IMPACT OF SEXUAL SATISFACTION, ANXIETY, AND DEPRESSION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: AN OBSERVATIONAL STUDY IN A REFERENCE CENTER

Abstract

J Coloproctol 2024;44(Suppl S1):S1 –S138. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141222 E-poster ANAL ADENOCARCINOMA IN A YOUNG MAN: CASE REPORT Vanessa Bernardes Daniel 1, Roberta Denise Alkmin Lopes de Lima1, Rayssa Sawan Mendonça 1, Karla Cristina Cintra 1, Maycon Lucas Sousa 1, Leonardo Mundin Porto 1, Miguel Miranda Vicentini1, Cláudio Henrique Reviriego Formigoni 1 1Santa Casa de Misericórdia de Franca, Franca, Brasil Case presentation A 33-year-old male presented with a three-year history of hematochezia, tenesmus, and anal prolapse. The condition progressed with worsening anal bleeding, requiring blood transfusion. He sought medical attention, and a colonoscopy revealed an arteriovenous mal- formation 2 cm above the pectinate line. Despite treatment, the symptoms persisted, and the bleeding worsened. He was referred to a specialized center with a provisional diagnosis of hemorrhoidal disease. A proctological examination under sedation was performed, revealing a bleeding, pedunculated lesion measuring 6 cm, located above the pectinate line. Local excision of the lesion was performed. Histopathological anal- ysis showed intramucosal adenocarcinoma associated with a villous adenoma with high-grade dysplasia, with clear surgi- cal margins.

Discussion

Primary adenocarcinoma of the anus is a rare disease accounting for only 5% –10% of anal canal malig- nancies. The presentation of this disease is generally late, with a mean age of diagnosis at 59 years, possibly due to the associated non-speci fic symptoms. Anal adenocarcinomas can be subdivided into two types: (1) colorectal from the mucosa above the dentate line and (2) extramucosal from anorectal fistulas or anal glands. Given the challenges with classification and the low number of cases overall, most of the literature is limited to case reports or outcome-driven obser- vational studies. This case highlights the challenges of early diagnosis of anal malignancies and the importance of imme- diate evaluation of the anorectal region when recto-anal symptoms, such as bleeding or mucus in the stool, are reported through digital rectal examination, sometimes neglected in medicine. The lesion presented a clinical picture similar to symptoms of hemorrhoidal disease, such as bleed- ing and anal prolapse. Anal tumors can also be identi fied in routine or diagnostic colonoscopy, even in asymptomatic patients.

Conclusion

Due to delayed diagnosis, anal adenocar- cinomas often have a poor prognosis. Understanding the patient’s symptoms and performing a physical examination, such as a digital rectal exam, supports early diagnosis and targeted treatment. This approach contributes to better patient outcomes and helps reduce the morbidity and mor- tality associated with the disease. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141705 E-poster ADENOCARCINOMA WITH SIGNET RING CELLS OF CECAL APPENDIX IN A PATIENT WITH TRANSVERSE COLON DUPLICATION: CASE REPORT Brunna Vitória Gouveia Prado 1, Lêda Telesi Castro 1, Marina Ströher2, Mychelly de Sá Carvalho 1, João Roberto Fagundes Júnior1, Maria Luiza Marinho Vidigal 2, Gabrielle Quessada 1 1Hospital Municipal Prof. Dr. Alípio Corrêa Netto, São Paulo, Brasil 2Faculdade de Medicina do ABC, Santo André, SP, Brasil Case presentation Male, 56 years old, with abdomi- nal pain and distension, nausea and change in bowel habit with watery diarrhea for 5 days. Epilepsy patient. No previous abdominal surgery. No family background. On examination, he appeared dehydrated, abdomen distended and painful on diffuse palpation, with signs of peritonitis. Empty rectal ampule. Abdomen tomography requested, which showed an area of thinering and distortion of the path of the mesenteric vessels in the mesogastria, with air- fluid levels in colic segments upward, with the possibility of acute obstructive abdomen. Exploratory laparotomy indicated with findings of tumor in the cecum and duplication in the transverse colon. Right hemicolectomy and ileo-transtomic anastomosis performed. Patient with good evolution, dis- charge on the 7th postoperative day. Anatomopathological study with findings of adenocarcinoma with signet ring cells in the cecal appendix and mesogastria. Presence of a 14 cm tubular fragment with mucosa of a usual colonic appearance, with continuous light with the transverse colon, correspond- ing to intestinal duplication.

Discussion

Primary appendix neoplasms have a prev- alence of 0.5 to 1% of cases. Primary signet ring cell adeno- carcinoma comprises 4% of them, with an overall survival of ISSN 2237-9363. © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by-nc-nd/4.0/). Thieme Revinter Publicações Ltda., Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil THIEME S1 Article published online: 2025-04-25 18% in 5 years, the lowest when compared to mucinosal adenocarcinoma and others. In 93% of cases, it presents metastases to adjacent areas. The intraoperative finding of tubular duplication of the transverse colon is a most common diagnosis in childhood. It has its first description in the 18th century and can occur throughout the gastrointestinal tract, either in a spherical or tubular form, with tubular duplication being the rarest. This variation results from embryonic developmental disturbances and may present with intussus- ception, volvulus, and obstruction. It can be associated with malignant neoplasms, most commonly adenocarcinoma.

Conclusion

Adenocarcinoma with signet ring cells of the appendix is a rare entity with a high mortality risk, requiring differential diagnosis and histopathological study to ensure proper management and follow-up. In cases of intestinal duplication, due to its potential for complications, surgical treatment is the preferred approach for symptomatic patients. An individualized assessment of each case is neces- sary to determine whether resection of only the duplicated segment or an extended resection of additional segments is warranted based on intraoperative findings. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138351 E-poster ADENOCARCINOMA OF THE ILEUM MIMICS CROHN ’S DISEASE – CASE REPORT Cristina Calloni 1, Daniel de Barcellos Azambuja 2, Andreia Azevedo2, Bruna Oliveira Trindade 2, Fares Hassan Hamaoui 3, Alice Oliveira3 1Universidade Feevale, Rio Grande do Sul, Brasil 2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil 3Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil

Introduction

Crohn’s Disease (CD) is characterized by episodes of in flammation of the gastrointestinal tract with the classic symptoms: abdominal pain, diarrhea, change in stool pattern and weight loss. These symptoms are equivalent in cases of intestinal neoplasia.

Method

Study based on medical record analysis and bibliographic review with the objective of reporting the importance of the differential diagnosis of ileal adenocarci- noma in cases previously diagnosed with CD. Case report: Female patient, 45 years old, started experiencing abdominal pain in July 2022. Under investigation, she underwent colo- noscopy with subsequent biopsy of fragments, but there was no assertive clari fication of the diagnosis, starting empirical treatment for CD with corticosteroids associated with aza- thioprine (AZA). After 8 months of treatment, she presented symptoms suggestive of intestinal sub-occlusion and com- puted tomography (CT) of the abdomen showed signi ficant circumferential and irregular parietal thickening of the seg- ment of the distal ileum, associated with in filtration of the adjacent adipose tissue, in addition to luminal narrowing. Findings that favor the clinical suspicion of in flammatory bowel disease (IBD), especially CD. As her condition pro- gressed, she underwent an ileocolectomy procedure with subsequent referral of an anatomical piece to the pathology department. During the study, the pathology identi fied moderately differentiated adenocarcinoma of the distal seg- ment of the ileum, with a usual tubular/intestinal pattern, ulcer-infiltrating, ring-shaped, extending to the mesentery and free surgical margins. With satisfactory postoperative evolution, she maintained the clinical segment with chemo- therapy according to protocol.

Discussion

Neoplasia of the small intestine is rare with an annual incidence of 2.1 cases in 100,000. Adenocar- cinoma is the second most common histological type, and its ileal location makes this entity even less common. Symptoms in patients with CD are indistinguishable from those with adenocarcinoma. Thus, this fact tends to mask and delay the diagnosis of malignancy. Around 10% of patients originally diagnosed with IBD have a change in diagnosis after reevaluation.

Conclusion

The discussed finding highlights not only the heterogeneity of these diseases, but also the dif ficulty of correctly determining their diagnoses. In this context, sys- tematic monitoring is, therefore, necessary so that the condi- tion does not remain undetermined, interfering with the patients’ quality of life and thus reducing their problems. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138613 E-poster RECTAL ADENOCARCINOMA AND PAPILLARY THYROID CARCINOMA IN A YOUNG ADULT WITH LYNCH SYNDROME Mayara de Almeida Stefano 1, Guilherme Abreu Guerra 2, Vanessa Siqueira Reis 3, Bruno Augusto Alves Martins 3, João Batista de Sousa 3, Romulo Medeiros de Almeida 3, Antônio Carlos Nóbrega dos Santos 3, Marccus Antônio Tolentino de Jesus3 1Universidade de Brasília, Brasília, Brasil 2Centro Universitário de Brasília, Brasília, Brasil 3Hospital Universitário de Brasília, Brasília, Brasil Presentation A 44-year-old woman treated at an outpatient clinic for hereditary colorectal cancer with a diagnosis of Lynch Syndrome with a pathogenic variant in the MSH6 gene. Family history of neoplasms with sisters diagnosed with gastric and thyroid cancer at ages 36 and 35, respectively. The patient presented with colonoscopy with an ulcerative lesion occupying 50% of the circumference of the middle rectum and histopathology with well-differentiated adenocarcinoma. Magnetic resonance imaging demonstrated cT3N1M0 staging. She underwent chemoradiotherapy along the lines of the “RAPIDO trial ”. Four months later, a recto- sigmoidoscopy was performed which showed an ulcerated area covered with fibrin, compatible with a partial response to neoadjuvant therapy. It also brings a biopsy report of a thyroid nodule with cytology compatible with papillary carcinoma, chosen to be discussed later. The case was dis- cussed in a clinical session, and the decision was made to perform anterior resection of the rectum and endoscopic follow-up. Proposed total hysterectomy and bilateral prophy- lactic adnexectomy, considering the incidence of gynecologi- cal cancer in patients with Lynch syndrome. The patient was discharged and cleared for treatment of the papillary carci- noma. Bowel continuity was restored, and the patient remains under outpatient follow-up.

Discussion

Lynch syndrome is the leading cause of hereditary colorectal cancer (CRC), accounting for approxi- mately 3% of CRC cases and 2–3% of endometrial cancer cases. With mutations in the MSH6 gene, the cumulative risk of J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS2 endometrial cancer can reach 50%. The decision to perform a total hysterectomy and prophylactic salpingo-oophorectomy remains controversial; however, in this case, the option was discussed with the patient, as she had already completed her family and was undergoing surgery. Other commonly affected sites include the ovaries, stomach, brain, and prostate. Family history of malignancies must be assessed, with colorectal cancer screening starting at age 30 or 2 –5 years before the youngest age of diagnosis in the family, repeated every three years. Studies have shown that colonoscopy in these patients reduces disease mortality and adds an average of 14 quality- adjusted life years compared to unscreened individuals.

Conclusion

Patient education about the disease is crucial, given the high likelihood of developing neoplasms throughout life. Attention to signs and symptoms indicative of disease in the primary sites should not be overlooked. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138081 E-poster MUCINOUS AND SIGNET RING CELL RECTAL ADENOCARCINOMA WITH ISOLATED BONE MARROW DISSEMINATION: A CASE REPORT Juanita Justina Ferreira da Silva 1, Beatriz Dias Rosa 1, Matheus Walerio Braido Arantes 1, Giovane Amui Fernandes 1, Gabriel Oriani Melo1, Fernanda Garcia de Carvalho Pereira 1, Renata de Souza Guerra 1, Marcelo Maia Caixeta Melo 1 1Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brasil Case Presentation A 56-year-old male, hypertensive, was admitted to the emergency department of a tertiary hospital on 03/20/2023 with a one-month history of lower back pain radiating to the lower limbs, associated with asthenia, anorexia, hematochezia, and a 4 kg weight loss, without prior colonoscopy. On admission, moderate bicito- penia and elevated LDH were observed. A computed tomog- raphy (CT) scan revealed concentric thickening of the rectal wall with adjacent mesorectal fat densi fication and locore- gional lymph nodes, suggesting primary rectal neoplasia. On proctological examination, a fixed lesion with irregular mu- cosa was found on the anterolateral left wall of the rectum, 6 cm from the anal margin. A colonoscopy was scheduled for 04/05/2024 but was postponed due to clinical worsening and refractory bicitopenia. On 04/05/2023, a bone marrow biopsy showed extensive in filtration by mucinous adenocarcinoma with signet-ring cells, low hematopoietic reserve, and grade 3 reticulin fibrosis. Immunohistochemistry con firmed a colo- rectal primary site. After a multidisciplinary discussion, a palliative approach was chosen due to the refractory bicito- penia to transfusion measures (9 units of red blood cells and 27 units of platelets during the entire hospitalization), as well as the mucinous subtype ’s poor response to chemotherapy. The patient was discharged after 23 days of hospitalization for outpatient follow-up but discontinued follow-up care.

Discussion

Rectal cancer with isolated bone marrow dissemination is extremely rare, occurring in 0 –1.1% of patients. This type of dissemination can lead to hematologic dysfunction, with the most common symptoms being ane- mia, lower back pain, and a tendency to bleed, though this initial presentation without changes in bowel habits is un- common. The main predictive factors for bone marrow metastasis include the rectal origin of the tumor, signet- ring cell characteristics, receipt of systemic chemotherapy, presence of pulmonary metastases, and higher tumor grade in patients with multiple metastatic sites. However, the association with isolated bone marrow metastasis has not been established. The prognosis is poor, regardless of treat- ment, with a survival rate of 3 months in many cases.

Conclusion

This case highlights the importance of investigating bicitopenia, with colorectal cancer being a diagnostic consideration even in the absence of gastrointes- tinal symptoms. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141707 E-poster RECTAL AND DUODENAL ADENOCARCINOMAS AFTER RESTORATIVE PROCTOCOLECTOMY IN A PATIENT WITH FAMILIAL ADENOMATOUS POLYPOSIS: A CASE REPORT Carla dos Santos Porto 1, Guinther Pedrosa Nogueira Goequing1, Luana Souza de Moraes Melo 1, Karina Mara Leitão Maia1, Vanessa Siqueira Reis2, Oswaldo de Moraes Filho2, Bruno Augusto Alves Martins 2, João Batista de Sousa 2 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil Case Presentation A 48-year-old woman with a family history of intestinal neoplasms and familial adenoma- tous polyposis (FAP) was diagnosed with FAP at the age of 27 and underwent restorative proctocolectomy. However, 17 years after the surgery, she was diagnosed with duodenal adenocarcinoma and treated with duodenopancreatectomy. In 2022, she was diagnosed with distal rectal adenocarcino- ma and opted for local excision of the tumor, followed by chemotherapy and radiotherapy (CT/RT). Exome sequencing revealed a pathogenic variant in the APC gene (c.532-1G >T), an autosomal dominant inheritance that may be associated with FAP .

Discussion

FAP is an autosomal dominant high-pen- etrance disease characterized by the formation of numerous adenomas in the rectum and colon. Around 70-80% of cases have family history. Therefore, screening is recommended starting at age 12, and prophylactic surgical treatment is indicated from age 18. The disease is initially asymptomatic but may progress with nonspeci fic symptoms and tumors. Due to the colorectal and extra-intestinal manifestations of FAP, as well as the possibility of developing cancers, prophy- lactic surgery is recommended. This may include restorative proctocolectomy with ileal reservoir, total colectomy with ileorectal anastomosis, or total proctocolectomy with per- manent ileostomy. In this case, the patient underwent restor- ative proctocolectomy, which involves excision of the colon and rectum. After rectal resection near the pelvic floor, 1 to 2 cm of rectal mucosa is left, followed by the formation of an ileal reservoir. During endoscopic follow-up, the patient developed adenocarcinoma in the remaining rectal stump. Despite prophylactic resection, neoplasms can still develop in rare cases, highlighting the importance of endoscopic monitoring.

Conclusion

Restorative proctocolectomy is consid- ered the gold-standard treatment for patients with more than 20 polyps in the rectum. This case is significant as it illustrates a rare occurrence in which the patient developed two J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S3 malignant neoplasms despite having undergone proctocolec - tomy, underscoring the importance of continued endoscopic surveillance. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138304 E-poster AGENESIS OF THE INFERIOR VENA CAVA IN A PATIENT UNDERGOING RESTORATIVE RECTOSIGMOIDECTOMY FOR COLORECTAL CANCER: A CASE REPORT AND ITS SURGICAL IMPLICATIONS Fernanda Garcia de Carvalho Pereira 1, Matheus Walerio Braido Arantes1, Leonardo Santos Viana 2, Renata de Souza Guerra 1, Beatriz Dias Rosa 1, Giovane Amui Fernandes 1, João Gomes Netinho1, Juanita Justina Ferreira da Silva 1 1Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brasil 2Faculdade de Medicina de Catanduva, Catanduva, Brasil Case Presentation A 50-year-old male presented with asthenia, weight loss, and hematochezia, symptoms which he attributed to long-standing hemorrhoidal disease. On physical examination, the abdomen was unremarkable, but the patient had grade IV hemorrhoids, varicocele, and a large number of varicose veins in the lower limbs. A colonos- copy revealed a vegetative lesion in the sigmoid colon, and histopathology con firmed adenocarcinoma. A CT scan showed thickening of the sigmoid colon and agenesis of the inferior vena cava (IVC), with collateral venous circulation in the retroperitoneum, mesenteric varices, and perirenal vari- ces. Due to these findings and the risk of bleeding, an open surgical approach was chosen. Intraoperatively, the sigmoid tumor and intense collateral circulation in the retroperito- neum, along with mesenteric vessel engorgement, were observed. The patient underwent rectosigmoidectomy, retro- peritoneal lymphadenectomy, and colorectal anastomosis. Despite careful retroperitoneal dissection, the surgery was complicated by higher-than-usual bleeding. The patient had a good postoperative recovery. Histopathological analysis con- firmed adenocarcinoma. The patient is currently undergoing adjuvant chemotherapy.

Discussion

Malformations of the IVC are estimated to occur in 0.5% of the population. The most common include duplications of the IVC, left-sided positioning of the aorta, interruption of one of its segments (infra-hepatic, pre-renal, renal, or infrarenal), and, very rarely, IVC agenesis, with low prevalence in the literature. The etiology of agenesis is typically embryological defects or intrauterine or perinatal thrombosis. This condition is usually asymptomatic but may present with nonspeci fic symptoms such as abdominal pain or lead to chronic venous insuf ficiency and deep vein throm- bosis. Diagnosis is often incidental, found on imaging studies or during abdominal surgery. Although rare, IVC abnormali- ties have signi ficant surgical implications and pose a major challenge for surgeons. Preoperative diagnosis of such anom- alies allows the surgeon to plan the surgical approach and, through careful exposure and dissection of the anomalous venous network, avoid severe iatrogenic injuries that could lead to massive bleeding and death.

Conclusion

This case highlights the rare diagnosis of IVC agenesis discovered during colorectal cancer staging, which signi ficantly impacted the surgical planning and helped avoid negative outcomes for the patient. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138252 E-poster ABDOMINOPERINEAL RESECTION OF THE RECTUM FOR LOW RECTAL GIST: A CASE REPORT Camila Nardi 1, Fernando Forghieri Silveira 1, Danilo Toshio Kanno1, Luana Borges Segantine Martins 1, Naualy Cunha Alencar1, Carlos Augusto Real Martinez 1 1Hospital Universitário São Francisco na Providência de Deus, Bragança Paulista, SP, Brasil Case Report A 67-year-old woman with changes in bowel habits and tenesmus since 2015 was diagnosed with a low rectal tumor and underwent transanal resection at another institution, with the result being low-grade GIST. In 2021, she returned to our clinic reporting tenesmus and hematochezia. She underwent a colonoscopy, which identi- fied a recurrence of the lesion. A pelvic MRI was performed, revealing an expansive lesion in the rectum about 2 cm from the anal verge, extending over 5.7 cm, involving the levator ani muscle and posterior vaginal wall, with associated bilat- eral external iliac and right obturator lymphadenopathy. A chest and abdominal CT scan showed no signs of distant metastasis. Neoadjuvant therapy with imatinib for 2 years was chosen. In 2023, a restaging MRI was performed, showing persistence of the lesion in the rectum but no associated lymphadenopathy. An extra-sphincteric abdominoperineal amputation with resection of the posterior vaginal wall and terminal colostomy was performed. The procedure was com- pleted without complications, and the patient was dis- charged on the 10th postoperative day. She returned to the clinic with the result of the surgical pathology report showing low-grade GIST, pT4apN0cM0, with free margins.

Discussion

GIST, the most common mesenchymal tumor of the digestive tract, primarily affects adults, with the most common locations being gastric (60-70%), small intestine (20-25%), and colorectal (5%). When located in the rectum, MRI provides greater bene fit for anatomical investi- gation and assessment of potential metastases. De finitive diagnosis is made by biopsy and immunohistochemistry, with over 95% of cases staining positively for CD117. The goal of surgery is complete tumor removal and histological study of its characteristics, which will be used to determine additional therapy. In cases where the tumor is surgically unresectable, treatment with Imatinib 400 mg/day should be initiated, and it has been successfully used in the treatment of metastatic GISTs for many years, with the potential for complete or partial remission.

Conclusion

Despite the rarity of the tumor presenta- tion in this case, it is essential to disseminate knowledge on the subject. In addition to describing a case of rectal GIST, which has a low incidence, this report also highlights the success of using Imatinib as neoadjuvant therapy in an attempt to convert an unresectable tumor into a resectable one, ultimately providing the opportunity for de finitive sur- gical treatment. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS4 Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 137935 E-poster ANALYSIS OF HOSPITALIZATIONS DUE TO MALIGNANT COLON NEOPLASMS IN GOIÁS BETWEEN 2008 AND 2023 Victor Cordeiro Simão 1, Pedro Eduardo da Costa Galvão 1, Arthur Cordeiro Simão 1, Nayã Pereira Portilho 2, Gabriela Luz Castelo Branco de Souza1, Isabely Gelinski1, Mylena Santana de Sena Araújo 1, Bruna Dell ‘acqua Cassão1 1Universidade Federal de Goiás, Goiânia, Brasil 2Pontifícia Universidade Católica de Goiás, Goiânia, Brasil

Introduction

Malignant colon neoplasm is one of the leading causes of morbidity and mortality related to cancer worldwide. In Goiás, as in the rest of Brazil, the impact of this disease on the healthcare system is signi ficant, reflected in a high number of hospitalizations. Understanding the epide- miology of this pathology is crucial to guide public health policies, develop preventive strategies, and improve the clinical management of patients in the region.

Objective

To qualitatively and quantitatively analyze hospitalizations due to malignant colon neoplasm in Goiás between 2008 and 2023.

Methods

This is a retrospective observational study based on the DATASUS database, using the Health Data Science Platform (PCDaS), developed by the Institute for Communication and Scienti fic and Technological Informa- tion in Health at FIOCRUZ, which allowed access to enriched data from the SUS Hospital Information System (SIH/SUS) and the analysis of hospitalizations for malignant colon neoplasm (ICD-10 C18) in Goiás between 2008 and 2023. A segmented regression (joinpoint) was performed to determine the trend in hospitalization rates.

Results

There were 11,192 hospitalizations between 2008 and 2023 with a primary diagnosis of C18. The pre- dominant sex in the sample was male, with 5,779 (51.63%) patients. The most frequent age group was between 50 and 69 years, with 5,260 (47.0%) patients. The main surgical proce- dures performed were hemicolectomy (1,832) and appendec - tomy (1,670). Among the procedures performed during hospitalizations, 6,893 (61.75%) were of moderate complexi- ty. The majority of hospitalizations were urgent, with 8,137 (72.7%) cases. Furthermore, 1,183 hospitalizations resulted in death, of which 1,064 were urgent cases. The statistics showed an increasing trend in hospitalizations.

Conclusion

The high rate of urgent hospitalizations and the signi ficant number of deaths, particularly among these hospitalizations, highlight the severity of the disease and the need for more effective interventions. The increasing trend in hospitalizations suggests a rise in the incidence or detection of malignant colon neoplasm, underscoring the importance of prevention policies and early diagnosis. These findings provide an important foundation for the formulation of public health strategies aimed at reducing morbidity and mortality associated with malignant colon neoplasm in Goiás. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 137762 E-poster SQUAMOUS CELL CARCINOMA ASSOCIATED WITH CHRONIC HIDRADENITIS SUPPURATIVA: CASE REPORT AND LITERATURE REVIEW Andrey Salgado Moraes Filho 1, Giovanna Savoy Pazin 1, Livia Moreira Genaro1, Morgana Danubia Gomes de Souza Bonfitto2, Priscilla de Sene Portel Oliveira 3, Renata Ferreira Magalhães 4, Maria de Lourdes Setsuko Ayrizono 1, Raquel Franco Leal 1 1Serviço de Coloproctologia, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil 2Departamento de Anatomia Patológica, Gastrocentro, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil 3Pós-graduação em Ciências da Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil 4Disciplina de Dermatologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil

Introduction

Hidradenitis Suppurativa (HS) is a chronic inflammatory disorder that affects the pilosebaceous unit, and Squamous Cell Carcinoma (SCC), also known as epidermoid carcinoma, may arise as a complication. Case Presentation A 58-year-old male, smoker, obese, and with type 2 diabetes, initially followed by the dermatology team for follicular occlusion syndrome mani- fested by HS, was referred to the coloproctology service due to the progression of a lesion in the perianal region near the HS lesions. On physical examination, an ulcerated, vegetative, painful, friable lesion was found in the right perianal region, consistent with SCC in the HS scar. Pelvic MRI revealed a neoplastic tissue proliferation at the right anal margin mea- suring 5.2 /C2 1.2 /C2 3.0 cm, with signs of neoplastic involve- ment of the internal and external anal sphincters. A biopsy of the lesion con firmed SCC (T3N1M0) in the HS scar. The patient underwent chemotherapy combined with radiother- apy; however, lesions recurred. Due to this, abdominoper- ineal amputation of the rectum was indicated. The patient remains under outpatient follow-up, disease-free for 2 years.

Discussion

Studies have shown that patients with chronic HS have a higher risk of developing SCC, especially when the perineal and gluteal regions are involved, though this is a rare occurrence. The standard protocol for SCC is chemoradiotherapy, aiming to preserve the anal sphincter by avoiding surgical procedures. Surgical intervention is re- served for cases that do not respond to chemoradiotherapy or for advanced cases where local resection alone is insufficient.

Conclusion

The reported case follows the epidemiol- ogy of HS, mainly affecting males with chronic lesions in the perianal, gluteal, and perineal regions. These lesions can evolve severely and become refractory to non-invasive meas- ures, requiring more aggressive surgery. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S5 Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138364 E-poster COLORECTAL CANCER AND PARANEOPLASTIC DERMATOMYOSITIS: CASE REPORT Gabriela Fonseca Lopes 1, Lucas Faraco Sobrado 1, Diego Fernandes Maia Soares 1, Guilherme Cutait de Castro Cotti 1, Caio Sergio Rizkallah Nahas 1, Carlos Frederico Sparapan Marques1, Ulysses Ribeiro Junior 1, Pedro Pastre Sponchiado 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Case Presentation A 40-year-old male, previously healthy, began oncological follow-up at a university hospital with a report of a 40 kg weight loss, abdominal cramps, and anemia. During the clinical investigation, a non-metastatic, stenosing adenocarcinoma was identi fied in the right colon, which was impassable via colonoscopy. In the perioperative period, the patient developed muscle pain and weakness in the scapular and pelvic girdles, a skin rash, and elevated creatine kinase (CPK). This combination of signs and symp- toms led to the suspicion of dermatomyositis as a paraneo- plastic syndrome, and a skin biopsy was performed on a lesion on the back of the hand. After evaluation by the rheumatology and neurology teams, preoperative immuno- globulin treatment was administered, leading to an improve- ment in the symptoms. The patient then underwent laparoscopic right colectomy with D2 lymphadenectomy, without anastomosis due to his clinical condition.

Discussion

Malignancies most commonly associated with dermatomyositis include ovarian, lung, breast, pancreat- ic, gastric, colon, and prostate cancers, as well as non-Hodgkin lymphomas. Dermatomyositis (DM) is generally considered a paraneoplastic syndrome, occurring predominantly in women and in 96% of cases associated with adenocarcinomas. This syndrome typically regresses with the surgical treatment of the underlying neoplasm but may reappear with recurrence of the malignancy. The association between colorectal cancer and dermatomyositis is linked to a worse prognosis, with reported mortality in up to 85% of cases.

Conclusion

In patients with dermatomyositis, it is essential to investigate underlying malignancies, as clinical symptoms may be related to a paraneoplastic syndrome. In this case report, the collaborative action of the multidisci- plinary team was crucial to the patient ’s treatment, from diagnosis to oncological surgery, enabling the management of this complex and rare condition. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138343 E-poster COLORECTAL CANCER IN YOUNG PATIENTS IN THE BRAZILIAN UNIFIED HEALTH SYSTEM (SUS): A COMPARATIVE STUDY ACROSS DIFFERENT REGIONS OF BRAZIL Bruna Oliveira Trindade 1, Daniel de Barcellos Azambuja 1, Debora Tagliari2, Cristina Calloni 3 1Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil 2Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil 3Universidade Feevale, Rio Grande do Sul, Brasil

Introduction

Colorectal cancer (CRC) ranks as the 4th most common cancer in Brazil. Although traditionally diag- nosed after the sixth decade of life, an increasing percentage of cases is being identified in young patients under 50 years of age.

Objective

To evaluate the geographic and temporal patterns of young patients (20-49 years old) with CRC treated surgically through the Uni fied Health System (SUS) in differ- ent regions of Brazil.

Method

The data from the “Oncology Panel” of Data- SUS was used to collect information on the number of CRC patients (considering ICD codes C18 to C21), geographic distribution, gender, age group, and treatment initiation time. The Brazilian regions were categorized into North, Northeast, Southeast, South, and Midwest. Statistical analysis were performed using SPSS software.

Results

Between 2013 and 2023, 12,659 young patients underwent surgery for CRC in Brazil, with an in- crease from 508 cases in 2013 to 1,807 cases in 2023. A statistically significant growth was observed (p<0.001), and a strong positive correlation was found between the number of cases and the years evaluated (Pearson correlation coefficient = 0.883). The age group of 40-49 years represented the largest proportion of cases (37.2%), while the 20-29 age group had the smallest proportion (6.9%). All age groups showed sta- tistically signi ficant growth. Only 6.42% of patients were operated on more than 60 days after diagnosis. Regionally, growth patterns followed the national trend, with the South- east and South regions leading with 5,485 and 3,319 patients, respectively, while the North region had 385 patients in the studied period. The Northeast region was the only one that did not show a high correlation between the number of cases and the years evaluated (Pearson correlation coef ficient = 0.669), although it still showed statistically signi ficant growth (p = 0.024). The North region stood out with 14.81% of patients undergoing surgery after 60 days from diagnosis.

Conclusion

The increase in CRC cases in young patients in Brazil may be related to technological advance- ments and greater access to healthcare services. However, there is a clear regional disparity. These findings emphasize the need for public policies that promote equity in access to early diagnosis and appropriate treatment of CRC in all regions of Brazil. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141083 E-poster HEREDITARY NONPOLYPOSIS COLORECTAL CANCER (HNPCC) - CASE REPORT Ester Mesquita Henriques da Silva1, Paulo Victor Alves Tubino1, Calil Salomao Abud Neto 1 1Escola Superior de Ciências da Saúde, Brasília, Brasil Case Presentation A 25-year-old female patient, with no comorbidities, was admitted to a tertiary unit reporting altered bowel habits and reduced stool volume. She disclosed J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS6 a family history of colorectal cancer, including her mother diagnosed at 38 years, an uncle diagnosed at 54 years, and two cousins diagnosed at 40 and 32 years, all on the maternal side. A colonoscopy revealed a vegetative lesion in the splenic flexure, ulcerated with areas of necrosis, causing approxi- mately 80% luminal narrowing, rendering the lesion impass- able. Contrast-enhanced abdominal computed tomography showed a segmental annular wall thickening at the splenic flexure, signi ficantly narrowing the intestinal lumen, with associated densi fication of the pericolic fat plane, without significant thickening of the left laterocoronal fascia, and an extension of approximately 7.0 cm. On physical examination, the abdomen was slightly distended, with no palpable mass. The histopathological diagnosis of the splenic flexure lesion confirmed invasive adenocarcinoma. Considering the diag- nosis of Hereditary Nonpolyposis Colorectal Cancer (HNPCC), the patient underwent a total colectomy with terminal ileorectal mechanical anastomosis and retroperitoneal lymphadenectomy without complications. The postoperative period was uneventful, and histopathological analysis of the surgical specimen revealed invasive adenocarcinoma with staging of pT3; pN0, with 42 lymph nodes evaluated. Immu- nohistochemistry (IHC) results were positive for CDX2, CK20, CK7, chromogranin, synaptophysin, and CD56. The patient was referred to oncology for joint follow-up.

Discussion

HNPCC is characterized by reduced or absent activity of mismatch repair (MMR) proteins. Its diag- nosis is predominantly clinical, relying on detailed assess- ment of a positive family history and the use of Amsterdam criteria, with genetic testing less commonly applied in clinical practice. This genetic syndrome is associated with a higher incidence of metachronous and synchronous tumors com- pared to sporadic colorectal cancer, often necessitating total colectomy as the treatment for patients diagnosed with HNPCC.

Conclusion

Characterizing the clinical-epidemiologi- cal aspects is crucial for clinical suspicion and early diagnosis of hereditary nonpolyposis colorectal cancer, enabling effec - tive family monitoring and appropriate treatment. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141755 E-poster METASTATIC ANAL CANAL SQUAMOUS CELL CARCINOMA (SCC) TO THE LIVER: CASE REPORT Rodrigo Gomes da Silva 1, Fernanda Sophya Leite Cambraia 1, Lara Floresta Neves Gonçalves 1, Jherlley Antonio Bazon Mendes1, Vitor Gonzaga Giancotti 1, Lucas Crepaldi Carvalho Nery1, José Henrique Paiva Rodrigues 1, Cleo Gonçalves Trindade Ribeiro1 1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil Case Presentation A 43-year-old female patient pre- sented with complaints of painful defecation, tenesmus, and narrow stools. She had no comorbidities or relevant family history. Physical examination revealed a vegetative, ulcerated lesion in the right anorectal ring. Colonoscopy identi fied a neoplastic lesion in the distal rectum and anal canal, measur- ing 4 cm, and histopathology confirmed poorly differentiated squamous cell carcinoma (SCC). Staging included abdominal and thoracic CT scans, which showed no metastases, while pelvic MRI revealed thickening of the distal rectum, meso- rectal fat invasion, and enlarged lymph nodes. The patient was referred for treatment with the Nigro protocol (chemo- radiation). Post-treatment MRI revealed hepatic lesions and rectal involvement beyond the muscularis propria. Physical examination identified a hardened lesion 3 cm from the anal verge. Biopsy con firmed SCC with atypia suggesting HPV infection. A PET scan showed uptake in the anal canal and liver lesion. Restaging Confirmed persistent/recurrent SCC with liver metastasis. Due to insuf ficient response to chemothera- py, abdominoperineal resection of the rectum and left hepa- tectomy were performed. Histopathology revealed SCC infiltrating up to the vaginal mucosa, with clear margins, and 1 of 17 lymph nodes affected (T4aN1M1). The patient is currently under outpatient follow-up with imaging control.

Discussion

SCC of the anal canal is rare, accounting for less than 2% of gastrointestinal tract cancers, and strongly associated with HPV. Up to 30% of cases may be asymptom- atic, with rectal bleeding as the most common symptom in 45% of cases. Other symptoms include pain, tenesmus, and incontinence. Prevention and screening involve HPV vaccina- tion and diagnostic tools such as high-resolution anoscopy and anal Pap smears, although no standardized screening program exists. Staging should assess the primary tumor ’s spread and locoregional disease, utilizing pelvic MRI, transa- nal ultrasound, and abdominal/thoracic CT scans. Data on chemotherapy for metastatic SCC cases with complete resec - tion is limited. Following the failure of the standard treat- ment, a multidisciplinary and individualized approach was adopted.

Conclusion

Until the 1980s, abdominoperineal resec - tion was the standard treatment, associated with high mor- bidity and permanent stoma rates. The Nigro protocol (1974) demonstrated ef ficacy with combined chemoradiation and has become the current standard of care. Metastatic disease is generally managed with systemic chemotherapy, but meta- stasectomy may improve overall survival in selected cases. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138357 E-poster ROBOTIC SURGERY VS. LAPAROSCOPIC SURGERY IN RIGHT COLECTOMY: A COMPARATIVE CASE ANALYSIS IN AN INSTITUTION Cristina Calloni 1, Daniel de Barcellos Azambuja 2, Andreia Kayser Cardozo2, Bruna Oliveira Trindade 2 1Universidade Feevale, Rio Grande do Sul, Brasil 2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil

Introduction

Colorectal cancer is one of the most common cancer types. With advancements in surgical tech- niques, right colectomy can be performed using laparoscopic or robotic approaches. Both methods offer speci fic bene fits, but the choice of the ideal technique remains debated. This study retrospectively compares clinical outcomes, including operative time, hospital stay duration, and patient quality of life, in right colectomy performed using both techniques.

Objective

To conduct a comparative analysis of right colectomy performed via robotic and laparoscopic approaches, evaluating clinical outcomes such as lymph J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S7 nodes resected, hospital stay duration, and postoperative bowel function recovery time, aiming to identify signi ficant differences between the techniques.

Results

Twenty surgical procedures were analyzed, including 10 laparoscopic and 10 robotic surgeries. The average patient age was 63.1 years, with a balanced gender distribution between the two groups. Most tumors were located in the ascending colon (9 cases), followed by the hepatic flexure (3 cases) and the cecum (8 cases). The average number of resected lymph nodes was similar between the approaches, with 19 nodes for the laparoscopic method (standard deviation of 11) and 20 for the robotic method (standard deviation of 8). The average hospital stay duration was six days for the laparoscopic approach (standard devia- tion of 4) and five days for the robotic approach (standard deviation of 1). The greater variability in the laparoscopic procedure was attributed to one case with postoperative complications. The average time to the resumption of bowel function was 3.5 days for laparoscopy (standard deviation of 1.5) and three days for robotics (standard deviation of 1). Regarding operative time, the robotic approach demonstrat- ed longer surgery durations.

Conclusion

The results indicate that both surgical techniques are equivalent in terms of clinical ef ficacy. The choice between robotic and laparoscopic surgery should consider factors such as the surgeon ’s experience, resource availability, and patient preferences. While robotic surgery offers technological advantages, including enhanced preci- sion, integrated 3D visualization, and improved dexterity, its high cost may limit its adoption. Therefore, it can be conclud- ed that there are no signi ficant differences in direct clinical benefits between the laparoscopic and robotic techniques for right colectomy. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 137690 E-poster SURGICAL CYTOREDUCTION OF PERITONEAL METASTASIS DUE TO RIGHT COLON ADENOCARCINOMA IN A PATIENT WITH LYNCH SYNDROME – CASE REPORT Augusto Zbonik Mendes 1, Henrique de Andrade Ferreira Pinto1, Ilson Geraldo dos Santos 1, Diogo Viana Abreu 1, Mario Inácio Carneiro Neto1, Guilherme de Almeida Santos 1, Jennyfer Kellen Lázaro da Rocha 1, Lais Campos Soares 2 1Santa Casa de Belo Horizonte, Belo Horizonte, Brasil 2Universidade Professor Edson Antônio Velano, Belo Horizonte, Brazil Case Presentation A 36-year-old male underwent a right colectomy for acute appendicitis in December 2022. The biopsy revealed colon adenocarcinoma, with immunohis- tochemistry showing microsatellite instability and loss of MLH1 and PMS2 repair protein expression, con firming a diagnosis of Lynch Syndrome. The patient received chemo- therapy cycles (5-Fluorouracil and leucovorin) and was re- ferred to the colorectal team due to a large, expansive peritoneal lesion in the right iliac fossa. The lesion measured 8.5 /C2 7 /C2 9 cm, with no cleavage plane from adjacent intesti- nal loops and the psoas muscle. There was an unclear cleavage plane involving a small portion of the right common iliac artery, affecting less than 30% of its circumference, and another peritoneal lesion near the umbilical scar. A joint colorectal and vascular surgery approach was performed, achieving complete cytoreduction of the right iliac fossa lesion. The procedure included a segmental enterectomy with primary anastomosis, partial resection of the psoas muscle, and resection of umbilical peritoneal metastasis. There was no vascular invasion, and the surgery was com- pleted without complications. The patient showed good postoperative progress, being discharged on the sixth day of hospitalization. Follow-up revealed decreased CEA levels and no signs of recurrence.

Discussion

Lynch Syndrome is the most common hereditary condition linked to colorectal cancer. Identifying these patients is crucial due to the more than 80% lifetime risk of colorectal cancer, often diagnosed at advanced stages, as in the case presented. Peritoneal metastases signi ficantly re- duce overall survival and are associated with a poor prognosis in 30-40% of cases. In selected patients, surgical cytoreduc - tion, either alone or combined with HIPEC, can improve oncological outcomes. This approach should consider the peritoneal carcinomatosis index (PCI) and the feasibility of complete cytoreduction. In the presented case, the presence of a limited number of lesions, despite their large size, allowed for a successful surgical approach.

Conclusion

Even in patients with advanced disease and peritoneal metastases, if the PCI is below 20 and complete cytoreduction is achievable, surgical intervention should be considered as a de finitive management strategy. This ap- proach can improve oncological outcomes, increasing surviv- al and quality of life for affected patients. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138311 E-poster TOTAL COLECTOMY IN A PATIENT WITH THREE SYNCHRONOUS COLORECTAL TUMORS: A CASE REPORT Fernanda Garcia de Carvalho Pereira 1, Juanita Justina Ferreira da Silva 1, Matheus Walerio Braido Arantes 1, Lucas Garcia de Carvalho Pereira 2, Renata de Souza Guerra 1, Giovane Amui Fernandes1, Beatriz Dias Rosa 1, João Gomes Netinho 1 1Faculdade de Medicina de São José do Rio Preto , São José do Rio Preto, Brasil 2Universidade Federal de Minas Gerais, Brasil Case Report A 63-year-old woman presented with abdominal pain, diarrhea, and hematochezia. Physical exam- ination showed no abnormalities. Initial CEA level was 32. CT scan revealed thickening in the descending colon and a hepatic nodule suggestive of a secondary implant. Colonos- copy showed a vegetating lesion in the sigmoid and descend- ing colon, preventing the passage of the scope. The patient underwent total colectomy with ileorectal anastomosis and hepatic metastasectomy. The pathological examination con- firmed 3 synchronous tumors (lesions in the sigmoid colon, descending colon, and a polyp in the ascending colon), all adenocarcinomas with mucinous areas. Immunohistochem- istry showed microsatellite stability and a KRAS gene muta- tion. The patient is currently under follow-up and receiving adjuvant therapy.

