (CRC). The endocannabinoid system is a\nmechanism related to CB1 and CB2 receptors. Studies have\nidentified the therapeutic potential of THC and cannabidiol in\nvarious pathologies. In the gastrointestinal tract, CB2 may be\nrelated to cytoprotection through GPCRs or PPARs\nstimulation.\nObjective To elucidate the effects of THC use in IBD\nand CRC through a literature review.\nMethodology This is a literature review on the effects\nof cannabinoid substances in the treatment of IBD and CRC.\nData was obtained from the following platforms: PubMed,\nLILACS, and SciELO. The English descriptors “Cannabinoids,”\n“Treatment,” and “Intestinal Diseases ” were used in combi-\nnation with the Boolean operator AND to find publications\nfrom the last decade with full text available. A total of 63 full-\ntext articles were retrieved, and after applying inclusion\ncriteria, 18 studies were selected.\nResults The use of a cannabinoid agonist was effective\nin reducing in flammation, inducing healing, and protecting\nagainst recurrences. Isolated THC was more effective in\nsymptom attenuation compared to THC þCBD or isolated\nCBD. Studies identi fied a signi ficant reduction in UC symp-\ntoms, associated with an endoscopic improvement of inflam-\nmation and a shorter hospitalization period. THC in CRC\nreduced tumor cell proliferation, justi fied by an increase in\nthe tone of the endocannabinoid system with a reduction in\nthe gene expression of proteins related to the cell replication\ncycle, tumor growth, and induction of apoptosis. In low doses,\nit may have a pro-tumoral effect. Reductions in cachexia,\nmuscle atrophy, and neuropathic pain caused by CRC were\nalso identified. Challenges of use include psychoactive effects\nand the dif ficulty of establishing a therapeutic standard.\nConclusion THC has therapeutic potential in IBD and\nCRC, promoting cytoprotection, analgesia, and reducing ca-\nchexia. The dif ficulty in identifying a therapeutic threshold\nand the psychoactive effects hinder the standardization of\ntreatment protocols involving Cannabis sativa substrates.\nExpanding studies is valuable for developing new effective\nprotocols.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S39\n\n\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141762\nE-poster\nCLINICAL-EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH\nFISTULIZING PERIANAL CROHN ’S DISEASE\nJoão Victor Maia Freitas1, Kristine Leão Alarcão 1, Bianca Corrêa\nDutra de Menezes 1, Igor Torres da Silveira Mendes 1, Luna\nVitória Gondim Ferreira 1, Oswaldo de Moraes Filho 2, Bruno\nAugusto Alves Martins 2, João Batista de Sousa 1\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nIntroduction Patients with Crohn’s disease (CD) may\npresent with nutritional deficits. Symptoms such as diarrhea,\nmalabsorption, and an increased resting energy expenditure\n(REE) can lead to greater weight loss, resulting in secondary\nprotein-energy malnutrition. Assessing energy needs is part\nof the therapeutic management, as both overfeeding and\nunderfeeding negatively impact nutritional status. Although\nindirect calorimetry (IC) is the gold standard for quantifying\nenergy needs in critically ill patients, it is rarely performed in\npractice, and alternatives such as formula-based methods are\nused. There is inconsistent evidence on the use of IC in\noutpatient patients and the relationship between total ener-\ngy expenditure (TEE) and disease activity. Furthermore, the\nagreement between methods, with IC plus 20% (responsible\nfor diet-induced thermogenesis and daily energy expendi-\nture) and the TEE estimated by the Pocket Formula (PF) in CD,\nled to the study.\nObjective To evaluate the agreement of REE measured\nby IC plus 20% with TEE calculated by PF and to investigate the\nrelationship between energy expenditure and disease activi-\nty, as well as other clinical and laboratory variables.\nMethod A cross-sectional, single-center study in\nadult patients with CD. REE measurements using IC and PF\nwere conducted simultaneously. Laboratory exams, socio-\ndemographic data, anthropometric assessments, and clinical\nactivity evaluations using the Harvey Bradshaw index were\ncollected. Statistical analyses were performed (5%\nsignificance).\nResults A total of 100 patients participated in the\nstudy. The mean age was 42.6 years, with 49% being male.\nMen had higher TEE than women (p<0.0001). PF showed low\nagreement with IC (CCI <0.4). A statistically signi ficant in-\nverse correlation was found between TEE and both age and\nage at diagnosis (r=-0.217 and r=-0.244 respectively; p<0.05).\nThe difference in energy expenditure between methods was\ninversely correlated with age, BMI, and age at diagnosis (r <-\n0.5 and p <0.05). No relationship was found between energy\nexpenditure and disease activity.\nConclusion The findings highlight the need for nutri-\ntional health monitoring in individuals with CD. Greater\nattention should be given to men and younger individuals,\nas they have higher energy expenditure. Although TEE is not\nrelated to disease activity, the use of IC, even in outpatient\npatients, is essential for proper nutritional management.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141731\nE-poster\nEPIDEMIOLOGICAL PROFILE OF INFLAMMATORY BOWEL\nDISEASES IN BRAZIL\nIgor Moreschi 1, Higor Roberto Spegiorin 2, Hugo Moreschi 1,\nHayani Yuri Ferreira Outi 3, Maria Laura Bueno 3, Ana Claudia\nMendes Ramos Lucatelli 4, José Ferraz de Oliveira Junior 4, Livia\nNunes Salessi 3\n1Faculdade Ceres de Medicina, São José do Rio Preto, Brasil\n2Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brasil\n3Centro Universitário de Adamantina, Adamantina, razil\n4Universidade de Araraquara, Araraquara, Brasil\nInflammatory Bowel Diseases (IBD) are chronic con-\nditions that cause in flammation of the gastrointestinal tract,\nleading to debilitating symptoms and severe complications.\nThe increasing incidence of IBD in developing countries, such\nas Brazil, highlights the need for a detailed analysis of\nepidemiological data to formulate effective public health\npolicies. The aim was to evaluate the epidemiological pro file\nof IBD in Brazil, including distribution by age, sex, clinical\ncharacteristics, and regional patterns of incidence and hos-\npitalization. Data from various studies published between\n2008 and 2024 that addressed the epidemiological pro file of\nIBD in different regions of the country were reviewed. Data\nwere collected from hospital records, national databases, and\nreports of speci fic studies that were available in full for\nanalysis. A growing prevalence of IBD in Brazil was observed,\nwith signi ficant regional variations. In the Federal District\n(DF), hospitalizations for Crohn ’s Disease and Ulcerative\nColitis increased by 20% in the last decade. In Mato Grosso\n(MT), the prevalence of IBD was higher in women (56%)\ncompared to men (44%). In Santa Catarina (SC), the majority\nof patients were between 30 and 50 years old, with a\nprevalence of 60% for Crohn ’s Disease. Studies in Espírito\nSanto (ES) and Paraná (PR) revealed that patients with IBD\nfrequently had comorbidities, such as obesity and diabetes,\ncomplicating disease management. The hospitalization rate\nfor IBD in Brazil ranged from 7.1 to 9.3 days, with the longest\nhospitalization times recorded in the Northeast. Mortality\nassociated with IBD was low, but there was an increase in the\nincidence of severe complications, such as abscesses and\nfistulas, especially in patients with Crohn ’s Disease. It was\nalso noted that the introduction of biological therapies\nsignificantly improved the quality of life for patients, reduc -\ning hospitalization rates and complications. The epidemio-\nlogical profile of IBD in Brazil shows an increase in prevalence\nand case complexity, with demographic and regional varia-\ntions that directly impact the management and treatment of\npatients. IBD predominantly affects young adults, with a\nslight predominance in women. The identi fication of associ-\nated comorbidities highlights the need for multifaceted\napproaches in management. Investing in public health poli-\ncies aimed at early detection and effective treatment of IBD is\ncrucial to improving patient outcomes and reducing the\nburden on the healthcare system.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS40\n\n\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 137679\nE-poster\nPYODERMA GANGRENOSUM COMPLICATING ILEOSTOMY IN A\nPATIENT WITH ULCERATIVE COLITIS – A CASE REPORT\nJéssica Siebra Macário de Brito 1, Jaciane Araújo Mota Fontes 1,\nJoana de Souza Simões 1, Marília Fernandes Gualberto de\nGaliza1, Neogélia Pereira de Almeida 1, Tereza Vilma Sobreira\nAlexandre1, Erodilho Sande Mota1, Flora Maria Lorenzo Fortes 1\n1Hospital Geral Roberto Santos, Salvador, Brasil\nCase Presentation KLS, female, 35 years old, diag-\nnosed with UC in 2020, colonoscopy revealed pancolitis and\nulcers. In addition to diarrhea with blood and mucus, she had\narthritis and sacroiliitis. She has an allergy to sulfasalazine and\nwas refractory to corticosteroid treatment, also showing inad-\nequate response to In fliximab, and was thus submitted to\nsubtotal colectomy with cecostomy in October 2020, a decision\nmade by the general surgery team as an emergency. After four\nmonths, symptoms returned, with sigmoidoscopy indicating\nMayo 3. Therapy with Tofacitinib was attempted without\nsuccess, followed by Vedolizumab for 14 months, which also\nproved ineffective, with symptoms and endoscopic worsening.\nGolimumab and Mesalazine suppository were tried without\nresponse, resulting in the need for total proctectomy with\ncecum resection and creation of a de finitive terminal ileos-\ntomy in December 2023. In March 2024, she was hospitalized\nwith nodular, purple, ulcerated lesions with raised edges,\npainful, with purulent secretion drainage in the peristomal\nregion and adjacent skin detachment, diagnosed with pyoder-\nma gangrenosum (PG). She underwent treatment with various\nantimicrobials and special dressings during prolonged hospi-\ntalization, without success. A decision was made for surgery to\nreposition the ileostomy and debride the ulcerated lesion on\nthe abdominal wall in April 2024. She was discharged after one\nmonth of surgery, with the wound improving, continuing\nfollow-up and care at home. Less than a month after discharge,\nlesions reappeared at the new stoma.\nDiscussion PG may occur in 1-5% of in flammatory\nbowel disease cases, not necessarily associated with disease\nactivity. It is de fined as a rare in flammatory disorder charac -\nterized by chronic, recurrent skin ulcers with necrotic edges.\nIts etiology and pathogenesis are complex, not well-de fined,\nand multifactorial. There is a wide range of therapeutic\noptions, and combining multiple modalities is more effective\nthan monotherapy, focusing on wound surgical treatment,\ntopical and systemic therapy.\nConclusion PG is an uncommon neutrophilic derma-\ntosis that presents diagnostic and therapeutic challenges. If\nleft untreated, it can signi ficantly impact morbidity and\nmortality, with an increased risk of developing squamous\ncell carcinoma in chronic wounds and a threefold increase in\nmortality among patients with uncontrolled disease.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138327\nE-poster\nPSORIASIS PARADOXAL WITH INFLIXIMAB USE: A CASE\nREPORT\nLara Cristina Silva Inácio 1, Michaela Helena Moretto Alves 1,\nLeandro Bernardini Tonelli 1, Guilherme Bussola Carazzatto 2,\nLetícia Isper2, Fernanda Queiroz Xavier1, Pedro Henrique Bauth\nSilva1, André Antônio Abissamra 1\n1Hospital Regional de Presidente Prudente, Presidente Prudente, Brasil\n2Universidade do Oeste Paulista, Presidente Prudente, Brasil\nA 46-year-old female patient, diagnosed with Crohn ’s\ndisease in the ileocolonic form in 2011. She used mesalazine\nand adalimumab for approximately two years and introduced\ninfliximab eleven months after discontinuing the other med-\nications, with a dosage of 4 vials every 2 months. The patient\nreports that one month after starting the medication, pruritic\nlesions began to appear on the fingers of both hands, with\nprogressive worsening over 4 months, revealing erythematous-\ndesquamative lesions on the palmoplantar region bilaterally,\naccompanied by pruritus. She also reports the appearance of\nblisters that soon collapsed, releasing clearfluid, with worsen-\ning after periods of stress. She denies lesions at other sites and\nreports no burning or pain. Her personal medical history\nincludes Crohn’s disease, depression, and hypertension. She\ncontinuously uses clonazepam 2mg, sertraline 100mg, losartan\n100mg/day, hydrochlorothiazide 25mg once a day, and inflix-\nimab 4 vials every 2 months. Upon physical examination,\nerythematous-desquamative lesions and excoriations were\nnoted on the palmoplantar region bilaterally. The case was\ndiscussed with the dermatology team, who advised that it was\nparadoxical psoriasis due to in fliximab use. They recom-\nmended starting halobetasol 0.50mg cream twice a day and\nurea cream once a day for hydration. The appearance of the\nlesions improved 7 days after starting treatment. One of the\nreported side effects of immunobiologics is paradoxical psori-\nasis, in patients with or without a previous psoriatic disease. It\nis characterized by an acute reaction when occurring in less\nthan 24 hours, and a delayed reaction between 24 hours and 14\ndays. It predominates in female patients and can occur in up to\n5% of patients using anti-TNF. The most common clinical form is\npalmoplantar. The etiology is not well-defined but is related to\nthe control between TNF-alpha levels and interferon with\ninflammatory cytokines. Treatment depends on the extent of\nthe condition; in this patient, topical treatment was chosen\nwhile on immunobiologic therapy. However, it may be neces-\nsary to switch to another class of immunobiologics if the\nphenomenon persists or worsens. The treatment of paradoxical\npsoriasis remains a challenge, as most patients still require\nanti-TNF for the management of their underlying condition.\nEarly identification of side effects and proper case management\ncan allow the continuation of the initial immunobiologic\ntreatment combined with topical treatment for psoriasis with-\nout affecting the patient ’s quality of life, always aiming for\neffective treatment and benefits.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 137678\nE-poster\nRECONSTRUCTION OF INTESTINAL TRANSIT WITH MODIFIED\nKONO-S ANASTOMOSIS (ILEO-CECAL) IN A PATIENT WITH\nCROHN’S DISEASE\nT. V. S. Alexandre1, J. S. M. Brito1, M. F. G. Galiza1, J. D. S. Simões1,\nJ. A. M. Fontes 1,N .P .A l m e i d a1, F. M. L. Fortes 1,E .S .M o t a1\n1Hospital Geral Roberto Santos, Salvador, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S41\n\n\nCase Presentation ALS, 35 years old, female, was\nadmitted with daily diarrhea, nausea, vomiting, and progres-\nsive weight loss. Associated with these symptoms, she pre-\nsented with amenorrhea, hair loss, asthenia, and malaise.\nLaboratory tests revealed leukocytosis. Imaging tests showed\nthickening with an in flammatory aspect in the distal ileum,\nextending to the cecum and cecal appendix, more accentuat-\ned near the ileocecal valve, associated with reactive mesen-\nteric lymph nodes and coexisting cholelithiasis. Endoscopic\nexamination revealed an irregular and friable lesion occupy-\ning the entire circumference of the cecum, preventing the\npassage of the endoscope through the ileocecal valve, with\nhistopathological examination indicating chronic in flamma-\ntory process. She was diagnosed with Crohn ’s disease and\nunderwent surgical treatment, where intraoperative findings\nshowed a localized mass in the right iliac fossa involving the\nterminal ileum, cecum, and transverse colon, with a fistulous\ntract between the terminal ileum and the transverse colon. A\nright ileocolectomy, transverse colostomy, terminal ileos-\ntomy (Brooke), and cholecystectomy were performed. She\nhad an uneventful recovery. Later, she was hospitalized for\nintestinal transit reconstruction surgery, where a Kono-S\nileocolic anastomosis was performed. She had no recurrence\nclinically or endoscopically.\nDiscussion Crohn’s disease (CD) is an in flammatory\ndisease characterized by transmural inflammation and asym-\nmetric segmental involvement of the entire gastrointestinal\ntract. Approximately 20% of patients present with stenotic\ncomplications at the time of diagnosis, which can account for\n40-70% of surgeries in the first 10 years of diagnosis. Unfor-\ntunately, postoperative recurrence of stenoses is common,\nespecially at the ileocolic anastomosis site. The Kono-S anas-\ntomosis is based on the concept that in flammation in CD\noriginates in the mesentery. Kono et al. proposed a terminal-\nto-terminal, antimesenteric anastomosis with the expecta-\ntion of reducing disease recurrence.\nConclusion The Kono-S anastomosis technique has\nemerged as a promising option to prevent recurrence at the\nanastomosis site and reduce postoperative complications,\nwith the advantages of preserving the diameter and dimen-\nsions of the anastomosis. Recent literature suggests that\nKono-S anastomosis may become a standard surgical tech-\nnique for CD. However, more clinical trials are needed to\nconfirm the effectiveness of this technique.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141696\nE-poster\nCASE SERIES IN CROHN ’S DISEASE (CD) – WITH DIFFERENT\nSURGICAL APPROACHES\nMyrna Maria Martins Ribeiro1, Camila Gomes1, Fernando Lopes\nVieira1, Walysson Alves Tocantins de Sousa 1, Rafael Ferreira\nCorreia Lima 1, Miguel Augusto Arcoverde Nogueira 1, João\nMarcelo Soares Ribeiro 2\n1Universidade Estadual do Piauí, Teresina, Brasil\n2Instituição de Educação Superior do Vale do Parnaíba, Parnaíba,\nBrazil\nCase Presentation Case 1 – Male patient, 45 years old,\nBMI 20 kg/m², presenting with abdominal pain, weight loss,\nmelena, and chronic diarrhea, already diagnosed with Crohn’s\nDisease (CD) 20 years ago, undergoing irregular in fliximab\ntreatment. Enterotomography: Multiple areas of substenosis\nin the small intestine and areas of stenosis with partial\nconcentric circumferential thickening in the distal ileum,\nwith signs of intestinal obstruction upstream. Underwent\nstenoplasty of the substenosis areas and segmental enter-\nectomy for stenosis of 20 cm of distal ileum, 15 cm from the\nileocecal valve (ICV), with primary anastomosis. Case 2 –\nFemale patient, 59 years old, BMI 22 kg/m², presenting with\nabdominal pain, watery diarrhea, and fever, undergoing\nirregular treatment with Adalimumab. Colonoscopy per-\nformed up to the sigmoid colon showing multiple serpiginous\nulcers with fibrin, associated with stenosis, which prevented\nprogression of the device. Enterotomography: stenosing\nthickening in the distal third of the transverse colon extend-\ning to 7.5 cm and two fistulous tracts to the left flank and\ngreater gastric curvature. Underwent segmental colectomy of\nthe stenotic area in the splenic flexure of the colon with\nmanual end-to-end primary anastomosis. Case 3 – Male\npatient, 18 years old, BMI 18 kg/m², presenting with right\niliac fossa pain, fever, anemia, and weight loss, who under-\nwent appendectomy in an emergency service, with worsen-\ning obstructive symptoms. After this episode, further\ninvestigation and diagnostic con firmation of CD were per-\nformed. Colonoscopy up to the cecum showed a fixed angu-\nlation at the ileocecal valve, preventing examination of the\nterminal ileum. Abdominal CT: Parietal thickening with\ncontrast enhancement and dilation upstream of the small\nbowel loops. Underwent right hemicolectomy with distal\nileum enterectomy of about 40 cm, with terminal ileostomy\nformation. All three cases had good post-operative outcomes.\nDiscussion The heterogeneous behavior and location\nof Crohn ’s Disease provides a variety of surgical treatments\nusing different techniques, as well as endoscopic and radio-\nlogical approaches, in fluenced by the nutritional status and\nadherence to medication.\nConclusion Multidisciplinarity is the foundation in\nmanaging Crohn ’s Disease. Surgical treatment as an initial\ntherapeutic approach, with its multiple variations depending\non the affected intestinal segment, has been a successful\nalternative.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141747\nE-poster\nSWEET’S SYNDROME IN PATIENTS WITH ULCERATIVE\nCOLITIS: DIAGNOSTIC AND THERAPEUTIC CHALLENGES\nCamila Leirós Vasconcelos 1, Rayanne Azevedo Peinado 1\n1Hospital das Clínicas Luzia de Pinho Melo, Mogi das Cruzes, Brasil\nCase Presentation A 60-year-old male patient with a\nhistory of Ulcerative Colitis (UC) diagnosed in 2020, on\nInfliximab and Azathioprine with partial control, continuing\nto experience occasional diarrhea and hematochezia, was\nadmitted to the Emergency Room with painful erythematous\nplaques on the trunk and upper limbs, associated with\npalpebral hyperemia and fever. Laboratory results revealed\nleukocytosis with neutrophilia. In collaboration with Derma-\ntology, a skin biopsy was performed, showing a dense neu-\ntrophilic in filtrate in the upper dermis without evidence of\nvasculitis, with histopathology confirming Sweet’s Syndrome\n(SS). Treatment with Prednisone at 1 mg/kg/day was started,\nand adjustments were made to the immunosuppressive\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS42\n\n\ntherapy. The patient showed a rapid clinical response, with\ncomplete regression of the lesions and systemic symptoms.\nThe corticosteroid dose was gradually reduced, and the\npatient remained in remission from the skin lesions.\nDiscussion Sweet’s Syndrome (SS) is a rare, recurrent\ncutaneous disease with an incidence peak between the fourth\nand seventh decades of life, predominantly affecting females\n(4:1). Described by Robert Douglas Sweet in 1964, it is\ncharacterized by the sudden appearance of multiple ery-\nthematous-violet, elevated, and painful plaques, associated\nwith fever, leukocytosis with neutrophilia, and a dermal\nneutrophilic in filtrate, often located on the upper parts of\nthe trunk. It is divided into 3 classes: associated with neo-\nplasms, drug-induced, or the classic (idiopathic) form, the\nlatter associated with In flammatory Bowel Diseases (IBD).\nDiagnosis is based on the criteria of Su and Liu (1986), defined\nby the presence of major criteria and at least 2 minor criteria\n(see table). The cause and pathogenesis remain unknown, but\nhistopathological findings suggest a hypersensitivity reaction\nrelated to the increase of pro-in flammatory cytokines, also\nfound in IBDs, such as IL-1, IL-3, IL-6, IL-8, interferon gamma,\nand colony-stimulating factors, which play an important role\nin neutrophil activation and migration to the skin, resulting in\nthe characteristic in filtrate. First-line treatment is cortico-\nsteroids in pulse therapy, with an initial dose of Prednisone\n30-60 mg/day with gradual tapering, in combination with\ntopical treatment. As alternatives, Colchicine and Potassium\nIodide can be used.\nConclusion Early recognition, appropriate manage-\nment, with clinical discussion, and a multidisciplinary ap-\nproach in collaboration with Dermatology were essential for\nthe positive outcome, highlighting the importance of multi-\ndisciplinary care in treating UC with dermatocutaneous\nmanifestations.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 139122\nE-poster\nSURGICAL TREATMENT OF ULCERATIVE COLITIS: 20-YEAR\nEXPERIENCE IN A REFERENCE CENTER\nJakeline Flávia Sertório Santos 1, Sandro da Costa Ferreira 1,\nOmar Féres1, José Joaquim Ribeiro da Rocha 1, Marley Ribeiro\nFeitosa1, Rogerio Sera fim Parra1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\nIntroduction and Objectives Ulcerative colitis (UC)\nmay be associated with an increased risk of hospitalizations\nand surgeries. Surgery is indicated in emergencies, for the\ntreatment of severe refractory acute colitis, toxic megacolon,\nperforation, or enterorrhagia. It is also indicated in cases of\ntreatment failure and in the presence of complications such\nas stenosis, severe dysplasia, and colorectal neoplasia. There\nis a scarcity of published data in Brazil regarding surgical\ntreatment for UC. The objective of this study was to analyze\nthe indications and frequency of surgical procedures per-\nformed over the past 20 years in patients with UC who\nunderwent surgery at a public reference hospital.\nMethods A retrospective analysis of the electronic\nmedical records of UC patients who underwent surgery from\n2002 to 2023 at a reference center. Surgical indications and\nclinical outcomes were evaluated, such as postoperative\ncomplications, reoperation rates, and mortality.\nResults A total of 83 surgeries were performed, of\nwhich 62 (74.7%) were elective and 21 (25.3%) were urgent.\nAmong the elective surgeries, the main indication was clinical\nintractability (n=55, 66.3%) and 9 cases of dysplasia or\ncolorectal cancer (10.8%). Among the urgent surgeries, 13\npatients (15.7%) underwent surgery for toxic megacolon/\nfulminant colitis and 6 cases (7.2%) for massive bleeding.\nThe main surgeries performed included: total proctocolec -\ntomy with ileal reservoir (n=38, 45.8%), total colectomy with\nileorectal anastomosis (n=25, 30.1%), partial colectomy\n(n=17, 20.5%), and total proctocolectomy with de finitive\nileostomy (n=3, 3.6%). Thirty-one patients (37.3%) required\nreoperation. The most common postoperative complications\nwere anastomotic dehiscence (n=7) and stoma-related com-\nplications (n=6). Fifty-nine percent of patients had a de fini-\ntive stoma. Half of the patients (n=38) who underwent total\nproctocolectomy with ileal reservoir had clinical and endo-\nscopic signs of “pouchitis” (inflammation of the pouch). The\nreservoir loss rate was 6% (n=5). The mortality rate among\noperated patients was 2.4% (n=9).\nConclusion The mortality rate in UC patients under-\ngoing surgical procedures was low. Total colectomy with or\nwithout ileorectal anastomosis and IPAA were the most\ncommonly performed techniques. Partial colectomy is re-\nserved for selected cases in elderly patients, with comorbid-\nities, and with colitis in remission.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141715\nE-poster\nTREATMENT WITH SUMP DRAINAGE IN PERCUTANEOUS\nDRAINAGE FAILURE IN ABSCESS DUE TO CROHN ’S DISEASE\nJean Luca Alves 1, Gersino Perin Ribeiro 1, Guilherme Samways\nGuzzi1, Jordana Martins Américo de Souza1, João Paulo Slongo1,\nTaiane Costa Santana1, Jackson Vinicus de Lima Bertuol1, André\nPereira Westphalen1\n1Hospital Universitário do Oeste do Paraná, Cascavel, Brasil\nMale, 24 years old, referred to a tertiary hospital due\nto sudden-onset abdominal pain lasting 24 hours, associated\nwith fever, nausea, and vomiting. He has a history of Crohn ’s\nDisease (CD) for 3 years and irregular use of corticosteroids\n(CS). Abdominal CT scan upon admission suspected a perfo-\nration of the distal ileum blocked by active CD. Empirical\nantibiotic therapy (ABT) and hydrocortisone were started.\nAfter 4 days, there was clinical deterioration, and a follow-up\nCT showed a large collection in the right lower abdomen,\nprompting percutaneous drainage. After 25 days, the patient\nrequired re-admission due to an enterocutaneous fistula\n(ECF), obstruction of the previous percutaneous catheter,\nand intra-abdominal abscess. A laparotomy was performed,\nrevealing a monobloc abdomen and placement of a three-way\nartisan sump drain. The patient was maintained with an\nirrigation system, vacuum aspiration, and tubular drainage\nthrough the drain, with ECF management. After clinical\nimprovement during hospitalization, in fliximab induction\n(5 mg/kg) was started, and the patient was discharged after\n10 days, with the drain removed 22 days post-surgery.\nFollow-up was arranged with low-output ECF management\nand in fliximab maintenance therapy. CD is a chronic\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S43\n\n\ninflammatory disorder that may require surgical treatment\nin up to 50% of cases. Resection of the affected intestine in CD\nmay improve symptoms but does not cure the disease, as\nrecurrence is common even after resection. In stable patients\nwith blocked perforation and active CD, clinical treatment\nwith ABT and CS is an option to preserve the affected\nsegment. Percutaneous drainage is a minimally invasive\ntreatment alternative for intra-abdominal abscesses. ECF\ndevelopment in CD is a possibility in transmural involvement,\nespecially when associated with stenosis. Immunobiological\ntreatments play a key role in disease control and ECF resolu-\ntion. Given the impossibility of resection due to the monobloc\nabdomen, creating a drainage system to cleanse the cavity\nand manage the ECF with a sump drain increases the chances\nof local resolution, especially when intestinal resection in CD\nis contraindicated. In surgical treatment of CD complications,\nthe resection of the smallest amount of intestine necessary\nfor disease control is recommended. Therefore, the use of a\nsump drain in malnourished patients with active infection,\ncombined with immunobiological therapy, enhances the\nlikelihood of successful disease remission.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 141688\nE-poster\nTREATMENT WITH TEDUGLUTIDE IN A PATIENT WITH SHORT\nBOWEL SYNDROME SECONDARY TO CROHN ’S DISEASE\nArtur Cury Féres 1, João Paulo Slongo 1, Matheus Couto Furtado\nAlbuquerque1, José Joaquim Ribeiro da Rocha1, Rogério Serafim\nParra1, Marley Ribeiro Feitosa 1, Omar Féres 1, Thomaz Lucas\nFéres2\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\n2Centro Universitário Estácio de Ribeirão Preto, Brasil\nCase Presentation A 35-year-old female with Crohn’s\ndisease since 2008, with an entero-colonic form. In 2009, she\nunderwent left colectomy with rectal burial and creation of a\nterminal colostomy. She developed lesions in the small\nintestine and underwent two additional surgeries with enter-\nectomies. During this period, she was treated with azathio-\nprine and in fliximab. She later developed enterocutaneous\nfistulas, with as many as 4 concurrent fistulas, requiring\ntreatment with parenteral nutrition and somatostatin. She\nunderwent multiple surgical procedures, with the last one in\n2018, involving extensive small intestine resection, and the\nterminal colostomy of the transverse colon was maintained. A\ntotal of 15 laparotomies were performed. The patient devel-\noped short bowel syndrome, with multiple episodes of\ndehydration and acute renal failure, requiring repeated hos-\npitalizations for hydration and nutritional support on average\nevery 48 hours over the last 5 years. In May 2024, treatment\nwith teduglutide 5 mg subcutaneously per day was initiated,\nand 30 days after the start of treatment, the patient no longer\nrequired hospitalization. As of now, 60 days into the treat-\nment, she has gained 3 kg.\nDiscussion Short bowel syndrome (SBS) is de fined\nwhen there is less than 200 centimeters of remaining small\nintestine, leading to an inability to absorb nutrients. The main\ncauses of SBS in adults are extensive or multiple enterecto-\nmies, which can occur in cases of Crohn ’s disease, radiation\nenteritis, mesenteric infarction, trauma, or cancer. These\npatients develop diarrhea, dehydration, malnutrition, acute\nrenal failure, and require recurrent hospitalizations for hy-\ndration and parenteral nutrition. Teduglutide is a drug indi-\ncated for the treatment of SBS patients, acting as a GLP-2\nanalogue, activating GLP-2 receptors in the intestine and\nreleasing insulin-like growth factors (IGF), nitric oxide, and\nkeratinocyte growth factor (KGF), promoting intestinal mu-\ncosal repair and growth by increasing villi and crypt depth.\nConclusionThis initial experience with teduglutide\nshows positive and encouraging results, as the patient no\nlonger requires repeated hospitalizations and no longer\nneeds parenteral nutrition. The only difficulty remains access\nto the drug due to its high cost.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138273\nE-poster\nINTESTINAL TUBERCULOSIS AS A DIFFERENTIAL DIAGNOSIS\nOF CROHN’S DISEASE – A CASE REPORT\nMarina Ströher1, Sérgio Henrique Couto Horta 1, Marcella Conz\nRodrigues1, Eduardo Vidal de Holanda 1, Alexia Dias Fontes\nRosa1, Enzo Shintaku 1, Flávia Balsamo 1, Sandra Di Felice\nBoratto1\n1Centro Universitário Faculdade de Medicina do ABC, Santo André,\nBrasil\nCase Presentation A 62-year-old female presented\nwith colicky abdominal pain and distension, but without\nchanges in bowel habits, bleeding, weight loss, or fever.\nColonoscopy revealed two oval ulcerated lesions with well-\ndefined borders and a fibrin-covered base, with an anatomo-\npathological diagnosis of intense chronic colitis, interstitial\nfibrosis, non-necrotizing granulomas, and dense eosinophilic\ninfiltration. A biopsy slide review with microorganism inves-\ntigation showed a non-caseating granuloma suggestive of\nintestinal tuberculosis (TB), in addition to a strongly positive\nPPD. The patient was referred to infectious diseases for\ntreatment.\nDiscussion TB is a chronic infectious disease endemic\nin Brazil. Although pulmonary involvement is the most\ncommon, intestinal TB is recognized as an important clinical\nmanifestation of the disease, and its suspicion as a differential\ndiagnosis is crucial, especially when the clinical picture\nsuggests other conditions. Intestinal TB can occur due to\nhematogenous spread of Mycobacterium tuberculosis from a\nprimary pulmonary focus or through the ingestion of con-\ntaminated food, resulting in granuloma formation and ulcer-\nation of the intestinal mucosa. The small intestine is the most\naffected, with a preference for the ileum, and symptoms may\ninclude abdominal pain, nausea, vomiting, diarrhea, weight\nloss, fever, and rectal bleeding, often mimicking the clinical\npresentation of Crohn ’s disease (CD). Systemic and pulmo-\nnary symptoms favor a TB diagnosis, which can be con firmed\nby the detection of mycobacteria and the presence of case-\nating granulomas on biopsy. It is crucial to distinguish\nbetween the two diseases due to therapeutic and prognostic\nimplications. The treatment of intestinal TB involves speci fic\nantimicrobial therapy with anti-tuberculosis drugs for six to\nnine months. In contrast, CD treatment generally includes\nimmunosuppressive therapy, corticosteroids, and advanced\ntherapeutic agents to control intestinal in flammation.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS44\n\n\nConclusion Differentiating between intestinal TB and\nCD is challenging. Early recognition and appropriate treat-\nment are essential to ensure favorable outcomes and prevent\nserious complications. Awareness among healthcare profes-\nsionals, particularly in endemic areas, is critical for effective\nmanagement.\nDoença Inflamatória Intestinal\nInflammatory Bowel Disease\nID – 138313\nE-poster\nVASCULITE LEUCOCITOCLÁSTICA\nCUTÂNEA ASSOCIADA A ANTI-TNF EM\nPACIENTE COM DOENÇA DE CROHN\nLEUKOCYTOCLASTIC CUTANEOUS VASCULITIS ASSOCIATED\nWITH ANTI-TNF IN A PATIENT WITH CROHN ’S DISEASE\nJanaina Giotti 1, Pedro Piassaroli de Abreu 1, Iana Faine Saran 1,\nBruna Meirelles Carregaro 1, Idblan Carvalho de Albuquerque 1,\nLilian Ramos Todinov 1, André Luigi Pincinato 1, Fernanda\nBellotti Formiga 1\n1Hospital Heliópolis\nCase Presentation Male, 45 years old, with Crohn ’s\ndisease (CD) A2L1B2, underwent ileocolectomy with termi-\nnal ileostomy as the first treatment 12 years ago due to\ncomplications from perforation and retroperitoneal abscess.\nHe received maintenance therapy postoperatively with inflix-\nimab and reconstructed intestinal transit after one year. After\nsix years of anti-TNF use, he developed cutaneous leukocyto-\nclastic vasculitis (CLV). Due to pharmacodermia, the biologi-\ncal treatment was switched to ustekinumab. He used it for\ntwo years with a good response, but due to socioeconomic\nreasons, it had to be discontinued, and a new induction with\nanti-TNF was done. Given the previous dermatological con-\ndition, certolizumab pegol was chosen for being humanized\nand having low immunogenicity. Four years after returning to\nanti-TNF therapy, erythematous punctate macules, non-pru-\nritic, appeared on the hands, forearms, legs, and feet. He was\nhospitalized with the clinical and histological diagnosis of\nCLV. After 30 days of treatment with corticosteroids and\nazathioprine, the patient showed improvement in the skin\ncondition but later died from a nosocomial infection.\nDiscussion Anti-TNF therapy optimized the manage-\nment of Crohn ’s disease, providing sustained remission of\nsymptoms. However, the use of these biological agents is not\nwithout complications, with CLV being a rare but clinically\nsignificant complication associated with its use. CLV is char-\nacterized by neutrophilic infiltration in the vascular wall with\nfragmentation of neutrophil nuclei, possibly with immune\ncomplex deposition. The result is skin lesions, such as pap-\nules, purpura, and ulcers, which can progress to necrosis. The\nepidemiology is variable, and its pathogenesis remains un-\ncertain. Management of these cases is based on discontinua-\ntion of the biological agent and treatment of the skin\nmanifestations, usually with corticosteroids. In severe or\nrefractory cases, additional therapies such as immunosup-\npressants and other biological agents, like the anti-CD20\nrituximab, may be necessary.\nConclusion Anti-TNF-induced CLV represents a rare\nbut potentially severe complication of biological therapy.\nEarly recognition, accurate diagnosis, and proper manage-\nment of this condition are essential to minimize complica-\ntions and optimize clinical outcomes for affected patients.\nDoenças Anorretais\nAnorectal Diseases\nID – 138277\nE-poster\nMULTIDISCIPLINARY APPROACH TO TOTAL RECTAL AND\nUTERINE PROLAPSE IN A REGIONAL HOSPITAL OF THE\nFEDERAL DISTRICT – CASE REPORT\nQuemuel Henrique Cruz Santos 1, Juliana Larissa Lauriano\nRamos1, Carolina Máximo Vieira 1, Geovanna Armaldo de\nSousa1, Lucas de Arruda Hidalgo 1, Mateus Fernandes de\nOliveira Vilela1, Dirceu de Castro Rezende Junior 1\n1Hospital Regional de Taguatinga, Brasília, Brasil\nCase Presentation A 74-year-old patient, G2PN1C1,\ndenied any comorbidities, allergies, alcohol use, or smoking.\nShe complained of uterine prolapse that started 10 years ago\nand rectal prolapse that began 9 years ago. She reported\nrecurrent episodes of urinary and fecal incontinence, as well\nas secretions due to the prolapsed organs. On physical\nexamination, she presented with total uterine prolapse and\ntotal rectal prolapse measuring approximately 30 cm from\nthe anal margin. She was admitted electively to a public\nregional hospital in the Federal District for simultaneous\nmanagement by the Gynecology and Proctology teams. The\nsurgery was performed in three stages. In the first stage, by\nthe Gynecology team, a vaginal hysterectomy and vaginec -\ntomy were performed. The second stage, by the Proctology\nteam, consisted of an Altemeier procedure (perineal recto-\nsigmoidectomy), and the third stage, again by the Gynecology\nteam, included posterior colpoperineoplasty and transobtu-\nrator sling placement. The procedure occurred without com-\nplications. The patient had a good clinical and laboratory\nevolution in the following days, tolerated diet well, and had\nnormal evacuations on the second postoperative day. She was\ndischarged for outpatient follow-up.\nDiscussion Rectal prolapse has an unclear pathophys-\niology, with several associated factors, and can occur at any\nage. 85% of patients with prolapse are women, with a much\nhigher incidence after the age of 60, with no difference\nbetween multiparous and nulliparous women. Uterine pro-\nlapse is part of a condition called pelvic organ prolapse.\nSymptoms can occur at any age but are more signi ficant in\nolder women, affecting up to 50% of women during this stage\nof life, with a peak between ages 70 and 79. The association of\nrectal and uterine prolapse occurs more frequently in older\nwomen and is found in a variable frequency of 16% to 27%.\nBoth conditions share coincident etiological factors: age over\n60 years, multiparity, increased intra-abdominal pressure\n(chronic obstructive pulmonary disease, constipation), ge-\nnetic diseases that affect collagen or elastin (Ehlers-Danlos\nsyndrome, joint hypermobility, Marfan syndrome), obesity,\namong others.\nConclusion This clinical case describes a rare associ-\nation between two conditions that compromise functionality\nand quality of life in affected patients. Surgical treatment and\nmultidisciplinary care follow-up provided an advantage in\nthe resolution of the case.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S45\n\n\nDoenças Anorretais\nAnorectal Diseases\nID – 141759\nE-poster\nANALYSIS OF SURGICAL TREATMENT OF ANORECTAL\nFISTULAS IN A SERIES OF 158 PATIENTS\nLaura Trotta Villar1, Mariana Trotta Villar1,S ofia Arrais Haidar1,\nLuna Vitória Gondim Ferreira 1, Paulo Gonçalves de Oliveira 2,\nAntonio Carlos Nóbrega dos Santos 2, Bruno Augusto Alves\nMartins2 João Batista de Sousa 1\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nIntroduction Anorectal fistulas are abnormal pas-\nsages between the anal canal and the perianal skin or other\nadjacent structures. Most fistulas result from an infectious\nprocess in the anal glands, which can progress to an abscess\nand, in most cases, to a fistula. They represent about 70% of\nperianal diseases that require surgical treatment, with a\nprevalence of approximately 1 in 10,000 inhabitants per\nyear, being more common in males. They are classi fied into\nfour main types: intersphincteric, transsphincteric, supra-\nsphincteric, and extrasphincteric, according to the relation-\nship between the fistula tracts and the anal sphincter\nmuscles.\nObjective To evaluate the epidemiological profile and\nclinical outcomes of a series of patients undergoing surgical\ntreatment for anorectal fistulas at a university hospital.\nMethods Analysis of 158 patients surgically treated\nfor anorectal fistulas between February 2010 and February\n2024. Patients with a confirmed diagnosis of anorectal fistula\nwere included, excluding those with in flammatory diseases.\nThe variables analyzed were demographic data, diagnosis,\nsymptom onset time, type of surgical treatment and its\nsuccess rates, hospitalization time, and the need for a second\nintervention.\nResults The average age of the patients was 41 years\nwith a standard deviation of 11.70. Of the 158 patients,\n66.45% were male. Fistulotomy was the most performed\nprocedure, representing 77.8% of surgeries, with an average\nhospitalization time of less than 2 days. Only 7 patients\n(4.43%) required a second procedure. The higher male pre-\ndominance (66.45%) suggests that men may have a higher risk\nof developing these conditions, possibly due to anatomical or\nbehavioral factors. In addition to fistulotomy, other proce-\ndures performed included fistulectomy, intersphincteric fis-\ntula tract ligation (LIFT), and video-assisted fistula treatment\n(VAFT).\nConclusion Based on the results obtained in this\nseries, it can be concluded that most fistulas have a crypto-\nglandular origin, and fistulotomy was the most commonly\nused treatment, showing resolution in the majority of cases.\nDoenças Anorretais\nAnorectal Diseases\nID – 141647\nE-poster\nANALYSIS OF THE RESULTS OF ONE THOUSAND\nHEMORRHOIDECTOMIES PERFORMED AT A UNIVERSITY\nHOSPITAL\nBeatriz da Costa Rossi Ramos de Carvalho 1, Camille Moreira\nBaptista da Silva1, Luna Vitória Gondim Ferreira1, Igor Torres da\nSilveira Mendes1, Vanessa Siqueira Reis 2, Antonio Carlos\nNobrega dos Santos 2, Bruno Augusto Alves Martins 2, João\nBatista de Sousa 2\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nIntroduction Hemorrhoidal disease has a high preva-\nlence in the global population. Hemorrhoids are characterized\nby vascular structures in the anal canal, originating from the\ndistal prolapse of arteriovenous connective tissue that drains\ninto the superior and inferior hemorrhoidal veins. They can be\nclassified as internal, external, and mixed, based on their location\nrelative to the pectinate line. Internal hemorrhoids are further\nclassified into grades I, II, III, and IV, depending on the degree of\nprolapse of the anal canal. Treatment ranges from behavioral\nmodifications to surgical approaches. The two main types of\nconventional hemorrhoidectomy are closed hemorrhoidectomy\n(Ferguson) and open hemorrhoidectomy (Milligan-Morgan).\nObjective To describe the results of one thousand\nconsecutive hemorrhoidectomies performed at a university\nhospital.\nMethods A retrospective study based on the analysis of\nelectronic medical records of all patients who underwent\nhemorrhoidectomy from January 1991 to April 2024. The\nvariables included were: age, sex, surgical technique, length\nof hospital stay, and complications associated with the surgery.\nResults A total of 1,012 patients were operated on\nduring the analyzed period. Of these, 984 patients (97.2%)\nunderwent the Milligan-Morgan technique, and 14 patients\n(1.3%) underwent the Ferguson technique. Regarding sex, 513\nmen (50.6%) and 499 women (49.3%) were operated on. The\naverage age of the patients was 45.79 years. The average\nlength of hospitalization was 1.02 days. Regarding the classi-\nfication of hemorrhoids, 651 were grade III, 191 were mixed,\n129 were grade IV, and 41 were grade II. Of the total number\nof patients operated on, 53 (5.2%) experienced complications\nin the immediate postoperative period: 23 had urinary\nretention, 22 had postoperative bleeding, 5 had hemorrhoidal\nthrombosis, 2 had perianal abscesses, and 1 had a urinary\ninfection. Four patients developed stenosis after healing.\nConclusion Based on the observed results, surgical\nexcision of hemorrhoids is an effective approach, especially for\nmore advanced cases and those with an external component.\nDespite the advent of new techniques, the Milligan-Morgan\nprocedure is still predominant at the institution analyzed in\nthis study. The complication rates are low, with the most\ncommon being minor bleeding and urinary retention.\nDoenças Anorretais\nAnorectal Diseases\nID – 138285\nE-poster\nEPIDEMIOLOGICAL ANALYSIS AND POSTOPERATIVE\nEVOLUTION OF PATIENTS WITH SUPPURATIVE HIDRADENITIS\nIN A REFERRAL SERVICE\nLucas Abreu Barreiro1, Isabela Dias Marques da Cruz 1, Flavia de\nCastro Ribeiro Fidelis1, Alexandre Lopes de Carvalho 1, Alana\nFrancisca Machado Melo1, Lina Maria Goes de Codes 1\n1Hospital Universitário Professor Edgard Santos, Salvador, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS46\n\n\nIntroduction Hidradenitis Suppurativa (HS; from the\nGreek hidros = sweat and aden = glands) is a chronic\ninflammatory skin disease also known as inverse acne and,\nhistorically, as Verneuil ’s disease. Current consensus and\nguidelines highlight the bene fits of multimodal treatment,\ncombining surgical and clinical-dermatological approaches\nfor HS. However, there is no consensus on which surgical\ntechnique offers the greatest bene fits to these patients and\nreduces the recurrence rates of the disease.\nObjective To evaluate the risk factors and relevant\nvariables in the course of Hidradenitis Suppurativa, as well as\nthe postoperative evolution in a medical residency service in\nColoproctology.\nMethodology A retrospective study based on data\ncollected from medical records, including patients with HS\nindicated for surgical treatment, with procedures performed\nat the Coloproctology service of the Hospital Professor Edgard\nSantos/UFBA, from 2016 to 2024.\nResults A total of 17 patients were analyzed in this\nstudy, all classi fied as Hurley III, with 64.7% being male, and\nan average age of 45.23 years. Eleven of them had comorbid-\nities associated with HS. In this sample, 35.4% had a history of\nsmoking, and 5.88% of patients had a positive family history of\nthe disease, with the same percentage of patients diagnosed\nwith inflammatory bowel disease in conjunction with HS. Of\nthe patients who underwent surgery (70% of the sample), 23%\nhad surgery in conjunction with plastic surgery, with about\n29.4% affected in other areas of the body (mainly axillas). The\naverage hospital stay was 11.2 days, and 23.07% used special\ndressings. During clinical follow-up, 47% of patients had\ndisease recurrence even after surgery, with treatment con-\ntinuing conservatively. About 70.5% of patients maintained\nmultidisciplinary follow-up with dermatology, with 29.4%\nusing immunobiologicals previously or currently, and an\naverage follow-up time of 12.7 years from diagnosis to the\npresent date.\nConclusion Hidradenitis Suppurativa is a multifacto-\nrial disease requiring longitudinal treatment and collabora-\ntion across various medical specialties. The need for\ncombined therapies promotes better postoperative outcomes\nand consequently better quality of life for patients with the\ndisease.\nDoenças Anorretais\nAnorectal Diseases\nID – 138168\nE-poster\nUNCOMMON PRESENTATION OF HAILEY-HAILEY DISEASE: A\nCASE REPORT\nThiago José Islanderson dos Santos Castro 1, Emily Cristina\nArenhart Bajerski 1, Brenna Martins Barboza Santana 1, Mateus\nFernandes Fagundes1, Joan de Matos Delmondes 1, Yasmin\nLuani Arenhart Bajerski 1, Tamires Robles 1\n1Centro Maurício de Nassau, Barreiras, Brazil\nCase Presentation HCS, 25 years old, female, presents\nto the outpatient clinic with lesions in the vagina and anus,\nwithout other complaints or comorbidities. Biopsy of the\nlesions indicated HPV as the causative agent. She used\nimiquimod for 16 weeks, with improvement only of vaginal\nlesions. On physical examination, the anus showed multiple\nverrucous and whitish lesions around the anal border, ante-\nrior perineum, and labia majora, but no lesions in the anal\ncanal. Topical podophyllin was prescribed in four sessions,\nwithout reduction of the lesions. A biopsy of the lesion in the\nleft anterior region revealed acantholytic dermatosis of the\nentire thickness of the epithelium, associated with Pigmen-\ntary Incontinence – Hailey-Hailey Disease (Chronic Benign\nFamilial Pemphigus).\nDiscussion Hailey-Hailey disease is an uncommon\nacantholytic condition, not autoimmune, autosomal domi-\nnant, manifesting as erosions, plaques, fissures, vesicles,\ncrusts, or blisters in areas of flexion (mainly axillary and\ninguinal). It affects young adults, with no sex preference. The\nclinical presentation is explained by histological changes (loss\nof cohesion between keratinocytes), associated with factors\nsuch as secondary infections and friction. Diagnosis is clinical\nand histopathological, and management involves avoiding\naggravating factors (sweat and heat). Corticosteroids are used\nas first-line treatment, with intralesional application recom-\nmended for patients who do not respond to topical use. Other\ntopical medications reported in case studies include calci-\nneurin inhibitors, vitamin D analogs, gentamicin, and 5%\nfluorouracil. Regarding systemic therapy, doxycycline for 3\nmonths has been effective in case series. In severe or refrac -\ntory cases, botulinum toxin injection, anticholinergic agents,\nimmunosuppressive or immunomodulatory therapy, and\ninterventions such as phototherapy, radiotherapy, or surgical\nexcision of lesions are recommended. Genetic counseling is\nadvised for the patient. The patient described, in addition to\npresenting lesions in an unusual location (anal border) and\nassociated with other HPV lesions, did not show improve-\nment with imiquimod use.\nConclusion Hailey-Hailey disease is a rare genetic\ndisorder, but with cutaneous manifestations similar to other\ndermatological diseases. Histological analysis is essential for\ndiagnosis, and studies are needed to de fine more effective\nmanagement strategies.\nDoenças Anorretais\nAnorectal Diseases\nID – 141710\nE-poster\nCLINICAL AND FUNCTIONAL EVALUATION OF DIFFERENT\nTECHNIQUES FOR SURGICAL TREATMENT OF ANAL FISTULA\nTainah Cristina Saboya de Queiroz Colares 1, Nayanne de\nAzevedo Frota1, Rejane Corrêa Furtado 1, Eduardo Barroso\nRibeiro1, Breno Moreira Viana Mendonça Brito 1, Ricardo\nEverton Dias Mont ‘alverne1, Benjamin Ramos de Andrade\nJunior1, Adriely Oliveira Quintela 2\n1Santa Casa da Misericordia de Fortaleza, Fortaleza, Brazil\n2Universidade Federal do Ceará, Fortaleza, Brazil\nIntroduction Anal fistulas are a common clinical\ncondition in coloproctology practice, characterized by the\nformation of an abnormal communication between the anal\ncanal and the adjacent skin. Despite signi ficant advances in\nsurgical management, this condition remains challenging\ndue to the high recurrence rate and the potential to cause\nfecal incontinence, which depend, among other factors, on\nthe surgical technique employed.\nObjectives To analyze factors associated with postop-\nerative complications and clinical outcomes in patients un-\ndergoing fistulotomy, identifying areas for therapeutic\nimprovement to enhance surgical prognosis.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S47\n\n\nMethods A cross-sectional study with a descriptive,\nquantitative, and retrospective approach. The population\nconsists of patients who underwent fistulotomies from Janu-\nary 2021 to October 2023, with postoperative follow-up until\nJanuary 2024.\nResults Seventy-four patients were selected, includ-\ning those who had multiple approaches, either due to recur-\nrence or fistulotomy with seton in multiple surgical stages.\nApproximately 54.05% (n=40) of the anal fistulas were trans-\nsphincteric, 37.83% (n=28) were intrasphincteric, 6.75% (n=5)\nwere suprasphincteric, and 1.35% (n=1) were super ficial. All\npatients underwent surgery, with a single-stage fistulotomy\nbeing the most common, performed in 35 patients (47.29%),\nfollowed by fistulotomy with seton in 28 patients (37.83%),\nthe LIFT technique in 9 patients (12.16%), punch fistulectomy\nin 1 patient (1.35%), and myomucosal flap advancement in 1\npatient (1.35%), which was used in conjunction with the LIFT\ntechnique. During follow-up, 10.81% (n=8) had recurrence.\nAmong those without recurrence (n=66), 6.06% (n=4) had\npain, and 19.69% (n=13) presented varying degrees of fecal\nincontinence, of which 30.76% (n=4) had fistulotomy with\nseton and 69.23% (n=9) had anal fistulotomy. Patients with\npostoperative pain underwent analfistulotomy. Among those\nwith recurrence, 62.5% underwent the LIFT technique.\nConclusion Fecal incontinence complication rates\nwere within expectations for the techniques used. However,\nthere was a high recurrence rate with the LIFT technique,\nwhich requires further refinement by the surgical team. Anal\nfistulotomy and the technique associated with seton remain\nsafe in terms of recurrence and incontinence, but larger\nstudies on sphincter-saving techniques should be considered.\nDoenças Anorretais\nAnorectal Diseases\nID – 138335\nE-poster\nALTMEIER SURGERY FOR CORRECTION OF TOTAL RECTAL\nPROLAPSE (RECTAL PROCIDENCE): PRESENTATION OF\nRESULTS FROM A COLOPROCTOLOGY REFERRAL SERVICE\nMaria Luiza Marinho Vidigal 1, Sandra Di Felicci Boratto 1, Flavia\nBalsamo1, Sergio Henrique Couto Horta1, Raphaella Assis Alves\nJanuario1, Marina Stroher 1, Eduardo Vidal de Holanda 1,\nAmanda Vitiello Pereira Brosco 1\n1Faculdade de Medicina do ABC, Santo André, Brazil\nIntroduction Complete rectal prolapse is character-\nized by the protrusion of all layers of the rectum through the\nanus and is associated with the progressive loss of function of\nthe pelvic floor structures. More common in women and the\nelderly, it presents risk factors such as vaginal childbirth,\nconstipation, and pelvic muscle weakness. Surgical correc -\ntion is required, and the perineal technique is one of the\noptions. Among these is the Altemeier procedure, which\ninvolves rectosigmoidectomy with transanal resection of\nthe full thickness of the prolapse and colo-anal anastomosis.\nObjective To evaluate the surgical outcomes of\npatients undergoing complete rectal prolapse correction via\nthe perineal approach using the Altemeier technique and\ncompare the results with the literature.\nMethod Retrospective observational study analyzing\nmedical records and actively searching for patients treated\nwith the Altemeier procedure between March 2017 and May\n2024. The results were compared to existing literature.\nResults A total of 19 patients were included, aged\nbetween 42 and 92 years, with 18 females and 1 male. All\npatients underwent the Altemeier procedure, and in 4 cases,\nthe procedure was associated with anal cerclage (Tiercsh\ntechnique). The size of the prolapse ranged from 5 to 17\ncentimeters, and the average length of hospitalization was\n4.26 days. Of the immediate postoperative complications,\nonly 1 case involved an infection of the surgical wound (at the\nTiercsh stitches), no dehiscence of the colo-anal anastomosis\nwas observed, and 1 patient developed pulmonary thrombo-\nembolism. In terms of early complications (30 days), 1 patient\ndeveloped mild incontinence, 8 experienced soiling, 6 had\nconstipation, and 3 complained of mild pain. On late follow-\nup, ranging from 3 months to 8 years, no recurrences were\nobserved, and 5 patients died from unrelated causes.\nConclusion In this study, no severe complications or\nrecurrences were observed using the Altemeier technique,\nwhich proves to be a good option for correcting complete\nrectal prolapse. These findings align with the literature,\nwhich also reports short hospitalization times and low\nmorbidity.\nDoenças Anorretais\nAnorectal Diseases\nID – 138316\nE-poster\nCORRECTION OF RECURRENT RECTOVAGINAL FISTULA WITH\nMARTIUS FLAP – CASE REPORT\nCristiane Koizimi Martos Fernandes 1, Artur Duarte e Duarte 1,\nLarissa Dummer Saebel 1, Antônio Henrique da Gama Martin 1,\nMarina Barbabela Grisolia de Oliveira 2, Letícia Brandão Castro 2\n1Hospital Municipal de Contagem, Contagem, Brazil\n2Hospital Felicio Rocho, Belo Horizonte, Brazil\nCase Presentation A 53-year-old female patient, with\na history of hypertension, underwent drainage of a perianal\nabscess in 2020. Subsequently, she developed an anterior\nanorectal fistula, which was corrected using the mucosal\nadvancement technique in 2021. Afterward, the patient\npresented with fecaluria, and a rectovaginal fistula was\ndiagnosed, likely of cryptoglandular etiology after the diag-\nnostic workup. She underwent two unsuccessful surgical\nattempts via transverse perineal approach in 2021 and\n2022. In June 2022, another surgery was performed using a\ntransverse incision in the perineum, which involved the\nresection of the fistulous tract and fibrotic edges at the\nanal fistula ori fice, followed by suturing in two layers with\nabsorbable sutures. Additionally, an incision was made on the\nright lateral portion of the labia majora, and a Martius flap\nwas rotated into the rectovaginal space. The posterior vaginal\nwall was reconstructed with simple sutures and absorbable\nsutures, followed by a multi-layer closure and insertion of a\nPortovac drain. The patient returned for follow-up visits\nwithout complaints or signs of fistula recurrence.\nDiscussion Rectovaginal fistulas (RVF) are abnormal\nconnections between the lower gastrointestinal tract and the\nvagina. They may result from obstetric trauma, pelvic radia-\ntion, Crohn ’s disease, malignancy, or an anorectal abscess.\nHigh RVFs are above the pectinate line, while “low” RVFs are\nthose involving the vagina and anus. Symptoms include\nuncontrollable passage of feces and gases through the vagina.\nFor asymptomatic RVFs, a watchful waiting approach may be\nsufficient. Several factors should be considered when\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS48\n\n\nchoosing a surgical approach, such as the number and type of\nprevious repairs, the patient ’s risk factors, concomitant fis-\ntulas, and sphincter integrity. If the RVF is refractory or if the\nadjacent tissue is signi ficantly damaged, interposition tech-\nniques are often recommended. The Martius flap is particu-\nlarly useful for patients with a thin rectovaginal septum and a\nhistory of radiation injury, with a healing rate of 79%. The use\nof a diversion when employing flap techniques remains\ncontroversial.\nConclusion In this reported case, the patient with a\ncryptoglandular RVF and recurrent episodes achieved resolu-\ntion with the Martius flap technique. This case demonstrates\nthe complexity of the technique and its signi ficant success\nrate.\nDoenças Anorretais\nAnorectal Diseases\nID – 132900\nE-poster\nDOENÇA DE BOWEN EM REGIÃO\nPERIANAL: UM RELATO DE CASO NA\nAMAZÔNIA LEGAL\nBOWEN’S DISEASE IN THE PERIANAL REGION: A CASE REPORT\nFROM THE LEGAL AMAZON\nVinícius Sussuarana Rocha 1, Raimundo Rocha Neto 1, Vítor\nAugusto Ribeiro Oliveira 1, Anna Cristina Pires da Luz Dória 1,\nMarcos Zuqueto Farias 1, Prisco de Paiva Bezerra Segundo 1,\nRaimundo Nonato Ribeiro de Oliveira Júnior 1, Wanda Pereira\nGoes dos Santos 1\n1UNIFAP, Macapá, AP, Brasil\nCase Presentation Patient E. G. S, female, 70 years old,\nsought treatment at the coloproctology service of a hospital\nin Macapá/AP, complaining of itching and discomfort in the\nperianal and coccygeal regions. During the physical exami-\nnation, an expansive verrucous lesion with elevated borders\nwas identi fied, extending from the perianal region to the\ncoccyx (superiorly) and to the gluteal region bilaterally, with\nan approximate diameter of 5.5 cm. Based on the clinical\npresentation, the decision was made to perform surgical\nexcision of the lesion and subsequent histopathological anal-\nysis. During the surgical excision, partial primary closure was\nperformed due to tension in the area, and healing by second-\nary intention was chosen. On the first postoperative day (PO),\nthe patient complained of pain in the surgical wound area and\nthe presence of serous secretion. However, on the second PO\nday, the complaints subsided, and on the third PO day, the\npatient was discharged without further complaints. Accord-\ning to the histopathological study of the lesion, verrucous\ncarcinoma associated with extensive “in situ ” carcinoma\n(Bowen’s Disease) was identi fied, with compromised lateral\nmargins and pathological staging: pT2. Subsequently, staging\nwas done using chest, abdominal, and cranial computed\ntomography (CT), all without alterations. During follow-up,\nthe patient progressed without complaints and with total\nlesion remission and complete healing.\nDiscussion Bowen’s disease is an in situ squamous\ncell carcinoma, usually asymptomatic, and commonly found\nin sun-exposed areas (rarely in the perianal region). It is a rare\nprecancerous lesion that can progress to invasive carcinoma\nin up to 5% of cases. Symptoms include complaints such as\nburning, itching, and bleeding. Diagnosis is made through\nhistopathological analysis. Treatment involves various\napproaches, including conventional surgery, topical therapies\n(such as 5-fluorouracil), and local procedures such as cauter-\nization, with surgical resection with margins considered the\nmost effective.\nConclusion Due to being a mostly asymptomatic and\nslow-growing disease, a definitive diagnosis may be delayed.\nAdditionally, when symptomatic, the lesion may resemble\nother conditions, such as genital warts and Paget ’s disease.\nTherefore, a detailed physical examination, combined with a\nbiopsy of the lesion, is essential for the correct and de finitive\ndiagnosis of the disease.\nDoenças Anorretais\nAnorectal Diseases\nID – 141559\nE-poster\nFISTULOTOMIA NO TRATAMENTO DA\nFISTULA ANAL INTER-ESFINCTERICA. O\nRISCO DE INCONTINÊNCIA FECAL\nÉ SIMILAR EM AMBOS OS SEXOS, APESAR\nDAS DIFERENÇAS ANATÔMICAS?\nFISTULOTOMY IN THE TREATMENT OF INTER-SPHINCTERIC\nANAL FISTULA: IS THE RISK OF FECAL INCONTINENCE SIMILAR\nIN BOTH GENDERS, DESPITE ANATOMICAL DIFFERENCES?\nSthela M. Murad-Regadas\n1, William Pinheiro Boavista de\nOliveira1, Francisco Sergio P . Regadas1, Francisco Sergio P .\nRegadas Filho1 Milena M. de Souza 1, Ricardo E. Dias\nMont‘alverne1, Carlos M. Q. da Cunha 1 Victor R. Siqueira 1\n1Universidade Federal do Ceará, Fortaleza, CE, Brasil\nIntroduction Studies correlating sex with sphincter\nanatomy, the length of muscles divided afterfistulotomy (FT),\nand fecal incontinence (FI) are incomplete.\nObjective To evaluate the incidence of FI in patients\nundergoing FT to treat inter-sphincteric anal fistula and\ncorrelate symptoms, anatomical conformation of the anal\ncanal, muscle length and percentage of divided muscles, and\nanal pressures, comparing genders.\nMethod A prospective cohort study included patients\nundergoing FT distributed by sex: GI = female and GII = male.\nPatients were evaluated before and after complete healing\n(between 2-3 months) for the Cleveland Clinic Incontinence\nScore (CCFIS); anal canal anatomy via 3D anorectal ultra-\nsound (3D-US) [cm]: length of the anterior external anal\nsphincter (EAS); posterior EAS plus puborectal (EAS-PR); gap\nlength (distance from the proximal edge of the anterior EAS to\nthe proximal edge of the posterior PR); length of the anterior\nand posterior internal anal sphincters (IAS); length and\npercentage of divided IAS and divided angle; and anal pres-\nsures via manometry (mmHg). Groups were compared, and\nmeasurements were correlated with FI scores. The Student ’s\nt-test, Wilcoxon test, chi-square test, and Spearman ’s corre-\nlation coefficient (ρ) were used.\nResults Of the 81 patients: 35 (43%) female and 46\n(57%) male. The average age, trajectory distribution, and\ninternal opening position were similar. The muscle length\nis longer and the gap shorter in men (p < 0.00). Additionally,\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S49\n\n\nthe length of the divided IAS is greater in men (1.6 vs. 1.3/\np < 0.00), and there was a positive correlation between CCFIS\nand the length of the divided IAS (r = 0.41/p < 0.00). However,\nthe percentage of divided IAS, the incidence of FI (54% vs.\n50%), and the score (1.8 vs. 1.9) were similar. The maximum\ncontraction pressure was higher in GII (p < 0.005). Resting\npressure decreased when comparing before and after surgery\nin both groups (p < 0.05).\nConclusion The risk of FI afterfistulotomy was similar\nbetween sexes, despite differences in the anatomical confor-\nmation of the anal canal, such as longer muscle length in men,\nassociated with a greater length of the divided IAS muscle\n(cut) during fistulotomy. In females, the muscle length is\nshorter, and the divided IAS muscle is smaller, so the per-\ncentage of divided IAS is similar in both sexes. The incidence\nof FI was high, with 50% of patients in both groups. However,\nthe symptoms were mild.\nDoenças Anorretais\nAnorectal Diseases\nID – 137806\nE-poster\nFÍSTULA PERIANAL COMPLEXA COMO\nMANIFESTAÇÃO DA TUBERCULOSE:\nRELATO DE CASO\nCOMPLEX PERIANAL FISTULA AS A MANIFESTATION OF\nTUBERCULOSIS: CASE REPORT\nBeatriz Castro de Sousa 1, Marjorye Schelle Magalhães 1, Yana\nJuliê Perondi1, Maria Roberta Meneguetti Seravali Ramos 1\n1Hospital Municipal da Piedade,Rio de Janeiro, RJ, Brasil\nWe present the case of a 45-year-old immunocompe-\ntent patient with a history of recurrent anal fistula, who\nunderwent anal fistulectomy in two stages, with an extension\nof the fistula into the scrotal sac. Magnetic resonance imaging\nrevealed an in flammatory fistulous collection occupying the\nposterolateral aspects of the perianal compartment extending\ntowards the left ischioanal fat, characterizing a perianalfistula.\nHistopathological examination demonstrated in flammatory\nchanges, an in filtrate of in flammatory cells, lymphocytes,\nplasma cells, and epithelioid cells, as well as fibrosis. During\nre-surgical intervention due to wound healing failure, material\nwas collected for tuberculosis culture, which con firmed the\ndiagnosis. Gastrointestinal tuberculosis is a rare condition,\naffecting less than 1% of individuals, with anorectal involve-\nment being even rarer, occurring in only 1% of cases of digestive\ntract tuberculosis. This case emphasizes the importance of\nconsidering tuberculosis as a differential diagnosis in recurrent\nanal lesions or those with poor healing, especially in endemic\nregions with significant rates of incidence of this disease.\nDoenças Anorretais\nAnorectal Diseases\nID – 141129\nE-poster\nCOMPLEX PERIANAL FISTULA DUE TO ANORECTAL\nTUBERCULOSIS\nBárbara érnica Zeferino 1, Carlos Henrique Marques dos\nSantos1, Carlos Otávio da Silva Ribeiro 1, Odinilson Almeida\nFonseca1, Camila Vieira Chiquetti 1\n1Hospital Regional do Mato Grosso do Sul, Campo Grande, Brazil\nCase Presentation A 46-year-old male patient pre-\nsented to the coloproctology service after a perianal abscess\nepisode, occurring three months after an infection. At the\ntime, he had an ulcerated external opening approximately\n2x2 cm at the 3 o ’clock position, with elevated and hardened\nedges and a small amount of purulent secretion. Colonoscopy,\npelvic MRI, and biopsy of the lesion were requested. The\nbiopsy revealed tissue consistent with a perianal fistula,\nshowing non-caseating granulomas containing multinucle-\nated giant cells and epithelioid cells, suggestive of Crohn ’s\ndisease. A month later, the patient returned to the clinic with\ncontinued secretion and the ulcerated lesion. He also\nreported a history of imprisonment. A perianal fistula caused\nby tuberculosis was suspected, and twenty days later, a new\nbiopsy and Xpert gene testing for\n/C3 Mycobacterium tuber-\nculosis/C3 were performed. The new biopsy con firmed the\npresence of a perianal fistula caused by anorectal tuberculo-\nsis, with low bacillary load and sensitivity to Rifampicin.\nDiscussion Perianal tuberculosis is more common in\nmen, with fistula being the most frequent symptom. A long\nonset period, recurrences, and a history of prior pulmonary\ndisease suggest the diagnosis. Typical histology shows giant\ncell granulomas with areas of caseous necrosis; however,\ncaseous granulomas are not always present, which compli-\ncates differentiation from Crohn ’s disease. Complete remis-\nsion of the condition is achieved with the institution of\neffective and targeted clinical treatment.\nConclusion Most cases have a good outcome, but it\nremains a subdiagnosed condition. Therefore, it is crucial that\ncases like this are reported, along with their outcomes.\nDoenças Anorretais\nAnorectal Diseases\nID – 138271\nE-poster\nCAVERNOUS COLORECTAL HEMANGIOMA: A CASE REPORT\nFelipe Pereira Gomes 1, Ana Caroline Bohn 1, Ana Júlia Schnorr\nMayer1, José Fernando Sens Junior, Júlia Wagner Guedes 1,\nMauro Minol Yaedu\n1Hospital Santa Isabel, São Paulo, Brazil\nCase Presentation A 23-year-old female patient,\nobese, with a history of hemorrhoidal disease since the age\nof 4, presented with hematochezia, chronic proctalgia, and\nsymptomatic anemia, requiring multiple blood transfusions.\nInitial colonoscopy suggested active proctocolitis. Treatment\nfor ulcerative colitis was initiated with prednisone, mesala-\nzine, and azathioprine, but with no improvement and normal\nrectal and sigmoid biopsies. A second colonoscopy revealed\nan extensive cavernous hemangioma from the distal sigmoid\nto the anal canal and hemorrhoidal plexus. An abdominoper-\nineal amputation of the rectosigmoid and terminal colostomy\nwere performed. Biopsy of the specimen con firmed the\ndiagnosis. The patient had a good immediate postoperative\nrecovery, and during a follow-up consultation two months\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS50\n\n\nlater, she showed good healing, adaptation to the ostomy, and\nno signs of recurrence.\nDiscussion Cavernous hemangioma of the rectosig-\nmoid is a rare benign vascular tumor, typically affecting\nyoung patients between the ages of 5 and 25. It often presents\nwith recurrent, painless rectal bleeding. Due to its rarity, it is\ncommonly misdiagnosed as hemorrhoids, proctocolitis, or\nother pathologies. Colonoscopy is essential for diagnosis,\nwith typical findings of multiple tortuous and dilated blood\nvessels. Thrombosis of these vessels can lead to ischemia of\nthe rectal wall, resembling colitis. Magnetic resonance imag-\ning can aid in diagnosis and assessment of the extent of\ninvasion of adjacent structures, the anal canal, and the\nsphincter. The only treatment that controls bleeding is com-\nplete surgical resection with preservation of the anal sphinc -\nter whenever possible. Although permanent colostomy is\nundesirable, especially in young patients, abdominoperineal\namputation of the rectosigmoid is necessary if the lesion\nextends to the anal canal and perineum. Non-surgical tech-\nniques such as sclerotherapy and selective embolization\nangiography can control acute bleeding and treat small\nlesions, but recurrence is high.\nConclusion Colorectal cavernous hemangioma is a\nrare pathology, with delayed diagnosis due to its presentation\nbeing similar to more common diseases. As seen in the\npresented case, many young patients end up undergoing\nabdominoperineal amputation with irreversible ostomy.\nThus, studies on alternative therapeutic approaches that\npreserve the anal sphincter in cases with perineal involve-\nment are needed.\nDoenças Anorretais\nAnorectal Diseases\nID – 138286\nE-poster\nPERIANAL PAPILLARY HIDRADENOMA\nMatheus Walerio Braido Arantes 1, Gabriela Pandini 1, Fernanda\nGarcia de Carvalho Pereira 1, Juanita Justina Ferreira da Silva 1,\nGiovane Amui Fernandes 1, João Gomes Netinho 1\n1Faculdade de Medicina de São José do Rio Preto, São José do Rio\nPreto, Brazil\nCase Presentation The patient is a 56-year-old white\nwoman who presented with a painless nodule in the perianal\nregion, which had been slowly growing for 6 months. She\ndenies any comorbidities or family history of neoplasms.\nUpon examination, a cystic nodule measuring 10 /C2 20 mm\nwas observed 3 cm from the anal margin. The patient\nunderwent excisional biopsy of the lesion under local anes-\nthesia, and the histological diagnosis was papillary\nhidradenoma.\nDiscussion Papillary hidradenoma is a rare, benign\ncystic tumor of apocrine glands. It typically presents as an\nanogenital nodule in women, most commonly between the\nages of 30 and 50. Its most common location is the vulva, with\nrare occurrences in other regions. Perianal involvement is\nrare, with only around 20 reported cases in the past 20 years.\nLiterature describes this lesion as a tumor that predominant-\nly affects post-pubertal white women. Clinically, the tumor\nappears as a single, painless, small ( <2 cm) unilateral nodule\nwith intact overlying skin, fibroelastic consistency, well-\ndefined borders, and mobility; it can also be polypoid,\nvegetative, or cystic in nature. Symptoms in the perianal\nregion are rare, but some cases may present with pain,\nburning sensation, discharge, bleeding, or pruritus. Histolog-\nically, the tumor is located in the dermis, separated from the\nepidermis by fibrous connective tissue. There is controversy\nin the literature regarding the tumor’s potential to evolve into\ncancer. Some authors consider malignancy a possibility,\nwhile others do not. Adenomatous hyperplasia with cellular\npleomorphism and irregular papillary acinar patterns with-\nout lumen formation raise speculations about its malignant\npotential; sometimes, this lesion is misdiagnosed as adeno-\ncarcinoma. The differential diagnosis is broad, including\nbenign lesions such as hemorrhoidal disease, anorectal ab-\nscess, viral warts, sebaceous cysts, lipomas, and neuro fibro-\nmas, as well as malignant lesions such as metastatic papillary\ncarcinoma and squamous cell carcinoma. Excisional biopsy\nwith margins is suf ficient for diagnosis, treatment, and cure.\nConclusion Considering the histological diversity of\nthe anal region, biopsy is essential for diagnostic clari fication\nof all unusual lesions in the perianal area.\nDoenças Anorretais\nAnorectal Diseases\nID – 137489\nE-poster\nPAPILLARY HIDRADENOMA IN THE PERIANAL REGION IN A\nMALE PATIENT: A CASE REPORT\nLarissa Ganança Buosi 1, Barbara Tannús Valadão 1, Bruna\nGrazielly Oliveira Silva1, Reginaldo Rodrigues Do Prado1, Ulisses\nMarques Cardoso 1, Mariane Tonin Jatobá 1, Mariella Furlan\nCarneiro1, Lívia Oliveira 1\n1Hospital São Francisco, Brasília, Brazil\nCase Presentation Patient, E.G.S., male, 46 years old,\nwas referred by dermatology for a right perianal nodule\npresent for 5 months, with associated in flammatory process.\nHe denies fever, weight loss, or pain upon palpation. On\nphysical examination, a 1 cm verrucous nodular lesion was\nfound, with no signs of in flammation or fistulous tract. He\ndenies comorbidities and a history of perianal diseases. Pelvic\nMRI showed a 1 cm perianal nodular image with no lymph-\nadenopathy. He underwent excision of the lesion with mar-\ngins. The histopathology report con firmed papillary\nhidradenoma in the right perianal region, with complete\nexcision of the lesion.\nDiscussion Papillary hidradenoma is a rare and be-\nnign cystic tumor originating from apocrine sweat glands in\nthe anogenital region. This tumor is more commonly found in\nwomen, with fewer occurrences in men between 30 and 45\nyears old. The vulva and labia majora are the most frequent\nsites, while it is less common in the labia minora, perineum,\nanal region, and extragenital areas. The vulvar occurrence is\nfour times more frequent than perianal. It typically presents\nas a small, painless, mobile tumor with fibroelastic consis-\ntency. It can be vegetative, polypoid, or cystic in nature.\nSymptoms in the perianal region may include pain, burning,\nand itching, often related to concomitant fecal passage.\nHistologically, it shows a hyperplastic adenomatous pattern\nwith clusters of glandular acini, cysts, and tubules, covered by\na double layer of columnar and myoepithelial cells in the\ndermis. Malignant transformation is rare, and the tumor has a\nbenign behavior with no recurrence or metastasis. Differen-\ntial diagnoses include external hemorrhoids, anal abscess,\nviral warts, and squamous cell carcinoma. It is less commonly\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S51\n\n\nconfused with neuro fibroma, sebaceous cysts, lipomas, or\nmelanoma.\nConclusion Anogenital papillary hidradenomas are\nuncommon tumors, and their histological and molecular\nprofiles have been little studied. Dermatoscopic analysis of\nthe lesion does not provide an accurate diagnosis, making\nproctological evaluation necessary. Local excision is the\ntreatment of choice, and recurrence is rare, typically due to\nincomplete excision of the primary tumor. The limited num-\nber of reports in the literature regarding male involvement,\ncoupled with the dif ficulty in suspicion, makes this issue\nchallenging. Due to the wide range of differential diagnoses,\nincluding both malignant and benign conditions, biopsy and\nhistopathological examination are essential for lesions in the\nperianal region, enabling diagnosis and treatment.\nDoenças Anorretais\nAnorectal Diseases\nID – 136547\nE-poster\nNECROTIZING SOFT TISSUE INFECTION IN THE PERIANAL\nREGION: A RETROSPECTIVE STUDY AT HOSPITAL ESTADUAL\nALBERTO TORRES\nAndré Figueiredo Accetta 1, Italo Accetta 2, Ronaldo Vianna\nSilva2, Giovanna Jurcunas de Oliveira Gaeta1, Angelica Freitas da\nSilva Kneipp 1, José Antonio Dias da Cunha e Silva 1, Leonardo\nSantos de Almeida Alves 1, Eduardo Cortez Vassallo 1\n1Universidade Federal Fluminense, Niterói, Brasil\n2Hospital Estadual Alberto Torres, São Gonçalo, Brasil\nIntroduction Necrotizing soft tissue infection (NSTI)\nis a severe condition that can affect the skin, subcutaneous\ntissue, fascia, and muscles. It is polymicrobial and rapidly\nprogressive, and if not recognized and treated early, it spreads\nto adjacent tissues with signi ficant potential for devastation\nand systemic impact. Other terms used include fasciitis,\nnecrotizing fasciitis, perineal necrosis, and Fournier ’s syn-\ndrome. Despite clinical, diagnostic, and intensive care advan-\nces, it carries high morbidity and mortality rates.\nObjective To study the characteristics of patients\ntreated for perineal NSTI.\nMethod A retrospective study conducted from Janu-\nary 2019 to December 2022, involving patients treated for\nNSTI. Data on age, gender, affected region, comorbidities,\nsigns and symptoms, complementary exams, clinical and\nsurgical treatment, hospitalization duration, and mortality\nwere collected.\nResults 31 patients were treated during the study\nperiod, ranging in age from 19 to 73 years, with 23 men. The\ngenital-perineal region was the most affected (28), followed\nby the buttocks and sacral region (2 each). Diabetes mellitus\nassociated with hypertension were the most common comor-\nbidities (14). Overweight was observed in 12 patients. Thirty\npatients complained of local pain, 24 had fever, and 23\npresented swelling and erythema with a mass. Crepitus\nand discharge with skin necrosis were seen in 24 cases.\nLeukocytosis above 12,000 was found in 28 patients, and\nabove 20,000 in 13. A CT scan was performed on 20 patients,\nwith 16 showing gas in the region and four showing only local\nedema. All patients received antibiotics upon admission, with\n26 maintaining the same regimen until treatment completion\nand five requiring changes or additions. Surgical debridement\nwas performed on all patients, with three requiring colosto-\nmy. A single debridement was sufficient in 24 cases, two were\nneeded in six, and four in one. Cultures of secretions or tissues\nwere done in 16 patients, with six results negative. The\nhospitalization period ranged from 5 to 30 days (median\n14.5), with 29 patients staying more than a week, and one\ndeath was recorded.\nConclusion NSTI constitutes a surgical emergency,\nwith treatment based on early and extensive debridement,\nantibiotic therapy, and maintenance of a clean surgical\nwound free from necrotic tissue. Colostomy should only be\nperformed in patients with perineal lesions who are\nbedridden.\nDoenças Anorretais\nAnorectal Diseases\nID – 141459\nE-poster\nELASTIC BAND LIGATION – DATA UPDATE\nBlanca da Silva Martinez 1, Mariana Gonçalves Marangon 1,\nRaquel Prando Moura dos Reis 1, Antonio Jose Tiburcio Alves\nJunior1, Odorino Hideyoshi Kagohara 1, Sergio Oliva Banci 1,\nCleberson Donizeti da Silva Leal 1, José Alfredo dos Reis Junior 1\n1Clínica Reis Neto, Campinas, SP, Brasil\nIntroduction Elastic Band Ligation is a minimally\ninvasive procedure used to treat hemorrhoidal disease.\nObjective To demonstrate the technique and present\nstatistical data related to Elastic Band Ligation.\nMethod A prospective study followed patients with\ninternal hemorrhoidal disease, without external hemor-\nrhoidal disease, of any age or sex, with postoperative fol-\nlow-up of Elastic Band Ligation for up to 12 months. From\nJanuary to December 2023, 101 patients with internal hem-\norrhoidal disease, grades II and III, were treated on an\noutpatient basis, with the aim of addressing all areas in a\nsingle session. Technique: With the patient in Sims ’ position,\nlocal anesthesia (0.5 ml of lidocaine in the submucosal layer)\nwas administered. Elastic Band Ligation was performed by\naspirating the affected internal hemorrhoidal nipple just\nabove the pectinate line. The procedure was carried out using\na rubber band applicator device designed speci fically for this\ntype of procedure, with a larger caliber and a wider and\nlonger anoscope, allowing for better visualization of the anal\ncanal.\nPreliminary Results The patients were followed up\nuntil July 2024, and the following complications were identi-\nfied: signi ficant or recurrent bleeding (8.6%), moderate to\nsevere pain (15%), pain requiring intravenous medication\n(1%), tenesmus (26%), urinary retention (8.6%). After clinical\nfollow-up of up to one year, a recurrence rate of 21% was\nobserved. Patients with recurrence were re-treated with a\nnew session of Elastic Band Ligation.\nConclusion Elastic Band Ligation proved to be an\nefficient technique with a low recurrence rate, minimal or\nno discomfort during or after the procedure, in addition to\nbeing cost-effective and easy to perform.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS52\n\n\nDoenças Anorretais\nAnorectal Diseases\nID – 138276\nE-poster\nINFERIOR MESENTERIC ARTERIOVENOUS MALFORMATION AS\nA DIFFERENTIAL DIAGNOSIS OF INFLAMMATORY BOWEL\nDISEASE: A CASE REPORT\nFelipe Pereira Gomes 1, Ana Caroline Bohn 1, Ana Júlia Schnorr\nMayer1, Júlia Wagner Guedes 1\n1Hospital Santa Isabel, São Paulo, Brazil\nCase Presentation A 32-year-old woman has been\nunder follow-up at the coloproctology outpatient clinic for 8\nyears due to increased frequency of bowel movements and\nthe presence of blood and pus in the stool. She was previously\ndiagnosed with ulcerative colitis based on colonoscopies\nshowing mucosal fragility in the rectosigmoid and increased\nvascularization, with histopathology indicating mild conges-\ntion of the lamina propria. She was initially treated with\nmesalazine, and later, azathioprine, infliximab, and adalimu-\nmab were added, but the symptoms remained uncontrolled,\nrequiring up to 7 units of packed red blood cells per month. In\nthe most recent endoscopic exam, the sigmoid and rectal\nmucosa showed increased vascular patterns, with multiple\nangiodysplasias. This led to the exclusion of an in flammatory\ndisease and the initiation of vascular investigation. Magnetic\nresonance angiography revealed the presence of multiplefine\ntortuous venous structures in the mesorectum and meso-\nsigmoid, with low flow, characterizing a vascular malforma-\ntion. These malformations were associated with marked\ndiffuse circumferential thickening of the rectum and sigmoid,\nespecially involving the submucosal layer. Both the angiog-\nraphy and arteriography failed to identify a predominant\nfeeding artery or draining vein. Given the presence of mal-\nformations extending to the anal canal, the decision was\nmade to perform an abdominoperineal amputation, with\nresection of the colon at the descending level and terminal\ncolostomy. During surgery, the sigmoid appeared violet-\ncolored, with vascular malformations visible. Histopathology\nconfirmed an arteriovenous malformation (AVM) affecting\nthe pericolonic adipose tissue and intestinal wall. The patient\nhad a good recovery in both the immediate and late postop-\nerative periods, with no further episodes of bleeding.\nDiscussion This case presents a diagnosis of an arte-\nriovenous malformation (AVM) originating from branches of\nthe inferior mesenteric artery, a less frequent location for this\nuncommon vascular phenomenon. AVMs are high- flow vas-\ncular malformations that cause symptoms due to reduced\ntissue oxygenation. In the colon, hypoxia may lead to ischemic\ncolitis, which is often a challenging diagnosis and can mimic\ninflammatory bowel disease or diverticulitis. Therefore, imag-\ning exams become a crucial tool in the diagnostic investigation.\nConclusion This case aims to highlight a rare differ-\nential diagnosis that should be considered when a patient is\nrefractory to treatment for the primary diagnosis.\nDoenças Anorretais\nAnorectal Diseases\nID – 138346\nE-poster\nTHE IMPACT OF DEFECOGRAPHY MAGNETIC RESONANCE\nIMAGING IN CLINICAL PRACTICE\nRenan de Assis Pereira 1, Gilberto Bruno Costa Araújo 2, Tiago\nVasques Bertoncini3, Alexandre Sérgio de Araujo Bezerra 3,\nAline Martins Oliveira 1,4, Joao Batista de Sousa 3, Mayra Veloso\nAyrimoraes Soares1,3,4, Layra Ribeiro de Souza Leão 1,4\n1Rede DASA, São Paulo, Brasil\n2D‘Or Star, São Paulo, Brasil\n3Universidade de Brasilia, Brasilia, Brazil\n4Hospital Sirio Libanes, São Paulo, Brazil\nIntroduction Defecographic magnetic resonance im-\naging is an advanced technique that plays a crucial role in\ndiagnosing pelvic floor disorders through a dynamic study\nthat analyzes the morphology and functionality during defe-\ncation. It is particularly useful in the differential diagnosis of\npelvic organ prolapse, evacuation disorders, and continence\nissues, enabling more effective clinical and surgical\napproaches.\nObjective To explain the effectiveness of Defeco-\ngraphic Magnetic Resonance Imaging in identifying pelvic\nfloor disorders and exemplify its application in clinical prac -\ntice, aiming to improve the diagnosis and treatment of these\nconditions.\nMethod A pictorial essay and analysis of clinical cases\nwhere dynamic defecography by MRI was used, comparing\ndiagnostic results with other imaging techniques such as\nfluoroscopy and ultrasonography.\nResults Compared to clinical examination and other\nimaging methods, defecographic MRI was able to diagnose a\nhigher proportion of patients with multi-compartmental\nperineal disorders. Additionally, it was more accurate than\nclinical examination alone in identifying pelvic organ pro-\nlapse and signi ficantly better in identifying cystocele, rectal\nprolapse, and enterocele. In patients with symptoms of pelvic\nfloor disorders, defecographic MRI provides additional infor-\nmation beyond clinical examination. Therefore, it is indicated\nfor symptomatic patients with negative clinical findings or\nsuspected multi-compartmental pelvic floor involvement.\nConclusion The ability to provide detailed and dy-\nnamic visualization of pelvic structures enhances diagnostic\naccuracy and guides more effective therapeutic interven-\ntions. Wider adoption of defecographic MRI, combined\nwith a multidisciplinary approach, is crucial for achieving\nbetter clinical outcomes.\nDoenças Anorretais\nAnorectal Diseases\nID – 138132\nE-poster\nRECTAL PROLAPSE IN A FEMALE PATIENT: CASE REPORT\nVinícius da Cruz Silva 1, Jacqueline Jessica de Marchi 1, Gustavo\nLima Guilherme 1, Maria Fernanda Almeida Miranda 1, Gabriely\nDiniz Bruno1, Gabriela Omena Silva 1, Rafael Morais Esteves de\nLima1\n1Universidade Federal do Mato Grosso, Cuiabá, Brazil\nCase Presentation A 70-year-old female patient with\na history of diabetes, hypertension, dyslipidemia, and four\nvaginal deliveries presented with active rectal bleeding,\nurinary urgency, lower abdominal pain, and fecal and urinary\nincontinence during minor physical efforts for three years.\nPrevious medical consultations did not resolve her\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S53\n\n\nsymptoms. On physical examination, rectal prolapse of ap-\nproximately 14 cm from the anal canal was observed. Defe-\ncography MRI revealed diffuse thinning of the pelvic floor\nmuscles, an open internal anal sphincter, and an open,\nshortened anal canal at rest. Additionally, moderate uterine\nprolapse, severe perineal descent with pronounced perito-\nneocele and sigmoidocele, a 14 cm descent of the anorectal\njunction below the pubococcygeal line, and signi ficant rectal\nprolapse were noted. Anorectal manometry showed resting\nand contraction pressures below normal limits, with reduced\nshort and ultrashort waves in the manometric trace and\ndecreased rectal sensitivity. As part of the diagnostic workup,\nthe patient was referred for both hysterectomy and rectopexy\nsurgery.\nDiscussion Rectal prolapse is a relatively rare and\nbenign condition, with a prevalence of approximately 0.5% in\nthe general population. It manifests as rectal protrusion\nthrough the anus and is more common in women of the\npatient’s age group. Typical symptoms include rectal bleed-\ning, fecal incontinence, and lower abdominal pain. The pres-\nence of rectal prolapse during physical examination aids in\nconfirming the clinical diagnosis, supported by defecography\nMRI findings. In this case, surgical intervention is well-\nindicated. Various surgical techniques, such as Delorme ’s\nprocedure, abdominal rectosigmoidectomy, or anal rectosig-\nmoidectomy, may be evaluated to eliminate prolapse, correct\nfunctional abnormalities related to incontinence and consti-\npation, and prevent intestinal complications. Consequently,\nthe initial referral for gynecological surgery is reasonable,\nemphasizing the necessity of a holistic evaluation and con-\nsideration of the patient ’s comorbidities in treatment\nplanning.\nConclusion This case underscores the importance of a\ncomprehensive and individualized approach to managing\nrectal prolapse. It highlights the need to address the condition\nitself alongside any comorbidities and additional factors that\nmay in fluence disease progression and therapeutic\noutcomes.\nDoenças Anorretais\nAnorectal Diseases\nID – 141626\nE-poster\nTOTAL RECTAL PROLAPSE MIMICKING RECTAL TUMOR IN A\nYOUNG PATIENT: CASE REPORT\nLara Burlamaqui Veras 1, Carolina Vannucci Vasconcelos\nNogueira Diógenes1, Victor Ripardo Siqueira1, William Pinheiro\nBoavista de Oliveira 1, Matheus Emanuel de Brito Castelo\nBranco1, Thaís Barroso Vieira Costa Bon fim1, Carlos Yuri\nMonteiro de Paiva 1, Bruna Beatriz de Sousa Vasconcelos 1\n1Universidade Federal do Ceará, Fortaleza, Brazil\nCase presentation A 21-year-old male patient, previ-\nously healthy, presented with one year of hematochezia,\nanemia, and a 5 cm rectal prolapse following defecation,\nrequiring manual reduction. He reported a 2 kg weight loss\nover two months with no changes in bowel habits. The\npatient denied comorbidities or prior surgeries but recalled\nan electric shock to the perineal region at age 14. Colonoscopy\nrevealed a friable, stenotic lesion 6 cm from the anal verge\n(AV), obstructing 80% of the lumen and extending up to 15 cm\nfrom the AV. Biopsies showed no malignancy. Endoanal\nultrasound demonstrated parietal thickening of the anorectal\njunction and lower rectum extending to the submucosa,\noccupying the entire posterior hemicircumference without\nsphincter involvement. The lesion was located 0.6 cm proxi-\nmal to the puborectal muscle and 4.4 cm from the anal\nmargin, suggesting rectal prolapse. Dynamic studies identi-\nfied mucosal prolapse, anismus, and recto-rectal intussus-\nception. Pelvic MRI showed diffuse, expansile thickening,\noccasionally with a sessile polypoid appearance, throughout\nthe rectum to the anal canal, con fined to the muscularis\npropria, without pelvic lymphadenopathy. Manometry\nrevealed resting pressure 55% below normal, voluntary pres-\nsure 50% below normal, preserved sustained contraction, and\nthe presence of anismus. Considering a potential neoplastic\nprocess, laparoscopic rectosigmoidectomy with ultralow co-\nlorectal anastomosis was planned. Intraoperatively, marked\nrectal wall thickening and dilation precluded stapling, neces-\nsitating a perineal approach. The surgery proceeded without\nfurther complications. Histopathology revealed angiodyspla-\nsia, hypertrophy of the external muscularis, and fibrosis, with\nno evidence of malignancy.\nDiscussion Rectal prolapse is the concentric protru-\nsion of the rectum through the anal canal, often associated\nwith fecal incontinence, constipation, and/or hematochezia.\nIt is most prevalent in elderly women, and its occurrence in\nyoung adults is rare, often linked to prior pelvic surgeries,\nwhich was not the case here. The treatment of choice is\nsurgical, with abdominal approaches preferred for younger\npatients and perineal approaches for elderly patients at high\nsurgical risk.\nConclusion Given the uncommon presentation of\nrectal prolapse in young patients, the possibility of malignant\nneoplasia cannot be excluded. This consideration may in flu-\nence the choice of surgical technique.\nDoenças Anorretais\nAnorectal Diseases\nID – 134773\nE-poster\nPSEUDO-STRANGULATED HEMORRHOIDS AFTER\nLAPAROSCOPIC RECTOSIGMOIDECTOMY\nRubens Sacchettin Marçal Rigo\n1, Bruna Meirelles Carregaro 1,\nIana Faine Saran 1, Janaina Giotti 1, Bernardo Fontel Pompeu 1,\nIdblan Carvalho de Albuquerque 1, André Luigi Pincinato 1,\nFernanda Bellotti Formiga 1\n1Hospital Heliópolis, São Paulo, SP, Brasil\nCase presentation A 48-year-old male patient with\nmixed hemorrhoidal disease and a diagnosis of sigmoid\nadenocarcinoma (cT3NþM0) underwent laparoscopic recto-\nsigmoidectomy with a mechanical end-to-end colorectal\nanastomosis. On the third postoperative day, he developed\nabdominal distension, cessation of stool and gas passage,\nnausea, poor dietary tolerance, and anal discomfort. Abdom-\ninal X-ray revealed small bowel distension, air- fluid levels,\nand a coin-stacking sign. The patient subsequently experi-\nenced pain and hematochezia, with findings of pseudo-\nstrangulated hemorrhoids, including necrosis of one internal\nhemorrhoidal cushion. Open classical hemorrhoidectomy\nwas performed on the fourth postoperative day. The patient\nshowed progressive improvement in abdominal distension\nand anal pain and was discharged on the seventh postopera-\ntive day.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS54\n\n\nDiscussion External and internal hemorrhoidal\nthrombosis are complications of hemorrhoidal disease, often\ntriggered by factors such as evacuation trauma due to chronic\nconstipation, opioid use, diarrhea, pregnancy, local trauma,\nor dietary excess. Pseudo-strangulated hemorrhoids repre-\nsent the most severe form of internal hemorrhoidal throm-\nbosis, characterized by prolapse of three hemorrhoidal\ncushions causing edema of external hemorrhoids or skin\ntags, with possible ischemia or necrosis due to sphincter\ncompression. This condition causes intense pain, hindering\ndefecation. Several surgical techniques employing the anal\nregion as a rectal access route (e.g., circular stapler, TEM,\nTAMIS, NOSE) are increasingly utilized. While anal trauma is a\npotential consequence of these techniques, complications\nsuch as pseudo-strangulated hemorrhoids are rare. To date,\nonly one case of hemorrhoidal thrombosis post-TAMIS has\nbeen reported in the literature. This case highlights the\noccurrence of pseudo-strangulated hemorrhoids secondary\nto stapling in minimally invasive surgery in a patient with\npre-existing hemorrhoidal disease. The complication led to\npostoperative ileus, required surgical intervention, and\ndelayed hospital discharge.\nConclusion Surgical trauma from anorectal access\nroutes can result in hemorrhoidal thrombosis. Adequate\nproctological examination during the perioperative period\nof abdominal surgery and prompt intervention can prevent\nmore severe complications.\nDoenças Anorretais\nAnorectal Diseases\nID – 138914\nE-poster\nRECTO-PERINEO-VAGINAL RECONSTRUCTION FOLLOWING\nSEVERE OBSTETRIC TRAUMA – CASE REPORT\nAugusto Zbonik Mendes 1, Sinara Mônica de Oliveira Leite 1,\nIlson Geraldo da Silva 1, Guilherme de Almeida Santos 1,\nMatheus Duarte Massahud 1, Patrícia Costa Sant ‘ana1, Mario\nInácio Carneiro Neto 1, Hana Jermani Coelho 1\n1Santa Casa de Belo Horizonte, Belo Horizonte, Brasil\nCase presentation A 56-year-old female patient with\nfecal and gas incontinence and recurrent urinary tract infec -\ntions was diagnosed with a laceration of the rectum, anal\nsphincter, perineal body, and the distal third of the vagina.\nObstetric history includes four vaginal deliveries with the use\nof forceps. Proctological examination revealed labiated ante-\nrior rectal and posterior vaginal mucosa, with a complete\nrupture of the musculature between these organs and rectal\nprolapse. Digital rectal examination showed the absence of\nanterior sphincteric musculature —an open ring —with com-\nplete hypotonia. Rectocele was present. Endoanal ultrasound\nconfirmed the anterior sphincter injury and perineal body\ninjury. Anorectal manometry showed decreased internal and\nexternal sphincter pressures without paradoxical contraction\nof the puborectal muscle. The surgery involved individualiza-\ntion of the vagina and rectum up to the cul-de-sac and cervix,\nlateral dissection of the rectum, with medial mobilization of\nthe rectal wall, reconstruction of the posterior vaginal wall\nover 7 cm, longitudinal plication of the anterior rectal wall\nover 8 cm to correct the rectocele, reconstruction of the distal\nanterior rectal wall, dissection of all damaged musculature\n(perineal body and sphincters) as a block, and medial mobili-\nzation. The musculature was sutured using X stitches without\ntension, followed by perineal skin closure. The patient was\ndischarged on the second postoperative day.\nDiscussion Fecal incontinence (FI) has a prevalence of\n15% in the population, primarily affecting multiparous and\nelderly women. Sphincter injuries may occur in 0.5-5% of\nvaginal deliveries, and 33-59% of these patients will develop\nFI as they age, signi ficantly impacting their quality of life.\nObstetric injuries can vary and may be complex, involving\ndifferent pelvic compartments, innervation, organs, and sup-\nporting structures, leading to a range of clinical presenta-\ntions. The goal of surgical intervention is to restore the\ndamaged anatomy. The earlier the intervention, the better\nthe results, with 40% of patients showing excellent outcomes\nwithin 5 years post-surgery. However, symptoms may recur\ndue to changes typical of menopause. Physiotherapeutic\nrehabilitation is essential for better functional results.\nConclusion Proper preparation during pregnancy is\nessential to prevent injuries during vaginal delivery. Postpar-\ntum injuries can be repaired immediately by a quali fied\nprofessional. Chronic injuries should be studied with atten-\ntion to the pelvic floor as a functional unit to ensure treat-\nment is strategic and multidisciplinary.\nDoenças Anorretais\nAnorectal Diseases\nID – 138295\nE-poster\nMUSCULAR FLAP IN THE TREATMENT OF RECURRENT\nRECTOVAGINAL FISTULA – CASE REPORT\nBreno Xaia Martins da Costa 1, Sandro Puig Pena 1, Marina\nBarbabela Grisolia de Oliveira 1, Artur Duarte e Duarte 1, Letícia\nBrandão Castro1, Marco Rinoldi 1, Vinicius Avelar Palhares 1\n1Hospital Felício Rocho, Belo Horizonte, Brazil\nCase Presentation A 20-year-old female patient pre-\nsented with a foreign body in the vagina, evolving into sepsis\nsecondary to a complicated rectovaginal fistula. An ileostomy\nwas performed. A pelvic MRI revealed extensive discontinuity\nof the posterior vaginal wall, with signs of communication\nwith the anterior rectal wall and small, partially de fined\ncollections. The patient underwent a new surgical treatment\ninvolving perineal reconstruction using a gracilis muscle flap.\nDiscussion Rectovaginal fistulas are abnormal com-\nmunications between the rectum and the vagina. Predispos-\ning factors include trauma, in flammatory bowel disease,\ninfection, tumors, and a history of pelvic radiation. Symptoms\nare characterized by the uncontrollable passage of feces and\ngases through the vagina. For asymptomatic patients, a peri-\nod of vigilant waiting may resolve the issue. When choosing a\nsurgical approach, factors such as risk factors, previous\nrepairs, and sphincter integrity should be considered. Inter-\nposition techniques are well-indicated in cases of refractory\nfistulas or when adjacent tissue is damaged. Among these\ntechniques, the use of the gracilis muscle has been shown to\nbe versatile due to its easy dissection, well-defined tendinous\nand muscular portions, long muscle length with great con-\ntractile potential, and minimal morbidity at the donor site.\nConclusion The presence of in flammation, infection,\nand scar tissue makes primary repair inadequate and is\nassociated with failure in subsequent surgical procedures.\nLocal treatments with advancement flaps or biomaterials are\nassociated with relatively high recurrence rates, likely due to\nthe inadequate volume of well-vascularized tissue.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S55\n\n\nReconstruction using autologous tissue interposition, such as\nthe gracilis flap, seems more promising as it introduces\nhealthy, vascularized tissue and creates better conditions\nfor local healing and defect correction. Managing rectovaginal\nfistulas remains a challenge. Regardless of the surgical option\nchosen, the failure and recurrence rates remain high.\nDoenças Anorretais\nAnorectal Diseases\nID – 138140\nE-poster\nTREATMENT OF URETHRORECTAL FISTULA BY TRANSANAL\nENDOSCOPIC SURGERY: STANDARDIZATION AND CRITICAL\nANALYSIS\nMariane Louise Quaglio Marques 1, Mirtes Okawa Essashika\nNascimento1, Marley Ribeiro Feitosa1, Antonio Balestrim Filho1,\nVanessa Foresto Machado 1, Rogério Sera fim Parra1, Omar\nFéres1, José Joaquim Ribeiro da Rocha 1\n1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil\nCase Presentation A 56-year-old male underwent\nopen radical prostatectomy for prostate adenocarcinoma. He\ndeveloped severe peritonitis and septic shock on the 8th\npostoperative day due to rectal perforation. Laparotomy was\nperformed with cavity lavage, loop colostomy, and prolonged\nbladder catheterization. After recovery, he developed urinary\nleakage through the anus. A proctological examination\nrevealed an anterior rectal opening, 3 cm from the anal rim,\n10 mm in diameter, with retraction of the adjacent mucosa.\nSurgical treatment for urethrorectal fistula (URF) through a\ntransanal approach was indicated. Dissection and removal of\nfibrous tissue were performed, exposing the urethral and rectal\nopenings. A layered suture was applied, interposing a submu-\ncosal flap from porcine small intestine between the urethral\nand rectal sutures. The bladder catheter was kept in place for\ntwo months and was removed after con firming complete\nclosure of the fistula through voiding uretrocystography.\nDiscussion Urethrorectal fistula (URF) is an uncom-\nmon condition, predominantly iatrogenic, particularly fol-\nlowing prostatectomy or rectal surgeries, although it may also\nresult from trauma, radiotherapy, or pelvic in flammatory\nprocesses. The standard treatment is surgical, and the ap-\nproach can in fluence success rates, recurrence, and the\npatient’s quality of life. Several approaches have been de-\nscribed: transanal, transperineal, transsphincteric, and trans-\nabdominal. Regardless of the technique, the treatment of URF\nmust adhere to surgical principles: adequate exposure with\nindividualized anatomical structures, removal of foreign\nbodies or synthetic materials, careful dissection with mini-\nmal trauma, well-adapted tension-free suturing in layers, use\nof well-vascularized flaps, urinary drainage, and prevention\nand treatment of infections with appropriate antibiotic use.\nThe use of fecal diversion, before or after correction, is\ncontroversial. In the reported case, the transanal technique\navoided combined abdominal approaches and provided good\nexposure of the surgical field, with a low risk of severe\nsequelae, as there was no excessive sphincter manipulation.\nConclusion Transanal endoscopic surgery proved to\nbe effective, with low morbidity, and should be considered for\nthe surgical treatment of patients with urethrorectal fistula.\nDoenças Anorretais\nAnorectal Diseases\nID – 138280\nE-poster\nTREATMENT OF HEMORRHOIDAL PROLAPSE WITH MYIASIS\nAT A REGIONAL HOSPITAL IN THE FEDERAL DISTRICT - CASE\nREPORT\nJuliana Larissa Lauriano Ramos 1, Carolina Máximo Vieira 1,\nGeovanna Arnaldo de Sousa 1, Lucas de Arruda Hidalgo 1,\nMateus Fernandes de Oliveira Vilela 1, Quemuel Henrique Cruz\nSantos1, Marccus Antônio Tolentino de Jesus 2\n1Hospital Regional de Taguatinga, Taguatinga, Brasília, Brazil\n2Hospital Universitário de Brasília, Brasília, Brazil\nCase Presentation A 53-year-old male patient, with\nno known comorbidities, in a vulnerable social situation, was\nadmitted to a regional public hospital in the Federal District\nwith complaints of bleeding, prolapsed hemorrhoids associ-\nated with hemorrhoidal myiasis. On physical examination,\ngrade IV hemorrhoidal nodules were present at 11 o ’clock\nand 7 o ’clock, with metaplasia in the distal third, active\nbleeding, and local myiasis. Antibiotic therapy was initiated,\nand an ivermectin dose was administered. A colonoscopy was\nperformed, revealing a normal endoscopic examination. A\nbiopsy was performed, showing moderate proctitis in the\nanal canal/distal rectum with reactive atypia, without evi-\ndence of high-grade dysplasia or invasive features. The pa-\ntient underwent a Milligan-Morgan hemorrhoidectomy on\nthe hemorrhoidal nodules. He had a good recovery and was\ndischarged with support from the social service for outpa-\ntient follow-up. Upon return evaluation, he presented with\nresidual plicae and no fistulas on examination, with no\ncomplaints or complications.\nDiscussion Hemorrhoidal disease is common and\naffects millions of people worldwide, representing a chal-\nlenge due to the uncomfortable symptoms and impact on\nquality of life. It is characterized by the enlargement and\ndisplacement of the anal cushions. The most common symp-\ntom is bleeding, and chronic increases in the effort during\nbowel movements can lead to prolapse. Physical examination\nis crucial for identifying hemorrhoids, and for patients with\nsuspected hemorrhoidal bleeding, endoscopic evaluation\nmay be necessary. Conservative treatment involves lifestyle\nchanges, while instrumental and surgical treatments are\nreserved for severe cases. Myiasis is a parasitic disease caused\nby the infestation of tissue by fly larvae. It can be classified as\nexternal (cutaneous) or internal (intestinal and cavity forms)\nand is directly associated with low socioeconomic status.\nConclusion The presence of myiasis associated with\nhemorrhoidal prolapse may be corroborated by the socioeco-\nnomic context present in this case. Clinical treatment, along\nwith surgical intervention, minimized the risk of other com-\nplications and improved the patient ’s quality of life.\nDoenças Anorretais\nAnorectal Diseases\nID – 138241\nE-poster\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS56\n\n\nRETRORECTAL CYSTIC TUMORS: CASE REPORT OF A TAILGUT\nCYST\nRoberta Oliveira Raimundo Borsato1, Ludymilla Ribeiro Bordoni\nde Oliveira1, Marcos Paulo Moraes Sales 1, Maria Clara Dias\nGiacomini1, Renata Sydio de Souza1, Cristiane de Souza Bechara\nMota1, Bianca Andrade Borsato 2, João Victor de Miranda\nAvelar1\n1Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de\nFora, Brazil\n2Centro Universitário Presidente Antônio Carlos, Juiz de Fora, MG,\nBrasil\nWoman, 34 years old, under investigation for anemia\nand menorrhagia. Pelvic magnetic resonance imaging revealed\na multiloculated retrorectal cystic lesion, hyperintense on T2-\nweighted images and hypointense on T1-weighted images,\nwith thickened walls, showing slight enhancement of the wall\nand septa with contrast. She underwent surgical cystectomy\nvia the Kraske approach, during which the lesion ruptured\nintraoperatively, resulting in the extrusion of thick, heteroge-\nneous, purulent content. She had a good clinical-surgical\nrecovery and was discharged on the 3rd postoperative day.\nHistopathology revealed an encapsulated, irregular, multi-\nloculated lesion measuring 6.8 /C2 4.5 /C2 3.0 cm, devoid of con-\ntent and lined with keratinizing and non-keratinizing\nsquamous epithelium. Findings were consistent with a retro-\nrectal cystic hamartoma with areas of rupture, without signs of\nmalignancy. Retrorectal space tumors can originate congeni-\ntally, secondary to embryological remnants, or from the\ndegeneration of adjacent anatomical structures. In adults,\nthese tumors are rare and predominantly benign, with a higher\nprevalence in middle-aged women. Most cases are asymptom-\natic and diagnosed incidentally, though they can present with\nrectal pain, hematochezia, infection, fistulization, or malig-\nnant degeneration. If infected, they may be misdiagnosed as\npilonidal cysts, anorectal fistulas, or recurrent retrorectal\nabscesses. On computed tomography or magnetic resonance\nimaging, they appear as well-de fined masses with heteroge-\nneous and multilobulated content. Findings of poorly defined\nmargins and local invasion suggest infection or malignancy.\nOther features indicative of malignant degeneration include\nwall thickening and the presence of intracystic vegetations.\nRegarding management, hindgut cysts require complete sur-\ngical excision for pathological analysis to confirm the diagnosis\nand rule out malignant degeneration, which may be focal and\nnot identified by guided biopsy. Differential diagnoses include\nepidermoid, dermoid, or rectal duplication cysts, mucinous\nperianal carcinoma, lymphangioma, and cystic teratoma. Ret-\nrorectal hamartomas are rare benign lesions, and histopatho-\nlogical evaluation enables diagnosis and exclusion of\nmalignancy. Complete surgical removal is necessary for de-\ntailed lesion assessment and to prevent recurrence.\nDoenças Anorretais\nAnorectal Diseases\nID – 138181\nE-poster\nUSE OF MESENCHYMAL CELLS IN THE TREATMENT OF A\nPATIENT WITH MULTI-RECURRENT FISTULA AND SYMPTOMS\nOF FECAL INCONTINENCE - CASE REPORT\nJoaquim Tiago Cardoso Leles de Jesus 1, Lucas Azevedo Ibrahin\nElmor2, Débora Alves Domingues Pereira 1, Elizabeth Madriaga\nBittencourt3, Bernardo Martins dos Santos 4\n1Hospital de Clínicas Nossa Senhora da Conceição, Três Rios, Brazil\n2Suprema Três Rios, Três Rios, Brazil\n3Hospital Central do Exército, Rio de Janeiro, Brazil\n4Santa Casa de Misericórdia de Barra Mansa, Barra Mansa, Brazil\nPatient LPMBS, a 41-year-old female, was referred to\nour service with a history of multi-recurrent anal fistula. She\nhad undergone three surgical procedures, including a con-\nventional fistulotomy with seton placement, which was\nsurgically removed after 30 days, and a ligation of the\nintersphincteric fistula tract (LIFT) procedure. Additionally,\ntwo ileocolonoscopies had been performed to rule out\nCrohn’s disease. The patient reported symptoms of urgency\nand rest incontinence for gas, as well as soiling due to a\n“keyhole defect ” caused by previous surgeries. Given her\ncomplaints, mesenchymal cell therapy was chosen as the\ntreatment approach. The surgical procedure involved collect-\ning material from the abdominal region using appropriate\nequipment. This material was used both to repair the fistula\nand to fill the “keyhole defect ” that caused her soiling\ncomplaints. The patient was discharged one day post-proce-\ndure. During outpatient follow-up, complete fistula healing\nwas observed by the third week, alongside improvements in\nsoiling and partial improvement in incontinence, with a\nreduction of 2 points on the Jorge-Wexner score. Fistula\nsurgery using mesenchymal cells has proven to be a safe\noption for complex fistula cases, with good cure rates. Dis-\ncussions are ongoing regarding its use in other conditions,\nsuch as anal fissures, Crohn ’s disease, cicatricial strictures,\nand as a filling substance. Notably, in this case, the therapy\nwas applied not only for fistula correction but also as a\ntherapeutic mechanism to mitigate the damage from previ-\nous procedures, yielding positive results. Thus, in addition to\nexpanding the therapeutic arsenal for complex fistulas, this\ntreatment may hold promise for other conditions.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 141673\nE-poster\nSPIROCHETE-INDUCED COLITIS BY BRACHYSPIRA SPECIES\nASSOCIATED WITH CHLAMYDIA MIMICKING CROHN ’S\nDISEASE: CASE REPORT\nJorge Lima Filho\n1, Glicia Estevam de Abreu 2, Paulo Andre Lago\nSilva3, Flora Maria Lorenzo Fortes 4\n1Faculdade Santo Agostinho, Teresina, Brazil\n2Escola Bahiana de Medina e Saúde Pública, Salvador, Brazil\n3Coloproctology Center of Bahia, Salvador, Brazil\n4Universidade Federal da Bahia, Salvador, Brazil\nCase Presentation We report the case of a 28-year-old\nman who has sex with men (MSM), with no prior history of\nimmunodeficiency, presenting to the clinic with complaints of\ndiarrhea with muco-bloody discharge, rectal pain, weight loss,\nand anorexia. Proctological examination revealed a posterior\nmidline analfissure with a sentinel skin tag and distal proctitis\nbut no purulent exudate. Given the clinical picture, laboratory\nand serological tests for sexually transmitted infections (STIs)\nwere requested, revealing positivity only for Chlamydia. How-\never, due to the patient’s age, diarrhea, and general symptoms,\nendoscopic examinations were also conducted to complement\nthe investigation. Although the initial findings from the colo-\nnoscopy supported the suspicion of in flammatory bowel\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S57\n\n\ndisease (Crohn’s Disease), the histopathological study revealed\ncolonization of the intestinal mucosa by spirochetes of the\nBrachyspira genus. The patient was treated with doxycycline\nfor 21 days, resulting in the complete resolution of intestinal\ncomplaints and general symptoms.\nDiscussion Intestinal spirochetosis, though rare, is a\ndisease that can mimic in flammatory bowel disease. Its\ndiagnosis is con firmed through histopathological examina-\ntion, and treatment is based on the use of antibiotics. The\nindividuals at higher risk are immunosuppressed patients\nand MSM; however, it can also occur in patients without\nimmunosuppression. Furthermore, it may be associated with\nanother infectious agent, as demonstrated in this case, where\nit was linked to Chlamydia.\nConclusion In patients, particularly MSM, presenting\nwith diarrhea and associated general symptoms, intestinal\nspirochetosis should be considered as a differential diagnosis,\neven in the absence of immunodeficiency. It may coexist with\nother infectious agents that also cause intestinal symptoms,\nsuch as Chlamydia.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 137989\nE-poster\nCHALLENGES IN THE TREATMENT OF HYPERTROPHIC HERPES\nIN A PATIENT LIVING WITH HIV: CASE REPORT OF CO2 LASER\nRESECTION\nYana Juliê Perondi1, Beatriz Castro de Sousa 1, Marjorye Schelle\nMagalhães1, Maria Roberta Meneguetti Seravali Ramos 1\n1Hospital Municipal da Piedade, Piedade, Rio de Janeiro, Brazil\nCisgender man, 61 years old, living with HIV/AIDS\n(PLWHA), with a CD4 count of 351 cells/mm³ and undetect-\nable viral load, presented with multiple recurrences of peria-\nnal lesions caused by hypertrophic herpes. Despite oral and\ntopical treatments, multiple surgical resections, and mainte-\nnance therapy with valacyclovir, the patient developed scar-\nring and partial anal border stenosis. Following the latest\nrecurrence and failure to respond to oral treatments, a CO2\nlaser resection was performed to prevent further complica-\ntions. The patient experienced faster-than-usual healing and\nreduced postoperative pain. Hypertrophic herpes virus infec -\ntion is a rare condition that poses diagnostic challenges,\nrequiring clinical suspicion and histological con firmation,\nparticularly to rule out squamous cell carcinoma. In PLWHA\nor immunocompromised individuals, atypical presentations\nof herpes virus, such as the hypertrophic pattern, can result in\ndiagnostic difficulties, drug resistance, and lesion recurrence.\nIn cases involving the perianal region, where surgical proce-\ndures risk causing stenosis and fecal incontinence, a combi-\nnation of topical and oral treatments is recommended to\nreduce lesions and prevent complications. CO2 laser treat-\nment emerges as an effective alternative in situations where\nconventional topical therapies are insuf ficient, especially for\nlarge lesions or those near the anal border.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138290\nE-poster\nIDIOPATHIC AND RAPIDLY PROGRESSIVE PERINEAL\nDESTRUCTION IN A PATIENT WITH ACQUIRED\nIMMUNODEFICIENCY SYNDROME\nArtur Cury Féres 1, Mirtes Okawa Essashika Do Nascimento 1,\nRodolfo Dahlem Melo 1, Thomaz Lucas Féres 2, Rogério Sera fim\nParra1, Marley Ribeiro Feitosa 1, Omar Féres 1, José Joaquim\nRibeiro da Rocha 1\n1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil\n2Centro Universitário Estácio de Ribeirão Preto, Ribeirão Preto, Brazil\nCase Presentation A 29-year-old man living with HIV\npresented to our outpatient clinic with a one-year history of a\nperianal nodule, hematochezia, and anal pain with discharge.\nOver the past six months, his condition progressively wors-\nened, requiring three drainages of perianal abscesses, two\nfistulotomies with seton placement in the operating room,\nand prolonged antibiotic therapy, none of which resulted in\ncomplete healing. He developed fecal incontinence and sub-\nsequently underwent ileostomy creation. Since the stoma\nprocedure, the anal lesion progressed rapidly, accompanied\nby refractory pain, dif ficulty sitting and walking, erectile\ndysfunction, and urine leakage through the perineum. The\npatient reported unintentional weight loss of 35 kg over one\nyear and the development of inguinal lymphadenopathy.\nProctological examination under anesthesia revealed an\nopen pelvic cavity, the rectum opening into the perineum,\nthe urethra transected at the prostate level, and surgical\nabsence of the sphincter apparatus. A urinary catheter was\ninserted through the perineum, and multiple biopsies (in-\ncluding inguinal lymph nodes) were performed, though no\ndefinitive diagnosis was established. The patient was placed\non systemic antibiotic therapy and received intensive care for\nthe perineal wound, which showed partial granulation.\nDiscussion The perineal region can be affected by\nsevere and advanced malignancies or by infectious diseases\nthat may progress to deep involvement and complete tissue\ndestruction. Squamous cell carcinoma, although rare, has\nseen a global increase in incidence, particularly among\nindividuals living with HIV, and was our primary diagnostic\nsuspicion in this patient. In 30 –40% of cases, inguinal lymph\nnode involvement is observed, as seen in this case. In addition\nto physical examination findings, biopsy is crucial for histo-\nlogical confirmation. In this case, biopsies were inconclusive,\nand the treatment aimed to promote wound healing through\nurinary diversion, intestinal bypass, antibiotic therapy, and\nintensive local care.\nConclusion The perineal region can harbor severe\nlesions, especially in immunocompromised patients. Even\nwithout a definitive diagnosis, prompt treatment is essential\nto control infection and encourage wound healing.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS58\n\n\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138367\nE-poster\nHYPERTROPHIC GENITAL HERPES IN THE ANAL AND GENITAL\nREGION MIMICKING ANAL AND VULVAR CARCINOMA: CASE\nREPORT\nGlicia Estevam de Abreu 1, Nilma Antas Neves2, Marilia Cardoso\nMassoni3, Felipe Santos Marimpietri 1, Carlos Eduardo Rocha\nMacedo1, Antônio Vitor Martinelli Braga 1\n1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil\n2Universidade Federal da Bahia, Salvador, Brazil\n3Centro de Coloproctologia da Bahia, Salvador, Brazil\nCase Presentation A 67-year-old female patient pre-\nsented with ulcerated, granulomatous lesions, with extensive\ninvolvement of the left vulva (approximately 4 cm) and an\nulcerated lesion with granulomatous borders affecting the\nperianal region and anal canal, extending close to the pecti-\nnate line, for approximately three months. The patient was\nunder oncological follow-up for a previously diagnosed thy-\nmoma and had undergone chemotherapy/immunotherapy\ndue to a recurrence of this condition. She reported prior\nherpetic lesions on the vulva before the appearance of the\nextensive granulomatous lesions on the anus and vulva,\nwhich were treated with a short course of antiviral therapy\n(Acyclovir). There was no history of human papillomavirus\n(HPV) infection or vaccination against this virus. A biopsy of\nthe lesions on the vulva and perianal region revealed ulcerat-\ned dermatovirosis caused by herpesvirus. Histopathology\nshowed multinucleated keratinocytes with molded and\nground-glass nuclei, intense chronic in flammation with un-\nderlying granulation tissue, and anastomosing cords of ker-\natinocytes with mild nonspecific atypia and mitoses beneath\nthe ulcer. The patient was referred for treatment with high-\ndose antiviral therapy for two months to achieve remission.\nDiscussion Diagnosing anal and genital lesions in\nimmunocompromised patients can be challenging, as benign\nconditions, such as herpes simplex virus (HSV) infections,\nmay mimic carcinomatous lesions. Thus, in the presence of\nulcerated lesions affecting the genital and anal regions,\nespecially in immunocompromised patients, differential di-\nagnoses should include infectious diseases, which can be\nchallenging to treat. Even with higher doses and prolonged\ncourses of antiviral therapy, patients with hypertrophic\nherpes may exhibit therapeutic resistance, requiring alterna-\ntive medications or even surgical management of the lesions.\nConclusion In the presence of vulvar and perianal\nlesions in immunosuppressed patients, particularly atypical\nlesions, differential diagnoses involving speci fic infectious\nagents, especially herpes simplex virus, should be considered.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138260\nE-poster\nPERIANAL HERPES: ATYPICAL PRESENTATION – CASE REPORT\nRafaela Fonseca Falcão Hudari1, Raphaella Assis Alves Januário1,\nSandra Di Felice Boratto 1, Guilherme Garcia Hudari 1, Flávia\nBalsamo1, Maria Luiza Marinho Vidigal 1 Eduardo Vidal de\nHolanda1, Marina Ströher 1\n1Faculdade de Medicina do ABC, Santo André, Brazil\nCase Presentation A 28-year-old male sought medical\nattention for a painful perianal ulcer with discharge, present\nfor 6 months. On physical examination, there was extensive,\ncircumferential perianal ulceration with a moderate amount of\nfibrin. An abdominal and pelvic CT scan showed diffuse\ndensification of the adipose and subcutaneous tissue planes\nwithout evidence offluid collection. Investigations for Crohn’s\ndisease were initiated with a colonoscopy, revealing rectal\nenanthema associated withflat erosions covered byfibrin. The\npatient underwent a proctological examination under anes-\nthesia, including a perianal biopsy, which showed chronic\nnonspecifici n flammatory changes. Immunohistochemistry\nwas requested, but before the patient could return for the\nresults, he presented to the hospital with severe anemia and a\ndeteriorating general condition. On examination, the patient\nhad a perianal lesion and a 5x3 cm ulcerated lesion on the left\nhemithorax with signs of active infection, prompting consid-\neration of Kaposi’s sarcoma. HIV serologies were positive, and\nthe case was transferred to internal medicine. The patient\nrapidly developed acute respiratory failure and cardiac arrest,\nwith no response to resuscitation efforts. The diagnosis of\nperianal ulcer was con firmed as positive for Herpes simplex\ntypes 1 and 2, and CK5/6 in immunohistochemistry during the\nfinal hospitalization.\nDiscussion Genital herpes is a common sexually\ntransmitted disease caused by the herpes simplex virus\n(HSV), characterized by periodic reactivation. Type 2 HSV is\nthe most common cause of anal infection and is a risk factor for\nsubsequent HIV infection. Both HSV types 1 and 2 can infect\nthe anal region, causing vesicles that may appear individually\nor in clusters on the genitals, perineum, buttocks, upper thighs,\nor perianal areas, and they ulcerate before resolving. In cases of\nsuspicion, other sexually transmitted diseases must be exclud-\ned, and pathogen detection should be performed via polymer-\nase chain reaction (PCR). Treatment includes antiviral\nmedication. The lack of a characteristic clinical picture, with\natypical ulcers, often delays the diagnosis and treatment.\nConclusion Concomitant infection with HSV-2 and\nHIV increases the severity of HSV episodes and the likelihood\nof atypical presentations. This case reports a patient with an\nulcer that lacked classic features, with a con firmed diagnosis\nfor both types of herpes through polymerase chain reaction.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 137564\nE-poster\nCHLAMYDIA TRACHOMATIS INFECTION MIMICKING\nSQUAMOUS CELL CARCINOMA: CASE REPORT\nLuísa de Rezende Cecilio Fares 1, Beatriz Gilda Jegerhorn\nGrinsztejn1, Sandra Wagner Cardoso1, José Ricardo Hildebrandt\nCoutinho1, Hugo Boechat Andrade 1, Mayara Secco Torres da\nSilva1, Valdiléa Gonçalves Veloso dos Santos 1, Maria Roberta\nMeneguetti Seravali Ramos 1\n1National Institute of Infectology, Rio de Janeiro, Brazil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S59\n\n\nCase Presentation A 53-year-old man who has sex\nwith men (MSM) and is living with HIV presented with\ncomplaints of tenesmus, anal bleeding, and discharge for\napproximately 5 months after an unconsented receptive\nanal sexual encounter. He reported self-medicating with 1\ngram of azithromycin, which resulted in partial symptom\nimprovement. However, the pain worsened, and he experi-\nenced weight loss, prompting him to seek medical care at the\nproctology outpatient clinic. On proctological examination,\nbilateral inguinal lymphadenopathy was observed, along\nwith a shallow ulcerated anal lesion with a fibrin-covered\nbase, hardened consistency, and pain upon palpation. Digital\nrectal examination revealed mild discomfort, and anoscopy\nwas dif ficult due to the presence of mucus in the lower\nrectum. A biopsy of the lesion was performed, and a swab\nwas taken for PCR testing for chlamydia and gonorrhea.\nEmpirical treatment with doxycycline for 21 days and ceftri-\naxone was initiated. After 15 days, the patient returned\nasymptomatic, with the histopathological result showing a\ndense in flammatory in filtrate with no malignancy, and PCR\nconfirmed a chlamydia infection.\nDiscussion The proctological symptoms of sexually\ntransmitted infections (STIs) can vary and include tenesmus,\nmucopurulent discharge, bleeding, and the appearance of\nvegetative or ulcerated lesions. When untreated, these\nlesions can lead to complications such as proctitis and\ninfiltrative lesions. STIs constitute a signi ficant group of\nconditions with a high prevalence in sexually active popula-\ntions and can mimic various other clinical conditions depend-\ning on the symptoms presented.\nConclusion Considering the chronicity and other\ncharacteristics of the lesion, as well as the signi ficant preva-\nlence of high-grade intraepithelial lesions and squamous cell\ncarcinoma in people living with HIV, it is crucial to be vigilant\nabout potential differential diagnoses and perform appropri-\nate diagnostic procedures to initiate the correct treatment as\npromptly as possible.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 141628\nE-poster\nLYMPHOGRANULOMA VENEREUM: CASE REPORT\nMatheus Henrique de Souza Gomes 1, Aline Costa Pinheiro 1,\nMarcos Paulo Barreto Saturnino 1, Mauricio José de Matos e\nSilva1, Thainá Lins de Figueiredo1, Ludmila Godinho da Silveira1,\nFernanda Furtado Leão 1, Pedro Henrique de Souza Gomes 2\n1Hospital Barão de Lucena, Recife, Brazil\n2Centro Universitário do Pará, Belém, Brazil\nA 22-year-old male patient with no history of recep-\ntive anal sex presented to the coloproctology service in April\n2023 with a history of diarrhea with blood since 2017,\nworsening in the last 6 months, and ribbon-shaped stools.\nOn physical examination, there was thickening of the skin in\nthe left perineum, and on rectal examination, the mucosa was\nhardened with stenosis that did not allow for a digital pulp\ninsertion. He had a previous diagnosis of ulcerative colitis\nsince 2017, with follow-up at another service, but without\nregular treatment or follow-up. Colonoscopy in March 2023\nrevealed rectal mucosa covered by fibrin, edema, enanthema,\ngranularity, serpiginous ulcers of moderate depth, con fluent,\nreaching up to 4cm from the anal margin, where a concentric,\nhardened stenosis prevented further progression. Suspecting\nlymphogranuloma venereum, serological tests for other STIs\nwere conducted, and treatment with doxycycline 100mg\ntwice a day for 21 days was started. Due to stenosis and\nthe impossibility of endoscopic dilation, MRI of the pelvis and\nbarium enema were performed for case documentation,\nfollowed by laparoscopic proctectomy. The pathology report\nconcluded that it was chronic granulomatous proctitis com-\npatible with lymphogranuloma venereum, with no morpho-\nlogical criteria for in flammatory bowel disease. PCR of the\nspecimen excluded tuberculosis. Lymphogranuloma vene-\nreum is an STI caused by the bacterium Chlamydia tracho-\nmatis (serotypes L1, L2, and L3). It is commonly associated\nwith other STIs, particularly HIV and syphilis. Diagnosis is\nmade by detecting the bacteria in urethral or rectal secretions\nand by blood testing for IgM to Chlamydia. In men who have\nsex with men, the most common finding is proctitis with\ntransient ulcers. Fistulas, proctalgia, and rectal discharge may\nalso occur. Stenosis is a possible, though less common,\npresentation. Treatment consists of doxycycline 100mg every\n12 hours for 21 days and should be initiated as early as\npossible to prevent chronic complications, such as rectal\nstenosis. All sexual partners should also be investigated to\nidentify asymptomatic patients and interrupt the disease ’s\nepidemiological chain.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138190\nE-poster\nHUMAN MYIASIS WITH EXTENSIVE ANAL INVOLVEMENT –\nCASE REPORT\nLetícia Mayumi Tsushima 1, Kelly Danielle Silva Vieira 1\n1Rede Mario Gatti, Campinas, Brazil\nCase Presentation A 72-year-old male patient, cir-\nrhotic, former alcoholic, and smoker was admitted with anal\npain, purulent discharge, and fever for 3 days. The patient had\npoor hygiene practices, was alert, but had limited under-\nstanding of his condition. On proctological examination, a\nlesion was observed in the perianal region with an abscess\ndraining a large number of larvae. During the operation,\nnecrotic anal borders and myiasis with a large number of\nlarvae were identi fied. The larvae were removed, and the\nnecrotic tissue was debrided. Antibiotic therapy and ivermec -\ntin were initiated. The following day, larvae continued to exit\nthrough the anal canal with feces in the wound. A sigmoi-\ndostomy was performed to divert the intestinal flow, along\nwith extensive debridement of the necrotic areas in the anal\nregion, which involved both the internal and external sphinc -\nters. The patient was discharged after 6 days. He returned\nwith poor self-care, no dressing change, feces in the surgical\nwound, and a collapsed colostomy, accompanied by pain and\nabdominal distension. Intravenous antibiotics and a new\nsurgical intervention were indicated. During the procedure,\na colostomy with fecal leakage into the subcutaneous tissue\nand an abscess extending to the pelvis was found. A terminal\ncolostomy was performed. The patient was transferred to the\nintensive care unit post-surgery but passed away 4 days later.\nDiscussion Myiasis is caused by fly larvae in the\ntissues of living beings. The most common location in\nhumans is the skin, but it can also affect cavities such as\nthe eye, ear, nostrils, anus, and vagina. Infestation is\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS60\n\n\nassociated with poor hygiene habits, diabetes, alcohol con-\nsumption, immunosuppression, psychiatric disorders, and\nrural populations. Diagnosis is clinical, with local pain or\nitching associated with the presence of larvae. Treatment\ninvolves mechanical removal of larvae, debridement of ne-\ncrotic tissue, and therapy with ivermectin and antibiotics. In\nanal myiasis, intestinal diversion may be indicated, especially\nwith extensive debridement in the anorectal region and\ninvolvement of the sphincter muscles. The stoma, commonly\na loop sigmoidostomy, aids in the healing of the anal region\nand reduces the risk of wound infection from feces.\nConclusion This case highlights the relationship be-\ntween the patient’s self-care and the onset and progression of\nanal myiasis. It emphasizes the need for extensive debride-\nment of necrotic areas, larval removal, and the creation of an\nostomy to aid in proper wound healing.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138330\nE-poster\nGASTROINTESTINAL PARACOCCIDIOIDOMYCOSIS IN AN\nADOLESCENT: CASE REPORT\nDébora Lopes Gonçalves1, Ana Luiza Araújo Machado 2, Dayane\nTábatha Santos Durães 1, Cristiano de Magalhães Nunes 1,\nRaymara Alves da Silva Mendes 1, Albanice Rodrigues de Lima 1,\nKamily Evan de Castro Mendes 3\n1Hospital Estadual Alberto Rassi, Goiânia, Brazil\n2Universidade de Rio Verde, Rio Verde, Brazil\n3Centro Universitário do Espírito Santo, Colatina, Brazil\nCase Presentation A 15-year-old female patient\nsought medical attention complaining of persistent abdominal\npain, fever, diarrhea with blood, and weight loss for approxi-\nmately 3 months. On examination, she was pale, afebrile, and\nhad a slightly distended abdomen. During the evaluation,\ncolonoscopy revealed distortion and stenosis of the terminal\nileum, multiple polypoid formations, ulcerations, friability in\nthe colon, and circumferential stenosis in the rectum. Labora-\ntory tests revealed anemia and leukocytosis, while abdominal\nand thoracic CT scans suggested granulomatous infectious\nlymphadenopathy, inflammatory bronchopathy, and enteritis.\nAfter histopathological confirmation of paracoccidioidomyco-\nsis (PCM), the patient was referred for hospital treatment,\nwhich included metronidazole, amphotericin B, and itracona-\nzole. After 16 days, she was discharged with ongoing itraco-\nnazole treatment. One year later, she returned asymptomatic\nand is under outpatient follow-up, awaiting a new colonoscopy\ndue to inadequate sample collection in the last test.\nDiscussion Paracoccidioidomycosis (PCM), a systemic\nfungal infection caused by Paracoccidioides brasiliensis ,i s\ncommon in Latin America. It is transmitted by inhalation of\nconidia and is asymptomatic in 80% of cases, but when\nsymptomatic, it can cause fever, cough, and dyspnea. PCM\nmanifests in two forms: juvenile (acute/subacute) with in-\nvolvement of the reticuloendothelial system, and adult/\nchronic (90% of cases), primarily affecting the lungs. Gastro-\nintestinal involvement is rare, and it may mimic in flamma-\ntory diseases like Crohn ’s disease, with symptoms such as\nabdominal pain, nausea, and diarrhea. The diagnosis is made\nby identifying fungal elements in histopathological and mi-\ncrobiological tests. Treatment includes systemic antifungals\nlike amphotericin B and itraconazole.\nConclusion This case highlights the rarity of gastroin-\ntestinal PCM and the complexity of its diagnosis. A teenager\npresented with gastrointestinal PCM, a rare and challenging\ncondition that mimicked Crohn ’s disease. The diagnosis was\nconfirmed by biopsy, and antifungal treatment resulted in\nsignificant clinical improvement without the need for surgical\nintervention. The positive response to treatment underscores\nthe importance of early diagnosis and appropriate treatment.\nPCM should be considered in the differential diagnosis of\ninflammatory bowel diseases, particularly in endemic areas.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138283\nE-poster\nANAL POLYP CAUSED BY SCHISTOSOMA MANSONI EGGS\nFelipe Pereira Gomes 1, Ana Júlia Schnorr Mayer 1, Ana Caroline\nBohn1, Júlia Wagner Guedes 1\n1Hospital Santa Isabel, São Paulo, Brazil\nMale patient, 27 years old, from Bahia. He presents\nwith anal pain and bleeding, evolving with worsening pain and\ntenesmus. On physical examination, a posterior anal fissure\nprogressing to a hardened nodular lesion was observed. Pelvic\nMRI showed findings of a subcutaneous nodular lesion with-\nout muscular extension, solid with regular contours, located in\nthe anorectal area, measuring 3.3x2x1.8 cm. No colonoscopy\nor laboratory tests were performed. An excisional biopsy\nrevealed rectal mucosa with granulomatous polypoid inflam-\nmation, associated withSchistosoma mansonieggs. The patient\nshowed improvement of symptoms at follow-up, treated with\npraziquantel after diagnosis. Intestinal schistosomiasis is a\ndisease with a classic late manifestation due to egg deposition\nin the intestinal wall and liver, leading to portal hypertension\nand hepatomegaly. The acute form is less common and\ninvolves itching, cough, and abdominal pain. The most signifi-\ncant symptom is colitis due to egg in filtration in the submu-\ncosa and a foreign body reaction, which can chronically evolve\ninto nodules, with eggs surrounded by intense granulomatous\ninflammation. This inflammatory infiltrate can cause necrosis,\nstenosis, or well-formed polyps. Rectal polyps are atypical and\nmore commonly associated with S. mansoni ,w h i c hh a sa\ntropism for the rectal mucosa and is more common in the\nAmericas. Although S. japonicum in Asia is more strongly\nrelated to polyps and cancer. About 96.4% of nodules are distal\nto the ascending colon, with more than 80% occurring in the\nrectum. Similar cases in Brazil and Yemen involve healthy\npatients with endemic exposure. The Brazilian case is most\nsimilar to this one, describing an anal tumor with progressive\ngrowth and pain, granulomatous and fibrotic tissue involving\nthe eggs and central necrosis. Cases in Asia follow the same\nhistopathology, but present with symptoms of altered bowel\nhabits, with the lesion not being the main complaint. In both\nreports, patients were treated with praziquantel and showed\nimprovement. The patient did not undergo further tests, so it is\nnot possible to compare rectal mucosa or involvement of other\nlocations; however, the imaging findings indicate rectal\nlesions as the sole manifestation. In conclusion, despite being\nan uncommon manifestation, both the clinical epidemiological\nprofile and histopathology are consistent with S. mansoni\ninfection and pseudotumoral schistosomiasis.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S61\n\n\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138203\nE-poster\nCHLAMYDIA PROCTITIS: A DIAGNOSTIC CHALLENGE AT THE\nINTERSECTION OF STIS AND INFLAMMATORY BOWEL\nDISEASES – CASE REPORT AND CLINICAL CONSIDERATIONS\nMarjorye Schelle Magalhães 1, Beatriz Castro de Sousa 1, Maria\nRoberta Meneguetti Seravali Ramos 1, Yana Juliê Perondi 1\n1Hospital Municipal da Piedade, Piedade, Brazil\nThe intersection between sexually transmitted infec -\ntions (STIs) and gastrointestinal diseases is an emergingfield in\nmedicine, presenting significant diagnostic challenges. In this\ncase report, we highlight a 30-year-old man who has sex with\nmen (MSM) and uses PrEP , who presented with complaints of\nanal pain, the presence of blood and mucus in the stool for\nthree weeks. He reported the last receptive anal intercourse\nwith a condom 60 days ago with a fixed partner. The patient\nhad been under outpatient care in gastroenterology for treat-\nment of ulcerative colitis (UC) with mesalazine, without\nimprovement in his clinical condition. Aflexible sigmoidosco-\npy revealed mild distal ulcerative proctitis, and histopatholog-\nical analysis showed intense active proctocolitis with\nulcerations. Subsequently, an STI panel was performed, which\ntested positive for Chlamydia trachomatis (CT). CT infection is\nbecoming increasingly common, especially among MSM and\npeople living with HIV (PLHIV). Studies indicate that about 70%\nof chlamydia infections can go unnoticed if only urogenital\ntests are conducted in MSM. The typical clinical presentation of\nchlamydia infection usually involves cervicitis, urethritis, or\ncan remain asymptomatic. However, in MSM who engage in\nanal sex, chlamydia can cause proctitis, characterized by\ntenesmus, hematochezia, and mucorrhea, mimicking symp-\ntoms of inflammatory bowel diseases (IBD). Accurate diagno-\nsis can be challenging if a detailed sexual history is not\nconducted. In this context, polymerase chain reaction (PCR)\nplays a key role in diagnostic clari fication, allowing sensitive\nand specific detection in rectal samples. This case highlights\nthe importance of considering STIs, such as chlamydia, as a\npossible etiology for gastrointestinal symptoms in patients\nwith high-risk sexual behavior. A comprehensive approach\nthat is sensitive to the patient ’s sexual history is essential to\nguide accurate diagnosis and management, thereby avoiding\ndelays in treatment and associated complications.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 141732\nE-poster\nLITERATURE REVIEW OF FLAT CONDYLOMA IN CHILDREN\nAND A CASE REPORT OF UNCOMMON PRESENTATION\nMIMICKING BUSCHKE-LÖWENSTEIN TUMOR\nIsabela Pereira Blanco 1, Eduardo Vidal de Holanda 1, Raphaella\nAssis Alves Januário 1, Sandra Di Felicci Boratto 1, Amanda\nVitiello Pereira Brosco 1, Guilherme Garcia Hudari 1, Flavia\nBalsamo1, Rafaela Fonseca Falcão Hudari 1\n1Faculdade de Medicina do ABC, Santo André, Brazil\nIntroduction Syphilis is a predominantly sexually\ntransmitted infection with increasing detection rates and a\nwide range of clinical manifestations. In children, acquired\nsyphilis presents almost all the features seen in adults, and\nin the perianal region, a vegetating lesion, known as flat\ncondyloma, may occur. This cutaneous manifestation is\nsometimes the only expression of secondary syphilis and\nmay mimic other pathologies. A high index of suspicion is\nimportant due to its primary mode of transmission, sexual\ncontact, especially in the context of childhood cases where\nsexual abuse should be considered as a hypothesis.\nObjective To identify cases of flat condyloma in\nchildren as a manifestation of secondary syphilis in the\nscientific literature and report an unusual presentation of\nthis lesion mimicking Buschke-Löwenstein tumor.\nMethod A literature review through a search in the\nPUBMED database in June 2024, using the descriptors “flat\ncondyloma” and “child,” along with the presentation of a case\nreport.\nResults Eight publications from 1989 to 2024 were\nfound, showing flat condyloma as the most common manifes-\ntation of secondary syphilis in children and the involvement of\nmedico-legal issues in the context of child sexual abuse. The\ncase to be presented and compared involves a 5-year-old male\npatient with a pruritic, white, vegetating perianal lesion for 3\nmonths. There was a history of similar lesions in his 9-year-old\nsister, 8-year-old cousin, and his mother (pregnant). The\nhypothesis of Buschke-Löwenstein tumor was raised, and a\nproctological examination under anesthesia revealed an ex-\ntensive, irregular, circumferential, elevated lesion, measuring\n10 cm in diameter on the perianal skin and circumferential\ninvolvement of the anal canal upon rectal examination. Histo-\npathological study suggested a secondary non-granulomatous\nlesion due to syphilis with a dense plasmocytic infiltrate in the\ndermis, and immunohistochemistry was negative for human\npapillomavirus. After treatment with crystalline penicillin, the\npatient progressed with a hyperchromic scar lesion and was\ndischarged with follow-up in coloproctology and pediatrics\nfocused on child sexual abuse.\nConclusion The differential and accurate diagnosis of\npediatric syphilis, in the face of an uncommon manifestation\nmimicking another pathology, is crucial for the treatment of\nthe infection, prevention of morbidity, and identi fication of\ncases of child sexual abuse, prompting necessary medico-\nlegal actions.\nDST e Doenças Infecto Parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138121\nE-poster\nEPIDEMIC KAPOSI ’S SARCOMA WITH COLORECTAL\nINVOLVEMENT\nJennyfer Kellen Lázaro da Rocha 1, Matheus Matta Machado\nMafra Duque Estrada Meyer 1, Guilherme de Almeida Santos 1,\nIlson Geraldo da Silva 1, Hana Jermani Coelho 1, Mário Inácio\nCarneiro Neto1, Augusto Zbonik Mendes 1, Marcilio José\nRodrigues Lima1\n1Santa Casa da Misericórdia de Belo Horizonte, Belo Horizonte, Brazil\nMale patient, 28 years old, admitted to the emergency\ndepartment with hematochezia and weight loss. Anal inspec -\ntion identi fied darkened papular lesions in the perianal\nregion, with thickening in the anal canal. A flexible\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS62\n\n\nsigmoidoscopy showed mucosal erythema extending to the\nmid-rectum, with a nodular lesion, irregular red surface, and\na diameter of 4 cm. Histopathological examination revealed\nan unspeci fici n flammatory nature. Subsequent diagnostic\nwork-up confirmed HIV, and antiretroviral therapy (ART) was\ninitiated. Immunohistochemical analysis tested positive for\nHHV8, CD34, and D240, suggesting Kaposi ’s sarcoma (KS).\nThe patient developed red papules on the anterior chest, with\nhistopathology con firming cutaneous dissemination of the\ndisease. Pelvic MRI revealed extensive lesions in the rectum\nand anal canal, mesorectal and para-aortic lymphadenopa-\nthy. Chemotherapy was initiated alongside ART. One year\nafter starting treatment, the patient remained stable, oligos-\nsymptomatic, with clinical improvement of the initial condi-\ntion, remission of papular lesions on the skin, and a reduction\nin rectal lesion size. CD4 count > 600, indicating disease\ncontrol. Kaposi’s sarcoma (KS) is an angioproliferative disease\nassociated with infection by human herpesvirus 8 (HHV-8).\nHIV-associated KS (epidemic KS) is the most common form of\ndisease. Since the introduction of ART, the incidence of KS has\nsignificantly decreased in HIV-positive patients. Cutaneous\ninvolvement is more common and is the usual initial presen-\ntation of KS. Visceral involvement frequently affects the\ngastrointestinal tract (GI). GI lesions may be asymptomatic\nor cause weight loss, abdominal pain, gastrointestinal bleed-\ning, or intestinal obstruction. They are recognized on endo-\nscopic examination as hemorrhagic nodules, which can be\nisolated or con fluent, occurring in any part of the GI tract.\nDiagnosis should be confirmed by biopsy whenever possible.\nTreatment is guided by the presence or absence of symptoms.\nThe main goals are to alleviate symptoms, prevent disease\nprogression, and reduce tumor size. Many patients experi-\nence tumor regression with ART alone. Patients with ad-\nvanced disease often require a combination of ART and\nchemotherapy. KS develops in immunosuppression, such as\nin AIDS. This case highlights the importance of considering\nthis diagnosis in the presence of lesions of in flammatory\nnature.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141763\nE-poster\nENDOSCOPIC FINDINGS IN A CONSECUTIVE SERIES OF\nPATIENTS UNDERGOING COLONOSCOPY\nLuis Felipe Mendonca de Oliveira 1, Catarina Ferreira Costa\nPraia1, Rafaela de Melo Sprogis1, Pedro dos Anjos Freixo1, Flávia\nBerford Leão dos Santos Gonçalves de Oliveira2, Camila Oliveira\nBarbosa2, Wilmar Junio Pereira Araújo 2, João Batista de Sousa 1\n1Universidade de Brasília, Brasilia, Brazil\n2Hospital Universitário de Brasília, Brasília, Brazil\nIntroduction Colonoscopy is an essential procedure\nfor the surveillance, therapeutic management, screening, and\ndiagnosis of diseases of the colon and rectum. An adequate\nbowel preparation is crucial for performing the procedure,\nwhich can be done either in a hospital setting or at home.\nObjective To describe the epidemiological pro file,\npreparation, andfindings of patients who underwent colonos-\ncopy at a reference coloproctology service throughout 2023.\nMethods A total of 1,194 colonoscopy reports con-\nducted between January and December 2023 at a reference\nhospital with a coloproctology residency program were ana-\nlyzed. The following variables were studied: age, gender,\nindication for the exam, preparation assessment, and exam\nfindings.\nResults During this period, 1,194 colonoscopies were\nperformed. The average age of the patients was 56.3 years,\nwith a minimum of 16 years and a maximum of 87 years. Of\nthe total patients, 801 (67%) were women, and 393 (33%)\nwere men. Regarding the indication for the exam, 54.4% (649)\nwere diagnostic in patients with symptoms, 23.9% (286) for\nscreening, 19.93% (238) for surveillance, 1.5% (18) for thera-\npeutic purposes, and 0.2% (3) for tattooing. Regarding the\npreparation assessment, using the Aronchick scale, 700\n(58.62%) were classi fied as good, 247 (20.68%) as fair, 177\n(14.82%) as poor or insuf ficient, and 70 (5.86%) were not\nreported. The exams were considered normal in 34.42% of the\ncases. Among the abnormal findings, the most frequent were\npolyps (27.38%), followed by diverticulosis (20.26%), in filtra-\ntive lesions (8.7%), and in flammatory signs (6.28%).\nConclusion The high number of findings in screening\nor surveillance exams is noteworthy. Of the exams performed\nfor these purposes, 43.9% were for screening or surveillance,\nbut only 34.42% of all exams were normal. The high rate of\npoor or inadequate preparation (14.82%) may be attributed to\nthe fact that, in this public hospital, bowel preparation was\nconducted at home.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141767\nE-poster\nANALYSIS AND CORRELATION OF THE BOSTON AND\nARONCHICK CLASSIFICATIONS IN COLONOSCOPIES\nBianca Corrêa Dutra de Menezes 1, João Victor Maia Freitas 1,\nKristine Leão Alarcão 1, Laura Trotta Villar 1, Vanessa Siqueira\nReis2, Flávia Berford Leão dos Santos Gonçalves de Oliveira 2,\nBruno Augusto Alves Martins 2, João Batista Sousa 1\n1Universidade de Brasília, Brasilia, Brazil\n2Hospital Universitário de Brasília, Brasília, Brazil\nIntroduction The quality of bowel preparation is\ncrucial for the success of colonoscopy and lesion detection.\nThe Boston Bowel Preparation Scale (BBPS) and the Universal\nPreparation Assessment Scale (UPAS, also known as Aron-\nchick) are widely used for this assessment. The BBPS eval-\nuates three regions of the colon (right, transverse, and left),\nassigning scores from 0 to 3 for each, resulting in a total score\nbetween 0 and 9. The Aronchick scale, in turn, uses scores\nfrom 0 to 4. A good bowel preparation is indicated by a score\nof 5 or higher on the BBPS, while on the UPAS, a score of 1 or\nlower is considered ef ficient.\nObjective To study the correlation between the Bos-\nton and Aronchick classi fications in evaluating bowel prepa-\nration for colonoscopy.\nMethod Data from 775 colonoscopies performed at a\nuniversity hospital in 2023 were analyzed. Bowel preparation\nquality was assessed using both the Boston and Aronchick\nscales, and the correlation between them was determined.