Discussion

Synchronous colorectal cancer refers to the presence of simultaneous tumors in a patient at initial presentation. The prevalence is 3.5%, and the occurrence of 3 or more tumors is rare. Literature reports a higher prevalence of synchronous tumors in males and elderly patients. There is J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS8 also a tendency for greater involvement of the ascending colon and mucinous pathology. Risk factors include in flam- matory bowel disease, Lynch syndrome, and familial adeno- matous polyposis, as well as genetic and molecular factors such as microsatellite instability and mutations in BRAF, KRAS, and p53 genes. Preoperative diagnosis is often chal- lenging. Complete colonoscopy is frequently hindered due to obstructive tumors. CT scans have good sensitivity. Virtual colonoscopy, MRI, and PET scans can be useful, especially when the colonoscopy is incomplete or if synchronous lesions are suspected. Treatment should consider tumor location, staging, and the patient ’s general condition. Studies recom- mend total colectomy to resect potentially undiagnosed lesions and prevent metachronous tumors. However, others recommend traditional surgery to preserve the colon. In the presented case, a rare occurrence of 3 synchronous colorectal tumors was observed. The patient had only the KRAS gene mutation as a risk factor. The preoperative colonoscopy identified two lesions, with the third lesion diagnosed only in the pathological examination.

Conclusion

This case highlights the importance of studying clinical and molecular risk factors in the pathophys- iology of synchronous colorectal lesions, as well as discussing the diagnosis and particularities of treatment, which remain controversial. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138205 E-poster TOTAL COLECTOMY IN ONCOLOGICAL PATIENTS: EPIDEMIOLOGICAL STUDY ON THE CENTRAL-WEST REGION BETWEEN 2018 AND 2023 Maria Luiza Ferreira da Costa 1, João Veríssimo da Silva Neto 1, Fabiana Silva Delmondes 1, Ana Carolina da Costa Ferreira 2, Aline Guimarães Sant ‘ana1, Milton Sant ‘ana de Freitas Filho 1 1Universidade Estadual de Goiás, Brasil 2Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

Total colectomy is characterized by the complete removal of the intraperitoneal colon, and its indi- cation ranges from complications of in flammatory bowel diseases to the presence of familial adenomatous polyposis (FAP) and colon cancer (CC).

Objectives

To determine the number of hospitaliza- tions for total colectomy in an oncological context; analyze the average hospitalization cost and average hospital stay for this procedure; and identify risk factors for the development of colonic neoplasia and their relationship to prevention.

Method

A retrospective epidemiological study was conducted, evaluating hospitalizations, average hospitaliza- tion cost, and average hospital stay for total colectomy in oncology in the states of the Central-West Region (CO) from 2018 to 2023. Data were collected from the SUS Hospital Information System and the Oncology Panel-BRASIL by the Department of Information Technology of the Uni fied Health System (SUS), accessed through the Health Information Tabulator.

Results

Between 2018 and 2023, 6448 cases of colon cancer were treated in CO, 47.5% of which were treated surgically. Goiás (GO) had the highest number of treatments (2706), followed by Mato Grosso do Sul (MS) (1287), Mato Grosso (MT) (1234), and the Federal District (DF) (1221). During this period, 143 hospitalizations for total colectomy due to oncological reasons were recorded, with 62 in DF, 47 in GO, 26 in MS, and 8 in MT. The average hospitalization cost was R$ 9082 in MS, R$ 9707 in MT, R$ 9977 in GO, and R$ 9231 in DF. The average hospital stay was 10.2 days in MS, 9.5 days in MT, 7.25 days in GO, and 9.5 days in DF. Risk factors for developing CC include genetic, environmental, and lifestyle factors such as alcohol consumption, obesity, hypertension, and diabetes.

Conclusion

Approximately half of the colon cancers were treated surgically, with only 2% requiring total colec - tomy. The average hospitalization cost was around R$ 9000, with GO having the highest cost and the shortest hospital stay. Modifiable risk factors are associated with an increased number of colon cancers, and delayed diagnosis is linked to advanced staging and the need for invasive measures like total colectomy. The improvement of public policies on lifestyle changes and colon cancer screening exams contrib- utes to a reduction in incidence and early diagnosis, thereby reducing the need for total colectomy and public expenditure on this procedure. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138257 E-poster DIFFICULTY IN DIFFERENTIAL DIAGNOSIS BETWEEN GYNECOLOGICAL AND PROCTOLOGICAL TUMORS – CASE SERIES R. F. F. Hudari 1, Flávia Balsamo 1, Sandra Di Felice Boratto 1, Marcella Conz Rodrigues 1, Guiherme Garcia Hudari 1, Sergio Henrique Couto Horta 1, Eduardo Vidal de Holanda 1, Lynardo Jose Fernandes Tavares 1 1Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brasil Case Presentations Case 1: Female, 75 years old, reports abdominal pain and changes in bowel habits. Colo- noscopy showed an ulcerative-in filtrative lesion 22 cm from the anal verge, histopathology indicating poorly differentiat- ed squamous cell carcinoma (SCC). Staging cT3N2M0. The patient developed a subintestinal obstruction and was indi- cated for loop transverse colostomy. Abdominal MRI sug- gested the primary neoplasia originated in the sigmoid. The patient underwent exploratory laparotomy and left oopho- rectomy due to peritoneal carcinomatosis. The diagnosis of high-grade papillary serous ovarian carcinoma was con- firmed by immunohistochemistry. The patient is currently undergoing chemotherapy and scheduled for cytoreductive surgery by gynecology. Case 2: Female, 28 years old, presents with abdominal pain. Colonoscopy showed a vegetative lesion 8 cm from the anal verge. Abdominal and pelvic CT and MRI revealed a tumor in the left adnexal region, rectum, and sigmoid, cT4bN2bM1a. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, segmental enterectomy, mechanical latero-lateral anastomosis, sigmoi- dectomy, terminal colostomy, left ureter resection, and re- section of tumor implants in the sacral region. Colonoscopy histopathology showed no evidence of the primary site. The patient was referred to oncology and died 2 months after diagnosis. Case 3: Female, 73 years old, with abdominal pain, enterorrhagia, and weight loss. Colonoscopy showed a lesion 13 cm from the anal verge. Abdominal and pelvic CT showed a J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S9 lesion in the uterine area in contact with the rectum and secondary involvement. Rectal biopsy con firmed invasive ulcerated colorectal carcinoma. The patient is under follow- up with gynecology and oncology.

Discussion

Complex pelvic lesions in women can originate from various anatomical structures and have a broad range of possible diagnoses. Most of these masses are of ovarian origin, and MRI is useful for diagnostic differ- entiation. When colorectal tumors are suspected, immuno- histochemistry is required. Colorectal SCC is rare (0.025-0.1 per 1,000 colon cancers), its clinicopathological character- istics are unclear, and its prognosis may be worse than that of adenocarcinoma.

Conclusion

Differential diagnosis of pelvic masses is necessary for appropriate patient treatment. Early detection is crucial for favorable prognosis. Three cases initially sus- pected of coloproctological neoplasms were presented, where the complexity of the advanced lesions hindered diagnosis. However, after investigation, the cases were con- firmed to be gynecological tumors. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138149 E-poster LARGE CARCINOID TUMOR OF THE CECUM: CASE REPORT Pierre Rodrigues Bernardino 1, Isabella da Silva Idelfonso 1, José Roberto Violatti Filho 1, Amanda Karolyne Batista Ferreira 1, Carlos Eduardo Oliveira Sodero 1 1Universidade Federal do Triângulo Mineiro, Uberaba, Brasil Case Presentation FFS, female, 60 years old. The patient presented with a 4-year history of colicky pain associated with severe abdominal distension of a progressive nature. She developed constipation, with bowel movements every 10 days, characterized by dry stools, in addition to anorexia, asthenia, and a 13 kg weight loss over the last 2 months. Upon admission, she underwent colonoscopy, which revealed a vegetative lesion in the cecum with smooth, yellowish areas and other rough, hyperemic areas. The histo- pathological examination (HE) of the lesion con firmed a carcinoid tumor (neuroendocrine), without adenomas. The patient underwent laparoscopic right hemicolectomy with- out complications, and no metastatic foci were found. The specimen sent for histopathological analysis revealed a grade I neuroendocrine carcinoma, multifocal, with the largest focus measuring 6x3 cm, staging MpT2pN1. The patient was referred to clinical oncology for follow-up.

Discussion

Carcinoid tumors are indolent neoplasms of the diffuse neuroendocrine cellular system and are typi- cally diagnosed late. Previously considered rare, this pathol- ogy is increasingly prevalent with advancements in diagnostic technologies such as computed tomography and colonoscopy. The symptoms are nonspeci fic, complicating the diagnosis. Initial manifestations are often associated with subocclusive syndromes, which are related to the tumor’s size and location in the gastrointestinal tract, and may progress to abdominal pain, asthenia, anorexia, and weight loss, as observed in the patient’s progression. Despite the low growth rate and metastasis rate, carcinoid tumors should be surgi- cally resected. Tumors larger than 2 cm are rare and are often associated with lymph node and hepatic metastases, which confer a worse prognosis, making adjuvant therapy necessary.

Conclusion

The patient presented with lesions that differed from the usual prevalence, with the increased size of the lesion conferring greater severity, a higher chance of metastasis, and a worse prognosis. Nevertheless, the patient had a favorable outcome during outpatient follow-up, with remission of obstructive symptoms. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141709 E-poster ACUTE KIDNEY INJURY IN THE POSTOPERATIVE PERIOD OF ELECTIVE COLORECTAL SURGERY: EVALUATION OF THE INFLUENCE OF AGE Leonardo Menezes Guarda1, Gabriela Portal Monteiro1, Yasmin Góis de Mello1, Isaac José Felippe Corrêa Neto1, Laercio Robles1 1Santa Marcelina

Introduction

Life expectancy has signi ficantly in- creased from the last century to the present due to advances in science, vaccination, medical care, and better lifestyles. Between 1990 and 2019, global life expectancy rose from 64 to 72.8 years. With an aging population, diseases such as colorectal cancer are more prevalent, especially among the elderly, increasing postoperative challenges, with acute kid- ney injury (AKI) being one of the most frequent complications.

Objective

To analyze risk factors related to acute kidney injury in the postoperative period of elective colorec - tal surgeries in patients over 65 years of age. Additionally, to outline the socioeconomic, clinical-surgical, and laboratory profile of the study population.

Method

A clinical, observational, longitudinal, pro- spective, and analytical study with a quantitative approach. It was conducted through the analysis of electronic medical records of patients who underwent colorectal surgery at a Teaching Hospital in São Paulo (SP), Brasil.

Results

Thirty patients who underwent elective colo- rectal surgery were analyzed. The average age was 70.4 years (range 66-85 years), with 53.3% female and 46.6% ex-smokers or active smokers. The main comorbidity was Systemic Arterial Hypertension (63.3%), followed by Diabetes Mellitus (23.3%), Dyslipidemia (16.6%), Hypothyroidism (10%), Heart Failure (6.6%), and Chronic Kidney Disease (3.3%). The major- ity of patients (73.2%) had adenocarcinoma of the rectum and sigmoid. Approximately 33.3% of the patients developed AKI. No significant association was observed between the devel- opment of AKI and the following variables: age, body mass index, volume infused during surgery, surgical time, and performance status.

Conclusion

The non-use of angiotensin-converting enzyme inhibitors prior to surgery was the only factor related to the development of AKI in the postoperative period. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS10 Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138292 E-poster LEIOMYOSARCOMA OF THE RIGHT COLON: A CASE REPORT Cristiane Koizimi Martos Fernandes 1, Fábio Lopes de Queiroz 1, Artur Duarte e Duarte 1, Letícia Brandão Castro 1, Letícia Brandão Castro1, Marina Barbabela Grisolia de Oliveira 1, Vinícius Avelar Palhares 1, Eduardo de Carvalho Barbosa 1 1Hospital Fellcio Rocho, Belo Horizonte, Brasil Case Presentation A 38-year-old male patient, post- renal transplant from a living donor in 2009 due to type 1 diabetes mellitus, presented with weight loss. A colonoscopy performed on 07/27/2022 revealed a pedunculated, lobulated, and voluminous lesion covered with fibrin, approximately 50mm in diameter, occupying about 70% of the intestinal lumen. Tattooing and biopsy of the lesion were performed. The pathological result showed a fusocellular neoplasm with focal moderate atypia and a low mitotic index. The patient was then subjected to right colectomy via laparoscopy on 08/11/ 2022. The pathological examination was consistent with a proliferative fusocellular colon lesion, predominantly affecting the submucosa, with extension to the mucosa and ulceration of the adjacent epithelium. One mitosis per 5mm² was identified. Surgical margins were free of disease. Twenty-nine lymph nodes were examined, all without signs of involvement. Immunohistochemistry revealed preserved histone H3 and focal smooth muscle actin positivity. The patient experienced multiple perioperative and postoperative complications, in- cluding latex anaphylaxis and anastomotic fistula. He under- went further surgical treatment and later ileocolostomy closure in 2023. Since then, there has been no disease recur- rence, with clinical improvement and significant weight gain.

Discussion

Intestinal leiomyosarcomas are rare, ac - counting for approximately 0.1% of cases of malignant neo- plasms in the colon. These tumors originate from the muscular layer of the intestinal wall or the muscularis mucosa. Some cases are asymptomatic, and the diagnosis is often an incidental finding during preventive screening exams. Diagnosis is based on clinical examination, supported by imaging, endoscopic evaluations, and pathology with immunohistochemistry. The recommended treatment is sur- gical resection of the affected intestinal segment. No estab- lished chemotherapy regimen exists due to the low incidence of the pathology and its limited impact on prognosis. Thefive- year survival rate for tumors smaller than 5 centimeters, without metastases, and well-differentiated is around 50%.

Conclusion

Malignant tumors derived from intestinal muscle are rare, emphasizing the importance of preventive colon exams for early detection. Histological and immuno- histochemical confirmation of the lesion is essential to deter- mine the appropriate treatment, which should preferably be surgical. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138344 E-poster ANAL MELANOMA: CASE REPORT Isabela de Oliveira Miranda 1, Maíra Leticia Schwaab 2, Giulia Luiza Cecconello2, Emanuella Roberta Ina Cirino 2, Renato Vismara Ropelato2, Alexandra Damasio Todescatto 2, Paulo Gustavo Kotze2 1Universidade Federal de Pelotas, Pelotas Brazil 2Hospital Universitário Cajuru, Curitiba, Brasil A 67-year-old white female with chronic kidney dis- ease and grade III obesity was referred to a coloproctologist due to hematochezia, pain, pruritus, and progressive anal protrusion over 8 months. Upon anal inspection, a vegetative, ulcerated, friable lesion with necrotic areas, irregular borders, and apparent infiltration into deeper layers was found on the left posterior-lateral anal edge, measuring approximately 4cm cranio-caudally. On palpation, a lesion with the same charac - teristics was felt up to 3cm from the anal edge. A colonoscopy performed 3 months earlier showed colonic diverticula and an erosive anal plica. Pelvic magnetic resonance imaging revealed an expansive, lobulated lesion in the posterior anal canal measuring 56x30mm, with an oval-shaped inguinal lesion on the left side measuring 25x19mm. The patient underwent partial excision of the lesion, with histopathology and immu- nohistochemistry confirming the diagnosis of anal canal mel- anoma, with positive S100 and MELAN-A markers. Two months after diagnosis, the patient passed away at an external oncology service. Anal melanoma is the third most common site for mucosal melanoma and the primary site in the gastrointestinal tract. It is more frequent in white women, with an average age of 55 years. At diagnosis, more than 60% of patients have metastases, a situation often due to tumor aggressiveness and delayed diagnosis caused by nonspeci fic symptoms resembling benign anorectal diseases. Anoscopy can help evaluate the “ABCDE” of melanoma, but lesions generally appear polypoid, ulcerated, and range from 1 to 6 cm. A definitive diagnosis is made by biopsy with immunohis- tochemistry, showing positive markers such as S100 and MELAN-A. For loco-regional and distant staging, positron emission tomography (PET) is superior to contrast-enhanced computed tomography due to the multiple lymphatic drainage areas in the region. Treatment involves local excision or abdominoperineal amputation, often with adjuvant therapies such as chemotherapy, radiation, and more recently, immuno- therapy. The prognosis is poor, with a 5-year survival rate of approximately 20%. This case report supports the epidemiolo- gy of anal mucosal melanoma and emphasizes the importance of thorough anorectal evaluation for early diagnosis of this aggressive tumor. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 137796 E-poster CUTANEOUS METASTASIS IN A PATIENT WITH COLORECTAL CANCER: A CASE REPORT Bruna Oliveira1, Lívia Oliveira 1, Barbara Tannús Valadão 1, Reginaldo Rodrigues do Prado 1, Meriella Furlan Carneiro 1, Mariane Tonin Jatobá 1, Ulisses Marques Cardoso 1, Larissa Ganança Buosi 1 1Hospital Sao Francisco Ribeirão Preto, Ribeirão Preto, Brasil Case Presentation A male patient, E.A.M.G., 59 years old, sought medical attention in November 2022, reporting J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S11 bright red blood in his stool and weight loss. A colonoscopy was requested, revealing an ulceroin filtrative lesion in the mid-rectum, affecting 50% of the circumference. Histopatho- logical examination (HE) showed a well-differentiated ulcer- oinvasive adenocarcinoma of the rectum. Tumor staging showed no distant metastasis. He was referred to oncology and underwent neoadjuvant chemoradiotherapy, followed by a rectosigmoidectomy with primary anastomosis and loop transverse colostomy. During the surgery, no metastasis was observed, and HE revealed no angiolymphatic or perineural neoplastic invasion, with clear circumferential and distal surgical margins (pT2 pN0). In November 2023, the patient returned, reporting a lesion in the perianal region. On physi- cal examination (PE), a single 4 cm, purple, painless, and mobile nodule was observed perianally. The lesion was excised, and HE con firmed moderately differentiated ulcer- ated adenocarcinoma in the skin at the anal margin. There was no neoplastic invasion, angiolymphatic, or perineural involvement, and surgical margins were free, with the closest margin being 3 mm.

Discussion

Colorectal cancer (CRC) is the fourth most common malignancy globally and the most frequent in the gastrointestinal tract (GIT). The general incidence of cutane- ous metastases from gastrointestinal malignancies is 5.3%, and most of these metastases are located near the primary tumor site. The mechanisms for the occurrence of cutaneous metastases have not been de finitively established, but they may appear through the peritoneal cavity or the lymphatic and hematologic systems. Iatrogenic implantation during surgery is rare. Metastatic carcinoma appears as violet or skin-colored, firm, freely movable, painless nodules, which can be solitary or multiple. They are mainly classi fied as adenocarcinoma, squamous cell carcinoma, and undifferen- tiated carcinoma. Local wide excision of the cutaneous meta- static lesion is the preferred treatment option, and in extensive cases, the treatment is palliative.

Conclusion

Cutaneous metastases from CRC are a rare manifestation, making it crucial to evaluate cutaneous lesions in patients with a history of CRC. Therefore, there is a need for physicians to educate and train patients on skin examina- tions, detecting any changes, and early reporting of any cutaneous alterations, especially in individuals with a history of visceral malignancy. By promoting a comprehensive un- derstanding of this phenomenon, physicians can contribute to better detection, intervention, and care for individuals with a history of CRC. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138334 E-poster METASTASIS OF RECTAL ADENOCARCINOMA MIMICKING HPV LESIONS Eduardo Vidal de Holanda 1, Sandra Di Felice Boratto 1, Isabela Pereira Blanco1, Anelise Stachewski Russo 1, Sergio Henrique Couto Horta1, Juliana Giangiardi Batista 1, Raphaella Assis Alves Januário1, Flavia Balsamo 1 1Faculdade de Medicina do ABC, Santo André, Brasil Case Presentation A 71-year-old male presented to the coloproctology outpatient clinic of a tertiary hospital after being referred from the emergency department due to an anoperineal abscess and suspected genital lesions from Human Papillomavirus (HPV). He complained of painful perianal protrusion, bleeding during bowel movements for one year, weight loss of 12 kg over the same period, as well as scrotal warts and painless inguinal nodules. His medical history included an anoperineal fistula for 30 years, requiring two surgeries. Undergoing oncological investigation in an external service, a colonoscopy revealed an ulcerovegetative lesion in the rectosigmoid, occupying 80% of the lumen, and histopathology confirmed adenocarcinoma. On proctological examination, multiple verrucous, in filtrative lesions with central ulceration were observed on the scrotum, perineum, and right groin, in addition to bilaterally enlarged,fibroelastic inguinal lymph nodes. A retoscopy showed normal mucosa up to 12 cm from the anal margin, where a polypoid, infiltrative lesion with friable, bleeding tissue was observed, occupying 50% of the rectal lumen up to 16 cm from the anal margin. Additional exams indicated in filtration of the mes- orectal fat, pelvic wall, and right spermatic vein. Histopathol- ogy of the verrucous lesions con firmed adenocarcinoma. Given the presence of high rectal tumor metastasis to the skin, an initial plan for resection and Hartmann colostomy, followed by systemic chemotherapy, was proposed. However, after discussing the palliative nature of the surgery due to the cutaneous metastasis, the patient and family opted for palli- ative chemotherapy.

Discussion

Cutaneous metastasis of colorectal ade- nocarcinoma is rare, with the abdominal wall being the most common site. It occurs through hematogenous and lymphatic dissemination and usually manifests late after the surgical resection of the primary tumor. The prognosis is poor, and the average survival for patients after the appearance of cutane- ous lesions ranges from 3 to 18 months.

Conclusion

This case aims to discuss possible differ- ential diagnoses for cutaneous metastases from colorectal adenocarcinomas. A high level of clinical suspicion is required for diagnosing metastatic skin lesions, as when present, cutaneous metastasis is a standalone poor prognostic factor for oncology. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138309 E-poster BREAST METASTASIS OF RECTAL ADENOCARCINOMA Natália Ferreira Cardoso de Oliveira 1, Fernanda Belotti Formiga1, Luisa Fernandes Bassoi 1, Vilmar Marques de Oliveira1, Louisie Galantini Lana de Godoy 1, Maria Antonieta Longo Galvão Silva 1, Luis Eduardo Silva Móz 1, Fang Chia Bin 1 1Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brasil Case Presentation A 42-year-old woman presented with colicky abdominal pain, abdominal distension, and altered bowel habits, including constipation. During the investigation, she was diagnosed with high rectal adenocar- cinoma, subocclusive, with a large, solitary hepatic metasta- sis. A 3 cm breast nodule was also diagnosed. Due to subocclusive symptoms, the patient underwent a rectosig- moidectomy, and histological analysis revealed a poorly differentiated adenocarcinoma with a mucinous component, pT4aN2a, with free margins and immunohistochemical stud- ies showing no alterations in repair proteins. She started chemotherapy with 5-fluorouracil and oxaliplatin, when the J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS12 breast nodule fistulized to the skin. A core biopsy was performed, suggesting triple-negative invasive ductal carci- noma. Chemotherapy was switched to carboplatin and pacli- taxel, and the patient underwent mastectomy with regional lymphadenectomy. The histological study con firmed meta- static gastrointestinal carcinoma, with free margins and regional lymph node involvement. Eight months after the colorectal surgery, the patient developed local recurrence, increased hepatic metastasis, new breast metastasis, and suspected cutaneous metastasis. She is currently receiving palliative chemotherapy.

Discussion

Breast metastasis from colorectal adeno- carcinoma is extremely rare. Primary tumors most commonly associated with breast metastasis include contralateral breast cancer, leukemia, melanoma, lymphoma, ovarian cancer, lung cancer, and stomach cancer. The literature reports only 49 cases of colorectal metastasis on the breast, all with poor prognosis and, in some cases, dif ficult diagnosis. Since both breast and colorectal tumors are the most common neo- plasms in the female population, the suspicion of a second primary tumor is inevitable. Treatment is challenging, as metastases often occur on multiple sites, indicating that the disease is systemic and progresses rapidly.

Conclusion

Breast metastasis from colorectal adeno- carcinoma is extremely rare. Diagnosis requires cooperation between the surgeon and pathologist to avoid unnecessary aggressive procedures and provide the best therapeutic approach. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138126 E-poster MUCOCELE OF THE APPENDIX: A CASE REPORT Antonio Lopes Muritiba Neto1, Edmundo Guilherme de Almeida Gomes1, Lais Maria Pinto Almeida 1, Gustavo Capitulino Araujo Santos1, Benicio Luiz Bulhões Barros Paula Nunes 1 1Santa Casa de Misericordia de Maceió, Alagoas, Brasil Case Presentation MJS, a 67-year-old male, was referred to the coloproctology outpatient clinic due to ab- dominal pain for several months, without changes in bowel habits, bleeding, pruritus, or weight loss. On physical exami- nation, a palpable mass was noted in the hypogastrium. Colonoscopy revealed a polyp (polypectomy), and abdominal ultrasound showed an oval lesion to the right of the bladder. A subsequent pelvic MRI showed an expansive, oval lesion with lobulated contours, hypointense on T1, hyperintense on T2, and peripheral contrast enhancement, measuring approxi- mately 7.9 /C2 4.3 /C2 5.0 cm, possibly corresponding to an appendiceal mucocele. As a result, a right colectomy was performed without complications. Intraoperatively, the le- sion had a cleavage plane with the bladder and involved the distal ileum. The pathological examination indicated a low- grade mucinous neoplasm of the cecal appendix with mod- erate atypia, con fined to the appendiceal mucosa, with free surgical margins, and no involvement of the colon or ileum. Lymph nodes were also free of neoplasia (0/30). Pathological staging: pTis, pN0. The patient, 60 days after surgery, is recovering well, with preserved bowel habits, no complaints, and no indication for adjuvant treatment. Awaiting immuno- histochemical results of the surgical specimen.

Discussion

Mucocele is the term used to describe the gelatinous tumor of the vermiform appendix, occurring due to the abundant production of mucus in the lumen or chronic obstruction, leading to its accumulation. It is a rare condition that affects 0.1-0.4% of the population and presents in three types: Type I, benign; Type II, mucinous cystadenoma, cov- ered by neoplastic epithelium; and Type III, appendiceal cystocarcinoma, a malignant and aggressive neoplasm. Its treatment is surgical: appendectomy for Types I and II, and right colectomy for Type III. In cases of diagnostic uncertainty or tumor invasion, or in the case of larger tumors, colectomy is preferred. It is crucial not to rupture the structure during specimen removal to prevent disease dissemination to the peritoneum—risk of pseudomyxoma peritonei.

Conclusion

The presented case highlights what is expected of an appendiceal mucocele: diagnosis through incidental finding and nonspecific abdominal pain. Therefore, understanding the pathology and its nuances in the presence of clinical suspicion is essential, as it can lead to negative outcomes if diagnosed late or managed inappropriately. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 132899 E-poster MALIGNANT COLON NEOPLASIA IN THE LEGAL AMAZON: A 10-YEAR PROFILE Vinícius Sussuarana Rocha 1, Raimundo Rocha Neto 1, Vítor Augusto Ribeiro Oliveira 1, Anna Cristina Pires da Luz Dória 1, Marcos Zuqueto Farias 1, Prisco de Paiva Bezerra Segundo 1, Raimundo Nonato Ribeiro de Oliveira Júnior 1, Iuri Silva Sena 1 1Universidade Federal do Amapá, Macapá, Brasil

Introduction

Colorectal cancer (CRC) is a signi ficant cause of global morbidity, associated with risk factors such as advanced age, low socioeconomic status, obesity, sedentary lifestyle, smoking, excessive alcohol consumption, and an unbalanced diet.

Objectives

To analyze the epidemiological pro file of hospitalizations for malignant colon neoplasms from 2013 to 2023 in the states of the Legal Amazon region.

Materials and methods

A descriptive study was conducted using data from the Hospital Information System (SIH/SUS), obtained through the Department of Informatics of the Unified Health System (DATASUS). The study analyzed hospitalizations and deaths due to malignant colon neo- plasms from 2013 to 2023 in the states of Acre, Amapá, Amazonas, Maranhão, Mato Grosso, Pará, Rondônia, Roraima, and Tocantins. The variables observed included age groups (under 1 year to 80 years or older), as well as male and female genders and race/ethnicity.

Results

Over 10 years, there were a total of 23,970 hospitalizations for malignant colon neoplasms, representing an increase of approximately 58.3%. The number of hospital- izations ranged from 1,811 cases in 2013 to 2,867 in 2023, with the lowest number recorded in 2015 (1,713 cases) and the highest in 2023 (2,867 cases). The state with the highest number of hospitalizations was Mato Grosso (9,048 cases), while Acre had the lowest (322 cases). During the same period, there were 2,014 deaths related to malignant colon neoplasms, ranging from 150 in 2013 to 268 in 2023. Mato Grosso had the highest incidence of deaths (510), while Amapá had the lowest (30). The female population accounted J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S13 for 11,891 hospitalizations, while the male population accounted for 12,079, representing approximately 50.3% of total hospitalizations. The most affected age group was 50 to 59 years (6,025 cases), and the least affected was under 1 year (36 cases). Regarding race/ethnicity, the mixed-race popula- tion had the highest number of cases (15,594), followed by the Indigenous population, with only 28 cases.

Conclusion

The increase in hospitalizations may re- flect better case reporting and access to healthcare services. The predominance of the mixed-race population can be explained by its demographic representation in the studied regions. The most affected age group is related to prolonged exposure to risk factors and the aging process. Despite the rising incidence among women, cases are more prevalent in men, possibly due to anatomical, hormonal, and behavioral differences. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 137663 E-poster INTESTINAL OBSTRUCTION DUE TO SIGMOID COLON GIST – A CASE REPORT Luiza da Silva Barbosa1, Denise Moreira de Araújo1, Laís Silva do Nascimento1, Jéssica Lins Bonfatti 1, Luciana Bessa Rosas 1, Gabriela Santos Silva1, Bruno Coelho Jardim1, Ana Luisa de Arêa Lesão Alves1 1Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil Case Presentation R.V.S.N., 58 years old, presented to the emergency room with a 4-day history of abdominal pain, absence of bowel movements, and vomiting. Physical exami- nation revealed abdominal distension and diffuse tenderness upon palpation. An abdominal CT scan showed signi ficant distension of the small intestine and descending colon with adjacent fat stranding. A large multiloculated solid-cystic lesion measuring 15 cm at its largest diameter was identified, causing upstream obstruction. The liver and lungs showed no lesions suggestive of metastasis. The patient underwent exploratory laparotomy, revealing a stenosing tumor of the sigmoid colon. A Hartmann ’s procedure was performed, and the surgical specimen was sent for biopsy. Pathological examination revealed a moderately cellular mesenchymal neoplasm with an immunohistochemical pro file consistent with a gastrointestinal stromal tumor (GIST). Clinical follow- up was chosen, with no need for adjuvant therapy.

Discussion

GISTs account for approximately 0.1–3% of colorectal cancers. They originate from Cajal cells and plurip- otent stem cells of the mesenchyme. Histologically, they exhibit spindle-shaped cells and are positive for the CD117 and CD34 antigens in 60 –70% of cases. GISTs are most common in the 6th and 7th decades of life and affect both sexes equally. They grow slowly and are often incidental findings. Common symptoms include hematochezia and abdominal pain. GISTs can metastasize to the liver and peritoneum, though lymph node involvement is rare. Diag- nosis is typically made via colonoscopy. CT and MRI are used for staging and to assess surgical resectability. Surgery is the treatment of choice, with at least a 1 cm margin required. Lymphadenectomy is unnecessary. Imatinib can be used as adjuvant therapy for incomplete surgical resections and metastatic disease, reducing recurrence risk. It is also employed as neoadjuvant therapy for initially unresectable tumors to reduce their size. Recurrence and metastasis occur in up to 50% of cases.

Conclusion

Despite the low incidence of GISTs in the colon and rectum, they should be considered as differential diagnoses in cases of intestinal obstruction. GISTs respond well to Imatinib in combination with surgical resection. Encouraging colorectal cancer screening through colonosco- py is vital for early diagnosis and better prognoses. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141513 E-poster EPIDEMIOLOGICAL PROFILE OF MALIGNANT NEOPLASM OF THE COLON IN GOIÁS OVER THE LAST FIVE YEARS Gustavo Hayasaki Vieira1, Milena Almeida Barbosa1, Giovana de Oliveira Araújo1, Rafaella Rodrigues de Freitas Vieira 1, Isabela Maciel Mesquita1, Samira Dionísio Maia 1, Gustavo Cartaxo de Sousa Melo1, Valentina Melo Rosa Centofanti 1 1Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brasil

Introduction

Malignant neoplasm of the colon is the third most common type of tumor worldwide, accounting for approximately 10% of all cases. It is the second leading cause of cancer-related deaths, presenting symptoms such as diar- rhea, constipation, blood in stool, abdominal pain, and low iron levels. Given its high morbidity and mortality rates, determining the epidemiological pro file of this disease is essential, particularly in the state of Goiás, where there is a lack of studies in this Brazilian region.

Objective

To describe the epidemiological pro file of malignant neoplasm of the colon in the state of Goiás between 2018 and 2023. Methodology This is a descriptive, retrospective, and quantitative study based on data from the Hospital Informa- tion System (SIH/SUS) accessed through the Department of Informatics of the Unified Health System (DATASUS). The data pertain to malignant neoplasm of the colon over the last five years in patients from Goiás. Filters applied included: ICD-10 Morbidity List (malignant neoplasm of the colon), hospital- izations, race/ethnicity, gender, age group, available period (January 2018 to December 2023), and year of processing. Data were tabulated and analyzed using Excel. The study adheres to the ethical guidelines of Resolution 466/12 of the National Health Council.

Results

Over the analyzed years, 5,350 hospitaliza- tions due to malignant neoplasm of the colon were recorded in Goiás. The most affected ethnicity was mixed-race indi- viduals, representing 58.2% of cases (n=3,116). The disease was more prevalent in men, accounting for 51.2% of hospital- izations (n=2,741), and among individuals aged 60-69 years, who represented 23.72% (n=1,269). Notably, 2023 had the highest number of hospitalizations, totaling 1,304 cases, with a progressive increase in cases over the years. From 2018 to 2023, there was an approximately 82.85% increase in hospi- talizations, indicating a rising trend in the incidence of this type of cancer. Regarding mortality, a total of 558 deaths were recorded. The age group with the highest number of deaths was individuals aged 60-69 years (n=148).

Conclusion

The analysis revealed that the most vul- nerable pro file for colon cancer includes men, mixed-race individuals, and those aged 60-69 years. Furthermore, there was a progressive increase in cases over the studied period, J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS14 highlighting the urgent need for effective strategies for prevention, screening, and treatment to combat malignant neoplasm of the colon in Goiás. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138331 E-poster EPIDEMIOLOGICAL PROFILE OF PATIENTS HOSPITALIZED FOR MALIGNANT NEOPLASM OF THE COLON IN A PUBLIC HOSPITAL IN THE LOWER AMAZON REGION BETWEEN 2020 AND 2022 Maristella Rodrigues Nery da Rocha 1, Marco Daniel Bentes Batista Júnior1, Luis Arthur Pereira Junior 1, Ana Paulina Santos de Souza 1, Thiago de Lima Lopes 1, josé Pedro Siviero Muczinski1, Humberto Vinícius Maciel Guimarães 1 1Universidade do Estado do Pará, Pará, Brasil

Introduction

Colon cancer is one of the leading malignant neoplasms of the gastrointestinal tract and poses a significant public health challenge due to its high morbidity and mortality rates. The increasing number of cases in Brazil is linked to inadequate lifestyle and dietary habits, such as obesity and sedentary behavior. In the northern region, particularly in the Lower Amazon, factors such as the geo- graphic distance from urban centers and limited access to early detection exams in fluence clinical outcomes of cancer patients. Recently, the COVID-19 pandemic may have exacer- bated these challenges. This study aims to improve public health strategies and enhance the quality of life for patients in Santarém.

Objective

To analyze the epidemiological pro file of patients hospitalized for colon cancer who progressed to death in a public hospital in Santarém between 2020 and 2022. Methodology This is an epidemiological study based on an observational, descriptive design with a quantitative approach. The data were extracted from the Hospital Infor- mation System (SIH/SUS) database concerning the mortality of patients hospitalized with colon cancer in a public hospital in the Lower Amazon region, Santarém, Pará, from 2020 to 2022. Sociodemographic variables such as sex, age group, and ethnicity were analyzed alongside clinical variables, includ- ing the number of hospitalizations per year. The data were organized and analyzed using Microsoft Excel 2021.

Results

Based on information from SIH/SUS, 114 patients were hospitalized for malignant colon neoplasm during the study period: 46 in 2020, 30 in 2021, and 38 in 2022. Of these, 12% progressed to death. Women of mixed ethnicity (parda) accounted for the highest number of cases, totaling 54. The mortality rate relative to hospitalizations was 10% in 2020, peaked at 23% in 2021, and signi ficantly de- creased to 5.2% in 2022. Regarding hospitalizations by age group, individuals aged 50 –59 years were the most affected (33 cases). However, in terms of mortality, the 60 –69 age group had the highest rate.

Conclusion

The epidemiological pro file of colon can- cer mortality in the Lower Amazon region from 2020 to 2022 is characterized by elderly women aged 60–69 years of pardo Brazilians. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 137586 E-poster EPIDEMIOLOGICAL PROFILE OF COLORECTAL CANCER IN THE NORTHERN REGION FROM 2014 TO 2023 Bárbara Alessandra Solano Silva 1, Rosa Helena de Figueiredo Chaves1, Louise Araújo Jassé Santos1, Letícia Gabrielle Machado Góes1, Hugo Ferreira Mendes 2, Renan Antonio Corrêa Medeiros3, Iago André Rocha Cardoso 1 1Centro Universitário do Pará, Belém, Brasil 2Universidade do Estado do Pará, Pará, Brasil 3Centro Universitário Metropolitano da Amazônia, Belém, Brazil

Introduction

Colorectal cancer is a malignant neo- plasm affecting the large intestine, particularly the colon and rectum. It is the third most common cancer worldwide and holds notable importance for Brazil, being the second most frequent cancer in women and the third in men. Thus, continuous screening for this cancer in the Northern region is essential to reduce morbidity and mortality rates in one of the areas most affected by it.

Objective

To analyze the epidemiological pro file of colorectal cancer in the Northern region from 2014 to 2023. Methodology This is a retrospective, quantitative, cross-sectional, and descriptive study using secondary data from the Department of Information Technology of the Unified Health System (DATASUS). The variables were ana- lyzed using descriptive statistics, focusing on male and female patients diagnosed with colorectal cancer in the Northern region of Brazil between 2014 and 2023. Variables include the number of patients diagnosed by state, month, year, sex, and age.

Results

and Discussion A total of 18,178 cases were reported during the analyzed period. The highest number of cases was recorded in 2023, with 2,575 cases. Regarding sex, females slightly predominated, accounting for 51.36% of cases. Mixed-race individuals (parda) represented the major- ity, with 71.03% of cases, followed by white individuals at 12.36%, which can be attributed to the region ’s demographic composition. The age group above 60 years stood out with 45.48% of cases, which aligns with the increased cancer risk associated with aging. Among the states, Pará reported the highest number of cases, accounting for 27.38% of the total, followed by Rondônia with 23.75%. The higher prevalence in Pará may be related to lower socioeconomic indices.

Conclusion

The epidemiological analysis of colorectal cancer aligns with patterns described in the literature, re- vealing a significant number of cases in the Northern region. The findings show no signi ficant differences between sexes but highlight disparities among racial groups, states, and age groups, with higher prevalence among mixed-race individu- als, the state of Pará, and the elderly. Despite advancements in medical science, the incidence of this disease remains high. Therefore, planning health policies and actions aimed at reducing these numbers and improving health indicators in the affected region is imperative. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S15 Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 137583 E-poster EPIDEMIOLOGICAL PROFILE OF DEATHS IN WOMEN IN BRAZIL DUE TO COLORECTAL CANCER FROM 2013 TO 2022 Bárbara Alessandra Solano Silva 1, Rosa Helena de Figueiredo Chaves1, Monyque Pinheiro Charchar 1, Rayane Calandrini de Azevedo1, Sávio Roberto Silva Costa 2, Karine Alves Ribeiro 1, Lucas da Silva Vinagre 3 1Centro Universitário do Pará, Belém, Brasil 2Universidade do Estado do Pará, Pará, Brasil 3Universidade Federal do Pará, Belém, Brasil

Introduction

Colorectal cancer (CRC) is the third most frequent malignant neoplasm worldwide, originating in the colon, rectum, or parts of the large intestine. It is often diagnosed at advanced stages, contributing to a high mortali- ty rate. In Brazil, according to the National Cancer Institute, the estimated incidence in women in 2020 was 20,470 cases. Thus, analyzing the mortality pro file of this cancer in the female population of the country is essential.

Objective

To analyze the epidemiological pro file of deaths due to CRC in women in Brazil from 2013 to 2022. Methodology This is an ecological, cross-sectional, quantitative, and descriptive study based on secondary data from the Department of Informatics of the Uni fied Health System (DATASUS) on deaths caused by colorectal cancer in women in Brazil from 2013 to 2022. The variables were analyzed using descriptive statistics and included deaths by region, age, race, education level, and marital status.

Results

and Discussion During the analyzed period, Brasil reported 96,033 deaths from CRC in women. The highest rates were recorded in 2022 (11,156 cases). Among the regions, the Southeast had the highest number of cases (52,155), while the North had the lowest (3,419), likely due to the Southeast’s predominantly female population. Regarding race, white women were the most affected, with 60,695 cases, and widowed women accounted for the majority (31,093 cases). The analysis of educational attainment revealed higher mortality among those with 1-3 years of schooling. In terms of age, individuals aged 80 years or older were the most affected (24,311 cases), which may be attributed to cellular aging, excessive exposure to mutagenic factors, and a decline in natural immunity.