\nResults A total of 775 colonoscopy exams were per-\nformed, using both classifications to assess bowel preparation\nquality. According to the Boston scale, 733 patients (94.5%)\nhad good preparation, while 570 patients (73.5%) had good\npreparation according to the Aronchick scale. The correlation\nanalysis resulted in a Pearson coefficient of -0.809 (p< 0.001),\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S63\n\n\nindicating an extremely strong and signi ficant correlation\nbetween the two scales. This suggests that both scales are\nhighly consistent and can be used interchangeably in clinical\npractice.\nConclusion Both scales can be reliably used to assess\nbowel preparation in colonoscopies.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 138178\nE-poster\nAPP FOR GUIDING MEDICAL PROFESSIONALS ON THE USE OF\nCOLONOSCOPY IN COLORECTAL CANCER SCREENING:\nCOLONOSCOPY GUIDE\nJoaquim Tiago Cardoso Leles de Jesus 1, Débora Alves\nDomingues Pereira1, Lucas Azevedo Ibrahin Elmor 2\n1Hospital de Clínicas Nossa Senhora da Conceição, Três Rios, Brazil\n2Suprema Três Rios, Três Rios, Brazil\nColorectal Cancer has become an increasing public\nhealth issue in Brazil. Data from the National Cancer Institute\nshows approximately 45,630 new cases in 2023. It is the\nsecond most common type of malignant neoplasm in both\nmen and women in the country, excluding skin cancers. Its\nmortality and cure rates are directly related to its detection at\nearlier stages. Screening can be done in different ways, with\nfecal occult blood tests and colonoscopy being the preferred\nmodalities. Colonoscopy is an endoscopic method capable of\nproviding early diagnosis and also removing precursor\nlesions of colorectal cancer (adenomatous polyps). It is,\ntherefore, the diagnostic method of choice. Thus, its indica-\ntions and appropriate time for repetition are essential for\ncorrect screening and prevention. However, its major limita-\ntion is high costs and still limited availability, so its accessi-\nbility to the population must be carefully considered and\naligned with current literature data. After conducting re-\nsearch with primary care physicians in the municipality of\nTrês Rios, located in the state of Rio de Janeiro, through\nquestionnaires and review of medical records, we observed\na high rate of errors in the indications for colonoscopy,\nespecially regarding follow-up after polypectomies. As a\nresult, we developed an application (Colonoscopy Guide)\navailable for the Android platform (and eventually iOS) that\nprovides a simple manual for doctors, with indications for the\nexam, preparation guidelines, and, mainly, the recommended\ntime for repetition, based on the results found. Among its\nfeatures, it automatically provides, after the physician enters\nthe patient ’s exam data, the recommended time for repeti-\ntion. The project was developed as part of the master ’s thesis\nof one of the authors and applied after its completion, with\ngood results and acceptance by the professionals in the\nregion. We hope to mitigate healthcare system costs and\nincrease the effectiveness of colorectal cancer screening.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141205\nE-poster\nCORRELATION BETWEEN THE PREVALENCE OF COLORECTAL\nPOLYPS IN PATIENTS WITH AND WITHOUT A FAMILY HISTORY\nOF COLORECTAL CANCER\nRaissa Scarlet Queiroz Fernandes1, Giordano Bruno Meireles de\nOliveira1, Graziela Olivia da Silva Fernandes 1, Rosilma Gorete\nLima Barreto1, Nikolay Coelho da Mota1, Lucas Albuquerque de\nSousa Martins 1, Maura Tarciany Coutinho Cajazeiras De\nOliveira1, Gabriel Albuquerque Costa 1\n1Hospital Universitário Presidente Dutra, São Luís, Brazil\nObjectives To assess the prevalence of polyps in\nasymptomatic patients undergoing colonoscopy for screen-\ning, comparing patients with a family history of colorectal\ncancer to those without a family history.\nMethods A cross-sectional study was conducted on a\ngroup of individuals who underwent colonoscopy between\nJanuary 2019 and April 2024. Patients were divided into two\ngroups: Group I (without a family history of colorectal cancer)\nand Group II (with a family history in first-degree relatives).\nDemographic characteristics, colonoscopyfindings, presence,\nlocation, and histological type of polyps were evaluated and\ncompared between the two groups.\nResults A total of 1,497 patients were evaluated, with\n1,367 in Group I and 130 in Group II. Polypoid lesions were\nfound in 550 patients (36.7%), with 506 (37%) in Group I and\n44 (33.8%) in Group II. In Group I, 243 (48%) had hyperplastic\npolyps, 188 (37%) had adenomatous polyps (120 tubular with\nlow-grade dysplasia, 40 tubular with high-grade dysplasia, 28\ntubulovillous with high-grade dysplasia), and 75 (15%) had\ninflammatory polyps. In Group II, 22 (50%) had hyperplastic\npolyps, 20 (45.4%) had adenomatous polyps (12 tubular with\nlow-grade dysplasia, 6 tubular with low-grade dysplasia, 4\ntubulovillous with high-grade dysplasia), and 2 (4.6%) had\ninflammatory polyps. There was no statistically signi ficant\ndifference between the groups (p=0.83). The prevalence of\nadenomas was similar in both groups (Group I = 188/37% vs\nGroup II = 20/45.4%) (p=0.83). The distribution of patients\nwith polyps was similar in terms of sex, with polyps found in\n339 (40%) female patients and 167 (31%) male patients in\nGroup I (p=1.00), and in 33 (37%) female patients and 11 (21%)\nmale patients in Group II (p=1.00).\nConclusion In this initial study, no correlation was\nfound between the prevalence of polyps and a family history\nof colorectal cancer.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 138189\nE-poster\nQUALITY CRITERIA IN COLONOSCOPY – EXPERIENCE OF A\nPRIVATE TERTIARY CARE CENTER\nAdriana Borgonovi Christiano Vieira 1, Mauro Augusto\nMarchiori Junior1, Maria de Lourdes Setsuko Ayrizono2, Danielle\nRossana Queiroz Martins Bonilha 1\n1Fundação Centro Médico de Campinas, Campinas, Brazil\n2Universidade Estadual de Campinas, Campinas, Brazil\nIntroduction Colorectal cancer (CRC) has seen an\nincrease in incidence worldwide, being the third leading\ncause of cancer mortality in Brazil, in both sexes. The carci-\nnogenesis of CRC is well-known, with adenomas being the\nprecursor lesions in approximately 70% of cases, highlighting\nthe importance of screening programs. Colonoscopy is the\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS64\n\n\nprimary screening method, and quality criteria, such as the\nadenoma detection rate (ADR), must be met.\nObjective To analyze the effectiveness of colonoscopy\nexams performed at a private tertiary care service by calcu-\nlating the adenoma detection rate (ADR), serrated lesions, and\nadvanced adenomas, and compare the results with the\nliterature.\nMethod This was a retrospective observational study\nof colonoscopy exams performed at the Centro Médico de\nCampinas between January 1, 2018, and January 31, 2020.\nThe ADR and advanced adenoma detection rate (AADR) were\ncalculated, along with adjustments for sex, age range, and the\nindications for the exams. Also calculated were the total polyp\ndetection rate (PDR), the hyperplastic polyp detection rate\n(HPDR), and the sessile serrated polyp detection rate (SSPDR).\nResults A total of 3,686 colonoscopies were per-\nformed during the period, with 3,076 exams included in\nthe analysis. The average age of the patients was 57.2 years,\nwith the majority (53.5%) being female. Tubular adenoma was\nthe most prevalent, found in 20% of the exams and in 62.7% of\nthe exams with findings of any lesion. A total of 191 hyper-\nplastic polyps and 61 serrated adenomas were described,\ntogether accounting for a quarter of the lesions in positive\nexams. The PDR was 23%, with a signi ficant increase associ-\nated with age (p < 0.01). The ADR was 20%, signi ficantly\nhigher with age (p < 0.001) and higher in men (27%). The\nAADR was 4%, with a predominance of these in the distal\nsegments. The HPDR was 6%, and the SSPDR was 2%.\nConclusion The adenoma detection rate, serrated\nlesions, and advanced adenoma rates were comparable\nwith those in the literature. The polyp detection rate was\nhigher in men and signi ficantly increased with age. Tubular\nadenomas predominated, and distal segments of the colon\nwere more commonly affected, with adenocarcinoma being\nrare.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 138319\nE-poster\nTEACHING IN COLONOSCOPY: AN EVALUATION OF\nPROCEDURES PERFORMED BY RESIDENT PHYSICIANS IN THE\nCOLOPROCTOLOGY SERVICE FROM 2021 TO 2023 AND\nPOSSIBLE STRATEGIES FOR INTERVENTIONS\nIgor Reggiani Gomes\n1, Hana Jermani Coelho 1, Guilherme de\nAlmeida Santos1, Ilson Geraldo da Silva1, Jennyfer Kellen Lázaro\nda Rocha1, Mário Inácio Carneiro Neto 1, Diogo Viana Abreu 1,\nMatheus Duarte Massahud 1\n1Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brazil\nColorectal cancer ranks among the cancers most\nbenefited by secondary prevention interventions. Colonos-\ncopy, selected as the gold standard method, plays a key role in\nprevention and screening. Despite its complexity and depen-\ndence on the examiner, the absence of a standardized teach-\ning system and the lack of measures to assess competency are\nevident. Insuf ficient training in the procedure leads to diag-\nnostic and therapeutic errors. This study analyzed colonos-\ncopies performed in a coloproctology service by six resident\nphysicians from December 2021 to June 2023. The goal was to\nidentify potential areas for improvement and propose inter-\nventions to enhance learning within the service. A total of\n5,855 colonoscopies were analyzed. Female patients\naccounted for 59.6%, and male patients for 40.4%, with an\naverage age of 61.4 years. The quality of bowel preparation\nwas classified as good (Boston scores 7, 8, and 9) in 55.6%, fair\n(Boston score 6) in 24.4%,dd and inadequate (Boston scores 0-\n5) in 20%. The cecal intubation rate was 85.3%, and the ileal\nintubation rate was 69.6%. However, when only the exams\nwith good preparation quality were considered, the rates\nreached 94% and 80.8%, respectively. Incomplete colonosco-\npies accounted for 14.2%, with inadequate preparation (81%)\nand technical dif ficulties (19%) as the main reasons. Indica-\ntions for the procedure included screening (16%), cancer\nfollow-up (16%), lower gastrointestinal bleeding (14%), and\npositive fecal occult blood test (12.6%). Polypectomies were\nperformed in 2,312 exams, with adenomas detected in 33%.\nThree colon perforations occurred (1/1,951). The main find-\nings in the reports were diverticulosis (13.8%), endoscopically\nsuspected neoplastic lesions (4.4%), and in flammatory dis-\neases (1.8%). In the obtained results, bowel preparation\neffectiveness emerged as a critical factor impacting colonos-\ncopy quality. One of the determinants for poor preparation\nquality was identified as the low socioeconomic status of the\npopulation served, combined with insuf ficient guidance on\ndiet and laxative management during the appointment\nscheduling. It was inferred that adequate patient understand-\ning of proper preparation is not always guaranteed. During\nthe pre-examination phase, improving patient access to\ninformation is essential to ensure proper bowel preparation.\nIt is important to encourage continuous improvement in\ncolonoscopy teaching.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 138167\nE-poster\nCOLON SPIROCHETOSIS: A REPORT OF AN\nEPIDEMIOLOGICALLY DISTINCT CASE\nThiago José Islanderson dos Santos Castro 1, Emily Cristina\nArenhart Bajerski 1, Brenna Martins Barboza Santana 1,\nFernanda Lopes Cardoso Castro 2, Kátia Rejane Marques Brito 1,\nTamires Robles1\n1Centro Maurício de Nassau, Barreiras, Brazil\n2Faculdade Zarns, Salvador, Brasil\nCase Presentation WSS, a 54-year-old female, pre-\nsented to the outpatient clinic with complaints of abdominal\npain and constipation, reporting bowel movements every 2–3\ndays without blood, mucus, or pus. She denied other symp-\ntoms. The patient reported inactive Hepatitis B under moni-\ntoring at a health center, without treatment. She denied\nallergies or comorbidities. Due to her symptoms and the\nindication for colorectal cancer screening, a colonoscopy\nwas performed in July 2021. It revealed an in filtrative lesion\nin the right colon, and biopsies were taken for histopatholog-\nical analysis, which indicated moderate chronic colitis with\nmild acute cryptitis and evidence of infection suggestive of\nspirochetosis. Dietary habit counseling was provided, and\nciprofloxacin and metronidazole were prescribed. Follow-up\nincluded a repeat colonoscopy in October 2023, showing focal\nareas of erythema in the sigmoid colon interspersed with\nnormal mucosa. During her last consultation to review biopsy\nresults, the patient was asymptomatic, and the histopatho-\nlogical findings revealed mild, nonspecific chronic colitis. The\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S65\n\n\napproach consisted of general advice and discharge from\noutpatient follow-up.\nDiscussion This case involves a patient with colonic\nspirochetosis, an infection or colonization of the colon by\nspirochetes, typically of the\n/C3 Brachyspira/C3 genus. These\norganisms are globally distributed and predominantly affect\nchildren, HIV-positive individuals, or those with other im-\nmunosuppressive conditions. However, the patient did not\nexhibit any of these risk factors, aside from inactive HBV\ninfection with no functional repercussions. This underscores\nthe importance of not dismissing diagnostic hypotheses\nbased solely on an atypical epidemiological pro file. Brachy-\nspira spp. are considered non-invasive, usually detected on\nthe epithelial surface and occasionally damaging microvilli.\nSymptomatic cases are treated with metronidazole, with\nassociated symptoms including chronic diarrhea (sometimes\ndysentery), abdominal pain, nausea, weight loss, and, in\nchildren, impaired development. Notably, this patient ini-\ntially presented with constipation, a symptom uncommon for\ncolonic spirochetosis.\nConclusion Although epidemiological analyses out-\nline the most common characteristics of a condition, excep-\ntions to the rule can occur. This case highlights the\nimportance of maintaining diagnostic vigilance even in atyp-\nical presentations. Furthermore, it emphasizes the role of\npreventive colonoscopy in diagnosing infections like\nspirochetosis.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 138266\nE-poster\nEVALUATION OF DEXMEDETOMIDINE AS A SEDATIVE AGENT\nFOR COLONOSCOPY: A SYSTEMATIC REVIEW AND\nCOMPARATIVE META-ANALYSIS\nKleuber Arias Meireles Martins\n1, Leonardo Januário Campos\nCardoso2, Isabela Coutinho Faria1, Maria Spínola Ramos1, Filipe\nda Silva Barbosa 1, Mariana Menezes Corcinio 3, Maria Luiza\nFerreira da Costa 4\n1Centro Universitário de Belo Horizonte, Belo Horizonte, Brazil\n2Universidade Federal de Minas Gerais, Belo Horizonte, Brazil\n3Universidade Tiradentes, Aracaju, Brazil\n4Universidade Estadual de Goiás, Goianésia, Brazil\nObjectives To compare the ef ficacy and safety of\ndexmedetomidine (DEX) with other sedatives (propofol, fen-\ntanyl, midazolam) in patients undergoing colonoscopy, he-\nmodynamic stability, and adverse effects.\nMethods Following PRISMA guidelines, we searched\nPubMed, Scopus, Cochrane, and Web of Science databases for\nstudies comparing the use of DEX with other commonly used\nsedative agents in colonoscopy procedures (propofol, fenta-\nnyl and midazolam). The primary outcome analyzed was the\nincidence of adverse effects, speci fically bradycardia, hypo-\ntension, and nausea and vomiting in both groups. Addition-\nally, Heart Rate (HR) and Mean Arterial Pressure (MAP) were\nanalyzed in the DEX group compared to the propofol and\nfentanyl groups 10 minutes after the onset of sedation. Risk\nratios (RR) and standardized mean differences (SMD) with a\n95% confidence interval (CI) were calculated using a random-\neffects model. The I² statistic and a leave-one-out analysis\nwere used to assess heterogeneity.\nResults Six studies, totaling 444 patients, with 209\nreceiving DEX, were included. The analysis revealed that the\nincidence of hypotension was similar between the two\ngroups (RR=1.88; 95%CI: 0.65 - 5.67, p=0.25; I²=55%), such\nas the occurrence of nausea and vomiting (RR=1.57; 95%CI:\n0.27 - 9.06, p=0.61; I²=61%). However, the use of DEX as a\nsedative agent was associated with a signi ficantly higher\nincidence of bradycardia (RR=2.76; 95% CI: 1.41 - 5.40, p <\n0.01; I²=0%). Regarding MAP 10 minutes after the onset of the\nprocedure, no differences were observed when compared to\nfentanyl (SMD= -0.04; 95% CI: -0.35 - 0.27, p=0.78; I²=0%) or\npropofol (SMD= -0.30; 95% CI: -0.71 - 0.11, p=0.15; I²=33%).\nFinally, the analysis of HR revealed a signi ficant difference\nbetween the DEX group and the propofol group (SMD= -1.31;\n95% CI: -1.90 - 0.71, p < 0.01; I²=60%), but no difference was\nobserved when compared to the fentanyl one (SMD= 0.12;\n95% CI: -0.32 - 0.56, p=0.58; I²=48%).\nConclusion DEX demonstrates ef ficacy and safety\ncomparable to other sedatives in colonoscopy, with similar\nincidences of hypotension and nausea/vomiting, but a higher\nrisk of bradycardia. While no signi ficant differences were\nobserved in MAP compared to fentanyl or propofol, there was\na significant difference in HR compared to propofol, but not\nwith fentanyl. These findings suggest that dexmedetomidine\nmay offer effective sedation for colonoscopy, but clinicians\nshould be vigilant for potential bradycardia.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141482\nE-poster\nEXPERIENCE WITH ENDOSCOPIC TREATMENT OF\nCOLORECTAL ANASTOMOTIC DEHISCENCE: CASE REPORT\nAND LITERATURE REVIEW\nAmanda Cristine Pereira de Amorim 1, Isabella Resende\nMartins1, Valéria Vieira da Silva Coutinho1, Bruno Barros Britto1\n1Instituto de Assistência Médica ao Servidor Público Estadual, São\nPaulo, Brazil\nCase Presentation A 71-year-old man underwent a\nrectosigmoidectomy for adenocarcinoma of the upper rectum\nwith primary anastomosis 4 cm from the anal verge, protective\nileostomy, and prophylactic cavity drainage. On the 5th post-\noperative day, he developed a semicircular anastomotic dehis-\ncence without signs of peritonitis or sepsis. Conservative\ntreatment was chosen with antibiotics and maintenance of\nthe cavity drain, which was well-positioned and draining\npurulent fluid. Clinical improvement allowed discharge on\nthe 14th postoperative day, with the cavity drain still in place.\nTwo months later, a follow-up colonoscopy revealed a patent\nanastomosis with a 1-cm fistulous opening communicating\nwith a 3-cm cavity, through which the tubulolaminar drain\nwas visible. Extraluminal vacuum therapy with an 18Fr endo-\nsponge was applied, later replaced by a double-tube system.\nAfter two weeks and three exchanges, the fistulous opening\nand tract were obliterated. Two weeks later, the ileostomy was\nclosed with good postoperative recovery and discharge on the\n3rd day. The patient subsequently presented with regular\nbowel movements and good continence.\nDiscussion Anastomotic fistula is the main complica-\ntion of colorectal surgeries, occurring in up to 15-20% of cases,\nand is associated with significant morbidity. In stable patients\nwith extraperitoneal anastomoses, particularly those with a\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS66\n\n\npre-existing diversion stoma, minimally invasive treatments\naimed at preserving the anastomosis are highly desirable.\nEndoscopic therapies, including stents, fibrin glue, clips,\ndouble pigtail catheter drainage, and, more recently, vacuum\ntherapy, are noteworthy. Vacuum therapy works by removing\nfluids, reducing edema and bacterial load, increasing blood\nflow, and stimulating granulation tissue. The average treat-\nment duration ranges from 35 to 60 days, requiring multiple\ndressing changes, which can be made with sponges or a\ndouble-tube structure, with or without substance instilla-\ntion. Early intervention is associated with better outcomes.\nConclusion Early consideration of endoscopic vacuum\ntherapy can increase the resolution rates of colorectal fistulas\nwith shorter treatment durations, reducing reoperation rates\nand permanent stomas. However, high costs, prolonged treat-\nment times, and the availability of trained professionals remain\nlimiting factors in the widespread use of this technique.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141768\nE-poster\nINFLUENCE OF LATERALITY ON THE ENDOSCOPIC AND\nHISTOPATHOLOGICAL CHARACTERISTICS OF PREMALIGNANT\nCOLON LESIONS IN WOMEN AGED 60 YEARS AND OLDER\nRafaela de Melo Sprogis\n1, Vanessa Siqueira Reis 1, Catarina\nFerreira Costa Praia 1, Luís Felipe Mendonça de Oliveira 1, Flavia\nBerford Leão dos Santos Gonçalves de Oliveira2, Camila Oliveira\nBarbosa2, Bruno Augusto Alves Martins2, João Batista de Sousa1\n1Universidade de Brasília, Brasilia, Brazil\n2Hospital Universitário de Brasília, Brasília, Brazil\nIntroduction The laterality of colon tumors in fluen-\nces clinical presentation and prognosis. These tumors often\noriginate from premalignant lesions, which can be identi fied\nand characterized through colonoscopy and biopsy.\nObjective To analyze the influence of laterality on the\nendoscopic and histopathological characteristics of prema-\nlignant colon lesions in women aged 60 years and older.\nMethod A retrospective, cross-sectional study of 4,412\nconsecutive colonoscopies performed in the coloproctology\ndepartment of a university hospital between January 2019 and\nDecember 2023. The sample was limited to women aged 60\nyears and older, without previous intestinal resection, who\nunderwent complete colonoscopies, presented with polyps\nduring the examination, and whose histopathological analysis\nwas conducted in the same service, totaling 262 patients. Each\npolyp found was individually analyzed for location, morpholo-\ngy, size, and histopathology. Polyps located at or distal to the\nsplenic flexure were classified as left colon (LC), while those\nproximal to the splenic flexure were classified as right colon\n(RC). Statistical analysis was performed using Fisher’s exact test\nand Chi-square test, with laterality as the dependent variable.\nResults A total of 510 polyps resected from the 262\npatients were analyzed. Regarding location, 282 (55.3%) were\nin the LC, and 228 were in the RC. Morphologically, 234 (88%)\nof the LC polyps were sessile, while 208 (93.3%) in the RC had\nthe same characteristic (p = 0.087). Polyps larger than 5 mm\nwere observed in 45 (16.4%) cases in the LC and 39 (17.2%) in\nthe RC (p = 0.901). In the LC, 135 (47.9%) polyps were\nhistopathologically classified as hyperplastic, 109 (38.7%) as\ntubular adenomas, 23 (8.2%) as tubulovillous adenomas, and\n6 (2.1%) as serrated adenomas. In the RC, 167 (73.2%) were\nclassified as tubular adenomas, 33 (14.5%) as hyperplastic\npolyps, 15 (6.6%) as tubulovillous adenomas, and 8 (3.5%) as\nserrated adenomas (p < 0.001). Dysplasia was absent in 142\nLC polyps (51.1%) and in 40 RC polyps (17.5%) (p < 0.001).\nConclusion The RC was associated with a higher\nprevalence of tubular and serrated adenomas, while the LC\nwas linked to hyperplastic polyps and the absence of dysplasia.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141846\nE-poster\nARTIFICIAL INTELLIGENCE AND CAPSULE COLONOSCOPY:\nAUTOMATIC ASSESSMENT OF INTESTINAL PREPARATION\nSCORES/DEGREE\nJoana Mota1,2, Miguel José Mascarenhas Saraiva 1,2,3, João\nAfonso1,2 Tiago Ribeiro1,2, Pedro Cardoso1,2, Miguel Martins1,2,\nGuilherme Macedo1,2,3\n1Centro Hospitalar Universitário São João, Porto, Portugal\n2Centro de Treino WGO, Porto, Portugal\n3Faculdade de Medicina Universidade do Porto, Porto, Portugal\nIntroduction Medicine is evolving toward increas-\ningly less invasive diagnostic modalities, with Gastroenterol-\nogy being a prime example of this trend. The diagnostic\nassessment of the colon using capsule endoscopy, through\nspecific protocols for colon capsule endoscopy or as part of\npanendoscopic evaluations, has gained growing importance\nas a first-line diagnostic method. Proper bowel preparation is\nessential for conclusive examinations, given the non-invasive\nnature of capsule endoscopy —which does not allow for\ninterventional measures to improve mucosal visibility. Sev-\neral scales have already been developed to classify bowel\npreparation for colon capsule endoscopy. However, their\napplicability is limited by inter-observer variability.\nObjective The aim of this study was to develop a deep-\nlearning algorithm for the automatic classi fication of colon\nbowel preparation.\nResults The algorithm achieved highly satisfactory\nresults, with sensitivity, speci ficity, and diagnostic accuracy\nof 91%, 97%, and 95%, respectively. The area under the curve\nranged from 0.92 to 0.97.\nConclusion This study is pivotal for the future wide-\nspread use of capsule endoscopy in colon evaluation and for\nminimally invasive panendoscopic modalities.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 137754\nE-poster\nTHE USE OF 4% FORMALIN SOLUTION FOR THE TREATMENT\nOF HEMORRHAGIC ACTINIC PROCTITIS: EXPERIENCE OF THE\nSERVICE\nMaycon Lucas de Souza\n1, Bruna Lima Daher 1, Karla Cristina\nCintra Mendes1, Matheus Lucas de Souza 1, Vanessa Bernardes\nDaniel1, Leonardo Mundim Andrade Porto1, Felipe Poli Leonel1,\nEduardo Reinaldo Silva1\n1Santa Casa de Misericórdia de Franca, Franca, Brazil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S67\n\n\nIntroduction Actinic proctitis due to radiation thera-\npy for pelvic neoplasms is a common complication. Among\ntherapeutic options, the use of formalin solution is an effec -\ntive and low-cost alternative.\nObjective To report the service ’s experience in treat-\ning hemorrhagic actinic proctitis post-prostate neoplasia\nwith intra-rectal 4% formalin application. Case 1: FA, an 88-\nyear-old male, underwent radiotherapy 24 months ago and\nwas admitted for acute exacerbation of chronic rectal bleed-\ning and symptomatic anemia (Hb=5.5). In a previous hospi-\ntalization, a colonoscopy with argon plasma coagulation and\nrectal sucralfate was performed. A subsequent examination\nrevealed submucosal telangiectasias with active bleeding and\nulcerations on the anterior rectal wall due to prior argon use.\nThe treatment of choice was the intra-rectal 4% formalin\napplication, following the Teixeira method: rectal instillation\nvia a catheter inserted into the colonoscope over the affected\narea. A total of 500 ml of 4% formalin was used in aliquots of\n50 ml, with each aliquot remaining in contact with the\nmucosa for 1 minute, followed by washing with 100 ml of\nsaline solution, aspiration of the residual liquid, and repeated\napplication (10 times). Between applications, cleaning of the\nanal border was performed to prevent skin lesions. There was\nremission of bleeding during follow-up, without the need for\nfurther procedures. Case 2: FBP, an 80-year-old male, under-\nwent radiotherapy 19 months ago and was admitted with\nrectal bleeding and anemia (Hb=7). He was hospitalized for\nhemorrhagic actinic proctitis and experienced recurrence of\nbleeding weeks after the use of argon. The decision was made\nto use 4% formalin under the previously described technique.\nHe evolved with remission of bleeding and hematimetric\nstability, leading to hospital discharge. Two weeks later, he\nreported sporadic bleeding, and a new rectosigmoidoscopy\nshowed circumferential fibrinous ulceration (eschar from\nprevious formalin instillation), without active bleeding.\nConclusion Among various therapies for hemorrhag-\nic actinic proctitis, argon plasma coagulation is the most\neffective, although it is less available, more costly, and carries\nthe risk of complications. Evidence shows positive results\nwith intra-rectal 4% formalin, and our experience has been\nsatisfactory. This method offers low cost and wide availabili-\nty, making it an effective option for refractory cases and a\nfirst-choice treatment in hospitals lacking other therapeutic\nresources.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141373\nE-poster\nORGANIZED COLORECTAL CANCER SCREENING IN\nHEALTHCARE WORKERS: POSITIVITY OF\nIMMUNOHISTOCHEMICAL AND\nIMMUNOCHROMATOGRAPHIC FECAL TESTS FOLLOWED BY\nCOLONOSCOPY\nJúlia Lucila de Moura\n1, John Anibal Tapia Baca1, Marcio Roberto\nFacanali Junior1, Isabella Nicacio de Freitas 1, Afonso Henrique\nda Silva e Sousa Júnior 1, Carlos Frederico Sparapan Marques 1,\nAdriana Vaz Safatle-Ribeiro 1, Amanda Cristina Lopes Atui 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brazil\nIntroduction Given the increasing incidence of colo-\nrectal cancer, prevention programs and strategies that in-\nclude screening for occult blood in feces, either through\nquantitative fecal immunochemical testing (FIT) or qualita-\ntive immunochromatographic fecal testing (ICT), followed by\ncolonoscopy, are being applied to detect lesions. FIT is an anti-\nglobulin test with high specificity, while ICT can detect blood\nfrom the entire gastrointestinal tract.\nObjective To evaluate the positivity rate of fecal tests\nand the adenoma detection rate (ADR) and colorectal cancer\n(CRC) detection rate in patients who tested positive.\nMethods A cross-sectional, analytical, and single-\ncenter study. During the organized CRC screening of health-\ncare workers at a reference hospital in the Coloproctology\nservice between April 2021 and June 2024, the positivity\nrates of FIT and ICT were evaluated. Patients with positive\ntests were referred for colonoscopy, and adenoma and CRC\ndetection rates were assessed.\nResults Of a total of 6679 healthcare workers aged 50\nto 75 years, 4048 (56%) underwent testing, of which 230\n(5.7%) were positive, indicating the need for colonoscopy.\nUsing a cutoff value of 50 ng/mL, the positivity rate for FIT was\n8%, and for ICT, it was 3%, a difference that could represent a\nsignificant loss of patients when using the qualitative test. Of\nthe 230 positive individuals, 156 underwent colonoscopy\n(67.8%). Of these, 129 (82.7%) used FIT and 27 (17.3%) used\nICT. The adenoma detection rate was 58.1% for FIT and 55.5%\nfor ICT. In patients who underwent FIT, 6 serrated lesions, 75\nadenomas (74 low-grade, 6 high-grade), and 4 neoplasms (1\nneuroendocrine, 3 adenocarcinomas) were found. In patients\nwho underwent ICT, 4 serrated lesions, 16 adenomas (15 low-\ngrade, 1 high-grade), and no neoplasms were found.\nConclusion 1. The results showed higher positivity for\nFIT compared to ICT. 2. The adenoma detection rate was\nsimilar for both tests. 3. Despite the difference in the number\nof tests, CRC was diagnosed only in the FIT group. 4. In an\nasymptomatic, average-risk population, occult blood testing\nfollowed by colonoscopy is an essential strategy for diagnos-\ning precursor and advanced colorectal lesions.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141720\nE-poster\nENCAPSULATED RETROPERITONEAL PNEUMOPERITONEUM\nAFTER MUCOSECTOMY FOR LST - CASE REPORT\nRejane Corrêa Furtado 1, Alisson Cordeiro Moreira 1, Gabriel\nLopes Ponte Prado 1, Ramiro Rolim Neto 1, Tainah Cristina\nSaboya de Queiroz Colares 1, Breno Moreira Viana Mendonça\nBrito1, Eduardo Barroso Ribeiro 1 Benjamin Ramos de Andrade\nJúnior1\n1Santa Casa da Misericórdia de Fortaleza, Fortaleza, Brasil\nCase Presentation A 40-year-old female patient with\nno prior comorbidities, in good nutritional status, underwent\na screening colonoscopy due to a family history of colorectal\ncancer. An LST (laterally spreading tumor) was found in the\nascending colon, near the cecum. The lesion was elevated\nwith saline solution and endoscopic mucosal resection (EMR)\nwas performed using a diathermic loop in a piecemeal\nfashion, without complications during the procedure. On\nthe 15th post-procedure day, the patient developed an in-\ncrease in abdominal volume in the hypogastric region, which\nwas painless. She did not present with fever, leukocytosis, or\nany systemic or intestinal symptoms, but had a signi ficant\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS68\n\n\nabdominal bulging with a palpable mass. A CT scan revealed\nan expansile formation with thin walls and gas content in the\nright iliac fossa, medial to the ascending colon, causing an\nimpression on the abdominal wall. After no resolution with\nconservative treatment, the patient underwent a videola-\nparoscopy on the 20th day post-mucosectomy, which\nrevealed a loculated retroperitoneal pneumoperitoneum,\nwith no apparent perforation or colon injury. A puncture\nwas performed on the bulging area, releasing a signi ficant\namount of gas, with no signs of enteric fluid or feces, and the\nposterior peritoneum was opened by approximately 1 cm,\nwhere the gas encapsulation was located. On the 15th post-\noperative day following VLP (videolaparoscopy), the patient\nreturned to the outpatient clinic with a similar painless\nabdominal volume increase, and imaging studies showed\ncompatible findings. A decision was made for a laparotomy\nthrough a transumbilical incision, with findings similar to the\nprevious VLP: a large encapsulated retroperitoneal pneumo-\nperitoneum with only gas inside, again with no apparent\nperforation or colon injury. A careful and extensive dissection\nof the peritoneal wall was carried out, and the cavity was\ndrained. The patient progressed well, with resolution of the\ncondition and late post-operative imaging showing no signif-\nicant findings. The pathological examination of the LST\nconfirmed it as a tubular-villous adenoma.\nDiscussion Endoscopic mucosal resection (EMR) is a\nprocedure used to remove early-stage precancerous lesions\nor other abnormal tissues from the gastrointestinal tract.\nMucosectomy for LST is a safe and effective technique for\ntreating sessile and flat lesions in the colon, with low recur-\nrence or complication rates, though it occasionally results in\npiecemeal excision for larger lesions. This case represents a\npeculiar and atypical post-mucosectomy complication, with\nfew similar cases described in the literature.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141778\nE-poster\nKLIPPEL-TRENAUNAY SYNDROME: CASE REPORT\nMatheus Henrique de Souza Gomes 1, Paulo Mozart de Barros 1,\nMaurício José de Matos e Silva 1, Amanda Casagrande Dias 1,\nEloisa Barbosa Brum 1, Bruna Bittencourt de Amorim 1,\nAlessandro Soares Rodrigues 2, Kauê Magalhães Castro dos\nSantos2\n1Hospital Barão de Lucena, Recife, Brazil\n2Universidade Federal do Amapá, Macapá, Brazil\nKlippel-Trenaunay Syndrome (KTS) is a rare condition\ncharacterized by vascular malformations and tissue hyper-\ntrophy. This report describes the case of a 24-year-old male\npatient diagnosed in childhood, with constant mild rectal\nbleeding, who underwent sclerotherapy at the age of 8 with\nno significant improvement. Other conditions were ruled out.\nThe patient continued the annual follow-up with colonosco-\npies for eight years. In 2015, the examination revealed\nvascular lesions with ulcerations in the distal and mid-\nrectum, as well as a hemangioma in the upper segment,\nindicating rectal involvement by KTS. In 2020, the patient\nreported worsening bleeding and rectal pain but managed\nthe condition with analgesics due to the COVID-19 pandemic.\nIn 2023, an ileocolonoscopy detected a friable lesion 2 cm\nfrom the anal margin, extending 8 cm, and a biopsy revealed a\nhyperplastic polyp. In 2024, a sigmoidoscopy highlighted an\nulcerated lesion in the mid and lower rectum, suggesting\nneoplasia or in flammation. MRI showed wall thickening of\nthe rectum and anal canal with high T2 signal, without\nextramural involvement, suggesting diffuse rectal hemangi-\noma or in flammatory lesions. A cystic lesion was also identi-\nfied in the deep post-anal space, suggestive of a retrorectal\nhamartoma or enteric cyst. The final histopathological exam-\nination revealed an ulcerated lesion with edematous connec -\ntive tissue, capillary neogenesis, and leukocytic in filtrate,\nwith adjacent hyperplastic and benign mucosa. Current\nmanagement includes follow-up colonoscopy and cauteriza-\ntions. KTS is a rare congenital condition characterized by\ncutaneous hemangiomas, bone hypertrophy, and vascular\nmalformations, primarily affecting the lower limbs. The\netiology is uncertain, and the lesions appear from birth.\nGastrointestinal involvement is rare but can cause bleeding.\nIn this case, the patient had an atypical manifestation of KTS\nwith rectal involvement and symptoms mimicking colorectal\ncancer. The worsening of the condition during the pandemic\nunderscores the need for continuous monitoring. Imaging\nand biopsy findings showed vascular and cystic lesions,\nhelping de fine the case and guide the non-interventional\napproach. The management with colonoscopies and cauteri-\nzation aims to control bleeding and prevent complications.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 138360\nE-poster\nDISSEMINATED JUVENILE POLYPOSIS SYNDROME: A CASE\nREPORT\nFelipe Pereira Lemos Costa 1, Priscylla Rangel Blaszak 1, Bruna\nMarcante1, Heveline Trajano Vasconcelos1, João Márdio Paixão\nde França1, Mardem Machado Souza1, Wladimyr Dias Moreno1,\nMariana de Oliveira Pantoja 1\n1Hospital Universitário Júlio Müller, Cuiabá, Brazil\nCase Presentation Male, 17 years old, with a family\nhistory of polyposis. At 4 years old, he presented with a polyp\nthat exteriorized during defecation; polypectomy was per-\nformed with no further issues. In November 2020, at 12 years\nold, he began experiencing abdominal pain and enterorrha-\ngia; colonoscopy showed sessile and pedunculated polyps in\nall colonic segments and rectum ( >100). Polypectomy was\nperformed, and histopathological analysis revealed an in-\nflammatory hyperplastic polyp. In January 2021, he pre-\nsented with abdominal pain associated with abdominal\ndistention, nausea, and enterorrhagia, with no signs of peri-\ntoneal irritation. He was referred to the emergency depart-\nment with a hemoglobin level of 10.4 g/dL. A CT scan\nsuggested intestinal intussusception involving the cecum,\nascending colon, and transverse colon, with the “head” of\nthe invagination located in the descending colon. Abdominal\nultrasound revealed free fluid in the pelvic cavity. Right\ncolectomy and ileo-transverse lateral-lateral anastomosis\nwere performed without complications. In follow-up care, a\ncolonoscopy in 2022 showed numerous sessile and peduncu-\nlated polyps ranging from 0.5 to 2 cm. Immunohistochemical\nstudy con firmed juvenile hamartomatous polyps, and an\nupper digestive endoscopy revealed a polyp in the cardia,\ndiagnosing Disseminated Juvenile Polyposis Syndrome. A\n2023 colonoscopy with polypectomy showed multiple\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S69\n\n\njuvenile polyps in the large intestine. He is currently under\noutpatient follow-up.\nDiscussion Juvenile Polyposis Syndrome is an auto-\nsomal dominant genetic condition characterized by the for-\nmation of multiple hamartomatous polyps in the\ngastrointestinal tract, more commonly affecting males,\nwith an average age of 18 years. In 80% of cases, polyps are\nfound in the colon and rectum. Most polyps are benign and\nsymptomatic, causing bleeding, anemia, intestinal obstruc -\ntion, rectal prolapse of the polyp, and intussusception. Diag-\nnosis requires at least five juvenile polyps in the colorectal\nregion, juvenile polyps in other parts of the gastrointestinal\ntract, or any number of juvenile polyps in an individual with a\nfamily history of juvenile polyps. Many cases are treated with\nendoscopic polypectomy, but surgery may be required in\nsome cases.\nConclusion This case underscores the importance of\ndiagnosis and continuous monitoring of the condition due to\nthe risk of progression to malignancy or obstructive compli-\ncations, which can lead to high mortality.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141501\nE-poster\n“NATURAL INTELLIGENCE”: INVESTIGATION OF THE\nADENOMA DETECTION RATE IN COLONOSCOPY WITH THE\nPRESENCE OF A TRAINEE ASSISTANT\nBarbara Andrade Prais1, João Baptista de Paula Fraga1, Carolina\nVieira de Faria 1, Rommel Ribeiro Lourenço Costa 2, Marcela de\nLima Paula3, Jeude Moisés da Silva Bravo 1\n1Hospital e Maternidade Therezinha de Jesus, Juiz de Fora, Brazil\n2Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil\n3Universidade Federal do Vale do São Francisco, Petrolina, Brazil\nGlobally, colorectal cancer (CRC) is the third most\ncommon cancer in the world, responsible for approximately\n10% of all cancer cases and is the second leading cause of\ncancer-related deaths worldwide. In Brazil, it is estimated\nthat there will be 45,000 new cases annually between 2023\nand 2025. The well-known adenoma-carcinoma sequence\nand advancements in CRC research are related to reduced\nmortality, early detection, and high cure rates. Colonoscopy is\ncrucial in the prevention and screening of CRC, and the\nadenoma detection rate (ADR) is the main quality indicator\nfor the exam. The exponential increase in technology, im-\nproving the images in endoscopic exams, is a reality and has\ncontributed to CRC prevention. The recommended ADR by\nthe American Society of Gastroenterology is /C21 30% in men and\n/C21 20% in women. Several factors are associated with an\nincreased ADR, such as the use of arti ficial intelligence,\nchromoscopy, the time spent withdrawing the device, the\nquality of bowel preparation, and the use of antispasmodics.\nStudies have shown that the presence of an attentive assistant\nduring the exam is also an important factor for a higher ADR.\nThe present study aims to assess the impact of a trainee\nassistant on the adenoma detection rate in a public hospital in\nJuiz de Fora.\nMethod Evaluation of colonoscopy reports performed\nbetween March and December 2023 in a public hospital by a\nteam of colorectal specialists. Data was collected regarding\nsex, age, hospitalization at the time of the exam, adenoma\ndetection rate, bowel preparation quality, and organized in an\nExcel spreadsheet.\nResults 104 colonoscopy reports were evaluated, with\n38 being performed only by an experienced colorectal special-\nist (Group 1) and 66 performed by this specialist along with a\nspecialist in training (Group 2). The ADR in Group 1 was 34%,\nwhile in Group 2 it was 45%. When compared to exams\nperformed on non-hospitalized (asymptomatic) patients, the\nADR was 28% and 50% in Groups 1 and 2, respectively.\nConclusion The ADR is an important parameter in the\nquality of colonoscopy, and it has been increasing alongside\nthe growth of technologies and techniques implemented in\nlarge centers. A cost-effective method to increase ADR is the\nroutine use of a second observer during exams.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141182\nE-poster\nACUTE PERFORATED ABDOMEN DUE TO METASTATIC\nLESIONS OF THE SMALL INTESTINE SECONDARY TO LUNG\nCANCER: CASE REPORT\nRenzo Stefenoni Finamore Simoni 1, Yasmin Góis de Mello 1,\nIsaac José Felippe Corrêa Neto1, Laercio Robles1, Gabriela Portal\nMonteiro1\n1Hospital Santa Marcelina, São Paulo, Brazil\nMDL, 75 years old, admitted to the emergency room\nwith abdominal pain and melena for 2 days. He was under\ninvestigation for pulmonary neoplasia, with local spread and\nmetastasis in the trachea and adrenal glands. A CT scan was\nperformed, showing pneumoperitoneum, and surgical inter-\nvention was indicated. During the abdominal cavity explora-\ntion, four vegetative and friable lesions were identified on the\nantimesenteric border of the small intestine, two of which\nwere perforated. A wedge resection of the perforated lesions\nand a small bowel anastomosis were performed due to\nhemodynamic instability. The pathological examination of\nthe resected lesions was consistent with malignant epitheli-\noid neoplasia, and the immunohistochemistry revealed\ntransmural in filtration by undifferentiated carcinoma in\nthe small bowel wall. Among cases of pancreatic cancer\n(PC) metastasizing to the gastrointestinal tract (GIT), only\n1.1% correspond to small bowel involvement. The most\ncommon location is in the jejunum, and the main symptoms\nare abdominal pain, melena, nausea, vomiting, and weight\nloss, but it is often diagnosed through complications. Hema-\ntogenous spread of the tumor forms lesions in the intestinal\nwall, which can lead to various complications. These may\ninclude obstructive acute abdomen if the tumor grows intra-\nluminally, malabsorption syndrome, perforative acute abdo-\nmen, and gastrointestinal bleeding if necrosis and ulceration\noccur at the site of the lesion. Small bowel perforation is more\nfrequent in metastases from pancreatic cancer compared to\nother primary cancers, meaning that if small bowel lesions\nsuggestive of secondary lesions are found during the ap-\nproach to a perforative acute abdomen, pancreatic cancer\nshould be investigated. Upon identifying the affected area\nintraoperatively, the procedure of choice is segmental enter-\nectomy. In this case, the patient was malnourished, with a\nserum albumin level of 2.8, metastases in the trachea and\nadrenal glands, and four jejunal lesions, two of which were\nperforated. Postoperatively, the patient was managed in the\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS70\n\n\nICU, and on the fourth day, he developed melena, worsened\nlaboratory values, and decreased level of consciousness. Due\nto the unfavorable progression and advanced disease, pallia-\ntive care measures were agreed upon with the family, and the\npatient passed away two days later. Perforation of neoplastic\nimplants in the small intestine in advanced lung cancer cases\nis a rare event. Furthermore, in cases where the neoplasm has\nnot been diagnosed on this site, if implantation in the small\nintestine occurs, this site should be investigated.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138254\nE-poster\nMODIFIED KRASKE APPROACH FOR RESECTION OF A GIANT\nRETRORECTAL CYST\nCarolina Reis Bonizzio 1, Rodrigo Ambar Pinto 1, Jorge Landivar\nCoutinho1, John Anibal Tapia Baca 1, Mateus Satoru Kajiwara 1,\nGabriela Lopes Fonseca 1, Carlos Frederico Sparapan Marques 1\n1Faculdade de Medicina da Universidade de São Paulo, São Paulo,\nBrazil\nCase Presentation A young woman noticed a bulge in\nthe right gluteal region, asymptomatic but progressively grow-\ning. Magnetic resonance imaging revealed a large retrorectal\ncystic formation (450 cm³) communicating with an exophytic\ncomponent (2750 cm³) extending into the gluteal region\nthrough the right parasacral musculature. While awaiting\nelective surgery, she presented to the emergency department\nin septic shock due to cyst infection. After clinical management,\ncyst drainage, and debridement, she showed good progress.\nTissue culture revealed infection by\n/C3 E. faecalis /C3 and multi-\ndrug-resistant/C3 E. coli/C3 . Following prolonged antibiotic therapy,\nshe proceeded to definitive surgical treatment, as discussed in a\nmultidisciplinary meeting involving colorectal and plastic\nsurgery teams. The patient was positioned prone under general\nanesthesia. Access to the pelvic cavity was achieved through a\nposterior approach, starting with a spindle-shaped incision\nencompassing the gluteal tumor and continuing with marginal\ndissection along the cyst capsule. The coccyx was resected to\nimprove pelvic access. The dissection remained extraperitone-\nal, preserving adjacent structures, including nerves, rectum,\nsphincter apparatus, and vagina. The cyst was removed en bloc.\nA “water leak test” confirmed rectal wall integrity. Closure was\nperformed in layers, with pelvic drainage using a Blake drain\nand a prophylactic vacuum dressing applied to the incision. The\npatient had a favorable postoperative recovery, and pathologi-\ncal examination excluded malignancy.\nDiscussion Retrorectal cystic tumors are rare, pri-\nmarily congenital, and often represent embryological rem-\nnants of the hindgut or neuroectoderm. The main types\ninclude dermoid cysts, epidermoid cysts, rectal duplication\ncysts, hamartomas, and teratomas. These tumors are gener-\nally asymptomatic and incidentally diagnosed through imag-\ning, with extrinsic bulging detectable on digital rectal\nexamination. Due to the risk of infection (30%), as in this\ncase, or malignancy (7 –45%), surgical treatment is indicated.\nComplete resection during surgery is essential to reduce the\nrecurrence risk, reported in up to 15% of cases. Posterior\napproaches such as Kraske and York-Mason are preferred for\nlow lesions (below S3). In this patient, the Kraske approach\nwas modified to address the gluteal component of the lesion,\nas demonstrated in the accompanying video.\nFinal Comments Retrorectal cystic tumors are rare\npathologies that can pose signi ficant challenges to the surgi-\ncal team. A multidisciplinary approach is crucial for achieving\nsuccessful outcomes in complex cases.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138269\nE-poster\nINTESTINAL INVOLVEMENT BY KAPOSI’S SARCOMA IN A NON-\nIMMUNOSUPPRESSED PATIENT\nRodrigo de Almeida Paiva 1, Daniel Maurício Londoño Estrada 1,\nMarina Barbabela Grisolia de Oliveira1, Letícia Brandão Castro1,\nEduardo de Carvalho Barbosa1, Vinicius Avelar Palhares1, Marco\nRinoldi1, Artur Duarte e Duarte 1\n1Hospital Felício Rocho, Belo Horizonte, Brazil\nCase Presentation A 77-year-old male patient with a\nhistory of lower gastrointestinal bleeding (enterorrhagia)\nunderwent a colonoscopy that revealed a bleeding lesion in\nthe sigmoid colon, which was treated with a hemostatic clip.\nThe bleeding recurred, and two additional procedures were\nperformed without resolving the issue. De finitive surgical\ntreatment with rectosigmoidectomy was then chosen.\nHistopathological findings: Vascular lesion with fea-\ntures consistent with Kaposi ’s sarcoma.\nDiscussion Kaposi’s Sarcoma (KS) is a type of cancer\noriginating in the blood and lymphatic vessel cells, associated\nwith human herpesvirus type 8 (HHV-8). The epidemiology of\nKS varies signi ficantly worldwide, with notably high preva-\nlence in Sub-Saharan Africa, where it is often related to AIDS\nand found endemically in children and the elderly, with a\nhigher prevalence in men. Clinically, it presents as pink-purple\npatches on the skin and can also affect mucous membranes and\ninternal organs, often causing significant bleeding. Diagnosis is\nconfirmed via histopathology, identifying spindle cells, HHV-8\nLANA antigen, abnormal blood vessel proliferation with leak-\nage, extravasated red blood cells, and inflammatory infiltrates.\nConclusion In conclusion, though rare, Kaposi ’s Sar-\ncoma is a multifocal vascular neoplasm with signi ficant\nprevalence among immunocompromised individuals, partic -\nularly those with HIV. However, in non-immunosuppressed\npatients, it should be considered as a differential diagnosis in\ncases of recurrent lower gastrointestinal bleeding.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141761\nE-poster\nANALYSIS OF INFORMATION QUALITY ABOUT SURGICAL\nTREATMENT FOR HEMORRHOIDAL DISEASE ON THE\nBRAZILIAN INTERNET\nRodrigo Galvão Moreno\n1, Jean Luca Alves 1, Gersino Perin\nRibeiro1, Jordana Martins Américo de Souza 1, João Paulo\nSlongo1, Delis Marques Gregoski 1, Daniele Ximenez 1, André\nPereira Westphalen1\n1Hospital Universitário do Oeste do Paraná, Cascavel, Brazil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S71\n\n\nIntroduction Although the internet has brought\npatients and doctors closer, not all health-related information\nfound online is accurate or well-written. This can disrupt\nappropriate medical practice, as some patients may distrust\nprofessionals due to inaccurate information read online.\nRegarding hemorrhoidal disease, numerous surgical techni-\nques have been developed, such as hemorrhoidectomy, hem-\norrhoidopexy, and Doppler-guided hemorrhoidal artery\nligation. These techniques are commonly searched for by\nthe general population interested in the subject.\nObjective/Method The study aimed to analyze\nwhether the information available online about surgical\ntreatment for hemorrhoidal disease, via Google, is of satisfac -\ntory, explanatory, and up-to-date quality. A total of 25 open-\naccess websites retrieved through the search engine were\nselected for analysis. The DISCERN tool was applied to\nevaluate the quality of health information regarding treat-\nment options. DISCERN encompasses 16 questions divided\ninto three sections, with the final section providing a general\nrating of the publication ’s quality.\nResults Section 3 of the DISCERN tool assesses the\noverall quality of the publication as a source of information\nabout treatment options, based on responses to all previous\nquestions. The average score for this section was 2.64 points\n(52.8%), with 16% of websites scoring 1, 36% scoring 2, 24%\nscoring 3, 16% scoring 4, and 8% scoring 5. Among the 25 sites\nanalyzed, at least 50% showed bias, favoring one treatment as\nsuperior. Notably, the transanal dearterialization technique\nwas mentioned in 32% of the websites as a more recent\nmethod. However, its long-term efficacy - especially for larger\nhemorrhoids - remains debatable, showing similar results to\nother techniques but with higher cost-effectiveness concerns.\nConclusion A general evaluation based on Section 3 of\nthe DISCERN tool revealed data about the quality of the\npublications. The study found that the average score for\nthis section was 2.64 out of 5, equivalent to 52.8 out of\n100. Therefore, the information available online about surgi-\ncal treatment for hemorrhoidal disease lacks satisfactory,\nexplanatory, and updated quality. Consequently, it does not\nprovide reliable information for the general public, hindering\npatients’ ability to seek and understand the best treatment\noptions for their cases.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141756\nE-poster\nACUTE APPENDICITIS COMPLICATED BY ENTEROCUTANEOUS\nFISTULA IN A YOUNG PATIENT: CASE REPORT\nBenjamin Bedin1, Izadora Midian Galvão Sarmento 1, Dirceu de\nCastro Rezende Júnior 1, Hugo de Freitas Queiroz 1, Lucas\nFerreira Aires Mendonça1, Geovanna Arnaldo de Sousa1, Marina\nFerreira da Silva 1, Pamela da Silva Zambianco 1\n1Hospital Regional de Taguatinga, Brasília, Brazil\nCase Presentation A 25-year-old female patient,\noverweight, presented to the emergency department with\ncomplaints of abdominal pain in the right iliac fossa that had\npersisted for seven days, accompanied by hyporexia, nausea,\nand vomiting. Abdominal computed tomography (CT)\nrevealed acute appendicitis with signs of perforation. A\nconventional appendectomy was performed, noting perfora-\ntion of the middle third of the cecal appendix. During\nhospitalization in the surgical ward postoperatively, the\npatient developed abdominal distension, nausea, vomiting,\nand purulent/enteric discharge from the surgical wound. A\nfollow-up abdominal CT scan showed gas pockets within the\nsubcutaneous tissue, anterior abdominal muscles, and adja-\ncent to the cecum near the surgical scar, indicating an enter-\nocutaneous fistula. A conservative approach was adopted,\ninvolving bowel rest (nil per os) and total parenteral nutrition\nfor nutritional support. The patient responded well to the\ntreatment and was discharged with instructions.\nDiscussion The appendix is a small organ located at\nthe initial portion of the large intestine. When its lumen\nbecomes obstructed, it leads to an in flammatory and infec -\ntious process. Appendicitis is a common condition in surgical\npractice and is the leading cause of acute abdomen. Postop-\nerative complications are well-documented, and the devel-\nopment of an enterocutaneous fistula is a rare occurrence,\naffecting approximately 2% of cases following appendectomy.\nAn enterocutaneous fistula is de fined as a communication\nbetween two epithelialized surfaces. Risk factors include\nappendix neoplasia, leakage from the appendiceal stump,\nintestinal infections, distal obstruction, and in flammatory\nbowel disease. Mortality rates range from 3% to 30%, with\nsepsis being a critical determinant of outcome.\nConclusion Enterocutaneous fistula is a rare compli-\ncation associated with surgical procedures, occurring in\nabout 2% of cases after appendectomy. Mortality rates vary,\nwith sepsis being a signi ficant factor in fluencing mortality.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138243\nE-poster\nEVALUATION OF THE DETECTION RATE OF ADENOMA AND\nADENOCARCINOMA IN A POPULATION-BASED COLORECTAL\nCANCER SCREENING PROGRAM IN THE MUNICIPALITY OF\nCAIRU, BAHIA\nAlana Francisca Machado Melo\n1, Alexandre Lopes de Carvalho1,\nIsabela Dias Marques da Cruz1, Flávia de Castro Ribeiro Fidelis1,\nLucas Abreu Barreiro 1, Lina Maria Goes de Codes 1\n1Hospital Universitario Professor Edgard Santos, Salvador, Brazil\nIntroduction In Brazil, colorectal cancer (CRC) is the\nthird most common cancer and the second leading cause of\ncancer-related death. The resection of precursor lesions and\nearly diagnosis impact its natural history, which makes\npopulation-based screening recommended. The quantitative\nfecal immunochemical test (FIT) is the preferred method for\nnon-invasive screening, and colonoscopy is the chosen endo-\nscopic method.\nObjective The aim of this study is to determine the\ndetection rate of adenomas and adenocarcinomas in the\nstudied population subjected to a population-based CRC\nscreening program in the municipality of Cairu, Bahia.\nMethod An observational study was conducted, with\ndata collected from the service records of the population-\nbased CRC screening program in Cairu, Bahia, during the first\nhalf of 2023. Residents aged 50 to 75 were subjected to FIT.\nPatients with FIT results above 25 ng/ml (considered positive)\nwere referred for colonoscopy. The specimens from resec -\ntions were sent for histopathological study.\nResults FIT results from 1,724 people were analyzed,\nwith 951 (55%) being women. The average age of participants\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS72\n\n\nwas 58.32 years. A total of 165 people (9.6%) had a positive FIT\nresult. Of these, 122 underwent colonoscopy, 58% were\nwomen, and the average age was 58.8 years. A total of 144\nlesions were identi fied in 41% of the examinations, with an\naverage of 1.1 lesions per exam. Of these, 141 (97.91%) were\nresected and classi fied according to the Paris classi fication.\nAmong the three lesions that were not resected, all were\nlocated in the rectum: one had a subepithelial appearance\nmeasuring 3.5 cm, one was a NG-LST type lesion of 16 mm,\nand there was a hyperplastic polyp con firmed by arti ficial\nintelligence. The subepithelial lesion was treated with transa-\nnal video-assisted surgery (D-Port platform), with a histo-\npathological diagnosis of neuroendocrine tumor. The second\nlateral growth lesion was resected transanally (histopatholo-\ngy: hyperplastic). Dysplastic lesions were present in 41 of the\n122 exams performed (33% of the sample). Histopathology\nresults of these resected lesions revealed a total of 82\npremalignant lesions (58.15%), of which 78 were adenoma-\ntous and 4 were serrated lesions. There were 58 benign\nlesions (41.13%). One lesion (0.72%) was identi fied as\nadenocarcinoma.\nConclusion Individuals with a positive FIT result who\nunderwent screening colonoscopy showed high detection\nrates of adenomas and adenocarcinomas, similar to those\nreported in the literature. This highlights the importance of\npopulation-based CRC screening programs.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141609\nE-poster\nBARBED VERSUS CONVENTIONAL SUTURES IN\nLAPAROSCOPIC-ASSISTED COLORECTAL SURGERY: A\nSYSTEMATIC REVIEW AND META-\nLucas Monteiro Delgado 1, Bernardo Fontel Pompeu 2, Eric\nPasqualotto3, Caio Mendonça Magalhães 1, Sergio Mazzola Poli\nde Figueiredo 4, Fernanda Bellotti Formiga 2\n1Universidade Federal de Minas Gerais, Belo Horizonte, Brazil\n2Hospital Heliópolis, São Paulo, Brasil\n3Universidade Federal de Santa Catarina, Florianópolis, Brazil\n4Cleveland Clinic Ohio, Cleveland, Ohio, United States\nIntroduction Minimally invasive surgery is the pre-\nferred method for treating colorectal disease. Laparoscopic\nsuturing is complex, and barbed sutures (BS) can improve\noutcomes. This study compares laparoscopic colonic anasto-\nmosis using BS versus conventional sutures (CS).\nMethods PubMed, Scopus, and Cochrane Library were\nsystematically searched for studies. Continuous outcomes\nwere compared using mean differences (MDs), and odds\nratios (ORs) for binary endpoints with 95% con fidence inter-\nvals (CIs). Heterogeneity was assessed with I² statistics.\nStatistical analysis was performed using Software R, version\n4.2.3.\nResults Four studies comprising 285 patients were\nincluded, with 143 patients (50.17%) undergoing BS. We\nobserved a signi ficantly reduced operative time (MD -16.25\nminutes; 95% CI -25.94,-6.56; p < 0.01; I²=0%) in BS. No\nsignificant differences in intraoperative complications, anas-\ntomotic leakage, and Clavien-Dindo /C21 III.\nConclusion BS signi ficantly reduced the operative\ntime in the anastomotic closure. There were no signi ficant\ndifferences in anastomotic leakage, intraoperative complica-\ntions, and severe postoperative complications.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141665\nE-poster\nILEAL STOMA COMPLICATED WITH FISTULA TO THE VAGINA\nIN A PATIENT WITH FAMILIAL ADENOMATOUS POLYPOSIS:\nCASE REPORT\nIgor Torres da Silveira Mendes1, Lucas Gabriel Castro Carvalho1,\nCamille Moreira Baptista da Silva1, Beatriz da Costa Rossi Ramos\nde Carvalho1, Oswaldo de Moraes Filho 2, Rômulo Medeiros de\nAlmeida2, Bruno Augusto Alves Martins2, João Batista de Sousa2\n1Universidade de Brasília, Brasilia, Brazil\n2Hospital Universitário de Brasília, Brasília, Brazil\nCase Presentation A 40-year-old woman diagnosed\nwith Familial Adenomatous Polyposis (FAP) was identi fied\nthrough screening due to a family history of polyposis. In\nSeptember 2019, she underwent restorative proctocolectomy\nwith a J-pouch ileal reservoir and a protective ileostomy. The\npatient developed a fistula between the ileal pouch and the\nposterior vaginal wall, which was surgically repaired via a\nperineal approach in September 2020. However, the fistula\nrecurred. A decision was made to resect the ileal pouch and\ncreate a new one, with simultaneous correction of the enter-\novaginal fistula during the surgery. The patient continued to\nexperience fecal leakage through the vaginal canal, accompa-\nnied by abdominal pain. A second ileal pouch resection and\ndefinitive terminal ileostomy were performed.\nDiscussion FAP is an autosomal dominant disease\naffecting 1 in 16,000 individuals in Brazil. It is rare but\nsignificant due to its potential for colorectal cancer develop-\nment, requiring surgical intervention, often prophylactically.\nSurgical options include restorative proctocolectomy with an\nileal pouch, total colectomy with ileorectal anastomosis, and\nproctocolectomy with a de finitive ileostomy. For patients\nwith fewer than 20 rectal polyps, ileorectal anastomosis is\npreferred. In this context, restorative proctocolectomy with\nan ileal pouch is indicated for patients with more than 20\nrectal polyps, maintaining intestinal transit. However, in this\ncase, an uncommon complication occurred: the development\nof a fistula between the pouch and the vagina. This compli-\ncation can result from inclusion of the posterior vaginal wall\nin the stapling during the anastomosis or from an anasto-\nmotic dehiscence leading to fistulization into the vagina. In\nthis case, the former was detected on the fourth postoperative\nday.\nConclusion Surgical treatment for FAP is a major\nprocedure, which can be performed via laparoscopic, robotic,\nor laparotomic approaches. When performing the anastomo-\nsis, it is crucial to visualize the posterior vaginal wall to\nprevent its inclusion in the stapling, which could result in an\nenterovaginal fistula.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S73\n\n\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 137926\nE-poster\nSURGERY FOR SPECIMEN EXTRACTION VIA NATURAL ORIFICE\n(NOSES) DURING LAPAROSCOPY FOR DEEP INFILTRATIVE\nENDOMETRIOSIS INVOLVING THE RECTUM\nRogerio Serafim Parra1, Gabriela Oliveira Bagano 1, Daniela\nFrança Camargo Freitas 1, Fernando Passador Valério 1, José\nVitor Cabral Zanardi 1, Omar Féres 1, José Joaquim Ribeiro da\nRocha1, Marley Ribeiro Feitosa 1\n1Faculdade de Medicina de Ribeirão Preto da Universidade de São\nPaulo, Ribeirão Preto, Brazil\nIntroduction Deep endometriosis is one of the most\nsevere forms of endometriosis, and in up to 25% of cases, it can\naffect the intestine. The lesions may be either single or\nmultifocal, and depending on the affected anatomical site,\nthey can cause symptoms ranging from dysmenorrhea to\ndyspareunia and rectal bleeding.\nObjective To describe the surgical technique of Natu-\nral Ori fice Specimen Extraction Surgery (NOSES) during\nlaparoscopy for deep in filtrative endometriosis involving\nthe rectum.\nMethods A 38-year-old patient with abnormal uterine\nbleeding and chronic pelvic pain, refractory to clinical treatment\nand with no desire for pregnancy, was evaluated. Preoperative\nimaging exams identifie dal e s i o ni nt h eu t e r i n et o r u s ,e x t e n d i n g\nto the insertion of both sacrouterine ligaments (LUS), measuring\n4.1x1.0x1.7 cm. On the anterior wall of the rectum, about 12 cm\nfrom the anal edge, there was a 4.4x1.1x1.9 cm nodule reaching\nthe inner layer, occupying 35% of the circumference, adhered to\nthe uterine torus. The surgery was performed laparoscopically,\nand the procedure included total hysterectomy, removal of the\nfallopian tubes, resection of the lesions on the uterine torus and\nLUS, appendectomy, and segmental resection of the rectum with\nspecimen removal via the vagina.\nDiscussion NOSES surgery can be offered to patients\nwith deep endometriosis requiring segmental resection of\nthe rectum and/or appendectomy. The passage of the laparo-\nscopic linear stapler for appendectomy is done through the\nalready opened vagina (in cases of laparoscopic hysterectomy\nor intentional or accidental vaginal opening). The removal of\nthe rectal segment can be done vaginally when the vagina is\nalready open. This approach improves postoperative pain,\nminimizes the chances of hernias, and reduces the risk of\nabdominal wall infections at the site of specimen extraction.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138270\nE-poster\nSECONDARY ISCHEMIC COLITIS DUE TO ARTERIOVENOUS\nMALFORMATION AT THE LEVEL OF THE INFERIOR\nMESENTERIC ARTERY\nLívia Peruzzo Zollinger Nova\n1, Meyline Andrade Lima 1, Carlos\nRamon Mendes 1, Ticiana Assemany Cruz 2, Lorena Boureau\nPereira2, Leticia Sandes Bittencourt de Carvalho Melo 3, Bruno\nFranco de Oliveira Santos 3, Fabiana Cerqueira Tararam 4\n1Coloproctologist at Hospital da Bahia, Salvador, Bahia, Brasil\n2Medical student, Centro Universitário Dom Pedro II, em Salvador\nBahia, Brasil\n3Medical student, Escola Bahiana de Medicina e Saúde Pública, em\nSalvador Bahia, Brasil\n4General surgery resident at Hospital Irmã Dulce, em Salvador Bahia,\nBrasil\nCase report This is a 41-year-old male patient who\npresented with diarrhea accompanied by mucus discharge and\nbleeding, in addition to abdominal pain, suspected to be\ninfectious colitis, requiring hospitalization. A computed to-\nmography angiography (CTA) was performed, which showed\nearly opacification of the inferior mesenteric vein during the\narterial phase of the study, with a tortuous and ectatic\nappearance, maintaining a direct relationship with branches\nof the inferior mesenteric artery, suggesting an arteriovenous\nfistula. A sigmoidoscopy was performed, revealing edema and\nmucosal erythema in the sigmoid colon, the presence of\nfibrinous exudate, and ulcers of varying sizes and shapes;\nthe rectum showed mucosal edema, erythematous areas, and\nobliteration of the submucosal vascular pattern. The patient\nwas treated with intravenous antibiotics but continued to\nexperience abdominal pain and mucus discharge. On physical\nexamination, he had a globular and flaccid abdomen, deep\npalpation tenderness, and mild pain upon sudden decompres-\nsion. No change was observed on CTA in a follow-up imaging\nexam. In laboratory tests in March 2024, the following values\nwere noted: C -reactive protein 61.7; AST 184; ALT 537; GGT 23.\nSurgical intervention was performed, including left colectomy\nwith the creation of a terminal colostomy in the transverse\ncolon via laparoscopy. The pathological examination conclud-\ned active erosive colitis and thrombosis of small vessels.\nDiscussion Ischemic colitis is in flammation of the\ncolon due to reduced blood flow to that region, which can\noccur due to factors such as atherosclerosis, obstruction, and\nvascular diseases. In rare cases, ischemic colitis can be associ-\nated with arteriovenous fistulas, abnormalities connecting\narteries to veins, which can result in ischemia or lesions in\nthe colon. The most common associated symptoms are acute\nabdominal pain, vomiting, diarrhea, or hematochezia, with\ntreatment being either surgical or non-surgical. In addition to\nphysical examination, complementary imaging such as CTA or\ncolonoscopy are used for a more precise diagnosis.\nConclusion This case highlights the importance of\nfollow-up and the use of complementary tests in diagnosing\nischemic colitis associated with arteriovenous fistulas. Early\nidentification and appropriate treatment, including surgical\nintervention when necessary, are essential for a good prognosis.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141179\nE-poster\nPSEUDOMEMBRANOUS COLITIS IN A POSTOPERATIVE\nPATIENT FOLLOWING ELECTIVE SURGERY,\nIMMUNOCOMPETENT, AND WITHOUT PRIOR USE OF\nANTIBIOTIC THERAPY\nYasmin Góis de Mello\n1, Isaac José Felippe Corrêa Neto1, Gabriela\nPortal Monteiro 1, Laercio Robles 1, Laura Leoncio Ribeiro 1,\nMariana Guimarães Coelho 1\n1Hospital Santa Marcelina, São Paulo, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS74\n\n\nCase presentation A 70-year-old man with insulin-\ndependent diabetes and hypertension, with negative serolo-\ngies for hepatitis and HIV, has a history of a prostate abscess in\n2020 that evolved into a rectal fistula, requiring intestinal\ndiversion. In 2024, he underwent a reconstruction surgery\nwith transverse ileal anastomosis, through a specific incision,\nwith antibiotic prophylaxis (ceftriaxone and metronidazole).\nTen days post-surgery, he developed abdominal pain, watery\ndiarrhea, fever, and loss of appetite. Abdominal and pelvic CT\nshowed pneumoperitoneum and diffuse distension of the\nintestinal loops, with no clinical signs of peritonitis. Treat-\nment with metronidazole was started, suspected as nonspe-\ncific colitis, and a test for Clostridium was collected. After a\npositive result for Clostridium, treatment with oral vanco-\nmycin was initiated for 14 days, resulting in clinical and\nlaboratory improvement. Sixty days after discharge, symp-\ntoms of diarrhea and abdominal pain reappeared, with\nanother positive culture for Clostridium. Oral vancomycin\ntreatment was restarted for 42 days in a tapering regimen.\nThe patient returned to the outpatient clinic 20 days after\ncompleting treatment, asymptomatic.\nDiscussion Although almost always related to antibi-\notic use, 30% of cases are associated with other risk factors,\nsuch as advanced age, hospitalization, and severe underlying\nconditions. For recurrent infection, risk factors include age >\n65 years, severe underlying medical conditions, ongoing\nantibiotic therapy during treatment for pseudomembranous\ncolitis, serum creatinine /C21 1.2 mg/dL, and lack of immune\nresponse mediated by antibodies to C. dif ficile toxins, espe-\ncially toxin B. Recurring episodes, which occur in 35% of cases,\nare de fined by symptom resolution during therapy and\nrecurrence within 2 months. The approach is the same, using\nfidaxomicin, vancomycin, or metronidazole. In these cases,\n50 to 60% may develop a new recurrence.\nConclusion Pseudomembranous colitis is a rare diag-\nnosis, particularly in immunocompetent patients without\nprior antibiotic therapy.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141625\nE-poster\nCOLORECTAL ANASTOMOSIS PLUS OMENTOPLASTY TO\nPREVENT ANASTOMOTIC LEAK: A SYSTEMATIC REVIEW AND\nUPDATED META-ANALYSIS\nLucas Monteiro Delgado 1, Bernardo Fontel Pompeu 2, Vitor\nLauar Pimenta de Figueiredo 1, Eric Pasqualotto 1, William Silva\nBarbosa1, Sergio Mazzola Poli de Figueiredo2, Fernanda Bellotti\nFormiga2\n1Universidade Federal de Minas Gerais, Belo Horizonte, Brasil\n2Hospital Heliópolis, São Paulo, Brasil\n3Cleveland Clinic Ohio, Cleveland, Ohio, United States\nIntroduction Anastomotic leakage in colorectal sur-\ngery is a major concern due to its association with increased\nmorbidity, mortality, need for surgical revision, and risk of\npermanent stoma formation. Omentoplasty, a technique\nusing a pedicle flap from the omentum to protect the\nanastomosis site, has shown promise in reducing postopera-\ntive complications such as leaks.\nObjective This study aims to conduct an updated\nsystematic review and meta-analysis comparing omento-\nplasty and non-omentoplasty in colorectal surgeries.\nMethods PubMed, Embase, and Cochrane Library\nwere systematically searched for studies comparing omento-\nplasty and non-omentoplasty in colorectal surgeries. Mean\ndifferences (MDs) were computed for continuous outcomes\nand odds ratios (ORs) for binary endpoints, with 95% con fi-\ndence intervals (CIs). Heterogeneity was assessed with I²\nstatistics. Statistical analysis was performed using Software\nR, version 4.3.3.\nResults A total of 6 studies were included comprising\n4,426 patients, of whom 669 patients (15.12%) were submit-\nted to omentoplasty and 3,757 (84.88%) were not submitted\nto omentoplasty. There were no signi ficant differences be-\ntween OMP and n-OMP groups for overall anastomotic\nleakage (OR 0.61; 95% CI 0.33-1.12; p=0.11; I2=56%), reoper-\nation (OR 0.63; 95% CI 0.37-1.08; p=0.09; I2=0%), mortality\n(OR 0.78; 95% CI 0.33-1.86; p=0.58; I2=25%), postoperative\ninfection rates (OR 1.19; 95% CI 0.75-1.87; p=0.46; I2=50%),\noperative blood loss (MD [mL] 19.46; 95% CI -14.78-53.70;\np=0.27; I2=0%) and length of hospital stay (MD [days] -0.65;\n95% CI -6.65-5.36; p=0.83; I2=96%).\nConclusion In this meta-analysis, use of omento-\nplasty in colorectal anastomosis showed no reduction in\nthe occurrence of anastomotic leakage, reoperation and\nmortality. These findings underscore omentoplasty as a via-\nble option, despite the need of more studies assessing its\nefficacy.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138068\nE-poster\nCORRECTION OF PARASTOMAL HERNIA USING THE PAULI\nTECHNIQUE\nDiogo Viana Abreu 1, Matheus Matta Machado Mafra Duque\nEstrada Meyer1, Ilson Geraldo da Silva 1, Guilherme de Almeida\nSantos1, Augusto Zbonik Mendes 1, Jennyfer Kellen Lázaro da\nRocha1, Mario Inácio Carneiro Neto 1, Hana Jermani Coelho 1\n1Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brasil\nMale, 53 years old, with a history of abdominoper-\nineal amputation due to rectal adenocarcinoma in 2017,\npresents oncological cure criteria. He developed a dif ficult-\nto-treat parastomal hernia, having undergone two surgeries\nwith on-lay mesh placement, both of which resulted in\nrecurrence. Clinically, he exhibited bulging and discomfort\nin the hernia location, and the CT scan showed a large\nparastomal hernia. In April 2024, he underwent another\napproach to the parastomal hernia using the Pauli technique,\nwhich was first described in 2016. The patient had a good\nrecovery, wore an abdominal belt for two months, and\nmaintained an appropriate weight control. To date, he shows\nno signs of recurrence. Parastomal hernia is the most com-\nmon complication after creating a stoma and can lead to\nsignificant morbidity, affecting quality of life. Its incidence is\nhigher in terminal colostomies, and the use of prophylactic\nsynthetic mesh is recommended by the European Hernia\nSociety. Several surgical techniques have been described, but\nrecurrence rates remain high, even with mesh use, ranging\nfrom 6.9% to 17%. Simple suture repair of the aponeurosis has\nrecurrence rates of around 46%. The Pauli technique is a\nmodification of the Sugarbaker technique, in which the stoma\nis left in place. A median incision is made, followed by an\nincision in the posterior sheath of the abdominal rectus,\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S75\n\n\nlateral retro-muscular dissection past the semilunar line to\nfree the transverse abdominal muscle, and then closure of the\nhernia defect in the posterior aponeurosis of the abdominal\nrectus or the transversalis fascia (below Douglas ’ arcuate\nline), laterally shifting the stoma. The mesh is placed in a\nsublay position, supporting the intestine without an opening\nin the mesh, similar to the Sugarbaker technique. Dissection\nmay be performed similarly on the opposite side, so that the\nmesh overlaps and corrects any defects in the midline. This\ntechnique offers clear advantages, such as maintaining the\nbiomechanical function of the abdominal wall, the ability to\nrepair hernias in the midline, keeping the stoma in the same\nlocation to avoid complications in the closure area or a new\nparastomal hernia in a new site. The authors recommend this\ntechnique for large hernias, recurrent cases, or when the\nminimally invasive Sugarbaker technique is not feasible.