Conclusion

The data analysis revealed that 2022 had the highest number of female deaths due to CRC, with prevalence in the Southeast region, among white, widowed women with low education levels. These findings are linked to higher exposure to risk factors and the greater number of reported cases in this population. Despite advancements in healthcare, high mortality rates from CRC persist. Thus, increased investment in health policies and actions aimed at reducing these rates is necessary. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138242 E-poster PYODERMA GANGRENOSUM AS A PARANEOPLASTIC SYNDROME OF TRANSVERSE COLON ADENOCARCINOMA Luis Henrique Alves de Queiroz Campos 1, Natália Ferreira Cardoso de Oliveira 1, Vitória Vicentin Giordano 1, Nadine Gomes de Souza 1, Luis Eduardo Silva Móz 1, John Verrinder Veasey1, Fernanda Bellotti Formiga 1, Fang Chia Bin 1 1Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brasil Case Presentation A 58-year-old male, hypertensive and diabetic, presented with a non-healing leg ulcer of 4 months’ duration. A biopsy of the lesion identi fied neutro- philic ulcerative dermatitis consistent with pyoderma gan- grenosum (PG). Oral corticosteroid therapy was initiated but resulted in lesion progression. The patient also exhibited chronic anemia and a weight loss of approximately 15 kg during this period, without gastrointestinal symptoms. Diag- nostic investigation included a colonoscopy, which revealed a vegetative lesion in the proximal transverse colon. Biopsy confirmed adenocarcinoma. Staging via abdominal MRI showed diffuse liver metastases, and the carcinoembryonic antigen (CEA) level was 954.85 mcg/L. Systemic chemothera- py, local wound care, and corticosteroid maintenance were recommended.

Discussion

PG is an ulcerative condition often asso- ciated with autoimmune systemic in flammatory diseases, such as rheumatoid arthritis and in flammatory bowel dis- ease. Less commonly, it can present as a paraneoplastic syndrome, most frequently associated with hematologic malignancies. However, there are reports of PG linked to solid tumors, with breast cancer being the most common, followed by gastrointestinal and colorectal cancers (predom- inantly rectal and sigmoid tumors). To date, no cases have been reported of PG associated with transverse colon adeno- carcinoma. Paraneoplastic PG ulcers typically appear before the cancer diagnosis and have a clinical course parallel to the malignancy, with the dermatological lesion expected to improve with cancer treatment.

Conclusion

Colorectal carcinoma should be consid- ered a differential diagnosis in patients with PG, particularly those without known autoimmune diseases or who do not respond to speci fic treatment. In such cases, colonoscopy should be included in the etiological investigation. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 137680 E-poster EXTRAMEDULLARY PLASMA CELL MYELOMA IN THE RECTUM: A DIAGNOSTIC CHALLENGE. CASE REPORT Marília Fernandes Gualberto de Galiza 1, Jéssica Siebra Macário de Brito1, Joana de Souza Simões 1, Luan Leal Oliveira 1, Marcus Vinícius Castro de Oliveira Lopes 1, Tereza Vilma Sobreira Alexandre1, Amanda Rafaella Ferreira de Jesus1, Erodilho Sande Mota1 1Hospital Geral Roberto Santos, Bahia, Brasil Case Presentation CALS, 40 years old, male, was admitted to the emergency department presenting with anorectal bleeding, altered bowel habits, and a 15 kg weight loss over the past year, associated with asthenia, left hemi- paresis, and dysarthria. He denies comorbidities. Admission exams revealed a history of ischemic stroke, as well as J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS16 concentric thickening and stenosis in the distal rectum and anal canal, with lymph node involvement, suggesting neo- plasia. During the pandemic, the patient lost follow-up with the Coloproctology team. Several endoscopic exams with biopsies were performed, all negative for neoplasia. A transa- nal biopsy was performed, along with immunohistochemis- try, which revealed rectitis and chronic in flammatory processes. The patient continued to experience worsening symptoms and general health, including weight loss, diar- rhea, intense proctalgia, and anorectal bleeding, requiring blood transfusions. Abdominoperineal amputation was rec - ommended for diagnosis and treatment guidance, as com- plementary exams suggested neoplastic involvement. Despite initial reluctance, due to the persistent clinical con- dition, the patient agreed to undergo the procedure after 6 months. In 2024, he underwent abdominoperineal amputa- tion (APA). The pathology report showed extramedullary plasmacytoma (EMP) in the rectum, with clear margins and three affected pelvic lymph nodes.

Discussion

Plasmacytoma is a rare disease, affecting the upper aerodigestive tract in 80% of cases, and gastroin- testinal involvement is rare. It is more common in males, with incidence increasing with age, typically around 60 years old. It is histopathologically con firmed by the presence of mono- clonal plasma cell in filtration outside the bone marrow. The diagnosis is based on finding a monoclonal tumor in an extramedullary site, excluding multiple myeloma (MM). As with diagnosis, treatment is a challenge. Due to the tumor ’s radiosensitivity, radiation therapy (RT) is central to treat- ment. Surgery may be considered as a first-line treatment to avoid the long-term impact of RT, although it is frequently performed for recurrent tumors. Adjuvant chemotherapy remains controversial.

Conclusion

Extramedullary plasmacytoma can be the first indication of a plasma cell neoplasm, and its progression to multiple myeloma occurs in up to 30% of cases after the initial diagnosis. Its prognosis is related to the tumor location and lymph node involvement. It should be considered as a differential diagnosis in abdominal tumors. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141712 E-poster FAMILIAL ADENOMATOUS POLYPOSIS: A CASE REPORT Wilson Júnior Pereira da Silva 1, Ana Beatriz Lopes 1, Maria Beatriz Souza Nascimento1, Talita Melo Nunes Caldas1, Vanessa Siqueira Reis2, Marccus Antônio Tolentino de Jesus 2, Bruno Augusto Alves Martins 2, João Batista de Sousa 1 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil Case Presentation A twelve-year-old boy was diag- nosed with familial adenomatous polyposis shortly after his father passed away from colorectal cancer. At age fifteen, he developed cancer of the descending colon and underwent subtotal colectomy with ileorectal anastomosis. At seven- teen, a biopsy con firmed rectal adenocarcinoma, leading to proctectomy with a J-pouch ileal reservoir and protective ileostomy, which was closed six months later. At twenty-six, he developed synchronous adenocarcinomas in the proximal jejunum and ileal reservoir, necessitating resection of the ileal pouch, segmental enterectomy of the proximal jejunum, and creation of a new ileal pouch. At thirty, he presented with a duodenal tumor with liver metastasis, both treated with chemotherapy. He succumbed to the disease at thirty-two years of age.

Discussion

Familial adenomatous polyposis is an autosomal dominant hereditary syndrome characterized by multiple colorectal adenomatous polyps. Screening should begin at the age of twelve, and patients should undergo prophylactic surgery. Prophylactic treatment is recom- mended by age eighteen to prevent progression to cancer, as untreated adenomatous polyps in the colon and rectum evolve into invasive carcinoma. Treatment options include restorative proctocolectomy with an ileal pouch, total colec - tomy with ileorectal anastomosis, or total proctocolectomy with de finitive ileostomy in cases of incontinence or distal rectal cancer. Even after surgery, tumors may develop in the remaining intestinal segments and the ileal pouch, requiring continuous monitoring.

Conclusion

Young individuals with familial adeno- matous polyposis are at an increased risk of developing cancer before the end of adolescence, as seen in this case. Given the patient ’s young age, the rectum was preserved; however, despite close follow-up, it progressed to rectal cancer and, unfortunately, he passed away at a young age. Postoperative surveillance is critical, regardless of the type of surgery performed, due to the cumulative risk of developing polyps and carcinoma over time. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141670 E-poster PRESERVATION OF COLORECTAL ANASTOMOSIS AFTER DEHISCENCE USING VACUUM THERAPY – CASE REPORT Giovana Moreira Minchillo1, Rodrigo Moises de Almeida Leite 1, Victor Edmond Seid 1, Lucas Soares Gerbasi 1, Sergio Eduardo Alonso Araujo 1, Rafael Vaz Pandini 1, Erika Borges 1, Francisco Tustumi1 1Hospital Israelita Albert Einstein, São Paulo, Brasil Case Presentation The case involves J.C.L., a 58-year- old male patient with hypertension and diabetes. He was diagnosed with high rectal adenocarcinoma, stage T3bN1 based on MRI, with no distant metastases. Surgical treatment was indicated, and a robotic -assisted low anterior resection with partial mesorectal excision, protective ileostomy, and cavity drainage was performed. Postoperatively, the patient experienced a slow recovery, presenting with prolonged metabolic ileus during hospitalization. On the 5th postoper- ative day, the drain showed fecaloid discharge. Abdominal CT revealed signs of colorectal anastomotic dehiscence on the posterior wall with a 20mL adjacent collection. Considering the patient’s stable clinical condition and the diverted intes- tinal transit, conservative treatment was chosen. This includ- ed antibiotic therapy and the installation of transanal vacuum therapy. Rectoscopy revealed an 80% dehiscence in the colo- rectal anastomosis. A continuous suction tube at 125mmHg was placed inside the recess, with the system exit via the anal route. After five days, there was significant improvement and tissue granulation, prompting a replacement and continua- tion of the vacuum system for an additional seven days. At the end of this period, control endoscopy showed resolution of the anastomotic disruption. Three weeks after vacuum J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S17 therapy removal, the anastomosis was intact and patent, with no signs of stenosis. Six months after the initial surgery, intestinal continuity was restored with the closure of the protective ileostomy.

Discussion

Postoperative complications in colorectal surgeries are a signi ficant topic of concern. Among them, anastomotic fistulas and dehiscences are the most feared. Vacuum-assisted therapy is a relatively new approach for treating colorectal anastomotic dehiscences. It involves the use of a negative pressure system to promote better healing, secretion drainage, vascularization, and stimulation of healthy tissue growth at the site.

Conclusion

This case report demonstrates that, in selected cases, vacuum therapy can yield satisfactory out- comes, allowing the preservation of colorectal anastomosis and reducing the need for surgical re-intervention in oncolo- gy patients. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141745 E-poster PREVALENCE OF EXTRA-INTESTINAL LESIONS IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS Mariana Trotta Villar 1, Luna Vitória Gondim Ferreira 1, Laura Trotta Villar1, Vanessa Siqueira Reis 2, Marccus Antônio Tolentino de Jesus 2, Romulo Medeiros de Almeida 2, Bruno Augusto Alves Martins 2, João Batista de Sousa 1 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil

Introduction

Familial adenomatous polyposis (FAP) is a hereditary genetic condition with an autosomal dominant inheritance pattern, predisposing individuals to colorectal cancer and a wide range of extra-intestinal manifestations. In addition to colorectal polyps, FAP can affect the entire gastrointestinal tract and other organs, including the stom- ach, duodenum, small intestine, thyroid, adrenal glands, pancreas, and pituitary gland. Benign extra-intestinal man- ifestations include sebaceous cysts, lipomas, osteomas, clubbed fingers, dental abnormalities, and desmoid tumors. Malignant manifestations encompass periampullary, bile duct, gastric, ileal, thyroid, adrenal, and central nervous system tumors. Early diagnosis and identi fication of these complications are crucial for effective disease management and improved patient quality of life.

Objective

The objective of this study was to analyze the prevalence and types of extra-intestinal manifestations in FAP patients treated at a university hospital. Methodology A retrospective analysis of medical records was conducted for patients diagnosed with FAP who were treated at the coloproctology outpatient clinic of the University Hospital between 1992 and 2024. Data col- lected included patient age, sex, and the presence of extra- intestinal manifestations at diagnosis or during follow-up. These manifestations were categorized as dental-bone lesions, desmoid tumors, duodenal tumors, sebaceous cysts, brain tumors, and mandibular osteomas.

Results

The analysis included 72 patients with FAP, of whom 15 (20.8%) presented with at least one extra-intestinal manifestation. The most common manifestations were den- tal-bone lesions, found in 9 patients (12.5%), desmoid tumors in 3 patients (4.2%), and duodenal tumors in 3 patients (4.2%). Other manifestations included mandibular osteomas in 2 patients (2.7%), sebaceous cysts in 1 patient (1.38%), and brain tumors in 1 patient (1.38%).

Conclusion

The results of this study indicate that extra-intestinal manifestations are relatively common in patients with FAP. Dental-bone lesions, desmoid tumors, and duodenal tumors were the most frequent manifestations. These findings underscore the need for a proactive clinical approach to identify and manage extra-intestinal complica- tions associated with FAP, contributing to improved disease management and patient quality of life. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 136556 E-poster LATE TUMOR PROGRESSION: SYSTEMIC METASTASIS AND PERINEAL RECURRENCE AFTER ABDOMINOPERINEAL RESECTION OF THE RECTUM Bruna Meirelles Carregaro 1, Denis Galhera 2, Guilherme Marques2, Pedro Magalhaes 2, Iana Saran Faine 1, André Luigi Pincinato1, Anderson da Costa Lino Costa 3, Fernanda Bellotti Formiga1 1Serviço de Coloproctologia do Hospital Heliópolis, São Paulo, Brasil 2Universidade de São Caetano do Sul, Medicina, Brasil 3Serviço de Patologia do Hospital Heliópolis, São Paulo, Brasil Case Presentation A 63-year-old male with stage II/III mid-rectal adenocarcinoma underwent neoadjuvant therapy in 2014 (5- fluorouracil and 5.4 Gy) achieving a complete clinical response. An organ-preservation protocol was fol- lowed for 18 months, after which a bleeding lesion was identified during rectoscopy, con firming tumor regrowth. The patient underwent abdominoperineal resection (APR) in 2016, with pathology showing ypT1N0. He remained under oncological follow-up without complications until 2022 (six years post-APR) when hepatic metastases developed. Seg- mentectomy (segments VII/VIII) was performed, followed by adjuvant therapy (capecitabine). Subsequently, a subcutane- ous 1 cm perineal nodule appeared near the surgical scar, causing mild pain. Initially, clinical observation was chosen, but the lesion demonstrated slow growth and increasing local pain. In 2023, MRI and PET-CT revealed hypermetabolism (SUVmax = 10.4) at the perineal surgical scar. The nodule was surgically excised, and histopathology con firmed tubulovil- lous adenocarcinoma in fibroadipose tissue, with clear margins.

Discussion

Local recurrence following surgical resec - tion of rectal adenocarcinoma occurs in 3% to 35% of cases within five years. After APR, recurrence can present as pelviperineal, pelvic, or perineal. Perineal recurrence, al- though rarely described in isolation, can often be detected during physical examination. Neoadjuvant therapy plays an undeniable role in reducing local recurrence rates. However, both classical and total neoadjuvant therapies have shown late systemic and local recurrences, the pathological mecha- nism of which remains unde fined. Surgical resection of systemic and local progression can achieve curative out- comes, emphasizing the importance of adequate oncological follow-up. In this case, the patient showed a good response to neoadjuvant therapy, achieving complete clinical response, enabling organ preservation. It is known that 30% of patients experience tumor regrowth, primarily within the first two J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS18 years of post-treatment. The rarity of this case lies in the prolonged interval of both systemic and perineal recurrence (more than five years), with successful curative resections and histological con firmation.

Conclusion

Prolonged and adequate oncological fol- low-up after multimodal treatment for rectal adenocarcino- ma appears to be the best strategy to improve disease-free survival, as late recurrence is increasingly being documented. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138595 E-poster RECTOSIGMOIDECTOMY WITH TME AFTER TEO, IN A PATIENT WITH A LESION MEETING HIGH-RISK CRITERIA João Pedro Pinto Cordeiro de Miranda Coutinho 1, Marcos Vinícius de Araújo Denadai 1, Felipe Daldegan Diniz 1, Luís Gustavo Capochin Romagnolo 1, Rodrigo Giacomini Bregeiro 1, Carlos Augusto Rodrigues Véo 1 1Hospital de Amor de Barretos, São Paulo, Brasil Case Presentation A 62-year-old female patient pre- sented to an oncological reference service with a colonoscopy showing a 20 mm polypoid lesion, with an eroded surface covered by fibrin and irregular microvascularization in the distal rectum, near the first Houston valve, with histopatho- logical findings of intramucosal adenocarcinoma. Staging exams, including MRI, reported an apparent sessile lesion on the anterior wall of the rectum, 6.5 cm from the anal margin, measuring 1.5 cm in length, with no suspicious lymph nodes in the mesorectum and no apparent invasion of the submucosa. A transanal resection using the TEO platform was initially chosen. The histopathological report showed low-grade invasive adenocarcinoma extending into the submucosa, Haggitt level 4, with a submucosal invasion thickness of 5 mm (about two-thirds of the submucosa), angiolymphatic invasion present, and intermediate tumor budding, classified as pT1, with no microsatellite instability. Due to the presence of high-risk factors in the histopathology, additional surgery was planned, and the patient underwent a rectosigmoidectomy with total mesorectal excision and a protective ileostomy via robotic surgery. The pathology of this procedure showed no residual neoplasia in the colon wall, however 2 out of 30 mesorectal lymph nodes were affected by neoplasia, and the patient was referred for adju- vant oncological treatment.

Discussion

The use of platforms for resection of rectal tumors is a valid option for sparing patients with early lesions from more extensive surgeries, with total mesorectal exci- sion, as long as the tumor size and location allow for an R0 resection. This procedure should be preceded by thorough staging with pelvic MRI or endorectal ultrasound to assess the tumor’s depth in the rectal wall and to check for lymph node involvement. Histopathological predictive factors for lymph node involvement include submucosal invasion, differentia- tion grade, lymphovascular and/or perineural invasion, and tumor budding. The risk of lymph node metastasis in T1 tumors is between 6.3% and 10%. Transanal endoscopic resection of rectal tumors can be both diagnostic and cura- tive, depending on the lesion ’s histopathology.

Conclusion

This case highlights the importance of proper analysis of the histopathological study following a TEO resection, as, despite the correct indication for local resection, high-risk factors were present, resulting in undetected lymph node invasion on imaging exams. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141742 E-poster ONCOLOGICAL TRANSABDOMINAL AND TRANSANAL RECTOSIGMOIDECTOMY VIA ROBOTIC-ASSISTED SURGERY Aryssa Anielli Sakai 1, Artur Cury Féres 1, João Paulo Slongo 1, Vanessa Foresto Machado 1, Marley Ribeiro Feitosa 1, José Joaquim Ribeiro da Rocha 1, Rogério Sera fim Parra1, Omar Féres1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, São Paulo, Brasil Cases Presentation First case: A 54-year-old male patient with low rectal adenocarcinoma located 3 cm from the anal verge, classi fied as cT2 cN2a cM0, underwent neo- adjuvant therapy according to the RAPIDO TRIAL protocol. Upon follow-up evaluation, the lesion remained in filtrative and hardened, starting 4 cm from the anal verge and extend- ing 4 cm cephalically. He underwent robotic -assisted transa- nal and transabdominal rectosigmoidectomy, with specimen removal via the anterior abdominal wall, colorectal anasto- mosis 2 cm from the anal verge stapled endoanal, and loop transverse colostomy on the left flank. Postoperatively, he experienced partial anastomotic dehiscence with retro-rectal abscess formation. Surgical drainage was performed via endoluminal access on postoperative day 24. Following this, he had a good clinical recovery with no evidence of surgical complications or disease recurrence during the 3- month follow-up. Second case: A 63-year-old male with a history of mid-rectal adenocarcinoma, located 7 cm from the anal verge, initially underwent transanal resection of the lesion (TAR). Due to pT3 stage disease, preoperative MRI showed evidence of lymph node involvement in the meso- rectum, and post-TAR imaging revealed pre-sacral lymph- adenopathy. Chemoradiotherapy with radiosensitizing agents was initiated. During the second year of clinical- radiological follow-up, local recurrence was observed, and total mesorectal excision was indicated. The patient under- went robotic -assisted transanal and transabdominal recto- sigmoidectomy, with specimen removal via transanal approach, mechanical colorectal anastomosis, and loop transverse colostomy, without complications. The patient is currently under outpatient follow-up with no evidence of surgical complications or neoplastic recurrence.

Discussion

Post-neoadjuvant middle rectal tumors often require a combined transabdominal and transanal approach to achieve resection and low anastomosis with a protective stoma. In these cases, we show the use of robotic surgery for the abdominal component and the use of a proctoscope developed in our service for the anal component, which easily accesses this type of patient.

Conclusion

Transabdominal and transanal resection is an effective therapeutic option for post-neoadjuvant mid- dle rectal tumors with low colorectal anastomosis, and robotic surgery may be a good option for the abdominal component. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S19 Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141137 E-poster ROBOTIC VERSUS LAPAROSCOPIC LOW ANTERIOR RESECTION: RESULTS FROM A PROSPECTIVE COHORT STUDY Rodrigo Moisés de Almeida Leite 1, Giovana Moreira Minchillo 1, Ana Sarah Portilho 1, Rafael Vaz Pandini 1, Francisco Tustumi1, Lucas Soares Gerbasi 1, Victor Edmond Seid 1, Sergio Eduardo Alonso Araujo 1 1Hospital Israelita Albert Einstein, São Paulo, Brasil

Introduction

The Robotic approach in Low Anterior Resection (LAR) for the Surgical Treatment of Rectal cancer may be associated with improved postoperative outcomes, such as shorter recovery time and reduced incidence of postoperative complications. However, longer operative times and higher costs may also be associated when com- pared to laparoscopic approach. We analyzed a single sur- geon prospective database comparing postoperative and intraoperative outcomes of LAR between robotic and laparo- scopic approaches.

Methods

We built a prospective cohort study includ- ing laparoscopic and robotic LAR for the treatment of low and middle rectal cancer. Summary of outcomes include: - Total Operative Time (in minutes); - Length of in-hospital stay (in days); - Incidence of Anastomotic Leak ; - Rate of unplanned conversions to open surgery; - Rate of any postoperative surgical complication. The statistical analysis was conducted on STATA 18 Standard Edition. 101 cases (66 robotic and 35 laparoscopic) were included for analysis. Robotic approach when compared to laparoscopy was associated with: - No increase in operative time (median 197 minutes {IQR 180- 240} vs 200 minutes {IQR 180-240}. p 0.628) - Signi ficant reduction in length of in-hospital stay (5 days vs 3 days), p 0.025 - Significant reduction in unplanned conversions (4.54% vs 20%), p 0.010 - Signi ficant reduction in postoperative complications (RR 0.38, 95%CI {0.17-0.86}, p 0.018). No benefit was observed regarding anastomotic leak.

Results

In this prospective, single center, cohort study, robotic approach in LAR with TME was associated with a shorter in-hospital stay, reduced conversions and postoperative complications without increase in operative time when compared to laparoscopy. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141125 E-poster ROBOTIC VS OPEN SURGERY FOR SIMULTANEOUS RESECTION OF COLORECTAL CANCER AND LIVER METASTASES: A SYSTEMATIC REVIEW AND META ANALYSIS Bruna Oliveira Trindade 1, Antônio Nocchi Kalil 2, Fares Hassan Hamaoui2, Cristina Calloni 3, Daniel de Barcellos Azambuja 2 Patrícia Marcolin4 1UFCPSA 2Santa Casa de Porto Alegre, Porto Alegre, Brasil 3Universidade Feevale, Rio Grande do Sul, Brasil 4Universidade Federal da Fronteira Sul, Santa Catarina, Brazil

Introduction

For patients with resectable colorectal liver metastases (CLM), surgery offers the best long-term survival and potential cure. Synchronous resection is pre- ferred, but while colorectal surgeries are often laparoscopic, minimally invasive CLM resections are not yet standard. The emergence of robotic surgery introduces new possibilities, but its impact on surgical outcomes compared to traditional open surgery is still debated, with various studies providing conflicting results. To address this uncertainty, we conducted a systematic review and meta-analysis to compare the surgi- cal outcomes of robotic versus open simultaneous resections for colorectal cancer and liver metastases.

Methods

A comprehensive search of PubMed, Embase, and Cochrane databases was conducted to identify studies comparing robotic and open surgery for simultaneous resection of colorectal cancer and liver metastases. The primary outcomes were (1) operative time; (2) anastomotic leakage; (3) bile leakage; (4) blood loss; and (5) postoperative hospital stays. Heterogeneity was examined with I2 statistics. Odds ratios (ORs), mean Differences (MD) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model.

Results

From a total of 582 studies, we included 5 studies with 1,696 patients, of whom 165 (9.73%) underwent a robotic surgery approach. The blood loss (MD -87.48; 95% CI [-103.76, -71.21]; p < 0.0001), postoperative hospital stays (MD -2.23; 95% CI [-2.96,-1.51]; p < 0.0001) were statistically significant lower in patients treated by robotic platform. On the other hand, operative time was higher in the open surgery group (MD 48.87; 95% CI [21.23,76.50]; p=0.0005). Anasto- motic leakage (OD 1.66; 95% CI [0.65,4.26]; p=0.29) and bile leakage (OR 0.57; 95% CI [0.57,3.98]; p=0.57) did not show a statistically significant difference between the groups.

Conclusion

This comprehensive systematic review and meta-analysis provides evidence that robotic approaches yield improved outcomes for patients undergoing simulta- neous resection of colorectal cancer and liver metastases. New studies are needed to evaluate new outcomes. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138296 E-poster SARCOMA INTESTINAL EM DOIS SEGUIMENTOS INTESTINAIS SIMULTÂNEOS: RELATO DE CASO Intestinal Sarcoma in Two Simultaneous Intestinal Segments: Case Report Raphaella Assis Alves Januário 1, Juliana Giangiardi Batista 1, Eduardo Vidal de Holanda 1, Rafaela Fonseca Falcão Hudari 1, Flávia Balsamo1, Sérgio Henrique Couto Horta 1, Laís Yumi Takaoka1, Sandra Di Felice Boratto 1 1Centro Universitário Faculdade de Medicina do ABC, São Paulo, Brasil Case Presentation A 71-year-old male patient pre- sented with abdominal pain, hematochezia, and a 15 kg weight loss over 4 months. He was referred to a tertiary J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS20 hospital in Greater São Paulo, where enterotomography revealed irregular segmental parietal thickening with a neo- plastic appearance in the proximal jejunal loop, beginning about 10 cm after the Treitz angle, extending 10 cm, and signs of fistulization extending into another jejunal loop, approxi- mately 80 cm from the Treitz angle, with 4.0 cm of involve- ment. There was also thickening in the ileal loop in the right hypogastrium, measuring 4.0 cm, without mesenteric lymphadenopathy. Following staging, the patient underwent exploratory laparotomy requiring 3 enterectomies and the creation of 3 enteroenterostomies: the first 4 cm from the Treitz angle, the second 70 cm from the Treitz angle, and the third at the site of the ileal tumor resection. The patient had a good postoperative recovery and was discharged on the 6th postoperative day. Histopathological examination revealed poorly differentiated malignant neoplasia with ulceration in both resected lesions, and immunohistochemistry (IHC) was consistent with angiosarcoma due to the following positive markers: CD-34, CD-31, ERG, Factor VIII, and FL1.

Discussion

Sarcomas are a rare and heterogeneous group of malignant mesenchymal tumors that account for less than 1% of all adult malignant neoplasms. The histopath- ological spectrum of sarcomas is broad, presumably because the embryonic mesenchymal cells from which they arise have the capacity to differentiate into skeletal and smooth muscle, adipose tissue, and fibrous tissue, among others. The reported incidence is between 10 and 15 cases per million inhabitants per year. Symptoms may include weight loss, intestinal subocclusion, and hematochezia, if the tumor is intestinal. Treatment is surgical, and the diagnosis of sarcoma is retro- spective, as it is made through IHC, which detects tumor cells positive for vascular markers such as CD31 and Factor VIII.

Conclusion

The incidence of intestinal sarcoma is rare, and its diagnosis is made through immunohistochemical

Results

after resection. Therefore, treatment, when possible, should be surgical, similar to other intestinal neoplasms. It is important to pay attention to the pathological results and request immunohistochemistry for differentiation. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141153 E-poster TRANSVERSE COLON SCHWANNOMA: A CASE REPORT Bárbara Adeline Ramalho Faro1, Maurício Prado Ribeiro2, Paulo Figueiredo Barreto Neto2, André Luiz Santos 2, Hernan Augusto Centurion Sobral 2, Gustavo Henrique de Souza Maranhão 1 1Universidade Tiradentes, Alagoas, Brasil 2Hospital São Lucas, São Paulo, Brasil Case Presentation A 39-year-old woman was referred for a colonoscopy following the identi fication of an image in the transverse colon during an abdominal contrast-enhanced CT scan. She denied changes in bowel habits, nausea, vomit- ing, fatigue, or weight loss. Physical abdominal examination revealed no pain, masses, or signs of peritoneal irritation. Proctological and laboratory exams were unremarkable. Co- lonoscopy identi fied a nodular, extramucosal lesion in the proximal transverse colon, measuring 30 mm and occupying ¼ of the intestinal lumen. Total abdominal CT suggested a lesion in the proximal transverse colon, indicative of intesti- nal tuberculosis or gastrointestinal stromal tumor (GIST). The patient underwent a right partial colectomy with D2 lymphadenectomy via laparoscopy. Surgical pathology con- firmed a Schwannoma in the colonic wall, measuring 2.5 cm with clear margins. Immunohistochemistry demonstrated diffuse S100 expression, supporting the diagnosis.

Discussion

Schwannomas are benign mesenchymal tumors caused by the excessive proliferation of Schwann cells in nerve sheaths. They can occur anywhere in the body, most commonly in the stomach and small intestine, but findings in the transverse colon are extremely rare. These tumors are typically observed between the fifth and eighth decades of life, making this case particularly unique. There remains controversy in the literature regarding the treatment ap- proach for intestinal schwannomas. Several studies suggest the malignant potential of colonic schwannomas is minimal, and pathological parameters, such as mitotic rate and tumor size, appear to have little prognostic signi ficance. Complete surgical resection seems to be the treatment of choice due to the preoperative diagnostic uncertainty and excellent long- term outcomes. Tumor recurrence is generally associated with incomplete surgical margins.

Conclusion

This report presents a rare case of intes- tinal schwannoma and aims to contribute to the scienti fic community by detailing the evolution and management of the treatment based on updated bibliographical references. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141725 E-poster TREATMENT OF PELVIC COLLECTION AFTER RECTOSIGMOIDECTOMY WITH SELF-EXPANDING LUMINAL- APPOSING METAL STENT: CASE REPORT Aryssa Anielli Sakai1, Artur Cury Féres1, Matheus Couto Furtado Albuquerque1, João Paulo Slongo 1, José Joaquim Ribeiro da Rocha1, Marley Ribeiro Feitosa 1, Rogério Sera fim Parra1, Omar Féres1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, São Paulo, Brasil Case Presentation A 59-year-old female patient with rectosigmoid adenocarcinoma (T3 N2 M1) underwent ab- dominal rectosigmoidectomy with a descending-colon-to- rectum mechanical anastomosis and a loop transverse colos- tomy. She was readmitted four days post-discharge with complaints of fever and cessation of stool output from the stoma. A CT scan revealed a pelvic abscess. Despite abdominal pain, she remained in good general condition, clinically stable, and without signs of peritonitis. A transrectal ultra- sound-guided drainage via endoscopic ultrasound (EUS) was chosen. Colonoscopy identi fied a partial anastomotic dehis- cence associated with a 6.5 /C2 4.0 cm pelvic collection poste- rior to the rectum, confirmed by EUS. A lumen-apposing self- expanding metal stent (LAMS) Hot Axios® was placed to drain the abscess, resulting in immediate evacuation of the collection. Follow-up CT scans showed a reduction in abscess size. The patient experienced a satisfactory clinical course, and the stent was removed via colonoscopy after two weeks. At six months of follow-up, no complications or reinterven- tions were required.

Discussion

The selection of LAMS for the drainage of pelvic collections post-colorectal surgery is based on its ability to provide effective and immediate evacuation while minimizing complications associated with traditional J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S21 methods, such as percutaneous or open drainage. The Hot Axios® system simpli fies the procedure by eliminating the need for guidewires and dilators, enhancing practicality. Though recent studies are limited, they emphasize the safety and ef ficacy of this alternative approach in selected cases, showing reduced hospitalization times, lower complication rates, and fewer subsequent interventions.

Conclusion

This case demonstrates the successful application of LAMS in managing a pelvic collection post- rectosigmoidectomy, highlighting its effectiveness as a safe and minimally invasive therapeutic method. This favorable clinical outcome supports the use of transluminal endoscopic techniques as a valuable option for treating complex postop- erative abdominopelvic complications, particularly in patients with therapeutic limitations. The experience under- scores the importance of personalized treatment strategies and advanced technologies to improve outcomes in patients with challenging clinical scenarios. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141717 E-poster BILATERAL KRUKENBERG TUMOR IN A PATIENT WITH CROHN’S DISEASE: CASE REPORT Mariana Geraldi Rodrigues 1, Rosane Louzada Machado 1, Eduardo de Paula Vieira 1, Fernanda Scelza Gianotti 1 1Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brasil Case Presentation A 39-year-old female patient with stenosing ileocolonic Crohn’s disease since 2004 presented in 2022 with nausea, postprandial fullness, and diarrhea. Colo- noscopy revealed stenosis in the descending colon and sig- moid. CT enterography identi fied an 11 cm stricture at the hepatic flexure. She underwent right ileocolectomy with ileostomy. Histopathology showed mixed colonic adenocar- cinoma (40% signet ring cells). Chemotherapy with XELOX was initiated but switched to bFOL due to toxicity. Six months later, carcinoembryonic antigen levels increased, and a cystic mass was detected in the supravesical region. PET-CT sug- gested ovarian implantation. In 2023, she underwent right salpingo-oophorectomy, and histopathology con firmed me- tastasis of colorectal adenocarcinoma. Treatment included chemotherapy with 5-FU þ Irinotecan, followed by total hys- terectomy and prophylactic left salpingo-oophorectomy in 2024. PET-CT detected residual lesions, which were treated with radiotherapy. Genetic testing revealed no mutations in KRAS, NRAS, or BRAF. Palliative chemotherapy with Irinote- can and Cetuximab was initiated.

Discussion

In Brazil, colorectal cancer (CRC) is the second most common cancer in women and the third in men. Patients with Crohn ’s disease (CD) have a 2- to 6-fold in- creased risk of developing CRC, which accounts for 10–15% of deaths in in flammatory bowel diseases. CRC associated with CD tends to affect younger individuals and is often diffuse, extensive, multifocal, and located in the right colon. Kruken- berg tumors (KT) are ovarian metastases, typically from gastrointestinal cancer. Approximately 76% of KTs originate from the stomach and 11% from the colorectum. Immuno- staining for CK20 and CK7 helps distinguish ovarian metas- tases from primary ovarian neoplasms; colorectal tumors are CK20 positive and CK7 negative. Up to 30% of ovarian malig- nancies are metastatic, affecting younger women with a median survival of 19–27 months. KTs from colorectal cancer have a better prognosis when unilateral. Prophylactic oopho- rectomy is recommended post-menopause and may be con- sidered pre-menopause to reduce the risk of metachronous metastasis and primary ovarian cancer.

Conclusion

This report highlights the importance of CRC screening and prevention in patients with in flammatory bowel disease, emphasizing the complex management of associated ovarian metastases. Prophylactic oophorectomy is recommended to improve prognosis and survival, particu- larly in premenopausal women and in cases with synchro- nous microscopic metastases. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 138150 E-poster LOCALLY INVASIVE DESMOID TUMOR: CASE REPORT Pierre Rodrigues Bernardino 1, Isabella da Silva Idelfonso 1, José Roberto Violatti Filho 1, Amanda Karolyne Batista Ferreira 1, Carlos Eduardo Oliveira Sodero 1, Luciano Ricardo Pelegrinelli 1 1Universidade Federal do Triângulo Mineiro, Minas Gerais, Brazil Case Presentation DCP, male, 36 years old. The patient reported progressive right hypochondrial pain over the past 30 days. A computed tomography (CT) scan revealed an oval, voluminous mesenteric mass measuring approxi- mately 10 cm, occupying the right hypochondrium and flank. The mass exhibited mixed density, was contiguous with the distal ileum, displaced the ascending colon at the hepatic flexure, and showed intimate relations with the second and third portions of the duodenum, the superior mesenteric artery, and the inferior vena cava, causing compression. Endoscopy and colonoscopy results were unremarkable. The patient underwent exploratory laparotomy, con firming findings consistent with the CT. Tumoral dissection involved the duodenal portions, pancreatic head, inferior mesenteric artery, and inferior mesenteric vein. A right colectomy was performed with the creation of a double-barrel stoma. His- topathological and immunohistochemical analysis confirmed a diagnosis of desmoid fibromatosis, with nuclear beta- catenin expression. The patient developed a cutaneous mu- cosal fistula, which resolved favorably. A subsequent intesti- nal transit reconstruction was performed without complications.

Discussion

Desmoid tumors, also known as deep fibromatosis, are locally aggressive tumors originating from fibroblasts in musculoaponeurotic tissues. They are non- malignant, incapable of metastasis, but highly invasive local- ly, potentially compressing adjacent structures and causing organ dysfunction. The etiology is uncertain, and these tumors are rare, with an incidence of 2 –4 cases per million people annually, accounting for about 0.03% of all neoplasms. They are more prevalent in adult women. Histologically, they consist of spindle cells forming spiral bundles, and 67 –80% show immunoreactivity to beta-catenin. Clinical manifesta- tions vary depending on the site of involvement. Due to their high recurrence rate and potential invasion of vital structures, management can be challenging. Imaging is critical for diag- nosis, determining lesion size, and assessing anatomical relationships. Surgical intervention is the preferred thera- peutic approach when feasible. Complications may include J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS22 intestinal obstructions, fistula formation, hemorrhages, and intestinal perforations.

Conclusion

This case is remarkable not only for the tumor’s rarity but also for the patient ’s demographic pro file and the extent of the lesion. Regular follow-up is essential given the high likelihood of recurrence. The management of such cases requires specialized diagnostic tools and a well- trained surgical team to ensure optimal treatment and care. Câncer do Cólon/Reto/Ânus Colon/Rectal/Anus Cancer ID – 141718 E-poster NEUROENDOCRINE TUMOR MIMICKING CROHN’S DISEASE: A CASE REPORT Camille Moreira Baptista da Silva1, Beatriz da Costa Rossi Ramos de Carvalho 1, Luna Vitória Gondim Ferreira 1, Igor Torres da Silveira Mendes1, Vanessa Siqueira Reis 2, Marccus Antônio Tolentino de Jesus2, Bruno Augusto Alves Martins2, João Batista de Sousa 1 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil Case Presentation A 43-year-old male patient pre- sented with recurrent episodes of colicky abdominal pain and intermittent abdominal distension over the past four years, initially diagnosed as Crohn ’s disease. He was on prednisone 40 mg/day and azathioprine 100 mg/day, scheduled to begin biological therapy with infliximab. Laboratory tests showed a C -reactive protein level of 2.98 mg/dL and fecal calprotectin of 553 μg/g. Colonoscopy revealed a thickened mucosa in the terminal ileum, with vascular pattern obliteration but no erosions or ulcers. Entero-CT showed focal, asymmetric wall thickening in an ileal loop segment in the right iliac fossa, measuring 5.0 cm, causing angulation of the intestinal seg- ment and significant luminal narrowing. This led to upstream ileal distension with fecaloid material, suggesting partial intestinal obstruction. Prominent mesenteric lymph nodes were noted, the largest measuring 2.0/C2 1.0 cm. A review of CT images raised suspicion of a primary small bowel neoplasm. The patient underwent segmental enterectomy with primary anastomosis without complications. He experienced signi fi- cant clinical improvement, with cessation of prior episodes of partial intestinal obstruction. Histopathological analysis revealed a well-differentiated, low-grade neuroendocrine tumor (NET) of the small intestine, pT2N1, located in the ileum, measuring 2.5 /C2 1.5 cm, invading the muscularis propria, with clear margins and angiolymphatic invasion. Immunohistochemistry showed Ki-67 positivity in 1%.

Discussion

Neuroendocrine tumors (NETs) are rare neoplasms with nonspeci fic presentations and slow growth, often excluded from the initial differential diagnosis. Most NETs of the jejunum and ileum are non-functioning tumors but may exhibit hepatic metastases and carcinoid syndrome. At diagnosis, these tumors are typically >2 cm, involving the muscularis propria with regional lymph node metastases. Clinical manifestations include abdominal pain, intestinal obstruction, diarrhea, weight loss, and bleeding. Surgical intervention remains the treatment of choice whenever feasible.

Conclusion

This case highlights the importance of considering differential diagnoses in patients with suspected Crohn’s disease. In this instance, careful reassessment of the clinical history and complementary examinations was criti- cal in revising the initial diagnosis. Coloproctologia experimental Experimental Coloproctology ID – 141797 E-poster COMBINATION OF LIFT AND FILAC FOR THE TREATMENT OF COMPLEX ANAL FISTULA: CASE REPORT Rejane Corrêa Furtado 1, Ricardo Everton Dias Mont ‘alverne1, Benjamin Ramos de Andrade Júnior1, Tainah Cristina Saboya de Queiroz Colares1, Ramiro Rolim Neto 1, Thiago Costa Maia 1, Gabriel Lopes Ponte Prado 1, Breno Moreira Viana Mendonça Brito1 1Santa Casa da Misericórdia de Fortaleza, Fortaleza, Brasil Case Presentation A 62-year-old male patient with coronary artery disease and hypertension presented with a one-year history of anal discharge. A colonoscopy revealed purulent discharge from an internal opening, prompting a 3D Endoanal Ultrasound, which documented a complex trans- sphincteric anorectal fistula involving 77% of the external anal sphincter. The patient expressed a strong preference for preserving continence and opted for a sphincter-preserving technique. The patient underwent the Ligation of Intersphinc - teric Fistula Tract (LIFT) procedure combined with the FiLaC (Fistula Tract Laser Closure) technique for the external tract. A radial fiber with a 1470-nanometer diode laser was used, delivering energy at 100 joules/cm. The patient experienced an uneventful early postoperative period without complaints. However, on the 30th postoperative day, purulent discharge was noted from the surgical wound, which was managed with oral antibiotics. Currently, the patient is asymptomatic, with complete resolution of the anorectal fistula.

Discussion

Various surgical options are available for treating anorectal fistulas, particularly complex cases where recurrence rates and the risk of postoperative incontinence remain significant challenges. In this context, the increasing interest in novel therapies, such as diode laser application, combined with multiple techniques, represents a promising approach for managing anorectal fistulas while preserving sphincter function. Coloproctologia experimental Experimental coloproctology ID – 138151 E-poster EFFECTS OF PLATELET-RICH FIBRIN APPLIED TO COLORECTAL SUTURES IN RATS Fábio Henrique de Oliveira 1, Guilherme Couto dos Santos 1, Luciana Xavier Pereirq, Fernanda Elias Rabelo, Vinicius Silva Belo, Lucas Silva de Oliveira, Antônio Lacerda- filho 2 1Universidade Federal de São João del-Rei, São João del-Rei, Brasil 2Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

The most feared complication in intes- tinal surgery is anastomotic dehiscence, which is closely J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S23 related to impaired healing and can occur in 2% to 15% of operated patients. This complication is associated with high morbidity and mortality rates, negatively impacts surgical outcomes, increases hospital costs, and worsens the progno- sis in oncological cases. Several factors can in fluence the healing of colonic anastomoses, such as poor nutritional status. The application of biomaterials, such as platelet-rich fibrin (PRF), has been extensively studied due to its significant properties in tissue healing and restoration. The potential beneficial effects of PRF on intestinal healing motivated this study.

Objective

To evaluate the effects of PRF on the healing of intestinal sutures in rats.

Materials and methods

Forty rats were divided into four groups. Two groups were fed a standard diet and considered well-nourished (Groups I and II). The other two groups were fed a cornmeal-based diet, which is low in protein, and considered malnourished (Groups III and IV). All animals underwent cecostomy and cecorrhaphy. Groups II and IV had their sutures overlaid with a human PRF mem- brane. The following parameters were assessed: animal weight, mortality, site of rupture, rupture pressure, collagen concentration, and reticulin concentration at the suture line.

Results

The use of PRF did not in fluence mortality, rupture pressure, or rupture sites in well-nourished animals. In malnourished animals, a signi ficant difference was ob- served in the rupture site (p=0.038) and reticulin concentra- tion (p=0.040) when PRF was used. While no differences were noted in rupture pressures, there was a trend toward in- creased collagen concentration in malnourished animals that received the PRF membrane.

Conclusion

The use of PRF did not influence healing in well-nourished rats. In malnourished animals, its application favored healing and allowed the colonic suture to demon- strate greater resistance than the colonic wall during rupture pressure testing and rupture site evaluation. Coloproctologia experimental Experimental coloproctology ID – 141733 E-poster HIGH-FLOW ILEOSTOMY: WHAT IS THE COST OF CONVENTIONAL TREATMENT (EXCLUSIVE TPN) COMPARED TO DISTAL ENTERAL RENUTRITION WITH PARTIAL PARENTERAL NUTRITION? A CASE REPORT Gian Francisco de Macedo Almeida 1, Ruth Avernias Lopes de Avila2, Rafael Rodrigues Leite 2, David de Faria Soares Rodrigues2, Alexandre Brindeiro de Amorim Filho 2, Háira Delvair Nogueira Ramos 2, Camilla de Sales Brito 2, Karina Queiroz Cruz Almeida 2 1Hospital Universitário Alcides Carneiro, Campina Grande, Brasil 2Universidade Federal de Campina Grande, Campina Grande, Brasil Nutritional management is crucial in surgical patients, especially in cases of complications from high- output enterostomies. Malnutrition and electrolyte imbal- ances are associated with worse prognoses, with direct implications for surgical management. Nutritional interven- tion can be enteral, partial parenteral nutrition (PPN), or total parenteral nutrition (TPN). In cases of high-output enteros- tomies, exclusive TPN may be used. This case describes a 66- year-old patient who underwent rectosigmoidectomy for neoplasia. They developed an abscess and perforation of the small intestine on the 10 th postoperative day (POD), requiring enterectomy, ileostomy, and mucosal fistula. Pro- gressing to high-output enterostomy, unresponsive to clinical treatment, the decision was made to perform ef fluent rein- fusion, along with prehabilitation measures and the use of PPN. In 14 days, the patient was fit for intestinal transit reconstruction, discharged with an exclusive oral diet after 7 days, and achieved normalization of the digestive tract, regaining 10 kg by the 30th POD. The aim is to describe the costs of PPN associated with ef fluent reinfusion versus TPN (hypothetical case). Energy needs were calculated by the nutrition department, prescribing 550 kcal daily via Olimel N4E (approximately 35% of the needs). One bag of Olimel N4E/ day was prescribed for 14 days at a cost of R$ 2,515.38. This supplement is used exclusively for PPN and administered via a peripheral line. Additionally, ascorbic acid (R$1.33) and B complex vitamins (R$2.34) were used daily, totaling R$51.38. These would also be prescribed for TPN. If exclusive TPN were performed, Olimel N7E (R$290.00/unit) and Olimel N9E (R $210.00/unit) would be used. For 1,833 kcal/day, 2 bags/day of TPN would be required. Thus, over 14 days, the cost would be R$8,120.00 with Olimel N7E and R$5,880.00 with Olimel N9E. Additionally, central venous access would be required, cost- ing R$36.89. Therefore, the total cost of PPN was R$2,566.76, while TPN would cost up to R$8,120.00, an increase of 316%. We did not consider the risks and side effects inherent to exclusive TPN, such as electrolyte, glycemic, and immunolog- ical disturbances, as well as the risks of central venous access. Thus, the technique of distal enteral re-nutrition, combined with PPN and prehabilitation measures, allowed reconstruc - tion to be performed in a shorter time and with potentially reduced complications, proving to be a safe and cost-effective procedure. Coloproctologia experimental Experimental coloproctology ID – 141070 E-poster IMPACT OF DISTAL ENTERAL RENUTRITION THERAPY ON WEIGHT GAIN IN A PATIENT WITH HIGH-OUTPUT ILEOSTOMY - A CASE REPORT Gian Francisco de Macedo Almeida 1, David de Faria Soares Rodrigues2, Rafael Rodrigues Leite 2, Alexandre Brindeiro de Amorim Filho 2, Ruth Avernias Lopes de Avila 2, Háira Delvair Nogueira Ramos 2, Camila de Sales Brito 2, Karina Queiroz Cruz Almeida3 1Hospital Universitário Alcides Carneiro, Campina Grande, Brasil 2Universidade Federal de Campina Grande, Campina Grande, Brasil 3Universidade de Pernambuco, Recife, Brasil High-output ileostomies, especially those involving the small intestine, can impair patients ’ quality of life and

Result

in electrolyte disturbances, particularly when they progress to high-output states1,2,3 Thus, intestinal transit reconstruction becomes an alternative to improving these patients’ quality of life and clinical status. However, achieving an optimal nutritional state is essential for surgical treat- ment, as preoperative malnutrition is associated with poorer prognoses and severe postoperative complications4. Preha- bilitation therapies can reduce postoperative complications by up to 50%5, along with other measures. This study aims to report the effect of ileostomy content reinfusion therapy in the preoperative period of intestinal transit reconstruction. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS24 The present work is an analytical case report that seeks to assess the impact of reinfused ileostomy content volume on weight gain in a patient with high-output ileostomy. The analysis was performed using RStudio version 4.4.0, testing the correlation between reinfused volume and weight, and between reinfused volume and BMI, using Pearson ’s correla- tion test. The case involves a 66-year-old male diagnosed with colorectal cancer, initially undergoing rectosigmoidectomy and colectomy of the descending colon. Subsequently, the patient underwent exploratory laparotomy with enterec - tomy, ileostomy, and mucosal fistula creation due to a cavi- tary abscess involving the small intestine. Thirty-two days after the last surgery, the patient returned to the service with malnutrition, accompanied by asthenia, tremors, and anorex- ia. During hospitalization, partial parenteral nutrition was combined with reinfusion of ileostomy content through the mucosal fistula for 14 days. The ileostomy had an output greater than 1000 mL/day. A signi ficant correlation was observed between reinfused volume and weight gain (p- value = 0.01805) and BMI (p-value = 0.01801). Considering the importance of preoperative nutritional therapy in surgi- cal patients, particularly oncological and malnourished indi- viduals, reinfusion therapy proved effective in this case. It facilitated weight gain and allowed for subsequent intestinal transit reconstruction without postoperative complications. Additionally, it reduced the risks and costs associated with prolonged parenteral nutrition, as highlighted in other studies3,4,6. Coloproctologia experimental Experimental coloproctology ID – 138347 E-poster VIDEO-ASSISTED NECROSECTOMY IN OMENTAL NECROSIS – A CASE REPORT Cristina Calloni 1, Bruna Oliveira Trindade 2, Daniel de Barcellos Azambuja2, André Bigolin 2, Fares Hassan Hamaoui 3, Mateus Parisotto3 1Universidade Feevale, Ribeirão Preto, Brasil 2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil 3Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brasil

Introduction

Video-assisted retroperitoneal necrosectomy (VAN) involves the insertion of a drainage tube via a transperitoneal approach to perform lavage and debridement of the necrotic area. This procedure is widely used and established in cases of necrotizing pancreatitis with satisfactory outcomes.

Method

A study based on medical record analysis and literature review aimed at describing a case of omental infarction resolved uniquely by video-assisted necrosectomy. Case Report A 52-year-old male patient with dysli- pidemia presented a single episode of lower gastrointestinal bleeding in December 2023. A computed tomography (CT) scan of the abdomen showed a thickened area in the splenic flexure of the colon with in filtration of adjacent fat, and a colonoscopy with biopsy fragments was performed. The subsequent histopathological report indicated poorly differ- entiated adenocarcinoma. Further staging exams showed no significant changes. In January 2024, the patient underwent robotic left colectomy with satisfactory progress and was discharged on the 3rd postoperative day. However, 8 days later, the patient returned with fever and abdominal pain. New exams revealed ischemia and omental necrosis, initially treated conservatively with antibiotics, followed by CT-guid- ed puncture for the placement of a pigtail drain to evacuate the collection in the necrotic area. After two months of conservative management without complete improvement and the inability to start chemotherapy due to septic con- ditions, the decision was made to perform video-assisted necrosectomy, which resulted in signi ficant improvement and enabled the possibility of chemotherapy.

Discussion

The choice of an additional procedure, in this case, video-assisted debridement, depends on the loca- tion of the collection relative to adjacent organs, availability of methods and technologies, time of presentation, appear- ance of the content, and the patient ’s clinical condition.

Conclusion

VAN proved to be potentially effective and feasible, and it can be implemented in cases of omental necrosis, even though its indication is more firmly estab- lished in pancreatic necrosis. As a minimally invasive proce- dure, it offers rapid recovery, avoids conventional procedures, and allows surgeons who are not fully skilled to achieve clinical resolution with lower risks. Coloproctologia experimental Experimental coloproctology ID – 138158 E-poster AORTIC VASCULAR PROSTHESIS IN ILEOSTOMY RESCUE - PREVENTING REINTERVENTION IN COMPROMISED ABDOMEN: A CASE REPORT Mariana Maiolino de Olival 1, Juliana Chaves Brandão1, Leonardo Machado de Castro1, Rodrigo Rocha Rodrigues1, Camila Tobias Queiroz1, Ana Luiza de Oliveira Nelaton 1, Rodrigo Rego Lins 1, Paulo Cesar de Castro Junior 1 1Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brasil Case Presentation MRHM, 62 years old, female, underwent right colectomy and primary anastomosis in August 2023 due to a colon lesion. She developed an anasto- motic fistula on the 7th postoperative day, requiring reoper- ation and creation of a terminal ileostomy and mucousfistula. In September 2023, an exploratory laparotomy was per- formed due to an intra-abdominal abscess, resulting in a new ileostomy and closure of the mucous fistula. She was transferred to a university hospital in October 2023 for the treatment of persistent abdominal collection, peristomal dermatitis, and infection of surgical wounds. The collection was resolved by radiological intervention; however, the patient progressed with partial collapse of the ileostomy, leading to subcutaneous contamination and a fistula to the surgical wound. An exceptional measure was adopted by attaching an aortic vascular prosthesis to the ileostomy to extend its length and reduce subcutaneous contamination. After 8 days of hospitalization, there was significant improve- ment, and the patient was discharged. Follow-up showed complete wound healing and resolution of dermatitis. In November 2023, the prosthesis was removed, revealing a flat ileostomy, well-fixed to the skin. MRHM is being followed by the proctology team.

Discussion

The creation of ileostomies, although common, can present signi ficant complication rates. Gener- ally performed in complex surgeries or reoperations, various complications are associated with it, with risk factors J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S25 including tensioned tissues, poor vascularization, and im- proper positioning, as well as factors such as obesity and patient malnutrition. These complications directly affect survival and quality of life due to infections, dermatitis, pain, dif ficulty in pouch attachment, prolonged hospitaliza- tions, and others. Even with necessary care, complications may occur, requiring creative management by the surgeon. In the case presented, an uncommon technique proved highly effective, accelerating peristomal healing, reducing local in- fection, and signi ficantly improving the patient ’s quality of life, with reduced pain and pouch change frequency, which was also re flected in her clinical and laboratory improvement. Final Considerations In selected and complex cases of retraction and collapse of stomas, the implementation of a vascular prosthesis can be an interesting alternative measure to optimize pouch attachment and reduce contamination and local dermatitis. Doença Diverticular Diverticular disease ID – 141708 E-poster PROGNOSTIC FACTORS IN COMPLICATED DIVERTICULITIS AT A TEACHING HOSPITAL IN SÃO PAULO Isaac José Felippe Corrêa Neto 1, Gabriela Portal Monteiro 1, Yasmin Góis de Mello1, Laercio Robles1, Allison de Lucena Silva1 1Hospital Santa Marcelina, São Paulo, Brasil

Introduction

Acute diverticulitis (AD) occurs in ap- proximately 15% of individuals with diverticular disease, being more common after the 6th decade of life and in male patients. Around 12% of these patients will present with complicated AD, and the treatment for cases with purulent or fecal peritonitis is typically surgical.

Objective

To evaluate the epidemiological data of patients with complicated acute diverticulitis presenting with purulent and/or fecal peritonitis who underwent surgi- cal treatment at a teaching hospital.

Methods

This is a retrospective, clinical-observation- al study with a quantitative cohort approach, based on the analysis of electronic medical records from a teaching hospi- tal in São Paulo, SP, Brasil.

Results

Eighteen patients with Hinchey 3 and 4 diverticulitis who underwent emergency surgery were ana- lyzed. The overall mean age was 54.9 years (ranging from 24 to 80), with 61.1% being male, and most patients had an ASA 3 anesthetic risk (72.2%). Among those with postoperative complications, the mean age was 58.9 years, and among those without complications, it was 47 years. Fourteen patients (77.7%) had comorbidities, of which 73.3% had Hinchey 3 AD and 100% had Hinchey 4 AD. Thirteen patients (72.2%) had C -Reactive Protein (CRP) levels greater than or equal to 250 mg/dL, and 88.8% showed leukocytosis.

Conclusion

A higher incidence of complicated AD with purulent or fecal peritonitis was observed in older individuals, male patients, those with chronic diseases, those showing signs of peritonitis upon admission physical exami- nation, and those with elevated leukocyte and C -reactive protein levels. Doença Diverticular Diverticular disease ID – 137821 E-poster HOSPITALIZATIONS FOR DIVERTICULAR DISEASE IN BRAZIL BETWEEN 2008 AND 2023: A QUALITATIVE AND QUANTITATIVE ANALYSIS Victor Cordeiro Simão 1, Mylena Santana de Sena Araújo 1, Gabriela Luz Castelo Branco de Souza 1, Nayã Pereira Portilho 2, Arthur Cordeiro Simão 1, Isabely Gelinski 1, Bruna Dell ‘acqua Cassão1, Pedro Eduardo da Costa Galvão 1 1Universidade Federal de Goiás, Goiânia, Brasil 2Pontifícia Universidade Católica de Goiás, Goiânia, Brasil

Introduction

Diverticular disease can become a se- vere condition, responsible for over 24,645 deaths in Brazil between 2008 and 2022. Understanding the pro file of hospi- talization rates within the Uni fied Health System (SUS) for this condition is crucial for assessing its impact and planning healthcare actions.

Objective

To conduct a quantitative and qualitative assessment of hospitalizations for diverticular disease in Brazil during the period from 2008 to 2023.

Methods

A retrospective observational study ana- lyzed the time series of hospitalization rates for Diverticular Disease of the Intestine (ICD-10 K57) in Brazil between 2008 and 2023. Data were obtained from DATASUS, and rates were calculated per 100,000 inhabitants. Trend analysis was con- ducted using segmented linear regression (joinpoint). Meas- ures such as Annual Percent Change (APC) and Average Annual Percent Change (AAPC) were used to evaluate trends over the period, considering 95% Con fidence Intervals (CI).

Results

During the period, 129,512 hospitalizations were identi fied, with 114,648 (88.52%) cases occurring as emergencies. The national hospitalization rate ranged from 2.75 (in 2008) to 5.53 (in 2023). Nationally, there was an increasing trend in hospitalization rates (AAPC 4.72), with higher rates observed in females (AAPC 5.13) and in the 40 – 59 age group (AAPC 3.48). A stationary trend was noted between 2018 and 2021 (APC -1.06; 95% CI: -3.52 to 2.76). The South region showed the highest growth in hospitaliza- tion rates (AAPC 4.88), followed by the Southeast (AAPC 4.42). The North, Northeast, and Central-West regions had higher AAPC values among females. The 40 –59 age group showed the highest AAPC values in the Central-West and Northeast regions and was the only age group with a growing trend in the Central-West. The 20–39 age group had the highest AAPC values in the Southeast and South regions.

Conclusion

The quantitative analysis of hospitaliza- tion data for diverticular disease revealed a growing trend, particularly in emergency admissions. Qualitative analysis highlighted that the increase in hospitalizations was concen- trated among females aged 40 –59 in the southernmost macroeconomic regions. This underscores the urgency of public health policies that address regional and gender- specific dynamics, which are essential for tackling the rise in hospitalizations for diverticular disease in the country. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS26 Doença Diverticular Diverticular disease ID – 141728 E-poster PYODERMA GANGRENOSUM IN DIVERTICULAR DISEASE WITH ACUTE EXACERBATION Heloisa G Mussnich1, Débora Oliveira Hutten1, Déborah Guedes Mussnich1, Jonatas Sthift 1, Denise Pelisolli Fattore 1, Daniela Cerqueira Koppe1, Eliana de Almeida Oliveira 1, Ana Maria S. Garcia1 1Hospital Moinhos de Vento, Porto Alegre, Brasil Case Presentation An 81-year-old female patient with a dermatological diagnosis of pyoderma gangrenosum presented with a skin lesion on the left pre-tibial region. After excluding inflammatory bowel disease (IBD) and malignan- cies, she was treated with immunosuppressive therapy (cor- ticosteroids and mycophenolate) with good disease control. Eight months after the onset of the dermatological condition, the patient developed anemia, elevated C -reactive protein, abdominal pain, and rectal bleeding. Abdominal computed tomography showed marked thickening of the sigmoid, descending colon, and upper rectum walls, with a well- organized thick-walled hydroaerial pelvic collection measur- ing approximately 25.3 cm³. This collection was near the sigmoid colon and demonstrated fistulous tracts originating from the upper rectum and distal sigmoid, converging in the mesorectum. Suspicion of IBD resurfaced, necessitating dif- ferential diagnosis with complicated acute diverticulitis. Clinical optimization was performed, including blood trans- fusion, parenteral nutrition, cessation of immunosuppres- sants, continuation of low-dose corticosteroids, and consultation with a specialized IBD team. After two weeks, the patient underwent laparoscopic rectosigmoidectomy with protective ileostomy. During surgery, the sigmoid colon was found to befirmly adhered to the pelvis, with a contained abscess that released purulent material upon dissection. Two months post-surgery, the ileostomy was reversed without complications, and the histopathological examination of the resected specimen con firmed a diagnosis of colonic divertic - ular disease with acute exudative in flammation (diverticuli- tis), ruling out IBD. The pyoderma lesion completely healed following the second surgery.

Discussion

Pyoderma gangrenosum is an autoim- mune dermatological condition often associated with other autoimmune disorders and malignancies. The patient ’s co- lonic in flammation, abscess, and fistulas raised concerns about a possible association with IBD. However, the manage- ment approach, regardless of etiology, was deemed surgical in this case.

Conclusion

This case report highlights the potential role of chronic in flammatory processes (in this instance, colonic diverticular disease) in perpetuating pyoderma gan- grenosum. The resolution of diverticulitis led to the complete healing of the dermatological lesion, underscoring the im- portance of addressing underlying in flammatory conditions in the management of pyoderma gangrenosum. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141180 E-poster SURGICAL TRAINING IN INFLAMMATORY BOWEL DISEASES: EVALUATION OF SERVICES ACCREDITED BY THE BRAZILIAN SOCIETY OF COLOPROCTOLOGY Daniel de Castilho da Silva 1, Gilmara Pandolfo Zabot, Carlos Henrique Marques dos Santos, Sinara Monica de Oliveira Leite, Juliana Ranalli Rinaldi, Cristina Flores, Abel Botelho Quaresma, Idblan Carvalho de Albuquerque 2 1Hospital Santa Catarina, São Paulo, Brasil 2Hospital Heliópolis, São Paulo, Brasil

Introduction

Surgery plays a crucial role in the treatment of patients diagnosed with in flammatory bowel disease (IBD), even with advancements in pharmacological therapies. However, the training of coloproctology residents in the surgical treatment of IBD patients remains insufficient, highlighting the need for this study.

Objective

To evaluate surgical training in IBD within the services accredited by the Brazilian Society of Coloproc - tology (SBCP). Methodology Final year coloproctology residents completed an electronic questionnaire sent via email. The survey included 28 closed-ended questions designed to as- sess the participants ’ knowledge and practices related to the surgical management of IBD, as well as the pro file of insti- tutions, residents, and faculty members.

Results

The evaluation revealed that, despite an ade- quate number of coloproctology residency programs in Brazil (61 in total), the number of residents and faculty members affiliated with the SBCP as full members and the Brazilian Organization for Crohn ’s Disease and Ulcerative Colitis (GEDIIB) is very limited.

Conclusion

Given the increasing incidence of IBD in Brazil and globally, the findings of this study warrant careful consideration. The results highlight de ficiencies in the surgi- cal training of medical professionals and weak ties with educational organizations specializing in IBD surgical treat- ment. Consequently, graduates from coloproctology residen- cy programs in Brazil demonstrate insuf ficient theoretical and practical, particularly surgical, training for managing these patients. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 137364 E-poster EMERGENCY SURGICAL APPROACH FOR ABDOMINAL TRAUMA IN A PATIENT WITH CROHN ’S DISEASE: CASE REPORT AND LITERATURE REVIEW Giovanna Savoy Pazin 1, Mayara Marina Sousa Senzano 1, Alexandre Foratto 1, Isabella Colombani 1, Claudio Saddy Rodrigues Coy1, Maria de Lourdes Setsuko Ayrizono 1 Gustavo Pereira Fraga1, Raquel Franco Leal 1 1Universidade Estadual de Campinas, Campinas, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S27

Introduction

Crohn’s disease (CD) is a chronic, recur- rent in flammatory condition that primarily affects the gas- trointestinal tract and can present with multiple complications, such as abscesses, fistulas, and perforations. Abdominal blunt trauma can more easily predispose to lacerations and perforations in areas affected by the disease. Case Presentation A 29-year-old male was brought to the emergency department of a tertiary university hospital after a high-impact automobile accident. In the initial treat- ment, a chest drain was performed for right-sided pneumo- thorax, maintaining hemodynamic stability. The patient then underwent a CT scan of the abdomen, revealing pneumo- peritoneum and thickening of the small intestine loops. The patient had a prior diagnosis of Crohn ’s disease with loss of follow-up, along with a history of alcohol and tobacco use. An exploratory laparotomy was indicated, where a jejunal loop perforation and several areas of stenosis and in flammation distal to the perforation were identi fied. A segmental enter- ectomy was performed, and the afferent and efferent loops were buried, with a vacuum peritoneostomy created due to instability. The patient stabilized and underwent reoperation 48 hours later, with an 8 cm enterectomy, creation of a right jejunostomy 1 meter from Treitz ’s angle, and a mucosal fistula on the left with a 2.5 meter distal loop. He was hospitalized for 30 days post-surgery for nutrition and stabi- lization. He underwent surgery for intestinal transit recon- struction by the Coloproctology team, with identification of 8 areas of intestinal stenosis, Meckel ’s diverticulum, and in- flammatory patterns with some areas of remission in the small intestine. Intestinal reconstruction was performed with a manual isoperistaltic side-to-side anastomosis, as well as Heineke-Mikulicz stenoplasties and balloon dilation for some of the stenoses. The postoperative evolution was without complications. After discharge, he continued ambulatory follow-up, remaining asymptomatic, and was reintroduced to immunobiologics for the treatment of Crohn ’s disease.

Conclusion

This is a rare case of blunt abdominal trauma in a patient with Crohn ’s disease. The surgical man- agement of traumatic intestinal injuries in these patients is controversial in literature. Thus, the management of this patient may offer a new perspective on care and attention to minimize the morbidity and mortality associated with these conditions. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138305 E-poster APPROACH TO GIANT CYSTIC LESION IN CROHN ’S DISEASE USING THE MODIFIED KRASKE PROCEDURE Rodolfo Dahlem Melo 1, Cristiane Jacomini 1, Antonio Balestrim Filho1, Vanessa Foresto Machado 1, Rogério Sera fim Parra1, Marley Ribeiro Feitosa 1, Omar Féres 1, José Joaquim Ribeiro da Rocha1 1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil Case Presentation A 45-year-old woman with ileo- colonic Crohn ’s disease for 17 years, using certolizumab (discontinued in fliximab 13 years ago due to anaphylactic reaction), previously underwent multiple abdominal surger- ies due to enteric and colonic fistulas. She presented with a palpable abdominal mass, abdominal pain, and foul-smelling secretion from the anus. An investigation with pelvic MRI revealed an expansive formation of 17 cm extending from the pelvis to the mesogastrium, predominantly to the left, with T2 hypersignal and no post-contrast enhancement, of un- known etiology. Due to a history of previous laparotomies and intestinal fistulas, the decision was made to use the Kraske incision for a transperineal approach to the pelvic lesion under investigation. Intraoperatively, the cystic con- tent was dark liquid, and there was glandular tissue inside, suspected to be ovarian tissue. Cytology of the surgery showed cystic, hemorrhagic, and benign fluid. The patient recovered satisfactorily and was discharged on the second postoperative day. The pathological examination of the lesion revealed ovarian tissue, diagnosing a left ovarian corpus luteum cyst.

Discussion

The perineal approach is an option for retrorectal tumors, low perineal lesions, and cases where conventional laparotomy access is dif ficult. Due to the loca- tion and, primarily, the size of the lesions, some complica- tions from the posterior approach may be observed, such as perforation of the neoplastic lesion, rectal perforation, and vascular and nerve damage. However, this approach has acceptable complication rates, short hospital stays, and quick recovery. The main complications of the approach are rec - tocutaneous fistulas, urinary dysfunction, and neurological issues.

Conclusion

The posterior approach using the modi- fied Kraske procedure can be used for giant pelvic lesions and yields acceptable results, making it a viable option for select- ed patients. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141634 E-poster ADENOCARCINOMA OF THE ILEUM OCCURRING AT THE SITE OF ILEOSTOMY CLOSURE AFTER ILEAL-ANAL POUCH CREATION FOR ULCERATIVE COLITIS Gabriela da Costa 1, Jorge Benjamin Fayad 1, Kelly Cavallini 1, Gabriel Oliveira Septimio 1, Claudia Maria Vale Joaquim Falbo Domingos1, Jayna Martins Neno Rosa 1, Martina Gutierrez Galhardo1 1Hospital Federal de Ipanema, Rio de Janeiro, Brasil Case Presentation A 55-year-old female patient with Idiopathic Ulcerative Colitis (IUC) since 1995. After 15 years of disease and clinical intractability, she underwent total proctocolectomy with ileo-anal pouch formation in three stages. In 2023, after multiple medical consultations over a period of 2 months, she was admitted for hospitalization due to hypogastric pain near the surgical scars, where the skin had a rock-like appearance, associated with fever and nausea. An abdominal CT scan revealed a mixed collection located anteriorly to the pelvis. A pouchoscopy and contrast exami- nation of the pouch showed no abnormalities. Percutaneous drainage of the pelvic collection was performed with a Pigtail catheter, initially draining purulent secretion. She then de- veloped intestinal obstruction and underwent exploratory laparotomy, which identi fied a collection in the abdominal wall, stenosis of the small intestine at the previous ileostomy closure site, fistulized to the abdominal wall, and intense fibrosis. An enterectomy of the previous ileo-ileal anastomo- sis was performed, with primary anastomosis and resection of the entero-cutaneous fistulous tract. Histopathological J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS28 examination diagnosed moderately differentiated adenocar- cinoma in the ileal segment, with perforation into the visceral peritoneum and fistulous tract, invading connective-adipose tissue and skeletal muscle.

Discussion

Among gastrointestinal neoplasms, only 2-3% originate from the small intestine, making them ex- tremely rare. Their diagnosis is often delayed due to nonspe- cific symptoms, presenting as an acute complication. A Canadian study demonstrated that only 16% of small intestine adenocarcinomas occurred in the ileum. A Swedish study analyzed 142,008 patients with In flammatory Bowel Disease (IBD) for the prevalence of small intestine tumors. Of these, 59.8% had Ulcerative Colitis (UC), and only 21 patients presented adenocarcinoma of the small intestine associated with UC. Among the UC patients, it was found that extensive disease had a 2.7 times greater risk of small bowel adenocar- cinoma. The highest risk was among patients diagnosed with IBD before the age of 40, as in the case of the reported patient.

Conclusion

Studies on this subject suffer from biases due to small sample sizes and short follow-up periods. Therefore, case reports are effective for gathering more reliable statistics in the future. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138326 E-poster COLON AGENESIS IN A PATIENT WITH SEVERE PERINEAL CROHN’S DISEASE Eduardo Vidal de Holanda 1, Fernanda Belz dos Santos 1, Guilherme Melchior Maia Lopes 1, Lorena Menezes Gadotti 1, Jaques Waisberg1, Sandra Di Felice Boratto 1, Marcella Conz Rodrigues1, Raphaella Assis Alves Januário 1 1Faculdade de Medicina do ABC, Santo André, Brasil Case Presentation A 30-year-old female was admit- ted to a tertiary hospital with a perianal abscess associated with hyperemia and the discharge of purulent secretion from the vaginal canal. She had a history of Crohn ’s disease, being followed at another service, and had used adalimumab, discontinuing treatment 6 years prior. She also had depres- sion and anxiety. She denied any previous surgeries. Upon examination, there were hardened circumferential plicomas and multiple anorectal and rectovaginal fistulas. The abdo- men was soft and painless, without scars. She was diagnosed with severe perineal abscessed Crohn ’s disease. MRI showed soft tissue edema adjacent to the anal canal, with multiple perianal fistulas, an irregular collection on the right, and a posterior collection extending to the coccyx, maintaining a fistula communicating with the posterior wall of the anal canal. Abdominal and pelvic CT revealed diffuse densification of the perirectal fat, indicating in flammation and infection. She underwent two perineal approaches, with drainage of collections, the largest on the right, and placement of five silicone drains. After resolving the septic condition, she had difficulty healing the surgical wound due to signi ficant fecal incontinence. A decision was made for a diverting transverse colostomy. During surgery, it was found that all colon seg- ments were absent, with the ileum located 270 cm distal to the Treitz angle, medianized at the level of the promontory, and covered with hypertrophic mesenteric tissue. A diverting ileostomy was then performed.

Discussion

Colon agenesis is a rare finding in medical literature, with most reported cases involving newborns with associated gastrointestinal and cardiac malformations. One form of presentation is the “colon pouch syndrome,” charac - terized by the partial or complete replacement of the colon by a dilated terminal ileum, often with an associated urogenital fistula.

Conclusion

The patient described in this case had a prior diagnosis of Crohn ’s disease made at another tertiary center in São Paulo and had previously received immunobio- logical therapy. A complete investigation was assumed to have been done, and the patient con firmed it at the onset of clinical manifestations, but follow-up exams were lost. This case highlights not only the rarity of the disease found but also the unusual age range, the association with in flammato- ry bowel disease, and the diagnostic failure over years of monitoring for Crohn ’s disease. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141693 E-poster ABDOMINOPERINEAL RESECTION OF THE RECTUM WITH ENLARGEMENT IN A CASE OF COMPLEX PERINEAL CROHN ’S DISEASE WITH DELAYED HEALING Rafael Andrade Cruz 1, Vinícius Miranda Baroni 1, Bárbara Máximo Nascimento1, Artur Cury Féres 1, Marley Ribeiro Feitosa1, Rogério Sera fim Parra1, José Joaquim Ribeiro da Rocha1, Omar Féres 1 1Faculdade de Medicina de Ribeirão Preto, São Paulo, Brasil Case Presentation A 26-year-old male patient, diag- nosed with Crohn ’s Disease (Montreal A2L2B3p), presented to the coloproctology outpatient clinic 7 years ago with complaints of perineal pain, colic, and diarrhea with mucus. He was treated with azathioprine, immunobiologics, and multiple perianal surgeries, but did not achieve complete perineal healing. After 5 years of follow-up, he developed rectal stenosis and extensive anal fibrosis with an open and purulent wound. Abdominoperineal resection of the rectum was indicated. Postoperatively, the patient had delayed and inefficient healing of the perineal wound, largely due to his systemic conditions, especially nutritional issues. He under- went 35 sessions of hyperbaric oxygen therapy (HBOT), resulting in partial healing. During this period, the disease recurred in the transverse colon, leading to another colec - tomy with terminal ileostomy and perineal resuture. An additional 14 sessions of HBOT were performed, with good healing and disease control. After healing, the patient gained 33 kg in weight over 6 months.

Discussion

Crohn’s Disease affects various regions of the gastrointestinal tract, but the most challenging compli- cations arise when it involves the perianal region. Despite various adjunctive treatments and local surgical interven- tions, there is a signi ficant risk of developing irreversible anorectal fibrosis and subsequent rectal amputation, which can occur in up to 15% of patients, as seen in this case. What stood out the most, however, was the prolonged and ineffec - tive healing of the postoperative wound due to the patient ’s malnutrition, requiring a total of 49 HBOT sessions, as well as the recurrence of the disease and the need for another colectomy. This was a high-complexity case that ultimately J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S29 resulted in satisfactory outcomes and improved the patient ’s quality of life.

Conclusion

This case illustrates the most challenging complications of Crohn ’s Disease in its perianal form and emphasizes the importance of continuous monitoring and frequent adjustments in the therapeutic plan, adapting to the disease’s progression and the patient’s individual response to treatment. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138191 E-poster ABDOMINOPERINEAL AMPUTATION DUE TO CROHN ’S DISEASE: CASE SERIES Bárbara Máximo Nascimento 1, Maria Eduarda Pequeno da Costa Reis1, Bárbara Neuber Fonseca 1, Artur Cury Féres 1, Marley Ribeiro Feitosa 1, Rogério Sera fim Parra1, José Joaquim Ribeiro da Rocha 1, Omar Féres 1 1Faculdade de Medicina de Ribeirão Preto, São Paulo, Brasil

Introduction

Crohn’s Disease (CD) affects various regions of the gastrointestinal tract. The most challenging complications occur when CD affects the perianal region, which is associated with a reduced quality of life for the patient. Although there are different treatments, there is a significant risk of progression to irreversible anorectal fibro- sis and consequent abdominoperineal amputation (AP), which can occur in up to 15% of cases.

Objective

To analyze the prevalence and clinical- laboratory characteristics related to perianal CD in patients undergoing AP in a public tertiary hospital service, as well as to understand the postoperative evolution and complications of these patients.

Methods

This is a retrospective study of data collect- ed from medical records of patients who underwent AP between 2000 and 2024 due to perianal CD. The Chi-square test was used to analyze the heterogeneity of frequency distribution in the studied cohort.

Results

In the analyzed period, considering all patients who underwent AP (n=479), it was observed that only 3.96% (19 patients) were due to Crohn ’s disease. Among them, the majority were female (63.2%), with a mean age of 39 /C6 11.3 years and a mean BMI of 23.7 /C6 5.1 when undergo- ing total proctectomy. The average time interval from diag- nosis to amputation was 13.8 /C6 6.7 years. Only one patient had never undergone surgery, and all others had previous perianal interventions, with fistulotomy (77.7%) being the most frequent. Of the total, 73.7% already had a prior ostomy. Only one death was associated with the procedure, and in 3 cases, malignancy was found in the surgical specimen. Com- paratively, it was observed that the presence of anemia and hypoalbuminemia did not affect the complication rates. There was no statistical difference in complication rates in patients using corticosteroids (0% vs. 47.1%; p=0.48), azathi- oprine (33.3% vs. 43.8%; p=1.00), and immunobiologics (45.5% vs. 37.5%; p=1.00). Similarly, no differences were observed in patients who had been previously ostomized (42.9% vs. 40.0%; p=1.00).

Conclusion

Despite therapeutic advances in CD, perianal involvement with consequent amputation remains an important outcome in the disease ’s progression. Although delayed by other therapeutic alternatives, it still occurs early and involves factors related to both the patient’s prior history and postoperative factors, which were analyzed in this study. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141296 E-poster EPIDEMIOLOGICAL ANALYSIS OF HOSPITALIZATIONS FOR CROHN’S DISEASE AND ULCERATIVE COLITIS IN THE GERIATRIC POPULATION: A BRAZILIAN OVERVIEW OF THE LAST DECADE Gustavo Hayasaki Vieira1, Milena Almeida Barbosa1, Giovana de Oliveira Araújo1, Rafaella Rodrigues de Freitas Vieira 1, Isabela Maciel Mesquita1, Samira Dionísio Maia 1, Valentina Melo Rosa Centofanti1, Gustavo Cartaxo de Sousa Melo 1 1Pontifícia Universidade Católica de Goiás, Goiânia, Brazil

Introduction

Inflammatory bowel diseases (IBD), including Crohn ’s disease (CD) and ulcerative colitis (UC), are conditions that cause signs such as in flammation of the gastrointestinal tract and abdominal pain. CD predominates between the ages of 15-35 and, secondarily, among the elderly. Thus, considering the IBD incidence in the geriatric population and the lack of studies for this age group in Brazil, it is essential to conduct an epidemiological analysis of this group.

Objective

To analyze the epidemiological pro file of hospitalizations of elderly Brazilian patients for Crohn ’s dis- ease and ulcerative colitis between 2013 and 2023.

Method

This is a descriptive, retrospective, and quan- titative study based on the Hospital Information System (SIH/ SUS), through the Department of Information and Informatics of the Unified Health System (DATASUS), referring to Crohn’s disease and ulcerative colitis over the last ten years, for patients in Brazil. The filters used were ICD-10 morbidity list (Crohn ’s disease and ulcerative colitis), hospitalizations, race/ethnicity, gender, age group, average hospital stay, avail- able period (January 2013 to December 2023), and processing year. The data were tabulated in Excel and analyzed using R 4.40 software with RStudio 2024.04.1 þ 748. The study adheres to the ethical guidelines of Resolution 466/12 from the National Health Council.

Results

The total number of hospitalizations in these ten years was 10,034. The Southeast region led the number of hospitalizations (50.6%), while the North region had the lowest number (4.5%). The age group with the most hospital- izations was 60-69 years (51.3%) and was mostly urgent (83.2%). The female sex was more affected (57.3%), and the predominant ethnicity was white, with 45.7% of the total. The data indicate an increase in hospitalizations for CD over the years, with 2023 having the most hospitalizations (n¼1,290), while the lowest record was in 2013 (n ¼70). The Northeast region had the highest average length of hospital stay (n ¼8).

Conclusion

The results highlight the importance of public health strategies for early diagnosis and effective management of CD and UC, aiming to reduce emergency hospitalizations and improve the quality of life for geriatric patients. Additionally, the regional variation in hospitaliza- tions and length of stay suggests that health policies tailored to local speci fics are vital to addressing the challenges presented by the disease in Brazil. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS30 Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141078 E-poster RARE PRESENTATION OF CROHN ’S DISEASE: CUTANEOUS METASTASIS Camila Vieira Chiquetti 1, Giulia Candida Ribeiro Garnes 2, Bárbara Érnica Zeferino 1, Carlos Henrique Marques dos Santos1, Carlos Otavio da Silva Ribeiro 1, Odinilson Almeida Fonseca1, Luiz Carlos Takita 2 1Hospital Regional do Mato Grosso do Sul, Campo Grande, Brasil 2Universidade Estadual do Mato Grosso do Sul, Campo Grande, Brasil Case Presentation A 23-year-old male patient, diag- nosed with Crohn ’s Disease six years ago, presented with perianal fistulas confirmed by colonoscopy and histopathol- ogy. He was treated with infliximab and azathioprine, achiev- ing partial improvement with incomplete healing. After one year, his treatment was optimized due to worsening perianal lesions, including anal fissures, ulcerated perianal lesions, and fistulous openings, consistent with perianal Crohn ’s Disease. He developed ulcerated lesions in the intergluteal fold, bilateral inguinal folds, and scars from external perianal orifices, requiring debridement and hyperbaric oxygen ther- apy. The patient underwent 26 sessions of hyperbaric oxygen therapy over two months, showing improvement but no complete healing, leading him to discontinue due to costs. He had a partial response to other therapies, needing cortico- steroids for stabilization. One year later, he was hospitalized with abscesses and ulcerated lesions in the perianal, penile, and inguinal regions (Figure 1). He underwent drainage and biopsy, which showed epithelioid granulomas, Langhans- type giant cells, and microabscesses in glandular crypts, indicating active Crohn ’s Disease and metastatic Crohn ’s (Figure 2). Due to treatment refractoriness, hyperbaric oxy- gen therapy and biologic therapy (in fliximab plus ustekinu- mab) were indicated. The patient showed improvement in the lesions, weight gain, and quality of life, though complete healing had not yet occurred at follow-up (Figure 3).

Discussion

Metastatic Crohn ’s Disease is character- ized by granulomatous skin lesions with histology similar to intestinal tissue. Its pathophysiology is not well understood, but studies suggest a correlation between abnormal T-cell responses in the intestinal mucosa that migrate to the skin as the disease progresses, leading to exposure to skin antigens and lesion formation. Due to its rarity, treatment requires a complex approach depending on the severity, generally involving high-dose steroids, followed by anti-TNF inhibitors like infliximab, and in refractory cases, therapy optimization with ustekinumab and hyperbaric oxygen therapy. In this case, a combination of two biologics was used, an off-label therapy, which yielded satisfactory results for the patient.

Conclusion

Metastatic Crohn ’s Disease is a rare and severe condition requiring prompt intervention and ongoing studies on treatments and their effectiveness. Thus, case descriptions, outcomes, and the applicability of therapeutic approaches are of paramount importance. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 137921 E-poster ASSESSMENT OF QUALITY OF LIFE IN PATIENTS WITH ULCERATIVE COLITIS UNDERGOING TOTAL PROCTOCOLECTOMY WITH ILEAL RESERVOIR: A CROSS- SECTIONAL COHORT STUDY IN A BRAZILIAN REFERRAL CENTER Israel Geraldo Silva 1, Sandro da Costa Ferreira 1, Cintia Maura Caseiro Nigro1, Omar Féres 1, Marley Ribeiro Feitosa 1, José Joaquim Ribeiro da Rocha 1, Rogerio Sera fim Parra1 1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

Introduction

and Objectives Restorative proctoco- lectomy with ileoanal anastomosis (IPAA) is the procedure of choice when colectomy is necessary for ulcerative colitis (UC) refractory to medical treatments. However, IPAA may be associated with signi ficant morbidity and impact on the patient’s quality of life (QoL). This study aimed to report QoL, long-term satisfaction with surgery, and post-IPAA functional outcomes in a referral center for In flammatory Bowel Diseases (IBD) in Brazil.