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138210\nE-poster\nINCIDENTAL DIAGNOSIS OF CECAL APPENDIX\nPHEOCHROMOCYTOMA IN A PATIENT UNDERGOING\nLAPAROSCOPIC APPENDECTOMY: A RARE CASE\nMarco Antônio da Silva Júnior 1, Luciano Ricardo Pelegrinelli 1,\nRenata Margarida Etchebehere 1, José Roberto Violatti Filho 1\n1Universidade Federal do Triângulo Mineiro, Uberaba, Brasil\nCase Presentation A 26-year-old white female from\nUberaba presented with a chronic history of mid-abdominal\ncolicky pain, associated with nausea and excessiveflatulence.\nShe was admitted to the emergency department due to\nexacerbation of pain for the past 3 days, with abdominal\ndistension and cessation of stool and gas passage after the\nonset of symptoms. She denied fever, chills, anorexia, urinary\nchanges, or previous similar episodes. The patient was previ-\nously healthy, using only oral contraceptives. On physical\nexamination, she was in good general condition, afebrile,\nwith a tense abdomen, diffusely tender on palpation, with\nincreased pain in the right iliac fossa, along with guarding and\npositive rebound tenderness in this region. A contrast-en-\nhanced abdominal CT scan was performed, revealing findings\nconsistent with acute appendicitis and diffuse thickening of\nthe cecal appendix. The patient underwent laparoscopic\nappendectomy without complications, and the pathological\nanalysis of the specimen revealed signi ficant thickening of\nthe appendix wall at the base. The histopathological study\nshowed an epithelioid neoplasm with expansive growth and\nperivascular involvement, with cells having ample cytoplasm,\nsometimes clear, sometimes eosinophilic granular, with a\ntendency to merge with the adjacent muscle layer and\nwithout nuclear atypia. The immunohistochemical analysis\nwas positive for smooth muscle actin and GP100 protein, and\nnegative for other antibodies, con firming the diagnosis of\nPEComa of the cecal appendix. Thoracic and pelvic CT scans\nwere performed, showing no abnormalities.\nDiscussion PEComas (Perivascular Epithelioid Cell\nTumors) are mesenchymal-origin tumors with typically be-\nnign behavior, although they have the potential for malig-\nnancy. Histologically, they are characterized by epithelioid\ncells with perivascular growth and immunoreactivity for\nmelanocytic and smooth muscle markers. The occurrence\nof this pathology is rare, and most individuals are asymp-\ntomatic, with incidental diagnosis found during imaging\nstudies or analysis of surgical specimens. Surgical treatment\nis the most common approach.\nConclusion Given the rarity of this condition and the\nlimited data in the literature, further studies are needed to\nestablish the ideal management and treatment, especially for\nmalignant cases. Well-established diagnostic methods are\ncrucial for the correct identi fication of this entity and dis-\ntinguishing it from other differential diagnoses.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 128473\nE-poster\nPANCREATIC STEATOSIS: A NEW AND CHALLENGING CLINICAL\nENTITY\nNívia Rézio Costa1, Eurípides Barsanulfo Borges dos Reis 1, Kelly\nCristina Ferreira de Moraes Paes 1\n1Faculdade Morgana Potrich, Mineiros, Brasil\nPancreatic steatosis is a condition characterized by\nthe accumulation of fat in the pancreas. Although it is not as\ncommon as hepatic steatosis (fat accumulation in the liver),\npancreatic steatosis can have serious consequences if left\nuntreated. Research on pancreatic steatosis aims to expand\nknowledge and improve understanding of the pathophysiol-\nogy, diagnosis, and treatment of the disease. For the devel-\nopment of this work, scientific articles were sourced from the\nU.S. database (PUBMED), the Scienti fic Electronic Library\nOnline (SCIELO), and Google Scholar using keywords such\nas “Pancreatic Steatosis,”“ pancreatic lipomatosis,” and “Non-\nalcoholic Fatty Pancreatic Disease (NAFPD), ” as well as their\ncorresponding Portuguese terms, published between 2013\nand 2023. Pancreatic steatosis (PS) is a condition character-\nized by fat accumulation in the pancreatic cells. This accu-\nmulation can lead to pancreatic dysfunction and\ninflammation, and eventually to chronic pancreatitis. Major\ncauses of PS include obesity, type 2 diabetes, and metabolic\nsyndrome. The most common diagnostic tests include ab-\ndominal ultrasonography, computed tomography (CT), and\nmagnetic resonance imaging (MRI). Currently, there are\nseveral clinical studies on PS, demonstrating its link to\nmetabolic causes and pancreatic cancer. The lack of knowl-\nedge and interest in fat accumulation in the pancreas, coupled\nwith a scarcity of case reports and studies on the subject,\ncomplicates the correct and effective treatment. This, in turn,\nleads to non-adherence or a lack of necessary care and\nattention, especially when it comes to preventing the disease.\nIn conclusion, there is a need for extensive research on fat\naccumulation in the pancreas and treatments that explore\nnew approaches for prevention.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138278\nE-poster\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS76\n\n\nCOMPARATIVE MATCHED STUDY BETWEEN EARLY\nPOSTOPERATIVE OUTCOMES OF LAPAROSCOPIC SURGERY\nAND LAPAROSCOPIC SURGERY WITH ROBOTIC PLATFORM\nBárbara Maria Tavares Pereira 1, Fábio Lopes de Queiroz 1,\nMarina Barbabela Grisolia de Oliveira 1, Lucas Alves Bessa\nCardoso1, Daniel Maurício Londoño Estrada 1, Letícia Brandão\nCastro1, Artur Duarte e Duarte 1\n1Hospital Felício Rocho, Belo Horizonte, Brasil\nIntroduction Minimally invasive surgery (MIS) has\nimproved postoperative outcomes, reduced the in flammato-\nry response to trauma, and accelerated recovery after surgical\nprocedures. Despite the advantages provided by laparoscopic\nsurgery (LS), of the 320,000 colectomies performed in the\nUSA in 2012, only 59% were performed laparoscopically. The\nlimited range of motion of instruments in the two-dimen-\nsional view of the pelvic cavity and the unstable camera view\nare some of the technical limitations. The development of\nrobotic platforms emerged as a tool to minimize the technical\ndifficulties of laparoscopic surgery. Despite the promise of\nminimizing the disadvantages of laparoscopy, robotic -\nassisted surgery (RAS) is still not standardized. Studies\nevaluating both LS and RAS are scarce, and there is a lack\nof research comparing safety and surgical outcomes between\nMIS modalities.\nObjective To evaluate 30-day complications and\nlength of hospitalization in RAS compared to LS in patients\nundergoing colorectal surgery.\nMethod A retrospective, single-center, comparative\ncohort study conducted from November 2017 to December\n2022. Patients were allocated into two groups based on the\nsurgical approach used: LS vs RAS. Propensity score matching\n(PSM) was performed considering variables such as age,\ngender, and ASA score.\nResults After PSM, 65 patients who underwent RAS\nand 85 patients who underwent LS were included in the\nstudy. The proportion of total mesorectal excision with\nrectosigmoidectomy was higher in the RAS group and lower\nin the LS group (19.4% vs. 5.9%, p=0.003), and the same\noccurred for shaving in intestinal endometriosis (6% vs. 0%,\np=0.003). Complications were more prevalent in the LS group\n(p=0.015). When comparing type I complications, the inci-\ndence was 74.7% (n=47) in LS and 62.2% (n=23) in RAS\n(p<0.001). The proportion of type 3B complications, which\ninvolve the need for surgical re-intervention under general\nanesthesia, was higher in the LS group with 4.8% (n=3). The\nRAS group did not have any type 3B complications (p=0.014).\nConclusion This study demonstrated that the robotic\nplatform is safe, with a lower complication rate and no\nincrease in length of hospitalization.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 132725\nE-poster\nEVALUATION OF EMPLOYEES‘ KNOWLEDGE OF COLORECTAL\nCANCER PREVENTION AND SCREENING AT A REFERENCE\nONCOLOGY CENTRE\nKarina Quely Andrade de Souza\n1, Glicia Estevam de Abreu 1,\nPaulo Andre Lago Silva 2, Marilia Cardoso Massoni 1, Dan Perdiz\nFucs Machado1, Gabriel Cury Andari David 2\n1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil\n2Centro de Coloproctologia da Bahia, Salvador, Brasil\nIntroduction Despite colorectal cancer ‘s high fre-\nquency and severity, the general public is mostly uninformed\nof its prevention and screening.\nObjectives To assess the level of knowledge on CRC\nprevention and screening among staff at a reference cancer\ncenter.\nMethods A cross-sectional investigation was carried\nout at a reference cancer center. Employees aged 18 and up\nwho had been with the oncology center for at least a year\nwere given a questionnaire that included sociodemographic\nand evaluative questions about CRC prevention and\nscreening.\nResults The sample comprised 266 employees, with a\nmedian age of 45 (53.00 - 35.75). The majority of staff (76.3%)\nwere female, had at least a year of experience at the reference\ncancer center (74.1%), and agreed on the de finition of CCR.\nInflammatory bowel illness was the least commonly recog-\nnized risk factor (67.6%). The majority of the sample (56%)\nrecognized all five warning flags. Colonoscopy was the most\npopular screening test (98.7). Although the health center does\nnot offer of ficial CRC education, the majority of staff (42.1%)\nreported learning about colorectal cancer while working.\nThere was no difference in perceptions of the optimal age\nto begin screening between employees 45 years or older and\nyounger workers (p = 0.729). Higher-educated employers\nwere more knowledgeable of the CRC (p = 0.001). Women\nprovided a higher percentage of accurate responses.\nConclusion A reference cancer center‘s staff, especial-\nly women, those who work directly with patients, and those\nwith higher education levels, have a satisfactory level of\nknowledge regarding CRC prevention and screening. This\nresult emphasizes the necessity of spreading CCR knowledge\nmore widely, especially to individuals with less education.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138298\nE-poster\nCYSTIC RETRO-RECTAL HAMARTOMA (TAILGUT CYST) WITH\nSURGICAL TREATMENT VIA POSTERIOR ACCESS: A CASE\nREPORT\nLucas Abreu Barreiro\n1, Isabela Dias Marques da Cruz 1, Flavia de\nCastro Ribeiro Fidelis 1, Alexandre Lopes de Carvalho 1, Alana\nFrancisca Machado Melo 1, Lina Maria Goes de Codes 1\n1Hospital Universitário Professor Edgard Santos, Salvador, Brasil\nCase Presentation A 45-year-old female patient with\nno comorbidities, with a family history of anal cancer, was\nadmitted with complaints of spontaneous pain in the hypo-\ngastric region, buttocks, and lower limbs, worsening progres-\nsively when walking. She reported daily bowel movements\nwith well-formed, occasionally dry stools, and three episodes\nof hematochezia during the period. A colonoscopy performed\na year and a half before admission identi fied a 4mm sessile\npolyp classi fied as Paris 0-Is, and the pathological exam\nshowed an in flammatory pseudopolyp. During follow-up, a\npelvic MRI revealed a circumscribed cystic image located in\nthe median retro-rectal region, in close contact with the\nlevator ani muscle, with probable hematic and hyperproteic\ncontent, measuring 2.1 /C2 2.5 /C2 2.9 cm, suggestive of Cystic\nHamartoma (HC). The patient underwent resection via pos-\nterior retro-rectal access using the Kraske approach, with\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S77\n\n\ngood postoperative recovery, and thefinal pathological result\nconfirmed the diagnosis of HC.\nDiscussion Presacral tumors are rare and dif ficult to\ndiagnose, occurring at a rate of 1 patient per 40,000-60,000 in\nthe general population. Clinical symptoms are typically relat-\ned to pelvic pain that worsens when sitting and improves\nwhen standing. Other symptoms may include fecal and\nurinary incontinence, constipation, and sexual dysfunction,\ndue to involvement of the sacral nerve in more advanced\ntumors. HC (Tailgut Cyst) is a type of congenital lesion\noriginating from the primitive hindgut and is more prevalent\nin females. This lesion is well-de fined, homogeneous, and\ndoes not communicate with the rectal lumen, and can be\neither unilocular or multilocular. Advances in diagnostic\nmethods and imaging studies, particularly MRI, have led to\nmore accurate diagnoses and better treatment outcomes for\npatients with these tumors.\nConclusion HC are rare and dif ficult-to-diagnose\nlesions that may undergo malignant transformation in\nsome cases. Current surgical resection techniques provide\nideal therapeutic results, with a focus on preserving the\nsphincter and nerve plexus, offering preservation of fecal\ncontinence and, ultimately, improving postoperative quality\nof life.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141753\nE-poster\nLOWER GASTROINTESTINAL BLEEDING DUE TO MECKEL ’S\nDIVERTICULUM IN AN ADULT\nJoão Victor Sprioli Martins 1, Gabriela Voltolini Alves 1, Cibele\nAlexandra Ferro1, Giovanna Latorraca Fachetti 1, João Vitor\nBordinhão Begnoci 1, Cassio Alfred Brattig Cantao 2, Tayanne\nFonseca Rodrigues1, Nathacia Bernando Chimello 3\n1Faculdade de Medicina de Catanduva, Catanduva, Brasil\n2Universidade de São Paulo, Ribeirão Preto, Brasil\n3Beneficência Portuguesa São Paulo, São Paulo, Brasil\nCase Presentation A 38-year-old male patient was\nadmitted to the emergency department with persistent\ngastrointestinal bleeding, presenting with enterorrhagia,\ncausing symptoms of weakness and malaise. He had no\nprevious similar episodes and no reported comorbidities.\nInitially, a protocol for upper gastrointestinal bleeding was\nstarted, and the patient was transfused with one unit of\npacked red blood cells due to a significant drop in hemoglobin\n(Hb 6.9). An upper gastrointestinal endoscopy (UGI) showed\nonly mild erosive gastritis in the antrum. During his hospi-\ntalization, two colonoscopies were performed without suc -\ncess in identifying the source of bleeding, and the patient\nreceived multiple blood transfusions. Subsequently, an ab-\ndominal CT scan and a scintigraphy for occult bleeding were\nperformed, but both were non-diagnostic. The patient ’s\ncondition worsened with hemodynamic instability, and he\nwas transferred to the urgent care unit and indicated for\nsurgical treatment. During laparoscopy, a Meckel’s diverticu-\nlum was found approximately 110 cm from the ileocecal valve\nwith signs of bleeding. After enlarging the supraumbilical\nmedian incision, a bowel loop was exteriorized, and entero-\nscopy was performed through the diverticulum, which\nrevealed bleeding below the diverticulum, scattered clots,\nand a non-bleeding polyp at the hepatic flexure. A segmental\nenterectomy was performed, followed by a latero-lateral\nanastomosis with a linear stapler without complications.\nAfter the surgery, the patient remained hemodynamically\nstable, with no further drops in hemoglobin.\nDiscussion This case of lower gastrointestinal bleed-\ning in an adult due to a Meckel ’s diverticulum is atypical and\nhighlights the dif ficulty of diagnosis in such cases where\ntraditional endoscopic examinations rarely provide answers.\nIn severe cases that are refractory to clinical measures and in\nthe absence of less invasive diagnostic tests, or in cases of\nhemodynamic instability, surgery still plays a critical role in\nmanaging the condition.\nConclusion It is important to always consider less\ncommon differential diagnoses in cases of occult gastrointes-\ntinal bleeding. Surgical intervention remains relevant in\ndiagnosing conditions like Meckel ’s diverticulum, which\nmay not be identi fied through imaging or traditional endo-\nscopic methods (endoscopy and colonoscopy), with the\nadded benefit of being therapeutic in many of these cases.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138209\nE-poster\nGASTROINTESTINAL BLEEDING CAUSED BY JEJUNAL GIST\nTaylene Rodrigues Souto 1, Luna Vitória Gondim Ferreira 1,\nBruno Augusto Alves Martins 2, Oswaldo de Moraes 2, Romulo\nMedeiros de Almeida2, Vanessa Siqueira Reis2, Isabela Augusta\nCarvalho Testi2, João Batista de Sousa 1\n1Universidade de Brasília, Brasilia, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nCase Presentation F.P.B, a 66-year-old male, was\nadmitted to the emergency department with a two-week\nhistory of melena. On physical examination, signi ficant cuta-\nneous pallor was observed. A complete blood count revealed\na hemoglobin level of 6.9 g/dl. An urgent upper gastrointesti-\nnal endoscopy was performed, which did not show signs of\nactive bleeding. Abdominal angiography (CT angiography)\nrevealed circumferential wall thickening of a jejunal loop near\nthe left flank, adjacent to the descending colon, with irregular\ncontours, calcification foci, and slight contrast enhancement,\nsuggesting a primary neoplasm. A surgical approach was\nundertaken, involving enterectomy and enteroanastomosis.\nFrom admission to surgery, the patient received 7 units of red\nblood cell concentrates. Pathological examination of the\nenterectomy specimen revealed a gastrointestinal stromal\ntumor (GIST) with a mixed histological pattern. Immunohis-\ntochemical studies for diagnostic con firmation showed posi-\ntive CD-117 expression in the cells of interest, supporting the\ndiagnosis of GIST.\nDiscussion GISTs are rare neoplasms, accounting for\napproximately 1-2% of primary gastrointestinal cancers.\nTheir estimated incidence is 10 to 20 cases per million people.\nThe most common site of occurrence is the stomach (40-60%),\nfollowed by the jejunum/ileum (25-30%). The most common\npresentation of GIST is gastrointestinal bleeding, as seen in\nthis case. Therefore, the manifestations of the disease are\nclosely related to the tumor’s location. Upper gastrointestinal\ntract involvement is typically accompanied by melena or\ndysphagia, while lower gastrointestinal tract neoplasms\nmay present with constipation or intestinal obstruction.\nRegarding the risk of progression of GISTs, factors such as\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS78\n\n\nmitotic index, tumor size, and location are considered. In this\ncase, the risk of tumor progression was considered high, with\na mitotic index above 5 mitoses/5 mm, a size of 3.6 cm, and\njejunal involvement.\nConclusion Although jejunal GISTs are rare and often\nchallenging to diagnose, it is important to maintain a high\nlevel of suspicion for the condition, especially in the context\nof gastrointestinal bleeding combined with suspicious radio-\nlogical findings. Early detection increases the likelihood of\nemploying surgical treatment, which offers higher cure rates.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 137753\nE-poster\nLOWER DIGESTIVE BLEEDING FROM THE SMALL INTESTINE\nCamila Vieira Chiquetti1, Carlos Henrique Marques dos Santos1,\nCarlos Otávio da Silva Ribeiro 1, Giulia Candida Ribeiro Garnes 2,\nBárbara Érnica Zeferino 1, Odinilson Almeida Fonseca 1\n1Hospital Regional do Mato Grosso do Sul, Campo Grande, Brasil\n2Universidade Estadual do Mato Grosso do Sul, Dourados, Brasil\nCase Presentation An 84-year-old female patient was\nadmitted to the medical service with melena. Her medical\nhistory includes diabetes mellitus, systemic arterial hyper-\ntension, and diverticular disease of the colon. Additionally,\nshe had right colon cancer 4 years ago, treated with right\ncolectomy, ileotransverse anastomosis, adjuvant chemother-\napy, and subsequent hospitalizations due to digestive bleed-\ning with melena, with normal upper digestive endoscopy.\nDuring the current hospitalization, after performing upper\ndigestive endoscopy, a CT scan, and colonoscopy, extensive\ndiverticular disease was observed, along with abundant\nbleeding originating from the terminal ileum, but without\nlesions. The liver appeared heterogeneous with blunt tips and\nsubcutaneous varices. Further investigation with angioto-\nmography revealed neovascularization in the small intestine\nwith a fistula between the lower epigastric vein and a branch\nof the mesenteric artery, requiring interventional radiology.\nA portography and ileal branch phlebography were per-\nformed, with a hemostatic valve inserted percutaneously\nvia a transhepatic approach in the right branch of the portal\nvein. A polyethylene catheter was selectively positioned in\nthe ileal branch, with contrast injections and imaging find-\nings consistent with a portosystemic ileo-femoral shunt.\nEmbolization was performed using histoacryl and lipiodol,\nachieving satisfactory devascularization of the main branches\nleading to the shunt. The patient continues to be monitored\nwithout further episodes of bleeding.\nDiscussion Lower gastrointestinal bleeding is primar-\nily characterized by hematochezia or enterorrhagia and may\nbe associated with hypovolemia. Causes include vascular\nlesions, such as arteriovenous malformations, common in\nthe right colon, hemorrhoids, and diverticulosis. The small\nintestine is typically the site of obscure bleeding origins. A\nportosystemic shunt is a rare condition in humans, mainly\nassociated with portal hypertension due to chronic liver\ndisease. Both shunts and small bowel bleeding require precise\nimaging for diagnosis and treatment. Due to the potential for\nsevere complications, stabilizing the patient and controlling\nthe bleeding is essential.\nConclusion Lower gastrointestinal bleeding from the\nsmall intestine is a rare and complex condition to diagnose,\nespecially with this particular adverse etiology. Prompt and\naccurate diagnosis is crucial for proper treatment, preventing\nmultiple hospitalizations and complications with unfavor-\nable outcomes.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138194\nE-poster\nGIANT GALLSTONE IMPACTION IN STENOSING COLON\nNEOPLASIA – CASE REPORT\nLetícia Mayumi Tsushima 1, Kelly Danielle Silva Vieira 1\n1Rede Mario Gatti, Campinas, Brasil\nCase Presentation A 72-year-old female patient with\na history of hypertension and diabetes, and a previous\ndiagnosis of cholelithiasis, had been awaiting elective surgery\nfor one month. She was admitted with severe right upper\nquadrant abdominal pain, nausea, and vomiting. She denied\nany changes in bowel habits, with the last bowel movement\noccurring one day prior. Physical examination revealed a\nmildly distended abdomen, tenderness on palpation of the\nright upper quadrant, and no signs of peritonitis. Imaging\n(abdominal CT and MRI) showed cholelithiasis with loss of\ncleavage between the gallbladder and the small bowel, pneu-\nmobilia, a gallstone in the cecum, as well as thickening of the\ntransverse colon and distension of the small bowel loops. A\nlaparotomy was indicated due to an intestinal obstruction.\nDuring surgery, intense adhesions were found between the\ngallbladder and the first portion of the duodenum, with a\n“napkin-ring” lesion in the transverse colon and mild disten-\nsion of the small bowel loops. A right hemicolectomy with\nprimary anastomosis and resection of the greater omentum\nwas performed, without addressing the cholecystoduodenal\nfistula during this procedure. Upon opening the specimen, a 3\ncm gallstone was found impacted in a stenosing tumor at the\nsplenic flexure of the transverse colon. The patient had an\nuneventful recovery and was discharged early. The postoper-\native pathological examination revealed an ulcerated mucin-\nproducing invasive adenocarcinoma, moderately differenti-\nated, in filtrating adjacent adipose tissue, with free surgical\nmargins and involvement of two regional lymph nodes. The\nstaging was T3N1M0, and the patient was referred for adju-\nvant chemotherapy.\nDiscussion Biliary ileus is a rare cause of colonic\nobstruction (2-8% of cases) caused by the impaction of a\ngallstone in a substenosing segment of the colon, secondary\nto diverticular disease or pelvic irradiation. Its diagnosis is\nsuggested by the presence of intestinal obstruction, pneumo-\nbilia, and ectopic gallstones, the “classic triad, ” though it is\npresent in fewer than 50% of cases. Treatment typically\ninvolves resolving the intestinal obstruction, with or without\ncorrection of the biliary fistula.\nConclusion We describe a rare case of intestinal\nobstruction due to biliary ileus with a gallstone impacted\nin a stenosing transverse colon tumor, which was an inciden-\ntal finding. The diagnosis and treatment of the tumor in this\ncase were only possible due to the acute and unusual ob-\nstruction presentation.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S79\n\n\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141631\nE-poster\nINCIDENCE OF NEUROENDOCRINE TUMOR OF THE APPENDIX\nIN LAPAROSCOPIC APPENDECTOMIES IN PATIENTS WITH\nINTESTINAL ENDOMETRIOSIS: A CASE SERIES\nDaniela França Camargo Freitas 1, Murilo Gomes de Paiva\nNeves1, José Joaquim Ribeiro da Rocha 1, Marley Ribeiro\nFeitosa1, José Vitor Cabral Zanardi 1, Fernando Passador\nValério1, Omar Féres 1, Rogerio Sera fim Parra1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\nIntroduction and Objectives Appendiceal endome-\ntriosis is uncommon, accounting for only about 1% of all cases\nof endometriosis. However, endometriosis is found in the\nappendix in approximately 8-13% of patients with deep\nendometriosis, and it is particularly common in patients\nwith severe forms of deep endometriosis. Neuroendocrine\ntumors (NETs) are the most common neoplasms of the\nappendix and may be misdiagnosed when there are multiple\nendometriosis lesions in the pelvis. The aim of this study was\nto analyze the incidence of NETs in patients with deep\nendometriosis involving the intestines.\nMethods This was a retrospective study using elec -\ntronically recorded data prospectively. All laparoscopic ap-\npendectomies performed in patients with deep\nendometriosis involving the intestines between April 2012\nand April 2024 were evaluated, along with the results of the\npathological examinations.\nResults A total of 78 laparoscopic appendectomies\nwere performed, with 6 cases (7.7%) of NETs. Based on the\npathological findings of the surgical specimen (well-differ-\nentiated NET at the tip of the appendix, measuring 1.3 cm,\nwith free margins but in filtration of the appendiceal adipose\ntissue and positive angiolymphatic invasion), the patient was\nadvised to undergo a complementary colectomy, but she\nrefused. The average age of the patients at the time of surgery\nwas 35.2 years (24-51 years). The main surgery performed\nwas segmental resection in 46 patients, disc resection in 22\ncases, shaving nodulectomy in 12 patients, and enterectomy\nin 5 patients. Laparoscopic hysterectomy was associated in 10\npatients. The average hospital stay was 1.5 days (1-3 days),\nand the surgical time was 125 minutes (45-300). There were\nno signs of NET recurrence in a mean follow-up period of\nmore than 2 years.\nConclusion In our study, the frequency of appendiceal\nneoplasms was 1 in every 12 appendectomies in patients\nwith intestinal endometriosis. This case series reinforces the\nneed for careful management of these lesions and supports\nthe recommendation for appendectomy when the appendix\nis affected by endometriosis. Although the most likely diag-\nnosis is appendiceal endometriosis, NETs cannot be excluded\nby imaging studies, and both conditions can occur in the same\npatients.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138197\nE-poster\nRECTAL LACERATION FOLLOWING FISTING PRACTICE\nVitoria Vicentin Giordano1, Fernanda Bellotti Formiga 1, Natalia\nFerreira Cardoso de Oliveira 1, Nadine Gomes de Souza 1,\nAmadeu Andre Soberanski 1, Louisie Galantini Lana de Godoy 1,\nVitoria Vicentin Giordano 1 Fang Chia Bin 1\n1Santa Casa de São Paulo, São Paulo, Brasil\nCase Presentation A 33-year-old male, HIV-positive,\nsought emergency care for enterorrhagia and abdominal pain\nafter engaging in fisting seven days before admission. He was\nhospitalized, underwent tests, and was treated with anti-\nbiotics while being observed, but he left the hospital after four\ndays of treatment. He required readmission due to anal pain\nassociated with bowel movements, though the bleeding\ncomplaint improved. Upon admission, there were no abnor-\nmalities in the abdominal physical exam. A proctological\nexamination revealed a laceration in the right posterolateral\nregion, extending 7 cm from the anal border. Abdominal CT\nscan showed irregular wall thickening in the middle and\nlower thirds of the rectum, with mesorectal fat densi fication\nand small adjacent gas foci. A flexible sigmoidoscopy was\nperformed, revealing a deep transmural linear laceration\nstarting at the pectinate line and extending about 8 cm\ncranially. The emergency department team recommended\nsurgery: suturing the laceration, presacral drainage, and loop\nsigmoidostomy. The patient progressed well and was dis-\ncharged on the seventh postoperative day.\nDiscussion The treatment of traumatic rectal injuries\nhas evolved. Initially, it was based on injuries occurring\nduring armed con flicts, such as landmine explosions in the\nVietnam War. Traditionally, the treatment of extraperitoneal\nrectal injuries had four main pillars: intestinal diversion,\npresacral drainage, distal rectal lavage, and local repair.\nHowever, recent guidelines have abandoned presacral drain-\nage due to higher rates of local infections, as well as distal\nrectal lavage, which has not shown proven bene fits. Current-\nly, despite controversy, ostomy is still recommended for\npatients with full-thickness extraperitoneal rectal lacera-\ntions, as it reduces the rate of infectious complications,\neven without affecting mortality. Surgical indications should\nconsider each case and the risk-benefit ratio of the morbidity\nassociated with ostomy. In the speci fic case described, the\ncoloproctology team suggested conservative management,\ngiven the time since the trauma (15 days) and the lack of\nsystemic repercussions, but the emergency team opted for\nsurgical intervention.\nConclusion The practice of fisting is becoming in-\ncreasingly popular, highlighting the need for updated man-\nagement approaches for post-traumatic rectal injuries.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 137791\nE-poster\nPERIANAL LEIOMYOMA: CASE REPORT\nMeyline Andrade Lima 1, Joana Carolina Saraiva de Paula\nPessoa2, Ticiana Assemany Cruz 3, Lorena Boureau Pereira 3,\nBruno Franco de Oliveira Santos4, Leticia Sandes Bittencourt de\nCarvalho Melo 4, Fabiana Cerqueira Tararam 5, Carlos Ramon\nMendes2\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS80\n\n\n1Hospital São Rafael Salvador, Bahia, Salvador, Brasil\n2Hospital São Rafael, Belo Horizonte, Brasil\n3Centro Universitário Dom Pedro II, Salvador, Brasil\n4Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil\n5GHospital Irmã Dulce, Salvador, Brasil\nCase Report A 49-year-old female patient was seen in\nthe Coloproctology outpatient clinic, complaining of a pain-\nless nodule in the perineal area for the past 3 years, without\nassociated symptoms. On physical examination, a 3 cm\nnodule was palpated in the left anterior perineum, between\nthe rectum and vagina. In March 2024, a pelvic floor MRI was\nperformed, with the report describing a solid nodular image,\nwith well-de fined borders, located in the left anterolateral\naspect of the intersphincteric plane in the perianal region,\nwithout cleavage plane with the anal canal wall, and external\nleft sphincter muscle bulging, measuring approximately\n3.4 /C2 2.6 /C2 2.5 cm. The diagnostic impression was indetermi-\nnate, although gastrointestinal stromal tumor (GIST) was\nconsidered as a differential diagnosis. During surgery, an\nincision was made in the left lateral perineum, and the lesion\nwas completely resected with clear margins. No invasion of\nthe rectum or vagina by the lesion was observed during\nsurgery. The patient had a good postoperative recovery\nwith complete healing. The resected specimen was sent for\nhistopathological examination, which described a perineal\nnodule, with elastic consistency, measuring 3.4 /C2 2.4 /C2 1.8\ncm, and was immunohistochemically positive for fumarate\nhydratase, desmin, and smooth muscle actin. The final diag-\nnosis was a benign mesenchymal neoplasm: leiomyoma.\nDiscussion Leiomyoma is a benign soft tissue tumor\noriginating from mesenchymal cells derived from smooth\nmuscle. The most common occurrence of this tumor is in the\nuterus, while it is rare in the anorectal region. The pathogen-\nesis is not well de fined. The prevalence is 1 in every 3,000\nrectal tumors, and the malignancy rates gradually increase\nwith age. It typically presents in the age range of 30-69 years\nand may present with symptoms like rectal bleeding, tenes-\nmus, proctalgia, and changes in bowel habits, or it may be\nasymptomatic, depending on its size. Due to the lack of\nspecific symptoms, diagnosis is often delayed. The standard\nand potentially curative treatment for anorectal leiomyomas,\nwithout invasion of adjacent organs as seen in this case, is\nsurgical excision with complete resection and clear margins\nto avoid recurrence.\nConclusion This case highlights the importance of\ndifferential diagnosis, early intervention, and follow-up to\ndetect potential recurrences and/or malignant\ntransformation.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 137801\nE-poster\nEXTRANODAL M.A.L.T LYMPHOMA OF THE CECUM: A CASE\nREPORT\nLívia Oliveira1, Bárbara Tannús Valadão 1, Bruna Grazielly\nOliveira Silva1, Reginaldo Rodrigues Do Prado1, Ulisses Marques\nCardoso1, Mariane Tonin Jatobá 1, Juliana Cruz Apolinário 1,\nLarissa Ganança Buosi 1\n1Hospital São Francisco de Ribeirão Preto, Ribeirão Preto, Brasil\nCase Presentation Patient FJS, 62 years old, male,\nwith a sole complaint of intestinal bleeding. Colonoscopy\nrevealed oval erosions covered by fibrin at the ileocecal valve,\nwithout histological characteristics of in flammatory bowel\ndisease (IBD). A biopsy showed lymphoid in filtration in the\ncecum, inconclusive for small B-cell lymphoma. Immunohis-\ntochemistry confirmed the diagnosis, with Ann Arbor staging\nIA (modi fied). Tests for sexually transmitted infections (STI)\nwere negative. CT scans of the abdomen/chest and PET CT\nwere negative. Endoscopy showed no apparent lesions and\nwas negative for\n/C3 H. Pylori /C3 . The patient underwent right\nhemicolectomy, with pathology con firming a diffuse B-cell\nlymphoid neoplasm (M.A.L.T lymphoma) in the mucosa and\nsubmucosa of the cecum/ileocecal valve, measuring 2.5 cm at\nits largest extent.\nDiscussion Primary extranodal lymphoma is de fined\nas involvement of a primary organ without clinical evidence\nof distant lymph node or organ spread. Colon marginal zone\nlymphomas are extremely rare, accounting for 2-3% of all\ncolonic neoplasms. The cecum is the most commonly affected\nsite, followed by the rectum. There is a male predilection. On\naverage, colorectal lymphoma is diagnosed in individuals\naged 50 to 60 years. The pathology in the colon arises from\nchronic antigenic stimulation secondary to infectious agents\nor autoimmune processes occurring in the mucosa. Risk\nfactors for primary extranodal non-Hodgkin lymphoma\n(NHL) include a family history of lymphoma, personal history\nof radiation or chemotherapy, organ transplantation, immu-\nnosuppression, viral immunity, and exposure to toxins. Im-\nmunosuppressive medications for IBD have been associated\nwith an increased risk of gastrointestinal lymphoma. Diag-\nnosis is made through biopsy analysis, obtained either by\ncolonoscopy or histology of the surgical resection specimen.\nTreatment modalities include radiotherapy, which can be\nused alone, or Rituximab as monotherapy, or Rituximab\nwith chemotherapy in advanced disease. Surgical treatment\nis also an individualized option for stages I and II.\nConclusion Primary colon lymphoma is an indolent\ndisease, with recurrence in nearly all cases. The choice of\nsurgical treatment is individualized, typically recommended\nin the early stages of the disease, and the decision should\ninvolve hematologists and surgeons. In this case, the patient\nbenefits from not undergoing alternative therapies such as\nradiotherapy, Rituximab, or chemotherapy, which may be\nconsidered in cases of disease recurrence.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 137793\nE-poster\nGIANT LIPOMA OF THE TRANSVERSE COLON WITH\nPROGRESSION TO INTUSSUSCEPTION: A CASE REPORT\nCarlos Ramon Mendes 1, Joana Carolina Saraiva de Paula\nPessoa1, Tassia Mendes Franco 1, Ticiana Assemany Cruz 2,\nBruno Franco de Oliveira Santos3, Leticia Sandes Bittencourt de\nCarvalho Melo3, Lorena Boureau Pereira 2, Julyana Costa Neiva 4\n1Hospital Cardiopulmonar Salvador, Salvador, Brasil\n2Medical Student, Centro Universitário Dom Pedro II, em Salvador\nBahia, Salvador, BA, Brasil\n3Medical Student, Escola Bahiana de Medicina e Saúde Pública, em\nSalvador Bahia, Salvador, BA, Brasil\n4General Surgery Resident at Hospital Irmã Dulce, em Salvador Bahia,\nSalvador, BA, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S81\n\n\nCase Report This is a 56-year-old female patient with\na history of abdominal pain. An endoscopic examination\nrevealed a subepithelial lesion approximately 8 cm in size\nlocated in the transverse colon. Biopsies were performed,\nrevealing a chronic in flammatory process associated with\nfocal ulceration and adipose tissue with areas of steatonec -\nrosis. The patient was scheduled for elective surgery but\ndeveloped intense anal pain and the evacuation of a mass.\nAbdominal tomography showed signs of left colon-colon\nintussusception secondary to a lipoma. The patient under-\nwent emergency partial colectomy in September 2023. His-\ntopathology of the surgical specimen revealed a segment of\nthe colon with intussusception secondary to a colon lipoma\nmeasuring 9.2 /C2 5.8 /C2 4.4 cm, located in the submucosa, with\na yellowish and shiny surface. Additionally, thirteen reactive\nmesocolic lymph nodes were identi fied, the largest measur-\ning 0.6 cm. The patient had a good postoperative recovery and\ncontinues with outpatient follow-up.\nDiscussion Giant colonic lipomas are benign, non-\nepithelial tumors typically located in the submucosa of the\nlarge intestine. They are more common in the cecum and\nright colon, with an increased incidence after the age of 50.\nLipomas smaller than 2 cm are usually asymptomatic, but\nlarger ones produce symptoms in more than 75% of cases,\nincluding colicky abdominal pain, palpable abdominal\nmasses, changes in bowel habits, and weight loss. Obstructive\nsigns can also occur when pedunculated, leading to intussus-\nception. Intussusception is a frequent complication of this\nneoplasm and is defined as the telescoping of one segment of\nthe intestine into an adjacent one. It is usually associated with\npathological lesions of the intestinal wall and can cause\nobstruction and, sometimes, ischemia. The diagnosis of co-\nlonic lipoma is made through clinical examination, colonos-\ncopy, and imaging studies, and the treatment is surgical.\nConclusion This case highlights the importance of\nmonitoring and intervening in patients with giant colonic\nlipomas, given the alarming signs and symptoms associated\nwith them and their potential complications.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 137672\nE-poster\nJEJUNAL MELANOMA: A CASE REPORT\nBárbara Tannús Valadão1, Larissa Ganaça Buosi1, Lívia Oliveira1,\nBruna Grazielly Oliveira Silva 1, Mariane Tonin Jatobá 1, Ulisses\nCardoso Marques 1, Reginaldo Rodrigues Do Prado 1, Juliana\nCruz Apolinário 1\n1Hospital Sao Francisco, Leiria, Portugal\nCase Presentation Patient C.E.C., 82 years old, with a\nhistory of melanoma removal in 2021 and no follow-up after\nthe surgical procedure. She sought medical attention in\nOctober 2022 due to asthenia, black stools, and signi ficant\nanemia (hemoglobin [hb] 6.2). She received two blood trans-\nfusions and underwent an upper digestive endoscopy (diag-\nnosed with hiatal hernia and erythematous gastritis). She was\ndischarged for outpatient follow-up after controlling the\nlower gastrointestinal bleeding. The patient did not attend\nfollow-up visits and, in June 2023, returned to the emergency\nroom with asthenia and melena, with a hemoglobin level of\n6.9. She received two blood transfusions and underwent\ncolonoscopy (diagnosed with colonic diverticulosis). She\nbegan follow-up with the coloproctology team in October\n2023, where a scintigraphy was requested, detecting non-\nactive gastrointestinal bleeding: intermittent bleeding in the\nprojection of the small intestine (duodenum and jejunum).\nSurgical intervention was then requested. A proximal jejunal\nenterectomy was performed due to the identification of three\ntumor masses. The histopathological report con firmed nod-\nular melanoma with necrosis signs in the mucosa, submuco-\nsa, and invasion of the muscularis propria. Fifteen mesenteric\nlymph nodes were dissected and the classi fication was TNM\n(AJCC 8th edition) pT2mpN0. Currently, the patient is under-\ngoing oncology follow-up, diagnosed with skin melanoma\nwith metastasis to the central nervous system, retroperito-\nneum, small intestine, and lungs.\nDiscussion Melanoma represents about one-third of\nmetastatic neoplasms detected in the gastrointestinal tract,\nbut it is diagnosed in only 1.5 to 4.4% of cases. Most cases are\nconcentrated in the small intestine (60%), and metastases to\nsolid organs occur in 55% of cases, predominantly in the liver\n(55%) and brain (45%). Around 60% of patients present with\nacute obstructive abdomen, 15% with perforative abdomen,\n10% with epigastric pain and heartburn, 5% with intense\nabdominal pain, 5% with melena, and 5% with obstructive\njaundice. Treatment of metastasis in hollow organs consists of\nexcising the lesion. The survival after metastasis treatment\nranges from 1 to 36 months.\nConclusion The prognosis for these patients is poor.\nAccording to the literature, survival is usually no more than\n36 months. A thorough medical history is essential for early\ndetection and intervention.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 136549\nE-poster\nSCLEROSING MESENTERITIS – A CASE REPORT\nAndré Figueiredo Accetta 1, Italo Accetta 2, Ronaldo Vianna\nSilva2, Giovanna Jurcunas de Oliveira Gaeta1, Angelica Freitas da\nSilva Kneipp 1, José Antonio Dias da Cunha e Silva 1, Leonardo\nSantos de Almeida Alves 1, Eduardo Cortez Vassallo 1\n1Universidade Federal Fluminense, Niterói, Brasil\n2Hospital Estadual Alberto Torres, São Gonçalo, Brasil\nCase Presentation A 50-year-old male was admitted\nwith abdominal pain, vomiting, and cessation of bowel move-\nments for 2 days. He was previously healthy and denied\nalcohol consumption, smoking, or medication use. His medi-\ncal history included an appendectomy 37 years ago, two\nlaparotomies for intestinal obstruction, and other episodes\nof subocclusion treated clinically. Upon examination, his\nabdomen was distended, painful, and hyperresonant. Labo-\nratory tests were normal. A CT scan suggested mechanical\nintestinal obstruction, and conservative treatment was initi-\nated but was unsuccessful. A laparotomy was performed with\nthe release of firm adhesions, and he was discharged on the\n5th day. He returned 48 hours later with subocclusion and a\npalpable mass on the left. A new CT scan showed diffuse\ndistension, mesenteric fat densi fication, deviation, and ecta-\nsia of some vessels. A second surgery was performed with\nadhesion release, peritoneostomy, and biopsies of the mes-\nentery, confirming sclerosing mesenteritis (SM). The patient\nwas started on total parenteral nutrition (TPN), prednisone,\nand tamoxifen, which were maintained for 60 days\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS82\n\n\npostoperatively. At that point, the abdomen became flaccid,\nallowing for closure, and the patient was discharged.\nDiscussion Sclerosing mesenteritis (SM) is a condi-\ntion affecting the mesentery, characterized by necrosis,\nchronic in flammatory in filtration, and fibrosis. Its etiology\nis not well established, but it may have an autoimmune origin\nor be associated with abdominal surgeries and neoplasms.\nLipodystrophy and panniculitis are considered early and\nintermediate stages, while mesenteritis is the advanced stage,\nmarked by fibrosis and vascular ectasia. It is more common in\nmen over 50 years old. Symptoms are nonspeci fic, including\nrecurrent abdominal pain, anorexia, weight loss, changes in\nbowel habits, and fever, with some patients presenting\nnormal physical exams. In advanced stages, a fixed, painful\nabdominal mass with ill-defined borders and firm consisten-\ncy occurs due to the entrapment of bowel loops and retraction\nof the mesentery, which may lead to obstruction, chylous\nascites, and thrombosis. CT scans show a heterogeneous\nexpanding mass with fat density, ectatic vessels, fibrotic\nretraction of the mesentery, and pseudocapsular tumor-like\nstructures delimiting affected and unaffected parts. The\ndiagnosis is presumptive and con firmed by histopathology.\nAlthough there is no consensus, prednisone, tamoxifen, aza-\nthioprine, or colchicine, alone or in combination, appear to\nprovide good responses.\nConclusion Sclerosing mesenteritis is a rare disease\nwith an uncertain etiology and dif ficult diagnosis for clini-\ncians, surgeons, radiologists, and pathologists. Its treatment\nis primarily conservative, and surgical intervention is indi-\ncated for cases of intestinal obstruction without satisfactory\nresolution or when malignancy is suspected in the affected\nmesenteric area.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138226\nE-poster\nECTOPIC GASTRIC MUCOSA IN RECTAL LST: A CASE REPORT\nLuna Vitória Gondim Ferreira 1, Taylene Rodrigues Souto 1,\nVanessa Siqueira Reis 2, Marccus Antônio Tolentino de Jesus 2,\nWilmar Junio Pereira Araújo 2, Antônio Carlos Nóbrega dos\nSantos2, Bruno Augusto Alves Martins 2, João Batista de Sousa 2\n1Universidade de Brasília, Brasilia, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nCase Presentation A 47-year-old male patient pre-\nsented at the coloproctology outpatient clinic with a one-year\nhistory of hematochezia and the need for manual reduction of\na nodule during bowel movements. During the first consul-\ntation in August 2023, a proctological examination revealed a\nsoft 2 cm lesion, flat, not adhering to deeper planes, located 4\ncm from the anal verge. A colonoscopy performed in the same\nmonth showed a laterally spreading lesion (LST) on the\nposterior wall of the distal rectum, measuring approximately\n3 cm. Based on the diagnosis, the patient underwent transa-\nnal resection of the LST. The histopathological findings\nrevealed gastric mucosa heterotopia in the colonic -type\nmucosa of the rectal LST, with deep margins free of hetero-\ntopia but with a compromised peripheral margin. In February\n2024, the patient underwent Milligan-Morgan hemorrhoi-\ndectomy due to persistent complaints of hematochezia and\nnodulation in the anal canal. In subsequent consultations, the\npatient reported significant improvement in symptoms, with\nthe surgical wound in advanced healing and no signs of\nbleeding.\nDiscussion The presence of ectopic gastric mucosa in\nthe rectum is an extremely rare and uncommon finding,\nstanding out in the medical literature as a pathological\ncuriosity. Gastric heterotopia is typically found in locations\nsuch as the esophagus and small intestine, being very rare in\nthe large intestine, particularly the rectum. LSTs in the rectum\ntypically present histological features that may include ser-\nrated adenomas, hyperplasia, and dysplasia, but not typically\ngastric mucosa. This discovery raises questions regarding the\netiology and development of this condition, suggesting the\npossibility of an anomaly in embryological development or\nabnormal metaplasia.\nConclusion Finally, the case illustrates a challenging\nclinical presentation leading to an unusual histopathological\nfinding. The presence of ectopic gastric tissue can lead to\nulceration and bleeding due to acid production, increasing\nthe complexity of management. Thus, the clinical implica-\ntions of this heterotopia are signi ficant, requiring careful and\nindividualized treatment. This case highlights the importance\nof detailed histopathological evaluation in atypical rectal\nlesions, contributing to a better understanding and manage-\nment of rare coloproctological conditions.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 137722\nE-poster\n-YEAR-OLD PATIENT WITH AN INCIDENTAL DIAGNOSIS OF A\nRETRORECTAL LESION: A CASE REPORT\nJoão Victor Batista Ferreira 1, Amanda Karolyne Batista\nFerreira1, Emerson Abdulmassih Wood da Silva 1, Carlos\nEduardo Oliveira Sodero 1, José Roberto Violatti Filho 1, Luciano\nRicardo Pelegrinelli1\n1Universidade Federal do Triângulo Mineiro, Uberaba, Brasil\nCase Presentation An 11-year-old patient presented\nwith intense colicky abdominal pain that worsened during\ndefecation, along with a 4 kg weight loss over the past month.\nShe had a prior hospitalization for abdominal pain, no family\nhistory of in flammatory bowel disease, but a maternal histo-\nry of constipation and hard stools. Imaging exams, including\nultrasound (US) and CT, revealed signi ficant small bowel\ndistension, an enlarged right adnexa for her age with multiple\nfollicular cysts, and a thick-walled cystic lesion with regular\ncontours located posterior to the rectum, displacing its lower\nthird anterolaterally to the right. MRI was performed for\nsurgical planning and con firmed a solid-cystic extraperito-\nneal lesion in the presacral region, with no evidence of\ninvasion into adjacent structures. Surgical excision of the\nlesion was conducted using a posterior approach with coccyx\nfracture during the procedure. Histopathological examina-\ntion con firmed the diagnosis of a retrorectal hamartoma\n(\"tail gut cyst\"). Postoperatively, the patient reported con-\ntrolled pain, functional bowel habits, but complained of\nweakness.\nDiscussion Retrorectal hamartomas (\"tail gut cysts\")\nare rare congenital lesions originating from embryological\nremnants of the hindgut. They are more common in middle-\naged women, typically between 30 and 60 years. Clinical\npresentation ranges from asymptomatic to signi ficant\nproctological symptoms, depending on the lesion ’s size and\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S83\n\n\nlocation. In this case, the patient experienced symptoms such\nas intense abdominal pain, vomiting, and signi ficant weight\nloss. Surgical resection, crucial to prevent future complica-\ntions such as infections, bleeding, or malignant transforma-\ntion, was performed via a posterior approach (Kraske\nincision) with coccyx fracture to access the lesion site.\nConclusion This case highlights the importance of a\ncomprehensive differential diagnosis in pediatric proctologi-\ncal patients with chronic abdominal pain and weight loss.\nAdvanced imaging techniques combined with histopatholog-\nical evaluation are essential for accurate diagnosis and thera-\npeutic planning. Complete surgical removal of retrorectal\nhamartomas is recommended due to their potential for\ncomplications, and adequate postoperative management is\ncrucial for the patient ’s full recovery.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138231\nE-poster\nROLE OF VENOUS SCLEROSIS THROUGH EMBOLIZATION IN\nTHE TREATMENT OF ANORECTAL VASCULAR MALFORMATION\nMirtes Okawa Essashika Do Nascimento 1, Maria Inez Machado\nFernandes1, Alexandre Souto de Moraes Morgado 1, Lucas\nMoretti Monsignore 1, Marley Ribeiro Feitosa 1, Omar Féres 1,\nJosé Joaquim Ribeiro da Rocha 1, Caroline Geraldo 1\n1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil\nCase Presentation A 5-year-old female patient pre-\nsented with small amounts of blood in her stool since thefirst\nmonths of life. At age 3, her mother sought medical attention\ndue to increased bleeding, which necessitated blood trans-\nfusions. A colonoscopy revealed submucosal bluish bulges in\nthe rectum. Pelvic computed tomography (CT) showed cir-\ncumferential thickening of the rectal wall with minimal\nenhancement and calci fications (phleboliths), consistent\nwith venous malformation. Magnetic resonance imaging\n(MRI) demonstrated mild, gradual enhancement of the ano-\nrectal wall extending to the upper third of the rectum, along\nwith multiple serpiginous structures in the perirectal fat,\nconfirming the diagnosis of vascular malformation (VM).\nConservative treatment with sclerotherapy via intervention-\nal radiology was chosen. The patient underwent partial\nembolization through portal venous access with the injection\nof lipiodol, polidocanol, and bleomycin into branches of the\ninferior mesenteric vein and superior rectal vein. Follow-up\nshowed a signi ficant reduction in episodes of hematochezia,\nwith no further need for transfusions.\nDiscussion Vascular malformations of the gastroin-\ntestinal tract are among the causes of gastrointestinal bleed-\ning, requiring differential diagnosis from rectal\nhemangiomas. They are classified based on histological com-\nponents and flow characteristics. Most cases are found in the\ncolon or small intestine, with rectal involvement being rare.\nThe main symptom of rectal vascular malformations is anal\nbleeding associated with anemia. MRI is the preferred imag-\ning modality to de fine the extent of the lesion and its\nrelationship to adjacent structures. CT, while less speci fic,\nis useful for identifying thrombotic foci and calci fications.\nAmong therapeutic options, vascular embolization has prov-\nen to be an effective alternative to surgery, particularly in\nfragile or high-risk patients. Embolization can be repeated if\nrecurrence occurs, and symptom control can be achieved\nquickly, as demonstrated in this case.\nConclusion Diffuse rectal vascular malformations are\nrare, and early diagnosis is crucial for implementing appro-\npriate treatment. Vascular embolization is a viable and safe\nalternative in cases where clinical conditions or anatomical\nsite constraints make surgery challenging.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141560\nE-poster\nPARTICIPATION OF WOMEN IN THE BRAZILIAN SOCIETY OF\nCOLOPROCTOLOGY OVER THE LAST 10 YEARS: WHAT IS THE\nFEMALE REPRESENTATION IN LEADERSHIP ROLES AND THE\nANNUAL CONGRESS OF THIS SPECIALTY?\nEduarda Alvarez Silva 1, Glicia Estevam de Abreu 1, Marilia\nCardoso Massoni1\n1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil\nIntroduction Despite the evident growth in the num-\nber of female physicians over the last decades, the underrep-\nresentation of women in surgical specialties and scienti fic\nevents related to this field is a topic that has been little\ndiscussed. There is a lack of references and scienti fic data to\nfoster discussions about this issue.\nObjective This study aims to evaluate the participa-\ntion of women in the Brazilian Society of Coloproctology\n(SBCP), analyzing the percentage of leadership positions held\nby women as well as their participation in the annual\ncongress of this specialty.\nMethods Data on the number of women in leadership\npositions and their participation in the specialty ’s congress\n(main sessions, awards received, and secondary sessions)\nwere collected from the online platform of the SBCP. These\ndata were organized in an Excel spreadsheet and subsequent-\nly analyzed to verify frequencies. Information on leadership\npositions and congresses held between 2013 and 2023 was\ngathered.\nResults Among the 9 presidents across 11 leadership\nterms (including one three-year term), only 2 (22.2%) were\nwomen. Regarding leadership positions during the evaluated\nperiod, of the 618 positions available, women held 139\n(22.49%). Concerning awards at congresses during the evalu-\nated period, of the 79 awards given, women received 40\n(50.6%). Evaluating presentations in plenary sessions (main\nsessions), women were responsible for 213 (24.8%) of the 857\npresentations conducted. For secondary sessions held in\n2022-2023, women delivered 34 (29.82%) of the 114\npresentations.\nConclusion Although the number of female physi-\ncians in the SBCP has increased and women received more\nthan half of the awards for scienti fic work, men continue to\ndominate prominent spaces in scienti fic discussions and\noccupy the majority of leadership positions.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS84\n\n\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141784\nE-poster\nEPIDEMIOLOGICAL PROFILE OF COLORECTAL CANCER CASES\nREPORTED IN BRAZIL FROM 2013 TO 2024\nAna Luísa dos Santos Pires 1, Caio Resende da Costa Paiva 1,\nGiovanna Oliveira Lial 2, Ana Carolina Sampaio Freire 1\n1Universidade de Brasília, Brasilia, Brasil\n2Centro Universitário de Brasília, Brasilia, Brasil\nIntroduction Colorectal cancer (CRC) is the second\nleading cause of cancer-related death worldwide and the\nmost frequent malignancy of the gastrointestinal tract. In\nBrazil, CRC presents a signi ficant burden of morbidity and\nmortality, ranking third in incidence, with approximately\n40,000 new cases diagnosed annually.\nObjective To describe the number of reported cases\nand the demographic pro file of colorectal cancer in Brazil\nbetween 2013 and 2024.\nMethods This is a descriptive, retrospective, popula-\ntion-based epidemiological study conducted in July 2024. It\nutilized secondary data recorded in the Oncology Panel\navailable on the website of the Department of Informatics\nof the Brazilian Uni fied Health System (DATASUS). The sam-\nple included all reported cases of colorectal cancer in Brazil\nbetween January 2013 and December 2024.\nResults During the study period, CRC incidence varied\nby region, with the Southeast leading, followed by the South\nand Northeast regions. In 2024, 5,441 new cases of colorectal\ncancer were diagnosed, with the Southeast region accounting\nfor the highest absolute number of cases (2,717 cases,\n49.93%), followed by the South (1,665 cases, 30.6%), Northeast\n(652 cases, 12.05%), Midwest (292 cases, 5.36%), and North\n(115 cases, 2.11%). Diagnosis was most common in individu-\nals over 50 years of age, ranging from 77.3% in the North to\n84.28% in the Southeast in 2024. Between 2013 and 2024, a\ntotal of 182,847 cases of colorectal cancer were reported in\nBrazil. The Southeast region was the most affected, with\n89,798 cases (49.11%), followed by the South (49,535 cases,\n27.09%) and Northeast (27,485 cases, 15.03%). The Midwest\nand North regions had fewer cases, with 11,572 (6.32%) and\n4,457 (2.43%), respectively. Similarly, diagnosis was predom-\ninantly observed in individuals over 50 years of age, with the\nSoutheast showing 80.76% of cases in this age group.\nConclusion This study highlights the high prevalence\nof colorectal cancer during the analyzed period, particularly\namong individuals over 50 years old across all regions of\nBrazil, with a predominance in the Southeast. These findings\nunderscore the importance of raising awareness about\nscreening exams, such as colonoscopies, especially for this\nage group, to ensure early detection, reduce underreporting,\nand achieve better clinical outcomes.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138201\nE-poster\nCOLONIC PERFORATION SECONDARY TO TOXIC EPIDERMAL\nNECROLYSIS\nVitoria Vicentin Giordano 1, Vitoria Vicentin Giordano 1,\nFernando Cascelli Oliva 1, Natalia Ferreira Cardoso de Oliveira 1,\nGabriela de Carvalho Simoes da Fonseca 1, Fernanda Bellotti\nFormiga1, Louisie Galantini Lana de Godoy 1, Fang Chia Bin 1\n1Santa Casa de São Paulo, São Paulo, Brasil\nCase Presentation A 59-year-old male patient pre-\nsented with a diffuse rash, blistering lesions across the body\nand buccal mucosa, fever, tremors, and tachypnea, progres-\nsively worsening for five days prior to admission. Thirty days\nearlier, he had started lamotrigine for drug-resistant epilepsy.\nToxic epidermal necrolysis (TEN) secondary to lamotrigine\nwas diagnosed. Three days after admission, the patient\ndeveloped abdominal pain and distension. An abdominal X-\nray revealed a hyperlucent area above the liver, and a\ncomputed tomography (CT) scan con firmed a large pneumo-\nperitoneum. Exploratory laparotomy identi fied a pinpoint\nperforation in the transverse colon and localized peritonitis,\nleading to the decision to perform a transverse colostomy.\nThe patient showed good clinical recovery and was dis-\ncharged on the 12th postoperative day with signi ficant\nimprovement in skin and mucosal lesions. During outpatient\nfollow-up, intestinal continuity was restored 21 months after\nthe colostomy.\nDiscussion TEN is a severe, rare delayed hypersensi-\ntivity reaction to medication, characterized by purpuric\nexanthema with mucosal involvement, blisters, and detach-\nment of more than 30% of the body surface area. The disease’s\npathogenesis involves a delayed type IV hypersensitivity\nimmune reaction, resulting in keratinocyte apoptosis medi-\nated by CD8 þ cytotoxic T cells. Aromatic anticonvulsants,\nsuch as lamotrigine, are the leading cause of TEN in Latin\nAmerican patients. TEN is part of the Stevens-Johnson syn-\ndrome spectrum but involves a larger body surface area and\nhas a more lethal progression. The epidermal detachment in\nTEN typically affects the skin or mucosa, most commonly\nocular and respiratory epithelium. Mortality rates can reach\n40%, primarily due to sepsis caused by skin barrier loss and\nrespiratory involvement. Intestinal mucosal involvement is\nrare, with only six cases of colonic necrosis secondary to TEN\nreported in the literature. This case, involving focal necrosis\nand a pinpoint perforation, represents a highly atypical\npresentation.\nConclusion TEN is a severe drug reaction, and colonic\nperforation secondary to it is extremely rare.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138341\nE-poster\nINTESTINAL PERINEUROMA IN DESCENDING COLON: A CASE\nREPORT\nLara Cristina Silva Inácio 1, Michaela Helena Moretto Alves 1,\nEduardo Alves Canedo 1, Guilherme Bussola Carazzatto 2,\nMatheus Zanelato Cavalleri 1, Letícia Isper 2, Pedro Henrique\nBauth Silva 1, André Antônio Abissamra 1\n1Hospital Regional de Presidente Prudente, Prudente, Brasil\n2Universidade do Oeste Paulista, Prudente, rasil\nMan, 41 years old, presents with anal pain and\nbleeding, characterizing hemorrhoidal disease. His personal\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S85\n\n\nhistory shows no comorbidities or family history of colorectal\ncancer. He was surgically treated for hemorrhoids, and during\na screening colonoscopy, a sessile polyp approximately 3mm\nin size was detected in the descending colon, where poly-\npectomy was performed. The pathological result showed\ncolonic mucosa with stromal expansion due to low-grade\nfusocellular proliferation, with a morphologically normal\nglandular component and no malignancy. Following this,\nthe immunohistochemistry result diagnosed the polyp as a\nperineuroma, revealing focal positivity for EMA, and claudin-\n1, and negativity for S-100. Perineuromas are rare benign\ntumors of the peripheral nerve sheath, and through reports,\nthey have also been identified in variants of soft tissues, with\nthe gastrointestinal tract being one such site. Literature on\nthe elucidation of the evolutionary characteristics and fol-\nlow-up of patients diagnosed and treated with perineuromas\nis still scarce. In the literature, using published articles as\nreferences, a total of 157 cases of colorectal perineuromas\nhave been reported, with a female predominance (F:M = 1.3).\nBased on the reports, it is still unclear whether symptoms\nsuch as abdominal pain, diarrhea, gastrointestinal bleeding,\nand a history of previous colorectal carcinoma are related or if\nthey are coincidental. The immunohistochemical character-\nistics of colorectal perineuromas allow for their identification\nand differentiation from other gastrointestinal neoplasms\nthrough speci fic markers. There are descriptions of GLUT1\nand claudin-1, which showed strong and diffuse immunore-\nactivity in 88% and 85% of cases, respectively. The expression\nof EMA, though present in 78% of cases, was weak and focal.\nThe expression of CD34 was observed in 23% of cases, but was\nreported as limited and focal. Desmin and C -Kit (CD117) were\nnegative, which aids in the differential diagnosis with in-\nflammatory myoglandular polyps and gastrointestinal stro-\nmal tumors, respectively. The expression of S100 protein was\nreported in one case. Therefore, it is necessary to have more\nreports in the literature on these rare origin benign polyps.\nLike the majority of intestinal perineuromas reported in the\nliterature, this one appeared distal to the splenic flexure and\nis described as a sessile polyp.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138216\nE-poster\nPRIMARY ENCAPSULATING SCLEROSING PERITONITIS: A RARE\nCAUSE OF INTESTINAL OBSTRUCTION - CASE REPORT\nDébora Alves Domingues Pereira1, Joaquim Tiago Cardoso Leles\nde Jesus1, Lucas Azevedo Ibrahin Elmor 2, Giselle Fonseca Sales\nMaia1, Thais Tavares Rezende 1\n1Hospital de Clínicas Nossa Senhora da Conceição, Três Rios, Brasil\n2Suprema Três Rios, Três Rios, Brasil\nPatient BFS, 34 years old, male, was referred to the\nemergency department with a presentation of cessation of\ngas and stool elimination, abdominal distention, and fecaloid\nvomiting that started approximately 48 hours prior. He\ndenied comorbidities and had no previous history of abdom-\ninal surgeries. He also did not report weight loss, hemato-\nchezia, changes in bowel habits, or other symptoms\nsuggestive of neoplastic disease. He denied a family history\nof colorectal cancer. An abdominal CT scan showed moderate\ndistention of intestinal loops clustered in the mesogastric\nregion, free abdominal fluid, and loculated collections. Given\nthe acute obstructive abdominal picture, exploratory lapa-\nrotomy was chosen, during which encapsulating sclerosing\nperitonitis was identi fied, with a fibrous, thick membrane\nsurrounding all the small bowel loops. The capsule was\ncarefully resected to avoid injury to the intestinal loops,\nand the material was sent for histopathological analysis.\nThe patient had a satisfactory postoperative evolution, with\ngood progress on diet starting from the third day, being\ndischarged on the seventh day after the procedure. The biopsy\nof the specimen showed chronic in flammatory processes\nwithout signs of malignancy. Encapsulating sclerosing peri-\ntonitis is a very rare case of intestinal obstruction. It can be\nprimary or secondary, with the latter being more common,\nparticularly arising as a result of peritoneal dialysis. The\nprimary form is even rarer, with a few cases reported in\nwomen, and retrograde menstruation has been proposed as a\npossible cause. Treatment is primarily surgical, with the\ntherapeutic approach being the resection of the fibrous\nmembranes and lysis of adhesions. The literature lacks\ndescriptions of cases like this, with its primary manifestation\nin men being even rarer and anecdotal, which is why we\nbelieve this case report is relevant.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138287\nE-poster\nCASE REPORT: TREATMENT OF COLOSTOMY STENOSIS IN A\nCRITICAL PATIENT THROUGH EXCORPOREAL STAPLING\nRodrigo de Almeida Paiva 1, Daniel Maurício Londoño Estrada 1,\nLetícia Brandão Castro 1, Artur Duarte e Duarte 1, Marina\nBarbabela Grisolia de Oliveira 1, Lucas Alves Bessa Cardoso 1,\nEduardo Carvalho Barbosa 1\n1Hospital Felício Rocho, Belo Horizonte, Brasil\nCase Presentation A male patient, 83 years old, with a\nhistory of hypertension, diabetes mellitus, coronary artery\ndisease, mild cognitive decline, and partial dependency,\nunderwent a retossigmoidectomy and primary anastomosis\ndue to colon adenocarcinoma. On the 5th postoperative day\n(DPO), he developed an anastomotic leak and was referred for\nanother surgical approach, resulting in a Hartmann colosto-\nmy. He had a prolonged hospitalization with slow recovery\nand mobility restriction. After returning home, he developed\nabdominal pain and loss of appetite. During outpatient\nfollow-up, an anastomotic stenosis was detected. Attempts\nat dilation were made, but without a de finitive resolution.\nDuring this period, the patient developed deep vein throm-\nbosis (DVT) in the lower limbs, requiring therapeutic anti-\ncoagulation, followed by a severe case of dengue, requiring\nintensive care for management of electrolyte disturbances\nand acute renal failure. In this context, the patient experi-\nenced worsening pain and an obstructive condition due to\nretraction and near-complete stenosis of the ostomy, along\nwith skin healing over the stoma. Given the worsening overall\nclinical condition, a local approach to the ostomy was chosen,\nand extracorporeal stapling was proposed and performed. A\nskin incision was made to expose the colonic mucosa, a\ncolostomy bag was placed in the terminal colostomy, and\nadjacent tissues (mucosa and skin) were approximated.\nStapling was done with a 28 mm circular stapler, re- fixing\nthe ostomy at the same site. Post-procedure, gas release was\nobserved on the 1st DPO, with proper function up to 60 days.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS86\n\n\nDiscussion Colostomy creation is a common proce-\ndure in colorectal surgeries, and stenosis occurs in up to 15%\nof postoperative complications, causing signi ficant discom-\nfort to patients and often requiring re-surgical intervention.\nPeriodic dilation is commonly used but often worsens the\ncondition. Thus, when there is no plan for reconstructive\nsurgery, especially in more severe clinical contexts, local\nostomy revision seems to be a viable alternative.\nConclusion Extracorporeal stapling proved to be a\ngood alternative for treating colostomy stenosis in a patient\nwith increased surgical risk and no planned reconstructive\nsurgery.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141649\nE-poster\nREMOVAL OF SURGICAL SPECIMEN VIA NATURAL ORIFICE\n(NOSES) VERSUS MINI-ABDOMINAL INCISION IN THE\nLAPAROSCOPIC SURGICAL TREATMENT OF INTESTINAL\nENDOMETRIOSIS\nRogerio Serafim Parra\n1, José Vitor Cabral Zanardi 1, Fernando\nPassador Valério1, Marley Ribeiro Feitosa1, José Joaquim Ribeiro\nda Rocha1, Omar Féres 1, Matheus Couto Furtado Albuquerque\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\nIntroduction and Objective Natural Ori fice Speci-\nmen Extraction (NOSES) emerged as an alternative to mini-\nabdominal incision (MIA) for segmental resection (RES) in\npatients with intestinal endometriosis. This study aims to\ncompare the surgical outcomes of the two techniques.\nMethods Patients who underwent RES of the rectum\nand/or sigmoid for endometriosis between January 2021 and\nMay 2024 were assessed. Data regarding operative time,\nhospitalization duration, early discharge (within 24 hours\nafter surgery), major postoperative complications (Clavien\nDindo II or III), and mortality were collected and compared.\nResults A total of 88 RES procedures were performed,\nwith 76 (86.4%) involving specimen removal via mini-ab-\ndominal incision (MIA) and 12 (13.6%) via NOSES. The average\nage at the time of surgery was lower in the MIA group\ncompared to the NOSES group (36.5 vs. 40.1 years), as was\nthe operative time (155.1 vs. 187.5 minutes). In the NOSES\ngroup, laparoscopic hysterectomy was performed in 5 cases\n(41.7%), vaginal dome lesions requiring intentional vaginal\nopening occurred in 6 cases (50%), and specimen removal via\nvaginal opening was done in 1 case (8.3%). In the MIA group, 9\nout of 76 cases (11.8%) required concomitant laparoscopic\nhysterectomy. The hospitalization duration was similar in\nboth groups (1.97 vs. 2.00 days), as was the rate of early\ndischarge (n=24, 31.6% vs. n=4, 33.3%). The frequency of major\npostoperative complications within 30 days of discharge was\nsignificantly higher in the NOSES group compared to the MIA\ngroup (n=4, 33.3% vs. n=8, 10.5%). However, 3 of the 4 patients\nwith complications (75%) had vaginal nodules, and only 1\n(25%) required vaginal opening due to hysterectomy. There\nwere no deaths.\nConclusion NOSES was associated with a higher rate\nof major postoperative complications and longer surgical\ntime compared to MIA. However, the majority of vaginal\nopenings in the NOSES group were due to in filtrative lesions\nin the vaginal dome. Hospitalization duration and early\ndischarge rates were similar. Randomized clinical trials are\nneeded to further evaluate NOSES as an alternative to MIA in\nminimally invasive colectomy for the treatment of intestinal\nendometriosis.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141727\nE-poster\nGIANT PELVIC SCHWANNOMA OPERATED VIA COMBINED\nPOSTERIOR AND ANTERIOR APPROACH\nArtur Cury Féres 1, Thomaz Lucas Féres 2, Aryssa Aniello Sakai 1,\nMatheus Couto Furtado Albuquerque1, Rogério Serafim Parra1,\nMarley Ribeiro Feitosa1, José Joaquim Ribeiro da Rocha 1, Omar\nFéres1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\n2Centro Universitário Estácio de Ribeirão Preto, Ribeirão Preto, Brasil\nCase Presentation A 47-year-old male presented in\n2020 at the oncology orthopedic clinic with complaints of\nconstipation for 3 years, rectal tenesmus, the need to use\nsuppositories, sharp stools, and urinary retention with a\nweak stream, requiring occasional bladder catheterization.\nOn physical examination, there was pain upon palpation of\nthe lower lumbar spine and sacral region, with a positive\nbilateral straight leg raise sign. A computed tomography scan\nperformed the previous year showed an expansive lesion\n(10.4x11.4x12.8 cm) pre-sacral in location, likely of blastom-\natous nature. The lesion displaced pelvic structures —the\nsigmoid colon and bladder (displaced to the antero-superior\nregion). A biopsy guided by CT and MRI was performed,\nrevealing a 14x10.5x9 cm sacral expansive lesion that pushed\nadjacent structures without invading the bladder or intesti-\nnal loops, with a relationship to the right neural foramen of\nS3-S4. The biopsy result was a benign mesenchymal neo-\nplasm—schwannoma. Surgical intervention was carried out\nby a joint team from orthopedics and coloproctology. Initially,\na transverse posterior incision and sacrectomy at the S3 level\nwere performed with tumor dissection by the orthopedic\nteam. Then, a laparotomy approach was undertaken by the\ncoloproctology team to remove the tumor intact, with no\ndamage to the bowel or other structures. The patient had a\nfavorable recovery and was discharged after 8 days. On his\nfinal follow-up with coloproctology, he continued to experi-\nence constipation, requiring lavage treatments.\nDiscussion Schwannoma is a rare tumor originating\nfrom Schwann cells and is the most common benign tumor of\nthe peripheral nerve sheath. It presents a variety of morpho-\nlogical forms and rarely manifests malignantly. Most schwan-\nnomas are idiopathic, but they can occur in association with\ngenetic syndromes. It is more common in individuals be-\ntween the ages of 20 and 60. Complete surgical excision is the\ntreatment of choice, but dif ficulties are often encountered\ndue to the location and proximity to important nerves and\nblood vessels.\nConclusion Schwannomas is most often presented as\nretro-rectal tumors, and the approach is typically via the\nposterior (sacral) route. More complex cases may require\ncombined surgical approaches, as seen in this case.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S87\n\n\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141117\nE-poster\nLAPAROSCOPIC SURGICAL TREATMENT OF DEEP\nENDOMETRIOSIS WITH INTESTINAL INVOLVEMENT:\nEXPERIENCE OF A REFERRAL CENTER\nRogerio Serafim Parra1, Matheus Couto Furtado Albuquerque1,\nMarley Ribeiro Feitosa 1, Daniela França Camargo Freitas 1, José\nVitor Cabral Zanardi 1, Fernando Passador Valério 1, José\nJoaquim Ribeiro da Rocha 1, Omar Féres 1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\nObjective This study aimed to describe the experience\nof a referral center in the laparoscopic surgical treatment of\ndeep endometriosis with involvement of the rectosigmoid.\nMethods A retrospective study using prospectively\nrecorded electronic data. The following parameters were\nevaluated: type of surgery, operative time, length of hospi-\ntalization, conversion rate to open surgery, need for stoma,\nand postoperative complications Clavien Dindo /C21 2. The\nstudy was approved by the Ethics and Research Committee.