Methods

A standardized questionnaire was adminis- tered to patients with UC who underwent IPAA surgery from March to August 2023, assessing QoL and bowel function. Parameters included daily bowel movements, fecal inconti- nence, diaper dependency, use of antidiarrheal medications, fecal urgency, social limitations, fatigue, impact on sexual life, and work capacity.

Results

Twenty-eight patients completed the ques- tionnaires (female, n=19, 67.9%, average age 44.8/C6 10.2 years). Patients reported an average of 6.0 /C6 1.8 bowel movements per day, with 27 (96.4%) experiencing diarrhea. Diapers were not required in most cases (22, 78.6%), with nocturnal bowel movements reported by most (24, 85.7%). Fecal urgency was common (17, 60.7%), with 21 patients (75%) requiring antidi- arrheal medication. After surgery, patients reported fatigue (27, 96.4%), impact on sexual life (18, 64.3%), social and work challenges (22, 78.6%), and embarrassment about their health condition (21, 75%). Overall, 22 patients (78.6%) were satis- fied with the procedure.

Conclusion

Despite high long-term satisfaction with IPAA, patients experienced negative effects on bowel habits and QoL. Thesefindings may inform strategies to improve QoL for future IPAA patients. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141700 E-poster BACTERIOPHAGES IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASE Matheus Amorim Grigorio 1, Raphael Vinicius Mendes Abreu 1, Sacha da Silva Faria 2, Luiza Camapum Fernandes Ribeiro 2, Ana Julia Faria Ramos 3, Lucas Adati Taira 1, Leandro Adati Taira 4, Eduardo Henrique Lacoski Santos 5 1Centro Universitário do Planalto Central Apparecido dos Santos, Brasília, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S31 2Universidade Evangélica de Goiás, Anápolis, Brasil 3IMEPAC, Araguari, Brasil 4Centro Universitário Presidente Antônio Carlos, Juiz de Fora, Brasil 5Pontifícia Universidade Católica, Curitiba, Brasil

Introduction

Inflammatory Bowel Disease (IBD) is a chronic condition with increasing incidence, caused by the interaction of environmental, genetic, and immunological factors, resulting in persistent in flammation in the intestine. Intestinal dysbiosis, an imbalance in the microbiota, is fre- quently associated with the development and worsening of IBD symptoms. Current therapies, such as aminosalicylates and immunosuppressants, may have side effects and are not always effective for all patients.

Objective

This scoping review aims to summarize scientific evidence on the use of bacteriophages, viruses that infect speci fic bacteria, as a promising therapeutic alternative in the treatment of IBD. Methodology A scoping review was conducted to map and summarize the existing knowledge on the use of bacteriophages in IBD. The search covered the SciELO and PubMed databases, using the descriptors “bacteriophage” and “inflammatory bowel disease ” in combination with the Boolean operator “AND.” The search period covered 2018 to 2023, including articles published in Portuguese and English. The selection of studies was based on relevance to the topic and methodological quality, prioritizing original articles, systematic reviews, and case studies.

Discussion

The research revealed the potential of bacteriophages in controlling intestinal dysbiosis, modulat- ing the microbiota, and reducing inflammation. The ability of bacteriophages to target drug-resistant bacteria makes them an attractive alternative in the context of increasing antimi- crobial resistance. Additionally, bacteriophage therapy appears to be a personalized and controlled option, with promising results in preliminary studies. The safety and efficacy of bacteriophages have been demonstrated in various areas, such as food safety and animal health, reinforcing their therapeutic potential in IBD.

Conclusion

The use of bacteriophages in the treat- ment of IBD emerges as a promising alternative, with the potential to control intestinal dysbiosis, reduce in flamma- tion, and improve patients’ quality of life. Continued research in this area is essential to establish effective and safe treat- ment protocols, opening new perspectives for IBD management. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141679 E-poster LATE PATHOLOGICAL DISTENSION OF ILEAL POUCH: CASE REPORT Bruna Bueno Biondi 1, Daniel Teixeira de Alencar 1, Magaly Gemio Teixeira1 1Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brasil Male patient, 48 years old, with severe universal ulcerative colitis. Symptoms began in 1994. Due to clinical intractability, the patient underwent total proctocolectomy with ileal pouch and loop ileostomy in 2007, with closure of the ileostomy in the same year. In 2009, the patient developed anal stenosis and underwent surgical dilation. In the same year, he had an episode of subocclusion and underwent exploratory laparotomy for adhesiolysis. In 2017, the patient developed a perianal fistula but refused surgical treatment. Biologic therapy with Adalimumab was started. In 2021, intestinal transit showed a normal-appearing ileal pouch. In 2023, the patient reported mild abdominal distension and a sensation of fullness, with an average of 2 bowel movements per day. An enteric MRI was performed, showing an increase in the ileal pouch with proximal dilation, without any ob- structive factors. The patient developed a symptomatic inci- sional hernia. During the intraoperative procedure, prolapsed dilated small bowel loops were identified. The ileal pouch was large (40 /C2 20 cm), with proximal dilation and no points of obstruction. The intraoperative proctological examination showed adequately patent pouch-anal anastomosis. As no obstruction points were identi fied, only the pouch was emptied, and the incisional hernia was corrected. No justi fi- cation for the late pathological dilation of the ileal pouch was found. There was no relation to the anal pouch-anastomosis stenosis, as it occurred 15 years earlier and was resolved. The imaging exam in 2021 showed a normal pouch. In 2023, the patient presented frustrating symptoms, leading to an imag- ing exam that already demonstrated pouch dilation, and due to improvement with symptomatic treatment, no interven- tion was made. It was not possible to diagnose what caused the dilation, and there was no consensus on the approach, as despite the dilation, the patient remained oligossympto- matic. Over the years, during the late follow-up of patients with ileal pouches, more frequent complications such as pouchitis and less frequent ones such as total ileal pouch prolapse, fecaloma with the need for emptying, and now identified pathological dilation of the pouch, have been recognized. No reports of ileal pouch dilation without ob- structive factors were found in the literature. Even after years of satisfactory evolution in these patients, attention must be given to these rare and late complications. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138359 E-poster ABSCESSED DIVERTICULITIS AS A DIFFERENTIAL DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE – CASE REPORT Cristina Calloni 1, Daniel de Barcellos Azambuja 2, Vivian Koch 3 1Universidade Feevale, Ribeirão Preto, Brasil 2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil 3Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brasil Inflammatory bowel disease (IBD) is characterized by episodes of inflammation in the gastrointestinal tract caused by an abnormal immune response to the micro flora, with Crohn’s Disease (CD) and Ulcerative Colitis (UC) being the main representatives. This study is based on medical record analysis and a literature review. A 68-year-old female patient, with a previous history of obesity, was hospitalized in 2021 due to an episode of intestinal bleeding. She underwent a colonoscopy, which showed luminal stenosis of the sigmoid colon with inability to progress endoscopically, in addition to inflammatory characteristics, leading to a diagnosis of UC. After the investigation, treatment with In fliximab (IFX) com- bined with Azathioprine (AZA) was started, but the response and disease control were inadequate, prompting J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS32 optimization of the IFX therapy. However, the stenosis per- sisted in follow-up exams performed in 2022 and 2023. In 2024, surgical management of the lesion was chosen after considering the possibility of neoplastic involvement, al- though the prolonged course of the disease was not sugges- tive of malignancy. The resected specimen was sent to pathology and diagnosed with an abscessed diverticulitis, an unexpected finding. Diverticular disease can present significant complications, such as in flammation (diverticuli- tis), abscesses, fistulas, and thickening, conditions that may also resemble a presentation of IBD. Therefore, surgical choice, both for diagnostic con firmation and therapy, should be individualized. Around 3% to 10% of patients with colon inflammation exhibit overlapping clinical and pathological features, making differentiation dif ficult, and approximately 10% of patients initially diagnosed with IBD (either CD or UC) may have their diagnosis changed upon re-evaluation. The discussed finding highlights not only the heterogeneity of these diseases but also the challenge of determining their diagnoses correctly. In this context, systematic monitoring is essential to prevent the condition from remaining undeter- mined, impacting the quality of life of patients and reducing their complications. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141713 E-poster COMPLICATED COLONIC CROHN ’S DISEASE WITH INTRA- ABDOMINAL HYPERTENSION AND TOXIC MEGACOLON WITH SIGMOIDOSTOMY AS A COLON PRESERVATION STRATEGY: A CASE REPORT Jordana Martins Américo de Souza 1, Gersino Perin Ribeiro 1, Jean Luca Alves 1, João Paulo Slongo 1, Jackeline Kalinoski 1, Taiane Costa Santana 1, Daniele Ximenez 1, André Pereira Westphalen1 1Hospital Universitário do Oeste do Paraná, Cascavel, Brasil Case Presentation A 40-year-old male patient, diag- nosed with Crohn ’s Disease (CD) 6 years ago, Harvey Brad- shaw Index (HBI - 8), was hospitalized due to hypersensitivity to the infusion of in fliximab after the second dose of the induction phase, presenting with rash, tachycardia, and fever, requiring intensive care unit admission. Managed with anti- biotic therapy and corticosteroids, the patient developed progressive abdominal distention due to toxic megacolon (TM) and was referred for surgical intervention due to compartment syndrome and failure of decompressing colo- noscopy. The first approach involved exploratory laparotomy and Barker peritoneostomy. The patient was re-operated on three days later for abdominal wall closure and a loop sigmoidostomy. The first dose of adalimumab was adminis- tered five days after the procedure, with clinical improve- ment and disease control, continuing with outpatient follow- up and no further hospitalizations.

Discussion

TM is the dilation of part or the entire colon ( > 6 cm), accompanied by toxemia, manifesting as abdominal distension, pain, and signs of sepsis. It is one of the most feared complications of ulcerative colitis and can also occur in CD. It has high mortality rates, particularly when it culminates in compartment syndrome, and surgical treat- ment with partial or total colectomy is the treatment of choice. Colectomy is the resection of a segment or the entire colon, indicated in various pathologies but considered espe- cially in emergencies, as a surgery with high morbidity and mortality. It can be associated with complications such as fistulas, bleeding, strictures, malabsorption syndromes, and increased hospitalization time. Loop sigmoidostomy involves opening a region of the sigmoid colon and exteriorizing it through the abdominal wall, decompressing the colon and preserving the segment, with the possibility of later assessing intestinal reconstruction. Following surgical intervention, clinical treatment with biologics should be associated to control the underlying disease.

Conclusion

In this case, loop sigmoidostomy was chosen as the treatment for TM to decompress the segment without resecting it, as a strategy for intestinal preservation and lower morbidity and mortality. The prior creation of peritoneostomy to resolve compartment syndrome, com- bined with clinical treatment with adalimumab, contributed to the success of the treatment, with no decompensations or complications from CD or new hypersensitivity reactions. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141721 E-poster CROHN’S DISEASE AND CUTANEOUS FISTULA: CASE REPORT Roberta Oliveira Raimundo Borsato 1, Tales Alvarenga Lopes e Silva2, Daniella Coelho Vandanezi Sobreira 2, Marina Tambasco Freire Vicente1, Ludymilla Ribeiro Bordoni de Oliveira 1, Alexandre Siles Vargas Júnior 1, Debora Francielle Dias 1 1Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil 2Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil Case Presentation A 62-year-old woman presented with purulent secretion from a spontaneous opening in the right iliac fossa (RIF) for the past 3 months, associated with fever episodes, refractory to antimicrobial therapy. She had a history of right ileocolectomy 28 years ago for the treatment of an enterocutaneous fistula, at which time she was diag- nosed with Crohn ’s disease (CD). She was on vedolizumab treatment. Abdominal enterography revealed a posterolater- al enterocutaneous fistula near the iliac portion of the iliopsoas muscle. After adequate nutritional support and correction of anemia, the patient underwent exploratory laparotomy – multiple adhesions and blocked perforation of the sigmoid colon, firmly adhered to the retroperitoneum on the right side, where an abscess adjacent to the psoas muscle was found, with a fistulous tract leading to the abdominal wall. A Hartmann ’s sigmoidectomy and abdomi- nal cavity drainage were performed. The postoperative peri- od was uneventful.

Discussion

CD can affect any part of the gastrointes- tinal tract (GIT), manifesting with in flammatory, stenosing, or penetrating phenotypes. Around 14% to 26% of patients develop fistulous processes. Of these, 24% will develop enter- enteric or enterocolonic fistulas, and only 6% will develop enterocutaneous or colocutaneous fistulas. The occurrence of two or more fistulas happens in less than one-third of cases and indicates severe CD. Fistula diagnosis requires contrast- enhanced imaging for better anatomical definition. The treat- ment of CD with the penetrating phenotype requires a multidisciplinary approach that integrates pharmacological and, sometimes, surgical therapies, along with nutritional J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S33 support. The goal is to control in flammation, promote heal- ing, and prevent sepsis, which is the main factor associated with morbidity and mortality. The treatment of immunolog- ical dysregulation includes biologic drugs, immunosuppres- sors, and corticosteroids. In the case of enterocutaneous or colocutaneous fistulas, surgical intervention is performed in 75% to 85% of cases and aims to restore GIT continuity, ensure proper coverage of the soft tissues surrounding the intra- abdominal content, and close the external opening. Intestinal loop fistulas are treated surgically only if symptomatic, which occurs in about 6% of cases.

Conclusion

This case illustrates the complexity of managing fistulas associated with CD, highlighting the need for a personalized multidisciplinary approach, especial- ly in patients with severe disease. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141677 E-poster CROHN’S DISEASE IN A FEMALE PATIENT: CASE REPORT Maria Fernanda Almeida Miranda 1, Vinícius da Cruz Silva 1, Gustavo Lima Guilherme 1, Camila Alves dos Santos 1, Letícia Ruth Valente de Oliveira 1, João Lopes 1, Mateus Silva Campos 1, Jacqueline Jessica de Marchi 1 1Universidade Federal do Mato Grosso, Cuiabá, Brasil Case Presentation A 45-year-old woman with a history of tuberculosis, endometriosis, and stroke, diagnosed with Crohn ’s Disease (CD) since 1998. Previous treatments included corticosteroids, 5-aminosalicylic acid, in fliximab, azathioprine, adalimumab, and 70 sessions of hyperbaric oxygen therapy. After 25 years of treatment, total proctoco- lectomy and terminal ileostomy were performed, with peria- nal complications and colon stenosis. In 2020, intravenous vedolizumab was chosen due to its selective action and safety, achieving remission of the disease. In 2024, the patient switched to the subcutaneous form of vedolizumab, present- ing with occult blood in the stool, bleeding from the ileos- tomy, pain, and abdominal distension. Ferripoly maltose and carboxymaltose iron were administered, and an enteroradi- ology scan revealed segmental wall thickening of the ileum near the gallbladder with partial stenosis, as well as in the right iliac fossa with signi ficant stenosis. The patient was returned to intravenous vedolizumab, and the disease en- tered latency again.

Discussion

CD affects 3 out of 100,000 people, pri- marily between the second and third decades of life. It is a chronic inflammation that can affect any part of the gastro- intestinal tract, with a higher frequency in the ileum, colon, and perianal region. Diagnosis involves clinical, laboratory, radiological, histopathological, and endoscopic data. The anatomopathological analysis may reveal segmental or skip lesions, deep ulcers, stenotic areas, and fistulas. Treatment is based on the disease activity phase, location, medications already used, and adverse effects. In severe cases, both surgical and pharmacological treatments are used, as in the case described, including terminal ileostomy, total proctoco- lectomy, and vedolizumab. The vedolizumab protocol begins with an intravenous induction phase, followed by intrave- nous or subcutaneous maintenance. Currently, there is insuf- ficient data to determine if dose escalation bene fits patients with a diminished response in subcutaneous maintenance, which is why induction and maintenance are indicated intravenously. Final Comments CD is a chronic disorder that causes significant morbidity, presenting in a variable manner with periods of activity and remission. Surgical intervention may be a therapeutic option but does not result in a cure. Therefore, longitudinal monitoring of CD patients is essential to adjust treatment as the disease progresses and to improve prognosis. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141630 E-poster PERIANAL FISTULIZING CROHN ’S DISEASE IN REMISSION: WHAT HAPPENS TO THE FISTULA AFTER REMOVAL OF THE SETON? Idblan Carvalho de Albuquerque 1, Iana Faine Saran 1, Bruna Meirelles Carregaro 1, Janaina Giotti 1, Andre Luigi Pincinato 1, Fernanda Bellotti Formiga 1, Pedro Piassaroli de Abreu 1 1Hospital Heliópolis, São Paulo, Brasil

Introduction

The surgical treatment of perianal fis- tulizing Crohn’s disease (PCD) initially involves abscess drain- age, seton placement, and in very severe cases, intestinal diversion. After scheduled surgeries to control the damage in conjunction with biological therapy, and in the presence of perianal remission, the surgical team may perform proce- dures such as fistulotomy, mucosal advancement, LIFT, or VAFT with the goal of treating the fistula. In this context, removal of the seton without any definitive treatment may be a therapeutic option.

Objective

To evaluate the evolution of the anorectal fistula in fistulizing Crohn’s disease after seton removal.

Method

This study was conducted through a review of medical records containing information about seton re- moval during the last surgery for the treatment of PCD between 12/2021 and 03/2024. The demographic data stud- ied included age, sex, and Montreal classi fication. The num- ber of surgical procedures up to the surgery for seton removal was quanti fied. Patients with fistulas of other etiologies or those lost to follow-up were excluded.

Results

During the study period, 47 patients were operated on due to PCD, of which 19 underwent seton removal and curettage of the fistula tract. The average age was 32 years, with a predominance of male patients (58%). Patients underwent an average of three surgical procedures (ranging from two to seven) from seton placement to remov- al. The average duration of seton placement was 13.6 months (ranging from two to 36 months). The majority of patients (13) had only one fistula tract. Fistula obliteration occurred in 69%, while 21% showed an epithelialized and asymptomatic fistula. Recurrence of in flammatory activity in the fistula tract was diagnosed in 10% of patients within six months of seton removal.

Conclusion

In this study, seton removal was effective, allowing fistula tract obliteration in 69% of patients. Only 10% of patients showed recurrence of inflammatory activity in the fistula tract within six months after the seton removal surgery. This is considered an appropriate therapeutic option for patients who have achieved perianal remission. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS34 Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141685 E-poster INFLAMMATORY BOWEL DISEASE IN THE ELDERLY: CLINICAL ASPECTS AND EPIDEMIOLOGY Sandro da Costa Ferreira 1, Rogerio Sera fim Parra1, Lílian Rose Otoboni Aprile1, Juarez Roberto de Oliveira Vasconcelos1, Artur Cury Féres1, Omar Féres1, José Joaquim Ribeiro da Rocha 1, Luiz Ernesto de Almeida Troncon 1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

Introduction

Inflammatory bowel disease (IBD) is generally associated with young adults. However, a signi fi- cant proportion of new IBD cases are diagnosed in older individuals as the incidence of IBD increases and our popula- tion ages. Older patients with IBD comprise two groups: those with a new diagnosis (late-onset IBD > 60 years) and patients with juvenile or adult-onset IBD who have reached advanced age. Older patients with IBD present a signi ficant challenge due to the limited speci fic studies and character- istics inherent to this population, such as polypharmacy, comorbidities, and frailty.

Objectives

To evaluate the clinical and epidemiologi- cal aspects of patients with late-onset IBD in comparison to patients diagnosed at younger ages ( <60 years).

Methods

A retrospective analysis of data from patients with late-onset IBD and younger-onset IBD, randomized in a 1:2 ratio based on sex, disease location, and phenotype of Crohn’s disease (CD) and ulcerative colitis (UC), and year of diagnosis, followed from January 2001 to December 2021. Disease severity, therapies, clinical and endoscopic remission, surgeries, comorbidities, and deaths were assessed.

Results

A total of 63 patients with late-onset IBD (57.1% female, mean age: 72.00 /C6 6.4 years, 52.4% UC) were included. Lower use of immunomodulators [CD (36.7% vs. 70.0%; p=0.0020), UC (15.2% vs. 45.6%; p=0.003)] and biologi- cal agents [CD (50.0% vs. 75.0%; p=0.020), UC (12.1% vs. 33.8%; p=0.003)] was signi ficantly observed in patients with late- onset IBD compared to those with younger-onset IBD. Greater disease severity was observed in patients with CD diagnosed at younger ages (66.7%; p=0.006). Higher frequency of comor- bidities (92.06% vs 31.25%; p <0.0001) and deaths (7.9% vs 0.7%; p=0.0015) were observed in patients with late-onset IBD compared to those with younger-onset IBD. No significant differences were observed regarding clinical and endoscopic remission, use of corticosteroids and aminosalicylates, and surgery (p >0.05).

Conclusion

Older patients with IBD have substantial comorbidities, higher mortality, and lower use of immuno- modulators and biological agents compared to younger patients with IBD. Further studies in this speci fic population are needed. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 133370 E-poster EFFECT OF RVD2 ON EXPERIMENTAL COLITIS IS ASSOCIATED WITH THE ACTIVATION OF THE ANTI-INFLAMMATORY CYTOKINE IL10 Lívia Bitencourt Pascoal 1, Fábio Henrique Mendonça Chaim 1, Bruna Biazon Palma 1, Bruno Lima Rodrigues 1, Marina Moreira de Castro1, Luiz Roberto Lopes 1, João José Fagundes 1, Raquel Franco Leal1 1Universidade Estadual de Campinas, Campinas, Brasil

Introduction

New therapeutic strategies targeting the inflammatory process are being proposed for in flamma- tory bowel diseases (IBD), as clinical failure remains a chal- lenge in managing these patients. Recent studies have highlighted the role of specialized pro-resolving lipid medi- ators (SPMs) in the active resolution of chronic inflammation. This study aimed to investigate how the effect of Resolvin D2 (RvD2) on dextran sodium sulfate (DSS)-induced experimen- tal colitis occurs.

Method

An experimental model was conducted using male C57BL/6J mice and IL10 knockout (KO) animals. Follow- ing the induction of DSS-induced experimental colitis, ani- mals were subdivided and treated with RvD2 or anti-TNF α. The metabolic phenotype and in flammatory profile of these animals were assessed through real-time PCR, ELISA, CBA multiplex, and histology. The study was approved by the Animal Use Ethics Committee.

Results

A reduction in colon length and progressive weight loss were observed in the IL10 KO groups with DSS- induced experimental colitis (p < 0.0001) and in the IL10 KO group with DSS-induced experimental colitis treated with RvD2 (p < 0.0001) compared to the non-colitic IL10 KO group. IL10 KO mice with DSS-induced experimental colitis and IL10 KO mice treated with RvD2 developed severe colitis charac - terized by weight loss by day 11 of exposure (p < 0.05). The mice exhibited soft to liquid stools with blood, which, along with weight variation, increased the Disease Activity Index and colon shortening. Additionally, signi ficant increases in IL1B were observed in colon samples from IL10 KO mice with DSS-induced colitis, regardless of RvD2 treatment (p < 0.05). Significant increases in IL6 (p < 0.01) and IL17 (p < 0.05) were observed in the IL10 KO DSS group, alongside a reduction in interferon-gamma (p < 0.05) when compared to the non- colitic IL10 KO group. None of the evaluated cytokines decreased signi ficantly in IL10 KO DSS mice treated with RvD2 compared to untreated ones.

Conclusion

IL10 KO animals did not exhibit a signi fi- cant reduction in pro-in flammatory cytokines following RvD2 treatment, demonstrating that the bene ficial effect of this mediator on experimental colitis occurs via IL10. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 137991 E-poster REAL-WORLD EVIDENCE OF THE USE OF IMMUNOBIOLOGICS IN CROHN’S DISEASE IN THE STATE OF GOIÁS FROM 2018 TO 2023: AN OPEN RETROSPECTIVE COHORT STUDY Victor Cordeiro Simão 1, Pedro Eduardo da Costa Galvão 1, Arthur Cordeiro Simão 1, Nayã Pereira Portilho 2, Gabriela Luz Castelo Branco de Souza 1, Mylena Santana de Sena Araújo 1, Isabely Gelinski1, Bruna Dell ‘acqua Cassão1 1Universidade Federal de Goiás, Goiânia, Brasil 2Pontifícia Universidade Católica de Goiás, Goiânia, Brazil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S35

Introduction

The use of immunobiologicals in the treatment of Crohn’s Disease has shown significant impact in reducing complications, hospitalizations, and surgical inter- ventions. Therefore, understanding the implementation of this treatment is essential to guide health planning actions.

Objective

To analyze real-world data on the use and implementation of immunobiologicals for the treatment of Crohn’s Disease in Goiás, from 2018 to 2023.

Methods

An open retrospective cohort study was conducted using data from DATASUS databases. Extraction, Transformation, and Load (ETL) algorithms were applied to two databases from the Brazilian Uni fied Health System ’s Outpatient Information System (SIA/SUS) —Ambulatory Pro- cedures and Medication Authorizations. Data from January 2018 to December 2023 in Goiás were analyzed, based on records of health resource utilization by individual patients with Crohn’s Disease. This approach allowed for a description and analysis of outpatient treatment regimens with immu- nobiologics in Goiás.

Results

A total of 625 patients were included in the cohort during the study period. The majority of patients were male (63.7%). The average age of patients was 35.3 years (Standard Deviation /C6 14.9), with the predominant age group being 20–39 years, comprising 347 (50%) patients. Infliximab was observed as the primary immunobiologic used, with its usage increasing from 92.9% to 95.3% of patients. A total of 441,687 units of in fliximab were dispensed during the study period, while 1,232,551 units were approved, averaging 205,426 units annually. The mean annual cost was R$ 3,343,455.41, with a total expenditure of R$ 20,060,732.50.

Conclusion

The data highlights the predominant use of infliximab for treatment and the prevalence of young male patients, underscoring the need for speci fic interventions for this group. Furthermore, the considerable financial invest- ment involved emphasizes the importance of targeted health planning aimed at optimizing resources and achieving better clinical outcomes for patients with Crohn ’s Disease. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141799 E-poster SOCIODEMOGRAPHIC FACTORS RELATED TO MORTALITY RATE AND DEATHS DUE TO INFLAMMATORY BOWEL DISEASE IN BRAZIL Talita Alves Harrop 1, Vinícius Sussuarana Rocha 1, Kauê Magalhães Castro dos Santos1, Gisele Rocha Lopes1, Ravi Cabral Gabriel1, Raimundo Rocha Neto 1, Carolline Alves Ibiapino 1, Paulo de Oliveira Neto 1 1Universidade Federal do Amapá, Macapá, Brasil

Introduction

Inflammatory Bowel Disease (IBD) encompasses a group of chronic illnesses, with Ulcerative Colitis (UC) and Crohn ’s Disease (CD) being the most promi- nent. Despite its association with potentially fatal complica- tions, Brasil faces a scarcity of data on its morbidity and mortality.

Method

This descriptive cross-sectional study uti- lized 2022 data from the Mortality Information System (SIM) for CD and UC, and the Brazilian Institute of Geography and Statistics (IBGE). The mortality rate (MR) was calculated as the ratio of deaths to the population for each year in the series, multiplied by 100,000.

Objective

To determine the MR for IBD in Brazil based on key sociodemographic variables.

Results

In 2022, 555 deaths from IBD were recorded in Brazil, corresponding to a general mortality rate of 0.273. The North (MR ¼0.115) and Northeast (MR ¼0.188) regions had the lowest rates, 57.8% and 31.0% lower than the national rate, respectively. In contrast, the South (MR ¼0.367) and Southeast (MR ¼0.326) regions exceeded the national MR by 34.4% and 19.4%, respectively, while the Central-West showed a rate similar to the national average (0.276). Regard- ing gender, female mortality (n¼299, MR¼0.285) was slightly higher than male mortality (n ¼256, MR¼0.259), with only a 2.6% variation. Concerning ethnicity, both absolute numbers and MR indicated a predominance among the White popula- tion (n ¼330, MR ¼0.373). The Yellow race had the second- highest MR (0.235) despite having the lowest number of deaths (n ¼2). Other racial groups had rates below the na- tional average: Brown (n ¼173, MR ¼0.187), Black (n ¼38, MR¼0.183), and Indigenous (n ¼2, MR ¼0.162). Finally, mor- tality was proportional to the age group. The lowest rate was observed in children aged 5 –9 years (0.014), surpassing the national average in the 45 –49 age group (0.285) and increas- ing exponentially thereafter, peaking at ages 75 –79 (1.09) and 80 þ years (2.46). These figures were 3.9 and 9 times higher, respectively, than the national MR.

Conclusion

Due to the lack of systematic registration of diagnosed IBD cases in Brazil, analyzing mortality rates is a critical factor in estimating its incidence across sociodemo- graphic variables. This evaluation revealed higher mortality rates in the South and Southeast regions, among the White and elderly populations, with a slight predominance in females. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141650 E-poster SIGMOID-SPINAL FISTULA IN A PATIENT WITH CROHN ’S DISEASE - CASE REPORT Gersino Perin Ribeiro1, Joao Paulo Slongo1, Jackeline Kalinoski1, Taiane Costa Santana 1, Ana Carolina Quadros 1, Jean Luca Alves1, Daniele Ximenez 1, André Pereira Westphalen 1 1Hospital Universitário do Oeste do Paraná, Cascavel, Brasil BNF, a 22-year-old female, was diagnosed with Crohn’s Disease (CD) in 2022 through colonoscopy and enter- otomography, showing stenosing involvement of the distal ileum and sigmoid. She started immunobiological therapy with in fliximab in February 2023 and, in August, presented with abdominal pain and complaints of bilateral sacroiliac pain, mainly on the left, with neuropathic pain and reduced mobility of the left lower limb, with suspected sacroiliitis secondary to Crohn ’s Disease. An MRI of the lumbosacral spine and CT of the abdomen were requested, revealing a fistulous tract from the sigmoid toward the sacrum, with a spinal collection and paravertebral extension posterior to the L5-S1 vertebral foramen, with heterogeneous collections. Due to the complication of a spinal fistula and the develop- ment of septic shock, the decision was made to perform laparotomy with a Maylard transverse incision. The surgery revealed a fistula in the terminal ileum and sigmoid with retroperitoneal abscess extension on the left, requiring seg- mental enterectomy with double-barrel ileostomy and J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS36 rectosigmoidectomy with terminal colostomy. The patient received antibiotic therapy and corticosteroids, with good postoperative recovery, improvement in the infectious con- dition, and resolution of neurological symptoms. Ambulato- rily, the in fliximab dose was optimized to 5mg/kg every 4 weeks after corticosteroid tapering. She underwent recon- struction of the bowel in February 2024 with colorectal anastomosis and subsequent endoscopic dilation of the anastomosis. In May 2024, a double-barrel ileostomy enter- oanastomosis was performed. She continues to show good clinical progress with optimized in fliximab therapy, achiev- ing clinical and endoscopic control of the disease, with an IHB of 1 point and no anastomotic recurrence. Crohn’s Disease, by its transmural nature, combined with the variability in the distribution of the affected intestinal segment, can lead to fistula formation, with the most common types being enter- ovesical, enterocutaneous, enterovaginal, and enteroenteric. In the case described, a spinal fistula was observed, requiring urgent surgical intervention due to intense pain, sepsis, impaired lower limb mobility, and risk of meningitis. This case highlights the potential complications caused by fistulas in CD, presenting atypically with diagnostic complexity that may resemble extra-intestinal symptoms, requiring the med- ical team to have a high level of suspicion and experience in managing CD and using anti-TNF agents for disease control. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141636 E-poster IS THERE A BENEFIT TO USING INDIRECT CALORIMETRY IN OUTPATIENT PATIENTS WITH CROHN ’S DISEASE? Raissa José de França Carvalho 1, Maria Carolina Gonçalves Dias1, Celso Ricardo Fernandes de Carvalho 1, Marcelo Rodrigues Borba1, Carlos Frederico Sparapan Marques 1, Carlos Walter Sobrado Junior 1, Carolina Bortolozzo Graciolli Facanali 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

Introduction

Patients with Crohn’s disease (CD) may present with nutritional deficits. Symptoms such as diarrhea, malabsorption, and an increased resting energy expenditure (REE) can lead to greater weight loss, resulting in secondary protein-energy malnutrition. Assessing energy needs is part of the therapeutic management, as both overfeeding and underfeeding negatively impact nutritional status. Although indirect calorimetry (IC) is the gold standard for quantifying energy needs in critically ill patients, it is rarely performed in practice, and alternatives such as formula-based methods are used. There is inconsistent evidence on the use of IC in outpatient patients and the relationship between total ener- gy expenditure (TEE) and disease activity. Furthermore, the agreement between methods, with IC plus 20% (responsible for diet-induced thermogenesis and daily energy expendi- ture) and the TEE estimated by the Pocket Formula (PF) in CD, led to the study.

Objective

To evaluate the agreement of REE measured by IC plus 20% with TEE calculated by PF and to investigate the relationship between energy expenditure and disease activi- ty, as well as other clinical and laboratory variables.

Method

A cross-sectional, single-center study in adult patients with CD. REE measurements using IC and PF were conducted simultaneously. Laboratory exams, socio- demographic data, anthropometric assessments, and clinical activity evaluations using the Harvey Bradshaw index were collected. Statistical analyses were performed (5% significance).

Results

A total of 100 patients participated in the study. The mean age was 42.6 years, with 49% being male. Men had higher TEE than women (p<0.0001). PF showed low agreement with IC (CCI <0.4). A statistically signi ficant in- verse correlation was found between TEE and both age and age at diagnosis (r=-0.217 and r=-0.244 respectively; p<0.05). The difference in energy expenditure between methods was inversely correlated with age, BMI, and age at diagnosis (r <- 0.5 and p <0.05). No relationship was found between energy expenditure and disease activity.

Conclusion

The findings highlight the need for nutri- tional health monitoring in individuals with CD. Greater attention should be given to men and younger individuals, as they have higher energy expenditure. Although TEE is not related to disease activity, the use of IC, even in outpatient patients, is essential for proper nutritional management. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138682 E-poster IMPACT OF SEXUAL SATISFACTION, ANXIETY, AND DEPRESSION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: AN OBSERVATIONAL STUDY IN A REFERENCE CENTER Roberta Mesquita Gomes da Silva 1, Sandro da Costa Ferreira 1, Cintia Maura Caseiro Nigro1, Omar Féres1, José Joaquim Ribeiro da Rocha1, Daniela Oliveira Magro 2, Claudio Saddy Rodrigues Coy2, Rogerio Sera fim Parra1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil 2Faculdade de Ciências Médicas de Campinas, Campinas, Brasil

Introduction

Inflammatory bowel diseases (IBD) are conditions associated with a negative impact on quality of life, especially during active disease and in critically ill patients. However, even patients in remission may experi- ence a reduced quality of life due to depressive or anxious symptoms. There are few national studies on the psychologi- cal factors affecting IBD patients and the assessment of sexual function in these individuals.

Objective

To evaluate the psychological pro file of patients with active and inactive IBD by applying validated questionnaires on anxiety/depression and sexuality.

Methods

Validated instruments (questionnaires) were applied to assess sexuality (male and female sexual quotient), anxiety, and depression (Beck Scales – Beck Anxi- ety Inventory and Beck Depression Inventory, respectively) in IBD patients at a Brazilian reference center for IBD. Variables related to gender, age, disease type, disease activity, and prior surgeries were collected. The study was approved by the Research Ethics Committee and registered in the Brazilian Platform.

Results

A total of 161 patients were included (Crohn’s Disease [CD], n=90, 55.9%; White, n=126, 78.3%; employed, n=107, 66.6%; average age 38.2 years; active disease, n=96, 56.9%; deep remission, n=41, 25.5%). There were no differ- ences in age (p=0.659), age at diagnosis (p=0.466), or disease duration (p=0.531) between patients with CD and Ulcerative J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S37 Colitis (UC), indicating that the groups were homogeneous. Overall, anxiety and depression were present in 65 (40.4%) and 72 (44.7%) patients, respectively. Women experienced significantly more sexual performance/satisfaction im- pairment than men (65.7% vs. 34.1%, p=), regardless of whether the disease was active or in remission. When comparing IBD types, women with UC had a signi ficantly greater negative impact on sexual performance/satisfaction (85.7% vs. 57.1%, p=0.028) than women with CD. Among men, the negative impact on sexual performance/satisfaction was similar between UC and CD (28.6% and 46.6%, p=0.766). Perianal disease, prior surgeries, or disease activity did not have statistical significance in relation to anxiety, depression, or sexuality rates.

Conclusion

Anxiety and depression affected more than 40% of patients with IBD. Women experienced a greater negative impact on sexuality compared to men. Women with UC had the highest negative impact on sexuality. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138225 E-poster AMERICAN CUTANEOUS LEISHMANIASIS IN A PATIENT WITH CROHN’S DISEASE UNDER BIOLOGICAL THERAPY WITH ANTI- TNF-ALPHA Isabella da Silva Idelfonso 1, Pierre Rodrigues Bernardino 1, José Roberto Violatti Filho 1, Amanda Karolyne Batista Ferreira 1, Emerson Abdulmassih Wood da Silva 1 1Universidade Federal do Triângulo Mineiro, Uberaba, Brasil

Introduction

Patients with Crohn’s disease (CD) may present with nutritional deficits. Symptoms such as diarrhea, malabsorption, and an increased resting energy expenditure (REE) can lead to greater weight loss, resulting in secondary protein-energy malnutrition. Assessing energy needs is part of the therapeutic management, as both overfeeding and underfeeding negatively impact nutritional status. Although indirect calorimetry (IC) is the gold standard for quantifying energy needs in critically ill patients, it is rarely performed in practice, and alternatives such as formula-based methods are used. There is inconsistent evidence on the use of IC in outpatient patients and the relationship between total ener- gy expenditure (TEE) and disease activity. Furthermore, the agreement between methods, with IC plus 20% (responsible for diet-induced thermogenesis and daily energy expendi- ture) and the TEE estimated by the Pocket Formula (PF) in CD, led to the study.

Objective

To evaluate the agreement of REE measured by IC plus 20% with TEE calculated by PF and to investigate the relationship between energy expenditure and disease activi- ty, as well as other clinical and laboratory variables.

Method

A cross-sectional, single-center study in adult patients with CD. REE measurements using IC and PF were conducted simultaneously. Laboratory exams, socio- demographic data, anthropometric assessments, and clinical activity evaluations using the Harvey Bradshaw index were collected. Statistical analyses were performed (5% significance).

Results

A total of 100 patients participated in the study. The mean age was 42.6 years, with 49% being male. Men had higher TEE than women (p<0.0001). PF showed low agreement with IC (CCI <0.4). A statistically signi ficant in- verse correlation was found between TEE and both age and age at diagnosis (r=-0.217 and r=-0.244 respectively; p<0.05). The difference in energy expenditure between methods was inversely correlated with age, BMI, and age at diagnosis (r <- 0.5 and p <0.05). No relationship was found between energy expenditure and disease activity.

Conclusion

The findings highlight the need for nutri- tional health monitoring in individuals with CD. Greater attention should be given to men and younger individuals, as they have higher energy expenditure. Although TEE is not related to disease activity, the use of IC, even in outpatient patients, is essential for proper nutritional management. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 128602 E-poster MONITORING SERUM INFLIXIMAB LEVELS IN CROHN ’S DISEASE PATIENTS: COMPARISON BETWEEN TWO TESTS Renato Lazarin Ricci 1, Luis Eduardo Miami Gomes 1, Livia Moreira Genaro 1, Marina Moreira de Castro 1, Michel Gardere Camargo1, Ligiana Pires Corona 1, Maria de Lourdes Setsuko Ayrizono1, Raquel Franco Leal 1 1Universidade Estadual de Campinas, Campinas, Brasil

Introduction

The treatment of Crohn ’s disease (CD) has increasingly relied on the use of biological agents. Safe and accessible tests have led to the active implementation of therapeutic drug monitoring in clinical practice. Several commercially available assays exist to detect serum levels of infliximab (IFX). Understanding and comparing the differ- ent methods of serum IFX level measurement is important for clinical practice.

Objective

To compare two distinct tests for detecting serum IFX levels in patients with Crohn ’s disease (CD).

Method

This is a prospective, observational, cross- sectional study. Seventy-five patients receiving maintenance therapy with IFX, aged between 18 and 60 years, were selected. Participants were allocated into the disease activity (CDA) or remission (CDR) groups. Disease activity was de- fined by endoscopic or radiological criteria. Serum IFX levels were measured by enzyme-linked immunosorbent assay (ELISA) and lateral flow rapid test. Differences between test

Results

within the measurement range were evaluated by the Wilcoxon test, Passing-Bablok regression, and Bland-Altman method.

Results

A signi ficant difference was observed (p < 0.001) in the median results between the two tests (2.27 for Promonitor [IQR: 1.36 –4.27] vs. 4.0 for Quantum Blue [IQR: 1.7–6.9]). The CUSUM test showed a linear relationship between the two measures, making the Passing-Bablok

Method

applicable (p > 0.20). The serum IFX concentrations, within the measurement range, assessed in 27 patients with CD for each method, showed higher values for the rapid test than for ELISA. The two IFX level tests had moderate agree- ment (r = -0.6758; p < 0.001). The Passing-Bablok regression intercept did not signi ficantly differ from 0 (-0.018; 95% CI -0.489 to 0.420), but the slope was less than 1 (0.589; 95% CI 0.454 to 0.766), indicating a proportional difference between the two tests. Additionally, a Bland-Altman test was per- formed to further compare and establish the level of agree- ment between the two assays. This analysis revealed J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS38 moderate agreement between the two assays, with only one value outside the con fidence interval.

Conclusion

Although the tests showed a statistically significant association, they cannot be considered inter- changeable, especially at higher IFX levels. Therefore, it is ideal for patients to be monitored using the same assay. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138164 E-poster MORTALITY DUE TO INFLAMMATORY BOWEL DISEASE: COMPARATIVE PATTERN BETWEEN THE NORTHEAST AND OTHER REGIONS OF BRAZIL Lidiane Gomes Bandeira 1, Vitor Caiaffo Brito 1 1Universidade Federal de Pernambuco, Recife, Brasil

Introduction

Inflammatory bowel diseases (IBD) are characterized by chronic in flammation of the intestines of unclear etiology. IBD occurs worldwide and represents a public health problem, impairing quality of life with increas- ing mortality outcomes.

Objective

To compare mortality rates due to IBD in the Northeast of Brazil between 2012 and 2022 with other regions of the country.

Methods

This is an observational, cross-sectional, retrospective, and descriptive epidemiological study based on secondary data collected from the DATASUS platform using the Health Information Tabulator (TABNET) for the years 2012–2022. The study analyzed the number of deaths, ethnicity, gender, and age group of patients by region.

Results

In the period analyzed, there were 49,948 deaths due to IBD in Brazil. The Northeast accounted for the highest number of cases (18,901), followed by the Southeast (16,837) and South (6,219). The Northeast had a higher number of female deaths (10,229) compared to males (8,676), with similar patterns in other regions, except for the North, where male deaths predominated. Regarding age group, the mortality pattern increased from 20 years onward for both the Northeast and other regions, with a peak for individuals over 80 years old. In this age group, the Southeast surpassed the Northeast with 7,850 deaths compared to 7,608. For the age range from infancy to 19 years, mortality was predominantly for infants under 1 year old in all regions, with the Northeast leading with 1,988 cases. Concerning ethnicity, higher mortality was observed among mixed- race individuals, followed by whites in the Northeast, North, and Central-West. However, in the South and Southeast, the pattern was reversed, with whites predominating, followed by mixed-race individuals.

Conclusion

The Northeast was responsible for the highest number of IBD-related deaths in Brazil during the analyzed period, with an increasing pattern of cases in the other regions, particularly from the age of 20. In terms of gender, the Northeast followed the trend of other regions, with higher mortality in females, except in the North. For age group, mortality among those over 80 years old was higher compared to other age groups, with the Southeast surpassing the North- east in this regard. Regarding ethnicity, the Northeast followed the pattern of the North and Central-West, with a predomi- nance of mixed-race individuals followed by whites, unlike the South and Southeast, where this pattern was reversed. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 137644 E-poster THE USE OF CANNABINOID DERIVATIVES AS A POTENTIAL THERAPEUTIC IN INFLAMMATORY BOWEL DISEASES Eloisa Possimoser Negri1, Vitória Foleto1, Thalia Ely Cervejeira1, Vitor Cavalli1, Lais Pedot Faris 1, José Rodoolfo Hildebrando Alves Leite2, Weverton Fernandes de Lima Souza 1 1Uninassau Vilhena, Vilhena, Brazil 2Universidade Federal de Mato Grosso, Cuiabá, Brasil

Introduction

Inflammatory Bowel Disease (IBD) is the chronic in flammation of the colon mucosa and portions of the small intestine and rectum. It presents abdominal pain, diarrhea, and weight loss. It is related to Ulcerative Colitis (UC) or Crohn’s Disease (CD). UC is an in flammation affecting variable extensions of the colon. CD is characterized by transmural and discontinuous involvement along the gastro- intestinal tract. The perpetuation of IBD increases the risk of colorectal cancer (CRC). The endocannabinoid system is a mechanism related to CB1 and CB2 receptors. Studies have identified the therapeutic potential of THC and cannabidiol in various pathologies. In the gastrointestinal tract, CB2 may be related to cytoprotection through GPCRs or PPARs stimulation.

Objective

To elucidate the effects of THC use in IBD and CRC through a literature review. Methodology This is a literature review on the effects of cannabinoid substances in the treatment of IBD and CRC. Data was obtained from the following platforms: PubMed, LILACS, and SciELO. The English descriptors “Cannabinoids,” “Treatment,” and “Intestinal Diseases ” were used in combi- nation with the Boolean operator AND to find publications from the last decade with full text available. A total of 63 full- text articles were retrieved, and after applying inclusion criteria, 18 studies were selected.

Results

The use of a cannabinoid agonist was effective in reducing in flammation, inducing healing, and protecting against recurrences. Isolated THC was more effective in symptom attenuation compared to THC þCBD or isolated CBD. Studies identi fied a signi ficant reduction in UC symp- toms, associated with an endoscopic improvement of inflam- mation and a shorter hospitalization period. THC in CRC reduced tumor cell proliferation, justi fied by an increase in the tone of the endocannabinoid system with a reduction in the gene expression of proteins related to the cell replication cycle, tumor growth, and induction of apoptosis. In low doses, it may have a pro-tumoral effect. Reductions in cachexia, muscle atrophy, and neuropathic pain caused by CRC were also identified. Challenges of use include psychoactive effects and the dif ficulty of establishing a therapeutic standard.

Conclusion

THC has therapeutic potential in IBD and CRC, promoting cytoprotection, analgesia, and reducing ca- chexia. The dif ficulty in identifying a therapeutic threshold and the psychoactive effects hinder the standardization of treatment protocols involving Cannabis sativa substrates. Expanding studies is valuable for developing new effective protocols. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S39 Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141762 E-poster CLINICAL-EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH FISTULIZING PERIANAL CROHN ’S DISEASE João Victor Maia Freitas1, Kristine Leão Alarcão 1, Bianca Corrêa Dutra de Menezes 1, Igor Torres da Silveira Mendes 1, Luna Vitória Gondim Ferreira 1, Oswaldo de Moraes Filho 2, Bruno Augusto Alves Martins 2, João Batista de Sousa 1 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil

Introduction

Patients with Crohn’s disease (CD) may present with nutritional deficits. Symptoms such as diarrhea, malabsorption, and an increased resting energy expenditure (REE) can lead to greater weight loss, resulting in secondary protein-energy malnutrition. Assessing energy needs is part of the therapeutic management, as both overfeeding and underfeeding negatively impact nutritional status. Although indirect calorimetry (IC) is the gold standard for quantifying energy needs in critically ill patients, it is rarely performed in practice, and alternatives such as formula-based methods are used. There is inconsistent evidence on the use of IC in outpatient patients and the relationship between total ener- gy expenditure (TEE) and disease activity. Furthermore, the agreement between methods, with IC plus 20% (responsible for diet-induced thermogenesis and daily energy expendi- ture) and the TEE estimated by the Pocket Formula (PF) in CD, led to the study.

Objective

To evaluate the agreement of REE measured by IC plus 20% with TEE calculated by PF and to investigate the relationship between energy expenditure and disease activi- ty, as well as other clinical and laboratory variables.

Method

A cross-sectional, single-center study in adult patients with CD. REE measurements using IC and PF were conducted simultaneously. Laboratory exams, socio- demographic data, anthropometric assessments, and clinical activity evaluations using the Harvey Bradshaw index were collected. Statistical analyses were performed (5% significance).

Results

A total of 100 patients participated in the study. The mean age was 42.6 years, with 49% being male. Men had higher TEE than women (p<0.0001). PF showed low agreement with IC (CCI <0.4). A statistically signi ficant in- verse correlation was found between TEE and both age and age at diagnosis (r=-0.217 and r=-0.244 respectively; p<0.05). The difference in energy expenditure between methods was inversely correlated with age, BMI, and age at diagnosis (r <- 0.5 and p <0.05). No relationship was found between energy expenditure and disease activity.

Conclusion

The findings highlight the need for nutri- tional health monitoring in individuals with CD. Greater attention should be given to men and younger individuals, as they have higher energy expenditure. Although TEE is not related to disease activity, the use of IC, even in outpatient patients, is essential for proper nutritional management. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141731 E-poster EPIDEMIOLOGICAL PROFILE OF INFLAMMATORY BOWEL DISEASES IN BRAZIL Igor Moreschi 1, Higor Roberto Spegiorin 2, Hugo Moreschi 1, Hayani Yuri Ferreira Outi 3, Maria Laura Bueno 3, Ana Claudia Mendes Ramos Lucatelli 4, José Ferraz de Oliveira Junior 4, Livia Nunes Salessi 3 1Faculdade Ceres de Medicina, São José do Rio Preto, Brasil 2Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brasil 3Centro Universitário de Adamantina, Adamantina, razil 4Universidade de Araraquara, Araraquara, Brasil Inflammatory Bowel Diseases (IBD) are chronic con- ditions that cause in flammation of the gastrointestinal tract, leading to debilitating symptoms and severe complications. The increasing incidence of IBD in developing countries, such as Brazil, highlights the need for a detailed analysis of epidemiological data to formulate effective public health policies. The aim was to evaluate the epidemiological pro file of IBD in Brazil, including distribution by age, sex, clinical characteristics, and regional patterns of incidence and hos- pitalization. Data from various studies published between 2008 and 2024 that addressed the epidemiological pro file of IBD in different regions of the country were reviewed. Data were collected from hospital records, national databases, and reports of speci fic studies that were available in full for analysis. A growing prevalence of IBD in Brazil was observed, with signi ficant regional variations. In the Federal District (DF), hospitalizations for Crohn ’s Disease and Ulcerative Colitis increased by 20% in the last decade. In Mato Grosso (MT), the prevalence of IBD was higher in women (56%) compared to men (44%). In Santa Catarina (SC), the majority of patients were between 30 and 50 years old, with a prevalence of 60% for Crohn ’s Disease. Studies in Espírito Santo (ES) and Paraná (PR) revealed that patients with IBD frequently had comorbidities, such as obesity and diabetes, complicating disease management. The hospitalization rate for IBD in Brazil ranged from 7.1 to 9.3 days, with the longest hospitalization times recorded in the Northeast. Mortality associated with IBD was low, but there was an increase in the incidence of severe complications, such as abscesses and fistulas, especially in patients with Crohn ’s Disease. It was also noted that the introduction of biological therapies significantly improved the quality of life for patients, reduc - ing hospitalization rates and complications. The epidemio- logical profile of IBD in Brazil shows an increase in prevalence and case complexity, with demographic and regional varia- tions that directly impact the management and treatment of patients. IBD predominantly affects young adults, with a slight predominance in women. The identi fication of associ- ated comorbidities highlights the need for multifaceted approaches in management. Investing in public health poli- cies aimed at early detection and effective treatment of IBD is crucial to improving patient outcomes and reducing the burden on the healthcare system. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS40 Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 137679 E-poster PYODERMA GANGRENOSUM COMPLICATING ILEOSTOMY IN A PATIENT WITH ULCERATIVE COLITIS – A CASE REPORT Jéssica Siebra Macário de Brito 1, Jaciane Araújo Mota Fontes 1, Joana de Souza Simões 1, Marília Fernandes Gualberto de Galiza1, Neogélia Pereira de Almeida 1, Tereza Vilma Sobreira Alexandre1, Erodilho Sande Mota1, Flora Maria Lorenzo Fortes 1 1Hospital Geral Roberto Santos, Salvador, Brasil Case Presentation KLS, female, 35 years old, diag- nosed with UC in 2020, colonoscopy revealed pancolitis and ulcers. In addition to diarrhea with blood and mucus, she had arthritis and sacroiliitis. She has an allergy to sulfasalazine and was refractory to corticosteroid treatment, also showing inad- equate response to In fliximab, and was thus submitted to subtotal colectomy with cecostomy in October 2020, a decision made by the general surgery team as an emergency. After four months, symptoms returned, with sigmoidoscopy indicating Mayo 3. Therapy with Tofacitinib was attempted without success, followed by Vedolizumab for 14 months, which also proved ineffective, with symptoms and endoscopic worsening. Golimumab and Mesalazine suppository were tried without response, resulting in the need for total proctectomy with cecum resection and creation of a de finitive terminal ileos- tomy in December 2023. In March 2024, she was hospitalized with nodular, purple, ulcerated lesions with raised edges, painful, with purulent secretion drainage in the peristomal region and adjacent skin detachment, diagnosed with pyoder- ma gangrenosum (PG). She underwent treatment with various antimicrobials and special dressings during prolonged hospi- talization, without success. A decision was made for surgery to reposition the ileostomy and debride the ulcerated lesion on the abdominal wall in April 2024. She was discharged after one month of surgery, with the wound improving, continuing follow-up and care at home. Less than a month after discharge, lesions reappeared at the new stoma.

Discussion

PG may occur in 1-5% of in flammatory bowel disease cases, not necessarily associated with disease activity. It is de fined as a rare in flammatory disorder charac - terized by chronic, recurrent skin ulcers with necrotic edges. Its etiology and pathogenesis are complex, not well-de fined, and multifactorial. There is a wide range of therapeutic options, and combining multiple modalities is more effective than monotherapy, focusing on wound surgical treatment, topical and systemic therapy.

Conclusion

PG is an uncommon neutrophilic derma- tosis that presents diagnostic and therapeutic challenges. If left untreated, it can signi ficantly impact morbidity and mortality, with an increased risk of developing squamous cell carcinoma in chronic wounds and a threefold increase in mortality among patients with uncontrolled disease. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138327 E-poster PSORIASIS PARADOXAL WITH INFLIXIMAB USE: A CASE REPORT Lara Cristina Silva Inácio 1, Michaela Helena Moretto Alves 1, Leandro Bernardini Tonelli 1, Guilherme Bussola Carazzatto 2, Letícia Isper2, Fernanda Queiroz Xavier1, Pedro Henrique Bauth Silva1, André Antônio Abissamra 1 1Hospital Regional de Presidente Prudente, Presidente Prudente, Brasil 2Universidade do Oeste Paulista, Presidente Prudente, Brasil A 46-year-old female patient, diagnosed with Crohn ’s disease in the ileocolonic form in 2011. She used mesalazine and adalimumab for approximately two years and introduced infliximab eleven months after discontinuing the other med- ications, with a dosage of 4 vials every 2 months. The patient reports that one month after starting the medication, pruritic lesions began to appear on the fingers of both hands, with progressive worsening over 4 months, revealing erythematous- desquamative lesions on the palmoplantar region bilaterally, accompanied by pruritus. She also reports the appearance of blisters that soon collapsed, releasing clearfluid, with worsen- ing after periods of stress. She denies lesions at other sites and reports no burning or pain. Her personal medical history includes Crohn’s disease, depression, and hypertension. She continuously uses clonazepam 2mg, sertraline 100mg, losartan 100mg/day, hydrochlorothiazide 25mg once a day, and inflix- imab 4 vials every 2 months. Upon physical examination, erythematous-desquamative lesions and excoriations were noted on the palmoplantar region bilaterally. The case was discussed with the dermatology team, who advised that it was paradoxical psoriasis due to in fliximab use. They recom- mended starting halobetasol 0.50mg cream twice a day and urea cream once a day for hydration. The appearance of the lesions improved 7 days after starting treatment. One of the reported side effects of immunobiologics is paradoxical psori- asis, in patients with or without a previous psoriatic disease. It is characterized by an acute reaction when occurring in less than 24 hours, and a delayed reaction between 24 hours and 14 days. It predominates in female patients and can occur in up to 5% of patients using anti-TNF. The most common clinical form is palmoplantar. The etiology is not well-defined but is related to the control between TNF-alpha levels and interferon with inflammatory cytokines. Treatment depends on the extent of the condition; in this patient, topical treatment was chosen while on immunobiologic therapy. However, it may be neces- sary to switch to another class of immunobiologics if the phenomenon persists or worsens. The treatment of paradoxical psoriasis remains a challenge, as most patients still require anti-TNF for the management of their underlying condition. Early identification of side effects and proper case management can allow the continuation of the initial immunobiologic treatment combined with topical treatment for psoriasis with- out affecting the patient ’s quality of life, always aiming for effective treatment and benefits. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 137678 E-poster RECONSTRUCTION OF INTESTINAL TRANSIT WITH MODIFIED KONO-S ANASTOMOSIS (ILEO-CECAL) IN A PATIENT WITH CROHN’S DISEASE T. V. S. Alexandre1, J. S. M. Brito1, M. F. G. Galiza1, J. D. S. Simões1, J. A. M. Fontes 1,N .P .A l m e i d a1, F. M. L. Fortes 1,E .S .M o t a1 1Hospital Geral Roberto Santos, Salvador, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S41 Case Presentation ALS, 35 years old, female, was admitted with daily diarrhea, nausea, vomiting, and progres- sive weight loss. Associated with these symptoms, she pre- sented with amenorrhea, hair loss, asthenia, and malaise. Laboratory tests revealed leukocytosis. Imaging tests showed thickening with an in flammatory aspect in the distal ileum, extending to the cecum and cecal appendix, more accentuat- ed near the ileocecal valve, associated with reactive mesen- teric lymph nodes and coexisting cholelithiasis. Endoscopic examination revealed an irregular and friable lesion occupy- ing the entire circumference of the cecum, preventing the passage of the endoscope through the ileocecal valve, with histopathological examination indicating chronic in flamma- tory process. She was diagnosed with Crohn ’s disease and underwent surgical treatment, where intraoperative findings showed a localized mass in the right iliac fossa involving the terminal ileum, cecum, and transverse colon, with a fistulous tract between the terminal ileum and the transverse colon. A right ileocolectomy, transverse colostomy, terminal ileos- tomy (Brooke), and cholecystectomy were performed. She had an uneventful recovery. Later, she was hospitalized for intestinal transit reconstruction surgery, where a Kono-S ileocolic anastomosis was performed. She had no recurrence clinically or endoscopically.

Discussion

Crohn’s disease (CD) is an in flammatory disease characterized by transmural inflammation and asym- metric segmental involvement of the entire gastrointestinal tract. Approximately 20% of patients present with stenotic complications at the time of diagnosis, which can account for 40-70% of surgeries in the first 10 years of diagnosis. Unfor- tunately, postoperative recurrence of stenoses is common, especially at the ileocolic anastomosis site. The Kono-S anas- tomosis is based on the concept that in flammation in CD originates in the mesentery. Kono et al. proposed a terminal- to-terminal, antimesenteric anastomosis with the expecta- tion of reducing disease recurrence.

Conclusion

The Kono-S anastomosis technique has emerged as a promising option to prevent recurrence at the anastomosis site and reduce postoperative complications, with the advantages of preserving the diameter and dimen- sions of the anastomosis. Recent literature suggests that Kono-S anastomosis may become a standard surgical tech- nique for CD. However, more clinical trials are needed to confirm the effectiveness of this technique. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141696 E-poster CASE SERIES IN CROHN ’S DISEASE (CD) – WITH DIFFERENT SURGICAL APPROACHES Myrna Maria Martins Ribeiro1, Camila Gomes1, Fernando Lopes Vieira1, Walysson Alves Tocantins de Sousa 1, Rafael Ferreira Correia Lima 1, Miguel Augusto Arcoverde Nogueira 1, João Marcelo Soares Ribeiro 2 1Universidade Estadual do Piauí, Teresina, Brasil 2Instituição de Educação Superior do Vale do Parnaíba, Parnaíba, Brazil Case Presentation Case 1 – Male patient, 45 years old, BMI 20 kg/m², presenting with abdominal pain, weight loss, melena, and chronic diarrhea, already diagnosed with Crohn’s Disease (CD) 20 years ago, undergoing irregular in fliximab treatment. Enterotomography: Multiple areas of substenosis in the small intestine and areas of stenosis with partial concentric circumferential thickening in the distal ileum, with signs of intestinal obstruction upstream. Underwent stenoplasty of the substenosis areas and segmental enter- ectomy for stenosis of 20 cm of distal ileum, 15 cm from the ileocecal valve (ICV), with primary anastomosis. Case 2 – Female patient, 59 years old, BMI 22 kg/m², presenting with abdominal pain, watery diarrhea, and fever, undergoing irregular treatment with Adalimumab. Colonoscopy per- formed up to the sigmoid colon showing multiple serpiginous ulcers with fibrin, associated with stenosis, which prevented progression of the device. Enterotomography: stenosing thickening in the distal third of the transverse colon extend- ing to 7.5 cm and two fistulous tracts to the left flank and greater gastric curvature. Underwent segmental colectomy of the stenotic area in the splenic flexure of the colon with manual end-to-end primary anastomosis. Case 3 – Male patient, 18 years old, BMI 18 kg/m², presenting with right iliac fossa pain, fever, anemia, and weight loss, who under- went appendectomy in an emergency service, with worsen- ing obstructive symptoms. After this episode, further investigation and diagnostic con firmation of CD were per- formed. Colonoscopy up to the cecum showed a fixed angu- lation at the ileocecal valve, preventing examination of the terminal ileum. Abdominal CT: Parietal thickening with contrast enhancement and dilation upstream of the small bowel loops. Underwent right hemicolectomy with distal ileum enterectomy of about 40 cm, with terminal ileostomy formation. All three cases had good post-operative outcomes.

Discussion

The heterogeneous behavior and location of Crohn ’s Disease provides a variety of surgical treatments using different techniques, as well as endoscopic and radio- logical approaches, in fluenced by the nutritional status and adherence to medication.

Conclusion

Multidisciplinarity is the foundation in managing Crohn ’s Disease. Surgical treatment as an initial therapeutic approach, with its multiple variations depending on the affected intestinal segment, has been a successful alternative. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141747 E-poster SWEET’S SYNDROME IN PATIENTS WITH ULCERATIVE COLITIS: DIAGNOSTIC AND THERAPEUTIC CHALLENGES Camila Leirós Vasconcelos 1, Rayanne Azevedo Peinado 1 1Hospital das Clínicas Luzia de Pinho Melo, Mogi das Cruzes, Brasil Case Presentation A 60-year-old male patient with a history of Ulcerative Colitis (UC) diagnosed in 2020, on Infliximab and Azathioprine with partial control, continuing to experience occasional diarrhea and hematochezia, was admitted to the Emergency Room with painful erythematous plaques on the trunk and upper limbs, associated with palpebral hyperemia and fever. Laboratory results revealed leukocytosis with neutrophilia. In collaboration with Derma- tology, a skin biopsy was performed, showing a dense neu- trophilic in filtrate in the upper dermis without evidence of vasculitis, with histopathology confirming Sweet’s Syndrome (SS). Treatment with Prednisone at 1 mg/kg/day was started, and adjustments were made to the immunosuppressive J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS42 therapy. The patient showed a rapid clinical response, with complete regression of the lesions and systemic symptoms. The corticosteroid dose was gradually reduced, and the patient remained in remission from the skin lesions.

Discussion

Sweet’s Syndrome (SS) is a rare, recurrent cutaneous disease with an incidence peak between the fourth and seventh decades of life, predominantly affecting females (4:1). Described by Robert Douglas Sweet in 1964, it is characterized by the sudden appearance of multiple ery- thematous-violet, elevated, and painful plaques, associated with fever, leukocytosis with neutrophilia, and a dermal neutrophilic in filtrate, often located on the upper parts of the trunk. It is divided into 3 classes: associated with neo- plasms, drug-induced, or the classic (idiopathic) form, the latter associated with In flammatory Bowel Diseases (IBD). Diagnosis is based on the criteria of Su and Liu (1986), defined by the presence of major criteria and at least 2 minor criteria (see table). The cause and pathogenesis remain unknown, but histopathological findings suggest a hypersensitivity reaction related to the increase of pro-in flammatory cytokines, also found in IBDs, such as IL-1, IL-3, IL-6, IL-8, interferon gamma, and colony-stimulating factors, which play an important role in neutrophil activation and migration to the skin, resulting in the characteristic in filtrate. First-line treatment is cortico- steroids in pulse therapy, with an initial dose of Prednisone 30-60 mg/day with gradual tapering, in combination with topical treatment. As alternatives, Colchicine and Potassium Iodide can be used.

Conclusion

Early recognition, appropriate manage- ment, with clinical discussion, and a multidisciplinary ap- proach in collaboration with Dermatology were essential for the positive outcome, highlighting the importance of multi- disciplinary care in treating UC with dermatocutaneous manifestations. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 139122 E-poster SURGICAL TREATMENT OF ULCERATIVE COLITIS: 20-YEAR EXPERIENCE IN A REFERENCE CENTER Jakeline Flávia Sertório Santos 1, Sandro da Costa Ferreira 1, Omar Féres1, José Joaquim Ribeiro da Rocha 1, Marley Ribeiro Feitosa1, Rogerio Sera fim Parra1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

Introduction

and Objectives Ulcerative colitis (UC) may be associated with an increased risk of hospitalizations and surgeries. Surgery is indicated in emergencies, for the treatment of severe refractory acute colitis, toxic megacolon, perforation, or enterorrhagia. It is also indicated in cases of treatment failure and in the presence of complications such as stenosis, severe dysplasia, and colorectal neoplasia. There is a scarcity of published data in Brazil regarding surgical treatment for UC. The objective of this study was to analyze the indications and frequency of surgical procedures per- formed over the past 20 years in patients with UC who underwent surgery at a public reference hospital.

Methods

A retrospective analysis of the electronic medical records of UC patients who underwent surgery from 2002 to 2023 at a reference center. Surgical indications and clinical outcomes were evaluated, such as postoperative complications, reoperation rates, and mortality.

Results

A total of 83 surgeries were performed, of which 62 (74.7%) were elective and 21 (25.3%) were urgent. Among the elective surgeries, the main indication was clinical intractability (n=55, 66.3%) and 9 cases of dysplasia or colorectal cancer (10.8%). Among the urgent surgeries, 13 patients (15.7%) underwent surgery for toxic megacolon/ fulminant colitis and 6 cases (7.2%) for massive bleeding. The main surgeries performed included: total proctocolec - tomy with ileal reservoir (n=38, 45.8%), total colectomy with ileorectal anastomosis (n=25, 30.1%), partial colectomy (n=17, 20.5%), and total proctocolectomy with de finitive ileostomy (n=3, 3.6%). Thirty-one patients (37.3%) required reoperation. The most common postoperative complications were anastomotic dehiscence (n=7) and stoma-related com- plications (n=6). Fifty-nine percent of patients had a de fini- tive stoma. Half of the patients (n=38) who underwent total proctocolectomy with ileal reservoir had clinical and endo- scopic signs of “pouchitis” (inflammation of the pouch). The reservoir loss rate was 6% (n=5). The mortality rate among operated patients was 2.4% (n=9).

Conclusion

The mortality rate in UC patients under- going surgical procedures was low. Total colectomy with or without ileorectal anastomosis and IPAA were the most commonly performed techniques. Partial colectomy is re- served for selected cases in elderly patients, with comorbid- ities, and with colitis in remission. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141715 E-poster TREATMENT WITH SUMP DRAINAGE IN PERCUTANEOUS DRAINAGE FAILURE IN ABSCESS DUE TO CROHN ’S DISEASE Jean Luca Alves 1, Gersino Perin Ribeiro 1, Guilherme Samways Guzzi1, Jordana Martins Américo de Souza1, João Paulo Slongo1, Taiane Costa Santana1, Jackson Vinicus de Lima Bertuol1, André Pereira Westphalen1 1Hospital Universitário do Oeste do Paraná, Cascavel, Brasil Male, 24 years old, referred to a tertiary hospital due to sudden-onset abdominal pain lasting 24 hours, associated with fever, nausea, and vomiting. He has a history of Crohn ’s Disease (CD) for 3 years and irregular use of corticosteroids (CS). Abdominal CT scan upon admission suspected a perfo- ration of the distal ileum blocked by active CD. Empirical antibiotic therapy (ABT) and hydrocortisone were started. After 4 days, there was clinical deterioration, and a follow-up CT showed a large collection in the right lower abdomen, prompting percutaneous drainage. After 25 days, the patient required re-admission due to an enterocutaneous fistula (ECF), obstruction of the previous percutaneous catheter, and intra-abdominal abscess. A laparotomy was performed, revealing a monobloc abdomen and placement of a three-way artisan sump drain. The patient was maintained with an irrigation system, vacuum aspiration, and tubular drainage through the drain, with ECF management. After clinical improvement during hospitalization, in fliximab induction (5 mg/kg) was started, and the patient was discharged after 10 days, with the drain removed 22 days post-surgery. Follow-up was arranged with low-output ECF management and in fliximab maintenance therapy. CD is a chronic J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S43 inflammatory disorder that may require surgical treatment in up to 50% of cases. Resection of the affected intestine in CD may improve symptoms but does not cure the disease, as recurrence is common even after resection. In stable patients with blocked perforation and active CD, clinical treatment with ABT and CS is an option to preserve the affected segment. Percutaneous drainage is a minimally invasive treatment alternative for intra-abdominal abscesses. ECF development in CD is a possibility in transmural involvement, especially when associated with stenosis. Immunobiological treatments play a key role in disease control and ECF resolu- tion. Given the impossibility of resection due to the monobloc abdomen, creating a drainage system to cleanse the cavity and manage the ECF with a sump drain increases the chances of local resolution, especially when intestinal resection in CD is contraindicated. In surgical treatment of CD complications, the resection of the smallest amount of intestine necessary for disease control is recommended. Therefore, the use of a sump drain in malnourished patients with active infection, combined with immunobiological therapy, enhances the likelihood of successful disease remission. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 141688 E-poster TREATMENT WITH TEDUGLUTIDE IN A PATIENT WITH SHORT BOWEL SYNDROME SECONDARY TO CROHN ’S DISEASE Artur Cury Féres 1, João Paulo Slongo 1, Matheus Couto Furtado Albuquerque1, José Joaquim Ribeiro da Rocha1, Rogério Serafim Parra1, Marley Ribeiro Feitosa 1, Omar Féres 1, Thomaz Lucas Féres2 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil 2Centro Universitário Estácio de Ribeirão Preto, Brasil Case Presentation A 35-year-old female with Crohn’s disease since 2008, with an entero-colonic form. In 2009, she underwent left colectomy with rectal burial and creation of a terminal colostomy. She developed lesions in the small intestine and underwent two additional surgeries with enter- ectomies. During this period, she was treated with azathio- prine and in fliximab. She later developed enterocutaneous fistulas, with as many as 4 concurrent fistulas, requiring treatment with parenteral nutrition and somatostatin. She underwent multiple surgical procedures, with the last one in 2018, involving extensive small intestine resection, and the terminal colostomy of the transverse colon was maintained. A total of 15 laparotomies were performed. The patient devel- oped short bowel syndrome, with multiple episodes of dehydration and acute renal failure, requiring repeated hos- pitalizations for hydration and nutritional support on average every 48 hours over the last 5 years. In May 2024, treatment with teduglutide 5 mg subcutaneously per day was initiated, and 30 days after the start of treatment, the patient no longer required hospitalization. As of now, 60 days into the treat- ment, she has gained 3 kg.

Discussion

Short bowel syndrome (SBS) is de fined when there is less than 200 centimeters of remaining small intestine, leading to an inability to absorb nutrients. The main causes of SBS in adults are extensive or multiple enterecto- mies, which can occur in cases of Crohn ’s disease, radiation enteritis, mesenteric infarction, trauma, or cancer. These patients develop diarrhea, dehydration, malnutrition, acute renal failure, and require recurrent hospitalizations for hy- dration and parenteral nutrition. Teduglutide is a drug indi- cated for the treatment of SBS patients, acting as a GLP-2 analogue, activating GLP-2 receptors in the intestine and releasing insulin-like growth factors (IGF), nitric oxide, and keratinocyte growth factor (KGF), promoting intestinal mu- cosal repair and growth by increasing villi and crypt depth. ConclusionThis initial experience with teduglutide shows positive and encouraging results, as the patient no longer requires repeated hospitalizations and no longer needs parenteral nutrition. The only difficulty remains access to the drug due to its high cost. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138273 E-poster INTESTINAL TUBERCULOSIS AS A DIFFERENTIAL DIAGNOSIS OF CROHN’S DISEASE – A CASE REPORT Marina Ströher1, Sérgio Henrique Couto Horta 1, Marcella Conz Rodrigues1, Eduardo Vidal de Holanda 1, Alexia Dias Fontes Rosa1, Enzo Shintaku 1, Flávia Balsamo 1, Sandra Di Felice Boratto1 1Centro Universitário Faculdade de Medicina do ABC, Santo André, Brasil Case Presentation A 62-year-old female presented with colicky abdominal pain and distension, but without changes in bowel habits, bleeding, weight loss, or fever. Colonoscopy revealed two oval ulcerated lesions with well- defined borders and a fibrin-covered base, with an anatomo- pathological diagnosis of intense chronic colitis, interstitial fibrosis, non-necrotizing granulomas, and dense eosinophilic infiltration. A biopsy slide review with microorganism inves- tigation showed a non-caseating granuloma suggestive of intestinal tuberculosis (TB), in addition to a strongly positive PPD. The patient was referred to infectious diseases for treatment.

Discussion

TB is a chronic infectious disease endemic in Brazil. Although pulmonary involvement is the most common, intestinal TB is recognized as an important clinical manifestation of the disease, and its suspicion as a differential diagnosis is crucial, especially when the clinical picture suggests other conditions. Intestinal TB can occur due to hematogenous spread of Mycobacterium tuberculosis from a primary pulmonary focus or through the ingestion of con- taminated food, resulting in granuloma formation and ulcer- ation of the intestinal mucosa. The small intestine is the most affected, with a preference for the ileum, and symptoms may include abdominal pain, nausea, vomiting, diarrhea, weight loss, fever, and rectal bleeding, often mimicking the clinical presentation of Crohn ’s disease (CD). Systemic and pulmo- nary symptoms favor a TB diagnosis, which can be con firmed by the detection of mycobacteria and the presence of case- ating granulomas on biopsy. It is crucial to distinguish between the two diseases due to therapeutic and prognostic implications. The treatment of intestinal TB involves speci fic antimicrobial therapy with anti-tuberculosis drugs for six to nine months. In contrast, CD treatment generally includes immunosuppressive therapy, corticosteroids, and advanced therapeutic agents to control intestinal in flammation. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS44

Conclusion

Differentiating between intestinal TB and CD is challenging. Early recognition and appropriate treat- ment are essential to ensure favorable outcomes and prevent serious complications. Awareness among healthcare profes- sionals, particularly in endemic areas, is critical for effective management. Doença Inflamatória Intestinal Inflammatory Bowel Disease ID – 138313 E-poster VASCULITE LEUCOCITOCLÁSTICA CUTÂNEA ASSOCIADA A ANTI-TNF EM PACIENTE COM DOENÇA DE CROHN LEUKOCYTOCLASTIC CUTANEOUS VASCULITIS ASSOCIATED WITH ANTI-TNF IN A PATIENT WITH CROHN ’S DISEASE Janaina Giotti 1, Pedro Piassaroli de Abreu 1, Iana Faine Saran 1, Bruna Meirelles Carregaro 1, Idblan Carvalho de Albuquerque 1, Lilian Ramos Todinov 1, André Luigi Pincinato 1, Fernanda Bellotti Formiga 1 1Hospital Heliópolis Case Presentation Male, 45 years old, with Crohn ’s disease (CD) A2L1B2, underwent ileocolectomy with termi- nal ileostomy as the first treatment 12 years ago due to complications from perforation and retroperitoneal abscess. He received maintenance therapy postoperatively with inflix- imab and reconstructed intestinal transit after one year. After six years of anti-TNF use, he developed cutaneous leukocyto- clastic vasculitis (CLV). Due to pharmacodermia, the biologi- cal treatment was switched to ustekinumab. He used it for two years with a good response, but due to socioeconomic reasons, it had to be discontinued, and a new induction with anti-TNF was done. Given the previous dermatological con- dition, certolizumab pegol was chosen for being humanized and having low immunogenicity. Four years after returning to anti-TNF therapy, erythematous punctate macules, non-pru- ritic, appeared on the hands, forearms, legs, and feet. He was hospitalized with the clinical and histological diagnosis of CLV. After 30 days of treatment with corticosteroids and azathioprine, the patient showed improvement in the skin condition but later died from a nosocomial infection.

Discussion

Anti-TNF therapy optimized the manage- ment of Crohn ’s disease, providing sustained remission of symptoms. However, the use of these biological agents is not without complications, with CLV being a rare but clinically significant complication associated with its use. CLV is char- acterized by neutrophilic infiltration in the vascular wall with fragmentation of neutrophil nuclei, possibly with immune complex deposition. The result is skin lesions, such as pap- ules, purpura, and ulcers, which can progress to necrosis. The epidemiology is variable, and its pathogenesis remains un- certain. Management of these cases is based on discontinua- tion of the biological agent and treatment of the skin manifestations, usually with corticosteroids. In severe or refractory cases, additional therapies such as immunosup- pressants and other biological agents, like the anti-CD20 rituximab, may be necessary.

Conclusion

Anti-TNF-induced CLV represents a rare but potentially severe complication of biological therapy. Early recognition, accurate diagnosis, and proper manage- ment of this condition are essential to minimize complica- tions and optimize clinical outcomes for affected patients. Doenças Anorretais Anorectal Diseases ID – 138277 E-poster MULTIDISCIPLINARY APPROACH TO TOTAL RECTAL AND UTERINE PROLAPSE IN A REGIONAL HOSPITAL OF THE FEDERAL DISTRICT – CASE REPORT Quemuel Henrique Cruz Santos 1, Juliana Larissa Lauriano Ramos1, Carolina Máximo Vieira 1, Geovanna Armaldo de Sousa1, Lucas de Arruda Hidalgo 1, Mateus Fernandes de Oliveira Vilela1, Dirceu de Castro Rezende Junior 1 1Hospital Regional de Taguatinga, Brasília, Brasil Case Presentation A 74-year-old patient, G2PN1C1, denied any comorbidities, allergies, alcohol use, or smoking. She complained of uterine prolapse that started 10 years ago and rectal prolapse that began 9 years ago. She reported recurrent episodes of urinary and fecal incontinence, as well as secretions due to the prolapsed organs. On physical examination, she presented with total uterine prolapse and total rectal prolapse measuring approximately 30 cm from the anal margin. She was admitted electively to a public regional hospital in the Federal District for simultaneous management by the Gynecology and Proctology teams. The surgery was performed in three stages. In the first stage, by the Gynecology team, a vaginal hysterectomy and vaginec - tomy were performed. The second stage, by the Proctology team, consisted of an Altemeier procedure (perineal recto- sigmoidectomy), and the third stage, again by the Gynecology team, included posterior colpoperineoplasty and transobtu- rator sling placement. The procedure occurred without com- plications. The patient had a good clinical and laboratory evolution in the following days, tolerated diet well, and had normal evacuations on the second postoperative day. She was discharged for outpatient follow-up.

Discussion

Rectal prolapse has an unclear pathophys- iology, with several associated factors, and can occur at any age. 85% of patients with prolapse are women, with a much higher incidence after the age of 60, with no difference between multiparous and nulliparous women. Uterine pro- lapse is part of a condition called pelvic organ prolapse. Symptoms can occur at any age but are more signi ficant in older women, affecting up to 50% of women during this stage of life, with a peak between ages 70 and 79. The association of rectal and uterine prolapse occurs more frequently in older women and is found in a variable frequency of 16% to 27%. Both conditions share coincident etiological factors: age over 60 years, multiparity, increased intra-abdominal pressure (chronic obstructive pulmonary disease, constipation), ge- netic diseases that affect collagen or elastin (Ehlers-Danlos syndrome, joint hypermobility, Marfan syndrome), obesity, among others.

Conclusion

This clinical case describes a rare associ- ation between two conditions that compromise functionality and quality of life in affected patients. Surgical treatment and multidisciplinary care follow-up provided an advantage in the resolution of the case. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S45 Doenças Anorretais Anorectal Diseases ID – 141759 E-poster ANALYSIS OF SURGICAL TREATMENT OF ANORECTAL FISTULAS IN A SERIES OF 158 PATIENTS Laura Trotta Villar1, Mariana Trotta Villar1,S ofia Arrais Haidar1, Luna Vitória Gondim Ferreira 1, Paulo Gonçalves de Oliveira 2, Antonio Carlos Nóbrega dos Santos 2, Bruno Augusto Alves Martins2 João Batista de Sousa 1 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil

Introduction

Anorectal fistulas are abnormal pas- sages between the anal canal and the perianal skin or other adjacent structures. Most fistulas result from an infectious process in the anal glands, which can progress to an abscess and, in most cases, to a fistula. They represent about 70% of perianal diseases that require surgical treatment, with a prevalence of approximately 1 in 10,000 inhabitants per year, being more common in males. They are classi fied into four main types: intersphincteric, transsphincteric, supra- sphincteric, and extrasphincteric, according to the relation- ship between the fistula tracts and the anal sphincter muscles.

Objective

To evaluate the epidemiological profile and clinical outcomes of a series of patients undergoing surgical treatment for anorectal fistulas at a university hospital.

Methods

Analysis of 158 patients surgically treated for anorectal fistulas between February 2010 and February 2024. Patients with a confirmed diagnosis of anorectal fistula were included, excluding those with in flammatory diseases. The variables analyzed were demographic data, diagnosis, symptom onset time, type of surgical treatment and its success rates, hospitalization time, and the need for a second intervention.

Results

The average age of the patients was 41 years with a standard deviation of 11.70. Of the 158 patients, 66.45% were male. Fistulotomy was the most performed procedure, representing 77.8% of surgeries, with an average hospitalization time of less than 2 days. Only 7 patients (4.43%) required a second procedure. The higher male pre- dominance (66.45%) suggests that men may have a higher risk of developing these conditions, possibly due to anatomical or behavioral factors. In addition to fistulotomy, other proce- dures performed included fistulectomy, intersphincteric fis- tula tract ligation (LIFT), and video-assisted fistula treatment (VAFT).

Conclusion

Based on the results obtained in this series, it can be concluded that most fistulas have a crypto- glandular origin, and fistulotomy was the most commonly used treatment, showing resolution in the majority of cases. Doenças Anorretais Anorectal Diseases ID – 141647 E-poster ANALYSIS OF THE RESULTS OF ONE THOUSAND HEMORRHOIDECTOMIES PERFORMED AT A UNIVERSITY HOSPITAL Beatriz da Costa Rossi Ramos de Carvalho 1, Camille Moreira Baptista da Silva1, Luna Vitória Gondim Ferreira1, Igor Torres da Silveira Mendes1, Vanessa Siqueira Reis 2, Antonio Carlos Nobrega dos Santos 2, Bruno Augusto Alves Martins 2, João Batista de Sousa 2 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil

Introduction

Hemorrhoidal disease has a high preva- lence in the global population. Hemorrhoids are characterized by vascular structures in the anal canal, originating from the distal prolapse of arteriovenous connective tissue that drains into the superior and inferior hemorrhoidal veins. They can be classified as internal, external, and mixed, based on their location relative to the pectinate line. Internal hemorrhoids are further classified into grades I, II, III, and IV, depending on the degree of prolapse of the anal canal. Treatment ranges from behavioral modifications to surgical approaches. The two main types of conventional hemorrhoidectomy are closed hemorrhoidectomy (Ferguson) and open hemorrhoidectomy (Milligan-Morgan).

Objective

To describe the results of one thousand consecutive hemorrhoidectomies performed at a university hospital.

Methods

A retrospective study based on the analysis of electronic medical records of all patients who underwent hemorrhoidectomy from January 1991 to April 2024. The variables included were: age, sex, surgical technique, length of hospital stay, and complications associated with the surgery.

Results

A total of 1,012 patients were operated on during the analyzed period. Of these, 984 patients (97.2%) underwent the Milligan-Morgan technique, and 14 patients (1.3%) underwent the Ferguson technique. Regarding sex, 513 men (50.6%) and 499 women (49.3%) were operated on. The average age of the patients was 45.79 years. The average length of hospitalization was 1.02 days. Regarding the classi- fication of hemorrhoids, 651 were grade III, 191 were mixed, 129 were grade IV, and 41 were grade II. Of the total number of patients operated on, 53 (5.2%) experienced complications in the immediate postoperative period: 23 had urinary retention, 22 had postoperative bleeding, 5 had hemorrhoidal thrombosis, 2 had perianal abscesses, and 1 had a urinary infection. Four patients developed stenosis after healing.