\nResults A total of 290 surgeries were performed\nbetween March 2012 and April 2024. The average age was\n36.1/C6 5.7 years (range, 20-55). There were 172 segmental\nresections (RES) of the rectosigmoid (59.3%), 81 disc resections\n(DIS) (29.9%), and 40 shavings (nodule excisions) (SHA) of the\nrectum (13.8%). Three patients (1.0%) had both DIS and RES in\nthe same operative session. Additional procedures were per-\nformed in 123 patients (42.4%) and included appendectomy\n(n=71, 24.5%), hysterectomy (n=45, 15.5%), ileo-cecectomy\n(n=13, 10.5%), and segmental enterectomy (n=8, 2.8%). In 13\npatients undergoing RES (7.5%), the surgical specimen was\nremoved via the vagina (NOSES). There were 4 conversions to\nopen surgery (1.4%). The mean surgical time was 134 /C6 55.9\nminutes (range, 45-380 minutes), significantly shorter for SHA\ncompared to DIS and RES (p <0.001) and shorter for DIS\ncompared to RES (p <0.001). The average length of hospitali-\nzation was 1.6 /C6 0.9 days (range, 1-12 days), signi ficantly\nshorter for SHA compared to DIS or RES (p<0.001) and shorter\nfor DIS compared to RES (p <0.001). Thirty-three patients\n(11.4%) had Clavien Dindo complications grade 2 (n=19,\n6.6%) or 3 (n=14, 4.8%), with no statistical difference in\ncomparisons between SHA vs DIS or RES (p=0.592), DIS vs\nSHA or RES (p=0.416), and RES vs SHA or DIS (p=0.259). Thirty-\nsix patients (12.4%) required rehospitalization, and 11 patients\n(3.8%) needed reoperation within 60 days post-surgery, with\nno differences between SHA, DIS, or RES. Eight patients\nrequired a stoma (2.8%), 3 for protection and 5 due to postop-\nerative complications. No deaths occurred.\nConclusion The laparoscopic surgical treatment of\nintestinal endometriosis presents low morbidity and low\nrates of stoma formation. Patients undergoing SHA or DIS\nhave shorter surgical times, shorter hospital stays, and no\ndifferences in rehospitalization or reoperation rates.\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 138274\nE-poster\nPRIMARY RETROPERITONEAL NEUROENDOCRINE TUMOR\nPRESENTING WITH SEGMENTAL SMALL INTESTINAL\nISCHEMIA: CASE REPORT\nLetícia Brandão Castro 1, Artur Duarte e Duarte 1, Marina\nBarbabela Grisolia de Oliveira 1, Vinícius Avelar Palhares 1,\nEduardo de Carvalho Barbosa 1, Marco Rinoldi 1, Fábio Lopes de\nQueiroz1, Breno Xaia Martins da Costa 1\n1Hospital Felício Rocho, Belo Horizonte, Brasil\nCase Presentation An 89-year-old female patient\npresented with a three-month history of colicky abdominal\npain, unmeasured weight loss, and anorexia. She visited the\nemergency department where a CT scan revealed segmental\nileal wall thickening, prominent mesenteric vascular en-\ngorgement, and extensive adjacent lymphadenopathy. One\nweek later, she developed intestinal ischemia in the ileal\nregion and underwent exploratory laparotomy. The patholo-\ngy report revealed a retroperitoneal tumor with morpholog-\nical features consistent with a neoplasm of uncertain\nhistogenesis affecting a fibroadipose tissue fragment. Surgi-\ncal margins were free, with no angiolymphatic or perineural\ninvasion. Metastasis was found in 2 of the 29 dissected lymph\nnodes. The immunohistochemical profile was consistent with\na well-differentiated, low-grade (G1) neuroendocrine tumor,\naffecting fibroadipose tissue (positive for Chromogranin A,\nSynaptophysin, and Ki 67 positive in 2%).\nDiscussion The retroperitoneum is not a typical site\nfor primary neuroendocrine tumors, with its presence com-\nmonly indicating metastatic disease originating from the\ngastrointestinal tract. These tumors are often discovered\nincidentally on routine exams, and they are oligossympto-\nmatic in their early stages. When symptomatic, they often\nrepresent advanced disease with metastatic potential. They\nare classified into two subtypes based on their composition:\nneural, expressing neuro filaments (paragangliomas), and\nepithelial, expressing keratin (carcinoid). In elderly patients,\nthe main cause of intestinal ischemia is thromboembolic\nevents. Literature reports of neuroendocrine tumors causing\nintestinal ischemia are rare, with symptoms typically linked\nto carcinoid syndrome. A literature search revealed no\nreports of primary retroperitoneal neuroendocrine tumors\npresenting with intestinal ischemia. Most cases present with\nabdominal pain, palpable masses on physical examination,\nand symptoms due to compression of adjacent organs/\nstructures.\nConclusion The diagnosis of a retroperitoneal neuro-\nendocrine tumor presents challenges in case management, as\nsymptoms may have atypical manifestations. Surgical resec -\ntion may be necessary, or in speci fic cases, chemotherapy for\nundifferentiated or unresectable tumors.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS88\n\n\nTemas Gerais Dentro da Especialidade\nGeneral Topics Within the Specialty\nID – 141744\nE-poster\nUSE OF GLP-1 ANALOGUE AS A CAUSE OF COMPLICATED\nACUTE OBSTRUCTIVE ABDOMEN WITH PERFORATION – CASE\nREPORT AND LITERATURE REVIEW\nEuler de Medeiros Azaro Filho 1, Flávio de Castro Feitosa 1, Lina\nMaria Góes de Codes 1, Flávia de Castro Ribeiro Fidelis 1, Thamy\nCristine Santana Marques 1 Rafaella Alcântara Alves Melo 1,\nSabrina Queron Silva Bacelar Boudoux 1, Mayara Maraux\nMaranhão1\n1Hospital Aliança, Salvador, Brasil\nCase Presentation A 38-year-old female patient with\nMyasthenia Gravis, using Azathioprine and injectable Sem-\naglutide, was admitted to the emergency unit with abdomi-\nnal pain, distension, and diarrhea. She had leukocytosis\nwithout deviation and no other signs of in flammatory re-\nsponse. Fecal calprotectin, fecal leukocytes, and rotavirus\ntests were negative. An abdominal CT scan revealed wall\nthickening in the left colon, with adjacent fat densi fication\nand liquid layers in between, suggesting colitis. Antibiotic\ntherapy was initiated, but on the second day of hospitaliza-\ntion, the patient showed worsening abdominal pain and\ndistension, with peritoneal irritation, though without hemo-\ndynamic repercussions or laboratory worsening. A rectosig-\nmoidoscopy showed no alterations and was stopped at 25 cm\nfrom the anal margin due to the presence of rock-like stool.\nOn the third day of hospitalization, the abdominal pain and\ndistension did not improve, and a new abdominal CT scan\nrevealed pneumoperitoneum and stool outside the loop,\nadjacent to the colprostasis seen in the previous examination.\nThe patient underwent exploratory laparotomy, which iden-\ntified a perforation in the sigmoid colon measuring about 2\ncm, with necrotic edges. A Hartmann ’s procedure was per-\nformed with rectosigmoidectomy. The pathological anatomy\nshowed wall necrosis, abscess in the subserosa, acute fibri-\nnoleukocytic peritonitis, and hypertrophy of the muscularis\npropria.\nDiscussion Patients with Myasthenia Gravis can pres-\nent with intestinal dysmotility; however, what stands out in\nthis case is that the onset of the obstructive condition\noccurred after the use of Semaglutide. The mechanism of\naction of GLP-1 receptor analogs involves decreased gastro-\nintestinal motility. Literature describes an increased risk of\nintestinal obstruction among both diabetic and non-diabetic\npatients using these drugs.\nConclusion Identifying risk factors for intestinal ob-\nstruction among patients who are candidates for GLP-1\nreceptor analog therapy and contraindicating the use in\nsuch cases could help prevent serious adverse effects related\nto this drug class. However, current data indicate that even\namong previously healthy individuals, there is an increased\nrisk of various gastrointestinal complications. With the recent\nincrease in Semaglutide and other GLP-1 analog prescrip-\ntions, adverse effects have been reported more frequently\nthan expected. Long-term studies are necessary to identify\npotentially severe complications related to these drugs.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138291\nOpen Topics (oral presentation)\nTHE INFLUENCE OF IMMUNOHISTOCHEMISTRY ON\nHISTOPATHOLOGICAL PREDICTORS OF LYMPH NODE\nMETASTASIS IN T1 COLORECTAL CANCER\nFábio Lopes de Queiroz 1, Artur Duarte e Duarte 1, Letícia\nBrandão Castro1, Marina Barbabela Grisolia de Oliveira 1,\nEduardo de Carvalho Barbosa 1, Marco Rinoldi 1, Vinicius Avelar\nPalhares1\n1Hospital Felício Rocho, Belo Horizonte, Brasil\nIntroduction There are different approaches for the\nproper management of T1 colorectal cancer after local resec -\ntion. The identi fication of lymph node metastasis usually\nrequires subsequent colorectal resection, and some histo-\npathological factors can predict its presence. The depth of\ninvasion of the submucosal layer is no longer considered an\nindependent risk factor for predicting lymph node spread.\nOver the years, studies have shown that other histopatholog-\nical factors, such as angiolymphatic invasion, are more\nrelevant.\nObjective To evaluate histopathological risk factors\nfor lymph node metastasis in T1 colorectal cancer, comparing\nmethods using Hematoxylin and Eosin (HE) with immuno-\nhistochemistry. Speci fically, to evaluate angiolymphatic in-\nvasion, perineural invasion, and tumor budding, determining\nhigher detection rates of these factors.\nMethods The study will investigate patients who\nunderwent resection of lesions by endoscopic methods and\nwere histologically diagnosed with T1 colorectal cancer.\nThese patients are under follow-up with the Coloproctology\nteam at Felício Rocho Hospital, Belo Horizonte - MG. The\nslides that determined the diagnosis using hematoxylin and\neosin were also subjected to immunohistochemical analysis\nusing antibodies such as D2-40, CD-34, Cytokeratins, and S-\n100, and these results were compared.\nResults During the period from January 2024 to June\nof the same year, 14 patients with T1 colorectal adenocarci-\nnoma were identified from colonoscopy or TEO, under follow-\nup with the team. Only 2 of these patients underwent surgery,\nand the others are being followed with conservative treat-\nment. The degree of differentiation found was either well or\nmoderately differentiated. Only 2 patients with angiolym-\nphatic invasion were detected by HE and were consistent\nwith immunohistochemical methods. None showed positivi-\nty for perineural invasion. The distinguishing factor was\ntumor budding, with two patients showing moderate and\nhigh grades by immunohistochemistry, in contrast to the low\ngrade (Grade I) identi fied by HE for both.\nConclusion Although this is an ongoing study with\npreliminary results, immunohistochemistry appears to be a\nmore effective and easier method to detect poor prognostic\nfactors in T1 colorectal cancer, thus facilitating the manage-\nment of these tumors, in which only 10% actually present\nlymph node metastasis.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S89\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141167\nOpen Topics (oral presentation)\nHIGH RECTAL ADENOCARCINOMA BEHAVES LIKE COLON:\nPREMISE OR REALITY?\nFernanda Bellotti Formiga 1, Iana Faine Saran 1, Janaina Giotti 1,\nPedro Piassaroli de Abreu 1, André Luigi Pincinato 1, Odilon\nVictor Porto Denardin1, Daniele Evaristo Vieira Alves1, Bernardo\nFontel Pompeu1\n1Hospital Heliópolis, São Paulo, Brasil\nIntroduction Extraperitoneal rectal adenocarcinoma\nhas a distinct prognosis and treatment compared to other\ncolorectal locations. The risk of local recurrence is higher in\nthese tumors due to the anatomical characteristics of the\npelvis, mesorectum, its lymph nodes, blood supply, the\ntechnical challenges of the surgical procedure, and the desire\nfor sphincter preservation. Since the introduction of neo-\nadjuvant therapy as a differential treatment for middle and\nlow rectal tumors, the treatment of high rectal tumors (RA)\nhas been considered similar to distal colon tumors. However,\nthere is little research on whether the behavior of these two\nsites differs. High rectal tumors have particularities: a narrow\npelvis, risk of a derivative stoma, mesorectal lymph nodes,\nand partial mesorectal resection.\nObjective To compare the oncological behavior of\nhigh rectal adenocarcinoma and distal colon (DC)\nadenocarcinoma.\nMethod A longitudinal prognostic study using retro-\nspective data from medical records of patients with RA,\nrectosigmoid transition, and sigmoid adenocarcinoma\ntreated with curative intent from January 2020 to May\n2024. Patients receiving treatment during this period were\nincluded, even if surgery had been performed earlier. Exclu-\nsion criteria included patients with unresectable tumors,\nsynchronous metastases, resections after mucosectomies,\npostoperative death, and those who received neoadjuvant\ntreatment. The RA and DC groups were compared using the\nchi-square test, and Kaplan-Meier survival curves were used,\ncompared with the Log-rank test, with p <0.05.\nResults The RA group included 35 patients, while the\nDC group included 111 patients. Regarding outcomes, the\ngroups differed in the location of tumor progression, with the\nDC group having a higher rate of metastatic disease (M1),\nwhile the RA group had a higher rate of local disease (DC 18%\nM1 and 3.6% local vs RA 5.7% M1 and 11.4% local, p=0.02).\nAdditionally, the RA group had a higher rate of de finitive\nstoma (DC 16.2% vs RA 31.4%, p=0.04). However, overall and\ndisease-free survival at two and five years did not differ\nbetween the groups (Log-rank overall survival p=0.52 and\ndisease-free survival p=0.59).\nConclusion High rectal adenocarcinoma and distal\ncolon adenocarcinoma do not differ in overall and disease-\nfree survival; however, the de finitive stoma rate is higher in\nhigh rectal tumors, and tumor progression to metastatic\ndisease is higher in distal colon tumors.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138325\nOpen Topics (oral presentation)\nANALYSIS OF PATIENTS OPERATED ON FOR RECTAL CANCER\nAFTER NEOADJUVANT THERAPY WITH NO RESIDUAL TUMOR\nIN THE PATHOLOGICAL EXAMINATION\nMayara Marina Sousa Senzano1, Carlos Augusto Real Martinez1,\nRaquel Franco Leal 1, Claudio Saddy Rodrigues Coy 1, Michel\nGardere Camargo 1, João José Fagundes 1, Maria de Lourdes\nSetsuko Ayrizono1\n1Universidade Estadual de Campinas, Campinas, Brasil\nIntroduction Around 10-25% of patients who under-\ngo surgery for rectal cancer (RC) after neoadjuvant therapy\nshow a complete pathological response in the surgical speci-\nmen. However, it is dif ficult to predict this response with\ncertainty based on the available exams, such as colonoscopy,\nmagnetic resonance imaging (MRI), and positron emission\ntomography-computed tomography (PET-CT).\nObjective To evaluate patients with rectal cancer who\nunderwent neoadjuvant treatment followed by surgery for\nincomplete response, and who did not present viable tumor\nin the pathological examination.\nMethod Retrospective analysis of medical records of\npatients operated between 2015 and 2023 at the Hospital das\nClínicas, Unicamp, who had a complete pathological response\nafter surgery.\nResults During this period, 227 patients with rectal\ncancer were operated after neoadjuvant treatment, with 20\nof them showing no viable tumor in the pathological exami-\nnation. Half received the Mayo regimen, and the other half\nreceived Xelox and radiotherapy. The average age was 56.8\nyears, with 70% being male. Of the 18 patients who under-\nwent PET-CT, 9 (50%) showed residual neoplasia; of the 15\ncolonoscopies, 11 (73.33%), and of the 17 MRIs, 12 (70.50%).\nThe average interval between the end of radiotherapy and\nsurgery was 29.8 weeks.\nConclusion Identifying patients with a complete\npathological response after neoadjuvant therapy remains a\nchallenge, and there is currently no exam capable of precisely\ndetermining this condition.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141641\nOpen Topics (oral presentation)\nANALYSIS OF REPORTED CASES OF COLORECTAL CANCER IN\nTHE STATE OF GOIÁS, BRAZIL (2013-2024)\nStephanie Souza Firmo\n1, Ana Carolina Oliveira Guaritá\nMarquez1, Danielle Toledo Gomes 1, Kethlen Torres Cavinato 1,\nHeron Kairo Saboia Sant ‘anna Lima 2\n1Universidade Nove de Julho, São Paulo, Brasil\n2Conjunto Hospitalar do Mandaqui, São Paulo, Brasil\nIntroduction Colorectal cancer is one of the main\nmalignant neoplasms in the state of Goiás, representing a\nsignificant challenge for local public health. In Goiás, it is the\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS90\n\n\nthird most prevalent type of cancer, surpassed only by breast\nand prostate cancer. The high incidence and severity of the\ndisease demand a detailed analysis to better understand its\ndistribution.\nObjective To analyze the distribution and pro files of\ncolorectal cancer cases diagnosed in the state of Goiás.\nMethod This is an analytical observational ecological\nstudy using data from the Oncology Panel available on the\nDepartment of Informatics of the Uni fied Health System\n(DATASUS) website. The sample included all cases of colorec -\ntal cancer (ICD codes C18, C19, C20, and C21) diagnosed in the\nstate of Goiás between 2013 and 2024.\nResults During the period, 8,405 new cases of the\ndisease were reported in Goiás, representing 2.6% of all\ncolorectal cancer cases in Brazil (314,635). The gender distri-\nbution was 50.5% in women and 49.5% in men, re flecting the\nnational distribution with similar numbers between genders.\nThere was a reduction in new diagnoses in 2020 and 2021,\npossibly due to the Covid-19 pandemic, which led to a decline\nin seeking medical care. The age distribution shows the\nhighest incidence in the 50 to 69 age group (51.4%) and the\nlowest incidence in individuals under 29 years of age (0.5%).\nThe most common treatment types were chemotherapy,\nfollowed by surgery and radiotherapy. This distribution is\ninconsistent with the recommended guidelines for colorectal\ncancer treatment, which prioritize surgical resection of the\ntumor. However, when compared to other studies, a similari-\nty in therapeutic strategies adopted is observed. The majority\nof diagnoses were made at stages 3 and 4, which is concerning\nas advanced-stage diagnoses are associated with worse prog-\nnoses and lower survival rates.\nConclusion This study revealed a high prevalence of\ncolorectal cancer in the state of Goiás, particularly in the 50 to\n69 age group and in both sexes. Chemotherapy and surgery\nwere the most commonly used treatments, and most diagno-\nses were made in advanced stages. The epidemiological\ninformation provided is essential for the promotion of public\nhealth measures and underscores the need for future and\nmore detailed studies on the subject.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138234\nOpen Topics (oral presentation)\nEPIDEMIOLOGICAL ANALYSIS OF COLORECTAL MALIGNANT\nNEOPLASMS IN THE YOUNG BRAZILIAN POPULATION\nEloisa Elena Xavier de Oliveira Ligoski 1, Lincólin Bardini\nGoulart1, Gabriele Eckerdt Lech 1, Giovanna Barcellos Gemelli 1,\nBrenda de Lima Louzada Pires 2\n1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,\nBrasil\n2Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande\ndo Sul, Porto Alegre, Brasil\nIntroduction Colorectal cancer has a higher inci-\ndence among the elderly population, with most diagnoses\nconcentrated in individuals aged 50-60 years. However, there\nhas been a noticeable increase in this neoplasm among young\npeople, where diagnosis may be delayed due to nonspeci fic\nsymptoms, negatively impacting the disease prognosis. To\ndate, no recent epidemiological analysis of colorectal cancer\nin the young population has been conducted.\nObjective To analyze the cases of colorectal malignant\nneoplasm diagnoses in the young population in Brazil.\nMethodology This ecological study utilized data\nextracted from the Department of Informatics of the Uni fied\nHealth System (DATASUS) through the Oncology Panel —\nBrazil, covering the period from 2018 to 2023. Participants\nincluded males and females aged 0 to 19 years. The variables\nanalyzed were malignant neoplasm of the colon (ICD10-C18),\nmalignant neoplasm of the rectosigmoid junction (ICD10-\nC19), malignant neoplasm of the rectum (ICD10-C20), gen-\nder, and age group. The analysis was conducted using de-\nscriptive statistics.\nResults During the analyzed period, 4,676 cases of\nmalignant neoplasms of the colon, rectosigmoid junction, and\nrectum were recorded in individuals aged 0 to 19 years of both\nsexes. Throughout this period, diagnoses were more frequent\namong males. In 2021, the highest number of colon cancer\ncases was recorded, with a total of 1,243 cases, 787 among\nmales and 456 among females. There was a 280.1% increase in\ncases from 2018 (327 cases) to 2021 (1,243 cases). However,\nfrom 2021 (1,243 cases) to 2023 (562 cases), a 54.8% reduction\nwas observed. Over the six-year period, 2018 presented the\ngreatest proportional difference in cases between males (224)\nand females (103), with a ratio of 2.17. Meanwhile, 2023\nshowed the smallest male-to-female ratio, with 329 cases in\nmales and 233 in females, representing a ratio of 1.41.\nConclusion The study corroborates findings in the\nliterature, confirming an increase in the prevalence of colo-\nrectal cancer in recent years, with a continued higher pro-\nportion of cases in males compared to females. Although the\nabsolute number of cases was higher in 2023 compared to\n2018, the growth trend in prevalence did not remain constant\nover the six-year period. This analysis includes data from\nbefore and after the 2020 pandemic, which may have in flu-\nenced the increased demand for healthcare and diagnostic\nimaging, particularly the post-pandemic peak in 2021. This\nstudy is highly relevant as it highlights the need for early\ndetection of this neoplasm in young individuals.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138239\nOpen Topics (oral presentation)\nEPIDEMIOLOGICAL ANALYSIS OF MALIGNANT NEOPLASM OF\nTHE RECTOSIGMOID JUNCTION IN BRAZIL BETWEEN 2018\nAND 2023\nGiovanna Barcellos Gemelli 1, Lincólin Bardini Goulart 1, Eloisa\nElena Xavier de Oliveira Ligoski1, Isadora Medeiros de Almeida1,\nBrenda de Lima Louzada Pires 2\n1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,\nBrasil\n2Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande\ndo Sul, Porto Alegre, Brasil\nIntroduction In 2022, approximately 20 million new\ncancer cases were reported globally. Colorectal cancer ranks\nthird in prevalence and holds the same position in mortality\nfor both genders.¹ Between 2023 and 2025, 45,000 annual\ncases of colorectal cancer are projected in Brazil.² Malignant\nneoplasm of the rectosigmoid junction is one of the types of\ncolorectal cancer. Therefore, it is crucial to assess the current\nepidemiological scenario of this neoplasm to improve the\nreach of primary care.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S91\n\n\nObjective The current summary aims to evaluate the\nepidemiological pro file of malignant neoplasm of the recto-\nsigmoid junction in Brazil between 2018 and 2023.\nMethod This is an ecological study based on data\ncollected from the Department of Informatics of the Uni fied\nHealth System (DATASUS) regarding diagnoses related to ICD-\n19 (malignant neoplasm of the rectosigmoid junction) regis-\ntered between March 2018 and 2023. The data of interest\nincluded the total number of recorded cases, year of diagno-\nsis, origin, and gender of the patients. Data collection took\nplace on June 10, 2024.\nResults Between 2018 and 2023, 12,899 cases of\nmalignant neoplasm of the rectosigmoid junction were\nrecorded, with a slight prevalence among women (6,516\nwomen diagnosed compared to 6,383 men). Over the years,\nthere was an approximate 82.7% increase in the total number of\ncases. The increase was 87.6% (638 cases) among women and\n77.8% (560 cases) among men. A plateau in the total number of\ncases was observed between 2019 and 2021 (2,150 and 2,183\ncases, respectively). During this period, the gender distribution\npattern remained consistent, with an increase 5.6 times higher\nin women (28 cases) compared to men (5 cases). After this\nperiod, the growth became progressive, with an increase of 129\nand 335 cases recorded in 2022 and 2023, respectively.\nConclusion The findings indicate that the incidence of\nmalignant neoplasm of the rectosigmoid junction has fol-\nlowed an increasing trend over the past five years, with\nprogressive growth in the last two years. These data highlight\nthe need for resources, material, and human allocation to\nmeet the growing demand. Women are the most affected\ngroup, emphasizing the need for enhanced primary health-\ncare attention regarding diagnosis and continued treatment\nfor this population.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141723\nOpen Topics (oral presentation)\nCLINICAL PRESENTATION, PATHOLOGICAL STAGING, AND\nDISEASE-FREE SURVIVAL OF COLORECTAL CANCER IN YOUNG\nADULTS\nMaria Beatriz Souza Nascimento\n1, Carla dos Santos Porto 1,\nLucas Gabriel Castro Carvalho 1,S o fia Arrais Haidar 1, Vanessa\nSiqueira Reis2, André Araújo de Medeiros Silva2, Bruno Augusto\nAlves Martins 2, João Batista de Sousa 2\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nIntroduction Colorectal cancer is the second most\nfrequent malignant tumor in men and women in Brazil and\nranks as the second leading cause of mortality from malig-\nnant neoplasms worldwide. Additionally, its incidence has\nbeen increasing among young adults.\nObjective To study the clinical presentation, patho-\nlogical staging, and disease-free survival of colorectal cancer\nin young adults.\nMethod This case series study analyzed 41 oncology\npatients up to 45 years of age who were diagnosed and\ntreated between 2010 and 2022. The variables collected\nincluded sex, age, body mass index (BMI), comorbidities\n(hypertension, diabetes mellitus, and smoking), American\nSociety of Anesthesiologists (ASA) classi fication, tumor loca-\ntion, staging, postoperative complications, follow-up, and\ndisease-free survival outcomes.\nResults The study included 41 patients with a median\nage of 40 years (range: 23–45), of whom 24 were women (58.5%)\nwith an average BMI of 23.13 kg/m². One patient had systemic\narterial hypertension, two had diabetes mellitus, and one was a\nsmoker. According to the ASA classification, 17 patients were\nclassified as ASA 1, 17 as ASA 2, and 7 as ASA 3. The cases\nincluded 4 right colon adenocarcinomas, 17 left colon adeno-\ncarcinomas, and 20 rectal adenocarcinomas. Regarding staging,\n11 patients were stage I, 5 were stage II, 20 were stage III, and 5\nwere stage IV. Surgical approaches included 21 open surgeries\nand 20 laparoscopic surgeries. Postoperative complications\noccurred in 15 patients (36.5%), including urinary retention (6\npatients), paralytic ileus (3 patients), pelvic abscess (3 patients),\nwound dehiscence (1 patient), pancreaticfistula (1 patient), and\nfever (1 patient), with no reported deaths. The average follow-\nup period was 35.59 months, and the disease-free survival rate\nfor stage I to III patients was 87.8%.\nConclusion This case series analyzed 41 young oncol-\nogy patients. Despite a 36.5% rate of postoperative compli-\ncations, surgical intervention proved to be the gold standard\ntreatment, with no operative mortality reported. Further-\nmore, the disease-free survival rate for patients in stages I, II,\nand III was 87.8%. These findings underscore the importance\nof appropriate management for favorable prognoses in colo-\nrectal cancer patients.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141525\nOpen Topics (oral presentation)\nEVALUATION OF PURINERGIC MARKER EXPRESSION IN\nCOLORECTAL CANCER PATIENTS\nDaniel de Barcellos Azambuja 1, Cristina Calloni 2, Gabriela\nRoliano1, Elizandra Braganhol 1\n1Universidade Federal de Ciências da Saúde de Porto Alegre, Porto\nAlegre, Brasil\n2Universidade Feevale, Novo Hamburgo, Brasil\nIntroduction Colorectal cancer (CRC) is associated\nwith an in flammatory response characterized by a cellular\ninfiltrate, with the relationship between in flammation and\ncancer being recognized. The role of purinergic signaling in\ndetermining the immune response to tumors has been a\nsubject of discussion. The enzyme CD73 is emerging as a\npotential new therapeutic target.\nObjective The aim of this study was to evaluate the\nexpression of genes related to immunosuppression in PBMCs\nisolated from the peripheral blood of patients with colorectal\ncancer and compare them with healthy individuals.\nMethod Three patients diagnosed with primary CRC\nwere selected. Blood samples were collected during the\npreoperative phase and subjected to a PBMC (Peripheral\nBlood Mononuclear Cells) isolation protocol, which separates\ndifferent blood cells by density differences. qPCR was per-\nformed for the genes: CD73, CD39, Ab2, and MCP-1.\nResults The patients were of both genders, over 50\nyears old, white, with a positive family history of cancer and a\ndiagnosis of colon adenocarcinoma. The analysis of the\nPBMCs revealed an increase in the expression of the enzymes\nCD39 and CD73 in the patient samples, which are responsible\nfor degrading ATP, ADP, and AMP, and generating adenosine in\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS92\n\n\nthe extracellular medium, an immunosuppressive molecule\nthat blocks the immune response against the tumor. An\nincrease in the expression of the A2b receptor, which has\nselective speci ficity for adenosine and is also involved in\nimmunosuppressive processes in CRC, was also observed. The\nMCP-1 gene (Monocyte Chemoattractant Protein-1) had in-\ncreased expression and is associated with increased macro-\nphage infiltration in CRC.\nConclusion The three patients with CRC presented an\nimmunosuppressive profile, evidenced by the increased gene\nexpression of purinergic markers compared to the control\nindividuals. These results suggest that there is modulation of\nimmune cells at the level of the peripheral blood system of\nthe patients. Further analyses are necessary to con firm how\nthese findings may help predict prognosis and metastasis\ndevelopment in patients.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141764\nOpen Topics (oral presentation)\nEVALUATION OF THE ONCOLOGICAL OUTCOME OF PATIENTS\nWITH DISTAL RECTAL ADENOCARCINOMA UNDERGOING\nMANUAL COLOANAL ANASTOMOSIS FROM 2015 TO 2020\nPedro Costa Moreira 1, Marcos Vinicius Araújo Denadai 1, Luis\nGustavo Capochin Romagnolo 1, Felipe Daldegan Diniz 1,\nRodrigo Giacomini Bregeiro 1, Carlos Augusto Rodrigues Veo 1\n1Hospital de Amor Barretos, Barretos, Brasil\nThis study investigates the effectiveness of manual\ncoloanal anastomosis in patients diagnosed with distal rectal\nadenocarcinoma, with the main objective of evaluating over-\nall survival, disease-free survival, and postoperative compli-\ncations. This retrospective study analyzed 37 patients who\nunderwent rectosigmoidectomy with total mesorectal exci-\nsion followed by manual coloanal anastomosis, between\nJanuary 2015 and December 2020, at the Hospital de Amor\nBarretos/SP. The results indicate that, although this anasto-\nmosis presents technical challenges, when performed cor-\nrectly and applied to appropriately selected patients, it can\nresult in favorable oncological outcomes, comparable to or\neven surpassing current literature, while minimizing postop-\nerative complications. It is concluded that manual coloanal\nanastomosis is a feasible and safe approach in properly\nselected patients with distal rectal adenocarcinoma, but\nfurther studies are emphasized to con firm these findings\nand optimize patient selection and surgical techniques.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 137865\nOpen Topics (oral presentation)\nEVALUATION OF SURGICAL AND ONCOLOGICAL OUTCOMES\nOF INTERSPHINCTERIC RESECTION AND MANUAL COLOANAL\nANASTOMOSIS IN THE TREATMENT OF DISTAL RECTAL\nADENOCARCINOMA\nLucas Faraco Sobrado 1, Fernando Noboru Cabral Mori 1, Yuri\nTebelskis Nunes Dias 1, Bruno Massanori Matsumura 1,\nGuilherme Cutait de Castro Cotti 1, Caio Sergio Rizkallah\nNahas1, Carlos Frederico Sparapan Marques 1, Ulysses Ribeiro\nJunior1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nIntroduction Historically, tumors in the distal rec -\ntum, close to the anal sphincter, were treated with abdom-\ninoperineal amputation to achieve wide, clear margins.\nRecently, it has been shown that margins of one centimeter\nare acceptable after chemoradiotherapy (CRT). Thus, for\ntumors without involvement of the intersphincteric plane,\nresection of the internal sphincter followed by manual coloa-\nnal anastomosis can be performed. Although some series\nshow the safety of this procedure, it is still rarely performed\noutside specialized centers, making the treatment of distal\nrectal adenocarcinoma quite heterogeneous.\nObjective To evaluate the surgical and oncological\noutcomes of intersphincteric resection and manual coloanal\nanastomosis in patients with localized distal rectal\nadenocarcinoma.\nResults A total of 97 patients were included, with T1/\nT2 tumors (44.3%), T3 (54.6%), and T4 (2.1%). Of these, 48.5%\nhad suspicious mesorectal lymph nodes and 22.7% had lateral\npelvic lymph nodes. Pre-neoadjuvant treatment, the inter-\nsphincteric plane was at risk or involved in 25%, and tumors\nwere located 0.4 /C6 0.9 cm from the anorectal ring. A total of\n90.7% underwent neoadjuvant treatment, and 10.2% were\ninitially treated under a watch and wait protocol. Upon\nrestaging, 14.1% still had the intersphincteric plane at risk.\nThe surgical approach was laparoscopic (68%), open (19.6%),\nand robotic (5.2%). In 12.4%, pelvic lateral lymphadenectomy\nwas performed, and in 6.2%, resection of another organ in a\nsingle block. The average hospital stay was 9.4 days, and there\nwas one early reoperation due to internal hernia. The histo-\npathological exam showed clear margins in 90.7%. During\nlong-term follow-up, 7.2% had local recurrence and 24.7% had\ndistant metastasis. A total of 7.2% required a de finitive stoma\ndue to pelvic recurrence (n=3), chronic anastomotic compli-\ncations (n=3), and severe anal incontinence (n=1). After an\naverage follow-up of 1563 days, 67% of the patients were alive\nwithout disease.\nConclusion Intersphincteric resection with manual\ncoloanal anastomosis for low rectal tumors has proven to be a\nsafe procedure with satisfactory oncological outcomes. The\nincidence of local recurrences and distant metastases high-\nlights the importance of continuous and rigorous follow-up.\nStandardizing this procedure could contribute to a more\nhomogeneous approach to the treatment of distal rectal\nadenocarcinoma.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138339\nOpen Topics (oral presentation)\nPRACTICAL EVALUATION OF MRI IN RECTAL CANCER: WHAT\nTHE SURGEON NEEDS TO KNOW\nMayra Veloso Ayrimoraes Soares 1,S ofia Arrais Haidar 2, Tiago\nVasques Bertoncini2, Alexandre Sérgio de Araujo Bezerra 2,\nAline Martins Oliveira 3, Fabio Pittella Silva 2, Romulo Medeiros\nde Almeida 2, João Batista de Sousa 2\n1Universidade de Brasilia, Rede DASA, Hospital Sirio Libanes, São\nPaulo, Brasília\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S93\n\n\n2Universidade de Brasilia, Brasil\n3Rede DASA, Hospital Sirio Libanes, Brasil\nIntroduction Magnetic resonance imaging (MRI) is\nthe imaging method of choice for the characterization and\nstaging of rectal cancer. Through it, preoperative anatomical\nstudy of the pelvic compartments can be performed, recog-\nnizing potential compromise of surgical planes and adjusting\nthe operative strategy. MRI also allows the identi fication of\nhigh-risk criteria, aiding in the decision of whether to use\nneoadjuvant treatment for potential tumor downstaging and\nimproved surgical outcomes.\nObjective The objective of this work is to demon-\nstrate, in a practical way, in seven steps, how to: - recognize a\ntechnically adequate MRI; - map the main characteristics\nrelated to TNM staging, as well as signs of locoregional\ninvolvement and adjacent structure compromise; - recognize\npatterns of mesorectal invasion; - recognize the mesorectal\nfascia and its potential tumor involvement; - identify lymph\nnode suspicion criteria and locate the main affected chains on\nMRI; - screen for factors indicating poor oncological progno-\nsis; - establish the involvement of important anatomical\nstructures, impacting the decision of surgical and oncological\nstrategy.\nMethod Evaluation of MRI exams of patients in\ndifferent tumor stages, to practically demonstrate the main\nanatomical repairs, the manifestations of rectal cancer on\nMRI, and imaging findings in various clinical scenarios (TNM).\nResults Systematic evaluation of MRI findings in\nrectal cancer, in seven steps: 1. Recognizing a technically\nadequate exam 2. Anatomy of the rectum on MRI 3. Meso-\nrectal fat and mesorectal fascia 4. Evaluating the T stage 5. The\nchallenge of lymph node evaluation 6. Extramural vascular\ninvasion and its significance 7. Tumor resection planning with\nMRI\nConclusion Magnetic resonance imaging is currently\nan indispensable tool in the diagnosis and reassessment of\npatients with rectal cancer. It enables pre-treatment tumor\nstaging, defining the best therapeutic strategy for each sce-\nnario, and contributes signi ficantly to post-neoadjuvant tu-\nmor reassessment. It is essential, therefore, that the colorectal\nsurgeon masters the concepts of imaging for the de finition of\nthe most appropriate surgical and oncological therapeutic\nstrategy and for better communication with the multidisci-\nplinary team.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141658\nOpen Topics (oral presentation)\nROBOTIC SURGERY VERSUS LAPAROSCOPIC SURGERY FOR\nRECTAL CANCER TREATMENT. COMPARATIVE ANALYSIS\nBETWEEN THE METHODS IN AN ONCOLOGICAL CENTER IN\nBRAZIL\nMarcos Vinícius Araújo Denadai\n1, Camila Lima Alves 1, Luís\nGustavo Capochin Romagnolo 1, Felipe Daldegan Diniz 1,\nRodrigo Giacomini Bregeiro 1, Carlos Augusto Rodrigues Véo 1,\nJoão Pedro Pinto Cordeiro de Miranda Coutinho 1, Alejandro\nDelfos Hermoza1\n1Hospital de Amor de Barretos, Barretos, Brasil\nIntroduction Minimally invasive surgeries have\ngrown substantially worldwide, and today they are one of\nthe main access routes for abdominal surgeries. The increas-\ning number of cancer cases leads to a rise in the number of\nsurgeries, highlighting the importance of expanding less\ninvasive surgical techniques in the colorectal field, with\nimprovements in patient outcomes and quality of life. The\nuse of advanced technology, such as robotics, raises the\nquestion of whether this is currently the best access route\nfor better surgical results. There is a lack of long-term studies\nwith a larger number of patients comparing the two techni-\nques used (videolaparoscopy vs. robotics) and thus demon-\nstrating the real bene fit of using robotic technology for\noncological treatment and accelerating postoperative\nrecovery.\nObjectives The aim of this study is to evaluate the\nbenefits of robotic surgery compared to videolaparoscopic\naccess in patients with rectal adenocarcinoma, who under-\nwent minimally invasive surgery between 2018 and 2022, in\na reference oncological center in Brazil.\nMaterials and Methods A retrospective study was\nconducted evaluating 878 patients operated on for rectal\ntumors between 2018 and 2022 in a reference oncology\nservice in Brazil. A database platform, RedCap, was used to\nassess the data.\nResults During the analyzed period, a total of 505\nvideolaparoscopic surgeries (VLP) and 373 robotic surgeries\n(RS) were performed. The robotic group had patients with a\nyounger age (58 þ/- 12 vs. 61 þ/- 12; p = 0.002), lower body\nweight (72 kg vs. 76 kg; p = 0.025), higher frequency of\nneoadjuvant therapy (p < 0.001), and longer surgery time\n(p < 0.001). However, there were no statistical differences in\npostoperative diet initiation, length of stay, conversion rates,\npostoperative complications, or oncological outcomes.\nConclusion The present study, comparing minimally\ninvasive techniques for rectal cancer surgery, showed similar\npostoperative complication rates and oncological outcomes\nbetween the robotic and videolaparoscopic approaches, with\nboth being safe and bene ficial for patients with colorectal\nneoplasms.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141079\nOpen Topics (oral presentation)\nCONVENTIONAL RIGHT HEMICOLECTOMY VS. COMPLETE\nMESOCOLON EXCISION: ANALYSIS OF LOCOREGIONAL\nRECURRENCE\nRodrigo Moisés de Almeida Leite 1, Lucas Pilotto Ramos 1, Lucas\nSoares Gerbasi1, Giovana Moreira Minchillo 1, Francisco\nTustumi1, Rafael Vaz Pandini 1, Victor Edmond Seid 1, Sergio\nEduardo Alonso Araujo 1\n1Hospital Israelita Albert Einstein, São Paulo, Brasil\nIntroduction Complete mesocolon excision may be\nassociated with lower rates of lymph node recurrence in right\ncolectomy for colon adenocarcinoma. The objective of this\nstudy was to compare conventional right colectomy with\ncomplete mesocolon excision (CME) for right colon adeno-\ncarcinoma. A retrospective cohort study was conducted at the\nVila Santa Catarina Hospital (Sociedade Bene ficente Israelita\nBrasileira Albert Einstein), São Paulo , Brazil .\nMethods Adult patients ( >18 years) diagnosed with\nright colon adenocarcinoma were included. Only minimally\ninvasive right colectomies (laparoscopic or robotic) were\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS94\n\n\nconsidered. The inclusion period was from 2019 to 2024. CME\nwas de fined as right colectomy with central ligation of the\nileocolic, right colic, and right branch of the colon arteries;\nmesenteric dissection through the embryonic layer; and D3\nlymphadenectomy. Our primary outcome was locoregional\nrecurrence, defined as nodal disease or local recurrence after\nthe start of follow-up for cancer. Disease-free survival was\ndefined as the absence of locoregional or distant recurrence\nafter surgery. We performed survival analysis for disease-free\nsurvival and multivariate Poisson regression to obtain risk\nratios for locoregional recurrence between the groups after\nadjustment for: - Age; - Sex; - BMI ; - Pathological T stage ; -\nPathological N stage; - Mismatch repair protein de ficiency; -\nNeoadjuvant chemotherapy; - Adjuvant chemotherapy; - First\npostoperative CEA level; - Hypertension; - Diabetes Mellitus; -\nASA score.\nResults A total of 154 cases were included for analysis,\n26 in the CME cohort and 128 in the conventional cohort. No\nlocal recurrences were observed in either group. Nodal\nrecurrence was observed in 6 patients in the conventional\ncohort (incidence of 9.52%). No nodal recurrence was ob-\nserved in the CME group. The mean time to nodal recurrence\nwas 28 months (SD 10 months). The main predictors of nodal\nrecurrence were pT4 and pN2 stages. After adjusting for\nmultiple confounding factors, CME was associated with a\nsignificant reduction in the risk of nodal recurrence (adjusted\nRR = 0.08; 95% CI: 0.05 to 0.09; p < 0.001) and a signi ficant\nincrease in disease-free survival (HR = 0.03; 95% CI: 0.003 to\n0.27; p = 0.002).\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141617\nOpen Topics (oral presentation)\nCOMPLETE MESOCOLIC EXCISION VERSUS CONVENTIONAL\nD2 LYMPHADENECTOMY IN RIGHT HEMICOLECTOMY: A\nMETA-ANALYSIS OF PROPENSITY SCORE MATCHED STUDIES\nAND RANDOMIZED CONTROLLED TRIALS\nBernardo Fontel Pompeu 1, Eric Pasqualotto 2, Patrícia\nMarcolin3, Lucas Monteiro Delgado4, Beatriz D’andrea Pigossi1,\nSergio Mazzola Poli de Figueiredo 5, Fernanda Bellotti Formiga 1\n1Hospital Heliópolis, São Paulo Brasil\n2Universidade Federal de Santa Catarina, Florianópolis, Brasil\n3Universidade Federal Fronteira do Sul Passo Fundo, Passo Fundo,\nBrasil\n4Universidade Federal de Minas Gerais, Belo Horizonte, Brasil\n6Cleveland Clinic, Ohio, United States\nIntroduction The complete mesocolic excision (CME)\nin right-sided hemicolectomy could result in higher lymph\nnode yield and decreased local recurrence. However, this\napproach could increase intraoperative and postoperative\ncomplications.\nObjective Our meta-analysis aims to demonstrate the\noutcomes of CME versus D2 conventional lymphadenectomy\nfor right-sided colon cancer.\nMethods We searched MEDLINE, Cochrane, Central\nRegister of Clinical Trials, and EMBASE for studies published\nuntil April 2024. Odds ratios (OR) with 95% con fidence\nintervals (CIs) were pooled using a random-effects model.\nHeterogeneity was assessed using the Cochran Q test and I²\nstatistics, with p-values < 0.10 and I² > 25% considered sig-\nnificant. Statistical analysis was performed using R Software,\nversion 4.1.2.\nResults Three randomized controlled trials and four\nobservational studies comprising 2,296 patients were includ-\ned, of whom 1,138 (49.6%) were submitted to the CME and\n1,158 (50.4%) to the conventional D2 lymphadenectomy. CME\nwas associated with decreased local recurrence rates (OR 0.07;\n95% CI 0.01 to 0.36; p=0.002). There were no signi ficant\ndifferences between groups in overall complications, severe\ncomplications, intraoperative complications, blood loss, and\n30-day mortality. No difference between groups was observed\nin distance metastasis and 3-year disease-free survival.\nConclusion In this meta-analysis, CME signi ficantly\ndecreased local recurrence rates and increased the number of\nharvested lymph nodes compared with D2 lymphadenecto-\nmy in patients with right-side colon cancer. No difference was\nobserved between groups in rates of overall complications,\nsevere complications, intraoperative complications, blood\nloss, and 30-day mortality.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141739\nOpen Topics (oral presentation)\nCORRELATION BETWEEN DIGITAL RECTAL EXAMINATION\nAND MAGNETIC RESONANCE IMAGING IN ASSESSING THE\nDISTANCE OF RECTAL TUMORS FROM THE ANAL MARGIN IN\nPATIENTS FROM A UNIVERSITY HOSPITAL\nCatarina Ferreira Costa Praia 1, Luís Felipe Mendonça de\nOliveira1, Rafaela de Melo Sprogis 2, Pedro dos Anjos Freixo 2,\nMayra Veloso Ayrimoraes Soares 1, Bruna Stefany Bento de\nSousa Teles2, Rômulo Medeiros de Almeida 1, João Batista de\nSousa1\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nIntroduction The evaluation of distal rectal cancer\n(RC) includes digital rectal examination (DRE), endoscopic\nexamination, and staging by magnetic resonance imaging\n(MRI). In clinical practice, specialists use DRE to assess the\ntumor’s distance from the anal margin. MRI is employed for\nstaging to indicate the degree of invasion in the mesorectal\nfascia layers, the presence of lymph nodes, and the tumor ’s\ndistance from the sphincter complex and anal margin.\nObjective To evaluate whether the distance of rectal\ntumors from the anal margin measured by DRE correlates\nwith the distance measured by MRI.\nMethod We reviewed 65 patient records with rectal\ntumors who underwent DRE and MRI to measure the tumor’s\ndistance from the anal margin between 2019 and 2024 at a\nuniversity hospital. Forty-one records were selected for\nevaluation based on the inclusion criterion of explicitly\nstating the tumor ’s distance from the anal margin in both\nDRE and MRI exams. The respective measurements were\nassessed using Pearson’s correlation coefficient (r) and Intra-\nclass Correlation Coef ficient (ICC), as well as paired T-tests.\nResults The mean distance of tumors from the anal\nmargin measured by DRE and MRI were 5.3 cm and 6.9 cm,\nrespectively, with standard deviations of 2.45 and 2.67. The\nanalysis revealed a moderately strong positive correlation\nbetween the measurements of both exams (r = 0.673),\nsuggesting that tumor size can be measured similarly by\nDRE and MRI. The Intraclass Correlation Coef ficient (ICC(3k))\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S95\n\n\nfor the agreement between the two exams was calculated to\nbe 0.80 (95% CI: 0.67-0.88), showing substantial agreement\nbetween them, indicating robust consistency in the measure-\nments and ensuring reliable clinical evaluations. The com-\nparison of the measured distances showed a statistically\nsignificant difference between DRE and MRI (Paired t-test: t\n(40) = 3.0348, p < 0.005), with an approximate mean differ-\nence of 0.985 (95% CI: 0.33-1.64), suggesting that although\nthe distances are not identical, the magnitude of the differ-\nence should be interpreted in the clinical context.\nConclusion Based on the data obtained in this study,\nit can be concluded that the measurement of the rectal\ntumor’s distance from the anal margin by DRE has a good\ncorrelation with the measurement by magnetic resonance\nimaging, although there is signi ficant variability.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141775\nOpen Topics (oral presentation)\nCORRELATION BETWEEN CIRCULATING FREE DNA LEVELS\nAND PREOPERATIVE SERUM CARCINOEMBRYONIC ANTIGEN\nLEVELS IN PATIENTS WITH COLORECTAL CANCER\nPedro dos Anjos Freixo 1, Beatriz Regis da Cunha 1, Catarina\nFerreirra Costa Praia1, Luís Felipe Mendonça de Oliveira1, Bruna\nStéfany Bento de Sousa 1, André Araújo de Medeiros Silva 1,\nBruno Augusto Alves Martins 1, João Batista de Sousa 1\n1Universidade de Brasília, Brasília, Brasil\nIntroduction Colorectal cancer is the third most\ncommon malignancy and the second leading cause of can-\ncer-related deaths worldwide, accounting for over 930,000\ndeaths annually. Given the signi ficance of this public health\nissue, early detection and effective monitoring are crucial for\nimproving clinical outcomes. New potential tumor markers\nare being widely studied for this purpose. CEA is a marker\ntraditionally used in clinical practice, despite its limitations,\nsuch as low speci ficity. cfDNA, on the other hand, is an\nemerging approach that promises greater precision in detect-\ning recurrences and monitoring treatment responses.\nObjective To investigate the correlation between pre-\noperative serum CEA levels and cfDNA levels in patients with\ncolorectal cancer, while evaluating their relationship and the\ninfluence of comorbidities and clinical characteristics.\nMethods This prospective study included 22 patients\nwith colorectal adenocarcinoma. Preoperative cfDNA was\ncollected through liquid biopsy immediately before surgery.\nCEA was collected immediately after diagnosis. Clinical and\nepidemiological variables were extracted from medical\nrecords. Variables collected included age, gender, diabetes\nmellitus, alcoholism, smoking, number of medications used,\nhypertension, and body mass index (BMI). Nine patients were\nmale, and 13 were female, with a mean age of 51 years.\nThirteen patients had hypertension (59%). Continuous vari-\nables with normal distribution were presented as mean /C6\nstandard deviation, while non-parametric continuous varia-\nbles were presented as median and interquartile range. The\ndirect correlation between cfDNA and CEA was analyzed\nusing Pearson, Spearman, and Kendall tests.\nResults 47% of patients presented CEA levels higher\nthan 5, while cfDNA levels ranged from 0.52 to 58.2. The\ndirect correlation between cfDNA and CEA, according to the\ntests, was positive but weak. Hypertension emerged as a\nsignificant variable with a negative effect on the likelihood of\npositive CEA levels. Other clinical characteristics did not show\nsignificant importance.\nConclusion Considering the limitations of the study,\nparticularly the small sample size, and based on the results\nobtained, it is reasonable to conclude that preoperative\ncirculating cfDNA serum levels do not correlate with CEA\nlevels.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141750\nOpen Topics (oral presentation)\nCORRELATION BETWEEN SERUM CIRCULATING TUMOR DNA\nLEVELS AND LYMPH NODE RATIO IN PATIENTS WITH\nCOLORECTAL CANCER\nBeatriz Regis da Cunha1, Pedro dos Anjos Freixo 1, Kristine Leão\nAlarcão1, André Araújo de Medeiros Silva2, Bruna Stéfany Bento\nde Sousa Teles 2, Mayra Veloso Ayrimoraes Soares 2, Fabio\nPittella Silva 2, João Batista de Sousa 1\n1Universidade de Brasília, Brasília, Brasil\n2Hospital Universitário de Brasília, Brasília, Brasil\nIntroduction Colorectal cancer (CRC) is the most\nprevalent malignancy worldwide. Colonoscopy is the gold\nstandard for CRC screening and diagnosis, but it is costly and\nrequires preparation and sedation. Therefore, the identi fica-\ntion of biomarkers to aid in CRC diagnosis is a pressing need in\nclinical practice. Among these, circulating free DNA (cfDNA)\nstands out. The detection of cfDNA involves a blood sample,\nwhich potentially increases patient adherence. Beyond its\ndiagnostic role, this tool can be used in staging, assessing\ntreatment response, and early detection of recurrences.\nObjective To evaluate the relationship between se-\nrum cfDNA levels and the lymph node ratio in patients with\nCRC.\nMethods A longitudinal and prospective study with\nmolecular analysis of cfDNA liquid biopsy from 25 patients\nwith CRC. Clinical and epidemiological data were collected\nfrom medical records. Continuous data with normal distri-\nbution were presented as mean /C6 standard deviation and\ncompared using covariance analysis adjusted for age and\ngender. Data with non-parametric distribution were pre-\nsented as median and interquartile range. Categorical varia-\nbles were compared using the chi-square test.\nResults The sample included 25 patients, of which 9\nwere male and 14 were female. Male sex (Odds Ratio - OR\n0.045) and diabetes (OR 0.0000155) tended to be protective\nfactors. However, hypertension was associated with more\nadvanced staging. A higher lymph node ratio predominated in\nthe third tertile of cfDNA levels. The estimated coefficient was\n94.423 with a p-value of 0.000712, indicating a positive,\nlinear, and statistically signi ficant relationship between the\nlymph node ratio and cfDNA levels. In the adjusted chi-square\nanalysis, approximately 43.28% of the variance in cfDNA\nlevels was explained by the lymph node ratio. In the normal\nmodel, there was a trend suggesting that Body Mass Index\n(BMI) influenced staging, and when cfDNA levels were added\nto the analysis, the impact of BMI was reinforced.\nConclusion In this study, cfDNA was not shown to be a\npredictive factor for invasion depth or staging in CRC patients,\nbut there was a strong relationship between this serum\nmarker and lymph node involvement. Furthermore, BMI\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS96\n\n\nwas the variable that demonstrated a statistically signi ficant\nassociation with cfDNA levels.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141126\nOpen Topics (oral presentation)\nCHALLENGES IN ACCESS TO ROBOTIC SURGERY IN RIO\nGRANDE DO SUL\nBruna Oliveira Trindade 1, Cristina Calloni 2, Fares Hassan\nHamaoui3, Antônio Nocchi Kalil 3, Daniel de Barcellos\nAzambuja3\n1Universidade Federal de Ciências da Saúde de Porto Alegre, Porto\nAlegre, Brasil\n2Universidade Feevale, Novo Hamburgo, Brasil\n3Santa Casa de Porto Alegre, Porto Alegre, Brasil\nIntroduction With technological advancements, ro-\nbotic surgery has gained prominence in the treatment of\ncolorectal cancer. However, Brazil still has limited robotic\nplatforms. The geographic distribution of people and these\ntechnologies creates inequalities in access to medical care.\nObjective To analyze the distribution of robotic sur-\ngery centers in Rio Grande do Sul (RS) and estimate the\nnumber of patients without access to this service.\nMethod Data from the DataSUS Oncology Panel was\nused to gather information on the number of patients diag-\nnosed with colorectal cancer (ICD C18 to C21) in each\nmunicipality of RS and how many underwent surgical treat-\nment. Municipal sociodemographic data were obtained from\nIBGE. Geospatial analysis was performed using ArcGIS Online\nsoftware, considering a 2-hour driving limit to robotic sur-\ngery centers.\nResults In RS, there are seven hospitals with robotic\nplatforms: three in Porto Alegre, one in Santa Maria, one in\nCaxias do Sul, one in Novo Hamburgo, and one in Passo Fundo.\nApproximately 134 (26.85%) municipalities in RS fall within\nthe 2-hour travel zone to a robotic surgery center, covering\naround 6,610,119 (60.75%) of the state ’s population. In 2023,\n5,488 patients were diagnosed with colorectal cancer via the\nSUS, with 1,118 undergoing surgical treatment. Considering\ntwo access scenarios for robotic surgery, 2,111 (38.47%) of the\npatients diagnosed with colorectal cancer and 383 (34.26%) of\nthose treated surgically are located more than 2 hours away\nfrom a robotic surgery center. Geographical analysis revealed\nthat most municipalities with the highest prevalence of\ncolorectal cancer are within the 2-hour travel zone, but there\nis a lack of access in the southwestern part of the state.\nSociodemographic data showed an average schooling rate of\n87.18% for children aged 6 to 14 years, a mean human\ndevelopment index of 0.62, and a per capita GDP of R\n$51,558.60 outside the 2-hour travel zone, compared to\n78.45%, 0.59, and R$52,624.12, respectively, within the travel\nzone. Only schooling showed a signi ficant difference (p =\n0.0009).\nConclusion Most of the population and colorectal\ncancer patients are near cities with robotic surgery centers,\nbut a significant portion remains underserved. The state data\nonly accounts for the SUS network, while current robotic\nsurgery users are predominantly private healthcare patients.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141678\nOpen Topics (oral presentation)\nIMPACTO DA OBESIDADE NA INCIDÊNCIADE CÂNCER COLORRETAL NO BRASIL\nIMPACT OF OBESITY ON THE INCIDENCE OF COLORECTAL\nCANCER IN BRAZIL\nHigor Roberto Spegiorin\n1, Rafael Lopes Mendes Silveira 2, Klaus\nGonçalves Souza Menezes 3, Otávio Lotti Paulino 1\n1Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brasil\n2Universidade Barão de Mauá, Ribeirão Preto, Brasil\n3Universidade de Ribeirão Preto, Ribeirão Preto, Brasil\nObesity is widely recognized as a signi ficant risk\nfactor for various chronic diseases, including colorectal can-\ncer (CRC). In Brazil, the rising prevalence of obesity represents\nan additional public health challenge, especially considering\nits influence on CRC incidence. Excess adipose tissue has been\nshown to promote chronic in flammation and hormonal\nimbalances, contributing factors to carcinogenesis. This study\naims to evaluate the relationship between obesity and CRC\nincidence in Brazil, using recent epidemiological and clinical\ndata. The research was conducted through an analysis of\narticles addressing this issue in Brazil. Data were extracted\nfrom hospital records and national databases, focusing on the\nrelationship between obesity indices and CRC cases. The\nanalyzed studies demonstrated a signi ficant correlation be-\ntween obesity and CRC incidence. In Alagoas, data indicated\nthat obese patients (OP) had a higher incidence of CRC\ncompared to those with normal weight. Similarly, an increase\nin CRC mortality rates was observed in populations with a\nhigh prevalence of obesity. The analysis revealed signi ficant\nregional disparities. In Rio Grande do Sul and Mato Grosso,\nthe association between obesity and CRC was also evident,\nwith elevated incidence and mortality rates. The following\nstate-specific correlations between obesity and CRC were\nidentified: AL: CRC incidence in 25% of OP compared to\nnormal-weight patients. RS: CRC mortality rate was 30%\nhigher in OP. MT: CRC mortality was 20% higher in OP . SP:\nOP had a 15% higher CRC incidence. MG: CRC mortality in OP\nwas 18% higher. BA: CRC incidence was 22% higher in OP. PR:\nObesity was associated with a 28% increase in CRC mortality.\nPE: CRC incidence was 19% higher in OP . Notably, obesity is\nassociated with delayed diagnoses and worse prognoses due\nto the complexity of treating obese patients. In conclusion,\nobesity has a substantial impact on CRC incidence and\nmortality in Brazil. Evidence suggests that obesity not only\nincreases the risk of developing CRC but also complicates\ndisease management and treatment.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S97\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141629\nOpen Topics (oral presentation)\nIMPACT OF PREOPERATIVE WEIGHT LOSS ON MUSCLE MASS\nAND FUNCTION IN PATIENTS WITH COLORECTAL CANCER\nMárcia Fábia Andrade 1, Fernanda Bellotti Formiga 2, Jaline\nZandonato Faiad1, Joyce Cristina Ferreira de Resende1, Gabriela\nSalim de Castro 1, Bernardo Fontel Pompeu 3, Fang Chia Bin 4,\nMarília Seelaender1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo , São Paulo, Brasil\n2Santa Casa de São Paulo e Hospital Heliópolis, São Paulo, Brasil\n3Hospital Heliópolis, São Paulo, Brasil\n4Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo,\nBrasil\nIntroduction Patients with colorectal cancer often\nexperience significant weight loss, primarily involving a loss\nof muscle mass, which is directly linked to increased com-\nplications in oncological treatment, whether systemic or\nsurgical. In patients undergoing colorectal resection, myope-\nnia (low muscle mass) and muscle weakness (low function)\nare associated with longer hospitalization, anastomotic com-\nplications, a higher risk of infection at the surgical site, poorer\nquality of life, and higher morbidity and mortality. Bioimpe-\ndance (BIA) is commonly used in studies as a good parameter\nfor evaluating muscle mass. Additionally, handgrip strength\n(HGS) is one of the most used methods for assessing muscle\nstrength and function.\nObjective To correlate preoperative weight loss and\nthe impact of muscle mass loss in colorectal cancer patients\nwith postoperative clinical outcomes.\nMethod This multicenter study was approved by the\nEthics Committees of the partnering institutions. Non-meta-\nstatic patients with colorectal adenocarcinoma were\nrecruited during their preoperative consultation. Bioimpe-\ndance, anthropometry, handgrip strength, and laboratory\ntests were performed on 16 patients of both sexes. The\npatients were divided into two groups: those with weight\nloss and those with stable weight. After the surgical proce-\ndure, data related to hospitalization time and postoperative\ncomplications, classi fied according to the Clavien-Dindo\nclassification, were collected.\nResults The included patients had a mean age of\n67.75/C6 12.04 years. Patients with preoperative weight loss\nhad a smaller calf circumference (p=0.034), lower handgrip\nstrength (p=0.034), lower hematocrit (p=0.0593), and leuco-\ncytosis (p=0.0593) at the time of surgery, compared to the\nstable weight group. We observed a correlation between\nphase angle (PA) and muscle mass and PA and body mass\nindex (p=0.986 and p=0.006, respectively) in the weight loss\ngroup. No statistical difference was found regarding body fat,\ntumor staging, or Clavien-Dindo classi fication when com-\npared to the stable weight group.\nConclusion Our results suggest that preoperative\nweight loss may lead to a decrease in muscle mass, reduced\nmuscle strength and function, and increased immune system\nactivation, which can impact the prognosis of these patients.\nFurther studies with larger sample sizes are needed to\nevaluate the robustness and signi ficance of these findings.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141664\nOpen Topics (oral presentation)\nARTIFICIAL INTELLIGENCE AND HIGH-RESOLUTION\nANOSCOPY: DEVELOPMENT OF AN INTEROPERABLE MODEL\nFOR THE DETECTION AND DIFFERENTIATION OF PRECUSORS\nOF SQUAMOUS CELL CARCINOMA OF THE ANAL CANAL – A\nTRANSATLANTIC MULTICENTER STUDY\nThiago da Silveira Manzione 1, Miguel Mascarenhas Saraiva 2,\nLucas Spindler3, Luis Barroso 4, Miguel Martins 5, Vincent de\nParedes6, João Ferreira 7, Sidney Roberto Nadal 8\n1Instituto de Infectologia Emilio Ribas, São Paulo, Brasil\n2Faculdade de Medicina da Uniersidade do Porto, Porto, Portugal\n3Hospital Paris Saint-Joseph, Paris, França\n4Atrium Health Wake Forest Baptist, North Carolina, United States\n5Hospital Universitário São João, Porto, Portugal\n6Hospital Paris Saint-Joseph, Paris, França\n7Faculdade de Engenharia da Universidade do Porto, Portugal\n8Instito de Infectologia Emilio Ribas, São Paulo, Brasil\nIntroduction High-resolution anoscopy (HRA) plays a\ncentral role in the screening of precursors to squamous cell\ncarcinoma of the anal canal. Arti ficial intelligence (AI) algo-\nrithms can have a positive impact on the detection and\ndifferentiation between high-grade (HSIL) and low-grade\n(LSIL) squamous intraepithelial lesions in HRA images. The\nobjective of this study was to develop a Convolutional Neural\nNetwork (CNN) for the automatic detection and differentia-\ntion of HSIL and LSIL using HRA images.\nMethod A multicenter, prospective study (three dis-\ntinct groups) was conducted to develop a CNN using 252\nfilmed HRA exams. Acetowhite lesions were marked and\nbiopsied to de fine them as either LSIL or HSIL based on\nhistopathology. This study enabled the recording of 65,380\nimages classified as HSIL or LSIL in an AI database to allow for\nmore accurate diagnosis during HRA. Statistical analysis\nevaluated sensitivity, specificity, accuracy, positive predictive\nvalue (PPV), negative predictive value (NPV), and area under\nthe curve (AUC).\nResults The evaluation of these data revealed sensi-\ntivity, speci ficity, PPV, and NPV values of 96.7%, 91.1%, 92%,\nand 96.3%, respectively. Accuracy was 94%, and AUC was 0.93.\nOur results demonstrated that the AI model had high diag-\nnostic performance in HRA. Interoperability and the hetero-\ngeneity of the dataset are essential aspects for the\nimplementation of AI models in HRA for clinical practice.\nConclusion The AI algorithm developed in this study\ndemonstrated its utility for detecting and differentiating\nprecursors to squamous cell carcinoma of the anal canal in\nimages obtained through HRA.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS98\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 133974\nOpen Topics (oral presentation)\nIATROGENIC URETERAL INJURIES IN COLORECTAL SURGERIES:\nA RETROSPECTIVE STUDY FROM A TERTIARY UNIVERSITY\nHOSPITAL\nGiovanna Savoy Pazin 1, Helena da Cunha Lopes de Lima 2,\nMarcelo Lopes de Lima 3, Raquel Franco Leal 1, Michel Gardere\nCamargo1, Carlos Augusto Real Martinez 1, Claudio Saddy\nRodrigues Coy1, Maria de Lourdes Setsuko Ayrizono 1\n1Universidade Estadual de Campinas, Campinas, Brasil\n2Pontifícia Universidade Católica de Campinas, Campinas, Brasil\n3Universidade Estadual de Campinas, Campinas, Brasil\nIntroduction Iatrogenic ureteral injuries (IUI) are\nrare surgical complications but are associated with high\nmorbidity, with an incidence ranging from 0.15% to 1.0%.\nThey are most commonly observed in gynecological and\ncolorectal surgeries. Risk factors include previous pelvic\nsurgeries, advanced colorectal cancer (CRC), radiotherapy,\ninflammatory bowel disease, infectious processes, and uro-\ngenital abnormalities.\nObjective To evaluate UIU in coloproctological sur-\ngeries performed at a tertiary hospital.\nMethod A retrospective analysis of medical records of\npatients who presented IUI during elective colorectal surger-\nies at the Hospital das Clínicas of Unicamp, from 2004 to 2022.\nThe following were analyzed: age, sex, race, body mass index\n(BMI), underlying disease, predisposing factors, type of sur-\ngery performed and access route, characteristics and location\nof the injuries, time to diagnosis, treatment, and\ncomplications.\nResults A total of 2,312 abdominopelvic surgeries\nwere performed, 1,998 via open surgery and 314 via laparo-\nscopic surgery, with 19 cases of IUI, corresponding to 0.82%.\nThe average age of the patients was 55.6 years; 57.9% were\nmale, and 89.5% were white. Overweight predominated\namong the patients, with 52.6%, and 73.7% had a history of\nabdominal surgery. Rectal adenocarcinoma was the most\ncommon disease (47.4%), followed by tumor recurrences\n(21%). The most common surgery performed was resection\nof the rectosigmoid (57.8%). IUIs were observed in 1.91% of\nlaparoscopic surgeries and 0.65% of open surgeries. The most\nfrequent location of the IUI was on the left (52.6%), with 89.5%\ninvolving the distal portion of the ureter. The main mecha-\nnism of injury was sectioning (57.8%). The diagnosis was\nmade intraoperatively in 12 patients (63.2%). Different surgi-\ncal techniques were used for correction, with a predominance\nof ureteral reimplantation (36.8%) and termino-terminal\nureteral anastomosis (21.0%). Complications after surgical\ntreatment of the IUI were frequent (47.4%), and one patient\ndied due to a non-surgical cause. In the long-term follow-up,\nseven patients are under follow-up, seven died due to disease\nprogression, and five lost follow-ups.\nConclusion IUI in coloproctological surgeries oc -\ncurred in 0.82% of cases. They were diagnosed late in 46.8%\nof patients, with high morbidity. The main risk factor was\nCRC.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141652\nOpen Topics (oral presentation)\nLAPAROSCOPIC LATERAL PELVIC LYMPHADENECTOMY IN\nRECTAL NEOPLASIA WITH INVOLVEMENT OF THE ILIAC\nLYMPH NODE CHAIN – INDICATIONS\nEuler de Medeiros Azaro Filho 1, Rafaella Alcântara Alves Melo1,\nThamy Cristine Santana Marques1, Mayara Maraux Maranhão1,\nFlávia de Castro Ribeiro Fidelis 1, Lina Maria Góes de Codes 1,\nElias Luciano Quinto de Souza 1, Euler de Medeiros Azaro Filho 1\n1Rede D’or Salvador, Salvador, Brasil\nCase Presentation A 52-year-old female patient,\nasymptomatic, with no comorbidities or family history of\ncolorectal cancer (CRC). Screening colonoscopy revealed a\nsubepithelial lesion, sessile, firm, 2.5 cm in size, with no\nelevation upon injection. Endoscopic ultrasound showed a\nlesion 7 cm from the anal margin, homogeneous, measuring\n1.5x1.3 cm, involving the deep mucosal and submucosal\nlayers. Pathology con firmed a well-differentiated neuroen-\ndocrine tumor, low histological grade, extending to the\nlamina propria, Ki67 positive. No distant metastases were\nfound, and pelvic MRI showed an oval image of 2.6x2.0 cm in\nthe mesorectum, maintaining contact with the mesorectal\nfascia, along with a lateral pelvic lymph node (LLN) in the left\niliac chain measuring 1.9x1.4 cm. PET-CT (somatostatin ana-\nlog) showed a hypercapturing lesion in the rectal wall, 4 cm\nfrom the anorectal transition, measuring 1.4 cm with in-\ncreased uptake (observed on MRI). After multidisciplinary\ndiscussion, total mesorectal excision with lateral pelvic\nlymphadenectomy, colorrectal anastomosis, and temporary\nileostomy was indicated. The surgical specimen had an intact\nmesorectum. The lateral lymph nodes were separately direct-\ned to the pathology department by the surgeon, and the\nspecimens were marked. Due to the preservation of struc -\ntures, it was possible to compare MRI images with the\nanatomical specimen sections, ensuring accurate identi fica-\ntion of positive lymph nodes. Pathology con firmed a pT2pN1\ntumor with metastases found in mesorectal lymph nodes (5/\n29) and lateral lymph nodes (1/11).\nDiscussion Pelvic lateral lymph nodes >6.8 mm may\nrequire dissection before radiotherapy and chemotherapy.\nThe literature supports that lateral pelvic lymph nodes (LLP)\n/C21 5 mm after neoadjuvant therapy were strongly associated\nwith pathological positivity, and subsequent dissection of\nthese nodes resulted in no recurrence in the lateral compart-\nment of treated patients. In terms of surgical technique,\nlaparoscopy proved superior in the number of lymph nodes\nretrieved compared to laparotomy. There was no signi ficant\ndifference between robotic and laparoscopic groups regard-\ning oncological outcomes and postoperative complications;\nhowever, robotic surgery showed shorter hospitalization\ntimes.\nConclusion Cancer can be eradicated in over 30% of\npatients with positive lateral pelvic lymph nodes (LLP). The\ndecision to perform lateral lymph node dissection will de-\npend on the size and characteristics of these nodes on\nimaging exams.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S99\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141653\nOpen Topics (oral presentation)\nANAL CANAL MELANOMA – REPORT OF TWO CASES,\nCLINICAL PRESENTATIONS, AND MANAGEMENT\nJulianna Matos Monteiro 1, Thamy Cristine Santana Marques 2,\nMayara Maraux Maranhão 2, Flávia de Castro Ribeiro Fidelis 2,\nLina Maria Góes de Codes 2, Elias Luciano Quinto de Souza 2,\nEuler de Medeiros Azaro Filho 2, Sabrina Queron Silva Bacelar\nBoudoux2\n1Hospital da Cidade, Salvador, Brasil\n2Rede D‘or Salvador, Salvador, Brasil\nCase Presentation Case 1: Male, 75 years old, with\nhemorrhoidal disease for 3 years, admitted due to anal pain,\nbleeding, and anemia. On examination, hardened nodules of 4\ncm were noted, sparing the right posterolateral and lateral\nareas, with areas of bleeding hemorrhoidal thrombosis. A\ncolonoscopy performed 4 months prior showed hemorrhoid-\nal nodules. Upon proctologic examination under anesthesia, a\nlarger lesion than described in the colonoscopy was observed,\nwith hyperpigmented and hypopigmented areas and central\nanterior-lateral left ulceration. Due to friability and bleeding,\nresection was performed on the right anterior-lateral and left\nposterior-lateral areas, preserving a mucosal bridge with an\napparent residual lesion. Pathology con firmed ulcerated\nnodular melanoma with compromised margins in both\nlesions. Staging with a chest and abdominal CT scan revealed\nhepatic and pulmonary metastases, and palliative chemo-\ntherapy was indicated. Case 2: Female, 72 years old, with a\nhistory of breast cutaneous melanoma resection in 2018,\npresented with persistent anal bleeding and burning, as well\nas ribbon-like stools. On examination, a vegetating perianal\nlesion starting about 3 cm from the anal margin, extending\ncranially by 3 cm, affected 30% of the anal canal and involved\nthe right puborectal sling. Colonoscopy revealed a vegetative,\nulcerated lesion extending into the rectum, and biopsy\nsuggested spindle cell neoplasm. Immunohistochemistry\nconfirmed mucosal melanoma after HSL 500 panel. PET-CT\nshowed involvement of mesorectal, para-aortic, and inter-\naortocaval lymph nodes. Radiotherapy and immunotherapy\nwith Ipilimumab and Nivolumab were initiated. On day 30 of\ntreatment, complete regression of the lesion was observed on\nendoscopic examination, with biopsy of the scar showing\nproctitis.\nDiscussion Mucosal anal melanoma is a rare and\naggressive condition, often diagnosed late, with 1/3 of\npatients presenting with metastasis at diagnosis. The diag-\nnostic process should include physical examination, immu-\nnohistochemistry, and advanced imaging for staging. The\nmain treatment is surgical excision of the lesion with wide\nmargins, and regional lymphadenectomy may be indicated.\nImmunotherapy has shown signi ficant bene fits in the adju-\nvant setting, improving disease-free survival in patients with\nanal mucosal melanoma.\nConclusion Anorectal melanoma has a poor progno-\nsis, and treatment guidelines are not clear. Surgical resection\nwith clear margins controls local disease, and other systemic\ntherapies may improve prognosis.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 137859\nOpen Topics (oral presentation)\nORGAN PRESERVATION AFTER TOTAL NEOADJUVANT\nTHERAPY FOR DISTAL RECTAL CANCER TREATED IN THE\nCOMMUNITY\nMônica de Azevedo Kalile Silva 1, Bruno Mendonça Protásio da\nSilva1, Carlos Ramon Silveira Mendes 2, Amanda Rafaella\nFerreira de Jesus Silva 2, Eduardo Dias de Moraes Moraes 1,\nMarco Antonio Oliveira Lessa 1, Gabriela Machado Alban 1,\nMeyline Andrade Lima 2\n1Grupo Oncoclínicas Bahia, Salvador, Brasil\n2Hospital Santa Izabel, Salvador, Brasil\nIntroduction Total Neoadjuvant Therapy (TNT) is a\nstandard treatment for locally advanced distal rectal cancer\n(LADRC), especially for candidates for an organ preservation\nstrategy.\nObjective To evaluate the overall organ preservation\n(OP) after TNT regimens in a population with LADRC treated\nin the community.\nMethod We performed a real-world retrospective\ncohort study in two health institutions between May 2020\nto June 2023. We included data from medical records of all\nconsecutive patients (pts) with LADRC treated with TNT. We\nonly selected pts with clinical primary tumor stage 3-4 and/or\nregional lymph node –positive whose distance from the anal\nverge /C20 6cm on magnetic resonance imaging (MRI) before\nstart TNT. All pts were restaging with digital rectal examina-\ntion, rectal MRI and endoscopy after TNT. The primary\nendpoint was Total Mesorectal Excision (TME) free survival\nafter completion of TNT. The secondary endpoints were rate\nof abdominoperineal resection surgery and rate of sphincter-\npreserving surgery after completion of TNT.\nResults A total of 16 pts were included. Median age\nwas 59 years (range: 33-77) and 8 (50%) were male. According\nto 8th AJCC, 11 pts (69%) were stage III, 13 pts (81%) were cT3,\nand 11 pts (69%) were cN1-2. Median tumor distance from\nanal verge was 4.1cm (range: 0.8-6.0). All pts were treated\nwith long-course concurrent chemoradiotherapy followed by\nconsolidation chemotherapy. At the time of this report, 12 pts\nhave completed treatment with TNT and have undergone\nprimary and secondary ef ficacy analyses. Median time from\ntreatment initiation was 19.6 months (range: 7.0-37.7). Me-\ndian time from completion of chemoradiation to restaging\nwas 6.2 months (range: 5.0-10.8). Overall TME-free survival\nafter completion of TNT was 50% [95% Con fidence Interval\n(CI): 25-75]. Overall rate of abdominoperineal resection\nsurgery and sphincter-preserving surgery were 33% (95%\nCI: 14-61) and 17% (95% CI: 5-45), respectively .\nConclusion Preliminary data suggest that half of\npatients with LADRC treated in the community can poten-\ntially achieve OP after TNT.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS100\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138161\nOpen Topics (oral presentation)\nPERSPECTIVES BETWEEN THE DIAGNOSIS INTERVAL AND\nTHERAPEUTIC START TIME FOR COLORECTAL CANCER IN\nBRAZIL: A DECADE-LONG STUDY UNDER THE SCOPE OF LAW\nNO. 12.732\nLidiane Gomes Bandeira\n1, Vitor Caiaffo Brito 1\n1Universidade Federal de Pernambuco, Recife, Brasil\nIntroduction Law 12.732/12 regulates that oncol-\nogical treatment must be initiated within 60 days after the\ndiagnosis of malignant neoplasia. This regulation allows for\nan analysis, more than 10 years after the law ’s consolidation,\nof the adequacy of therapeutic modalities, especially for\nneoplasms like colorectal cancer (CRC), which is the third\nmost common cancer in the world.\nObjective To evaluate the time between diagnosis and\nthe start of treatment for colorectal cancer and its compliance\nwith Law 12.732/12, from 2014 to 2023.\nMethods This is an observational, cross-sectional, and\ndescriptive study based on secondary data collected from the\nDATASUS platform, using the Oncology Panel, with reference\nto ICD-10 codes: C18, C19, and C20, corresponding to CRC.\nThe therapeutic modalities of focus were surgery, chemo-\ntherapy, and radiology, filtered by the time of diagnosis and\ntreatment from 2014 to 2023.\nResults During the analyzed period, 272,328 cases of\nCRC were diagnosed in Brazil. Of these, 45.63% started\ntreatment within the appropriate period, 30.27% started\ntreatment after 60 days, and 24.10% had no therapeutic\ninformation in the records. Chemotherapy was the most\ncommon therapeutic modality, with 117,554 (43.16%) treat-\nments, followed by surgery with 63,851 (23.44%) treatments,\nand radiotherapy with 20,512 (7.54%). Among these modali-\nties, some treatments involved combined chemotherapy and\nradiotherapy, accounting for 4,800 (1.76%) treatments. Re-\ngarding compliance with Law 12.732/12, chemotherapy and\nradiotherapy accounted for the majority of delays beyond 60\ndays, predominantly occurring within the 61-91 day range.\nAdditionally, a residual portion indicated delays of more than\n2 years for these modalities, with respective rates of 2.35%\nand 1.76%. However, for surgical therapy, there was a pre-\ndominance of treatments initiated within 30 days after\ndiagnosis, with 91.91% of cases treated within 60 days, and\na delay of 0.02% for treatments delayed by over 2 years.\nConclusion The findings indicate that, 11 years after\nthe implementation of Law 12.732/12, therapeutic delays\ncontinue to primarily affect patients treated with chemother-\napy and radiotherapy, with peak delays occurring around 90\ndays and extending up to 2 years. However, surgical therapy is\ncloser to effective compliance with the law, with the majority\nof cases resolved in accordance with the prescribed time\nframe.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141702\nOpen Topics (oral presentation)\nPREDICTION OF RESPONSE TO NEOADJUVANT THERAPY FOR\nRECTAL CANCER BASED ON INFLAMMATORY MARKERS IN\nPERIPHERAL BLOOD\nRoger Beltrati Coser1, Caio Sergio Rizkallah Nahas2, Omar Sayed\nTaddeo Ghani1, Rafaela Brito Bezerra Pinheiro 2, Artur de Souza\nAlmeida1, Sergio Carlos Nahas 1, Carlos Frederico Sparapan\nMarques2\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\n2Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil\nIntroduction Rectal cancer treatment is complex,\nmultimodal, and associated with high morbidity. It is known\nthat patients undergoing neoadjuvant chemoradiotherapy\n(nQRT) present varying degrees of tumor response, ranging\nfrom no response to complete response (CR). There is great\ninterest in studying tools that can identify these patients\n(responders and non-responders). Among the numerous\nmarkers being studied, peripheral blood in flammatory\nmarkers stand out, such as the neutrophil-to-lymphocyte\nratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the\nlymphocyte-to-monocyte ratio (LMR), based on the close\nrelationship between in flammation and cancer.\nObjective To study the relationship between systemic\ninflammatory response markers (NLR, PLR, and LMR) and the\ndegrees of response to neoadjuvant treatment in patients\nwith rectal cancer, according to the TRG classi fication.\nMethods A retrospective evaluation was conducted\non 396 patients from a single institution with rectal cancer\nwho underwent nQRT. The evaluation involved clinical, lab-\noratory, and pathological data. NLR, PLR, and LMR were\ncalculated based on pre-nQRT hemogram data of the patients.\nPatients were strati fied by tumor response (TRG) to nQRT\nbased on the protocol of the American College of Pathologists.\nResults Patients with incomplete response (TRG 1-2-\n3) had higher levels of NLR (p<0.001), PLR (p=0.002), and CEA\n(p<0.001). Patients with complete response (TRG 0) had a\nhigher number of comorbidities (p=0.001), higher hemoglo-\nbin levels (p=0.049), higher LMR (p <0.001), and more fre-\nquent use of antihypertensive medication (p=0.012) and\nantiplatelet/anticoagulant drugs (p=0.045). To estimate in-\ncomplete response: NLR > 2.08 - RR: 2.30 (95% CI: 1.60-3.31);\nPLR > 129.36 - RR: 1.79 (95% CI: 1.25-2.05) and LMR > 2.67 -\nRR: 0.42 (95% CI: 0.26-0.66). In the multifactorial linear\nmodel, NLR > 2.08 was independently associated with the\nabsence of CR, RR: 1.19 (95% CI: 1.07-1.28), p=0.001, with an\narea under the curve (AUC) of 0.659 (95% CI: 0.599-0.718).\nConclusion NLR, PLR, and LMR are predictors of\nresponse to nQRT in patients with rectal cancer. NLR greater\nthan 2.08 is a predictive factor for incomplete pathological\nresponse to nQRT. These findings add a low-cost and widely\navailable tool to the management of rectal cancer, with a\nfocus on treatment individualization.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S101\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141148\nOpen Topics (oral presentation)\nPROADI-SUS – MAPA GENOMA BRASIL – SUBPROJECT\nONCOLOGY: PORTRAIT OF COLORECTAL ADENOCARCINOMA\nIN DIFFERENT BRAZILIAN REGIONS\nFernanda Bellotti Formiga1, Augusto Modesto de Souza Neto 2,\nJosé Fernando Bastos de Moura 3, Edimar de Moura Santos 4,\nCristina de Deus Anjos Tavares Sampaio 5, Fábio de Oliveira\nFerreira6, Edenir Inez Palmeiro 6, Grupo Proadi-sus-mgbo 7\n1Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo,\nBrasil\n2Hospital Aristides Maltes, Salvador, Brasil\n3Hospital Haroldo Juaçaba, Ceará, Brasil\n4Liga Norte Riograndense, Natal, Brasil\n5Hospital Regional do Mato Grosso do Sul, Campo Grande, Brasil\n6Beneficência Portuguesa de São Paulo, São Paulo, Brasil\n7https://proadi.bp.org.br/mod/page/view.php?id=247\nIntroduction The Mapa Genoma Brasil (MGB) - Pre-\ncision Health - Correlation between genomic, epidemiologi-\ncal, clinical, and familial profiles in cancer and cardiovascular\ndiseases (PROADI-SUS) Project is an initiative by the Ministry\nof Health. The Oncology Subproject (MGBO) involved 9\ncenters specialized in cancer treatment, representing the 5\nBrazilian regions: Fundação CECON (AM), Ophir Loyola (PA),\nHaroldo Juaçaba (CE), Liga Norte Riograndense (RN), Aristides\nMaltes (BA), Hospital Regional de Mato Grosso do Sul (MT);\nHospital BP – A Beneficência Portuguesa de São Paulo (control\ncenter), Santa Casa de São Paulo (SP), and Erasto Gaertner\n(PR). A total of 275 patients over the age of 18 with diagnoses\nof breast cancer (140), prostate cancer (65), and colorectal\ncancer (CCR 70) were included, as well as 2 first- or second-\ndegree relatives for each index case. Patients underwent\ngermline whole-genome sequencing (WGS) (blood; 103-\ngene panel, 54 related to cancer) and somatic sequencing\n(tumor). Family members of patients with positive findings\nwere sequenced using the Sanger technique.\nObjective To describe the demographic, epidemiolog-\nical, clinical, familial, pathological, and molecular character-\nistics of patients with colorectal cancer (CCR).\nMethod Analysis of the database from the PROADI-\nSUS MGBO prospective cohort using colorectal cancer (CCR)\ndiagnosis as a filter.\nResults Among the 70 patients with CCR (36 male and\n34 female), the median age was 59 years (range 29-87) and\nthe median BMI was 24 (range 13-37). Regarding lifestyle\nhabits, 48.6% were smokers (11 pack-years), 68.6% reported\nalcohol consumption (10g/day), 100% consumed red meat\n(82.9% /C20 100g/week), 82.9% consumed processed meats,\n98.6% consumed fried foods, 80% used industrialized season-\nings, and 95.7% consumed re fined sugar. 25.7% reported\nregular physical activity. Comorbidities were reported by\n65.7%: hypertension (38.6%), diabetes mellitus (17.1%), pre-\nvious cancer history (4.3%). Regarding tumor location, 48.5%\noccurred in the distal colon, 25% in the proximal colon, and\n22.5% in the rectum. Regarding pathological staging, 2.9%\nwere Tis, 2.9% T1, 11.8% T2, 57.4% T3, 25% T4, 57.4% N þ, and\n13.2% Mþ at diagnosis. Pathogenic Variants (PVs) were found\nin the genes MLH1, MSH6, PMS2, TP53, and MUTYH in 5\npatients (7.1%), and Oncogenic Variants (OVs) were found in\n36 tumors (51.4%): KRAS (29), NRAS (5), BRAF (2).\nConclusion We observed a population strongly ex-\nposed to risk factors, diagnosed at a locally advanced stage,\nwith pathogenic and oncogenic variants that could contribute\nto genetic risk assessment and personalized treatment.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141071\nOpen Topics (oral presentation)\nRADIOMICS VERSUS CONVENTIONAL MAGNETIC RESONANCE\nIMAGING FOR PREDICTION OF COMPLETE PATHOLOGICAL\nRESPONSE - SYSTEMATIC REVIEW AND META-ANALYSIS\nRodrigo Moisés de Almeida Leite\n1, Victor Edmond Seid1, Rafael\nDal Ben Martins 1, Giovana Moreira Minchillo 1, Lucas Soares\nGerbasi1, Francisco Tustumi1, Sergio Eduardo Alonso Araujo 1,\nRafael Vaz Pandini 1\n1Hospital Israelita Albert Einstein, São Paulo, Brasil\nIntroduction Radiomics has emerged as a promising\ntool in oncology, providing an innovative approach to predict\ncomplete pathological response (pCR) in patients with rectal\ncancer. By utilizing advanced machine learning algorithms to\nanalyze quantitative characteristics extracted from radiology\nimages, radiomics allows for a detailed assessment of the\ntumor and its microenvironment. These radiomic features\ninclude information on texture, shape, intensity, and spatial\npatterns, which can correlate with tumor biology and the\nresponse to neoadjuvant therapy. Recent studies show that\nradiomics can predict pCR with high accuracy, potentially\nsurpassing traditional Magnetic Resonance Imaging methods\nin the context of rectal cancer after neoadjuvant treatment.\nMethodology A systematic literature review was\nconducted in the PUBMED and Embase databases. The inclu-\nsion criteria were: - Prospective or retrospective studies; -\nPatient population diagnosed with Rectal Adenocarcinoma; -\nIntervention of interest: radiomics models based on Magnetic\nResonance Imaging; - Control for comparison: conventional\nradiomics; - Outcome of interest: complete pathological\nresponse; - Timing of intervention: restaging after neoadju-\nvant therapy. Studies that used other imaging modalities (e.g.,\nultrasound or tomography) or focused on other rectal neo-\nplasms were excluded. A meta-analysis was performed on the\nareas under the curve (AUC) using a random-effects model.\nResults A total of 224 studies were included in the\nsystematic review. After applying inclusion/exclusion crite-\nria, 16 studies were included in the meta-analysis. Radiomics\nmodels showed higher diagnostic accuracy for predicting\ncomplete pathological response compared to conventional\nMagnetic Resonance Imaging (AUC 0.82, 95% CI 0.76 - 0.88,\np<0.001). There was signi ficant heterogeneity of results (I2\n96%). No publication bias was detected.\nConclusion Radiomics was associated with higher\ndiagnostic accuracy for predicting pCR than conventional\nMRI. References: Limkin EJ, Sun R, Dercle L, et al. Promises\nand challenges for the implementation of computational\nmedical imaging (radiomics) in oncology. Ann Oncol.\n2017;28(6):1191-1206. 2. Lambin P, Rios-Velazquez E, Leije-\nnaar R, et al. Radiomics: Extracting more information from\nmedical images using advanced feature analysis. Eur J Cancer.\n2012;48(4):441-446.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS102\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141642\nOpen Topics (oral presentation)\nTOTAL NEOADJUVANT THERAPY FOR RECTAL CANCER\nTREATMENT IN A PATIENT WITH SYSTEMIC LUPUS\nERYTHEMATOSUS\nRafaella Alcântara Alves Melo 1, Sabrina Queron Silva Bacelar\nBoudoux1, Thamy Cristine Santana Marques 1, Flávia de Castro\nRibeiro Fidelis1, Lina Maria Góes de Codes1, Elias Luciano Quinto\nde Souza 1, Euler de Medeiros Azaro Filho 1, Mayara Maraux\nMaranhão1\n1Rede D’or Salvador, Salvador, Brasil\nCase Presentation Female, 54 years old, diagnosed\nwith Systemic Lupus Erythematosus (SLE), regularly using\nHydroxychloroquine, without previous surgeries or a family\nhistory of colorectal cancer. The patient has been experienc -\ning episodes of hematochezia for 3 months and underwent a\ncolonoscopy, which revealed a vegetative lesion 10 cm from\nthe anal margin, measuring approximately 5 cm in length.\nPathology: well-differentiated adenocarcinoma. The patient\nunderwent magnetic resonance imaging (MRI), which\nshowed a polypoid expansile formation located 10 cm from\nthe anal margin, with the distal margin 7.5 cm above the\nanorectal ring. The epicenter and most of the lesion were\nbelow the peritoneal re flection. It involved 25% of the cir-\ncumference and in filtrated 2 mm beyond the muscularis\npropria. The lesion affected the mesorectal fascia. No suspi-\ncious lymph nodes or evidence of extramural venous invasion\nwere found. cT3bN0M0. Total Neoadjuvant Therapy (TNT)\nwas opted for. The patient experienced episodes of diarrhea,\nrequiring hospitalization and a temporary interruption of\nCapecitabine and Oxaliplatin (CAPOX) for 5 weeks. After this,\na restaging was performed, including a sigmoidoscopy and\nMRI, suggesting a complete response, although the previous\nlesion could not be assessed by rectal examination. After 26\nweeks of neoadjuvant therapy, the patient underwent a\nrectosigmoidectomy with total mesorectal excision (TME)\nand low colorectal anastomosis with loop ileostomy, encoun-\ntering technical dif ficulties due to extensive fibrosis. Pathol-\nogy: no residual neoplasia.\nDiscussion SLE is associated with a slight overall\nincrease in cancer risk compared to the general population.\nGastrointestinal toxicity due to chemotherapy is a frequent\ncomplication, and it was more intense due to the underlying\ndisease. The surgical procedure was technically challenging\ndue to severe fibrosis, as the surgery was delayed due to the\ntemporary interruption of CAPOX, and there was also an\nincrease in scar tissue resulting from the SLE. Studies indicate\nexacerbation of fibrosis and greater technical dif ficulty dur-\ning TME in patients with collagen diseases who undergo\nneoadjuvant radiotherapy, often leading to higher postoper-\native complications. This finding may suggest a relative\ncontraindication for TNT in this patient group.\nComments A better understanding of the pathophys-\niology and underlying elements of this risk will lead to more\nefficient and individualized treatments.\nColoproctologia experimental\nID – 141620\nOpen Topics (oral presentation)\nFIRST STOOL BANK OF THE NORTH-NORTHEAST REGIONS:\nIMPACT OF ORAL FECAL MICROBIOTA TRANSPLANT ON\nGRAFT-VERSUS-HOST DISEASE\nLara Burlamaqui Veras 1, Aldo ângelo Moreira Lima 1, Fernando\nBarroso Duarte1, William Pinheiro Boavista de Oliveira 1, Victor\nRipardo Siqueira1, Matheus Emanuel de Brito Castelo Branco 1,\nJosé Nilo de Lima Filho 1, Adryeli Oliveira Quintela 1\n1Universidade Federal do Ceará, Ceará, Brasil\nIntroduction Fecal microbiota transplantation (FMT)\nhas shown promise in several conditions. In this context,\ngraft-versus-host disease (GVHD) following allogeneic he-\nmatopoietic stem cell transplantation has gained promi-\nnence. Evidence suggests that alterations in the gut\nmicrobiota are associated with the occurrence of intestinal-\ntype GVHD. Therefore, FMT could be a promising and feasible\ntreatment option.\nObjectives The creation of a stool bank to investigate\nthe impact of oral fecal microbiota transplantation on the\ntreatment of graft-versus-host disease after allogeneic he-\nmatopoietic stem cell transplantation.\nMethod Healthy donors are selected, excluding indi-\nviduals with infectious diseases transmitted by blood or\nprevious FMT, and those who increase the risk of transmitting\nmultidrug-resistant organisms. These donors undergo inter-\nviews, and their laboratory and stool tests are collected. The\nstool samples are stored in a stool bank developed in the\nPharmacology Laboratory at the Federal University of Ceará\n(UFC). On average, 50 grams of fecal substrate are diluted in a\n0.9% sterile saline solution, processed, and stored within 6 to\n8 hours. Cryopreservation is a key step in the creation of the\nstool bank, as it preserves the clinical effect of FMT, prevents\nmaterial crystallization, and allows on-demand treatment.\nCapsules are considered promising due to their easy admin-\nistration, less invasiveness, and absence of the risks associat-\ned with invasive procedures. A prospective clinical\nintervention trial is then conducted, and twenty patients\nare divided into two groups: one receiving conventional\ntreatment for GVHD and the other receiving FMT. Both\ngroups are followed for 2 years.\nResults The importance of a stool bank lies in provid-\ning ready-to-use products of high quality, in addition to\nenabling monitoring of treatment responses, side effects,\nand long-term outcomes of FMT. It is expected that FMT\nwill be safe and viable for the participating patients, with low\nincidence of adverse events and the ability to repopulate the\ngut microbiota, aiding in the recovery of the gastrointestinal\ntract and maintaining a favorable long-term clinical response\nwhile reducing GVHD recurrence.\nConclusion The impact of FMT as a promising and\nfeasible option for intestinal GVHD is best proven when there\nis a well-structured and monitored stool bank, as the\nresponses become much more reliable and reproducible.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S103\n\n\nDoença Diverticular\nDiverticular disease\nID – 138310\nOpen Topics (oral presentation)\nTREATMENT OF COLORECTAL ANASTOMOSIS FISTULA WITH\nVACUUM THERAPY GUIDED BY COLONOSCOPY\nMarco Antônio Miranda dos Santos 1, Fábio Lopes de Queiroz 1,\nArtur Duarte e Duarte 1, Marina Barbabela Grisolia de Oliveira 1,\nLetícia Brandão Castro 1, Eduardo de Carvalho Barbosa 1, Marco\nRinoldi1, Vinícius Avelar Palhares 1\n1Hospital Felicio Rocho, Belo Horizonte, Brasil\nCase Presentation A 77-year-old female patient with\nchronic kidney disease, hypothyroidism, and hearing im-\npairment underwent a rectosigmoidectomy, colonic lowering\nwith colorectal anastomosis, and protective ileostomy in\n2021 due to diverticular disease. The surgical procedure\nwas completed without complications. On the fourth post-\noperative day, the patient underwent a CT scan, revealing a\nsmall presacral collection without contrast extravasation\nthrough the colorectal anastomosis. With antibiotic therapy,\nshe had a good postoperative recovery. Three months later, a\npostoperative colonoscopy identi fied an anastomotic fistula\n7 cm from the anal margin, with purulent secretion. An\nattempt at expectant treatment was unsuccessful. Surgical\nattempts including debridement, suturing, and clipping of the\norifice also failed. In March 2023, the patient underwent\ncurettage of the tract and vacuum dressing placement via\ncolonoscopy. Successive follow-up at 7 and 14 days showed\neffective granulation of the fistulous tract. A subsequent\nendoscopic evaluation at 21 days revealed increased granu-\nlation tissue with erosion in part of the tract leading to the\nintestinal lumen, resulting in a septum of the sinus tract with\nlowered colon. After three months, a septotomy was per-\nformed, and no fistula was documented on colonoscopy or\nMRI. The patient later underwent ileostomy closure without\nany leakage at the colorectal anastomosis.\nDiscussion Colorectal fistulas affect up to 14% of\npatients undergoing surgical treatment and can be fatal in\n7% of cases. However, many cases are asymptomatic or mildly\nsymptomatic. Factors contributing to a lower risk of fistula\nformation in anastomoses include adequate blood supply,\ntension-free anastomosis, and the patient’s clinical condition.\nEndoscopic therapy with negative pressure is successful in\nmost cases, with healing rates of around 90% and few adverse\nevents. Literature suggests that the average treatment dura-\ntion may range from 18 to 47 days, with about 4 to 7\nendoscopic procedures.\nConclusion In the reported case, the patient pre-\nsented with a refractory benign colorectal anastomosis fistu-\nla, resistant to several treatments. Vacuum therapy guided by\ncolonoscopy is not a widely used treatment method but offers\nhigh success rates and minimal harm to the patient.\nDoença Inflamatória Intestinal\nID – 138294\nOpen Topics (oral presentation)\nANATOMICAL AND FUNCTIONAL DAMAGE IN SEVERE\nPERIANAL CROHN’S DISEASE\nNatália Ferreira Cardoso de Oliveira 1, Vitória Vicentin\nGiordano1, Nadine Gomes de Souza 1, Louisie Galantini Lana de\nGodoy1, Fernanda Bellotti Formiga1, Andreia Vieira1, Fang Chia\nBin1\n1Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo,\nBrasil\nCase Presentation T w of e m a l ep a t i e n t sw i t hC r o h n’s\ndisease, with onset at ages 18 and 14, are described. The first\npatient started with ileocolitis, progressing to rectal stenosis\ndespite combined therapy with anti-TNF (azathioprine with\ninfliximab and later, adalimumab). She developed perianal\nfistulizing Crohn’s disease (pCD), with progressive severity,\nincluding deep perineal, perianal, vulvar, and intergluteal ulcers,\nas well as a rectovaginalfistula and multiple ano-genital subcu-\ntaneousfistulas. The second patient initially presented with pCD,\nwhich later progressed to ascending colitis up to the rectum. She\nused combined anti-TNF therapy (infliximab and adalimumab)\nat the onset, but discontinued medication due to poor adherence.\nThere was worsening of the perianal disease, with ano-vulvar\ndestruction. Due to difficulty accessing drugs with other mech-\nanisms of action, low quality of life, and anatomical and func -\ntional damage, intestinal diversion was opted for both patients.\nThefirst patient accepted the proposed treatment, but there was\nno improvement in perianal involvement, requiring total proc -\ntocolectomy with amputation. After seven months of an open\nwound, a new intervention for skin resection from the buttocks,\nlocal dressings, and hyperbaric chamber therapy resulted in\ncomplete healing. After 10 years, new intergluteal ulcers devel-\noped, in addition to esophageal Crohn’s disease and metastatic\nintermamary Crohn’s disease. The second patient has not yet\naccepted the diversion or the amputation.\nDiscussion pCD is a severe phenotype affecting 17-\n43% of patients, and it presents a challenging treatment\nmanifestation. Management of pCD involves both clinical\nand surgical treatments. Initial surgical approaches are per-\nformed via proctological examination under anesthesia to\ncontrol perineal sepsis with abscess drainage, ulcer and tract\ncurettage, placement of drains, and opening of cavities.\nMultiple procedures are necessary. However, considering\nfunctional and anatomical damage, intestinal diversion can\nbe proposed as a bridge to de finitive treatment. In disease\nprogression, lack of response to clinical treatment, and local\nanatomical failure, rectal amputation becomes necessary.\nOne-fifth of patients with pCD undergo this surgery.\nConclusion There is a tendency to delay surgical\nindication for severe pCD due to the mutilation associated\nwith a permanent stoma. However, the morbidity and sever-\nity of the disease demand aggressive and resolutive actions,\nas irreversible anatomical and functional damage occurs.\nDoença Inflamatória Intestinal\nID – 136774\nOpen Topics (oral presentation)\nDETECTION OF IMMUNE COMPLEXES IN PATIENTS WITH\nCROHN’S DISEASE USING ADALIMUMAB MAY ASSIST IN\nPRECISION MEDICINE\nLivia Moreira Genaro 1, Juliana Carron 1, Marina Moreira de\nCastro1, Cristiane Kibune Nagasako Vieira da Cruz 1, Glaucia\nFernanda Soares Rupert Reis 1, Ligiana Pires Corona 1, Maria de\nLourdes Setsuko Ayrizono 1, Raquel Franco Leal 1\n1Universidade Estadual de Campinas, Campinas, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS104\n\n\nIntroduction The interaction between the immune\nsystem and the intestine, especially regarding the role of TNF-\nα, is crucial in the pathophysiology of Crohn ’s disease (CD).\nThe monoclonal antibody adalimumab works by neutralizing\nTNF-α and regulating in flammatory responses but can cause\nimmunogenic reactions, impacting its ef ficacy. Monitoring\nserum levels and anti-drug antibodies (ADA) is recommended\nto improve therapy. Understanding the genetic factors linked\nto the response to adalimumab seeks to clarify the relation-\nship between genetics, immunology, and the clinical picture\nin CD.\nObjectives To quantify the serum level of adalimumab\nand compare the ELISA (Promonitor) and lateral flow assay\n(Quantum Blue). To detect ADA, evaluate immune complexes,\nand investigate polymorphisms associated with the response\nto adalimumab.\nMethods We included 70 patients undergoing treat-\nment with adalimumab, divided into active (CA) and remis-\nsion (CR) groups. Serum concentrations of adalimumab were\nmeasured using the Promonitor® and Quantum Blue® assays\nand compared using Passing-Bablok regression and Bland-\nAltman analysis. ADA presence and immune complex forma-\ntion were analyzed by ELISA. DNA was genotyped for\nATG16L1 and CD96.\nResults Serum concentrations of adalimumab did not\ndiffer between the groups. Both tests for detecting serum\nlevels showed signi ficant differences between them, with\nmoderate agreement. ADA were detected in 6/31 patients\nwith sub-therapeutic levels, with 4 in the CA group and 2 in\nthe CR group. Immune complex analysis revealed significant-\nly higher concentrations in the CA group. The wild-type\ngenotype for CD96 was associated with higher CRP values\nand sub-therapeutic levels of adalimumab, while the CC\ngenotype for ATG16L1 was associated with higher CDEIS\nand fecal calprotectin values.\nConclusion The ef ficacy of treatment with adalimu-\nmab was not directly related to higher medication levels. The\ndisparity between the tests indicates the need to use only one\ntest in patient follow-up to ensure accuracy in therapeutic\nmonitoring. Genotypic differences highlight the correlation\nbetween the wild-type genotype for CD96 and ATG16L1 with\nunfavorable laboratory and endoscopic response to adalimu-\nmab. Finally, pioneering evidence showed that greater im-\nmune complex formation occurred in the CA group compared\nto the CR group, indicating an association with poorer clinical\nresponse.\nDoença Inflamatória Intestinal\nID – 138246\nOpen Topics (oral presentation)\nEPIDEMIOLOGY OF HOSPITALIZATIONS FOR INFLAMMATORY\nBOWEL DISEASE IN ADULTS IN BRAZIL, FROM 2019 TO 2024\nLincólin Bardini Goulart 1, Eloisa Elena Xavier de Oliveira\nLigoski1, Giovanna Barcellos Gemelli 1, Carolina Polidori\nAguiar1, Brenda de Lima Louzada Pires 2\n1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,\nBrasil\n2Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande\ndo Sul, Porto Alegre, Brasil\nIntroduction Inflammatory bowel disease (IBD)\nencompasses chronic inflammatory disorders of the digestive\ntract, such as Crohn ’s disease and ulcerative colitis. Its\nprevalence is associated with environmental, hereditary,\nand racial factors. When severe, IBD can be disabling, nega-\ntively affecting patients’ quality of life. Epidemiological anal-\nyses of hospitalizations are essential to identify trends, the\nimpact on public health, and gaps in healthcare policies for\nindividuals with this condition.\nObjective To analyze hospitalizations of adults with\nIBD in Brazil over the last 5 years. The analysis aims to outline\nthe epidemiological pro file of these patients, providing\ninsights for the development of collective measures aimed\nat the most affected populations and optimizing public health\nresources.\nMethods A cross-sectional, descriptive, retrospective,\nand quantitative study on hospitalizations for Crohn’s disease\nand ulcerative colitis from January 2019 to January 2024. The\ndata from the Department of Informatics of the Brazilian\nUnified Health System (DATASUS) were used. The variables\nselected for the study were: sex, race, age group, and length of\nstay. Only patients aged 20 to 80 years were included in the\nanalysis.\nResults Between 2019 and 2024, there were 27,304\nhospitalizations for IBD in Brazil, of which 52.7% were female\npatients. The most affected age groups were 20 to 29 years\nand 30 to 39 years, representing 17.5% and 16%, respectively.\nRegarding self-declared color/race, the most affected group\nwas white, totaling 40.1% of the hospitalizations, followed by\nbrown, with 38.2%. In 2022, the highest average length of stay\nwas recorded, with 6.9 days, while the overall average for the\nanalyzed years was 6.5 days.\nConclusion The results indicate a higher occurrence\nof IBD hospitalizations among adults aged 20 to 39 years.\nThere was a slight difference between genders, with 3% more\nwomen hospitalized. Special attention is given to the small\npredominance of whites compared to browns, with only a 2%\ndifference between the two groups, highlighting the particu-\nlar role of ethnicity in the epidemiology of the Brazilian\npopulation. Additionally, the length of stay suggests the\ncomplexity of care in healthcare services. Although the con-\nclusions are not de finitive, the findings allow for better\ntargeting of diagnostic and treatment actions toward the\nmost affected populations.\nDoença Inflamatória Intestinal\nID – 141624\nOpen Topics (oral presentation)\nEXTENDED VERSUS LIMITED MESENTERIC EXCISION IN\nBOWEL RESECTION FOR CROHN ’S DISEASE: A META-\nANALYSIS AND SYSTEMATIC REVIEW\nBernardo Fontel Pompeu1, Patricia Marcolin2, Fábio Israel Lima\nCastelo Branco Marques 1, Giulia Almiron da Rocha Soares 3,\nAndré Luiz Costa e Silva 1, Beatriz D ’andrea Pigossi 1, Sergio\nMazzola Poli de Figueiredo 4, Fernanda Bellotti Formiga 1\n1Hospital Heliópolis, São Paulo, Brasil\n2Universidade Federal Fronteira do Sul Passo Fundo, Passo Fundo,\nBrasil\n3Universidade Metropolitana de Santos, Santos, Brasil\n4Cleveland Clinic Ohio, Ohio, United States\nBackground There is controversy regarding the ex-\ntended excision of the mesentery in intestinal resection for\nCrohn’s disease (CD). Some studies suggest that extended\nmesenteric excision (EME) can reduce the surgical recurrence\nof the disease compared with limited mesenteric excision\n(LME).\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S105\n\n\nObjective We aimed to perform a systematic review\nand meta-analysis comparing EME and LME for CD.\nMethods We searched MEDLINE, Cochrane, Central\nRegister of Clinical Trials, and EMBASE for studies published\nuntil April 2024. Odds ratios (OR) with 95% con fidence\nintervals (CIs) were pooled using a random-effects model.\nHeterogeneity was assessed using the Cochran Q test and I²\nstatistics, with p-values < 0.10 and I² > 25% considered sig-\nnificant. Statistical analysis was performed using R Software,\nversion 4.1.2.\nResults A total of 5 observational studies were in-\ncluded, comprising 4,365 patients; 992 (22.7%) underwent\nEME and 3,373 (77.2%) to LME. No signi ficant differences\nwere observed between EME and LME in overall postopera-\ntive complication, Clavien-Dindo /C21 3, bleeding that needed\ntransfusion, anastomotic leak, intrabdominal abscess, SSI,\nreoperations, readmission, and ileus. EME was associated\nwith a decrease in surgical recurrence compared with LME\n(OR 0.31; 95% CI 0.12 to 0.84; p = 0.021).\nConclusion In this meta-analysis of patients with CD\nwho underwent intestinal resection, EME was associated\nwith a significant reduction in surgical recurrence compared\nwith LME, without a signi ficant difference in complication\nrates.\nDoença Inflamatória Intestinal\nID – 138318\nOpen Topics (oral presentation)\nINFLUENCE OF THE TYPE OF MANIFESTATION OF CROHN ’S\nDISEASE ON THE CORRELATION BETWEEN CLINICAL,\nENDOSCOPIC, AND HISTOLOGICAL INDICES\nPaula Fernandes de Sousa 1, Natascha Mourão Moreira 1, João\nVictor Ribeiro Tajra 2\n1Centro Universitário do Planalto Central Apparecido dos Santos,\nBrasília, Brasil\n2Unieuro, Brasília, Brasil\nIntroduction Crohn’s Disease (CD) can affect any part\nof the gastrointestinal tract. It is in fluenced by environmen-\ntal, genomic, microbial, and immunological factors. The goal\nof therapy is to keep patients asymptomatic, but 40% of\npatients in clinical remission still show endoscopic activity.\nCurrently, endoscopic remission is the desired target, with\ndiscussions about histological remission as the ultimate goal.\nThe correlation between clinical, endoscopic, and histological\nscores has not yet been clearly established.\nMethods Thirty-five patients participated in a cross-\nsectional study from January 2020 to 2022. Clinical activity\nwas assessed using the Crohn’s Disease Activity Index (CDAI),\nendoscopic activity was assessed using the Simpli fied Endo-\nscopic Score for Crohn ’s Disease (SES-CD), and histological\nactivity was assessed using the Global Histological Activity\nScore (GHAS). Clinical remission was de fined as CDAI /C20 150,\nendoscopic remission as SES-CD /C20 2, and histological remis-\nsion as GHAS /C20 4.\nDiscussion In the study, clinical remission was ob-\nserved in 34.1% of cases, endoscopic remission in 39%, and\nhistological remission in 22%. Statistical analysis showed a\nstrong correlation between SES-CD and GHAS in the Montreal\nclassification L2 phenotype (r = 0.73; p = 0.001). These results\nsuggest that combining endoscopic and histological data\nprovides a more comprehensive view of disease activity.\nResidual histological in flammation may in fluence therapeu-\ntic strategy, indicating the importance of integrated evalua-\ntion. Studies suggest that histological activity is an important\nprognostic indicator, especially in cases with persistent mu-\ncosal inflammation. Recent clinical trials recommend includ-\ning endoscopic and histological data for a more effective\ntreatment approach.\nConclusion The study has limitations, including a\nheterogeneous population, extremes of age, variable treat-\nment duration, and a small sample size, but statistical\nparameters were preserved. The results show a strong posi-\ntive relationship between endoscopic and histological find-\nings in the L2 region. Combining endoscopic and histological\ndata provides a more complete view of disease activity,\nassisting in more accurate and effective therapeutic strate-\ngies. Future research should focus on larger and more homo-\ngeneous samples with standardized biopsy protocols to\nimprove the quality of life for patients with CD and reduce\nthe morbidity associated with the disease.\nDoença Inflamatória Intestinal\nID – 141843\nOpen Topics (oral presentation)\nARTIFICIAL INTELLIGENCE AND MINIMALLY INVASIVE\nASSESSMENT OF INFLAMMATORY ACTIVITY: A STUDY ON THE\nDEVELOPMENT AND CORRELATION OF INDICES WITH A\nCONVOLUTIONAL NEURAL NETWORK MODEL IN\nPANENDOSCOPY\nMaria João Almeida\n1,2, Miguel Mascarenhas 1,2,3, Pedro\nCardoso1,2, João Afonso 1,2, Tiago Ribeiro 1,2, João Ferreira 3,\nGuilherme Macedo1,2,3\n1Hospitalar Universitário São João, Porto, Portugal\n2Centro Treino WGO, Porto, Portugal\n3Universidade do Porto, Porto, Portugal\nIntroduction In patients with Crohn ’s Disease (CD),\ncapsule endoscopy (CE) is an important method for assessing\nmucosal in flammatory activity. Traditionally, in flammation\nis evaluated through the combination of analytical values and\nvalidated scores, such as the Lewis score (LS), the Capsule\nEndoscopy Crohn ’s Disease Activity Index (CECDAI), and\nELIAKIM. Recent developments in arti ficial intelligence (AI)\nhave enabled the automatic selection of the most relevant\nimages in CE.\nObjective This study aimed to develop an automated\nscoring system to objectively classify in flammation in CE\nimages.\nMethods A retrospective study was conducted on\npanenteric CE videos (PillCam Crohn ’s) performed between\n09/2020 and 01/2023, and the LS, CECDAI, and ELIAKIM\nscores were calculated. An automated score based on a\nconvolutional neural network was developed, encompassing\nthe percentage of positive frames selected by the algorithm\nfor both the small intestine and the colon separately. The AI-\ngenerated score (AIS) was then correlated with clinical data\nand the validated scores.\nResults The study included 61 patients. The median\nscores were LS 225 (0-6006), CECDAI 6 (0-33), ELIAKIM 4 (0-\n38), and SB_AIS 0.5659 (0-29.45). A strong correlation was\nfound between SB_AIS and the validated scores: LS, CECDAI,\nand ELIAKIM (Spearman ’s r = 0.751, r = 0.707, r = 0.655, p =\n0.001). Strong correlations were also found between LS and\nELIAKIM (r = 0.768, p = 0.001), CECDAI and LS (r = 0.854, p =\n0.001), and CECDAI and ELIAKIM (r = 0.827, p = 0.001).\nConclusion The results of our study demonstrated a\nstrong correlation between the AI-generated score and the\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS106\n\n\nclinically validated scores, suggesting that it could be an\nobjective and ef ficient way to assess in flammatory activity\nin patients with CD. The initial results of our study provide a\nsolid foundation for the future development of a score that\ncould correlate with prognostic factors and assist in the\nmanagement of these patients.\nDoença Inflamatória Intestinal\nID – 141788\nOpen Topics (oral presentation)\nKONO-S TECHNIQUE IN PATIENTS WITH CROHN ’S DISEASE\nILEOCECAL: INITIAL EXPERIENCE IN A TERTIARY UNIVERSITY\nHOSPITAL\nCarlos Walter Sobrado 1, Afonso Henrique da Silva Souza Jr 1,\nMariane Gouvea Monteiro de Camargoo 1, Gabriela Fonseca\nLopes1, Lucas Faraco Sobrado 1, Marcelo Rodrigues Borba 1,\nCarlos Frederico Sparapan Marques 1, Ulysses Ribeiro Junior 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nIntroduction Ileocecal resection is the most fre-\nquently performed surgical procedure in patients with ab-\ndominal Crohn ’s disease (CD), and various techniques and\nanastomosis con figurations (end-to-end, side-to-side, end-\nto-side, among others) are used, depending on the surgeon ’s\npreference and the access route (laparotomy, laparoscopy, or\nrobotic platform). Recurrence occurs at or near the anasto-\nmosis site. In 2011, Kono and colleagues in Japan described a\nnew technique for a wide, anti-mesenteric anastomosis with\nthe goal of reducing surgical recurrence.\nObjective To describe in detail the Kono-S technique\nand present the initial experience and results observed at a\ntertiary university hospital.\nMethods The technique involves the release of the ileum\nand ascending colon via laparoscopy, followed by a median\nsupra- and infra-umbilical incision approximately 10 cm in\nlength, with exteriorization of the ileocecal segment and subse-\nquent resection of the diseased area. A support column is then\ncreated by approximating the stapled segments to prevent\ntwisting of the anastomosis. After suturing and approximating\nthe two stumps, two enterotomies are made—one in the ileum\nand the other in the colon —7 to 8 cm in length, on the anti-\nmesenteric border, approximately 1 cm from the support col-\numn. Finally, an anti-mesenteric end-to-end manual anastomo-\nsis is performed with absorbable 000 sutures. A video detailing\nthe technical steps and materials used will be presented.\nResults From February 2022 to November 2023, six\npatients with ileocecal CD underwent the Kono-S procedure,\nwith four females (66.6%) and a median age of 35 years (range\n22 to 63 years). Colon preparation was performed in 4\npatients, and therapeutic antibiotics were administered to\nall patients, along with peritoneal cavity drainage. No\npatients required reoperation, and there were no deaths.\nThe average hospital stay was 11 days (range 6 to 19 days).\nAll patients are undergoing recurrence prophylaxis (three\nwith anti-TNF, two with vedolizumab, and one with usteki-\nnumab). No recurrence was observed after a median follow-\nup of 17 months (range 7 to 25 months).\nConclusion Our study concluded that the Kono-S\ntechnique is safe and may bene fit recurrence rates, although\nthe follow-up period is short. Multicenter global randomized\nstudies with long-term follow-up are needed to validate this\ntechnique.\nDoença Inflamatória Intestinal\nID – 141798\nOpen Topics (oral presentation)\nTRANSVERSECTOMY FOR THE TREATMENT OF SUBSTENOSIS\nIN CROHN ’S DISEASE: TECHNICAL ASPECTS\nGabriela Fonseca Lopes 1, Fernando D ’almeida Perazzo1,\nRodrigo Ambar Pinto 1, Carlos Walter Sobrado 1, Carlos\nFrederico Sparan Marques 1, Ulysses Ribeiro Junior 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nCase Presentation A 42-year-old female patient was\ndiagnosed with Crohn ’s Disease at the age of 15, with a\ncolonic location and stenosing behavior. She also had arthritis\nas an extra-intestinal manifestation. Initially, biological treat-\nment with In fliximab was started for 2 years, but due to\nclinical response loss, the medication was switched to Ada-\nlimumab in association with Azathioprine. The patient un-\nderwent outpatient follow-up for approximately 8 years\nwithout disease exacerbation, when she developed symp-\ntoms of subintestinal obstruction, abdominal distension, and\ntenesmus. In complementary exams for clinical investigation,\nEntero-Tomography and colonoscopy revealed a lesion in the\ntransverse colon segment, with a fibrotic and stenosing\nappearance. The patient was considered a candidate for\nsurgical intervention of the stenosis, and a decision was\nmade for a segmental colectomy, with preservation of the\nileocecal valve, using the laparoscopic transversectomy tech-\nnique with a colonic anastomosis.\nObjective The purpose of this video is to demonstrate\nthe laparoscopic transversectomy technique, illustrating the\nstep-by-step surgical approach, with the aim of standardizing\na complex surgery for the surgeon. The video will demon-\nstrate the approach, including patient positioning, surgical\ntactics, and postoperative results.\nConclusion The patient had intestinal transit in the\nsecond postoperative day but developed post-epidural anes-\nthesia headache as a postoperative complication. An epidural\nblood patch was indicated by the anesthesiology team to\ncontrol the symptoms, which delayed her hospital discharge.\nThe patient had a 30-day clinical follow-up, with good food\nacceptance, daily bowel movements, and no new episodes of\nsubintestinal obstruction. The histopathological exam con-\nfirmed stenosis due to Crohn ’s Disease, without signs of\nmalignancy. The transversectomy technique demonstrated\nin the video, despite the complexity of the procedure, should\nbe part of the skillset of a colorectal surgeon as an option for\ncases of segmental colectomy.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S107\n\n\nDoenças Anorretais\nAnorectal Diseases\nID – 141632\nOpen Topics (oral presentation)\nEVALUATION OF LOW-LEVEL LASER THERAPY IN THE\nPOSTOPERATIVE PERIOD OF OPEN PROCTOLOGICAL\nWOUNDS\nFernanda Belloti Formiga 1, Karina Bruno Bianco Vassoler 1,\nPedro Piassaroli de Abreu 1, Matheus Reginato Araujo 1, Bruna\nMeirelles Carregaro1, Iana Faine Saran 1, Janaina Giotti 1, Andre\nLuigi Pincinato1\n1Hospital Heliópolis, São Paulo, Brasil\nIntroduction The postoperative (PO) period of any\nproctological surgery is challenging. Healing by secondary\nintention of open wounds (OW) is a common reality in\nanorectal-sacral conditions. Consequently, pain and healing\ntime are the primary dif ficulties in the PO period. Intra-\noperative techniques (mechanical anopexy, hemorrhoido-\npexy, CO2 and diode lasers), as well as PO interventions\nsuch as low-level infrared laser therapy and botulinum toxin,\nhave emerged to minimize pain and accelerate healing.\nHowever, the efficacy of many of these techniques in proctol-\nogy has yet to be proven. Low-level infrared laser therapy has\nanalgesic, anti-inflammatory, wound-healing, and circulato-\nry bene fits.\nObjective To compare the evolution of patients un-\ndergoing proctological surgeries resulting in OW who re-\nceived conventional PO care versus those treated with\ninfrared laser therapy. Additionally, to evaluate the overall\nhealing time of hemorrhoidectomy procedures.\nMethods This was a prospective, randomized, single-\nblind study conducted from 09/23 to 05/24. Patients with\nproctological conditions that resulted in OW following surgery\nwere included. On the 7th PO day, patients were randomized\ninto two groups: the conventional group received standard\nfollow-up care, while the laser group received infrared laser\ntherapy (9J) applied to OW. Patients were evaluated on the 7th,\n14th, and 21st PO days using subjective parameters (pain,\nburning, edema, itching, and discharge) via a visual analog\nscale, as well as objective assessments through physical\nexaminations (edema, discharge, and wound appearance).\nSubjective variables were analyzed using the general linear\nmodel (GLM), followed by Bonferroni post-hoc tests. Objective\nparameters were analyzed with a generalized linear model and\nchi-square tests (p < 0.05).\nResults A total of 33 patients were included: 18 in the\nconventional group and 15 in the laser group. Gender, age,\nand diagnosis proportions did not differ between groups.\nGLM analysis showed improvement over time in all subjec -\ntive parameters, except for itching, which worsened. No\nsignificant differences were found between groups in subjec -\ntive parameters (pain p = 0.58; burning p = 0.43; edema p =\n0.53; itching p = 0.80; discharge p = 0.71) or objective\nparameters (edema p = 0.08; discharge p = 0.52; wound\nappearance p = 0.34). In hemorrhoidectomy cases (10 con-\nventional and 11 laser), complete healing occurred faster in\nthe laser group but without statistical signi ficance (conven-\ntional: 52.4 days vs. laser: 45.2 days, t = 0.019; p = 0.89).\nConclusion The use of infrared laser therapy did not\ndemonstrate an impact on symptom improvement in the\nearly PO period of patients with proctological OW, nor did it\nsignificantly affect early healing parameters.\nDoenças Anorretais\nAnorectal Diseases\nID – 138308\nOpen Topics (oral presentation)\nDOPPLER-GUIDED TRANSANAL HEMORRHOIDAL\nDEARTERIALIZATION VERSUS DIGITAL PALPATION-GUIDED: A\nSYSTEMATIC REVIEW AND META-ANALYSIS\nMarília Cardoso Massoni 1, Glicia Estevam de Abreu 1, Felipe\nSantos Marimpietri1\n1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil\nIntroduction Transanal hemorrhoidal dearterializa-\ntion (THD) is a widely used method for treating hemorrhoidal\ndisease (HD). However, there is no consensus on the potential\nbenefit of using Doppler ultrasound —a more costly technol-\nogy—for identifying the arteries to be ligated.\nObjectives To compare Doppler-guided THD versus\ndigital palpation-guided THD in postoperative outcomes\nthrough a systematic review and meta-analysis.\nMethods A systematic review of randomized clinical\ntrials comparing patients undergoing THD with and without\nthe use of Doppler was performed. Searches were conducted\nin PUBMED, Embase, and Cochrane databases on 04/22/2024.\nThe outcomes analyzed were postoperative pain (1st to 7th\npostoperative day), prolapse (after 12 months), bleeding\n(after 6 months), operative time, and patient-reported satis-\nfaction. Statistical analysis was conducted using RevMan Web\nfrom the Cochrane Library, with calculations expressed as\nmean difference (MD), standardized mean difference (SMD),\nand odds ratio (OR).\nResults A total of 966 patients from 10 randomized\nclinical trials were included, comparing outcomes in patients\nundergoing arterial ligation with or without Doppler for the\ntreatment of grade I-IV hemorrhoids according to the\nGoligher scale, with follow-up ranging from 6 months to 3\nyears. Bleeding at 6 months showed no signi ficant difference\nbetween the use of Doppler and digital palpation (OR 1.38;\n95% CI 0.68 –2.79; P = 0.62; I² = 0%). Similarly, prolapse\nrecurrence at one year showed no signi ficant difference\n(OR 1.60; 95% CI 0.62 –4.13; P = 0.08; I² = 52%) nor did\npostoperative pain (MD 1.10; 95% CI -0.33 –2.52; P = 0.13;\nI² = 86%). Finally, operative time also did not reveal any\nstatistically signi ficant difference between the techniques\n(MD 3.87; 95% CI -18.94 –26.67; P = 0.74; I² = 99%).\nConclusion Our findings demonstrate no signi ficant\ndifference between digital palpation-guided THD and Dopp-\nler-guided THD in terms of postoperative bleeding, prolapse\nrecurrence, and operative time. These results suggest that\nequivalent ef ficacy can be achieved with lower-cost treat-\nments, broadening the accessibility of surgical approaches\nusing these techniques.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS108\n\n\nDoenças Anorretais\nAnorectal Diseases\nID – 138198\nOpen Topics (oral presentation)\nCOMPLEX PERIANAL FISTULA COMPLICATED BY\nRECTOVAGINAL FISTULA TREATED WITH MESENCHYMAL\nCELLS\nBarbara Andrade Prais1, Carolina Vieira de Faria2, João Victor de\nAbreu Martins 3, Maria Vitória Figueiredo Martins 2, Priscila\nTocantins Tanure4, João Baptista de Paula Fraga 4, Rómmel\nRibeiro Lourenço Costa 4, Jander Bairral Vasconcelos 4\n1Universidade Professor Edson Antônio Velano , Belo Horizonte, Brasil\n2Faculdade de Ciências Médicas e da Saúde, Juiz de Fora, Brasil\n3Universidade Federal de São João del-Rei, São João del-Rei, Brasil\n4Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil\nCase Presentation A 44-year-old female patient with\na history of complex perianal and rectovaginal fistula was\ninitially diagnosed in December 2021 with a perianal abscess,\nwhich required drainage under anesthesia. In May 2022, an\nMRI revealed a complex perianal fistula complicated by a\nrectovaginal fistula, though no external opening was ob-\nserved at the time. In December 2023, the patient presented\nwith an external fistula opening, con firmed by a new MRI\nperformed in September 2023, which aligned with physical\nexamination findings of the fistulous tract. Treatment was\ninitiated in January 2024 using autologous mesenchymal\ncells, which were collected, processed, and applied during\nthe same procedure. At the 10-day follow-up, the patient\nexhibited a small amount of secretion, which was considered\na normal postoperative finding. At the 120-day follow-up,\nanoscopy findings were normal. After 150 days, a follow-up\nMRI showed fibrotic scar tissue with no evidence of fistulas.\nDiscussion Rectovaginal fistulas are rare conditions\nthat occur primarily after gynecological or obstetric trauma\nand in the context of Crohn ’s disease. Other potential causes\ninclude neoplasms, pelvic radiotherapy, infections, and un-\nintentional consequences of anorectal surgery. Treatment\noptions for rectovaginal fistulas vary based on symptoms,\nfistula anatomy, adjacent tissue quality, and prior repair\nattempts. Mesenchymal cells, a subtype of adult stem cells,\nexhibit properties such as immunomodulatory, anti-in flam-\nmatory, analgesic, anti-apoptotic, and particularly neoangio-\ngenic effects. These properties make them a promising option\nfor treating complex perineal fistulas.\nConclusion The use of mesenchymal cells in the\ntreatment of complex perineal fistulas has shown promising\nresults, as demonstrated in reported studies and in this case\nreport.\nDoenças Anorretais\nAnorectal Diseases\nID – 141657\nOpen Topics (oral presentation)\nINJECTION OF FRESHLY HARVESTED AUTOLOGOUS FAT FOR\nTHE TREATMENT OF COMPLEX ANORECTAL FISTULA: A SAFE\nAND PROMISING EXPERIENCE\nMarina Barbabela Grisolia de Oliveira 1, Fabio Lopes Queiroz 1,\nCristiane Koizimi Martos Fernandes 1, Daniel Maurício Londoño\nEstrada1, Artur Duarte Duarte 1, Letícia Brandão Castro 1, Paulo\nRocha França Neto 1\n1Hospital Felício Rocho, Belo Horizonte, Brasil\nIntroduction Complex anorectal fistulas present a\nsignificant challenge for colorectal surgeons. Surgical treat-\nment aimed at a cure carries a risk of fecal incontinence of up\nto 40%. Sphincter-sparing techniques reduce this risk but\nincrease the recurrence rate of fistulas. Treatment with\nautologous mesenchymal stem cell (MSC) injection has\nshown promise, with a 57% cure rate within one year.\nHowever, it requires laboratory centers with expertise in\ncell culture, which limits its accessibility. A potential solution\nis the use of allogeneic stem cells, which, while producing\nsimilar results, comes at a high cost (up to $87,000). The\ninjection of freshly harvested autologous adipose tissue for\nthe treatment of complex fistulas has emerged as an alterna-\ntive. This technique is cost-effective, performed in a single\nsurgical session, sphincter-sparing, and has outcomes com-\nparable to MSC and allogeneic stem cell injections.\nObjectives To evaluate the ef ficacy and safety of\ntreating complex anorectal fistulas with freshly harvested\nautologous adipose tissue injection.\nMethodology We conducted an analysis of electronic\nmedical records for all patients who underwent this treat-\nment at a tertiary hospital. Variables analyzed included\nclinical cure, reduction in secretion drainage, and postopera-\ntive complications. Patients lost to clinical follow-up were\nexcluded from the study.\nResults To date, six patients were included, all of\nwhom had undergone at least two previous procedures\nwith fistula recurrence. Among these, five showed clinical\nresponse to the treatment. Four met the criteria for clinical\ncure (closure of the external opening, cessation of secretion\ndrainage, and absence of a palpable internal opening), and\none demonstrated complete healing of two external openings\nwhile retaining one external opening with signi ficantly re-\nduced secretion drainage. One patient reported no clinical\nimprovement and was the only individual with an ostomy.\nNone of the patients were smokers. One patient with clinical\ncure developed soiling, which had not been reported\npreoperatively.\nConclusion Freshly harvested autologous fat injec -\ntion is a safe, accessible, and promising technique. This study\nhas the inherent limitations of a prospective observational\nsingle-center study but con firms the feasibility of the tech-\nnique and positive results at a Brazilian tertiary hospital.\nThese results can be reproduced safely in other Latin Ameri-\ncan centers, making this approach a valuable addition to the\ntherapeutic arsenal of colorectal surgeons.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S109\n\n\nDoenças Anorretais\nAnorectal Diseases\nID – 138284\nOpen Topics (oral presentation)\nLASER PILONIDOTOMY WITH MINIMAL ENERGY (MELPI) -\nMULTICENTER STUDY OF A NEW METHOD IN PILONIDAL\nDISEASE\nFabricio Doin Paz Oliveira 1, Sonia Cristina Cordero Time, Ana\nCarolina Buffara Blitzkow 2, Lucas Rodrigues Boarini, Aline\nAmaro Munhoz, Elisa Treptow Marques 3\n1Hospital São Camilo, Concórdia, Brasil\n2Hospital Santa Cruz, Curitiba, Baasil\n3Academia do Laser, Florianópolis, Brasil\nObjective Laser surgery, a minimally invasive proce-\ndure for the definitive approach to Pilonidal Disease (PD), has\nbeen frequently studied in recent years. This study aims to\ndescribe a new method of pilonidectomy using minimal\nenergy and evaluate its initial results.\nMethods Retrospective multicenter study. A total of\n47 consecutive patients underwent 50 minimal energy pilo-\nnidectomies (MELPi) between 2019 and 2023 at four centers\nin Brazil. The following factors were analyzed: age, BMI, sex,\nsmoking, diabetes, Güner classi fication, disease duration,\nenergy used, hospitalization time, complications, recurrence,\nwound closure, pain, and return to activities.\nResults The median age was 27 years; 61.7% were\nmen and 38.3% women. The median BMI was 25.7. Smoking\nwas evident in 14.9% of cases, and diabetes in 2.1%. The\naverage disease duration was 3 years. Most surgeries (36%)\nwere performed at stage R of the disease. The median\nhospitalization time was 6 hours, and the median healing\ntime was 15 days. The average energy used in the procedures\nwas 433 joules. The median postoperative pain score was 2.\nSecretion occurred in 14% of cases on the 60th day. Compli-\ncations (cellulitis) occurred in 4% of cases. The median time to\nreturn to work was 7 days. The average follow-up time was 12\nmonths; recurrence occurred in 5 (10%) patients. In 3 of them,\na second MELPi procedure was performed and was effective.\nConclusion MELPi presents promising initial results:\nlow pain, low complication rates, and a rapid return to\nactivities. It is a good option for cases of recurrence and\ncan be performed more than once if necessary.\nKeywords Pilonidal cyst, Laser surgery, Colorectal\nsurgery, Laser ablation, Laser therapies\nDoenças Anorretais\nAnorectal Diseases\nID – 138314\nOpen Topics (oral presentation)\nTREATMENT OF ANAL FISSURE WITH LASER – A MINIMALLY\nINVASIVE OPTION FOR PAIN MANAGEMENT IN ANAL\nFISSURES? A BRAZILIAN MULTICENTER STUDY\nAbel Botelho Quaresma 1, Fabricio Doin Paz Oliveira 2, Ana\nCarolina Buffara Blitzkow 3, Sonia Cristina Cordero Time 3,\nMarcelo Marciano4, Rodnei Bertazzo Sampietro 5, Luana\nPerondi1\n1Universidade do Oeste de Santa Catarina, Joaçaba, Brasil\n2Academia do Laser, Santa Catarina, Brasil\n3Hospital Santa Cruz, Curitiba, Brasil\n4Private Practice, Votuporanga, SP, Brasil\n5Hospital São Camilo Concórdia, Concórdia, Brasil\nIntroduction Anal fissure (AF) is a common condition\nin proctologists ’ offices. Although internal lateral sphincter-\notomy remains the gold standard surgery for chronic AF, it\nstill has a considerable rate of anal incontinence. The aim of\nthis study is to describe an alternative and minimally invasive\ntechnique for the treatment of AF using photobiomodulation\nand high-power laser (Laser Fissure Treatment - LFT), and to\npresent the initial results, primarily evaluating pain relief in\nboth acute and chronic AF.\nMethods A retrospective study was conducted with\n38 patients treated on an outpatient basis with LFT in three\ndifferent hospitals across different states in Brazil (Santa\nCatarina, Paraná, and São Paulo). The objective was to assess\nthe effects of LFT treatment on pain and incontinence rates in\npatients with AF after the procedure. The Wilcoxon test was\nused to identify the effects of LFT treatment over time (D0,\nD7, D15, D30, and D60). For post-operative pain intensity, the\nVisual Analog Scale (VAS) was used; and for the analysis of\nanal incontinence, the Wexner scale was applied.\nResults Of the patients, 65.79% (n=25) were male. The\nmedian age was 49 years. Constipation was reported by\n31.5%; 13% were smokers, and 21% had recently used opioids.\nIn 92.1% of cases, AF was located posteriorly. Skin tags were\npresent in 26.9%, and 21% had recently undergone prior anal\nsurgeries. A signi ficant reduction in pain over time was\nobserved, with post-operative pain intensity measured by\nthe VAS. Before surgery (D0), the average VAS score was 4.08,\nprogressively decreasing to 0.06 by day 60 post-operatively\n(P < 0.05). No signi ficant changes in fecal continence were\nobserved by the end of the 60-day follow-up period. Com-\nplications occurred in 3 patients (1 hemorrhoidal thrombosis,\n1 skin tag, and 1 “failure”). The recurrence rate was low, with\nonly one reported case. Satisfaction after 90 days was present\nin 93.6%.\nConclusion The results suggest that the treatment of\nanal fissure with laser therapy leads to a significant reduction\nin pain intensity over time, without affecting anal continence.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141848\nOpen Topics (oral presentation)\nDEEP LEARNING AND CAPSULE ENDOSCOPY: AUTOMATIC\nMULTI-BRAND PANENDOSCOPIC DETECTION OF VASCULAR\nLESIONS\nPedro Cardoso1,2, Miguel Mascarenhas 1,2,3, Maria João\nAlmeida1,2, Miguel Martins 1,2, Francisco Mendes 1,2, Hélder\nCardoso1,2, João Ferreira 4,3, Guilherme Macedo 1,2,3,5\n1São João University Hospital, Porto, Portugal\n2WGO Training Center, Porto, Portugal\n3University of Porto, Porto, Portugal\n4Instituto CUF, Porto, Portugal\n5Center, Porto, Portugal\nIntroduction Capsule endoscopy (CE) is commonly\nused as the initial exam in situations of suspected mid-\ngastrointestinal bleeding, after normal upper and lower\nendoscopy. Although the assessment of the small bowel is\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS110\n\n\nthe primary focus of CE, detection of upstream or down-\nstream vascular lesions may also be clinically significant. This\nstudy aimed to develop and test a Convolutional Neural\nNetwork (CNN)-based model for panendoscopic automatic\ndetection of vascular lesions during CE.\nAims & Methods A multicentric retrospective study\nwas conducted, based on 1022 CE exams. We used a total of\n35655 frames, from seven types of CE devices (PillCam Colon\n1, PillCam Crohn ‘s, PillCam SB1, PillCam SB3, OMOM HD,\nOlympus, Mirocam), of which 11091 were considered to have\nvascular lesions (angiectasia or varices) after triple validation.\nWe divided data into a training and a validation set, the latter\nbeing used to evaluate the model ’s performance. At time of\ndivision, all frames from a given patient were assigned to the\nsame dataset. Our primary outcome measures were sensitiv-\nity, speci ficity, accuracy, positive predictive value (PPV),\nnegative predictive value (NPV) and an area under the preci-\nsion-recall curve (AUC -PR).\nResults A total of 35655 frames were used, with\n11091 including vascular lesions. The validation data set\ncontained 2433 frames with normal mucosa and 933 vascular\nlesions. Sensitivity and speci ficity were 86.4% and 98.3%,\nrespectively. PPV was 95.2%, while the NPV was 95.0%. Overall\naccuracy was 95.0%. The AUC -PR value was 0.96. The CNN\nprocessed 115 frames per second.\nConclusion The study presents promising results for\nthe application of AI deep learning models in panendoscopic\nautomatic detection of vascular lesions in various gastroin-\ntestinal topographies. The methodological details, including\nthe patient-split design and the use of frames from different\ntypes of CE devices, suggest that the model could be effec -\ntively used in routine clinical practice independently of the\ndevice brand. This study highlights the potential of panendo-\nscopic evaluation of all gastrointestinal tract and the need for\nfurther research in this area. Overall, the high diagnostic\nperformance of this CNN in multibrand devices addresses an\nimportant issue of technological interoperability, allowing it\nto be replicated in multiple technological settings. However,\nthe study has some limitations, including a small number of\nframes and a retrospective design, which may introduce\nselection bias, therefore prospective and multicentric studies\nare needed before introducing this deep learning model into\nclinical practice. This is the first proof-of concept AI deep\nlearning model developed for panendoscopic automatic de-\ntection of vascular lesions during CE.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141847\nOpen Topics (oral presentation)\nDeep Learning and Capsule Endoscopy: Automatic\nPanendoscopic Detection of Protruding Lesions\nMiguel Mascarenhas1,2,3, Maria João Almeida 1,2, Miguel\nMartins1,2, Pedro Cardoso 1,2, Francisco Mendes 1,2, Hélder\nCardoso1,2, João Ferreira 1,4, Guilherme Macedo 1,2,3\n1São João University Hospital, Porto, Portugal\n2WGO Gastroenterology and Hepatology Training Center, Porto,\nPortugal\n3F University of Porto, Porto, Portugal\n4DigestAID — Digestive Artificial Intelligence Development, , Portugal\nIntroduction Capsule endoscopy (CE) provides a\nminimally invasive exam modality for panendoscopic evalu-\nation of the entire gastrointestinal (GI) tract. However, con-\nventional reading methods can be time-consuming and error-\nprone. Protruding lesions are a relatively common entity that\ncan be found with a variable incidence and different patho-\nlogical significance throughout GI tract.\nAim The aim of this study was to develop and test a\nConvolutional Neural Network (CNN)-based algorithm for\npanendoscopic automatic detection of protruding lesions\non CE exams.\nMethods A multicentric retrospective study was con-\nducted, based on 1245 CE exams. We used a total of 191455\nframes, from 6 types of CE devices, of which 52717 had\nprotruding lesions (polyps, epithelial tumors or subepithelial\nlesions) after triple validation. Data was divided into a\ntraining and testing set (90% vs 10%), using an exam-split\ndesign. During training stage, we performed a 5-fold cross\nvalidation. Our outcome measures were sensitivity, specifici-\nty, accuracy, positive predictive value (PPV), negative predic -\ntive value (NPV) and area under the conventional receiver\noperating characteristic curve (AUC -ROC) and the precision-\nrecall curve (AUC -PR).\nResults Regarding test set, the sensitivity were 99.7%\nand speci ficity 96.5%. The PPV and NPV were 96.8% and\n99.3.0%, respectively. The global accuracy was 98.4%.\nConclusion This study aims to address the gap in AI-\nenhanced capsule panendoscopy by investigating the devel-\nopment of the first CNN for the detection of protruding\nlesions across the GI tract. AI ‘s improvement of CE‘s diagnos-\ntic accuracy, along with the growing interest in minimally\ninvasive procedures, may contribute to increasing access to\nthis diagnostic tool.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 138297\nOpen Topics (oral presentation)\nENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY\nCOLORECTAL NEOPLASIA: INITIAL EXPERIENCE FROM A\nPUBLIC REFERRAL SERVICE\nGabriela Domingues Andrade Ribeiro 1, Lina Meneses Chaves 1,\nGeraldo Ferreira Coutinho Junior 1, Laura Moretti Vidotto 1,\nPaula Buozzi Tarabay 1, Joaquim José Oliveira Filho 1, Gustavo\nSeva Pereira1, Marcello Imbrizi Rabello 1\n1Hospital Municipal Dr. Mario Gatti, Campinas, Brasil\nIntroduction Endoscopic resection is a treatment\noption for both malignant and non-malignant colorectal\nneoplasms. Endoscopic submucosal dissection (ESD) allows\nen bloc resection, but the experience with this technique for\ncolorectal lesions is still limited in Latin America, especially in\npublic centers.\nObjective To describe the initial experience of a\nBrazilian public coloproctology service in the indication,\nperformance, and follow-up of patients with colorectal\nlesions eligible for endoscopic submucosal dissection (ESD).\nMethod This is a retrospective, single-center study,\nwhich included patients with colorectal lesions suitable for\ntreatment using the endoscopic submucosal dissection tech-\nnique. Patients of both sexes, aged over 18 years, from a public\nreferral center between 2020 and 2024, were selected. Epi-\ndemiological, colonoscopic, and histopathological data were\nretrieved from the hospital ’s digital system and tabulated in\nExcel for analysis.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S111\n\n\nResults 12 patients eligible for endoscopic submuco-\nsal dissection were treated by the team during the referred\nperiod. The average waiting time between diagnosis and\ntreatment was 242 days (SD 120). The average size of the\nlesions was 41.08 mm (SD 21). Three cases (25%) required\nsurgical conversion. All patients who required surgical con-\nversion had deep submucosal invasion. In the remaining\ncases, the treatment was curative, corresponding to 72% of\nthe cohort. No deaths occurred. Ten patients underwent\ncolonoscopic follow-up with no evidence of tumor recur-\nrence, and two patients are awaiting control endoscopic\nexamination.\nConclusion Although the waiting time from diagnosis\nto treatment was long, endoscopic therapeutic success was\nachieved in most cases.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141844\nOpen Topics (oral presentation)\nARTIFICIAL INTELLIGENCE AND PANENDOSCOPY – MULTI-\nDEVICE AUTOMATIC DETECTION OF PLEOMORPHIC LESIONS\nDURING DEVICE-ASSISTED ENTEROSCOPY\nFrancisco Mendes1,2, Miguel Mascarenhas 1,2,3, Tiago\nRibeiro1,2,3, João Afonso 1,2,3, Pedro Cardoso 1,2,3, Miguel\nMartins1,2, Miguel Mascarenhas Saraiva 7, Guilherme\nMacedo1,2,3\n1Centro Hospitalar Universitário São João, Porto, Portugal\n2WGO Gastroenterology and Hepatology Training Center, Porto,\nPortugal\n3Universidade do Porto, Porto, Portugal\n7ManopH - Endoscopy and Digestive Motility Laboratory, Porto,\nPortugal\nIntroduction Device-assisted enteroscopy is the only\ndiagnostic and therapeutic procedure that allows evaluation\nof the entire gastrointestinal tract. During the procedure,\ndifferent types of lesions are detected, including vascular\nlesions, protruding lesions, ulcers, and erosions. However, its\ndiagnostic accuracy is suboptimal. Convolutional neural net-\nworks, which are artificial intelligence models developed and\noptimized for image analysis, have shown their usefulness in\nvarious areas of medicine, although there is limited data on\ntheir utility in device-assisted enteroscopy.\nObjective The present study aimed to develop a\nmulti-device convolutional neural network for the detection\nand differentiation of pleomorphic lesions during device-\nassisted enteroscopy.\nMethods A retrospective evaluation was performed\non 338 procedures conducted at two reference centers,\nincluding 152 single-balloon enteroscopies (Fuji film®), 172\ndouble-balloon enteroscopies (Olympus®), and 14 spiral\nenteroscopies (Olympus®). The convolutional neural net-\nwork was trained with 40,655 images (esophageal, gastric,\nenteric, and colonic), with 90% (36,599 images) used for the\ntraining dataset in a cross-validation design with 5 sub-\ngroups, and the remaining 10% (4,066 images) used for\nvalidation. The network ’s classi fication was compared with\nthe expert consensus classi fication and evaluated based on\nsensitivity, speci ficity, positive predictive value, negative\npredictive value, accuracy, and the area under the preci-\nsion-recall curve.\nResults The convolutional neural network detected\npleomorphic lesions with a sensitivity of 88.9%, speci ficity of\n98.9%, positive predictive value of 95.8%, and negative pre-\ndictive value of 97.1%, with an accuracy of 96.8% and an area\nunder the precision-recall curve of 0.97.\nConclusion Our group developed the first convolu-\ntional neural network worldwide for multi-device panendo-\nscopic detection of pleomorphic lesions during device-\nassisted enteroscopy. This work demonstrates the impor-\ntance of developing deep learning models with high accuracy\nto improve diagnostic accuracy in panendoscopic evaluation\nof pleomorphic lesions.\nEnteroscopia, Colonoscopia e Pólipos\nEnteroscopy, Colonoscopy, and Polyps\nID – 141790\nOpen Topics (oral presentation)\nUSE OF THE NICE CLASSIFICATION BY DIGITAL\nCHROMOENDOSCOPY WITHOUT IMAGE MAGNIFICATION\nFOR PREDICTION OF THE HISTOLOGICAL TYPE OF\nCOLORECTAL POLYP LESIONS\nLucas Alves Bessa Cardoso\n1, Antonio Lacerda Filho 2, Letícia\nBrandão Castro3, Bárbara Maria Tavares Pereira 3, Marina\nBarbabela Grisolia de Oliveira3, Artur Duarte e Duarte3, Rodrigo\nde Almeida Paiva 3\n1Universidade Federal de Minas Gerais , Belo Horizonte, Brasil\n2Universidade Federal de Minas Gerais, Belo Horizonte, Brasil\n3Hospital Felício Rocho, Belo Horizonte, Brasil\nIntroduction Colorectal cancer is the third most\ncommon cancer in men and the second in women, both in\nBrazil and worldwide. Among the screening methods, colo-\nnoscopy can reduce its incidence and mortality by up to 80%\nin the distal colon and 60% in the proximal colon. Most polyps\nare benign, but their resection is still necessary for histologi-\ncal con firmation, subjecting the patient to the risk of com-\nplications and increased examination costs. Digital\nchromoscopy emerged to better characterize lesions, mini-\nmize risks related to resection, and reduce histopathological\nstudy costs when not required. The sensitivity of the Narrow-\nBand Imaging system is above 90% for neoplastic polyps.\nHowever, most of these classi fications require endoscopic\nmagnification, which is not always available. Thus, this study\naims to use the NICE classi fication—Narrow-Band Imaging\nInternational Colorectal Endoscopic Classi fication—without\nmagnification as a potential method to predict the histologi-\ncal type of lesions in colonoscopy.\nObjective To demonstrate that the NICE classification,\nwithout the use of magni fication, has predictive accuracy for\nthe histological type of polyps before resection, compared\nwith histopathological analysis.\nMethods Patients undergoing colonoscopy at the\nendoscopy service of Hospital Felício Rocho had lesions\nidentified and classi fied into one of the three NICE types\n(1: hyperplastic, 2: adenomatous, and 3: invasive neoplastic)\nby experienced colonoscopists, followed by resection. The\nNICE type, size, and location of resection were recorded for\nsubsequent database assembly and comparison with histo-\npathological analysis. These data were used to calculate the\naccuracy of the method.\nResults The overall accuracy was 70.1%. Accuracy by\nsegment: 70.8% for the right colon, 65.6% for the transverse\nand left colon, and 83.6% for the rectum. Discriminating by\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS112\n\n\nlesion size: 65.2% for lesions smaller than 4mm, 72.0% for\nlesions between 4-10mm, and 86.0% for lesions larger than\n10mm.\nConclusion The NICE classi fication helped identify\nthe histology of the lesions, but it was not de finitive for\ndetermining clinical management. Throughout the study,\nexaminer pro ficiency with the classi fication improved, sug-\ngesting that with prolonged use, its performance may\nenhance.\nFisiologia Anorretocólica\nAnorectal Physiology\nID – 141724\nOpen Topics (oral presentation)\nTHE IMPORTANCE OF NEUROPELVIOLOGY FOR THE\nTREATMENT OF COLOPROCTOLOGICAL PATIENTS\nLara Burlamaqui Veras 1, Rodrigo Dornfeld Escalante 1, Victor\nRipardo Siqueira1, William Pinheiro Boavista de Oliveira 1, Thaís\nBarroso Vieira Costa Bon fim1, Matheus Emanuel de Brito\nCastelo Branco1, Francisco Duque de Paiva Giudice Junior 1,\nCauã Ferreira Câmara 1\n1Universidade Federal do Ceará, Ceará, Brasil\nIntroduction Neuropelveology, the field that studies\nall diagnostic and therapeutic approaches involving pelvic\ninnervation, integrates the specialties of urology, gynecology,\nand coloproctology. It has become essential in the manage-\nment of pelvic disorders. Coloproctological patients often\nface debilitating conditions with various etiologies. Tradition-\nally, treatments have been based on symptomatic approaches\nwith limited results. However, advances in neuropelveology\nhave revolutionized the ability to diagnose and treat pelvic\nneurological dysfunctions.\nObjectives To demonstrate the importance of neuro-\npelveology in coloproctological patients with pelvic floor\ndisorders.\nMethods A review was conducted using searches\nfrom the PUBMED, BVS, and Scielo databases, with the\ndescriptors “Neuropelveology” associated with “Coloproctol-\nogy,”“ Pelvic Floor Dysfunction, ” as well as variable descrip-\ntors: “Treatment” and “Diagnosis.”\nResults A total of 317 articles were found, of which 11\narticles published in the last 10 years with the mentioned\ndescriptors were selected. In coloproctology, the sphincter\nand pelvic floor muscles, the anal canal, rectum, sigmoid, and\nleft colon function due to nervous stimulations from the\nsacral roots S2, S3, and S4 through the pudendal nerve and\npelvic splanchnic nerves, respectively. Dysfunction of the\nposterior pelvic compartment is understood to originate\nfrom disturbances in the function of these innervations,\nand the etiology should be investigated through functional\nand anatomical tests (anorectal manometry, three-dimen-\nsional and dynamic endoanal neuro-ultrasonography, and\npelvic magnetic resonance imaging). These dysfunctions may\nstem from vascular entrapment, nerve compression, iatro-\ngenic surgical injuries, endometriosis, among others. The\ntreatment depends on the diagnosis and may range from\nlocal botulinum toxin injection, neuromodulation, to mini-\nmally invasive laparoscopic or robotic surgery for nerve\nrelease.