Conclusion

Based on the observed results, surgical excision of hemorrhoids is an effective approach, especially for more advanced cases and those with an external component. Despite the advent of new techniques, the Milligan-Morgan procedure is still predominant at the institution analyzed in this study. The complication rates are low, with the most common being minor bleeding and urinary retention. Doenças Anorretais Anorectal Diseases ID – 138285 E-poster EPIDEMIOLOGICAL ANALYSIS AND POSTOPERATIVE EVOLUTION OF PATIENTS WITH SUPPURATIVE HIDRADENITIS IN A REFERRAL SERVICE Lucas Abreu Barreiro1, Isabela Dias Marques da Cruz 1, Flavia de Castro Ribeiro Fidelis1, Alexandre Lopes de Carvalho 1, Alana Francisca Machado Melo1, Lina Maria Goes de Codes 1 1Hospital Universitário Professor Edgard Santos, Salvador, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS46

Introduction

Hidradenitis Suppurativa (HS; from the Greek hidros = sweat and aden = glands) is a chronic inflammatory skin disease also known as inverse acne and, historically, as Verneuil ’s disease. Current consensus and guidelines highlight the bene fits of multimodal treatment, combining surgical and clinical-dermatological approaches for HS. However, there is no consensus on which surgical technique offers the greatest bene fits to these patients and reduces the recurrence rates of the disease.

Objective

To evaluate the risk factors and relevant variables in the course of Hidradenitis Suppurativa, as well as the postoperative evolution in a medical residency service in Coloproctology. Methodology A retrospective study based on data collected from medical records, including patients with HS indicated for surgical treatment, with procedures performed at the Coloproctology service of the Hospital Professor Edgard Santos/UFBA, from 2016 to 2024.

Results

A total of 17 patients were analyzed in this study, all classi fied as Hurley III, with 64.7% being male, and an average age of 45.23 years. Eleven of them had comorbid- ities associated with HS. In this sample, 35.4% had a history of smoking, and 5.88% of patients had a positive family history of the disease, with the same percentage of patients diagnosed with inflammatory bowel disease in conjunction with HS. Of the patients who underwent surgery (70% of the sample), 23% had surgery in conjunction with plastic surgery, with about 29.4% affected in other areas of the body (mainly axillas). The average hospital stay was 11.2 days, and 23.07% used special dressings. During clinical follow-up, 47% of patients had disease recurrence even after surgery, with treatment con- tinuing conservatively. About 70.5% of patients maintained multidisciplinary follow-up with dermatology, with 29.4% using immunobiologicals previously or currently, and an average follow-up time of 12.7 years from diagnosis to the present date.

Conclusion

Hidradenitis Suppurativa is a multifacto- rial disease requiring longitudinal treatment and collabora- tion across various medical specialties. The need for combined therapies promotes better postoperative outcomes and consequently better quality of life for patients with the disease. Doenças Anorretais Anorectal Diseases ID – 138168 E-poster UNCOMMON PRESENTATION OF HAILEY-HAILEY DISEASE: A CASE REPORT Thiago José Islanderson dos Santos Castro 1, Emily Cristina Arenhart Bajerski 1, Brenna Martins Barboza Santana 1, Mateus Fernandes Fagundes1, Joan de Matos Delmondes 1, Yasmin Luani Arenhart Bajerski 1, Tamires Robles 1 1Centro Maurício de Nassau, Barreiras, Brazil Case Presentation HCS, 25 years old, female, presents to the outpatient clinic with lesions in the vagina and anus, without other complaints or comorbidities. Biopsy of the lesions indicated HPV as the causative agent. She used imiquimod for 16 weeks, with improvement only of vaginal lesions. On physical examination, the anus showed multiple verrucous and whitish lesions around the anal border, ante- rior perineum, and labia majora, but no lesions in the anal canal. Topical podophyllin was prescribed in four sessions, without reduction of the lesions. A biopsy of the lesion in the left anterior region revealed acantholytic dermatosis of the entire thickness of the epithelium, associated with Pigmen- tary Incontinence – Hailey-Hailey Disease (Chronic Benign Familial Pemphigus).

Discussion

Hailey-Hailey disease is an uncommon acantholytic condition, not autoimmune, autosomal domi- nant, manifesting as erosions, plaques, fissures, vesicles, crusts, or blisters in areas of flexion (mainly axillary and inguinal). It affects young adults, with no sex preference. The clinical presentation is explained by histological changes (loss of cohesion between keratinocytes), associated with factors such as secondary infections and friction. Diagnosis is clinical and histopathological, and management involves avoiding aggravating factors (sweat and heat). Corticosteroids are used as first-line treatment, with intralesional application recom- mended for patients who do not respond to topical use. Other topical medications reported in case studies include calci- neurin inhibitors, vitamin D analogs, gentamicin, and 5% fluorouracil. Regarding systemic therapy, doxycycline for 3 months has been effective in case series. In severe or refrac - tory cases, botulinum toxin injection, anticholinergic agents, immunosuppressive or immunomodulatory therapy, and interventions such as phototherapy, radiotherapy, or surgical excision of lesions are recommended. Genetic counseling is advised for the patient. The patient described, in addition to presenting lesions in an unusual location (anal border) and associated with other HPV lesions, did not show improve- ment with imiquimod use.

Conclusion

Hailey-Hailey disease is a rare genetic disorder, but with cutaneous manifestations similar to other dermatological diseases. Histological analysis is essential for diagnosis, and studies are needed to de fine more effective management strategies. Doenças Anorretais Anorectal Diseases ID – 141710 E-poster CLINICAL AND FUNCTIONAL EVALUATION OF DIFFERENT TECHNIQUES FOR SURGICAL TREATMENT OF ANAL FISTULA Tainah Cristina Saboya de Queiroz Colares 1, Nayanne de Azevedo Frota1, Rejane Corrêa Furtado 1, Eduardo Barroso Ribeiro1, Breno Moreira Viana Mendonça Brito 1, Ricardo Everton Dias Mont ‘alverne1, Benjamin Ramos de Andrade Junior1, Adriely Oliveira Quintela 2 1Santa Casa da Misericordia de Fortaleza, Fortaleza, Brazil 2Universidade Federal do Ceará, Fortaleza, Brazil

Introduction

Anal fistulas are a common clinical condition in coloproctology practice, characterized by the formation of an abnormal communication between the anal canal and the adjacent skin. Despite signi ficant advances in surgical management, this condition remains challenging due to the high recurrence rate and the potential to cause fecal incontinence, which depend, among other factors, on the surgical technique employed.

Objectives

To analyze factors associated with postop- erative complications and clinical outcomes in patients un- dergoing fistulotomy, identifying areas for therapeutic improvement to enhance surgical prognosis. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S47

Methods

A cross-sectional study with a descriptive, quantitative, and retrospective approach. The population consists of patients who underwent fistulotomies from Janu- ary 2021 to October 2023, with postoperative follow-up until January 2024.

Results

Seventy-four patients were selected, includ- ing those who had multiple approaches, either due to recur- rence or fistulotomy with seton in multiple surgical stages. Approximately 54.05% (n=40) of the anal fistulas were trans- sphincteric, 37.83% (n=28) were intrasphincteric, 6.75% (n=5) were suprasphincteric, and 1.35% (n=1) were super ficial. All patients underwent surgery, with a single-stage fistulotomy being the most common, performed in 35 patients (47.29%), followed by fistulotomy with seton in 28 patients (37.83%), the LIFT technique in 9 patients (12.16%), punch fistulectomy in 1 patient (1.35%), and myomucosal flap advancement in 1 patient (1.35%), which was used in conjunction with the LIFT technique. During follow-up, 10.81% (n=8) had recurrence. Among those without recurrence (n=66), 6.06% (n=4) had pain, and 19.69% (n=13) presented varying degrees of fecal incontinence, of which 30.76% (n=4) had fistulotomy with seton and 69.23% (n=9) had anal fistulotomy. Patients with postoperative pain underwent analfistulotomy. Among those with recurrence, 62.5% underwent the LIFT technique.

Conclusion

Fecal incontinence complication rates were within expectations for the techniques used. However, there was a high recurrence rate with the LIFT technique, which requires further refinement by the surgical team. Anal fistulotomy and the technique associated with seton remain safe in terms of recurrence and incontinence, but larger studies on sphincter-saving techniques should be considered. Doenças Anorretais Anorectal Diseases ID – 138335 E-poster ALTMEIER SURGERY FOR CORRECTION OF TOTAL RECTAL PROLAPSE (RECTAL PROCIDENCE): PRESENTATION OF

Results

FROM A COLOPROCTOLOGY REFERRAL SERVICE Maria Luiza Marinho Vidigal 1, Sandra Di Felicci Boratto 1, Flavia Balsamo1, Sergio Henrique Couto Horta1, Raphaella Assis Alves Januario1, Marina Stroher 1, Eduardo Vidal de Holanda 1, Amanda Vitiello Pereira Brosco 1 1Faculdade de Medicina do ABC, Santo André, Brazil

Introduction

Complete rectal prolapse is character- ized by the protrusion of all layers of the rectum through the anus and is associated with the progressive loss of function of the pelvic floor structures. More common in women and the elderly, it presents risk factors such as vaginal childbirth, constipation, and pelvic muscle weakness. Surgical correc - tion is required, and the perineal technique is one of the options. Among these is the Altemeier procedure, which involves rectosigmoidectomy with transanal resection of the full thickness of the prolapse and colo-anal anastomosis.

Objective

To evaluate the surgical outcomes of patients undergoing complete rectal prolapse correction via the perineal approach using the Altemeier technique and compare the results with the literature.

Method

Retrospective observational study analyzing medical records and actively searching for patients treated with the Altemeier procedure between March 2017 and May 2024. The results were compared to existing literature.

Results

A total of 19 patients were included, aged between 42 and 92 years, with 18 females and 1 male. All patients underwent the Altemeier procedure, and in 4 cases, the procedure was associated with anal cerclage (Tiercsh technique). The size of the prolapse ranged from 5 to 17 centimeters, and the average length of hospitalization was 4.26 days. Of the immediate postoperative complications, only 1 case involved an infection of the surgical wound (at the Tiercsh stitches), no dehiscence of the colo-anal anastomosis was observed, and 1 patient developed pulmonary thrombo- embolism. In terms of early complications (30 days), 1 patient developed mild incontinence, 8 experienced soiling, 6 had constipation, and 3 complained of mild pain. On late follow- up, ranging from 3 months to 8 years, no recurrences were observed, and 5 patients died from unrelated causes.

Conclusion

In this study, no severe complications or recurrences were observed using the Altemeier technique, which proves to be a good option for correcting complete rectal prolapse. These findings align with the literature, which also reports short hospitalization times and low morbidity. Doenças Anorretais Anorectal Diseases ID – 138316 E-poster CORRECTION OF RECURRENT RECTOVAGINAL FISTULA WITH MARTIUS FLAP – CASE REPORT Cristiane Koizimi Martos Fernandes 1, Artur Duarte e Duarte 1, Larissa Dummer Saebel 1, Antônio Henrique da Gama Martin 1, Marina Barbabela Grisolia de Oliveira 2, Letícia Brandão Castro 2 1Hospital Municipal de Contagem, Contagem, Brazil 2Hospital Felicio Rocho, Belo Horizonte, Brazil Case Presentation A 53-year-old female patient, with a history of hypertension, underwent drainage of a perianal abscess in 2020. Subsequently, she developed an anterior anorectal fistula, which was corrected using the mucosal advancement technique in 2021. Afterward, the patient presented with fecaluria, and a rectovaginal fistula was diagnosed, likely of cryptoglandular etiology after the diag- nostic workup. She underwent two unsuccessful surgical attempts via transverse perineal approach in 2021 and 2022. In June 2022, another surgery was performed using a transverse incision in the perineum, which involved the resection of the fistulous tract and fibrotic edges at the anal fistula ori fice, followed by suturing in two layers with absorbable sutures. Additionally, an incision was made on the right lateral portion of the labia majora, and a Martius flap was rotated into the rectovaginal space. The posterior vaginal wall was reconstructed with simple sutures and absorbable sutures, followed by a multi-layer closure and insertion of a Portovac drain. The patient returned for follow-up visits without complaints or signs of fistula recurrence.

Discussion

Rectovaginal fistulas (RVF) are abnormal connections between the lower gastrointestinal tract and the vagina. They may result from obstetric trauma, pelvic radia- tion, Crohn ’s disease, malignancy, or an anorectal abscess. High RVFs are above the pectinate line, while “low” RVFs are those involving the vagina and anus. Symptoms include uncontrollable passage of feces and gases through the vagina. For asymptomatic RVFs, a watchful waiting approach may be sufficient. Several factors should be considered when J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS48 choosing a surgical approach, such as the number and type of previous repairs, the patient ’s risk factors, concomitant fis- tulas, and sphincter integrity. If the RVF is refractory or if the adjacent tissue is signi ficantly damaged, interposition tech- niques are often recommended. The Martius flap is particu- larly useful for patients with a thin rectovaginal septum and a history of radiation injury, with a healing rate of 79%. The use of a diversion when employing flap techniques remains controversial.

Conclusion

In this reported case, the patient with a cryptoglandular RVF and recurrent episodes achieved resolu- tion with the Martius flap technique. This case demonstrates the complexity of the technique and its signi ficant success rate. Doenças Anorretais Anorectal Diseases ID – 132900 E-poster DOENÇA DE BOWEN EM REGIÃO PERIANAL: UM RELATO DE CASO NA AMAZÔNIA LEGAL BOWEN’S DISEASE IN THE PERIANAL REGION: A CASE REPORT FROM THE LEGAL AMAZON Vinícius Sussuarana Rocha 1, Raimundo Rocha Neto 1, Vítor Augusto Ribeiro Oliveira 1, Anna Cristina Pires da Luz Dória 1, Marcos Zuqueto Farias 1, Prisco de Paiva Bezerra Segundo 1, Raimundo Nonato Ribeiro de Oliveira Júnior 1, Wanda Pereira Goes dos Santos 1 1UNIFAP, Macapá, AP, Brasil Case Presentation Patient E. G. S, female, 70 years old, sought treatment at the coloproctology service of a hospital in Macapá/AP, complaining of itching and discomfort in the perianal and coccygeal regions. During the physical exami- nation, an expansive verrucous lesion with elevated borders was identi fied, extending from the perianal region to the coccyx (superiorly) and to the gluteal region bilaterally, with an approximate diameter of 5.5 cm. Based on the clinical presentation, the decision was made to perform surgical excision of the lesion and subsequent histopathological anal- ysis. During the surgical excision, partial primary closure was performed due to tension in the area, and healing by second- ary intention was chosen. On the first postoperative day (PO), the patient complained of pain in the surgical wound area and the presence of serous secretion. However, on the second PO day, the complaints subsided, and on the third PO day, the patient was discharged without further complaints. Accord- ing to the histopathological study of the lesion, verrucous carcinoma associated with extensive “in situ ” carcinoma (Bowen’s Disease) was identi fied, with compromised lateral margins and pathological staging: pT2. Subsequently, staging was done using chest, abdominal, and cranial computed tomography (CT), all without alterations. During follow-up, the patient progressed without complaints and with total lesion remission and complete healing.

Discussion

Bowen’s disease is an in situ squamous cell carcinoma, usually asymptomatic, and commonly found in sun-exposed areas (rarely in the perianal region). It is a rare precancerous lesion that can progress to invasive carcinoma in up to 5% of cases. Symptoms include complaints such as burning, itching, and bleeding. Diagnosis is made through histopathological analysis. Treatment involves various approaches, including conventional surgery, topical therapies (such as 5-fluorouracil), and local procedures such as cauter- ization, with surgical resection with margins considered the most effective.

Conclusion

Due to being a mostly asymptomatic and slow-growing disease, a definitive diagnosis may be delayed. Additionally, when symptomatic, the lesion may resemble other conditions, such as genital warts and Paget ’s disease. Therefore, a detailed physical examination, combined with a biopsy of the lesion, is essential for the correct and de finitive diagnosis of the disease. Doenças Anorretais Anorectal Diseases ID – 141559 E-poster FISTULOTOMIA NO TRATAMENTO DA FISTULA ANAL INTER-ESFINCTERICA. O RISCO DE INCONTINÊNCIA FECAL É SIMILAR EM AMBOS OS SEXOS, APESAR DAS DIFERENÇAS ANATÔMICAS? FISTULOTOMY IN THE TREATMENT OF INTER-SPHINCTERIC ANAL FISTULA: IS THE RISK OF FECAL INCONTINENCE SIMILAR IN BOTH GENDERS, DESPITE ANATOMICAL DIFFERENCES? Sthela M. Murad-Regadas 1, William Pinheiro Boavista de Oliveira1, Francisco Sergio P . Regadas1, Francisco Sergio P . Regadas Filho1 Milena M. de Souza 1, Ricardo E. Dias Mont‘alverne1, Carlos M. Q. da Cunha 1 Victor R. Siqueira 1 1Universidade Federal do Ceará, Fortaleza, CE, Brasil

Introduction

Studies correlating sex with sphincter anatomy, the length of muscles divided afterfistulotomy (FT), and fecal incontinence (FI) are incomplete.

Objective

To evaluate the incidence of FI in patients undergoing FT to treat inter-sphincteric anal fistula and correlate symptoms, anatomical conformation of the anal canal, muscle length and percentage of divided muscles, and anal pressures, comparing genders.

Method

A prospective cohort study included patients undergoing FT distributed by sex: GI = female and GII = male. Patients were evaluated before and after complete healing (between 2-3 months) for the Cleveland Clinic Incontinence Score (CCFIS); anal canal anatomy via 3D anorectal ultra- sound (3D-US) [cm]: length of the anterior external anal sphincter (EAS); posterior EAS plus puborectal (EAS-PR); gap length (distance from the proximal edge of the anterior EAS to the proximal edge of the posterior PR); length of the anterior and posterior internal anal sphincters (IAS); length and percentage of divided IAS and divided angle; and anal pres- sures via manometry (mmHg). Groups were compared, and measurements were correlated with FI scores. The Student ’s t-test, Wilcoxon test, chi-square test, and Spearman ’s corre- lation coefficient (ρ) were used.

Results

Of the 81 patients: 35 (43%) female and 46 (57%) male. The average age, trajectory distribution, and internal opening position were similar. The muscle length is longer and the gap shorter in men (p < 0.00). Additionally, J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S49 the length of the divided IAS is greater in men (1.6 vs. 1.3/ p < 0.00), and there was a positive correlation between CCFIS and the length of the divided IAS (r = 0.41/p < 0.00). However, the percentage of divided IAS, the incidence of FI (54% vs. 50%), and the score (1.8 vs. 1.9) were similar. The maximum contraction pressure was higher in GII (p < 0.005). Resting pressure decreased when comparing before and after surgery in both groups (p < 0.05).

Conclusion

The risk of FI afterfistulotomy was similar between sexes, despite differences in the anatomical confor- mation of the anal canal, such as longer muscle length in men, associated with a greater length of the divided IAS muscle (cut) during fistulotomy. In females, the muscle length is shorter, and the divided IAS muscle is smaller, so the per- centage of divided IAS is similar in both sexes. The incidence of FI was high, with 50% of patients in both groups. However, the symptoms were mild. Doenças Anorretais Anorectal Diseases ID – 137806 E-poster FÍSTULA PERIANAL COMPLEXA COMO MANIFESTAÇÃO DA TUBERCULOSE: RELATO DE CASO COMPLEX PERIANAL FISTULA AS A MANIFESTATION OF TUBERCULOSIS: CASE REPORT Beatriz Castro de Sousa 1, Marjorye Schelle Magalhães 1, Yana Juliê Perondi1, Maria Roberta Meneguetti Seravali Ramos 1 1Hospital Municipal da Piedade,Rio de Janeiro, RJ, Brasil We present the case of a 45-year-old immunocompe- tent patient with a history of recurrent anal fistula, who underwent anal fistulectomy in two stages, with an extension of the fistula into the scrotal sac. Magnetic resonance imaging revealed an in flammatory fistulous collection occupying the posterolateral aspects of the perianal compartment extending towards the left ischioanal fat, characterizing a perianalfistula. Histopathological examination demonstrated in flammatory changes, an in filtrate of in flammatory cells, lymphocytes, plasma cells, and epithelioid cells, as well as fibrosis. During re-surgical intervention due to wound healing failure, material was collected for tuberculosis culture, which con firmed the diagnosis. Gastrointestinal tuberculosis is a rare condition, affecting less than 1% of individuals, with anorectal involve- ment being even rarer, occurring in only 1% of cases of digestive tract tuberculosis. This case emphasizes the importance of considering tuberculosis as a differential diagnosis in recurrent anal lesions or those with poor healing, especially in endemic regions with significant rates of incidence of this disease. Doenças Anorretais Anorectal Diseases ID – 141129 E-poster COMPLEX PERIANAL FISTULA DUE TO ANORECTAL TUBERCULOSIS Bárbara érnica Zeferino 1, Carlos Henrique Marques dos Santos1, Carlos Otávio da Silva Ribeiro 1, Odinilson Almeida Fonseca1, Camila Vieira Chiquetti 1 1Hospital Regional do Mato Grosso do Sul, Campo Grande, Brazil Case Presentation A 46-year-old male patient pre- sented to the coloproctology service after a perianal abscess episode, occurring three months after an infection. At the time, he had an ulcerated external opening approximately 2x2 cm at the 3 o ’clock position, with elevated and hardened edges and a small amount of purulent secretion. Colonoscopy, pelvic MRI, and biopsy of the lesion were requested. The biopsy revealed tissue consistent with a perianal fistula, showing non-caseating granulomas containing multinucle- ated giant cells and epithelioid cells, suggestive of Crohn ’s disease. A month later, the patient returned to the clinic with continued secretion and the ulcerated lesion. He also reported a history of imprisonment. A perianal fistula caused by tuberculosis was suspected, and twenty days later, a new biopsy and Xpert gene testing for /C3 Mycobacterium tuber- culosis/C3 were performed. The new biopsy con firmed the presence of a perianal fistula caused by anorectal tuberculo- sis, with low bacillary load and sensitivity to Rifampicin.

Discussion

Perianal tuberculosis is more common in men, with fistula being the most frequent symptom. A long onset period, recurrences, and a history of prior pulmonary disease suggest the diagnosis. Typical histology shows giant cell granulomas with areas of caseous necrosis; however, caseous granulomas are not always present, which compli- cates differentiation from Crohn ’s disease. Complete remis- sion of the condition is achieved with the institution of effective and targeted clinical treatment.

Conclusion

Most cases have a good outcome, but it remains a subdiagnosed condition. Therefore, it is crucial that cases like this are reported, along with their outcomes. Doenças Anorretais Anorectal Diseases ID – 138271 E-poster CAVERNOUS COLORECTAL HEMANGIOMA: A CASE REPORT Felipe Pereira Gomes 1, Ana Caroline Bohn 1, Ana Júlia Schnorr Mayer1, José Fernando Sens Junior, Júlia Wagner Guedes 1, Mauro Minol Yaedu 1Hospital Santa Isabel, São Paulo, Brazil Case Presentation A 23-year-old female patient, obese, with a history of hemorrhoidal disease since the age of 4, presented with hematochezia, chronic proctalgia, and symptomatic anemia, requiring multiple blood transfusions. Initial colonoscopy suggested active proctocolitis. Treatment for ulcerative colitis was initiated with prednisone, mesala- zine, and azathioprine, but with no improvement and normal rectal and sigmoid biopsies. A second colonoscopy revealed an extensive cavernous hemangioma from the distal sigmoid to the anal canal and hemorrhoidal plexus. An abdominoper- ineal amputation of the rectosigmoid and terminal colostomy were performed. Biopsy of the specimen con firmed the diagnosis. The patient had a good immediate postoperative recovery, and during a follow-up consultation two months J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS50 later, she showed good healing, adaptation to the ostomy, and no signs of recurrence.

Discussion

Cavernous hemangioma of the rectosig- moid is a rare benign vascular tumor, typically affecting young patients between the ages of 5 and 25. It often presents with recurrent, painless rectal bleeding. Due to its rarity, it is commonly misdiagnosed as hemorrhoids, proctocolitis, or other pathologies. Colonoscopy is essential for diagnosis, with typical findings of multiple tortuous and dilated blood vessels. Thrombosis of these vessels can lead to ischemia of the rectal wall, resembling colitis. Magnetic resonance imag- ing can aid in diagnosis and assessment of the extent of invasion of adjacent structures, the anal canal, and the sphincter. The only treatment that controls bleeding is com- plete surgical resection with preservation of the anal sphinc - ter whenever possible. Although permanent colostomy is undesirable, especially in young patients, abdominoperineal amputation of the rectosigmoid is necessary if the lesion extends to the anal canal and perineum. Non-surgical tech- niques such as sclerotherapy and selective embolization angiography can control acute bleeding and treat small lesions, but recurrence is high.

Conclusion

Colorectal cavernous hemangioma is a rare pathology, with delayed diagnosis due to its presentation being similar to more common diseases. As seen in the presented case, many young patients end up undergoing abdominoperineal amputation with irreversible ostomy. Thus, studies on alternative therapeutic approaches that preserve the anal sphincter in cases with perineal involve- ment are needed. Doenças Anorretais Anorectal Diseases ID – 138286 E-poster PERIANAL PAPILLARY HIDRADENOMA Matheus Walerio Braido Arantes 1, Gabriela Pandini 1, Fernanda Garcia de Carvalho Pereira 1, Juanita Justina Ferreira da Silva 1, Giovane Amui Fernandes 1, João Gomes Netinho 1 1Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil Case Presentation The patient is a 56-year-old white woman who presented with a painless nodule in the perianal region, which had been slowly growing for 6 months. She denies any comorbidities or family history of neoplasms. Upon examination, a cystic nodule measuring 10 /C2 20 mm was observed 3 cm from the anal margin. The patient underwent excisional biopsy of the lesion under local anes- thesia, and the histological diagnosis was papillary hidradenoma.

Discussion

Papillary hidradenoma is a rare, benign cystic tumor of apocrine glands. It typically presents as an anogenital nodule in women, most commonly between the ages of 30 and 50. Its most common location is the vulva, with rare occurrences in other regions. Perianal involvement is rare, with only around 20 reported cases in the past 20 years. Literature describes this lesion as a tumor that predominant- ly affects post-pubertal white women. Clinically, the tumor appears as a single, painless, small ( <2 cm) unilateral nodule with intact overlying skin, fibroelastic consistency, well- defined borders, and mobility; it can also be polypoid, vegetative, or cystic in nature. Symptoms in the perianal region are rare, but some cases may present with pain, burning sensation, discharge, bleeding, or pruritus. Histolog- ically, the tumor is located in the dermis, separated from the epidermis by fibrous connective tissue. There is controversy in the literature regarding the tumor’s potential to evolve into cancer. Some authors consider malignancy a possibility, while others do not. Adenomatous hyperplasia with cellular pleomorphism and irregular papillary acinar patterns with- out lumen formation raise speculations about its malignant potential; sometimes, this lesion is misdiagnosed as adeno- carcinoma. The differential diagnosis is broad, including benign lesions such as hemorrhoidal disease, anorectal ab- scess, viral warts, sebaceous cysts, lipomas, and neuro fibro- mas, as well as malignant lesions such as metastatic papillary carcinoma and squamous cell carcinoma. Excisional biopsy with margins is suf ficient for diagnosis, treatment, and cure.

Conclusion

Considering the histological diversity of the anal region, biopsy is essential for diagnostic clari fication of all unusual lesions in the perianal area. Doenças Anorretais Anorectal Diseases ID – 137489 E-poster PAPILLARY HIDRADENOMA IN THE PERIANAL REGION IN A MALE PATIENT: A CASE REPORT Larissa Ganança Buosi 1, Barbara Tannús Valadão 1, Bruna Grazielly Oliveira Silva1, Reginaldo Rodrigues Do Prado1, Ulisses Marques Cardoso 1, Mariane Tonin Jatobá 1, Mariella Furlan Carneiro1, Lívia Oliveira 1 1Hospital São Francisco, Brasília, Brazil Case Presentation Patient, E.G.S., male, 46 years old, was referred by dermatology for a right perianal nodule present for 5 months, with associated in flammatory process. He denies fever, weight loss, or pain upon palpation. On physical examination, a 1 cm verrucous nodular lesion was found, with no signs of in flammation or fistulous tract. He denies comorbidities and a history of perianal diseases. Pelvic MRI showed a 1 cm perianal nodular image with no lymph- adenopathy. He underwent excision of the lesion with mar- gins. The histopathology report con firmed papillary hidradenoma in the right perianal region, with complete excision of the lesion.

Discussion

Papillary hidradenoma is a rare and be- nign cystic tumor originating from apocrine sweat glands in the anogenital region. This tumor is more commonly found in women, with fewer occurrences in men between 30 and 45 years old. The vulva and labia majora are the most frequent sites, while it is less common in the labia minora, perineum, anal region, and extragenital areas. The vulvar occurrence is four times more frequent than perianal. It typically presents as a small, painless, mobile tumor with fibroelastic consis- tency. It can be vegetative, polypoid, or cystic in nature. Symptoms in the perianal region may include pain, burning, and itching, often related to concomitant fecal passage. Histologically, it shows a hyperplastic adenomatous pattern with clusters of glandular acini, cysts, and tubules, covered by a double layer of columnar and myoepithelial cells in the dermis. Malignant transformation is rare, and the tumor has a benign behavior with no recurrence or metastasis. Differen- tial diagnoses include external hemorrhoids, anal abscess, viral warts, and squamous cell carcinoma. It is less commonly J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S51 confused with neuro fibroma, sebaceous cysts, lipomas, or melanoma.

Conclusion

Anogenital papillary hidradenomas are uncommon tumors, and their histological and molecular profiles have been little studied. Dermatoscopic analysis of the lesion does not provide an accurate diagnosis, making proctological evaluation necessary. Local excision is the treatment of choice, and recurrence is rare, typically due to incomplete excision of the primary tumor. The limited num- ber of reports in the literature regarding male involvement, coupled with the dif ficulty in suspicion, makes this issue challenging. Due to the wide range of differential diagnoses, including both malignant and benign conditions, biopsy and histopathological examination are essential for lesions in the perianal region, enabling diagnosis and treatment. Doenças Anorretais Anorectal Diseases ID – 136547 E-poster NECROTIZING SOFT TISSUE INFECTION IN THE PERIANAL REGION: A RETROSPECTIVE STUDY AT HOSPITAL ESTADUAL ALBERTO TORRES André Figueiredo Accetta 1, Italo Accetta 2, Ronaldo Vianna Silva2, Giovanna Jurcunas de Oliveira Gaeta1, Angelica Freitas da Silva Kneipp 1, José Antonio Dias da Cunha e Silva 1, Leonardo Santos de Almeida Alves 1, Eduardo Cortez Vassallo 1 1Universidade Federal Fluminense, Niterói, Brasil 2Hospital Estadual Alberto Torres, São Gonçalo, Brasil

Introduction

Necrotizing soft tissue infection (NSTI) is a severe condition that can affect the skin, subcutaneous tissue, fascia, and muscles. It is polymicrobial and rapidly progressive, and if not recognized and treated early, it spreads to adjacent tissues with signi ficant potential for devastation and systemic impact. Other terms used include fasciitis, necrotizing fasciitis, perineal necrosis, and Fournier ’s syn- drome. Despite clinical, diagnostic, and intensive care advan- ces, it carries high morbidity and mortality rates.

Objective

To study the characteristics of patients treated for perineal NSTI.

Method

A retrospective study conducted from Janu- ary 2019 to December 2022, involving patients treated for NSTI. Data on age, gender, affected region, comorbidities, signs and symptoms, complementary exams, clinical and surgical treatment, hospitalization duration, and mortality were collected.

Results

31 patients were treated during the study period, ranging in age from 19 to 73 years, with 23 men. The genital-perineal region was the most affected (28), followed by the buttocks and sacral region (2 each). Diabetes mellitus associated with hypertension were the most common comor- bidities (14). Overweight was observed in 12 patients. Thirty patients complained of local pain, 24 had fever, and 23 presented swelling and erythema with a mass. Crepitus and discharge with skin necrosis were seen in 24 cases. Leukocytosis above 12,000 was found in 28 patients, and above 20,000 in 13. A CT scan was performed on 20 patients, with 16 showing gas in the region and four showing only local edema. All patients received antibiotics upon admission, with 26 maintaining the same regimen until treatment completion and five requiring changes or additions. Surgical debridement was performed on all patients, with three requiring colosto- my. A single debridement was sufficient in 24 cases, two were needed in six, and four in one. Cultures of secretions or tissues were done in 16 patients, with six results negative. The hospitalization period ranged from 5 to 30 days (median 14.5), with 29 patients staying more than a week, and one death was recorded.

Conclusion

NSTI constitutes a surgical emergency, with treatment based on early and extensive debridement, antibiotic therapy, and maintenance of a clean surgical wound free from necrotic tissue. Colostomy should only be performed in patients with perineal lesions who are bedridden. Doenças Anorretais Anorectal Diseases ID – 141459 E-poster ELASTIC BAND LIGATION – DATA UPDATE Blanca da Silva Martinez 1, Mariana Gonçalves Marangon 1, Raquel Prando Moura dos Reis 1, Antonio Jose Tiburcio Alves Junior1, Odorino Hideyoshi Kagohara 1, Sergio Oliva Banci 1, Cleberson Donizeti da Silva Leal 1, José Alfredo dos Reis Junior 1 1Clínica Reis Neto, Campinas, SP, Brasil

Introduction

Elastic Band Ligation is a minimally invasive procedure used to treat hemorrhoidal disease.

Objective

To demonstrate the technique and present statistical data related to Elastic Band Ligation.

Method

A prospective study followed patients with internal hemorrhoidal disease, without external hemor- rhoidal disease, of any age or sex, with postoperative fol- low-up of Elastic Band Ligation for up to 12 months. From January to December 2023, 101 patients with internal hem- orrhoidal disease, grades II and III, were treated on an outpatient basis, with the aim of addressing all areas in a single session. Technique: With the patient in Sims ’ position, local anesthesia (0.5 ml of lidocaine in the submucosal layer) was administered. Elastic Band Ligation was performed by aspirating the affected internal hemorrhoidal nipple just above the pectinate line. The procedure was carried out using a rubber band applicator device designed speci fically for this type of procedure, with a larger caliber and a wider and longer anoscope, allowing for better visualization of the anal canal. Preliminary Results The patients were followed up until July 2024, and the following complications were identi- fied: signi ficant or recurrent bleeding (8.6%), moderate to severe pain (15%), pain requiring intravenous medication (1%), tenesmus (26%), urinary retention (8.6%). After clinical follow-up of up to one year, a recurrence rate of 21% was observed. Patients with recurrence were re-treated with a new session of Elastic Band Ligation.

Conclusion

Elastic Band Ligation proved to be an efficient technique with a low recurrence rate, minimal or no discomfort during or after the procedure, in addition to being cost-effective and easy to perform. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS52 Doenças Anorretais Anorectal Diseases ID – 138276 E-poster INFERIOR MESENTERIC ARTERIOVENOUS MALFORMATION AS A DIFFERENTIAL DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE: A CASE REPORT Felipe Pereira Gomes 1, Ana Caroline Bohn 1, Ana Júlia Schnorr Mayer1, Júlia Wagner Guedes 1 1Hospital Santa Isabel, São Paulo, Brazil Case Presentation A 32-year-old woman has been under follow-up at the coloproctology outpatient clinic for 8 years due to increased frequency of bowel movements and the presence of blood and pus in the stool. She was previously diagnosed with ulcerative colitis based on colonoscopies showing mucosal fragility in the rectosigmoid and increased vascularization, with histopathology indicating mild conges- tion of the lamina propria. She was initially treated with mesalazine, and later, azathioprine, infliximab, and adalimu- mab were added, but the symptoms remained uncontrolled, requiring up to 7 units of packed red blood cells per month. In the most recent endoscopic exam, the sigmoid and rectal mucosa showed increased vascular patterns, with multiple angiodysplasias. This led to the exclusion of an in flammatory disease and the initiation of vascular investigation. Magnetic resonance angiography revealed the presence of multiplefine tortuous venous structures in the mesorectum and meso- sigmoid, with low flow, characterizing a vascular malforma- tion. These malformations were associated with marked diffuse circumferential thickening of the rectum and sigmoid, especially involving the submucosal layer. Both the angiog- raphy and arteriography failed to identify a predominant feeding artery or draining vein. Given the presence of mal- formations extending to the anal canal, the decision was made to perform an abdominoperineal amputation, with resection of the colon at the descending level and terminal colostomy. During surgery, the sigmoid appeared violet- colored, with vascular malformations visible. Histopathology confirmed an arteriovenous malformation (AVM) affecting the pericolonic adipose tissue and intestinal wall. The patient had a good recovery in both the immediate and late postop- erative periods, with no further episodes of bleeding.

Discussion

This case presents a diagnosis of an arte- riovenous malformation (AVM) originating from branches of the inferior mesenteric artery, a less frequent location for this uncommon vascular phenomenon. AVMs are high- flow vas- cular malformations that cause symptoms due to reduced tissue oxygenation. In the colon, hypoxia may lead to ischemic colitis, which is often a challenging diagnosis and can mimic inflammatory bowel disease or diverticulitis. Therefore, imag- ing exams become a crucial tool in the diagnostic investigation.

Conclusion

This case aims to highlight a rare differ- ential diagnosis that should be considered when a patient is refractory to treatment for the primary diagnosis. Doenças Anorretais Anorectal Diseases ID – 138346 E-poster THE IMPACT OF DEFECOGRAPHY MAGNETIC RESONANCE IMAGING IN CLINICAL PRACTICE Renan de Assis Pereira 1, Gilberto Bruno Costa Araújo 2, Tiago Vasques Bertoncini3, Alexandre Sérgio de Araujo Bezerra 3, Aline Martins Oliveira 1,4, Joao Batista de Sousa 3, Mayra Veloso Ayrimoraes Soares1,3,4, Layra Ribeiro de Souza Leão 1,4 1Rede DASA, São Paulo, Brasil 2D‘Or Star, São Paulo, Brasil 3Universidade de Brasilia, Brasilia, Brazil 4Hospital Sirio Libanes, São Paulo, Brazil

Introduction

Defecographic magnetic resonance im- aging is an advanced technique that plays a crucial role in diagnosing pelvic floor disorders through a dynamic study that analyzes the morphology and functionality during defe- cation. It is particularly useful in the differential diagnosis of pelvic organ prolapse, evacuation disorders, and continence issues, enabling more effective clinical and surgical approaches.

Objective

To explain the effectiveness of Defeco- graphic Magnetic Resonance Imaging in identifying pelvic floor disorders and exemplify its application in clinical prac - tice, aiming to improve the diagnosis and treatment of these conditions.

Method

A pictorial essay and analysis of clinical cases where dynamic defecography by MRI was used, comparing diagnostic results with other imaging techniques such as fluoroscopy and ultrasonography.

Results

Compared to clinical examination and other imaging methods, defecographic MRI was able to diagnose a higher proportion of patients with multi-compartmental perineal disorders. Additionally, it was more accurate than clinical examination alone in identifying pelvic organ pro- lapse and signi ficantly better in identifying cystocele, rectal prolapse, and enterocele. In patients with symptoms of pelvic floor disorders, defecographic MRI provides additional infor- mation beyond clinical examination. Therefore, it is indicated for symptomatic patients with negative clinical findings or suspected multi-compartmental pelvic floor involvement.

Conclusion

The ability to provide detailed and dy- namic visualization of pelvic structures enhances diagnostic accuracy and guides more effective therapeutic interven- tions. Wider adoption of defecographic MRI, combined with a multidisciplinary approach, is crucial for achieving better clinical outcomes. Doenças Anorretais Anorectal Diseases ID – 138132 E-poster RECTAL PROLAPSE IN A FEMALE PATIENT: CASE REPORT Vinícius da Cruz Silva 1, Jacqueline Jessica de Marchi 1, Gustavo Lima Guilherme 1, Maria Fernanda Almeida Miranda 1, Gabriely Diniz Bruno1, Gabriela Omena Silva 1, Rafael Morais Esteves de Lima1 1Universidade Federal do Mato Grosso, Cuiabá, Brazil Case Presentation A 70-year-old female patient with a history of diabetes, hypertension, dyslipidemia, and four vaginal deliveries presented with active rectal bleeding, urinary urgency, lower abdominal pain, and fecal and urinary incontinence during minor physical efforts for three years. Previous medical consultations did not resolve her J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S53 symptoms. On physical examination, rectal prolapse of ap- proximately 14 cm from the anal canal was observed. Defe- cography MRI revealed diffuse thinning of the pelvic floor muscles, an open internal anal sphincter, and an open, shortened anal canal at rest. Additionally, moderate uterine prolapse, severe perineal descent with pronounced perito- neocele and sigmoidocele, a 14 cm descent of the anorectal junction below the pubococcygeal line, and signi ficant rectal prolapse were noted. Anorectal manometry showed resting and contraction pressures below normal limits, with reduced short and ultrashort waves in the manometric trace and decreased rectal sensitivity. As part of the diagnostic workup, the patient was referred for both hysterectomy and rectopexy surgery.

Discussion

Rectal prolapse is a relatively rare and benign condition, with a prevalence of approximately 0.5% in the general population. It manifests as rectal protrusion through the anus and is more common in women of the patient’s age group. Typical symptoms include rectal bleed- ing, fecal incontinence, and lower abdominal pain. The pres- ence of rectal prolapse during physical examination aids in confirming the clinical diagnosis, supported by defecography MRI findings. In this case, surgical intervention is well- indicated. Various surgical techniques, such as Delorme ’s procedure, abdominal rectosigmoidectomy, or anal rectosig- moidectomy, may be evaluated to eliminate prolapse, correct functional abnormalities related to incontinence and consti- pation, and prevent intestinal complications. Consequently, the initial referral for gynecological surgery is reasonable, emphasizing the necessity of a holistic evaluation and con- sideration of the patient ’s comorbidities in treatment planning.