\nConclusion For proper management of pelvic floor\ndysfunctions, it is crucial to understand pelvic innervations\nand their functioning. Treating the apparently dysfunctional\norgan may not be the best choice, as its function is preserved\nby its innervation. Further studies and research are needed\nfor a better understanding of the diagnostic approach and\nneuropelveological interventions in coloproctology.\nFisiologia Anorretocólica\nAnorectal Physiology\nID – 141771\nOpen Topics (oral presentation)\nFECAL CONSISTENCY AS A MARKER OF GOOD RESPONSE IN\nTHE TREATMENT OF INTESTINAL FUNCTIONAL DISORDERS\nAND THE ROLE OF SOLUBLE FIBERS\nIlario Froehner Junior\n1, Jocemari Noeli Buzato 1\n1PELVIA Motilidade Digestiva e Continência, Curitiba, Brasil\nIntroduction Intestinal functional disorders are\namong the most frequent gastrointestinal disorders. Soluble\ndietary fibers are included in some constipation and fecal\nincontinence guidelines. A simple way to assess normal\nintestinal transit is through fecal consistency, commonly\ndemonstrated by the Bristol Stool Scale (BSS). Individuals\nwith normal stools (BSS 3 and 4) tend to have a lower\nincidence of gastrointestinal symptoms.\nObjective To evaluate the clinical response to the use\nof partially hydrolyzed guar gum soluble fibers and inulin,\naccording to fecal consistency, as the first approach in the\ntreatment of intestinal functional disorders.\nMethods Prospective study of 742 patients with\nfunctional bowel disorders taking one measuring spoon\n(5g) of partially hydrolyzed guar gum (60%) and inulin\n(40%) added to water two times a day for 30 days. If BSS\nwas 1 to 2, patients were told to mix the measuring spoon to\n250 - 300 mL of water. If BSS was 5 to 7, to 50 - 100 mL, and if\nBSS was 3 to 4, to 200 mL. Mean BSS, global improvement\npercentage, complication rate, Constipation Scoring System\n(CSS) and Cleveland Clinic Incontinence Score (CCIS) were\napplied during the first appointment and during the 30-day\nfollow-up appointment.\nResults Of the 742 patients, 63.5% were female, with a\nmean age of 49.2 years. All patients informed no dif ficulty in\ncomplying with the soluble fiber protocol. Initial mean CSS\nwas 13,0 ( þ-4,2) and CCIS was 2 ( þ-1). Mean BSS of consti-\npation patients was 2 ( þ- 1) of functional diarrhea and fecal\nincontinence was 5 ( þ-1) and of irritable bowel syndrome\nwas 5 ( þ-1), respectively. On the 30-day follow-up appoint-\nment, 73.5% of the patients had BSS types 3 and 4, associated\nwith 65.9% ( þ- 15.7) of signi ficant overall improvement.\nMean CSS was 6 ( þ-3,9) and CCIS was 1 ( þ-1), p < 0,01.\nPatients who presented the other types of fecal consistency\n(26.5%), the signi ficant overall improvement was only 20.2%\n(þ-15.2). Mean CSS was 9 ( þ-1,5) and CCIS was 2 ( þ-1), p >\n0,01.\nConclusion Achieving normal fecal consistency is\nassociated with significant overall improvement. Oral soluble\nfibers use according to fecal consistency are a valid tool for\ntreating bowel movement disorders.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S113\n\n\nFisiologia Anorretocólica\nAnorectal Physiology\nID – 138363\nOpen Topics (oral presentation)\nIMPACT OF SATISFACTION RATE, SCORE, AND RISK FACTORS\nIN THE TREATMENT OF FECAL INCONTINENCE: BIOFEEDBACK,\nELECTRO-STIMULATION, OR SACRAL NEUROMODULATION AS\nTHE FIRST OPTION?\nSthela Maria Murad-regadas\n1, Francisco Sergio Pinheiro\nRegadas1, José Jader Araujo de Mendonça Filho 1, Francisco\nSergio Pinheiro Regadas Filho 1, Carlos Magno Queiroz da\nCunha1, Lavier Kelvin Holanda Vidal 1, Victor Ripardo Siqueira 1,\nWilliam Pinheiro Boavista de Oliveira 1\n1Universidade Federal do Ceará, Ceará, Brasil\nIntroduction The treatment of fecal incontinence (FI)\nremains challenging, as patients expect effective and long-\nterm results.\nObjectives To evaluate the impact of satisfaction rate,\nscore, and risk factors in patients with fecal incontinence\ntreated with biofeedback (BIO), electrostimulation combined\nwith biofeedback (ELET þ BIO), or sacral neuromodulation\n(NS) as the first option.\nMethodology Prospective data from women treated\nfor FI over a 5-year period, without surgical indication and\ncapable of undergoing BIO treatment. The fecal incontinence\nscore (Cleveland Clinic Fecal Incontinence Score – CCFIS), 3D\nanorectal ultrasonography, and anal manometry were\nassessed. The patients were matched by age and grouped\ninto: BIO, ELET þ BIO, and NS. Within each group, they were\nsubdivided by CCFIS /C20 10 vs. CCFIS > 10. Risk factors, scores,\npercentage of response, and satisfaction rates (using a visual\nanalog scale – EVA [0 = best; 100 = worst]) were compared\nbefore and after treatment. The follow-up period was 6\nmonths for BIO and ELET þ BIO and at least one year for NS.\nANOVA and paired tests were used.\nResults A total of 165 women were included: 58\ntreated with BIO (CCFIS/C20 10 = 34, CCFIS > 10 = 24); 51 treated\nwith ELET þ BIO (31, 20); and 56 treated with NS (11, 45). The\nnumber of vaginal deliveries, sphincter defects, and previous\nsurgeries were similar across groups. Resting pressure was\nlower in the NS group. The pre-treatment satisfaction impact\n(EVA) was higher in the NS group (p < 0.00). There was\nsignificant improvement in the score and EVA compared to\npre- and post-treatment in all three groups. However, the\npercentage of improvement was higher in the NS group\ncompared to BIO and ELET þ BIO (88% vs. 43% vs. 34%,\np < 0.00), and the satisfaction scale showed the best post-\ntreatment response in the NS group (16 vs. 49 vs. 57, p = 0.00).\nAdditionally, all patients in the NS group showed a symptom\nimprovement rate of FI > 50%, with 30% achieving complete\ncontinence. Subgroup analysis showed that the improvement\npercentage and satisfaction were higher after NS in both\nsubgroups (CCFIS /C20 10: NS = 94% vs. BIO = 48% vs. ELET þ BIO\n=4 0 % ,p < 0.00) and (CCFIS > 10: NS = 87% vs. BIO = 36% vs.\nELET þ BIO = 24%, p< 0.00), as well as better satisfaction (CCFIS\n/C20 10: NS = 9 vs. BIO = 39 vs. ELETþ BIO = 47, p = 0.00) and (CCFIS\n> 10: NS = 18 vs. BIO = 64 vs. ELET þ BIO = 73, p < 0.00).\nConclusion All three modalities led to reduced scores,\nand no risk factors were identifi\ned that influenced the results.\nHowever, the improvement percentage and satisfaction rate\nhad an impact on the choice of sacral neuromodulation as the\nfirst treatment option, even in patients with CCFIS /C20 10.\nFisiologia Anorretocólica\nAnorectal Physiology\nID – 141845\nOpen Topics (oral presentation)\nARTIFICIAL INTELLIGENCE AS A TRANSFORMATIVE FACTOR IN\nMOTILITY DISORDERS – AUTOMATIC DETECTION OF\nMOTILITY PATTERNS IN HIGH-RESOLUTION ANORECTAL\nMANOMETRY\nMiguel Martins\n1, Miguel Mascarenhas 1,2, Francisco Mendes 1,\nJoana Mota1, João Cordeiro3, João Ferreira2, Cecílio Santander4,\nGuilherme Macedo1,2\n1Centro Hospitalar Universitário São João, Porto, Portugal; Centro\nTreino WGO, Porto, Portugal\n2Universidade do Porto, Porto, Portugal\n3Instituto Universitário de Lisboa, Lisbon, Portugal\n4Hospital Universitario La Princesa, Madrid, Espanha\nIntroduction Anorectal functional disorders are prev-\nalent in clinical practice, presenting signi ficant diagnostic\nchallenges. High-resolution anorectal manometry (HR-ARM)\nis the first-line examination for assessing these disorders, but\nits application is limited by accessibility and the complexity of\ndata interpretation. The aim of this study was to develop and\nvalidate an Arti ficial Intelligence (AI) model to identify and\ndifferentiate tone and contractility disorders in HR-ARM.\nMethods A retrospective, single-center study was\nconducted using 813 HR-ARM exams. The classi fication of\nanorectal motility disorders was based on the London Clas-\nsification. Several machine learning (ML) models were evalu-\nated. The dataset was split, with 80% used for training and 20%\nfor testing. The performance of the models was evaluated\nusing accuracy, sensitivity, speci ficity, and positive and neg-\native predictive values.\nResults The LightGBM and xGB models demonstrated\nthe highest overall accuracy. These models identi fied tone\nand contractility disorders with an accuracy of 97.6%, sensi-\ntivity of 98.9%, speci ficity of 94.7%, and positive and negative\npredictive values of 95.6% and 97.5%, respectively.\nConclusion The LightGBM and xGB models success-\nfully identified and differentiated tone and contractility dis-\norders in HR-ARM studies. This is the first global study to\ndemonstrate the accuracy of ML models in detecting and\ndifferentiating motility patterns in HR-ARM. The development\nof AI models is crucial to improve the availability and accuracy\nof these exams, leading to more objective and precise man-\nagement of patients with anorectal functional disorders.\nFisiologia Anorretocólica\nAnorectal Physiology\nID – 138112\nOpen Topics (oral presentation)\nPELVIC DYSSYNERGIA ON HIGH-RESOLUTION ANORECTAL\nMANOMETRY (HR-ARM) IN CHILDREN WITH LOWER\nURINARY TRACT SYMPTOMS (LUTS)\nCatarina Barretto de Araújo Rosier\n1, Glicia Estevam de Abreu 1,\nNatalin Oliveira da Costa 1, Ana Aparecida Martineli Braga 1,\nUbirajara Barroso Junior 1, Marilia Cardoso Massoni 1, Maria\nLuiza Veiga1\n1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS114\n\n\nObjective Assessing the presence of pelvic dyssyner-\ngia on high-resolution anorectal manometry (HR-ARM) in\nchildren with lower urinary tract symptoms (LUTS).\nMethods HR-ARM has been performed on children\nwith LUTS aged /C21 5 years. Children were categorized accord-\ning to LUTS into non-monosymptomatic enuresis, mono-\nsymptomatic enuresis, and isolated urinary with daytime\nurination. The evaluation of the urinary symptoms was\ncarried out with the help of a structured questionnaire and\na voiding diary. HR-ARM was performed according to the\nLondon protocol. According to Rao´s classi fication, pelvic\ndyssynergia was classi fied as Type I dyssynergia, II, III, and\nIV. Functional constipation (FC) was assessed using the Rome\nIV criteria.\nResults Forty children with a mean age of 9.33 /C6 2.66\nyears, 22 (55%) were male, underwent HR-ARM. Twenty (50%)\npatients suffered from constipation. Twenty-eight children\n(70%) had pelvic dyssynergia, with Type I dyssynergia being\nthe most common. Among children with pelvic dyssynergia,\nseventeen (60,7%) had non-monosymptomatic enuresis\n(p=0.04). Patients with dyssynergia had a higher intrarectal\nexpulsion pressure, with a median 54.15(IC 45.88 –\n66.23) /C2 28.05 (IC 25.98 – 36.53); p < 0.001. In addition,\nthey had a lesser anal relaxation during straining, with a\nmedian -10.35 (IC -28.82 – 9,15) /C2 36.6 (IC 22.85 – 50); p <\n0.001.\nConclusion The presence of pelvic dyssynergia is\nassociated with the simultaneous presence of daytime and\nnocturnal symptoms, hence non-monosymptomatic enure-\nsis. This could indicate that the presence of pelvic incoordi-\nnation is more common in more severe cases of LUTS.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 141181\nOpen Topics (oral presentation)\nANALYSIS OF THE CHARACTERISTICS OF INTESTINAL\nENDOMETRIOSIS LESIONS WITH RECTAL INVOLVEMENT\nUSING THREE-DIMENSIONAL ENDOANAL ULTRASOUND\nGraziela Olivia da Silva Fernandes 1, Rosilma Gorete Lima\nBarreto1, Yana de Sousa Crispim Pavan 1, Nikolay Coelho da\nMota1, Maura Tarciany Coutinho Cajazeiras Oliveira 1, Raissa\nScarlet Queiroz Fernandes 1, Marcelo Travassos Pinto 1, Bruno\nBarreto Figueiredo Soares 1\n1Hospital Universitário da Universidade Federal do Maranhão, São\nLuís, Brasil\nIntroduction Intestinal endometriosis represents a\ncomplex and challenging form of the condition, involving the\ngastrointestinal tract, particularly the rectum. Three-dimen-\nsional endoanal ultrasound provides detailed and precise\nimages of endometriotic lesions in the rectum and is an\nimportant tool for the diagnosis and proper management\nof these patients.\nObjective To evaluate the characteristics of endome-\ntriosis lesions affecting the rectum using three-dimensional\nendoanal ultrasound.\nMethod This is a retrospective study, with data\nobtained through the evaluation of electronic medical\nrecords of patients seen in the coloproctology service of a\nUniversity Hospital. All patients were referred for rectal\nultrasound evaluation due to suspected lesions from previous\nimaging studies (transvaginal ultrasound or magnetic reso-\nnance imaging). Patients underwent three-dimensional\nendoanal ultrasound from May 2017 to May 2024 using the\nFlex-Focus equipment from BK Medical. Patients with asso-\nciated anorectal conditions, such as in flammatory bowel\ndisease, anorectal cancer, or those who had previously re-\nceived pelvic radiation, were excluded. The evaluated data\nincluded the location of the lesion, depth in the rectal wall,\nlesion length, and distance to the anal margin. The sample\nconsisted of 69 patients with intestinal endometriosis, with 3\nexcluded because rectal involvement was not con firmed.\nStatistical analysis was performed using GraphPad Prism\nand Excel.\nResults All lesions were found in the anterior hemi-\ncircumference of the rectum. The most common locations\nwere the mid rectum (25) and upper rectum (27), with 8\nlesions found in the lower rectum. Six patients had lesions in\nmore than one segment. Of the 72 lesions found, most (39)\naffected the muscular layer of the rectum. Twenty-four\ninvolved the perirectal fat, 6 extended to the submucosa,\nand 3 reached the mucosal muscular layer. The mean length\nof the largest axis of the lesion in the longitudinal plane was\n1.84 cm (0.37 cm –3.5 cm), and in the axial plane, the mean\nwas 2.08 cm (1.12 cm –8.8 cm). The average distance of the\nlesions from the anal margin was 9.0 cm.\nConclusion Intestinal endometriosis lesions predom-\ninantly occur in the mid and upper rectum, approximately 9.0\ncm from the anal margin, and most commonly affect the\nmuscular layer of the rectum.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 141737\nOpen Topics (oral presentation)\nACADEMIC COLECTOMIES: SURGICAL TRAINING ON\nCADAVERS FOR MEDICAL STUDENTS\nCarolina Reis Bonizzio\n1, Felipe Giraldo Alvarez Gonçalves 2,\nEmily Caroline da Fonseca Sampaio 2, Artur de Souza Almeida 2,\nGabriela Fonseca Lopes 1, Ian Torres de Lima 1, Carlos Frederico\nSparapan Marques 1, Bruno Damico Terada 2\n1Hospital da Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\n2Faculdade de Medicina da USP, Sao Paulo, Brasil\nIntroduction Historically, surgical education has fo-\ncused on training in operative techniques due to the inher-\nently manual nature of surgical work. However, traditional\ntraining models present problems: training on living humans,\neven when supervised by experienced surgeons, can pose\nrisks to patients; animal models do not fully capture the\ncomplexity of the human body and raise ethical concerns. For\nthis reason, cadaver-based training models have gained in-\ncreasing acceptance, especially because they accurately rep-\nlicate human anatomy without exposing any living beings to\nrisk. Academic leagues are extracurricular extensions of\nmedical courses designed to complement students ’ theoreti-\ncal and practical knowledge in various fields. In the academic\nleague of coloproctology at the institution, students have the\nopportunity to study anatomy and perform surgical techni-\nques on cadavers.\nObjective To demonstrate the technical steps of right\nand left colectomy on fresh cadavers for surgical training of\nmedical students.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S115\n\n\nMethod In the death veri fication service, medical\nstudents performed, under the tutelage of instructors and\nresidents from the Digestive Surgery and Coloproctology\ndepartment of the institution, a right colectomy with me-\nchanical ileotransverse anastomosis and a left colectomy\nwith high rectal resection. They had personal protective\nequipment, a surgical instrument set, disposable materials,\nand two fresh cadavers. To simulate the surgical procedure,\nstudents followed a flowchart based on previously studied\nand discussed procedures with their tutors: access to the\nperitoneal cavity, inventory; release of paracolic gutters\nwhile preserving retroperitoneal structures; intercolic -epi-\nploic dissection; ligation of colic vessels; lymphadenectomy;\nbowel sectioning; and in the right colectomy, mechanical\nileotransverse anastomosis with correction of the mesenteric\ngap.\nResults and Conclusion The dissection result,\ndepicted in the video, demonstrates the feasibility and im-\nportance of using cadaver models for surgical education.\nCombined with theoretical instruction, practical training\non cadavers allowed students to re fine complex techniques\nand deepen their anatomical knowledge of the abdominal\ncavity. The video, edited by the students, also serves as a\nhighly valuable teaching tool.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 141607\nOpen Topics (oral presentation)\nCREATION OF A SCORE FOR QUANTIFICATION OF\nCOLOPROCTOLOGICAL AND AUTONOMIC SYMPTOMS IN\nINTESTINAL ENDOMETRIOSIS\nLara Burlamaqui Veras1, William Pinheiro Boavista de Oliveira1,\nEttore Carvalho Lopes Cezar 1, Guilherme Rolim Santa Cruz 1,\nVictor Ripardo Siqueira 1, Adryano Gonçalves Marques 1,\nMatheus Emanuel de Brito Castelo Branco1, Thaís Barroso Vieira\nCosta Bon fim1\n1Universidade Federal do Ceará, Ceará, Brasil\nIntroduction Endometriosis is characterized by the\npresence of endometrial tissue outside the uterine cavity.\nIntestinal involvement occurs in 8 –12% of cases, affecting\nvarious structures, including the rectum/sigmoid colon. The\nmain coloproctological symptoms include visceral-type\nabdominopelvic pain (in the lower abdomen, radiating to\nthe lumbar region, diffuse and dull), dyschezia, dyspareunia,\nabdominal distension, tenesmus, proctalgia, and autonomic\nsymptoms such as syncope, tachycardia, nausea, and vomit-\ning, among others.\nObjective To develop a scoring system to quantify the\nmost common coloproctological and autonomic symptoms in\nintestinal endometriosis and facilitate the evaluation of\npostoperative improvement.\nMethodology The medical records of 46 patients who\nunderwent surgery for intestinal endometriosis between\n2019 and 2024 at a tertiary hospital in Fortaleza (CE), Brasil,\nwere analyzed. The most common preoperative symptoms\nwere dyschezia, dyspareunia, diarrhea (evacuation urgency),\nconstipation (>3 days between bowel movements), abdomi-\nnal pain, abdominal distension, tenesmus, the sensation of\nincomplete evacuation, pelvic pain, and proctalgia. These\nsymptoms were tabulated and scored based on their frequen-\ncy (never - 0, rare - 1, sometimes - 2, usually - 3, and always -\n4). Mild symptoms scored 0 –13; moderate, 14 –26; and\nsevere, 27 –40. Symptoms scored as moderate to severe\nwere shown to have a greater impact on quality of life.\nResults The prevalence of symptoms before and after\nsurgery, respectively, was as follows: dyschezia (36.96% vs.\n15.22%), dyspareunia (51.52% vs. 9.69%), constipation (34.78%\nvs. 26.08%), diarrhea (15.22% vs. 2.17%), abdominal pain\n(23.91% vs. 15.22%), abdominal distension (10.87% vs. 6.5%),\ntenesmus (28.26% vs. 13.04%), sensation of incomplete evac -\nuation (15.22% vs. 13.04%), pelvic pain (41.30% vs. 8.69%), and\nproctalgia (8.69% vs. 6.52%). The median and mean number of\nsymptoms per patient before surgery were 2 and 2.82,\nrespectively, while postoperatively, they were 1 and 1.19.\nConclusion There was a reduction in the percentage\nof analyzed symptoms as well as the mean and median\nnumber of complaints per patient after surgery, highlighting\nthe importance of symptom assessment to measure quality of\nlife. Quantifying coloproctological and autonomic symptoms\nthrough the development of a scoring system is essential to\nstandardize this evaluation and facilitate postoperative\nsymptom control in patients with intestinal endometriosis.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 137945\nOpen Topics (oral presentation)\nIMPACT OF ORAL ANTIBIOTIC USE IN PREPARATION FOR\nCOLORECTAL SURGERIES\nDiogo Viana Abreu 1, Júlia Salles Rezende Dias 1, Guilherme de\nAlmeida Santos1, Ilson Geraldo da Silva 1, Augusto Zbonik\nMendes1, Mario Inácio Carneiro Neto 1, Jennyfer Kellen Lázaro\nda Rocha1, Matheus Matta Machado Mafra Duque Estrada\nMeyer1\n1Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brasil\nThe use of prophylactic oral antibiotics in colorectal\nsurgeries has been the focus of recent studies, which have\ndemonstrated their impact in reducing rates of infectious\ncomplications, such as surgical site infections (SSI) and\nintestinal fistulas. This study aims to conduct a prospective,\nrandomized, double-blind trial to evaluate the impact of oral\nantibiotic use on postoperative infectious complications in\npatients undergoing elective colorectal surgeries. The prima-\nry outcome being studied is the in fluence of oral antibiotics\non surgical site infection rates, while the secondary outcome\nfocuses on the incidence of intestinal fistulas. The study is\nongoing, and preliminary results are presented here. Patients\nwere divided into two groups: the test group, in which\npatients received oral neomycin and metronidazole on the\nday before surgery, and the control group, in which patients\nreceived a placebo the day before surgery. Both groups\nreceived standard intravenous antibiotic prophylaxis. Colon\npreparation was performed according to institutional proto-\ncols, regardless of group assignment. No mechanical bowel\npreparation was performed for right ileocolectomy or\nabdominoperineal resection. For surgeries involving the left\ncolon, upper rectum, or total colectomy, preparation included\nglycerin enemas. For rectosigmoidectomy with total meso-\nrectal excision, mechanical bowel preparation was per-\nformed. A total of 44 eligible patients were included in the\nstudy, with 21 in the test group and 23 in the control group.\nThe groups were comparable, differing only in median age,\nwhich was 55 years in the test group and 67 years in the\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS116\n\n\ncontrol group. For the primary outcome, the control group\nexhibited a higher rate of infectious complications (19% vs.\n43.5%; p-value: 0.082). For the secondary outcome, the\ngroups were similar (5.6% vs. 11.8%; p-value: 0.512). The\nresults for surgical site infections are notable, and while there\nis no statistically significant difference, this may be attributed\nto the small sample size. Thefindings thus far are encouraging\nand support further studies on the use of oral antibiotics in\npreoperative preparation for colorectal surgeries.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 141776\nOpen Topics (oral presentation)\nLATE CLOSED LOOP OBSTRUCTION OF THE SIGMOID AFTER\nLEFT URETERAL ENDOMETRIOSIS RESECTION: MINIMALLY\nINVASIVE RESOLUTION WITH COLONOSCOPIC STENT\nPLACEMENT FOLLOWED BY LAPAROSCOPIC\nSIGMOIDECTOMY\nRodrigo Ambar Pinto\n1, Thaís Villela Peterson 1, Daniel José\nSzor1, Gabriela Fonseca Lopes 1, Jarbas Faraco Maldonado\nLoureiro1, Isaac José Felippe Corrêa Neto1, Caio Sérgio Rizkallah\nNahas1, Carlos Frederico Sparapan Marques 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nCase Presentation A 35-year-old female physician,\npreviously undergoing partial resection of the left ureter and\nend-to-end anastomosis, along with partial resection of the\nmesosigmoid for deep endometriosis, developed a localized\nabscess in the sigmoid. This was treated clinically with\nsystemic antibiotics. Six months later, while on vacation,\nshe experienced abdominal pain, distention, and cessation\nof flatulence and feces. She went to the emergency room\nwhere she was diagnosed with a closed loop obstruction in\nthe sigmoid and was advised to undergo an emergency\ncolostomy. The patient opted to return to her city. A colonos-\ncopy revealed a complete and short 4 cm sigmoid obstruction,\nand a 9 cm colon stent was placed. The effect was immediate,\nwith immediate evacuations and an improvement in the\ncolon distension confirmed by imaging. A slow bowel prepa-\nration was carried out over 2 days with Movinlax, which was\neffective, resulting in liquid evacuations, and surgery was\nindicated.\nSurgical Procedure Laparoscopy was performed with\nthe placement of five trocars: one 11 mm in the epigastric\nregion, one 12 mm in the right iliac fossa, and three 5 mm in\nthe left iliac fossa and flanks. A blockage of the small intestine\nin the left iliac fossa was identi fied and relieved, with the\nstent found in the cavity. The left paracolic gutter was freed\nfrom the retroperitoneum. The proximal rectum at the level\nof the promontory was prepared, stapled with a linear\nstapler, and the sigmoid vessels were ligated, extending\nfrom the colon to the region above the stent. The specimen\nwas exteriorized via a 5 cm Pfannenstiel incision, and the 29\nmm Echelon® circular stapler was placed. An intra-corporeal\nend-to-end anastomosis was performed, with a negative leak\ntest, and the cavity was drained.\nPostoperative Course The patient showed excellent\nrecovery, with evacuations from the first day and oral diet\nintroduction. She was discharged on the 5th day after drain\nremoval. Thirty days post-surgery, the patient was asymp-\ntomatic, with normal, daily evacuations.\nDiscussion The self-expanding metallic endoscopic\nstent represents a minimally invasive and effective alterna-\ntive for relieving intestinal obstruction. Initially proposed for\ncolorectal malignant tumors in the 1990s, it is now used as a\nbridge to surgery to avoid emergency stoma creation, as\ndemonstrated in this case.\nConclusion The decision to use a stent as a bridge to\nminimally invasive surgery without a colostomy proved to be\na safe and effective measure for resolving a severe problem\nwith high complication potential.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 141619\nOpen Topics (oral presentation)\nTURNBULL-CUTAIT PULL-THROUGH COLOANAL\nANASTOMOSIS VERSUS STANDARD COLOANAL\nANASTOMOSIS PLUS DIVERTING ILEOSTOMY FOR LOW\nANTERIOR RESECTION: A META-ANALYSIS AND SYSTEMATIC\nREVIEW\nBernardo Fontel Pompeu\n1, Eric Pasqualotto 2, Beatriz D ’andrea\nPigossi1, Patrícia Marcolin3, Sergio Mazzola Poli de Figueiredo4,\nFang Chia Bin 5, Fernanda Bellotti Formiga 1\n1Hospital Heliópolis, São Paulo, Brasil\n2Universidade Federal de Santa Catarina, Santa Catarina, Brasil\n3Universidade Federal Fronteira do Sul Passo Fundo, Passo Fundo,\nBrasil\n4Cleveland Clinic Ohio, Ohio, United States\n5Irmandade de Midericórdia da Santa Casa de São Paulo, São Paulo,\nBrasil\nPurpose Coloanal anastomosis with loop diverting\nileostomy (CAA) is an option for low anterior resection of the\nrectum, and Turnbull-Cutait coloanal anastomosis (TCA)\nregained popularity in the effort to offer patients a recon-\nstructive option.\nObjective In this context, we aimed to compare both\ntechniques.\nMethods PubMed, Cochrane, and Scopus were\nsearched for studies published until January 2024. Odds\nratios (ORs) with 95% con fidence intervals (CIs) were pooled\nwith a random-effects model. Statistical signi ficance was\ndefined as p < 0.05. Heterogeneity was assessed using the\nCochran Q test and I² statistics, with p-values inferior to 0.10\nand I² > 25% considered signi ficant. Statistical analysis was\nconducted in RStudio version 4.1.2 (R Foundation for Statis-\ntical Computing). Registered number CRD42024509963.\nResults One randomized controlled trial and nine\nobservational studies were included, comprising 1,743\npatients, of whom 899 (51.5%) were submitted to TCA and\n844 (48.5%) to CAA. Most patients had rectal cancer (52.2%),\nfollowed by megacolon secondary to Chagas disease (32.5%).\nTCA was associated with increased colon ischemia (OR 3.54;\n95% CI 1.13 to 11.14; p < 0.031; I² = 0%). There were no\ndifferences in postoperative complications classi fied as Clav-\nien-Dindo /C21 IIIb, anastomotic leak, pelvic abscess, intestinal\nobstruction, bleeding, permanent stoma, or anastomotic\nstricture. In subgroup analysis of patients with cancer, TCA\nwas associated with a reduction in anastomotic leak (OR 0.55;\n95% CI 0.31 to 0.97 p = 0.04; I² = 34%).\nConclusion TCA was associated with a decrease in\nanastomotic leak rate in subgroups analysis of patients with\ncancer.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S117\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141741\nOpen Videos\nCOMBINED APPROACH FOR DISTAL RECTAL NEOPLASIA AND\nLATERAL LYMPHADENECTOMY: ROBOTIC WITH USE OF TEO\nRodrigo Gomes da Silva 1, Magda Maria Profeta da Luz 1,\nBernardo Hanan 1, Kelly Cristine Lacerda Rodrigues Buzatti 1,\nRenato Gomes Campanati 1, Luiza Rogerio 1, Cleo Gonçalves\nTrindade Ribeiro1, Mariana Alves Santana de Araújo 1\n1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo\nHorizonte, Brasil\nIntroduction Distal rectal neoplasms represent a\nchallenge for surgical approach, especially in cases where a\nmanual coloanal anastomosis is required. Performing dissec -\ntion of the most distal part with adequate preservation of the\nmesorectum can be facilitated by the minimally invasive\nabdominal technique combined with the use of the TEO\nplatform for careful rectal sectioning.\nObjectives In this video, we aim to demonstrate how\nthe combination of two modern techniques can result in a\nmore careful surgery, with proper mesorectal preservation\nand lateral lymphadenectomy.\nMethods A 64-year-old patient with symptoms of\nhematochezia and diarrhea underwent colonoscopy for in-\nvestigation, which indicated a lesion in the middle/distal\nrectum with a pathological diagnosis of adenocarcinoma.\nStaging MRI indicated T2N1 tumor with suspicious pelvic\nlateral lymph nodes on the right. An upfront surgery was\nchosen, performed robotically in combination with the TEO\nplatform for proper mesorectal dissection in its most distal\nportion, without violation.\nResults The use of robotics for the abdominal portion\nallows for careful and precise dissection, and the TEO plat-\nform facilitates sectioning under visual control of the anal\ncanal, preserving tissues and ensuring a safer subsequent\ncoloanal anastomosis.\nConclusion The combined approach of modern tech-\nniques can provide careful mesorectal dissection and prevent\nits violation, which is one of the principles in the oncologi-\ncally adequate treatment of rectal cancer. When available,\ntheir combination can promote an intact surgical specimen.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138218\nOpen Videos\nPERINEAL HERNIA REPAIR WITH MESH VIA ROBOTIC\nSURGERY\nMichel Gardere Camargo 1, Michel Gardere Camargo 1, Rodrigo\nGiacomini Bregeiro2, Luis Gustavo Capochin Romagnolo 2,\nMayara Marina Sousa Senzano 1, Felipe Daldegan Diniz 2, Carlos\nAugusto Rodrigues Veo 2, Marcos Vinicius Araújo Denadai 2\n1Universidade Estadual de Campinas, Campinas, Brasil\n2Hospital do Amor, Barretos, Brasil\nThis free video aims to demonstrate the correction of\na perineal hernia using a dual-sided Proceed surgical mesh\n(Ethicon) via robotic surgery. This procedure was performed\nduring the Robotic Colorectal Surgery Certi fication Program\nat the Hospital do Amor (Barretos/SP). The patient is a 53-\nyear-old female with a history of a late surgical procedure, an\nabdominoperineal resection of the rectum via robotic sur-\ngery due to rectal cancer. The perineal hernia repair surgery\nwas performed through an abdominal approach using the Da\nVinci X robotic platform and also through the perineal\napproach to reduce the herniated content. A Proceed Ethicon\nmesh was used to fill the pelvis. During the release of the\nbowel loops, there was an inadvertent injury to an ileal loop,\nwhich was managed with simple sutures. In the postopera-\ntive period, the patient developed adynamic ileus, which\nresolved with clinical treatment, and she was discharged\non the fifth day post-surgery. The robotic technique for\nperineal hernia repair is feasible and safe, even when per-\nformed in a training setting, as was the case in our study.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141783\nOpen Videos\nRESCUE SURGERY IN LOW RECTAL CANCER WITH\nRECURRENCE IN PELVIC AND INGUINAL LYMPH NODES, BOTH\nVIA MINIMALLY INVASIVE APPROACH\nPedro Costa Moreira 1, Felipe Daldegan Diniz 1, Carlos Augusto\nRodrigues Veo1, Luis Gustavo Capochin Romagnolo 1, Marcos\nVinicius Araujo Denadai 1, Rodrigo Giacomini Bregeiro 1\n1Hospital de Amor, Barretos, Brasil\nIntroduction Low rectal cancer is a challenging con-\ndition, particularly when a patient experiences recurrence\nafter neoadjuvant treatment and initial surgery. This video\npresents a case of low rectal cancer with recurrence in pelvic\nand inguinal lymph nodes, and describes the minimally\ninvasive surgical approach for pelvic lateral lymphadenecto-\nmy and also for inguinal lymphadenectomy.\nObjectives To demonstrate the technique and out-\ncomes of both pelvic lateral and inguinal lymphadenectomy\nvia minimally invasive approach in a patient with recurrence\nof low rectal cancer.\nMethods A 68-year-old male patient, diagnosed with\nadenocarcinoma of the low rectum, underwent neoadjuvant\nchemotherapy and radiotherapy followed by abdominoperi-\nneal amputation of the rectum. Subsequently, he developed\nrecurrence in the right lateral pelvic and right inguinal lymph\nnodes. A rescue surgery was performed with right pelvic lateral\nlymphadenectomy via videolaparoscopy and right inguinal\nlymphadenectomy via minimally invasive approach, an inno-\nvative technique for performing this lymphadenectomy.\nResults The video demonstrates the detailed surgical\ntechnique for both pelvic lateral and inguinal lymphadenec -\ntomy, including how to perform inguinal lymphadenectomy\nvia minimally invasive approach, patient positioning, ana-\ntomical marking, dissection, and removal of affected lymph\nnodes. The surgery was successful, with complete removal of\nthe recurrent lymph nodes and no signi ficant post-operative\ncomplications. The minimally invasive approach proved ef-\nfective in reducing hospitalization time and promoting post-\noperative recovery.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS118\n\n\nConclusion Minimally invasive pelvic lateral and\ninguinal lymphadenectomy is an effective and safe approach\nfor patients with recurrence of low rectal cancer in pelvic and\ninguinal lymph nodes. This video illustrates the surgical\ntechniques and benefits of this approach in the management\nof nodal recurrences.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138206\nOpen Videos\nOPTIMAL CYTOREDUCTION ASSOCIATED WITH HIPEC: A\nBENEFICIAL TREATMENT FOR PSEUDOMYXOMA PERITONEI\nIN SELECTED CASES\nVitoria Vicentin Giordano 1, Vitoria Vicentin Giordano 1, Caio\nNasser Mancini2, Natalia Ferreira Cardoso de Oliveira1, Gabriela\nde Carvalho Simoes da Fonseca 1, Fernanda Bellotti Formiga 1,\nFang Chia Bin 1, Carolina Pontes de Moraes Hungria 1\n1Santa Casa de São Paulo, São Paulo, Brasil\n2AC Camargo, São Paulo, Brasil\nCase Presentation A 61-year-old female, under on-\ncological follow-up for mucinous neoplasm of the appendix\nsince 2018, developed pseudomyxoma peritonei. She under-\nwent two lines of chemotherapy treatment, which had to be\ninterrupted in 2022 due to severe toxicity. She developed an\nincrease in carcinoembryonic antigen (CEA) after suspension\nof systemic treatment, along with worsening abdominal pain,\nassociated with a palpable tumor. In the intraoperative peri-\nod, a peritoneal carcinomatosis index (PCI) of 13 was identi-\nfied, and she underwent total resection of the right\ndiaphragm peritoneum and partial resection of the left dia-\nphragm, resection of the caudate lobe, falciform ligament,\npelvic peritoneum, implants from the hepatic capsule, ab-\ndominal wall, and sigmoid, in addition to splenectomy,\nomentectomy, cholecystectomy, and total hysterectomy. Op-\ntimal cytoreduction and hyperthermic intraperitoneal che-\nmotherapy (HIPEC) were performed, with good clinical\nprogression and hospital discharge on the seventh postoper-\native day. She required readmission after 30 days due to a\ncollection in the splenectomy pouch, diagnosed as a pancre-\natic fistula, which was drained by radiointervention, with\nimprovement after antibiotic therapy. She is currently under\noutpatient follow-up, with resolution of the collection in a\ncontrol CT scan and no abdominal complaints.\nDiscussion Pseudomyxoma peritonei is the progres-\nsive accumulation of mucinous ascites in the abdominal\ncavity, highly associated with mucinous neoplasms of the\ncecal appendix. Its incidence is low, with 1-3 cases per million\ninhabitants. Initially, disseminated peritoneal disease was\nsynonymous with a terminal condition and exclusive pallia-\ntive treatment. However, in selected cases, it is possible to\nperform cytoreductive surgery, which involves complete\nresection of macroscopic lesions, combined with HIPEC,\naimed at eradicating microscopic tumor lesions, thereby\nsubjecting the patient to curative-intention treatment. For\nthis, it is necessary to evaluate the patient ’s baseline con-\nditions, the type of tumor, its response to chemotherapy, and\nthe PCI. It is a major surgery with high morbidity and\nmortality, so careful patient selection is required to ensure\ntherapeutic benefit.\nConclusion Patients with good performance status\nand low peritoneal carcinomatosis index are the best candi-\ndates for cytoreduction and HIPEC.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141735\nOpen Videos\nLAPAROSCOPIC RIGHT HEMICOLECTOMY COMBINED WITH\nPARTIAL DUODENAL RESECTION FOR THE TREATMENT OF\nASCENDING COLON ADENOCARCINOMA\nRodrigo Gomes da Silva1, Magda Maria Profeta da Luz 1, Renato\nGomes Campanati 1, Luiza Rogerio 1, Cleo Gonçalves Trindade\nRibeiro1, Kelly Cristine Lacerda Rodrigues Buzzati 1, Giovane\nBotelho Bacelar1, Bernardo Hanan 1\n1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo\nHorizonte, Brasil\nIntroduction Ascending colon tumors, when locally\nadvanced, may invade adjacent vital structures, posing a\nchallenge for oncologically adequate resection. For an ade-\nquate margin, it is often necessary to resect contiguous\norgans, and performing this by minimally invasive techniques\ncan be complex.\nObjectives Surgical description of oncological right\nhemicolectomy where the tumor was pinching the duode-\nnum, requiring partial enterectomy for R0 resection.\nMethods A 64-year-old patient presented with severe\nabdominal pain and signi ficant weight loss. A colonoscopy\nrevealed a stenosing and in filtrative lesion, likely in the\nascending colon, with an adenocarcinoma diagnosis. Staging\nimages confirmed a tumor in the ascending colon and multi-\nple lesions suggestive of liver metastases. Due to obstructive\nsymptoms, a minimally invasive approach to the colon was\nchosen. During the cavity exploration, a large tumor was\nidentified, pinching the duodenum in its third portion. It was\ndecided to proceed with the standard dissection until isolat-\ning the area of duodenal invasion and perform tangential\nstapling of the duodenum to release the specimen with\nadequate oncological margins.\nResults Partial duodenal enterectomy with the assis-\ntance of an endostapler proved to be an effective alternative\nfor a surgery with clear margins, allowing the patient to\nrecover quickly and continue with oncological treatment.\nConclusion Tangential invasion of adjacent structures\ncan be managed by minimally invasive techniques with good\noncological outcomes and no adverse effects on the patient ’s\nrecovery.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S119\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138301\nOpen Videos\nRIGHT HEMICOLECTOMY WITH D3 LYMPHADENECTOMY:\nDEMONSTRATION OF THE TECHNIQUE IN LAPAROSCOPIC\nONCOLOGICAL SURGERY\nLeonardo Ervolino Corbi 1, Giovanna Cardoso de Oliveira 2,\nFelipe Giraldo Alvarez Gonçalves 2, Bruno Damico Terada 2,\nGuilherme Pagin São Julião 1, Bruna Borba Vailati 1, Angelita\nHabr-Gama3, Rodrigo Oliva Perez 1\n1Hospital Alemão Oswaldo Cruz & Bene ficência Portuguesa de São\nPaulo, São Paulo, Brasil\n2Faculdade de Medicina da Universidade de São Paulo, São Paulo,\nBrasil\n3Hospital Alemão Oswaldo Cruz, São Paulo, Brasil\nIntroduction The increasing incidence of colon can-\ncer, particularly diagnosed in elderly patients, intensi fies the\ndebate over surgical treatments. Right hemicolectomy with\nD3 lymphadenectomy performed laparoscopically is a safe\noption with excellent oncological outcomes for patients.\nObjective The goal of this video is to demonstrate the\ndetails of the technique used for the resection of a cancer in\nthe ascending colon through right hemicolectomy with D3\nlymphadenectomy via laparoscopy.\nCase Presentation A 79-year-old male patient with\nhypertension and diabetes presented with asthenia and\nweakness. Laboratory tests con firmed anemia, and colonos-\ncopy revealed a lesion in the right colon. No secondary lesions\nwere detected on staging via CT scan. The decision was made\nto perform right hemicolectomy with D3 lymphadenectomy\nlaparoscopically, which allows for the dissection of lymph\nnodes from the origin to the terminal branch of the main\nartery supplying the tumor. The pathological analysis of the\nresected segment revealed tubular adenocarcinoma with\npT3pN0 staging and no neoplastic involvement in the lymph\nnodes (0 out of 32 lymph nodes). The patient progressed well\npostoperatively, with no complications, and was discharged\non the 6th day.\nDiscussion D3 lymphadenectomy in right hemicolec -\ntomy for tumors of the ascending colon is a technically\nchallenging procedure that requires detailed knowledge of\nsurgical anatomy and careful dissection. With studies already\nsuggesting its oncological importance, it is vital to study its\nsteps to familiarize colorectal surgeons with this approach.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141672\nOpen Videos\nLAPAROSCOPIC RIGHT HEMICOLECTOMY WITH COMPLETE\nEXCISION OF THE MESOCOLON\nGiovana Moreira Minchillo1, Rodrigo Moises de Almeida Leite 1,\nFrancisco Tustumi1, Rafael Vaz Pandini 1, Victor Edmond Seid 1,\nSergio Eduardo Alonso Araujo 1, Lucas Soares Gerbasi 1, Elis\nOliveira1\n1Hospital Israelita Albert Einstein, São Paulo, Brasil\nCase Presentation Patient: O.M.L, 69 years old, pre-\nsented with melena, weakness for about a year, and a 10 kg\nweight loss over the past month. Colonoscopy revealed an\nextensive vegetating lesion in the cecum, 8 cm in size, with\nhistopathology compatible with adenocarcinoma. Initial\nexams showed a CEA of 2.2, no distant metastases, and a\nCT scan of the abdomen revealed suspected lymphadenopa-\nthy at the root of the superior mesenteric vessels. The patient\nunderwent right hemicolectomy with complete mesocolon\nexcision (CME) and creation of an isoperistaltic side-to-side\nileotransversoanastomosis intracorporeally via laparoscopy.\nThe specimen was removed through a transverse suprapubic\nincision. The histopathological examination of the surgical\nspecimen revealed medullary carcinoma of the right colon –\npT3pN0 (00/61). The patient was discharged on the third\npostoperative day and is under oncological follow-up.\nDiscussion Complete mesocolon excision in the treat-\nment of colon cancer was introduced to ensure inclusion of\nthe central lymph nodes during lymphadenectomy at the\nvascular root. The procedure involves separating the meso-\ncolic and parietal planes, exposing the superior mesenteric\nvein to dissect all lymphatic tissue and performing central\nligation of the colic vessels and Henle ’s trunk vessels, includ-\ning potentially involved lymph nodes. Special attention must\nbe given during lymphadenectomy, which should only in-\nvolve the lateral side of the superior mesenteric vein while\npreserving the gastric colic trunk vessels.\nConclusion In the management of advanced right\ncolon cancer, complete mesocolon excision with central\nligation of the vessels plays a key role in ensuring proper\noncological surgery for large tumors with suspected lymph\nnodes at the root of the mesentery. In our practice, this\ntechnique is performed selectively, not routinely. This video\ndemonstrates that the laparoscopic approach is feasible and\nsafe; however, due to the higher technical dif ficulty and\npotential bleeding, the surgeon ’s skill and knowledge of the\nanatomical structures are crucial for the quality and safety of\nthe procedure.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141802\nOpen Videos\nLEFT HEMICOLECTOMY WITH PRESERVATION OF THE\nINFERIOR MESENTERIC VEIN THROUGHOUT ITS ENTIRE\nLENGTH\nElis Oliveira1, Rafael Vaz Pandini 1, Giovana Moreira Minchillo 1,\nRodrigo Moises Almeida Leite 1, Francisco Tustumi1, Lucas\nSoares Gerbasi1, Victor Edmond Seid 1, Sergio Eduardo Alonso\nAraujo1\n1Hospital Israelita Albert Einstein, São Paulo, Brasil\n68 years old, female. Complaints of dark stools and\npositive occult blood test. No changes upon examination.\nColonoscopy showed a polypoid, ulcerated lesion in the\nproximal descending colon, 30 mm, with endoscopic tattoo-\ning and histopathology consistent with adenocarcinoma.\nStaging exams: CEA 1.85, chest CT unremarkable, abdomi-\nnal/pelvic CT showed parietal thickening at the splenic flex-\nure, 2.2 cm. Laparoscopic left hemicolectomy was performed\nwith intracorporeal anastomosis and preservation of the\ninferior mesenteric vein. The patient progressed well and\nwas discharged on the 4th postoperative day. Surgical\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS120\n\n\npathology: invasive and ulcerated adenocarcinoma, free mar-\ngins, pT3pN0(0/20) lymph nodes. The patient is under oncol-\nogical follow-up. The video shows a laparoscopic left\nhemicolectomy, with the patient positioned in the right\nlateral decubitus position. The retroperitoneal dissection\nbegan from the inferior mesenteric vein, with reference to\nthe Treitz angle, detaching the mesocolon from Gerota’s fascia\nand the pancreas, providing access to the retrocavity of the\nomentum. Preservation of the inferior mesenteric vein\nthroughout its length was chosen. Dissection continued to\nthe splenic flexure, freeing the left paracolic gutter. The\ntumor in the proximal descending colon was sealed at the\norigin of the left colic artery, preserving the inferior mesen-\nteric artery and the left branch of the middle colic artery at its\norigin. The proximal and distal margins of the tumor were\ndefined, the colon was sectioned, and an intracorporeal\nlatero-lateral anastomosis was performed with closure of\nthe breach using V-Loc 3.\nDiscussion Cancers of the distal transverse colon,\nproximal descending colon, and splenic flexure account for\n<10% of all colorectal cancers. Left hemicolectomy is the\nprocedure of choice, as studies suggest that lymphadenecto-\nmy is adequate and suf ficient with ligation of the left colic\nartery and the left branch of the middle colic artery at their\norigin. However, ligation of the inferior mesenteric vein is not\nperformed for oncological purposes, but rather for better\nmobilization of the colon to achieve a tension-free anasto-\nmosis. If the ligation of the inferior mesenteric vein is close to\nits root, it may impair venous return. Colonic ischemia after\nsurgery is a serious complication resulting from arterioscle-\nrosis, functional disorders, and venous congestion due to poor\nblood circulation\nConclusion Venous congestion may result in anasto-\nmotic dehiscence, worsening morbidity and mortality of the\nprocedure. Therefore, this technique aims to improve venous\nreturn and reduce rates of late dehiscence.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141751\nOpen Videos\nSEGMENTAL LEFT HEMICOLECTOMY AT THE SPLENIC\nFLEXURE: ANATOMICAL LANDMARKS AND\nINTRACORPOREAL ANASTOMOSIS TECHNIQUE\nRodrigo Gomes da Silva\n1, Magda Maria Profeta da Luz 1, Kelly\nCristine Lacerda Rodrigues Buzatti 1, Renato Gomes\nCampanati1, Bernardo Hanan 1, Luiza Rogerio 1, Cleo Gonçalves\nTrindade Ribeiro1, Giovane Botelho Bacelar 1\n1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo\nHorizonte, Brasil\nIntroduction Tumors located at the splenic flexure\npresent a challenge for surgeons due to the absence of a\ndefined standard approach. Differences in vascularization\nand drainage areas (between mesenteric territories) create\nthe possibility for different techniques, and even the de fini-\ntion of the splenic flexure boundaries can vary in the\nliterature.\nObjectives To provide a standardized surgical de-\nscription of segmental left colectomy with anatomical land-\nmarks and the performance of an intracorporeal anastomosis.\nMethods A 66-year-old patient presented with col-\nicky abdominal pain, associated with hematochezia and a\nweight loss of 6kg in 1 month. A colonoscopy revealed a\nstenosing lesion in the descending colon – with an adenocar-\ncinoma diagnosis. Staging CT scans showed the tumor located\nat the splenic flexure of the colon, and a decision was made to\nperform a segmental left colectomy via minimally invasive\nsurgery. A standard dissection was performed with ligation of\nthe inferior mesenteric vein and left colic artery, followed by\nan intracorporeal isoperistaltic anastomosis between the\nmedial transverse colon and lateral sigmoid colon.\nResults The standardized approach with ligation of\nthe inferior mesenteric vein and only the left colic artery\nallows for adequate colon mobilization while preserving\ncritical vascularization at the drainage point, which is the\nsplenic flexure. The anastomosis was performed without\ntension, and the patient had a good postoperative outcome.\nConclusion A standardized technique for approach-\ning tumors at the splenicflexure may lead to better outcomes,\nwith lower rates of surgical complications in patients with\ntumors at the splenic flexure.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138207\nOpen Videos\nLAPAROSCOPIC COLECTOMY USING THE N.O.S.E. TECHNIQUE\n- VIDEO\nVictória Mara Vieira Rocha 1, Luis Eduardo Braz de Moraes\nAlves1, Bárbara Klyslie Kato 2, Luiza Soares Guerra 1, Millene\nGonzalez Manente 2, Bernardo Fontel Pompeu 1, Fábio Israel\nMarques1, Luiz Fernando Paes Leme 1\n1Hospital Heliópolis, São Paulo, Brasil\n2Universidade de São Caetano do Sul, São Caetano do Sul, Brasil\nIntroduction The “Natural Ori fice Specimen Extrac -\ntion” (N.O.S.E.) technique offers bene fits when properly\nindicated, but its use is not yet routine. It results in less\npain, reduced medication needs, and quicker return to intes-\ntinal activity compared to conventional open colectomy.\nCase Presentation A 48-year-old female patient pre-\nsented with a six-month history of blood in her stool.\nColonoscopy revealed a friable, hardened, 5 cm lesion at\nthe rectosigmoid junction, without causing stenosis. A lapa-\nroscopic approach using the N.O.S.E. technique was chosen.\nThe specimen was extracted transrectally without requiring\nan abdominal incision. A colorectal anastomosis was per-\nformed intracorporeally. The procedure was a laparoscopic\nleft colectomy with N.O.S.E. Pneumoperitoneum was estab-\nlished using the Hasson technique, supraumbilically, with a\n10mm trocar and the introduction of the optics. Four more\ntrocars were placed: a 12mm trocar in the right iliac fossa\n(P2), 5mm trocars in the right hypochondrium (P3), left\nhypochondrium (P4), and left iliac fossa (P5). The inferior\nmesenteric vein was identified, and subsequent dissection of\nthe peritoneum in the paraduodenal fossa was performed.\nThe inferior mesenteric vein was ligated with two LT-300\nclips and a bipolar clamp. The sigmoid colon and descending\ncolon were mobilized up to the splenic flexure along the left\nlateral wall, with separation of the left ureter and gonadal\nvessels. Linear stapling was performed with at least a 5cm\nmargin proximal and distal to the tumor. The distal stapler\nline was removed, and a Forrester clamp was inserted\nthrough the rectum to extract the surgical specimen. A\ncircular stapler was introduced through the rectum to\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S121\n\n\nperform a mechanical end-to-end anastomosis. The leak test\nwas negative. The pathology report indicated a 4.0 cm inva-\nsive adenocarcinoma, grade G2, in filtrating into the peri-\nintestinal adipose tissue, with no vascular or perineural\ninvasion. Peritumoral in flammatory in filtrate was present.\nSurgical margins were clear, and no lymph node involvement\nwas found (0/17). Pathological staging was pT3pN0.\nDiscussion The N.O.S.E. technique offers advantages\nsuch as less postoperative pain and a shorter duration of\nmetabolic ileus. Surgical specimens are smaller (less than\n6.5cm), with minimal mesorectal thickening. Given the aes-\nthetic appeal and the patient’s suitability for this technique, it\nwas chosen for the surgery. While still not widely used, it is a\ngood option for colorectal surgeries.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 134792\nOpen Videos\nCORRECTION OF COMPLETE COLORECTAL ANASTOMOSIS\nSTENOSIS BY TRANSANAL STENOPLASTY WITH SINGLE-PORT\nAND MECHANICAL REANASTOMOSIS ASSISTED BY\nILEOCOLONOSCOPY\nGiovanna Savoy Pazin 1, Michel Gardere Camargo 1, Mayara\nMarina Sousa Senzano 1, Philipe Franco Do Amaral Tafner 1,\nMaria de Lourdes Setsuko Ayrizono 1, Raquel Franco Leal 1,\nClaudio Saddy Rodrigues Coy 1, Carlos Augusto Real Martinez 1\n1Universidade Estadual de Campinas, Campinas, Brasil\nCase Presentation A 43-year-old male patient under-\nwent laparoscopic anterior rectal resection with total meso-\nrectal excision (TME) for treatment of a serrated adenoma,\nmeasuring 7 cm in diameter, located 10 cm from the anal\nmargin, which was not amenable to resection by colonoscopy.\nThe patient underwent a retossigmoidectomy with TME and\nmechanical colorectal anastomosis, 8 cm from the anal\nmargin, with a protective ileostomy. The patient was dis-\ncharged on the 7th postoperative day. Due to the Covid-19\npandemic, the patient returned for follow-up two years after\nsurgery. At this time, a digital rectal exam showed complete\nanastomotic stenosis. The stenosis could not be corrected\nwith pneumatic balloons or metallic dilators, as it was\ncomplete. A computed tomography scan with iodinated\ncontrast administered through the efferent loop of the ileos-\ntomy and the anus showed that the stenosis of the anasto-\nmosis (SA) was less than 1 cm in length and was located at the\nstapler line. The decision was made to correct the SA through\na transanal approach with a single-port (SILS™ Port), assisted\nby colonoscopy performed via the efferent loop of the ileos-\ntomy. After performing transanal circular strictureplasty\nwith a monopolar hook, a circular stapler No. 29 was intro-\nduced through the anus, guided by colonoscopy, so that the\nstapler’s anvil was positioned above the strictureplasty and\nthe stapler ’s body below. After stapling, the integrity of the\nnew anastomosis was confirmed via colonoscopy. The patient\nhad a satisfactory postoperative course and was discharged\non the first postoperative day. Three months later, the\nileostomy was closed. The patient is currently under outpa-\ntient follow-up with no signs of recurrence of the stenosis.\nDiscussion TME is the most commonly used surgical\nprocedure for the treatment of locally advanced rectal cancer.\nHowever, complications related to extraperitoneal colorectal\nanastomosis may occur. Anastomotic stenosis (AS) represents\nthe second most severe complication, and various techniques\nfor its correction have been proposed. We describe a tech-\nnique that has been successfully reported for the treatment of\ncomplete benign anastomotic strictures following TME,\nwhich are dif ficult and recurrent.\nConclusion The treatment of low colorectal anasto-\nmotic stenosis can be successfully performed through transa-\nnal strictureplasty with a single-port approach followed by a\nnew mechanical anastomosis assisted by enterocolonoscopy.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141749\nOpen Videos\nDETAILS OF TOTAL MESORECTAL EXCISION IN COMBINED\nAPPROACH: LAPAROSCOPIC þ TEO\nRodrigo Gomes da Silva 1, Cleo Gonçalves Trindade Ribeiro 1,\nBernardo Hanan 1, Magda Maria Profeta da Luz 1, Kelly Cristine\nLacerda Rodrigues Buzatti 1, Renato Gomes Campanati 1, Luiza\nRogerio1, Mariana Alves Santana de Araújo 1\n1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo\nHorizonte, Brasil\nIntroduction It is estimated that in 2023, Brasil\nregistered more than 45,000 cases of colorectal cancer. The\nstandardization of the total mesorectal excision technique by\nHeald in 1982, which involves precise dissection of the\nmesorectal fascia and removal of an intact specimen, led to\na decline in local recurrence rates from 30% to 5%. Addition-\nally, the use of laparoscopy combined with the TEO platform\nin distal rectal cancer surgeries, besides ensuring a good\npostoperative recovery, can facilitate the dissection with total\nmesorectal excision and careful rectal sectioning, especially\nin cases requiring manual coloanal anastomosis.\nObjectives To demonstrate the combined technique\nof laparoscopy and the TEO platform as an option that may\nresult in more careful surgery in patients with distal rectal\ntumors requiring total mesorectal excision.\nMethods A 78-year-old patient presented with a histo-\nry of hematochezia for 5 years. Colonoscopy indicated a vegeta-\ntive and ulcerated lesion on the posterior wall of the rectum\nabout 2 cm from the anal margin, with histopathological\ndiagnosis of adenocarcinoma. Staging MRI showed a T2N0\ntumor, and thoracic and abdominal CT scans showed no evi-\ndence of distant disease. A decision was made to proceed with\nupfront surgery, performed laparoscopically combined with the\nTEO platform for appropriate mesorectal dissection at the most\ndistal portion, without violation, and distal rectal sectioning.\nResults The use of videolaparoscopy for the abdomi-\nnal portion allowed for sharp dissection of the mesorectal\nplane, obtaining an intact mesorectum, preservation of\nnerves and autonomic plexuses, and appropriate distal mes-\norectal clearing. In addition, the use of the TEO platform\nensured careful sectioning under direct vision of the anal\ncanal, preserving the tissues for the manual coloanal\nanastomosis.\nConclusion The combination of less invasive surgical\ntechniques, such as videolaparoscopy and the TEO platform,\ncan contribute to the careful and intact dissection of the\nmesorectum, as well as ensuring better postoperative recov-\nery for the patient.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS122\n\n\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138212\nOpen Videos\nRIGHT HEMICOLECTOMY WITH COMPLETE EXCISION OF THE\nMESOCOLON VIA ROBOTIC APPROACH\nMichel Gardere Camargo 1, Marcos Vinícius Araújo Denadai 2,\nLuis Gustavo Capochin Romagnolo 2, Carlos Augusto Rodrigues\nVeo2, Rodrigo Giacomini Brejeiro 2, Felipe Daldegan Diniz 2,\nMayara Marina Sousa Senzano 1, Michel Gardere Camargo 1\n1Universidade Estadual de Campinas, Campinas, Brasil\n2Hospital do Amor, Barretos, Brasil\nThis free video aims to demonstrate the surgical\ntechnique of right hemicolectomy with complete excision\nof the mesocolon via a robotic approach. The procedure was\nperformed at the Hospital do Amor in Barretos/SP during the\nRobotic Colorectal Surgery Certi fication Program. The sur-\ngery was conducted on a 63-year-old male patient with an\nascending colon tumor classified as adenocarcinoma, accom-\npanied by a lymph node mass located near the inferior\nmesenteric vessels. Preoperative staging showed no distant\nmetastases. The procedure involved a right hemicolectomy\nwith complete mesocolon excision and lymphadenectomy of\nthe superior mesenteric vessels, followed by an isoperistaltic\nileocolic mechanical anastomosis using the Da Vinci X robotic\nplatform. The patient was discharged on the third postoper-\native day without early or late complications. Robotic surgery\nhas proven to be both feasible and safe for complex proce-\ndures, even in training environments, as demonstrated in this\ncase.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138155\nOpen Videos\nLATERAL LYMPHADENECTOMY VIA ROBOTIC APPROACH IN\nCOLORECTAL CANCER\nJuliana Chaves Brandão 1, Rodrigo Rego Lins 1, Leonardo\nMachado de Castro1, Rodrigo Rocha Rodrigues1, Camila Tobias\nQueiroz1, Ana Luiza de Oliveira Nelaton1, Paulo Cesar de Castro\nJúnio1\n1Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brasil\nMS, a 54-year-old female, sought proctological care\ndue to intestinal constipation with ribbon-like stools and\nhematochezia that began two months earlier. Colonoscopy\nidentified an infiltrative and ulcerated lesion approximately 4\ncm from the anal margin, occupying 45% of the lumen.\nSubsequent histopathology confirmed a diagnosis of moder-\nately differentiated adenocarcinoma. Pelvic MRI revealed a\ncrescent-shaped infiltrative lesion in the anterior rectal wall,\nlocated 6 cm from the anorectal margin, showing signs of\nextension beyond the muscular layer, compromising the\nmesorectal fascia anteriorly to the left. Additionally, suspi-\ncious lymphadenopathy was identi fied in the external iliac\nand obturator chains on the left, measuring 2.1 cm, as well as\nin bilateral inguinal nodes. Neoadjuvant therapy with che-\nmotherapy (capecitabine) and radiotherapy (5040/28) was\ninitiated and completed in July 2022. A digital rectal exam\nperformed post-neoadjuvant therapy showed a palpable\nlesion 4 cm from the anal margin, semicircumferential on\nthe left lateral wall. A follow-up MRI performed 24 weeks\npost-treatment (February 2023) revealed the lesion now\nlocated 6.9 cm from the anal margin, in filtrating mesorectal\nfat at the 3 o ’clock position with a radial extension of 6 mm,\nwithout evident signs of mesorectal fascia in filtration. The\nsuspicious lymphadenopathies in the left iliac chain and\nbilateral inguinal regions persisted. ue to family reasons,\nthe patient opted to delay surgical management, resuming\nfollow-up at the end of 2023. A new MRI conducted 62 weeks\nafter neoadjuvant therapy (November 2023) demonstrated\nprogression of the lesion, now located 5 cm from the anal\nmargin and 1.5 cm from the anorectal junction, with involve-\nment of the left lateral mesorectal fascia and a suspicious\nlymph node in the left obturator chain. In December 2023, the\npatient underwent abdominoperineal amputation with ro-\nbotic lateral lymphadenectomy. Histopathological analysis\nconfirmed adenocarcinoma with vascular and perineural\ninvasion and high tumor budding scores. Surgical margins\nwere clear, but 13 lymph nodes in the main specimen were\ninvolved. The histopathology of the lateral lymphadenectomy\nrevealed metastasis of adenocarcinoma in 3 lymph nodes.\nCurrently, MS is undergoing adjuvant chemotherapy and\nremains under follow-up with the proctology team. This\ncase includes an intraoperative video presentation of robotic\nlateral lymphadenectomy.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138267\nOpen Videos\nDELOYERS’ MANEUVER FOR COLORECTAL ANASTOMOSIS:\nWHAT CAN WE DO WHEN THE COLON CANNOT BE\nLOWERED?\nLeonardo Ervolino Corbi 1, Felipe Giraldo Alvarez Gonçalves 2,\nBruno Damico Terada 2, Artur de Souza Almeida 2, Guilherme\nPagin São Julião 1, Bruna Borba Vailati 1, Angelita Habr-Gama 3,\nRodrigo Oliva Perez 1\n1Hospital Alemão Oswaldo Cruz & Bene ficência Portuguesa de São\nPaulo, São Paulo, Brasil\n2Faculdade de Medicina da Universidade de São Paulo, São Paulo,\nBrasil\n3Hospital Alemão Oswaldo Cruz, São Paulo, Brasil\nIntroduction This video presents the Deloyers ’ Ma-\nneuver, which involves the mobilization and counterclock-\nwise rotation of the right colon followed by an anastomosis\nwith the rectum. This procedure may be necessary after\nextensive colon resections when lowering the transverse\ncolon alone is not feasible due to tension.\nObjective To provide a didactic and replicable dem-\nonstration of the Deloyers ’ procedure after extensive\ncolectomy.\nCase Presentation A patient presented with com-\nplaints of rectal bleeding and underwent a colonoscopy,\nwhich revealed synchronous lesions in the rectum and left\ncolon. Staging for colorectal cancer showed no evidence of\ndistant metastases, and MRI indicated T2N0 malignancy in\nthe rectum. Combined resection of both lesions was planned.\nDuring surgery, the high tension in the lowered transverse\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S123\n\n\ncolon prevented a safe colorectal anastomosis, making the\nDeloyers’ Maneuver necessary.\nThe VideoThe video demonstrates the procedure step\nby step in a didactic manner, showcasing this important\nmaneuver, which is not typically the first choice in standard\ncolorectal resections. It is reserved for more complex cases,\nparticularly in extensive colectomies. The video illustrates\nthe full mobilization of the right paracolic gutter, the coun-\nterclockwise rotation of the ascending colon, and the me-\nchanical anastomosis with the rectum using a 29mm circular\nstapler.\nConclusion In colorectal surgery, the Deloyers ’ Ma-\nneuver is an essential tool for colorectal surgeons, offering\none of the most critical strategies to avoid tensioned anasto-\nmoses in extensive colorectal resections. This safe and repro-\nducible technique enables adequate colorectal anastomosis\nin challenging cases.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141154\nOpen Videos\nMULTIVISCERAL ROBOTIC RESECTION: LEFT HEPATECTOMY\nAND RECTOSIGMOIDECTOMY\nDaniel de Barcellos Azambuja 1, Bruna Oliveira Trindade2, Fares\nHassan Hamaoui1, Antônio Nocchi Kalil 1, Cristina Calloni 3\n1Santa Casa de Porto Alegre, Porto Alegre, Brasil\n2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto\nAlegre, Brasil\n3Universidade Feevale, Novo Hamburgo, Brasil\nThis video presents a unique case of multivisceral\nrobotic resection, involving a left hepatectomy and rectosig-\nmoidectomy, performed using the da Vinci Xi robotic plat-\nform. The patient was diagnosed with a sigmoid tumor and a\nsolitary metastasis in the left hepatic lobe. This innovative\nsurgical strategy demonstrates the simultaneous approach to\nmanaging multifocal malignancies with advanced robotic\ntechnology. The hepatectomy began with the mobilization\nof the left hepatic lobe through the dissection of the triangu-\nlar ligaments, providing adequate exposure to the liver seg-\nments. Parenchymal dissection targeted the second and third\nsegments, using monopolar and bipolar forceps. The careful\nand controlled dissection minimized blood loss and pre-\nserved as much healthy liver tissue as possible. A laparoscopic\nstapler completed the hepatic parenchyma resection, ensur-\ning thorough liberation of the surgical specimen. The recto-\nsigmoidectomy involved the strategic mobilization of the\nlateral colon wall, with exposure and ligation of critical blood\nvessels. A linear stapler resected the lesion, effectively sepa-\nrating the surgical specimen from the remaining colon. After\nsectioning the colon, the specimen was carefully removed,\nand an anastomosis was performed using a circular stapler,\nensuring a secure and functional reconnection of the colon.\nThis case showcases the utilization of the da Vinci Xi robotic\nplatform with a single docking technique, allowing for simul-\ntaneous resection of both hepatic and colorectal lesions. This\napproach offers several unique advantages: unparalleled\nprecision and control, reduced operative time, preservation\nof healthy tissues, and a minimally invasive procedure that\nresults in reduced postoperative pain, shorter hospital stays,\nand faster recovery times compared to traditional surgeries.\nThe innovative surgical strategy integrates cutting-edge tech-\nnology with expert techniques to effectively treat multifocal\nand complex tumors. Overall, this video serves as a valuable\neducational resource for surgeons and medical professionals,\nhighlighting the potential and effectiveness of robotic -\nassisted surgery in managing complex oncological cases. It\nillustrates the future direction of surgical oncology, where\nprecision, innovation, and minimally invasive techniques\nimprove patient outcomes.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141676\nOpen Videos\nPROPOSAL FOR STANDARDIZATION OF TOTAL MESORECTAL\nEXCISION SURGERY ON THE ROBOTIC PLATFORM\nFabio Lopes Queiroz 1, Marina Barbabela Grisolia de Oliveira 1,\nHélida Aline Tomacheski Amaral 1, Paola Monção 2, Leticia\nBrandão Castro3, Artur Duarte Duarte 1\n1Hospital Felício Rocho, Belo Horizonte, Brasil\n2Hospital Mater de\n3Hospital Mater Dei\nIntroduction The robotic platform has been estab-\nlished with the aim of minimizing the dif ficulties associated\nwith videolaparoscopy. However, despite these promises,\nrobotic surgery (RS) is still not standardized in some special-\nties and surgical techniques, mainly due to the dif ficulty of\naccess to technology. Unlike videolaparoscopy, which has a\nstandardized technique, usually involving dissection of the\nmesocolon and retrocavity from medial to lateral, through a\nhigh-resolution video of total mesorectal excision surgery on\nthe robotic platform, we propose identifying the ureter and\ndissecting the parietocolic gutter and retrocavity from lateral\nto medial.\nMethod Demonstration of surgical steps through a\nhigh-resolution video of total mesorectal excision surgery.\nThe proposed steps of the surgery are: laparoscopy with\ncavity inventory, robot docking, identification and dissection\nof the inferior mesenteric vein (IMV), opening of the retro-\ncavity above the IMV followed by ligation, pancreas and\nretroperitoneum release, transverse colon and splenicflexure\nrelease, repositioning of the patient and re-docking with\nrelease of the descending colon and sigmoid and identi fica-\ntion of the ureter from lateral to medial, mesocolon dissection\nuntil identi fication of the inferior mesenteric artery (IMA),\nmedial exposure of the IMA followed by its dissection and\nligation, dissection and preservation of the hypogastric\nnerves, mesorectal dissection down to the pelvic floor, rectal\nresection with endo-stapler, specimen removal, colo-anal\nanastomosis with circular stapler, methylene blue test.\nDiscussion The lateral-to-medial approach, per-\nformed in laparotomy, was not reproduced in videolaparo-\nscopic surgery mainly due to the dif ficulty of exposure and\nthe limited movement range of the camera and forceps to\nperform safe lateral dissection. In our experience, the robotic\nplatform and the endowrist technology, coupled with three-\ndimensional vision, enable dissection of the parietocolic\ngutter and safe identi fication of the left ureter from lateral\nto medial, also facilitating the medial dissection of the IMA\nwith preservation of the mesocolic plane.\nConclusion We propose these surgical steps with the\naim of standardizing and facilitating the training of new\nsurgeons, as the standardized technique compartmentalizes\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS124\n\n\nand organizes intraoperative care, enhancing the safety of the\nprocedure.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141156\nOpen Videos\nSYNCHRONOUS RESECTION OF GIST IN THE RECTUM AND\nPROSTATIC ADENOCARCINOMA WITH THE DA VINCI ROBOTIC\nPLATFORM\nRodrigo Moisés de Almeida Leite 1, Lucas Soares Gerbasi 1,\nFrancisco Tustumi1, Rafael Vaz Pandini 1, Ana Sarah Portilho 1,\nVictor Edmond Seid 1, Sergio Eduardo Alonso Araujo 1, Giovana\nMoreira Minchillo 1\n1Hospital Israelita Albert Einstein, São Paulo, Brasil\nThe synchronous robotic resection of a gastrointesti-\nnal stromal tumor (GIST) in the rectum and prostatic adeno-\ncarcinoma is a rare and challenging procedure due to the\nanatomical complexity and the differences in surgical\napproaches required for each condition, with distinct robotic\ndocking and the proximity of the vesico-urethral anastomosis\nto the colorectal anastomosis. This case report describes a 65-\nyear-old male patient simultaneously diagnosed with rectal\nGIST and prostatic adenocarcinoma. The patient had no rectal\nsymptoms, and the diagnosis was made during a Multipara-\nmetric MRI for prostate tumor evaluation. The diagnosis was\nconfirmed through ultrasound-guided biopsy. The surgical\napproach was carried out on the Da Vinci SI platform,\ninvolving radical prostatectomy for the prostatic adenocarci-\nnoma, followed by marginal resection of the GIST from the\nanterior surface of the rectum within the same docking, as\ndemonstrated in the video. The patient had a favorable\npostoperative course, with discharge on the 3rd postopera-\ntive day. This video highlights the importance of meticulous\nsurgical planning and a collaborative approach between\nspecialties for the effective management of complex synchro-\nnous tumors.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 141746\nOpen Videos\nCombined Rectosigmoidectomy with Ureterectomy and\nUreteral Reimplantation by Videolaparoscopy – Technical\nDetails\nRodrigo Gomes da Silva 1, Luiza Rogerio 1, Renato Gomes\nCampanati1, Magda Maria Profeta da Luz 1, Bernardo Hanan 1,\nKelly Cristine Lacerda Rodrigues Buzatti 1, Cleo Gonçalves\nTrindade Ribeiro1, Giovane Botelho Bacelar 1\n1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo\nHorizonte, Brasil\nIntroduction Locally advanced colon neoplasms with\ninvasion of adjacent organs can often pose a challenge for\nachieving R0 surgery using minimally invasive techniques.\nSigmoid lesions may invade organs of the genitourinary tract,\nand to achieve free margins, resection may be necessary, and,\nwhen indicated, reconstruction, as in the case of urinary tract\ninvasion.\nObjectives Technical description of rectosigmoidec -\ntomy with the need for ureterectomy in a patient with an\nadvanced sigmoid tumor, where ureteral reimplantation was\nperformed in the psoic bladder.\nMethods A 74-year-old patient presented with ab-\ndominal pain and diarrhea. Colonoscopy identified a neoplas-\ntic lesion in the sigmoid. Staging exams showed no evidence\nof distant disease. A laparoscopic resection was planned, and\nduring the inventory, left ureter adhesion to the tumor was\nidentified. Ureterectomy was performed, followed by laparo-\nscopic ureteral reimplantation using a modi fied Lich-Gregoir\ntechnique.\nResults The rectosigmoidectomy combined with ure-\nteral reimplantation was successfully performed, achieving\nfree margins. The patient had no complications from the\nprocedure and was referred for adjuvant chemotherapy.\nConclusion Resection of organs and structures ad-\nhered to the tumor is crucial for obtaining an oncologically\nadequate result, and performing the entire procedure via\nminimally invasive surgery facilitates a faster recovery for the\npatient.\nCâncer do Cólon/Reto/Ânus\nColon/Rectum/Anus Cancer\nID – 138872\nOpen Videos\nTREATMENT OF LOCALLY ADVANCED COLON TUMORS VIA\nROBOTIC SURGERY IN A SPECIALIZED CENTER\nMarcos Vinicius Araújo Denadai 1, João Pedro Pinto Cordeiro de\nMiranda Coutinho 1, Felipe Daldegan Diniz 1, Carlos Augusto\nRodrigues Véo1, Luís Gustavo Capochin Romagnolo 1, Rodrigo\nGiacomini Bregeiro1\n1Hospital de Amor de Barretos, Barretos, Brasil\nVideo Description A compilation of three videos\ndemonstrating locally advanced sigmoid and rectosigmoid\njunction tumors, T4b, invading adjacent organs such as the\nsmall bowel and bladder, successfully operated via robotic\nsurgery, applying advanced techniques for multi-organ resec -\ntion without the need for conversion.\nDiscussion Approximately 10% of colorectal cancer\npatients have locally advanced disease at the time of diagno-\nsis, either T4a, with involvement of the peritoneum adjacent\nto the lesion, or T4b, with invasion of one or more adjacent\norgans. Surgery with R0 resection is the treatment of choice,\npotentially curative, and of patients undergoing multi-organ\nresection with curative intent, 7 to 33% progress with isolated\nregional recurrence. Statistically, there is a lower rate of\nconversion to laparotomy when the approach is robotic,\ncompared to laparoscopic surgery.\nConclusion Such an approach was only possible\nbecause the cases were treated at a specialized oncology\ncenter and due to the experience of the assisting team in\nminimally invasive approaches.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S125\n\n\nDoença Diverticular\nDiverticular disease\nID – 141354\nOpen Videos\nSIGMOID-URINARY BLADDER AND SIGMOID-VAGINAL\nFISTULAS POST-ACUTE DIVERTICULITIS. SURGICAL\nTREATMENT WITH ROBOTIC PLATFORM AND\nMULTIDISCIPLINARY TEAM\nLuiz Carlos Benjamin Do Carmo\n1, Rogers Camargo Mariano da\nSilva2, Renato Panhoca1, Luiz Guilherme Lisboa Gomes3, Thiago\nIbiapina Alves1, Raissa Teixeira Rosalino 1, Renato Barretto\nFerreira da Silva 3\n1Hospital São Luiz, São Paulo, Brasil\n2Hospital Brasil, Santo André, Brasil\n3Hospital e Maternidade Santa Joana, São Paulo, Brasil\nIntroduction The most frequent fistula after acute\ndiverticulitis is the colon-vesical fistula, followed by the\ncolon-vaginal fistula. Surgical treatment is challenging due\nto the pelvic blockage, the in flammatory process involving\nimportant structures such as the ureters, pelvic vessels,\nbladder, and vagina. A multidisciplinary team is crucial for\nthe management and surgical treatment of these fistulas. The\nrobotic platform, with its high-definition 3D imaging, articu-\nlated instruments, and the use of fluorescence, provides\ngreater safety and facilitates the surgical procedure.\nObjective To demonstrate through a video the surgi-\ncal treatment of a patient with colon-vesical and colon-\nvaginal fistulas post-acute diverticulitis, using the robotic\nplatform and a multidisciplinary team.\nMethod A 58-year-old female patient with a history\nof recurrent acute diverticulitis crises followed by air leakage\nthrough the urethra and vagina, and a previous hysterectomy.\nA cystoscopy was performed, revealing a fistulous opening to\nthe bladder. The ureters were catheterized, and indocyanine\ngreen was infused to identify the ureters during surgery using\nFirefly fluorescence. The first dif ficulty was the release of\nadhesions due to the recurrent acute diverticulitis crises and\nprior hysterectomy. After identifying the fistula with the\nbladder, the urologist opted to open the bladder to better\ndissect and avoid injury to the ureteral ori fices. The gynecol-\nogist performed the dissection of the vaginal vault, injecting\nindocyanine green into the vagina and using Fire fly to iden-\ntify the fistulous tract. The colorectal surgeon performed a\nrectosigmoidectomy, with the specimen removed through a\nsuprapubic incision, and the loop was prepared for\nanastomosis.\nResult The patient progressed well postoperatively\nwith minimal pain and early ambulation. Discharged on the\n5th postoperative day with a urinary catheter in place.\nConclusion The robotic platform has demonstrated a\nsignificant contribution to achieving good results in cases of\nthese complex fistulas. The use of fluorescence for identifying\nthe ureters and perfusing the anastomoses provides greater\nsafety for the surgeon, resulting in successful surgeries.\nAdditionally, the involvement of a multidisciplinary team\nin managing pelvic structures ensures a safer surgery and\nbetter outcomes.\nDoença Diverticular\nDiverticular disease\nID – 141598\nOpen Videos\nCASE SERIES: RECTOSIGMOIDECTOMY AFTER DIVERTICULITIS\nCRISIS WITH PRESERVATION OF LEFT COLIC AND SUPERIOR\nRECTAL ARTERIES\nThamy Cristine Santana Marques1, Mayara Maraux Maranhão1,\nLina Maria Goes de Codes 1, Rafaella Alcântara Almeida Melo 1,\nFlávia de Castro Ribeiro Fidelis1, Elias Luciano Quinto de Souza1,\nSabrina Queiron Boudoux 1, Euler de Medeiros Azaro 1\n1Hospital Aliança, Salvador, Brasil\nIntroduction Colon resections involve various aspects\nthat determine a satisfactory outcome. Among the numerous\ncomplications related to the surgical procedure, anastomotic\ndehiscence is undoubtedly one of the most feared by surgeons.\nOne of the factors that directly impacts the success of the\nanastomosis is local blood supply. As a result, vascular ligations\nhave become increasingly conservative to maintain adequate\nblood flow to the remaining colon and, most importantly, to\nthe anastomosed region. The preservation of the left colic and\nsuperior rectal arteries during rectosigmoidectomy has been\nwidely practiced with satisfactory results, including in the\nrestoration of early intestinal transit.\nObjective To report a series of cases of patients who\nunderwent rectosigmoidectomy after diverticulitis crises,\nwhere the left colic and superior rectal arteries were pre-\nserved, showing the technique used through video.\nMethod All patients who underwent laparoscopic\nrectosigmoidectomy due to diverticulitis crises were cata-\nloged. Medical records were reviewed to obtain data and\ncalculate results, followed by video editing of one of the\nprocedures, illustrating the main steps of the surgery.\nResult A total of 15 patients were operated on be-\ntween January 2023 and June 2024. Of the 15 patients, 8 were\nfemale and 7 were male, with an average age of 59.3 years.\nFour patients presented with paralytic ileus, and the other 11\nhad restored intestinal transit within 4 days. There was no\nanastomotic dehiscence or need for reoperation in the ana-\nlyzed sample. The average hospital stay was 7.25 days.\nConclusion The strategy of preserving the left colic and\nsuperior rectal arteries is valid, yields good results, and improves\nblood supply at the anastomotic level, reducing the risk of local\nischemia and, consequently, anastomotic dehiscence. The resto-\nration of intestinal function and hospital discharge time were\nsimilar to the data found in the global literature.\nDoenças Anorretais\nAnorectal Diseases\nID – 138047\nOpen Videos\nANTERIOR ANAL SPHINCTEROPLASTY SURGERY WITH\nPERINEAL RECONSTRUCTION VIA Z-PLASTY\nGabriela Oliveira Bagano\n1, Rogerio Sera fim Parra1, Vanessa\nForesto Machado Leal 1, Antonio Balestrim Filho 1, Mariane\nLouise Quaglio Marques1, Marley Ribeiro Feitosa1, Omar Féres1,\nJosé Joaquim Ribeiro da Rocha 1\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS126\n\n\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\nIntroduction Injury to the external anal sphincter can\noccur as a result of obstetric trauma, colorectal surgeries, or in\nthe context of polytrauma, potentially leading to social\nimpairment and loss of quality of life when associated with\nfecal incontinence.\nObjective To demonstrate the technique of anterior\nanal sphincteroplasty with perineal reconstruction via Z-\nplasty.\nMethods A 37-year-old female patient was referred to\nthe Coloproctology outpatient clinic with complaints of fecal\nincontinence (Wexner score = 15) following a vaginal delivery\nwith a Grade IV perineal tear two years prior. Upon examina-\ntion, there was significant reduction in the perineal body due\nto scar tissue, with a slightly open anus and a hypotonic\nsphincter with low-amplitude voluntary contraction. Ano-\nrectal manometry showed the absence of a functional anal\ncanal with a resting pressure of 20 mmHg, a contraction\npressure of the EAS of 29 mmHg, and a total voluntary\ncontraction pressure of 39 mmHg. Colonoscopy was normal.\nPelvic MRI revealed partial fat substitution in the right levator\nani muscles. Surgical technique: Dissection of the rectovagi-\nnal septum and separation of the vaginal wall from the\nanterior rectal wall, with identi fication of the remaining\nmuscle fibers of the EAS, and suturing them together with\nVicryl 2-0. Bilateral V-shaped incision in the perineal skin.\nTransverse incision in the perineal body. Release of flaps and\ncreation of a Z-plasty flap (PDS 3-0) for reconstruction and\nelongation of the perineal body. A sigmoidostomy was per-\nformed for intestinal diversion.\nResults The patient recovered well after the proce-\ndure and was discharged on the third postoperative day\nwithout wound dehiscence, local infection, or other clini-\ncal-surgical complications. Over 90 days postoperatively, the\npatient expressed high satisfaction with the surgical result,\nreporting significant aesthetic improvement and recovery of\nfecal continence, with plans for further anorectal manometry\nand surgery for reconstruction of intestinal transit.\nConclusion Anterior anal sphincteroplasty with per-\nineal reconstruction via Z-plasty is a surgical technique with\nexcellent aesthetic and functional results in the medium-to-\nlong term in cases of EAS injury, especially in younger\npatients.\nDoenças Anorretais\nAnorectal Diseases\nID – 141557\nOpen Videos\nPILONIDAL FISTULA: SURGERY WITH PRIMARY CLOSURE –\nMODIFIED BASCOM TECHNIQUE – TECHNICAL DETAILS AND\nTIPS\nSthela Maria Murad Regadas\n1, Victor Ripardo Siqueira 1, Carlos\nMagno Queiroz da Cunha 1, Lavier Kelvin Holanda Vidal 1,\nFrancisco Sergio P . Regadas Filho1, Jose Jader de Mendonça\nFilho1, Francisco Sergio P . Regadas1, William Pinheiro Boavista\nde Oliveira1\n1Universidade Federal do Ceará, Ceará, Brasil\nIntroduction Surgical techniques for the treatment of\npilonidal disease are described, including open excision with\nsecondary healing or excision with primary closure with or\nwithout the use of a flap. The appropriate technique would be\nthe one with the shortest healing time and lowest recurrence\nrate. The modi fied Bascom technique involves reducing the\ndepth of the gluteal cleft and performing primary closure\noutside the midline using a flap advancement.\nObjective The video demonstrates patients who un-\nderwent surgery using the modi fied Bascom technique for\nrecurrent cases, highlighting technical details and tips for\nexecuting the procedures.\nMethod The video presents technical details of\npatients treated with the modi fied Bascom technique, who\nhad previously undergone surgery with secondary healing\nwithout success. It demonstrates details of flap marking, tips\nfor creating larger flaps, excision of the gluteal cleft, and\nprimary closure, ensuring the effectiveness of the appropriate\nflap and wound drainage. No intraoperative complications\noccurred. A 1.5 cm opening in the epidermis and dermis was\nobserved in one of the cases. No recurrence was noted during\ntwo years of follow-up.\nConclusion The modified Bascom technique with flap\nadvancement and primary closure, executed according to\ntechnical principles, was effective for the treatment of recur-\nrent pilonidal disease, with patients showing a healing time\nof up to six weeks.\nDoenças Anorretais\nAnorectal Diseases\nID – 141796\nOpen Videos\nMILLIGAN MORGAN HEMORRHOIDECTOMY: TECHNICAL\nDETAILS EVERY COLOPROCTOLOGIST SHOULD KNOW\nLucas Faraco Sobrado 1, Jose Americo Bachi Hora 1, Afonso\nHenrique da Silva e Sousa Jr 1, Carlos Frederico Sparapan\nMarques1, Carlos Walter Sobrado 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nIntroduction The Milligan-Morgan hemorrhoidec -\ntomy is an excisional surgical technique described in 1937,\nused to remove symptomatic internal and external hemor-\nrhoids. Hemorrhoidectomy is indicated in grade II hemor-\nrhoidal disease (HD) when other conservative treatment\noptions have failed and for large HD (Grade III/IV). Through-\nout the 20th century and even today, excisional methods have\nsolidified as the most effective due to their good control over\nbleeding and prolapse, and their lower recurrence rates,\ndespite the emergence of several minimally invasive techni-\nques (laser, harmonic scalpels, radiofrequency, PPH, and\nTHD). The main goal of this presentation is to explore and\npresent the key technical details of the traditional open\nhemorrhoidectomy for the improvement of younger\ncoloproctologists.\nCase Presentation A 61-year-old female patient pre-\nsented with complaints of anal bleeding and prolapse during\nevacuation efforts for 3 years, associated with anal discomfort\nand local pruritus. She had previously undergone dietary,\npharmacological treatments, and elastic band ligation ses-\nsions with slight improvement. On proctological examina-\ntion, three small anal plicae and three hemorrhoidal nipples\nwere observed. Colonoscopy was unremarkable. No bowel\npreparation was performed, and antibiotic prophylaxis was\nused. The patient was positioned in the Lloyd-Davies position\nafter balanced general anesthesia. Bupivacaine in filtration\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S127\n\n\nwith vasoconstrictor was administered to reduce bleeding\nfrom small vessels. The patient underwent hemorrhoidec -\ntomy using the open technique under balanced general\nanesthesia without complications. The cutaneous-hemor-\nrhoidal complex was resected without damaging the sphinc -\nter muscle, pedicles were ligated with absorbable 2-0 sutures,\nhemostasis was carefully achieved, and appropriate cutane-\nous-mucosal bridges were preserved. The surgical wounds\nwere left open to heal by secondary intention. The same\nprocedure was performed for the three hemorrhoidal nipples.\nResults The patient passed stool and was discharged\non the first postoperative day without complications.\nConclusion Although the Milligan-Morgan hemor-\nrhoidectomy is an invasive procedure, it is an effective\ntechnique for controlling prolapse and bleeding, safe, and\nwith a low recurrence rate. Due to its simpler learning and\nexecution, and low cost, it should be the method of choice in\nthe training of coloproctologists in Brazil.\nDoenças Anorretais\nAnorectal Diseases\nID – 141643\nOpen Videos\nGRACILIS FLAP IN THE CORRECTION OF RECTOVAGINAL\nFISTULA DUE TO CROHN ’S DISEASE\nAndre Pereira Westphalen 1, João Paulo Slongo 1, Peterson\nFasolo Bilhar1, Geanine Baggio Fracaro 1, Daniele Ximenez 1,\nGersino Perin Ribeiro 1, Ana Carolina de Quadros 1\n1Universidade Estadual do Oeste do Paraná, Cascavel, Brasil\nCase Presentation A 31-year-old female patient with\nCrohn’s disease affecting the colon and ileum since 2013,\nassociated with 4 complex anal fistulas, one of which was\nrectovaginal. She underwent treatment with sedeno and\nanti-TNF Adalimumab starting in June 2017, achieving remis-\nsion of the intestinal disease and healing of the anal fistulas,\nbut the rectovaginal fistula persisted without in flammatory\nfindings in the anal canal. The patient was treated with a\nvaginal mucosal flap in December 2018, but the procedure\nwas unsuccessful. An ileostomy was performed in July 2019,\nfollowed by a right-sided bulbocavernous interposition repair\nin September 2019 using the Martius technique, which also\nfailed. A second Martius repair was done on the left side in\nFebruary 2020, also without success. In February 2022, a\nrectovaginal fistula correction was performed using the\ngracilis muscle flap. A video describing the detailed technique\nwas recorded.\nDiscussion Rectovaginal fistulas cause significant re-\nduction in the quality of life, especially in patients with Crohn’s\ndisease, and their management is extremely complex and\ndifficult. Surgical interventions are indicated once the inflam-\nmatory activity of the disease is controlled. While there is no\nclear consensus on the preferred procedure, guidelines rec -\nommend starting with flaps followed by techniques that\ninvolve healthy tissue interposition, such as the Martius flap\nand the gracilis muscle flap, which was originally described in\n1928. Given that this is a complex and rare surgery, we present\na video with detailed technical descriptions.\nConclusion The use of the gracilis muscle flap for\nrectovaginal fistula repair represents an advanced surgical\ntherapy for patients who have failed simpler flap techniques\nor bulbocavernous muscle interposition procedures.\nDoenças Anorretais\nAnorectal Diseases\nID – 141743\nOpen Videos\nMARTIUS FLAP þ SPHINCTEROPLASTY FOR RECTOVAGINAL\nFISTULA TREATMENT – TECHNIQUE DESCRIPTION\nRodrigo Gomes da Silva1, Renato Gomes Campanati1, Bernardo\nHanan1, Kelly Cristine Lacerda Rodrigues Buzatti1, Magda Maria\nProfeta da Luz 1, Cleo Gonçalves Trindade Ribeiro 1, Luiza\nRogerio1, José Henrique Paiva Rodrigues 1\n1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo\nHorizonte, Brasil\nIntroduction Rectovaginal fistulas are often associat-\ned with traumatic injuries after childbirth and are dif ficult to\ntreat, sometimes requiring more than one approach for\ncomplete resolution. There are several available approaches,\nand tissue interposition techniques (using healthy tissue)\nseem to yield good results. The Martius flap involves inter-\nposition of the bulbocavernosus muscle and has shown to be\na minimally invasive option for treating these fistulas.\nObjectives Description of the Martius flap technique\ncombined with sphincteroplasty to treat a patient with a\nrectovaginal fistula and sphincter injury after a long-term\nvaginal delivery, without previous corrections.\nMethods A 37-year-old patient presented with fecal\nincontinence through the vagina after a vaginal delivery 13\nyears ago. Colonoscopy and rectal examination identified the\nfistulous opening to the vagina. Endoanal ultrasound showed\na gap in the external sphincter. Sphincteroplasty was chosen\nwith an overlap technique, combined with Martius flap\ncorrection. A small incision was made adjacent to the left\nlabium, and the bulbocavernosus muscle was dissected and\ninterposed between the rectum and vagina to prevent fistula\nrecurrence.\nResults The patient had an excellent postoperative\noutcome, with complete resolution of symptoms and early\nhospital discharge (2nd postoperative day).\nConclusion The Martius flap technique is minimally\ninvasive (requiring small incisions) and has low morbidity,\nyet is highly effective for treating rectovaginal fistulas. It can\nbe considered a first-line treatment option with good success\nrates.\nDoenças Anorretais\nAnorectal Diseases\nID – 138250\nOpen Videos\nENDORECTAL ADVANCEMENT FLAP FOR CORRECTION OF\nVAGINAL-POUCH FISTULA: VIDEO-ASSISTED TECHNIQUE\nCarolina Reis Bonizzio 1, Rodrigo Ambar Pinto 1, Jorge Landivar\nCoutinho1, John Anibal Tapia Baca 1, Gabriela Lopes Fonseca 1,\nCarlos Frederico Sparapan Marques 1\n1Faculdade de Medicina da Universidade de São Paulo, Sao Paulo,\nBrasil\nCase Presentation A 60-year-old obese woman with\nchronic ulcerative colitis refractory to medical treatment\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS128\n\n\ndeveloped a rectovaginal fistula during the first week after\ntotal proctocolectomy with ileal pouch and elective loop\nileostomy. Despite the intestinal diversion, the patient expe-\nrienced daily mucus discharge from the vagina and recurrent\nurinary infections until reoperation. A pouchoscopy revealed\nan ileorectal anastomosis 3 cm from the anal verge with a 1\ncm fistulous opening at the staple line in the anterior wall.\nThe chosen surgical correction was an advancement endor-\nectal flap. The patient was placed in a prone position. Despite\nthe use of an endoanal retractor, the dissection of the fistula\nwas difficult due to a narrow anal canal and a highfistula. The\nintroduction of a 30° scope through the anal canal assisted in\nall stages of the surgery, allowing the surgeon to better\nvisualize the operative field. The steps were: 1. removal of\nthe metal staples from the anastomosis surrounding the\nfistula; 2. dissection and resection of the fistula; 3. dissection\nof the rectovaginal septum; 4. vaginal suturing in two layers\nwith separate Vycril 3.0 stitches; 5. dissection of theflap from\nthe ileal pouch segment and advancement into the distal\nrectum with separate stitches of the same suture. The patient\nwas discharged on the third postoperative day and is cur-\nrently under follow-up with no complications.\nDiscussion Rectovaginal fistulas are abnormal com-\nmunications between the rectum and vagina, which can\noccur after perineal trauma, pelvic radiation, local infection,\ninflammatory bowel disease, tumors, or surgeries, especially\nobstetric procedures. Various surgical techniques exist for\ntreating rectovaginal fistulas, but they are associated with\nhigh recurrence rates. Intestinal diversion provides better\ncontrol of local infection, and the interposition of well-\nvascularized tissues in surgical reconstruction (such as the\nMartius or gracilis flap) enhances healing. In this case, the\nclinical presentation shortly after the surgery suggests that\nthe fistula occurred due to technical failure of the ileorectal\nanastomosis, where the posterior vaginal wall was inadver-\ntently included in the stapling.\nConclusion This video demonstrates the surgical\nsteps for the endoanal correction of a complex rectovaginal\nfistula assisted by video, providing the surgeon with better\nvisualization of the operative field. This technique is particu-\nlarly valuable in cases with a narrow anal canal and high\nrectovaginal fistulas.\nDoenças Anorretais\nAnorectal Diseases\nID – 141787\nOpen Videos\nHOUSE FLAP ANOPLASTY TECHNIQUE FOR SURGICAL\nTREATMENT OF IDIOPATHIC ANAL STENOSIS\nGabriela Fonseca Lopes 1, Evelyn Moura de Assis 1, Rodrigo\nAmbar Pinto1, Carlos Frederico Sparan Marques 1, Ulysses\nRibeiro Junior 1, Jose Americo Bacchi Hora 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nIntroduction/Case Presentation A 71-year-old male\npatient with a history of hypertension and diabetes, with no\nhistory of anal trauma or previous surgeries, presented with\ndifficulties during bowel movements for the past 10 years.\nThe patient reported signi ficant straining and narrowing of\nthe stool without any bleeding. Additionally, the patient had a\nsuspicious nodule in the prostate but was unable to undergo a\nbiopsy due to anal canal stenosis. The patient was referred for\nevaluation by a coloproctologist. On initial proctological\nexamination, there was evidence of anal canal stenosis,\nidentified as a fibrotic ring with resistance to digital exami-\nnation. Colonoscopy was performed with adequate bowel\npreparation, revealing only hypertrophic papillae in the anal\ncanal, with no further abnormalities extending to the termi-\nnal ileum. The patient was treated conservatively with hy-\ngiene measures, dietary modifications, and topical treatment\nwith Diltiazem. However, the patient experienced headaches\nas a side effect of the ointment and reported no improvement\nin the evacuation symptoms after 3 months of the instituted\nmeasures. A surgical approach was then chosen, and the\npatient underwent analplasty using the modi fied skin ad-\nvancement flap technique (House Flap).\nObjective The goal of this video is to demonstrate the\nskin advancement flap technique, illustrating the step-by-\nstep procedure as a surgical approach to anal stenosis. It\nincludes positioning the patient, surgical technique, and\npostoperative results.\nConclusion After the surgery, the patient showed an\nopen anal canal on proctological examination, with no resis-\ntance during digital examination. The postoperative course\nwas uneventful, and the patient reported improvement in\nevacuation symptoms, including daily bowel movements\nwithout alterations, which allowed him to return to his\nnormal lifestyle. Anal stenosis is a rare condition but can\ncause significant discomfort during defecation. It is common-\nly described as a complication following hemorrhoidectomy,\nchronic anal fissures, or in flammatory bowel disease. How-\never, in this case, no speci fic cause for the pathology was\nidentified. The House Flap technique demonstrated in this\nvideo should be part of the coloproctologist ’s surgical reper-\ntoire, as it is a reproducible and effective approach for\nmanaging this condition.\nDoenças Anorretais\nAnorectal Diseases\nID – 141760\nOpen Videos\nKARYDAKIS TECHNIQUE FOR PILONIDAL CYST CORRECTION:\nADVANTAGES OF A FLAP WITH AN INCISION OUTSIDE THE\nMIDLINE\nElis Oliveira1, Evellyn Moura Assis 1, Gabriela Fonseca Lopes 1,\nCarolina Bonizzio 1, Isaac José Felippe Corrêa Neto 1, Ulysses\nRibeiro Junior 1, Carlos Frederico Sparapan Marques 1, Rodrigo\nAmbar Pinto1\n1Hospital das Clínicas de São Paulo, São Paulo, Brasil\nCase Presentation Male, 19 years old. Three years\nago, he developed a painful sacral swelling with intermittent\nepisodes of in flammation, treated with oral antibiotics and\nwarm compresses. There were three openings along the\nmidline. An ultrasound of the soft tissues showed a super fi-\ncial, hypoechoic, and regular cystic image of 3.0 cm in the\nlongest axis. Surgical intervention was indicated, involving\nresection and closure of the defect using the Karydakis\ntechnique. This technique aims to displace the midline suture,\nwithout tension, flattening the gluteal fold depression and\nreducing mechanical stress during the postoperative period.\nThe patient was positioned prone under local anesthesia,\nwith the pilonidal cyst identi fied and demarcated. An exten-\nsive incision was made to include the main sinus and the two\nsecondary ones, left of the midline. A circumferential\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S129\n\n\ndissection was performed, reaching the presacral fascia,\nfollowed by cyst excision. The subcutaneous deep flap was\ncreated up to the contralateral gluteal fold, followed by\ndissection of the super ficial flap, below the dermis in the\nsame direction and extent. The flap was advanced from right\nto left, with U-shaped separated sutures using Vicryl 3-0. The\nwound was moved away from the midline, and a Portovac\ndrain was placed. The dermis was then closed with the same\nsuture material, finishing with nylon 4-0 epidermal sutures,\nfollowed by an occlusive and compressive dressing. The\npatient progressed well, was discharged on the first day,\nand the drain was removed on the tenth day without wound\ndehiscence. Follow-up after 3 months showed no signs of\nrecurrence.\nDiscussion The pilonidal cyst is an infectious condi-\ntion that is twice as common in young males. It can be acute,\nwith abscesses, or chronic, with intermittent discharge from\nsinus tracts. The nests are located in a deeper cavity with hair\npresence. Treatment is usually surgical in symptomatic cases,\nbut there is no consensus regarding the best technique. The\nmain objectives are to stop the suppuration, resolve the cyst,\nreduce morbidity, and decrease the risk of recurrence. The\nwound complication rate is low, around 8%, and recurrence is\nless than 2%. Moreover, compared to an open wound, this\ntechnique has the advantages of lower morbidity, fewer lost\nworkdays, and fewer medical visits for dressing changes;\ncompared to midline primary closure, it results in less\nrecurrence and fewer wound complications.\nConclusion The Karydakis technique proved to be\nsafe and effective for correcting the pilonidal cyst, promoting\nprimary closure with low local morbidity and allowing for\nearly return to activities.\nDoenças Anorretais\nAnorectal Diseases\nID – 138229\nOpen Videos\nSURGICAL TREATMENT OF COMPLEX PERIANAL FISTULA\nTHROUGH FISTULECTOMY, WITH TOTAL EXTRACTION OF THE\nFISTULOUS TRACT\nLaís Yumi Takaoka\n1, Luiz Carlos Benjamin Do Carmo1, Sandra Di\nFelice Boratto1, Renato Barretto Ferreira da Silva 1, Juliana\nGiangiardi Batista 1, Raíssa Teixeira Rosalino 2, Sérgio\nGontscharow2, Thiago Ibiapina Alves 2\n1Faculdade de Medicina do ABC, Santo André, Brasil\n2Hospital São Luiz Itaim, São Paulo, Brasil\nCase Presentation A male patient diagnosed with a\ncomplex transsphincteric perianal fistula. The decision was\nmade to perform a first-stage surgical correction using the\nfistulectomy technique, with complete removal of the fistu-\nlous tract, ensuring the preservation of the sphincter muscle\nand isolating it with a Seton to allow drainage of the fistulous\ntract. The subcutaneous tissue in the resected area was\napproximated to shorten the healing time. A second inter-\nvention was performed three months after the first to allow\nfor the proliferation of the fibrotic healing process, enabling\nthe safe division of the muscle isolated by the Seton without\nthe risk of incontinence, followed by curettage of the surgical\nwound for healing by secondary intention. The patient\nshowed good postoperative progress with no complications.\nDiscussion Complex perianal fistulas with extensive\ninvolvement of the external sphincter muscle are a therapeu-\ntic challenge due to the increased risks of fecal incontinence\nand recurrence. The therapeutic strategy should aim for high\nsuccess rates while maintaining continence. In fistulotomy,\nthe fistulous tract is kept open, whereas in fistulectomy, the\nentire tract is completely resected to reduce the risk of\nrecurrence from the loss of secondary tracts, in addition to\nproviding a complete histological sample for study.\nConclusion Fistulectomy is a good surgical option for\ncomplex perianal fistulas. To avoid complications, dissections\nshould be performed near the fistulous tract, isolating and\npreserving the sphincter muscle, and completing the proce-\ndure in a second stage. This technique demonstrates good\nresults in curing the disease, with low rates of postoperative\ncomplications and morbidity. Several techniques are avail-\nable for complex perianal fistulas, all with the possibility of\nrecurrence and complications, making the surgical treatment\nof these fistulas a challenge for surgeons.\nDoenças Anorretais\nAnorectal Diseases\nID – 141777\nOpen Videos\nSURGICAL TREATMENT OF OBSTETRIC ANAL SPHINCTER\nINJURY – CASE SERIES\nGeorge Lucas Ferreira de Castro 1, Lara Miranda Kaminice 1,\nVittória Machado Agresta 2, Monique Arantes Pereira 1, Julinely\nGomes Weber Porto 1, Izadora Cruz Andrade 1, Daniela Ferreira\nVitalina3, Renato Hugues Atique Cláudio 1\n1Universidade Federal de Uberlândia, Uberlândia, Brasil\n2Faculdade de Medicina do ABC, Santo André, Brasil\n3Faculdade de Medicina de São José do Rio Preto, São José do Rio\nPreto, Brasil\nCase Presentation A 29-year-old woman, a first-time\nmother, had a vaginal delivery assisted by a doctor with the\nneed for an episiotomy, resulting in a fourth-degree perineal\ntear. A second case involved a 30-year-old woman who had a\nvaginal delivery and a third-degree tear. Thefirst patient gave\nbirth in 2018 and had a Wexner score of 12 points, while the\nsecond patient gave birth in early 2024 with a Wexner score\nof 13 points.\nDiscussion Obstetric anal sphincter injury can result\nin mild to severe fecal incontinence, with symptoms possibly\nappearing immediately after childbirth or decades later. The\nincidence is higher in women who experience more severe\nperineal tears, grades III or IV, or those who require an\nepisiotomy. Diagnosis is made at the time of delivery and\ncan be con firmed through endoanal ultrasonography, which\ndetects the anatomical defect, and by high-resolution ano-\nrectal manometry, which assesses functional de ficits of the\nsphincter complex and identi fies the location of muscular\nfailure through vectorgrams. Surgical treatment yields good\nfunctional results, particularly in the short- and medium-\nterm. Studies show that in the long-term, women may\nexperience recurring complaints of fecal incontinence, either\nmild or severe. In the patients described here, anal sphincter-\noplasty with muscle overlap and skin flap transposition to\naugment or create the perineal body was performed. Despite\nthe time elapsed between the injury and surgery, both\npatients had good functional outcomes for their anal sphinc -\nter apparatus.\nConclusion Surgical treatment is required for obstet-\nric anal sphincter injury, and despite the various techniques\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS130\n\n\navailable, muscle overlap is superior to others. This technique\ncan be performed even when surgery is delayed.\nDoenças Anorretais\nAnorectal Diseases\nID – 138211\nOpen Videos\nSURGICAL TREATMENT FOR ANAL STENOSIS AFTER\nHEMORRHOIDECTOMY\nGabriela Jacques1, Daniele Rezende Ximenez 1, Ana Carolina\nMedeiros1, Giovanna Gomes Waldrigues 1, Maria Cristina\nSartor1, Antonio Sérgio Brenner1, Guilherme Henrique Perine1,\nMarssoni Deconto Rossoni 1\n1Complexo do Hospital de Clínicas da Universidade Federal do\nParaná, Curitiba, Brasil\nCase Presentation A 60-year-old patient who under-\nwent hemorrhoidectomy 2 years ago presented with pro-\ngressive dif ficulty in evacuating, experiencing pain and a\nsensation of anorectal obstruction during bowel movements.\nOver this period, the symptoms persisted despite continuous\nuse of laxatives, with recurrent fecalomas and episodes of\nabdominal distension and pain, necessitating emergency\nvisits. On physical examination, a scar was noted in the\nperineal area, with anal stenosis that could only be passed\nwith a small finger, and fibrosis in the anterior midline. The\npatient was submitted to surgery for anoplasty with a dia-\nmond-shaped flap, under anesthesia via spinal block. The\nprocedure was filmed to demonstrate the steps of the surgical\ntechnique. The surgery began with marking the diamond-\nshaped flap, measuring approximately 3 cm at its largest axis\nin the perineal body. The fibrotic area in the anterior anal\ncanal was resected, followed by mobilization of the flap to\ncover the defect area without tension while preserving its\nvascularization. After suturing the flap, the increased diame-\nter of the anal canal was con firmed. The patient was dis-\ncharged the day after surgery. She had a good immediate and\nlong-term recovery, with daily bowel movements without\nstrain or anorectal discomfort.\nDiscussion Anal stenosis is a rare complication of\nanorectal surgeries, most commonly occurring after hemor-\nrhoidectomies. Treatment ranges from conservative meas-\nures to surgical correction in more severe cases. In the\nreported case, anoplasty with a diamond-shaped flap was\nchosen, as demonstrated in the video. However, several other\ntechniques have been described with different healing rates,\nand there is no consensus on the best technique due to the\nlack of comparative prospective studies.\nConclusion Surgical treatment for anal stenosis is\neffective in cases refractory to conservative treatment. The\nprocedure was completed without complications and filmed\nto showcase the steps of the surgical technique discussed in\nthe video.\nDoenças Anorretais\nAnorectal Diseases\nID – 141793\nOpen Videos\nSURGICAL TREATMENT FOR PERIANAL FISTULA:\nDEMONSTRATION OF THE LIFT TECHNIQUE\nGabriela Fonseca Lopes 1, Jose Americo Bacchi Hora 1, Elis\nOliveira1, Fernando D ’almeida Perazzo1, Carlos Frederico\nSparan Marques 1, Ulysses Ribeiro Junior 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nIntroduction/Case Presentation A 61-year-old fe-\nmale, previously healthy, presented with a perianal abscess\nof cryptoglandular origin 9 years ago, which was surgically\ndrained in an urgent setting. She was subsequently referred to\na proctologist due to complaints of intermittent discharge of\nfecaloid material from the perianal region. During follow-up,\na proctological examination identified an external opening of\na perianal fistula located antero-laterally to the left, 1.5 cm\nfrom the anal margin, with fecaloid discharge and no signs of\ninflammation or infection. The patient had no complaints of\nanal incontinence, and the fistula diagnosis was confirmed by\npelvic MRI, classified as PARKS I and Grade I according to the\nSt James radiological classification. During the intraoperative\nexamination under anesthesia, the fistula was reclassified as\nPARKS II, leading to the decision to perform surgical manage-\nment of the perianal fistula using the LIFT (Ligation of\nIntersphincteric Fistula Tract) technique.\nObjective The objective of the video is to demonstrate\nthe LIFT technique (ligation of the intersphincteric fistula\ntract), illustrating the step-by-step process of the method,\nfrom patient positioning and surgical strategy to postopera-\ntive results.\nFinal Comments/Conclusion The patient was dis-\ncharged on thefirst postoperative day and continues to follow\nup without signs of changes in anal continence or recurrence\nof the fistula. The LIFT technique demonstrated in the video\nwas initially described by Rojanasakul in 2007 and is prefer-\nably indicated for transsphincteric and rectilinear inter-\nsphincteric fistulas. Currently, it should be part of the\narmamentarium of techniques for the surgical management\nof anorectal fistulas for colorectal surgeons.\nDoenças Anorretais\nAnorectal Diseases\nID –\nOpen Videos\nLATE SURGICAL TREATMENT FOR CLOACA DUE TO OBSTETRIC\nTRAUMA\nGabriela Jacques1, Daniele Rezende Ximenez1, Giovanna Gomes\nWaldrigues1, Ana Carolina Medeiros 1, Maria Cristina Sartor 1,\nAntonio Sérgio Brenner 1, Guilherme Henrique Perine 1,\nGuilherme Mattioli Nicollelli 1\n1Complexo do Hospital de Clínicas da Universidade Federal do\nParaná, Curitiba, Brasil\nCase Presentation A 63-year-old female presented\nwith complete fecal incontinence for over 35 years. She had\ntwo vaginal deliveries in her second decade of life, with\nobstetric trauma during the second birth, which remained\nuntreated since then. The patient sought medical help late\ndue to recurrent urinary infections, which led to the diagnosis\nof a perineal lesion described as“cloaca,” and she was referred\nto the Coloproctology clinic. On physical examination, there\nwas a complete rupture of the perineal body and anterior\nmucosal rectal prolapse. The ends of the anal sphincter\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S131\n\n\nmuscles were easily palpable in the anterior quadrants of the\nanus, close to the coronal line. The patient underwent peri-\nneal reconstruction surgery under spinal anesthesia. The\nrectovaginal septum was dissected, and the fascia of the\npuborectal muscles was approximated, with reinforcement\nfrom the existing fibrosis. The transverse perineal muscle was\nalso identi fied and reconstructed. An anterior midline anal\nsphincteroplasty was performed using the overlapping tech-\nnique. The anterior mucosal prolapse was also corrected via\nendo-anal suturing. The procedure was conducted after an\nanterograde colon preparation for better postoperative com-\nfort. The patient was discharged the day after surgery. She\nhad a good immediate and long-term recovery, with im-\nproved fecal continence and no longer needing daily pads.\nDiscussion The most common cause of traumatic\nfecal incontinence is obstetric injury. Early diagnosis and\ntreatment provide better chances of preventing long-term\nfecal incontinence. Some cases, especially those not\naddressed early, develop severe anatomical defects, such as\ntraumatic cloaca, negatively affecting quality of life and\nhealth outcomes. In this case, the patient had lived with\ncloaca for decades, but after surgical correction with a\nspecialized team, there was signi ficant improvement in fecal\nincontinence.\nConclusion Surgical treatment of fecal incontinence\nfollowing severe obstetric injury, whether early or late,\nprovides excellent functional and anatomical results, posi-\ntively impacting the quality of life of these patients and their\nfamilies.\nDoenças Anorretais\nAnorectal Diseases\nID – 141803\nOpen Videos\nTREATMENT OF IRREDUCIBLE RECTAL PROLAPSE BY\nPERINEAL RECTOSIGMOIDECTOMY: TECHNICAL DETAILS\nEVERY SPECIALIST SHOULD KNOW\nGabriela Fonseca Lopes1, Carlos Walter Sobrado 1, Lucas Faraco\nSobrado1, Jose Americo Bacchi Hora1, Afonso Henrique da Silva\ne Souza Junior1, Rodrigo Ambar Pinto1, Carlos Frederico Sparan\nMarques1, Ulysses Ribeiro Junior 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nIntroduction/Case Presentation A 77-year-old fe-\nmale patient, hypertensive, diabetic, and cardiopathic, has\nbeen experiencing pain, constipation, anal incontinence, and\ndifficulty mobilizing due to rectal prolapse for the past 2\nyears. Upon proctological examination, the patient presented\nwith irreducible rectal prolapse approximately 10 cm in\nlength, associated with fungal perianal dermatitis. Colonos-\ncopy revealed multiple diverticula in the sigmoid colon, with\nno other lesions. Due to the patient ’s clinical context, classi-\nfied as frail elderly with signi ficant comorbidities, a decision\nwas made to address the rectal prolapse with perineal\nrectosigmoidectomy.\nObjective The objective of the video is to discuss the\ntechnical details of perineal rectosigmoidectomy, illustrating\nthe step-by-step method, from patient positioning to surgical\ntechnique and postoperative results.\nConclusion The patient had a good postoperative\nevolution, with intestinal transit present on the second\npostoperative day. Currently, she is under outpatient fol-\nlow-up, with bowel movements every two days and no signs\nof recurrence of the pathology. Perineal rectosigmoidectomy\nis a less invasive procedure compared to the abdominal\napproach. It is primarily indicated for elderly patients with\ncomorbidities who have contraindications for abdominal\naccess, as it can be performed under neuro-axial anesthesia\n(spinal or epidural anesthesia). As a disadvantage, it involves\nthe resection of the rectal reservoir and has a higher recur-\nrence rate compared to abdominal techniques, but it should\nbe part of the surgical repertoire of the coloproctologist.\nDoenças Anorretais\nAnorectal Diseases\nID – 141683\nOpen Videos\nVIDEO: CORRECTION OF RECTOCELE USING A CIRCULAR\nSTAPLER UNDER THE TREMS TECHNIQUE\nCamila Gomes\n1, Fernando Lopes Vieira 1, Walysson Alves\nTocantins de Sousa 1, Rafael Ferreira Correia Lima 1, Miguel\nAugusto Arcoverde Nogueira 1, Fabiana Brito Campelo Barros 1,\nValéria Maria Caland Morais 1, Myrna Maria Martins Ribeiro 1\n1Universidade Estadual do Piauí, Piauí, Brasil\nCase Presentation A 57-year-old female patient pre-\nsented to the outpatient clinic with complaints of chronic\nconstipation, associated with symptoms of obstructed evac -\nuation, including the need for manual assistance through the\nvaginal wall, and alternating periods of constipation and\ndiarrhea. Upon proctological examination, an anterior rec -\ntocele was detected. The patient underwent preoperative\nassessments and returned with the following exam results:\ndefecography showing a grade 3 rectocele; anorectal manom-\netry suggesting voluntary muscle dyssynergy. Surgical cor-\nrection of the rectocele was indicated using the TRREMS\ntechnique.\nDiscussion Once surgery was indicated, the patient\nunderwent rectocele correction using a circular stapler under\nthe TRREMS technique. The procedure was performed with-\nout complications. The patient was discharged on the second\npostoperative day. She returned for a follow-up appointment\n15 days after surgery, without complaints and with improved\nsymptoms compared to before the procedure.\nConclusion The chosen treatment led to a positive\noutcome for the patient ’s case.\nDST e Doenças infecto parasitárias\nSTIs and Infectious Parasitic Diseases\nID – 138281\nOpen Videos\nSURGICAL TREATMENT OF COMPLETE ANAL STENOSIS DUE TO\nMONKEYPOX INFECTION\nLina Meneses Chaves\n1, Paula Buozzi Tarabay 1, Gustavo Sevá\nPereira1, Gabriela Domingues Andrade Ribeiro 1, Geraldo\nFerreira Coutinho Junior1, Adriana Borgonovi Christiano Vieira1,\nFábio Henrique Mendonça Chaim1, Joaquim José Oliveira Filho1\n1Hospital Municipal Dr. Mario Gatti, Campinas, Brasil\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS132\n\n\nCase Presentation A 24-year-old male patient, HIV-\npositive, presented with a case of Monkeypox infection\nmanifesting perianally, initially as a painful anal ulcer. The\nlesion progressed, leading to anal stenosis and severe proc -\ntalgia, necessitating hospitalization for pain management.\nThe patient underwent transverse loop colostomy and\nstarted speci fic therapy with Tecovirimat after a positive\nPCR result for the Monkeypox virus from a lesion biopsy.\nFollowing medical treatment and lesion healing, the patient\ndeveloped complete anal stenosis. Initial treatment involved\ntopical application of betamethasone and hyaluronidase for\nthree weeks without improvement. Subsequently, surgical\nintervention was performed. The anal opening was created\nusing puncture with intraoperative colonoscopy guidance\n(via the colostomy). After opening the anal ori fice, a guide-\nwire was passed, and anal dilation was performed with\nSavary dilators. During the same surgical procedure, intesti-\nnal transit was reconstructed by closing the loop colostomy.\nIn the postoperative period, the patient showed good clinical\nprogress and was discharged on the eighth day with an anal\ndilator for home use and topical diltiazem 2% ointment for\nanal muscle relaxation. Weekly sessions of anal dilation using\nHegar dilators were performed until the sixth postoperative\nweek, followed by biweekly sessions and three local applica-\ntions of triamcinolone. The patient remains under outpatient\nfollow-up without complaints of fecal incontinence.\nDiscussion Perianal manifestations of Monkeypox\ninfection, such as vesicles, pustules, and ulcers, can cause\nproctalgia that is often refractory to simple analgesia. To our\nknowledge, there are no reports in the literature of perianal\nmanifestations of Monkeypox infection resulting in complete\nanal stenosis. Surgical treatment of complete anal stenosis is\nchallenging due to the risk of sphincter injury and fecal\nincontinence.\nConclusion Anal stenosis is a potential complication\nof Monkeypox infection with perianal manifestations, and its\ntreatment may involve ostomy procedures. Surgical correc -\ntion of complete anal stenosis carries signi ficant risks, with\nfecal incontinence being the most feared due to its consider-\nable impact on patients’ quality of life. Adequate treatment of\ncomplete anal stenosis is highly complex, requiring a team of\nspecialists and long-term follow-up.\nFisiologia Anorretocólica\nAnorectal Physiology\nID – 141711\nOpen Videos\nASSOCIATION OF VENTRAL RECTOPEXY WITH MESH AND\nLAPAROSCOPIC SIGMOIDECTOMY: AN APPROACH OPTION\nFOR OBSTRUCTED DEFECATION SYNDROME IN RECTOCELE\nASSOCIATED WITH SIGMOIDOCELE\nRodrigo Ambar Pinto 1, Isaac José Felippe Corrêa Neto 1, Thaís\nVillela Peterson1, Diego Fernandes Maia Soares 1, Mariane\nGouvea Monteiro de Camargo 1, Ulysses Ribeiro Junior 1, Carlos\nFrederico Sparapan Marques 1, Gabriela Fonseca Lopes 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nCase Presentation A 72-year-old woman presented\nwith a 5-year history of obstructed defecation syndrome.\nInitially diagnosed with rectocele, she was managed with\nlaxatives, which provided good results at first. However, in\nthe past six months, her symptoms worsened signi ficantly,\nincluding severe dif ficulty passing stools, a sensation of\nblockage, and rectal heaviness despite the use of stimulant\nlaxatives. Defecography revealed an enlarged rectocele mea-\nsuring 5.5 cm and a sigmoidocele compressing the distal\nrectum. A laparoscopic abdominal surgery was planned,\ncombining sigmoidectomy with ventral rectopexy due to\nthe presence of sigmoidocele. The surgical procedure was\nperformed using a 12 mm trocar in the right iliac fossa and 5\nmm ports in the other quadrants. A reverse-J incision was\nmade on the peritoneum from the promontory to the right of\nthe rectum, reaching the peritoneal re flection and exposing\nthe ligament of the sacrum. Dissection proceeded into the\nrectovaginal septum, separating the anterior rectal wall from\nthe posterior vaginal wall down to the levator ani muscles. A\ncoated composite mesh (Proceed®, 15x5 cm) was fixed to the\nanterior rectal wall with separate non-absorbable sutures\n(Ethibond 2-0®) at distal, mid, and proximal levels below the\nperitoneal reflection and to the vaginal apex. Approximately\nfive Securestrap® staples secured the cranial portion of the\nmesh to the promontory. Sigmoid resection was performed\nalong its wall, with lateral gutter mobilization to prevent\ndevascularization and minimize tissue damage. A double-\nstapled colorectal end-to-end anastomosis was performed.\nThe peritoneum was closed using a continuous V-Loc® suture\nto cover the mesh. The patient had an excellent postoperative\ncourse, with bowel movements resuming on the second day\nand discharge on the third day. At the 4-month follow-up, the\npatient was no longer using laxatives, evacuating daily with\nonly dietary adjustments.\nDiscussion Ventral rectopexy was initially developed\nfor rectal prolapse with the aim of reducing postoperative\nconstipation (from 54% to 15%). Over the past 15 years, it has\nalso been used for obstructed defecation syndrome caused by\nrectocele and intussusception, yielding good results. Sigmoi-\ndocele, though less commonly associated with other anatom-\nical abnormalities, presents a challenging decision-making\nscenario. The technique modi fication in this case, combining\nsigmoidectomy with ventral rectopexy, may be a viable\noption to improve intestinal constipation in these patients.\nConclusion The combination of sigmoidectomy with\nventral rectopexy using mesh may be an attractive surgical\noption for treating obstructed defecation syndrome associat-\ned with sigmoidocele.\nFisiologia Anorretocólica\nAnorectal Physiology\nID – 141714\nOpen Videos\nLAPAROSCOPIC VENTRAL RECTOPEXY (D ’HOORE) FOR THE\nTREATMENT OF ACUTE RECTAL PROLAPSE POST-\nABDOMINOPLASTY: A DEFINITIVE SOLUTION FOR AN\nUNEXPECTED PROBLEM\nRodrigo Ambar Pinto 1, Gabriela Fonseca Lopes 1, Mariane\nGouvea Monteiro de Camargo 1, Nathália Carmin Calixto\nSarroche da Silva1, Isaac José Felippe Corrêa Neto1, Thaís Villela\nPeterson1, Diego Fernandes Maia Soares 1, Carlos Frederico\nSparapan Marques 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nCase Presentation A 56-year-old woman underwent\nabdominoplasty. In the postoperative period, she experi-\nenced difficulty evacuating, and after 10 days, she presented\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S133\n\n\nwith acute externalization of all layers of the rectal wall\n(rectal prolapse) measuring approximately 7 cm, which\nbrought her to the emergency department. Manual reduction\nwas performed, and she was admitted for clinical observa-\ntion. During her next bowel movement in the hospital, she\nexperienced another painful externalization, again requiring\nassisted manual reduction. A decision was made to perform\nlaparoscopic ventral rectopexy with mesh. The most notable\nfeature of this procedure was the signi ficant reduction of the\nabdominal cavity caused by the prior abdominoplasty. A 12-\nmm trocar was inserted in the right iliac fossa, and three 5-\nmm ports were placed in the other quadrants. The peritone-\num was incised at the anterior-lateral right peritoneal re flec -\ntion in an inverted J shape. Dissection exposed the\npromontory and isolated the anterior ligament of the spine.\nThe procedure continued through the rectovaginal septum,\nseparating the anterior rectal wall from the posterior vaginal\nwall down to the pelvic floor (levator ani muscles). A covered\npolypropylene mesh (Proceed® 15 /C2 5 cm) was fixed to the\nanterior rectal wall with separate non-absorbable sutures\n(Ethibond 2-0®) at distal, middle, and proximal levels below\nthe peritoneal reflection. The cranial portion of the mesh was\nsecured to the anterior spinal ligament with Securestrap®\nstaples. Additionally, the vaginal vault was pexed to the mesh.\nThe patient had an excellent postoperative course, achieving\nnormal bowel function from the second day onward without\nfurther externalization. She was discharged on the fourth\npostoperative day. Six months after the surgery, the patient\nhas had no complaints of intestinal issues or prolapse\nrecurrence.\nDiscussion Ventral rectopexy is currently widely\naccepted and utilized for managing rectal prolapse, becoming\nthe most common abdominal procedure due to its excellent\nlong-term outcomes, with a low recurrence rate of 8% over a\n10-year follow-up. Functional outcomes are also favorable,\nwith an 80% improvement in fecal incontinence and a reduc -\ntion in constipation rates from 54% to 15%. Its use for acute\nrectal prolapse with incarceration has not been speci fically\ndescribed in the literature, making this case an innovative\napproach in this context.\nConclusion The D’Hoore technique proved to be a safe\nand definitive treatment for acute rectal prolapse caused by\nincreased abdominal pressure following abdominoplasty.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 141738\nOpen Videos\nTECHNICAL ASPECTS OF MINIMALLY INVASIVE SURGERY FOR\nTHE TREATMENT OF ENDOMETRIOSIS INVOLVING THE\nRECTUM\nRodrigo Gomes da Silva1, Magda Maria Profeta da Luz 1, Renato\nGomes Campanati 1, Luiza Rogerio 1, Bernardo Hanan 1, Cleo\nGonçalves Trindade Ribeiro 1, Giovane Botelho Bacelar 1, Kelly\nCristine Lacerda Rodrigues Buzatti 1\n1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo\nHorizonte, Brasil\nIntroduction Endometriosis is a chronic disease de-\nfined as the presence of endometrial tissue outside the\nuterus. Involvement of the colon and rectum can occur in\nup to 10% of women, primarily in the rectosigmoid region. In\ncases where clinical treatment is refractory, surgical treat-\nment may be indicated and can involve resection of the\naffected organs to achieve adequate disease control.\nObjectives To surgically describe a minimally invasive\napproach to endometriosis with massive invasion of the\nrectum, where a totally laparoscopic colorectal anastomosis\nwas performed.\nMethods A 37-year-old patient presented with com-\nplaints of colicky abdominal pain worsening during menstru-\nation, as well as stool thinning, tenesmus, and constipation.\nDigital rectal examination revealed a hardened lesion in the\nrectum, and MRI showed endometriotic foci in the uterosac -\nral ligament and rectum, along with significant adenomyosis.\nWith a de fined parity, surgery was opted for, involving\nhysterectomy combined with rectosigmoidectomy to control\nthe symptoms.\nResults A standard laparoscopic rectosigmoidectomy\ncombined with hysterectomy was performed, with vaginal\nextraction of the surgical specimen. A circular stapler head\nwas introduced via the vaginal route, and a totally laparosco-\npic colorectal anastomosis was successfully completed. The\npatient experienced excellent outcomes, with complete res-\nolution of her symptoms.\nConclusion A totally laparoscopic approach with\nvaginal specimen extraction in cases of benign disease can\nbe successfully performed, offering the bene fit of avoiding\nabdominal incisions.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 138605\nOpen Videos\nCOLORECTAL ANASTOMOSIS DEHISCENCE. MINIMALLY\nINVASIVE TREATMENT\nLuiz Carlos Benjamin Do Carmo 1, Luiz Guilherme Lisboa\nGomes2, Sergio Gontscharow 1, Thiago Ibiapina Alves 1, Raíssa\nTexeira Rosalino1, Debora Fontes Santos 1, Renato Barretto\nFerreira da Silva 2\n1Hospital São Luiz, Itaim, São Paulo, Brasil\n2Hospital e Maternidade Santa Joana, São Paulo, Brasil\nIntroduction Colorectal anastomosis dehiscence has\ndecreased in recent decades with the introduction of new\nsutures and staplers, along with minimally invasive surgery\nand methods to assess anastomotic perfusion, such as fluo-\nrescence with Indocyanine Green, as well as devices and\nmaterials to reinforce the anastomosis. In benign diseases,\nunlike malignancies, the incidence of anastomotic dehiscence\nis low. However, when it occurs, it is a serious complication\nthat increases hospital stays, reoperations, and infections.\nObjective To demonstrate the use of minimally inva-\nsive procedures in patients who underwent colorectal anas-\ntomosis via laparoscopic or robotic surgery and experienced\nanastomotic dehiscence in benign diseases, such as acute\ndiverticulitis and intestinal endometriosis.\nMethods In a cohort of 1,170 patients who underwent\nlaparoscopic and robotic surgeries for benign intestinal dis-\neases from August 2016 to March 2024, our incidence of\nanastomotic fistula was 0.85%, compared to 0.92% to 1.98%\nreported in the literature. We will demonstrate through\nvideos our approach using minimally invasive techniques\nto avoid laparotomies. Procedures included laparoscopic\ndrainage puncture, lavage and drainage, resection with new\nanastomosis, colostomies, ileostomies, and endoscopic\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS134\n\n\nvacuum therapy, all accompanied by nutritional support via\nparenteral feeding.\nDiscussion The most commonly used approach for\nlow-output anastomotic fistulas without signi ficant general\nhealth implications is conservative treatment. However, in\ncases where this treatment fails or in the presence of perito-\nnitis, wide laparotomies and diverting stomas are performed,\nincreasing complications, hospital stays, infections, dehis-\ncences, and hernias at the surgical incision site, as well as\nthromboembolic complications due to delayed early\nmobilization.\nConclusion It is important to individualize each case\nand apply minimally invasive approaches. Not all cases\nrequire reoperation, and not every reoperated case needs\nresection or a terminal stoma. Newer, minimally invasive\ntreatments, such as endoscopic vacuum therapy, should\nalways be considered. Our patients experienced less postop-\nerative pain, fewer complications, a lower rate of surgical\nreadmissions, and a faster return to their activities.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 138362\nOpen Videos\nRECTAL ENDOMETRIOSIS: PARTICULARITIES OF SHAVING\nRESECTION VIA LAPAROSCOPY AND ROBOTICS\nRodrigo Ambar Pinto1, Ruy de Oliveria Machado Junior1, Priscila\nMatsuoka Locali1, Thaís Villela Peterson 1, Ulysses Ribeiro\nJunior1, Carlos Frederico Sparapan Marques 1, Gabriela Fonseca\nLopes1, Isaac José Felippe Corrêa Neto 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nCase Presentation These are two cases of deep rectal\nendometriosis. Both patients have similar clinical histories,\nexperiencing cyclical abdominal pain during menstruation\nand discomfort with bowel movements. The first, a 28-year-\nold woman with uterine fibroids and a desire for reproduc -\ntion, and the second, a 40-year-old woman with completed\nfamily, whose symptoms began after childbirth. The first case\nwas approached laparoscopically, and the lesion was adhered\nto the uterine torus. After myomectomy, the approach was\ninitially to release the lesion from the rectovaginal septum by\ndissecting the lateral regions, addressing the Okabayashi\nspace to avoid injury to adjacent structures. Subsequently,\nthe rectal lesion was dissected initially at its edges, isolating it\nfrom the mesorectum. Dissection was continued along the\nrectal muscle layer using low-voltage electrocautery (15), in\npure cut mode, with a hook. After the resection of the lesion,\nrectal integrity was con firmed, and no residual lesions were\nnoted. The blow test was performed, and the serosa was\nclosed with transverse sutures. In the second case, the robotic\napproach was chosen. After subtotal hysterectomy, the rectal\nlesions were not directly connected to the rectovaginal\nseptum. Circumferential isolation of the lesions was per-\nformed with a robotic scissors in low voltage, in cut mode.\nThe lesions were then detached from the rectal muscle and\nsutured transversely. The blow test was negative. The main\nadvantage of the robotic approach was the stability of the\noptics, providing better visibility and precision in\nmovements.\nDiscussion Deep endometriosis is characterized by\nthe involvement of the peritoneal surface at a depth greater\nthan 4 mm. Rectal involvement occurs in about 10% of cases of\nendometriosis and requires the approach of a colorectal\nspecialist. The rectum is an essential organ for continence\nand intestinal function, and whenever possible, it should be\npreserved. Tangential resection (shaving) of the rectal wall is\nan ideal option when attempting to preserve the rectum in\nendometriosis surgeries. About 10 years ago, robotic surgery\nwas introduced to optimize the precision and success of these\nprocedures. However, to date, the results of both techniques\nare comparable.\nConclusion The key importance of this video is to\ndetail the shaving resection technique, regardless of the\napproach used, in order to spread the technique and encour-\nage more surgeons to consider rectal function preservation in\ncases of identi fiable endometriosis.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 138366\nOpen Videos\nSIGMOID ENDOMETRIOSIS: WHEN SEGMENTAL RESECTION\nIN LARGE LESIONS WITH LATERAL-LATERAL ANASTOMOSIS\nASSISTED BY ROBOT CAN BE A GOOD OPTION\nRodrigo Ambar Pinto1, Gabriela Fonseca Lopes1, Flávio Massato\nKawamoto1, Isaac José Felippe Corrêa Neto 1, Priscila Matsuoka\nLocali1, Rafael Fagionato Locali1, Ulysses Ribeiro Junuir 1, Carlos\nFrederico Sparapan Marques 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nCase Presentation A 39-year-old woman presented\nwith colicky pain around her menstrual period, in addition to\ninfraumbilical abdominal pain associated with an increased\nfrequency of bowel movements from 1 to 3 times a day and\ndyspareunia. The patient desired to have children. Trans-\nvaginal ultrasound with preparation revealed, in addition to\novarian and deep pelvic peritoneal involvement, a lesion in\nthe sigmoid colon that was not contiguous with the previous\nlesions. A robotic approach was chosen, and resection of\nperitoneal endometriosis foci, ureterolysis, and resection of\nthe uterosacral ligaments were performed. The evaluation of\nthe lesion above the rectosigmoid transition showed that it\nwas larger than 4 cm and invaded the muscular layer, so a\nsegmental resection of the sigmoid of approximately 7 cm\nwas performed. The dissection of the mesocolon with the\nrobotic arms was done near the loop without ligating more\nproximal vessels, without compromising irrigation. A me-\nchanical isoperistaltic lateral-lateral anastomosis was then\nperformed using a linear stapler. Highlights included the\noptical stability, providing better vision, and the increased\nprecision of movements. The patient had an excellent post-\noperative recovery, with bowel movement on the first day\nand discharge on the second. Intestinal function returned to\nnormal shortly after the surgery.\nDiscussion The intestine is a common site of involve-\nment in deep endometriosis, which causes significant anxiety\nfor patients and gynecologists due to uncertainties about\nmanagement, function, and especially the need for a stoma.\nAbout 10% of patients with endometriosis have intestinal\ninvolvement, with the sigmoid colon being the second most\naffected segment, involved in 25% of cases, second only to the\nrectum (80%). Because the sigmoid wall is narrower and the\nstool consistency is solid in this segment, more extensive\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S135\n\n\ntangential resection is generally avoided. Furthermore, par-\ntial sigmoid resection does not compromise function. This\ncase demonstrates an economical segmental resection tai-\nlored to the extent of the intestinal lesion and highlights the\nprecision of robotic surgery, encouraging greater diffusion of\nthis technique for addressing a challenging, multidisciplinary\ndisease that can greatly bene fit young patients. The robotic\napproach is still rarely practiced in Brazil for such a complex\ndisease and should be more widely promoted.\nConclusion This video demonstrated the importance\nof robotic -adjusted segmental sigmoid resection with lateral-\nlateral anastomosis. The technique proved to be safe and\nteachable, making it a valuable tool for spreading knowledge.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 134895\nOpen Videos\nTHE COLON DOESN ’T REACH THE PELVIS, NOW WHAT?\nRETROILEAL TUNNEL AND DELOYERS ’ MANEUVER\nLucas Faraco Sobrado 1, Carolina Reis Bonizzio 1, Jorge Landivar\nCoutinho1, Diego Fernandes Maia Soares 1, Antonio Rocco\nImperiale1, Carlos Walter Sobrado 1, Carlos Frederico Sparapan\nMarques1, Ulysses Ribeiro Junior 1\n1Hospital das Clínicas da Faculdade de Medicina da Universidade de\nSão Paulo, São Paulo, Brasil\nThe reconstruction of intestinal transit after left-sided\ncolectomies and rectosigmoidectomies for the treatment of\ncolorectal cancer involves the mobilization of the splenic\nflexure and ligation of the inferior mesenteric vein, allowing\nthe colon to descend for a colorectal anastomosis. However, in\ncases of extensive left-sided colon resections, such as in\nsynchronous tumors or ischemia of the colon after ligation\nof the inferior mesenteric artery, the remaining colon may\nnot reach the pelvis due to tension on the middle colic vessels,\npreventing the anastomosis. In this video, we demonstrate\ntwo important techniques for colon descent when the usual\nmaneuvers to mobilize the splenic flexure are insufficient. In\nthe first case, a patient with two locally advanced synchro-\nnous tumors located in the proximal rectum and the descend-\ning-sigmoid transition underwent a rectosigmoidectomy\nwith total mesorectal excision and partial left colon resection.\nSince the remaining colon did not reach the pelvis after\ncomplete mobilization of the splenic flexure, the creation\nof a retroileal tunnel was necessary for the transmesenteric\nlowering of the colon and the formation of a tension-free\nanastomosis. In the second case, a young patient with locally\nadvanced distal rectal adenocarcinoma underwent neoadju-\nvant chemoradiotherapy but developed an inoperable steno-\nsis of the rectum and a subocclusive condition. A\nrectosigmoidectomy with intersphincteric resection, manual\ncoloanal anastomosis, and intraoperative colon preparation\nwas indicated. After ligation of the inferior mesenteric artery,\nit was noted that the left colon was ischemic, a finding\nconfirmed with intraoperative laser angiography (SPY Plat-\nform). Therefore, a counterclockwise rotation of the right\ncolon (DeLoyers ’ maneuver) was performed to lower the\ncolon into the pelvis and perform an ascending-anal manual\nanastomosis, which was completed without complications.\nThe aim of this video is to demonstrate the step-by-step\nprocess of two important techniques that should be part of\nthe colorectal surgeon’s arsenal, allowing for intestinal transit\nreconstruction in complex situations when the remaining\ncolon does not reach the pelvis.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 141121\nOpen Videos\nSEGMENTAL RESECTION OF THE SIGMOID RECTUM WITH\nSURGICAL SPECIMEN EXTRACTION VIA VAGINAL ROUTE\n(NOSES) COMBINED WITH PAN-HYSTERECTOMY. STEP-BY-\nSTEP LAPAROSCOPIC TECHNIQUE\nDaniela França Camargo Freitas 1, José Vitor Cabral Zanardi 1,\nFernando Passador Valério 1, Marley Ribeiro Feitosa 1, Cristiane\nde Souza Donega 1, José Joaquim Ribeiro da Rocha 1, Omar\nFéres1, Rogerio Sera fim Parra1\n1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto,\nRibeirão Preto, Brasil\nThis work aims to demonstrate the step-by-step\nsurgical treatment of deep endometriosis involving the rec -\nto-sigmoid via video laparoscopy, with surgical specimen\nextraction through a natural ori fice, utilizing the vaginal\nopening during hysterectomy. It concerns a 53-year-old\npatient who complained of changes in bowel habits, thinning\nof stools, and no hematochezia for about 2 years. She had an\nincomplete colonoscopy performed at another facility, whose\nreport showed a fixed angulation and possible obstruction\napproximately 15-20 cm from the anal margin. She has one\ndaughter, vaginal delivery 20 years ago, and is widowed. A\ntransvaginal ultrasound with bowel preparation was\nrequested, which found: a right retrouterine ovary, adhered\nto the right uterosacral ligament, with a 15.5 cm³ endome-\ntrioma. Deep endometriosis lesions in both uterosacral liga-\nments. The vagina appeared normal. Three lesions in the\nrecto-sigmoid, the most distal about 9 cm from the anal\nmargin, the second 12 cm from the anal margin, and the most\nproximal located about 18 cm from the anal margin, occupy-\ning about 50% of the sigmoid circumference, with a size of 4.5\ncm. Given these findings, surgery was proposed, and the\nprocedure performed was laparoscopic pan-hysterectomy\nwith treatment of the endometriosis lesions and segmental\nresection of the rectum and sigmoid, encompassing the 3\nlesions, removing the surgical specimen via the vagina\n(NOSES). The illustrative video shows the step-by-step of\nthe surgery for deep endometriosis with intestinal involve-\nment, when there are multiple intestinal lesions and sigmoid\nobstruction. The video will show the cavity inventory, pro-\ntection of nerves and ureters, release of the rectum and\nsigmoid, pan-hysterectomy, removal of the vaginal specimen,\nsectioning of the rectum with a laparoscopic linear stapler\nwith a single load, preservation of the mesorectum, removal\nof the bowel via the vagina, creation of the purse-string\nsuture, passage of the circular stapler ’s anvil, new pneumo-\nperitoneum, creation of the anastomosis with double sta-\npling, integrity test of the anastomosis, and vaginal closure by\nlaparoscopy.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS136\n\n\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 138356\nOpen Videos\nTREATMENT OF DIGESTIVE BLEEDING BY\nVIDEOLAPAROSCOPY DUE TO ULCER IN MECKEL ’S\nDIVERTICULUM - CASE REPORT\nFernando Forghieri Silveira 1, Camila Nardi 1, Naualy Cunha\nAlencar1, Luana Segantine 1, Danilo Toshio Kanno 1, Rayama\nMoreira Siqueira 1, Paula Cristina Steffens Novelli 1, Carlos\nAugusto Real Martinez 1\n1hospitalUniversitário Sao Francisco na Providência de Deus, Bragança\nPaulista, Brasil\nA 18-year-old boy with a recent history of NSAID use\n(for 3 days one week ago) was admitted to the hospital with\nsuspected upper gastrointestinal bleeding, presenting with\nmelena, large-volume enterorrhagia, deterioration of general\ncondition, pallor, and sweating, along with hemodynamic\ninstability, and was transferred to the ICU. After receiving 3\nunits of packed red blood cells and clinical management to\nimprove shock, an endoscopy (normal), preparation, and\ncolonoscopy (normal) were performed. The patient was\nthen submitted to computed tomography angiography,\nwhich identi fied a Meckel ’s diverticulum loop in the cecal\narea of the right iliac fossa with active bleeding inside the\ndiverticulum. Laparoscopy was performed. In the intra-\noperative period, after identifying the Meckel’s diverticulum,\nthe wall of the small bowel loop was opened, and the optical\ndevice was passed through the opening to perform entero-\nscopy. An ulcer inside the Meckel ’s diverticulum with active\nbleeding was identi fied. A segmental enterectomy with\nlateral enteroanastomosis was performed.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 138224\nOpen Videos\nENDOSCOPIC TREATMENT OF COLORECTAL ANASTOMOSIS\nFISTULA\nLaís Yumi Takaoka1, Luiz Carlos Benjamin Do Carmo1, Sandra Di\nFelice Boratto1, Renato Barretto Ferreira da Silva 1, Raíssa\nTeixeira Rosalino2, Sérgio Gontscharow 2, Thiago Ibiapina\nAlves2, Juliana Giangiardi Batista 1\n1Faculdade de Medicina do ABC, Santo André, Brasil\n2Hospital São Luiz Itaim, São Paulo, Brasil\nCase Presentation A 38-year-old obese female pa-\ntient developed a colorectal anastomosis fistula on the 7th\npostoperative day following laparoscopic retossigmoidec -\ntomy for complicated acute diverticulitis (Hinchey III). The\npatient was treated with endoscopic vacuum-assisted closure\nthrough colonoscopy, resulting in complete closure of the\nfistula within two weeks. We will demonstrate, through\nvideo, how this procedure was performed.\nDiscussion Endoscopic vacuum therapy has become a\nwell-established therapeutic option in the treatment of gas-\ntrointestinal fistulas, and it has shown promising results for\ncolorectal anastomotic fistulas. It is a less invasive method for\ncorrecting anastomotic fistulas, effective in stable patients\nwithout generalized peritonitis. This technique promotes\nhealing by stimulating granulation tissue formation, reducing\nedema and bacterial proliferation, and enhancing local vas-\ncularization. The treatment involves inserting an endoscopic\nsponge at the site of the lesion, connecting it to a vacuum\nsystem, typically for 7 to 14 days, with success rates of up to\n92% in studies.\nConclusion Endoscopic therapy is an excellent option\nfor clinically stable patients with colorectal anastomotic\nfistulas, presenting high success rates and low complication\nrates. While it is not yet widely available in the Brazilian\nhealthcare system, we believe that, once fully established, it\nwill lead to a reduction in morbidity, avoiding further surgical\ninterventions, and consequently reducing hospital costs.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 138321\nOpen Videos\nUse of the NOSE Technique for Minimally Invasive\nLaparoscopic Surgery and Robotic-Assisted Surgery in Deep\nEndometriosis\nRaphaella Assis Alves Januário 1, Marina Ströher 1, Juliana\nGiangiardi Batista1, Sandra Di Felice Boratto1, Eduardo Vidal de\nHolanda1, Maria Luiza Marinho Vidigal 1, Luiz Carolos Benjamin\nDo Carmo 1, Renato Barreto Ferreira da Silva 1\n1Centro Universitário Faculdade de Medicina do ABC, Santo André,\nBrasil\nIntroduction Laparoscopic surgery for colon diseases\nhas seen increased use by surgeons due to its many advan-\ntages, such as reduced morbidity, less pain, and earlier\nambulation compared to open surgery. Current techniques\nrequire an abdominal incision for specimen removal, which\nincreases pain and complication rates, such as infection,\nhernia formation, and less favorable cosmetic outcomes.\nThus, there is a trend toward performing intracorporeal\nanastomosis, and the technique called NOSE (Natural Ori fice\nSpecimen Extraction) has become more widespread either by\nopportunity or by choice. Current studies show bene fits for\npatients who undergo this procedure, including improved\npostoperative pain, faster recovery, reduced nerve injury and\nsurgical site infection, and fewer incisional hernias, leading to\nbetter cosmetic outcomes. This technique has a short learning\ncurve, both in laparoscopy and robotic surgery.\nObjective To demonstrate that transvaginal specimen\nextraction is a viable and safe approach in colorectal resection\nfor deep endometriosis.\nMethod Video of surgery using the NOSE technique\nand retrospective analysis of hospitalization time, surgery\nduration, and incidence of fistulas in segmental\nrectosigmoidectomy.\nResult A multidisciplinary surgical team from a large\nhospital in São Paulo performed a total of 1,216 surgeries,\nwith 944 performed via robotic surgery and 272 via laparos-\ncopy. There were no cases of conversion to laparotomy. The\nNOSE technique was used in 102 surgeries for specimen\nextraction. There was no increase in hospitalization time\nwhen comparing this technique to conventional surgery, and\nno increase in the incidence of rectovaginal fistulas.\nJ Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstract S137\n\n\nConclusion The NOSE technique is an interesting\napproach for patients undergoing rectosigmoidectomy for\nendometriosis. The complication rate appears comparable to\nthe conventional surgical approach (minilaparotomy) and\nhas shown to improve postoperative pain, enable early\ndischarge, and reduce the risk of infection and hernia at\nthe abdominal incision site.\nTemas gerais dentro da especialidade\nGeneral Topics Within the Specialty\nID – 138202\nOpen Videos\nVAGINOPLASTY WITH SIGMOID COLON IN A GENDER\nREASSIGNMENT PATIENT WITH PREVIOUS LOSS OF\nCUTANEOUS-MUSCULAR FLAP – A CASE REPORT\nIsabela Pereira Blanco1, Pedro Fernandes Louback1, João Emílio\nLemos Pinheiro Filho 1, Erica Sakamoto 1, André Roncon Dias 1,\nJacques Waisberg1, Bárbara Cristina Jardim Miranda 1\n1Faculdade de Medicina do ABC, Santo André, Brasil\nCase Presentation A 43-year-old transgender woman\nwith a diagnosis of gender dysphoria underwent gender\naffirmation surgery using inverted penile skin for the crea-\ntion of the vaginal canal in June 2018. In 2022, she developed\ndyspareunia and partial loss of the cutaneous flap of the\nneovagina, which did not improve with topical Promestriene.\nIn November 2022, a revision of the neovagina was performed\nwith dissection of the vaginal canal ’s fundus and autologous\nfull-thickness skin graft in the suprapubic region. Upon\nfollow-up, a short vaginal canal and persistent granulation\ntissue were noted, along with continued dyspareunia. The\npatient was evaluated by the Digestive Surgery team for the\nuse of an intestinal flap and neovagina correction. In January\n2024, she underwent sigmoid colon vaginoplasty with a\ndescending-sigmoid anastomosis by videolaparoscopy. She\ncurrently has normal bowel habits and no complaints.\nDiscussion Gender identity disorder is a condition in\nwhich individuals strongly identify with the gender opposite\nto their biological sex, causing social and occupational dis-\ntress. For transgender women, the most common surgery is\nvaginoplasty, which involves removal of male genitalia and\nthe creation of a neovagina. There are three main surgical\ntechniques for vaginoplasty: skin grafts, penile-scrotal cuta-\nneous flaps, and pedicled segments of small or large intestine.\nThe intestinal segment technique is most commonly used\nwhen there is a lack of penoscrotal skin or when previous\nvaginoplasty attempts have failed. Intestinal vaginoplasty can\npresent complications, such as intestinal fistulas, urinary\nretention, bleeding, urethral stenosis, surgical site infection,\nrectal injuries, and tissue necrosis. Performing the procedure\nlaparoscopically offers advantages, including better visuali-\nzation and ease in recreating the neovagina. A team of\nspecialists, including a gastrointestinal surgeon with ad-\nvanced laparoscopic skills, is essential to minimize compli-\ncations and ensure the success of the procedure.\nConclusion The lack of evidence makes it dif ficult to\nchoose the ideal technique for vaginoplasty in transgender\nwomen. Penile skin inversion is more studied, but vagino-\nplasty with intestinal segments does not appear to be inferior.\nProspective studies with larger groups and long-term follow-\nup are needed. Until then, the experience of the team and\navailable resources should guide the choice of technique.J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).\nAbstractS138","source_license":"CC0","license_restricted":false}