Conclusion

This case underscores the importance of a comprehensive and individualized approach to managing rectal prolapse. It highlights the need to address the condition itself alongside any comorbidities and additional factors that may in fluence disease progression and therapeutic outcomes. Doenças Anorretais Anorectal Diseases ID – 141626 E-poster TOTAL RECTAL PROLAPSE MIMICKING RECTAL TUMOR IN A YOUNG PATIENT: CASE REPORT Lara Burlamaqui Veras 1, Carolina Vannucci Vasconcelos Nogueira Diógenes1, Victor Ripardo Siqueira1, William Pinheiro Boavista de Oliveira 1, Matheus Emanuel de Brito Castelo Branco1, Thaís Barroso Vieira Costa Bon fim1, Carlos Yuri Monteiro de Paiva 1, Bruna Beatriz de Sousa Vasconcelos 1 1Universidade Federal do Ceará, Fortaleza, Brazil Case presentation A 21-year-old male patient, previ- ously healthy, presented with one year of hematochezia, anemia, and a 5 cm rectal prolapse following defecation, requiring manual reduction. He reported a 2 kg weight loss over two months with no changes in bowel habits. The patient denied comorbidities or prior surgeries but recalled an electric shock to the perineal region at age 14. Colonoscopy revealed a friable, stenotic lesion 6 cm from the anal verge (AV), obstructing 80% of the lumen and extending up to 15 cm from the AV. Biopsies showed no malignancy. Endoanal ultrasound demonstrated parietal thickening of the anorectal junction and lower rectum extending to the submucosa, occupying the entire posterior hemicircumference without sphincter involvement. The lesion was located 0.6 cm proxi- mal to the puborectal muscle and 4.4 cm from the anal margin, suggesting rectal prolapse. Dynamic studies identi- fied mucosal prolapse, anismus, and recto-rectal intussus- ception. Pelvic MRI showed diffuse, expansile thickening, occasionally with a sessile polypoid appearance, throughout the rectum to the anal canal, con fined to the muscularis propria, without pelvic lymphadenopathy. Manometry revealed resting pressure 55% below normal, voluntary pres- sure 50% below normal, preserved sustained contraction, and the presence of anismus. Considering a potential neoplastic process, laparoscopic rectosigmoidectomy with ultralow co- lorectal anastomosis was planned. Intraoperatively, marked rectal wall thickening and dilation precluded stapling, neces- sitating a perineal approach. The surgery proceeded without further complications. Histopathology revealed angiodyspla- sia, hypertrophy of the external muscularis, and fibrosis, with no evidence of malignancy.

Discussion

Rectal prolapse is the concentric protru- sion of the rectum through the anal canal, often associated with fecal incontinence, constipation, and/or hematochezia. It is most prevalent in elderly women, and its occurrence in young adults is rare, often linked to prior pelvic surgeries, which was not the case here. The treatment of choice is surgical, with abdominal approaches preferred for younger patients and perineal approaches for elderly patients at high surgical risk.

Conclusion

Given the uncommon presentation of rectal prolapse in young patients, the possibility of malignant neoplasia cannot be excluded. This consideration may in flu- ence the choice of surgical technique. Doenças Anorretais Anorectal Diseases ID – 134773 E-poster PSEUDO-STRANGULATED HEMORRHOIDS AFTER LAPAROSCOPIC RECTOSIGMOIDECTOMY Rubens Sacchettin Marçal Rigo 1, Bruna Meirelles Carregaro 1, Iana Faine Saran 1, Janaina Giotti 1, Bernardo Fontel Pompeu 1, Idblan Carvalho de Albuquerque 1, André Luigi Pincinato 1, Fernanda Bellotti Formiga 1 1Hospital Heliópolis, São Paulo, SP, Brasil Case presentation A 48-year-old male patient with mixed hemorrhoidal disease and a diagnosis of sigmoid adenocarcinoma (cT3NþM0) underwent laparoscopic recto- sigmoidectomy with a mechanical end-to-end colorectal anastomosis. On the third postoperative day, he developed abdominal distension, cessation of stool and gas passage, nausea, poor dietary tolerance, and anal discomfort. Abdom- inal X-ray revealed small bowel distension, air- fluid levels, and a coin-stacking sign. The patient subsequently experi- enced pain and hematochezia, with findings of pseudo- strangulated hemorrhoids, including necrosis of one internal hemorrhoidal cushion. Open classical hemorrhoidectomy was performed on the fourth postoperative day. The patient showed progressive improvement in abdominal distension and anal pain and was discharged on the seventh postopera- tive day. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS54

Discussion

External and internal hemorrhoidal thrombosis are complications of hemorrhoidal disease, often triggered by factors such as evacuation trauma due to chronic constipation, opioid use, diarrhea, pregnancy, local trauma, or dietary excess. Pseudo-strangulated hemorrhoids repre- sent the most severe form of internal hemorrhoidal throm- bosis, characterized by prolapse of three hemorrhoidal cushions causing edema of external hemorrhoids or skin tags, with possible ischemia or necrosis due to sphincter compression. This condition causes intense pain, hindering defecation. Several surgical techniques employing the anal region as a rectal access route (e.g., circular stapler, TEM, TAMIS, NOSE) are increasingly utilized. While anal trauma is a potential consequence of these techniques, complications such as pseudo-strangulated hemorrhoids are rare. To date, only one case of hemorrhoidal thrombosis post-TAMIS has been reported in the literature. This case highlights the occurrence of pseudo-strangulated hemorrhoids secondary to stapling in minimally invasive surgery in a patient with pre-existing hemorrhoidal disease. The complication led to postoperative ileus, required surgical intervention, and delayed hospital discharge.

Conclusion

Surgical trauma from anorectal access routes can result in hemorrhoidal thrombosis. Adequate proctological examination during the perioperative period of abdominal surgery and prompt intervention can prevent more severe complications. Doenças Anorretais Anorectal Diseases ID – 138914 E-poster RECTO-PERINEO-VAGINAL RECONSTRUCTION FOLLOWING SEVERE OBSTETRIC TRAUMA – CASE REPORT Augusto Zbonik Mendes 1, Sinara Mônica de Oliveira Leite 1, Ilson Geraldo da Silva 1, Guilherme de Almeida Santos 1, Matheus Duarte Massahud 1, Patrícia Costa Sant ‘ana1, Mario Inácio Carneiro Neto 1, Hana Jermani Coelho 1 1Santa Casa de Belo Horizonte, Belo Horizonte, Brasil Case presentation A 56-year-old female patient with fecal and gas incontinence and recurrent urinary tract infec - tions was diagnosed with a laceration of the rectum, anal sphincter, perineal body, and the distal third of the vagina. Obstetric history includes four vaginal deliveries with the use of forceps. Proctological examination revealed labiated ante- rior rectal and posterior vaginal mucosa, with a complete rupture of the musculature between these organs and rectal prolapse. Digital rectal examination showed the absence of anterior sphincteric musculature —an open ring —with com- plete hypotonia. Rectocele was present. Endoanal ultrasound confirmed the anterior sphincter injury and perineal body injury. Anorectal manometry showed decreased internal and external sphincter pressures without paradoxical contraction of the puborectal muscle. The surgery involved individualiza- tion of the vagina and rectum up to the cul-de-sac and cervix, lateral dissection of the rectum, with medial mobilization of the rectal wall, reconstruction of the posterior vaginal wall over 7 cm, longitudinal plication of the anterior rectal wall over 8 cm to correct the rectocele, reconstruction of the distal anterior rectal wall, dissection of all damaged musculature (perineal body and sphincters) as a block, and medial mobili- zation. The musculature was sutured using X stitches without tension, followed by perineal skin closure. The patient was discharged on the second postoperative day.

Discussion

Fecal incontinence (FI) has a prevalence of 15% in the population, primarily affecting multiparous and elderly women. Sphincter injuries may occur in 0.5-5% of vaginal deliveries, and 33-59% of these patients will develop FI as they age, signi ficantly impacting their quality of life. Obstetric injuries can vary and may be complex, involving different pelvic compartments, innervation, organs, and sup- porting structures, leading to a range of clinical presenta- tions. The goal of surgical intervention is to restore the damaged anatomy. The earlier the intervention, the better the results, with 40% of patients showing excellent outcomes within 5 years post-surgery. However, symptoms may recur due to changes typical of menopause. Physiotherapeutic rehabilitation is essential for better functional results.

Conclusion

Proper preparation during pregnancy is essential to prevent injuries during vaginal delivery. Postpar- tum injuries can be repaired immediately by a quali fied professional. Chronic injuries should be studied with atten- tion to the pelvic floor as a functional unit to ensure treat- ment is strategic and multidisciplinary. Doenças Anorretais Anorectal Diseases ID – 138295 E-poster MUSCULAR FLAP IN THE TREATMENT OF RECURRENT RECTOVAGINAL FISTULA – CASE REPORT Breno Xaia Martins da Costa 1, Sandro Puig Pena 1, Marina Barbabela Grisolia de Oliveira 1, Artur Duarte e Duarte 1, Letícia Brandão Castro1, Marco Rinoldi 1, Vinicius Avelar Palhares 1 1Hospital Felício Rocho, Belo Horizonte, Brazil Case Presentation A 20-year-old female patient pre- sented with a foreign body in the vagina, evolving into sepsis secondary to a complicated rectovaginal fistula. An ileostomy was performed. A pelvic MRI revealed extensive discontinuity of the posterior vaginal wall, with signs of communication with the anterior rectal wall and small, partially de fined collections. The patient underwent a new surgical treatment involving perineal reconstruction using a gracilis muscle flap.

Discussion

Rectovaginal fistulas are abnormal com- munications between the rectum and the vagina. Predispos- ing factors include trauma, in flammatory bowel disease, infection, tumors, and a history of pelvic radiation. Symptoms are characterized by the uncontrollable passage of feces and gases through the vagina. For asymptomatic patients, a peri- od of vigilant waiting may resolve the issue. When choosing a surgical approach, factors such as risk factors, previous repairs, and sphincter integrity should be considered. Inter- position techniques are well-indicated in cases of refractory fistulas or when adjacent tissue is damaged. Among these techniques, the use of the gracilis muscle has been shown to be versatile due to its easy dissection, well-defined tendinous and muscular portions, long muscle length with great con- tractile potential, and minimal morbidity at the donor site.

Conclusion

The presence of in flammation, infection, and scar tissue makes primary repair inadequate and is associated with failure in subsequent surgical procedures. Local treatments with advancement flaps or biomaterials are associated with relatively high recurrence rates, likely due to the inadequate volume of well-vascularized tissue. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S55 Reconstruction using autologous tissue interposition, such as the gracilis flap, seems more promising as it introduces healthy, vascularized tissue and creates better conditions for local healing and defect correction. Managing rectovaginal fistulas remains a challenge. Regardless of the surgical option chosen, the failure and recurrence rates remain high. Doenças Anorretais Anorectal Diseases ID – 138140 E-poster TREATMENT OF URETHRORECTAL FISTULA BY TRANSANAL ENDOSCOPIC SURGERY: STANDARDIZATION AND CRITICAL ANALYSIS Mariane Louise Quaglio Marques 1, Mirtes Okawa Essashika Nascimento1, Marley Ribeiro Feitosa1, Antonio Balestrim Filho1, Vanessa Foresto Machado 1, Rogério Sera fim Parra1, Omar Féres1, José Joaquim Ribeiro da Rocha 1 1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil Case Presentation A 56-year-old male underwent open radical prostatectomy for prostate adenocarcinoma. He developed severe peritonitis and septic shock on the 8th postoperative day due to rectal perforation. Laparotomy was performed with cavity lavage, loop colostomy, and prolonged bladder catheterization. After recovery, he developed urinary leakage through the anus. A proctological examination revealed an anterior rectal opening, 3 cm from the anal rim, 10 mm in diameter, with retraction of the adjacent mucosa. Surgical treatment for urethrorectal fistula (URF) through a transanal approach was indicated. Dissection and removal of fibrous tissue were performed, exposing the urethral and rectal openings. A layered suture was applied, interposing a submu- cosal flap from porcine small intestine between the urethral and rectal sutures. The bladder catheter was kept in place for two months and was removed after con firming complete closure of the fistula through voiding uretrocystography.

Discussion

Urethrorectal fistula (URF) is an uncom- mon condition, predominantly iatrogenic, particularly fol- lowing prostatectomy or rectal surgeries, although it may also

Result

from trauma, radiotherapy, or pelvic in flammatory processes. The standard treatment is surgical, and the ap- proach can in fluence success rates, recurrence, and the patient’s quality of life. Several approaches have been de- scribed: transanal, transperineal, transsphincteric, and trans- abdominal. Regardless of the technique, the treatment of URF must adhere to surgical principles: adequate exposure with individualized anatomical structures, removal of foreign bodies or synthetic materials, careful dissection with mini- mal trauma, well-adapted tension-free suturing in layers, use of well-vascularized flaps, urinary drainage, and prevention and treatment of infections with appropriate antibiotic use. The use of fecal diversion, before or after correction, is controversial. In the reported case, the transanal technique avoided combined abdominal approaches and provided good exposure of the surgical field, with a low risk of severe sequelae, as there was no excessive sphincter manipulation.

Conclusion

Transanal endoscopic surgery proved to be effective, with low morbidity, and should be considered for the surgical treatment of patients with urethrorectal fistula. Doenças Anorretais Anorectal Diseases ID – 138280 E-poster TREATMENT OF HEMORRHOIDAL PROLAPSE WITH MYIASIS AT A REGIONAL HOSPITAL IN THE FEDERAL DISTRICT - CASE REPORT Juliana Larissa Lauriano Ramos 1, Carolina Máximo Vieira 1, Geovanna Arnaldo de Sousa 1, Lucas de Arruda Hidalgo 1, Mateus Fernandes de Oliveira Vilela 1, Quemuel Henrique Cruz Santos1, Marccus Antônio Tolentino de Jesus 2 1Hospital Regional de Taguatinga, Taguatinga, Brasília, Brazil 2Hospital Universitário de Brasília, Brasília, Brazil Case Presentation A 53-year-old male patient, with no known comorbidities, in a vulnerable social situation, was admitted to a regional public hospital in the Federal District with complaints of bleeding, prolapsed hemorrhoids associ- ated with hemorrhoidal myiasis. On physical examination, grade IV hemorrhoidal nodules were present at 11 o ’clock and 7 o ’clock, with metaplasia in the distal third, active bleeding, and local myiasis. Antibiotic therapy was initiated, and an ivermectin dose was administered. A colonoscopy was performed, revealing a normal endoscopic examination. A biopsy was performed, showing moderate proctitis in the anal canal/distal rectum with reactive atypia, without evi- dence of high-grade dysplasia or invasive features. The pa- tient underwent a Milligan-Morgan hemorrhoidectomy on the hemorrhoidal nodules. He had a good recovery and was discharged with support from the social service for outpa- tient follow-up. Upon return evaluation, he presented with residual plicae and no fistulas on examination, with no complaints or complications.

Discussion

Hemorrhoidal disease is common and affects millions of people worldwide, representing a chal- lenge due to the uncomfortable symptoms and impact on quality of life. It is characterized by the enlargement and displacement of the anal cushions. The most common symp- tom is bleeding, and chronic increases in the effort during bowel movements can lead to prolapse. Physical examination is crucial for identifying hemorrhoids, and for patients with suspected hemorrhoidal bleeding, endoscopic evaluation may be necessary. Conservative treatment involves lifestyle changes, while instrumental and surgical treatments are reserved for severe cases. Myiasis is a parasitic disease caused by the infestation of tissue by fly larvae. It can be classified as external (cutaneous) or internal (intestinal and cavity forms) and is directly associated with low socioeconomic status.

Conclusion

The presence of myiasis associated with hemorrhoidal prolapse may be corroborated by the socioeco- nomic context present in this case. Clinical treatment, along with surgical intervention, minimized the risk of other com- plications and improved the patient ’s quality of life. Doenças Anorretais Anorectal Diseases ID – 138241 E-poster J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS56 RETRORECTAL CYSTIC TUMORS: CASE REPORT OF A TAILGUT CYST Roberta Oliveira Raimundo Borsato1, Ludymilla Ribeiro Bordoni de Oliveira1, Marcos Paulo Moraes Sales 1, Maria Clara Dias Giacomini1, Renata Sydio de Souza1, Cristiane de Souza Bechara Mota1, Bianca Andrade Borsato 2, João Victor de Miranda Avelar1 1Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil 2Centro Universitário Presidente Antônio Carlos, Juiz de Fora, MG, Brasil Woman, 34 years old, under investigation for anemia and menorrhagia. Pelvic magnetic resonance imaging revealed a multiloculated retrorectal cystic lesion, hyperintense on T2- weighted images and hypointense on T1-weighted images, with thickened walls, showing slight enhancement of the wall and septa with contrast. She underwent surgical cystectomy via the Kraske approach, during which the lesion ruptured intraoperatively, resulting in the extrusion of thick, heteroge- neous, purulent content. She had a good clinical-surgical recovery and was discharged on the 3rd postoperative day. Histopathology revealed an encapsulated, irregular, multi- loculated lesion measuring 6.8 /C2 4.5 /C2 3.0 cm, devoid of con- tent and lined with keratinizing and non-keratinizing squamous epithelium. Findings were consistent with a retro- rectal cystic hamartoma with areas of rupture, without signs of malignancy. Retrorectal space tumors can originate congeni- tally, secondary to embryological remnants, or from the degeneration of adjacent anatomical structures. In adults, these tumors are rare and predominantly benign, with a higher prevalence in middle-aged women. Most cases are asymptom- atic and diagnosed incidentally, though they can present with rectal pain, hematochezia, infection, fistulization, or malig- nant degeneration. If infected, they may be misdiagnosed as pilonidal cysts, anorectal fistulas, or recurrent retrorectal abscesses. On computed tomography or magnetic resonance imaging, they appear as well-de fined masses with heteroge- neous and multilobulated content. Findings of poorly defined margins and local invasion suggest infection or malignancy. Other features indicative of malignant degeneration include wall thickening and the presence of intracystic vegetations. Regarding management, hindgut cysts require complete sur- gical excision for pathological analysis to confirm the diagnosis and rule out malignant degeneration, which may be focal and not identified by guided biopsy. Differential diagnoses include epidermoid, dermoid, or rectal duplication cysts, mucinous perianal carcinoma, lymphangioma, and cystic teratoma. Ret- rorectal hamartomas are rare benign lesions, and histopatho- logical evaluation enables diagnosis and exclusion of malignancy. Complete surgical removal is necessary for de- tailed lesion assessment and to prevent recurrence. Doenças Anorretais Anorectal Diseases ID – 138181 E-poster USE OF MESENCHYMAL CELLS IN THE TREATMENT OF A PATIENT WITH MULTI-RECURRENT FISTULA AND SYMPTOMS OF FECAL INCONTINENCE - CASE REPORT Joaquim Tiago Cardoso Leles de Jesus 1, Lucas Azevedo Ibrahin Elmor2, Débora Alves Domingues Pereira 1, Elizabeth Madriaga Bittencourt3, Bernardo Martins dos Santos 4 1Hospital de Clínicas Nossa Senhora da Conceição, Três Rios, Brazil 2Suprema Três Rios, Três Rios, Brazil 3Hospital Central do Exército, Rio de Janeiro, Brazil 4Santa Casa de Misericórdia de Barra Mansa, Barra Mansa, Brazil Patient LPMBS, a 41-year-old female, was referred to our service with a history of multi-recurrent anal fistula. She had undergone three surgical procedures, including a con- ventional fistulotomy with seton placement, which was surgically removed after 30 days, and a ligation of the intersphincteric fistula tract (LIFT) procedure. Additionally, two ileocolonoscopies had been performed to rule out Crohn’s disease. The patient reported symptoms of urgency and rest incontinence for gas, as well as soiling due to a “keyhole defect ” caused by previous surgeries. Given her complaints, mesenchymal cell therapy was chosen as the treatment approach. The surgical procedure involved collect- ing material from the abdominal region using appropriate equipment. This material was used both to repair the fistula and to fill the “keyhole defect ” that caused her soiling complaints. The patient was discharged one day post-proce- dure. During outpatient follow-up, complete fistula healing was observed by the third week, alongside improvements in soiling and partial improvement in incontinence, with a reduction of 2 points on the Jorge-Wexner score. Fistula surgery using mesenchymal cells has proven to be a safe option for complex fistula cases, with good cure rates. Dis- cussions are ongoing regarding its use in other conditions, such as anal fissures, Crohn ’s disease, cicatricial strictures, and as a filling substance. Notably, in this case, the therapy was applied not only for fistula correction but also as a therapeutic mechanism to mitigate the damage from previ- ous procedures, yielding positive results. Thus, in addition to expanding the therapeutic arsenal for complex fistulas, this treatment may hold promise for other conditions. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 141673 E-poster SPIROCHETE-INDUCED COLITIS BY BRACHYSPIRA SPECIES ASSOCIATED WITH CHLAMYDIA MIMICKING CROHN ’S DISEASE: CASE REPORT Jorge Lima Filho 1, Glicia Estevam de Abreu 2, Paulo Andre Lago Silva3, Flora Maria Lorenzo Fortes 4 1Faculdade Santo Agostinho, Teresina, Brazil 2Escola Bahiana de Medina e Saúde Pública, Salvador, Brazil 3Coloproctology Center of Bahia, Salvador, Brazil 4Universidade Federal da Bahia, Salvador, Brazil Case Presentation We report the case of a 28-year-old man who has sex with men (MSM), with no prior history of immunodeficiency, presenting to the clinic with complaints of diarrhea with muco-bloody discharge, rectal pain, weight loss, and anorexia. Proctological examination revealed a posterior midline analfissure with a sentinel skin tag and distal proctitis but no purulent exudate. Given the clinical picture, laboratory and serological tests for sexually transmitted infections (STIs) were requested, revealing positivity only for Chlamydia. How- ever, due to the patient’s age, diarrhea, and general symptoms, endoscopic examinations were also conducted to complement the investigation. Although the initial findings from the colo- noscopy supported the suspicion of in flammatory bowel J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S57 disease (Crohn’s Disease), the histopathological study revealed colonization of the intestinal mucosa by spirochetes of the Brachyspira genus. The patient was treated with doxycycline for 21 days, resulting in the complete resolution of intestinal complaints and general symptoms.

Discussion

Intestinal spirochetosis, though rare, is a disease that can mimic in flammatory bowel disease. Its diagnosis is con firmed through histopathological examina- tion, and treatment is based on the use of antibiotics. The individuals at higher risk are immunosuppressed patients and MSM; however, it can also occur in patients without immunosuppression. Furthermore, it may be associated with another infectious agent, as demonstrated in this case, where it was linked to Chlamydia.

Conclusion

In patients, particularly MSM, presenting with diarrhea and associated general symptoms, intestinal spirochetosis should be considered as a differential diagnosis, even in the absence of immunodeficiency. It may coexist with other infectious agents that also cause intestinal symptoms, such as Chlamydia. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 137989 E-poster CHALLENGES IN THE TREATMENT OF HYPERTROPHIC HERPES IN A PATIENT LIVING WITH HIV: CASE REPORT OF CO2 LASER RESECTION Yana Juliê Perondi1, Beatriz Castro de Sousa 1, Marjorye Schelle Magalhães1, Maria Roberta Meneguetti Seravali Ramos 1 1Hospital Municipal da Piedade, Piedade, Rio de Janeiro, Brazil Cisgender man, 61 years old, living with HIV/AIDS (PLWHA), with a CD4 count of 351 cells/mm³ and undetect- able viral load, presented with multiple recurrences of peria- nal lesions caused by hypertrophic herpes. Despite oral and topical treatments, multiple surgical resections, and mainte- nance therapy with valacyclovir, the patient developed scar- ring and partial anal border stenosis. Following the latest recurrence and failure to respond to oral treatments, a CO2 laser resection was performed to prevent further complica- tions. The patient experienced faster-than-usual healing and reduced postoperative pain. Hypertrophic herpes virus infec - tion is a rare condition that poses diagnostic challenges, requiring clinical suspicion and histological con firmation, particularly to rule out squamous cell carcinoma. In PLWHA or immunocompromised individuals, atypical presentations of herpes virus, such as the hypertrophic pattern, can result in diagnostic difficulties, drug resistance, and lesion recurrence. In cases involving the perianal region, where surgical proce- dures risk causing stenosis and fecal incontinence, a combi- nation of topical and oral treatments is recommended to reduce lesions and prevent complications. CO2 laser treat- ment emerges as an effective alternative in situations where conventional topical therapies are insuf ficient, especially for large lesions or those near the anal border. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 138290 E-poster IDIOPATHIC AND RAPIDLY PROGRESSIVE PERINEAL DESTRUCTION IN A PATIENT WITH ACQUIRED IMMUNODEFICIENCY SYNDROME Artur Cury Féres 1, Mirtes Okawa Essashika Do Nascimento 1, Rodolfo Dahlem Melo 1, Thomaz Lucas Féres 2, Rogério Sera fim Parra1, Marley Ribeiro Feitosa 1, Omar Féres 1, José Joaquim Ribeiro da Rocha 1 1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil 2Centro Universitário Estácio de Ribeirão Preto, Ribeirão Preto, Brazil Case Presentation A 29-year-old man living with HIV presented to our outpatient clinic with a one-year history of a perianal nodule, hematochezia, and anal pain with discharge. Over the past six months, his condition progressively wors- ened, requiring three drainages of perianal abscesses, two fistulotomies with seton placement in the operating room, and prolonged antibiotic therapy, none of which resulted in complete healing. He developed fecal incontinence and sub- sequently underwent ileostomy creation. Since the stoma procedure, the anal lesion progressed rapidly, accompanied by refractory pain, dif ficulty sitting and walking, erectile dysfunction, and urine leakage through the perineum. The patient reported unintentional weight loss of 35 kg over one year and the development of inguinal lymphadenopathy. Proctological examination under anesthesia revealed an open pelvic cavity, the rectum opening into the perineum, the urethra transected at the prostate level, and surgical absence of the sphincter apparatus. A urinary catheter was inserted through the perineum, and multiple biopsies (in- cluding inguinal lymph nodes) were performed, though no definitive diagnosis was established. The patient was placed on systemic antibiotic therapy and received intensive care for the perineal wound, which showed partial granulation.

Discussion

The perineal region can be affected by severe and advanced malignancies or by infectious diseases that may progress to deep involvement and complete tissue destruction. Squamous cell carcinoma, although rare, has seen a global increase in incidence, particularly among individuals living with HIV, and was our primary diagnostic suspicion in this patient. In 30 –40% of cases, inguinal lymph node involvement is observed, as seen in this case. In addition to physical examination findings, biopsy is crucial for histo- logical confirmation. In this case, biopsies were inconclusive, and the treatment aimed to promote wound healing through urinary diversion, intestinal bypass, antibiotic therapy, and intensive local care.

Conclusion

The perineal region can harbor severe lesions, especially in immunocompromised patients. Even without a definitive diagnosis, prompt treatment is essential to control infection and encourage wound healing. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS58 DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 138367 E-poster HYPERTROPHIC GENITAL HERPES IN THE ANAL AND GENITAL REGION MIMICKING ANAL AND VULVAR CARCINOMA: CASE REPORT Glicia Estevam de Abreu 1, Nilma Antas Neves2, Marilia Cardoso Massoni3, Felipe Santos Marimpietri 1, Carlos Eduardo Rocha Macedo1, Antônio Vitor Martinelli Braga 1 1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil 2Universidade Federal da Bahia, Salvador, Brazil 3Centro de Coloproctologia da Bahia, Salvador, Brazil Case Presentation A 67-year-old female patient pre- sented with ulcerated, granulomatous lesions, with extensive involvement of the left vulva (approximately 4 cm) and an ulcerated lesion with granulomatous borders affecting the perianal region and anal canal, extending close to the pecti- nate line, for approximately three months. The patient was under oncological follow-up for a previously diagnosed thy- moma and had undergone chemotherapy/immunotherapy due to a recurrence of this condition. She reported prior herpetic lesions on the vulva before the appearance of the extensive granulomatous lesions on the anus and vulva, which were treated with a short course of antiviral therapy (Acyclovir). There was no history of human papillomavirus (HPV) infection or vaccination against this virus. A biopsy of the lesions on the vulva and perianal region revealed ulcerat- ed dermatovirosis caused by herpesvirus. Histopathology showed multinucleated keratinocytes with molded and ground-glass nuclei, intense chronic in flammation with un- derlying granulation tissue, and anastomosing cords of ker- atinocytes with mild nonspecific atypia and mitoses beneath the ulcer. The patient was referred for treatment with high- dose antiviral therapy for two months to achieve remission.

Discussion

Diagnosing anal and genital lesions in immunocompromised patients can be challenging, as benign conditions, such as herpes simplex virus (HSV) infections, may mimic carcinomatous lesions. Thus, in the presence of ulcerated lesions affecting the genital and anal regions, especially in immunocompromised patients, differential di- agnoses should include infectious diseases, which can be challenging to treat. Even with higher doses and prolonged courses of antiviral therapy, patients with hypertrophic herpes may exhibit therapeutic resistance, requiring alterna- tive medications or even surgical management of the lesions.

Conclusion

In the presence of vulvar and perianal lesions in immunosuppressed patients, particularly atypical lesions, differential diagnoses involving speci fic infectious agents, especially herpes simplex virus, should be considered. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 138260 E-poster PERIANAL HERPES: ATYPICAL PRESENTATION – CASE REPORT Rafaela Fonseca Falcão Hudari1, Raphaella Assis Alves Januário1, Sandra Di Felice Boratto 1, Guilherme Garcia Hudari 1, Flávia Balsamo1, Maria Luiza Marinho Vidigal 1 Eduardo Vidal de Holanda1, Marina Ströher 1 1Faculdade de Medicina do ABC, Santo André, Brazil Case Presentation A 28-year-old male sought medical attention for a painful perianal ulcer with discharge, present for 6 months. On physical examination, there was extensive, circumferential perianal ulceration with a moderate amount of fibrin. An abdominal and pelvic CT scan showed diffuse densification of the adipose and subcutaneous tissue planes without evidence offluid collection. Investigations for Crohn’s disease were initiated with a colonoscopy, revealing rectal enanthema associated withflat erosions covered byfibrin. The patient underwent a proctological examination under anes- thesia, including a perianal biopsy, which showed chronic nonspecifici n flammatory changes. Immunohistochemistry was requested, but before the patient could return for the results, he presented to the hospital with severe anemia and a deteriorating general condition. On examination, the patient had a perianal lesion and a 5x3 cm ulcerated lesion on the left hemithorax with signs of active infection, prompting consid- eration of Kaposi’s sarcoma. HIV serologies were positive, and the case was transferred to internal medicine. The patient rapidly developed acute respiratory failure and cardiac arrest, with no response to resuscitation efforts. The diagnosis of perianal ulcer was con firmed as positive for Herpes simplex types 1 and 2, and CK5/6 in immunohistochemistry during the final hospitalization.

Discussion

Genital herpes is a common sexually transmitted disease caused by the herpes simplex virus (HSV), characterized by periodic reactivation. Type 2 HSV is the most common cause of anal infection and is a risk factor for subsequent HIV infection. Both HSV types 1 and 2 can infect the anal region, causing vesicles that may appear individually or in clusters on the genitals, perineum, buttocks, upper thighs, or perianal areas, and they ulcerate before resolving. In cases of suspicion, other sexually transmitted diseases must be exclud- ed, and pathogen detection should be performed via polymer- ase chain reaction (PCR). Treatment includes antiviral medication. The lack of a characteristic clinical picture, with atypical ulcers, often delays the diagnosis and treatment.

Conclusion

Concomitant infection with HSV-2 and HIV increases the severity of HSV episodes and the likelihood of atypical presentations. This case reports a patient with an ulcer that lacked classic features, with a con firmed diagnosis for both types of herpes through polymerase chain reaction. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 137564 E-poster CHLAMYDIA TRACHOMATIS INFECTION MIMICKING SQUAMOUS CELL CARCINOMA: CASE REPORT Luísa de Rezende Cecilio Fares 1, Beatriz Gilda Jegerhorn Grinsztejn1, Sandra Wagner Cardoso1, José Ricardo Hildebrandt Coutinho1, Hugo Boechat Andrade 1, Mayara Secco Torres da Silva1, Valdiléa Gonçalves Veloso dos Santos 1, Maria Roberta Meneguetti Seravali Ramos 1 1National Institute of Infectology, Rio de Janeiro, Brazil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S59 Case Presentation A 53-year-old man who has sex with men (MSM) and is living with HIV presented with complaints of tenesmus, anal bleeding, and discharge for approximately 5 months after an unconsented receptive anal sexual encounter. He reported self-medicating with 1 gram of azithromycin, which resulted in partial symptom improvement. However, the pain worsened, and he experi- enced weight loss, prompting him to seek medical care at the proctology outpatient clinic. On proctological examination, bilateral inguinal lymphadenopathy was observed, along with a shallow ulcerated anal lesion with a fibrin-covered base, hardened consistency, and pain upon palpation. Digital rectal examination revealed mild discomfort, and anoscopy was dif ficult due to the presence of mucus in the lower rectum. A biopsy of the lesion was performed, and a swab was taken for PCR testing for chlamydia and gonorrhea. Empirical treatment with doxycycline for 21 days and ceftri- axone was initiated. After 15 days, the patient returned asymptomatic, with the histopathological result showing a dense in flammatory in filtrate with no malignancy, and PCR confirmed a chlamydia infection.

Discussion

The proctological symptoms of sexually transmitted infections (STIs) can vary and include tenesmus, mucopurulent discharge, bleeding, and the appearance of vegetative or ulcerated lesions. When untreated, these lesions can lead to complications such as proctitis and infiltrative lesions. STIs constitute a signi ficant group of conditions with a high prevalence in sexually active popula- tions and can mimic various other clinical conditions depend- ing on the symptoms presented.

Conclusion

Considering the chronicity and other characteristics of the lesion, as well as the signi ficant preva- lence of high-grade intraepithelial lesions and squamous cell carcinoma in people living with HIV, it is crucial to be vigilant about potential differential diagnoses and perform appropri- ate diagnostic procedures to initiate the correct treatment as promptly as possible. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 141628 E-poster LYMPHOGRANULOMA VENEREUM: CASE REPORT Matheus Henrique de Souza Gomes 1, Aline Costa Pinheiro 1, Marcos Paulo Barreto Saturnino 1, Mauricio José de Matos e Silva1, Thainá Lins de Figueiredo1, Ludmila Godinho da Silveira1, Fernanda Furtado Leão 1, Pedro Henrique de Souza Gomes 2 1Hospital Barão de Lucena, Recife, Brazil 2Centro Universitário do Pará, Belém, Brazil A 22-year-old male patient with no history of recep- tive anal sex presented to the coloproctology service in April 2023 with a history of diarrhea with blood since 2017, worsening in the last 6 months, and ribbon-shaped stools. On physical examination, there was thickening of the skin in the left perineum, and on rectal examination, the mucosa was hardened with stenosis that did not allow for a digital pulp insertion. He had a previous diagnosis of ulcerative colitis since 2017, with follow-up at another service, but without regular treatment or follow-up. Colonoscopy in March 2023 revealed rectal mucosa covered by fibrin, edema, enanthema, granularity, serpiginous ulcers of moderate depth, con fluent, reaching up to 4cm from the anal margin, where a concentric, hardened stenosis prevented further progression. Suspecting lymphogranuloma venereum, serological tests for other STIs were conducted, and treatment with doxycycline 100mg twice a day for 21 days was started. Due to stenosis and the impossibility of endoscopic dilation, MRI of the pelvis and barium enema were performed for case documentation, followed by laparoscopic proctectomy. The pathology report concluded that it was chronic granulomatous proctitis com- patible with lymphogranuloma venereum, with no morpho- logical criteria for in flammatory bowel disease. PCR of the specimen excluded tuberculosis. Lymphogranuloma vene- reum is an STI caused by the bacterium Chlamydia tracho- matis (serotypes L1, L2, and L3). It is commonly associated with other STIs, particularly HIV and syphilis. Diagnosis is made by detecting the bacteria in urethral or rectal secretions and by blood testing for IgM to Chlamydia. In men who have sex with men, the most common finding is proctitis with transient ulcers. Fistulas, proctalgia, and rectal discharge may also occur. Stenosis is a possible, though less common, presentation. Treatment consists of doxycycline 100mg every 12 hours for 21 days and should be initiated as early as possible to prevent chronic complications, such as rectal stenosis. All sexual partners should also be investigated to identify asymptomatic patients and interrupt the disease ’s epidemiological chain. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 138190 E-poster HUMAN MYIASIS WITH EXTENSIVE ANAL INVOLVEMENT – CASE REPORT Letícia Mayumi Tsushima 1, Kelly Danielle Silva Vieira 1 1Rede Mario Gatti, Campinas, Brazil Case Presentation A 72-year-old male patient, cir- rhotic, former alcoholic, and smoker was admitted with anal pain, purulent discharge, and fever for 3 days. The patient had poor hygiene practices, was alert, but had limited under- standing of his condition. On proctological examination, a lesion was observed in the perianal region with an abscess draining a large number of larvae. During the operation, necrotic anal borders and myiasis with a large number of larvae were identi fied. The larvae were removed, and the necrotic tissue was debrided. Antibiotic therapy and ivermec - tin were initiated. The following day, larvae continued to exit through the anal canal with feces in the wound. A sigmoi- dostomy was performed to divert the intestinal flow, along with extensive debridement of the necrotic areas in the anal region, which involved both the internal and external sphinc - ters. The patient was discharged after 6 days. He returned with poor self-care, no dressing change, feces in the surgical wound, and a collapsed colostomy, accompanied by pain and abdominal distension. Intravenous antibiotics and a new surgical intervention were indicated. During the procedure, a colostomy with fecal leakage into the subcutaneous tissue and an abscess extending to the pelvis was found. A terminal colostomy was performed. The patient was transferred to the intensive care unit post-surgery but passed away 4 days later.

Discussion

Myiasis is caused by fly larvae in the tissues of living beings. The most common location in humans is the skin, but it can also affect cavities such as the eye, ear, nostrils, anus, and vagina. Infestation is J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS60 associated with poor hygiene habits, diabetes, alcohol con- sumption, immunosuppression, psychiatric disorders, and rural populations. Diagnosis is clinical, with local pain or itching associated with the presence of larvae. Treatment involves mechanical removal of larvae, debridement of ne- crotic tissue, and therapy with ivermectin and antibiotics. In anal myiasis, intestinal diversion may be indicated, especially with extensive debridement in the anorectal region and involvement of the sphincter muscles. The stoma, commonly a loop sigmoidostomy, aids in the healing of the anal region and reduces the risk of wound infection from feces.

Conclusion

This case highlights the relationship be- tween the patient’s self-care and the onset and progression of anal myiasis. It emphasizes the need for extensive debride- ment of necrotic areas, larval removal, and the creation of an ostomy to aid in proper wound healing. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 138330 E-poster GASTROINTESTINAL PARACOCCIDIOIDOMYCOSIS IN AN ADOLESCENT: CASE REPORT Débora Lopes Gonçalves1, Ana Luiza Araújo Machado 2, Dayane Tábatha Santos Durães 1, Cristiano de Magalhães Nunes 1, Raymara Alves da Silva Mendes 1, Albanice Rodrigues de Lima 1, Kamily Evan de Castro Mendes 3 1Hospital Estadual Alberto Rassi, Goiânia, Brazil 2Universidade de Rio Verde, Rio Verde, Brazil 3Centro Universitário do Espírito Santo, Colatina, Brazil Case Presentation A 15-year-old female patient sought medical attention complaining of persistent abdominal pain, fever, diarrhea with blood, and weight loss for approxi- mately 3 months. On examination, she was pale, afebrile, and had a slightly distended abdomen. During the evaluation, colonoscopy revealed distortion and stenosis of the terminal ileum, multiple polypoid formations, ulcerations, friability in the colon, and circumferential stenosis in the rectum. Labora- tory tests revealed anemia and leukocytosis, while abdominal and thoracic CT scans suggested granulomatous infectious lymphadenopathy, inflammatory bronchopathy, and enteritis. After histopathological confirmation of paracoccidioidomyco- sis (PCM), the patient was referred for hospital treatment, which included metronidazole, amphotericin B, and itracona- zole. After 16 days, she was discharged with ongoing itraco- nazole treatment. One year later, she returned asymptomatic and is under outpatient follow-up, awaiting a new colonoscopy due to inadequate sample collection in the last test.

Discussion

Paracoccidioidomycosis (PCM), a systemic fungal infection caused by Paracoccidioides brasiliensis ,i s common in Latin America. It is transmitted by inhalation of conidia and is asymptomatic in 80% of cases, but when symptomatic, it can cause fever, cough, and dyspnea. PCM manifests in two forms: juvenile (acute/subacute) with in- volvement of the reticuloendothelial system, and adult/ chronic (90% of cases), primarily affecting the lungs. Gastro- intestinal involvement is rare, and it may mimic in flamma- tory diseases like Crohn ’s disease, with symptoms such as abdominal pain, nausea, and diarrhea. The diagnosis is made by identifying fungal elements in histopathological and mi- crobiological tests. Treatment includes systemic antifungals like amphotericin B and itraconazole.

Conclusion

This case highlights the rarity of gastroin- testinal PCM and the complexity of its diagnosis. A teenager presented with gastrointestinal PCM, a rare and challenging condition that mimicked Crohn ’s disease. The diagnosis was confirmed by biopsy, and antifungal treatment resulted in significant clinical improvement without the need for surgical intervention. The positive response to treatment underscores the importance of early diagnosis and appropriate treatment. PCM should be considered in the differential diagnosis of inflammatory bowel diseases, particularly in endemic areas. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 138283 E-poster ANAL POLYP CAUSED BY SCHISTOSOMA MANSONI EGGS Felipe Pereira Gomes 1, Ana Júlia Schnorr Mayer 1, Ana Caroline Bohn1, Júlia Wagner Guedes 1 1Hospital Santa Isabel, São Paulo, Brazil Male patient, 27 years old, from Bahia. He presents with anal pain and bleeding, evolving with worsening pain and tenesmus. On physical examination, a posterior anal fissure progressing to a hardened nodular lesion was observed. Pelvic MRI showed findings of a subcutaneous nodular lesion with- out muscular extension, solid with regular contours, located in the anorectal area, measuring 3.3x2x1.8 cm. No colonoscopy or laboratory tests were performed. An excisional biopsy revealed rectal mucosa with granulomatous polypoid inflam- mation, associated withSchistosoma mansonieggs. The patient showed improvement of symptoms at follow-up, treated with praziquantel after diagnosis. Intestinal schistosomiasis is a disease with a classic late manifestation due to egg deposition in the intestinal wall and liver, leading to portal hypertension and hepatomegaly. The acute form is less common and involves itching, cough, and abdominal pain. The most signifi- cant symptom is colitis due to egg in filtration in the submu- cosa and a foreign body reaction, which can chronically evolve into nodules, with eggs surrounded by intense granulomatous inflammation. This inflammatory infiltrate can cause necrosis, stenosis, or well-formed polyps. Rectal polyps are atypical and more commonly associated with S. mansoni ,w h i c hh a sa tropism for the rectal mucosa and is more common in the Americas. Although S. japonicum in Asia is more strongly related to polyps and cancer. About 96.4% of nodules are distal to the ascending colon, with more than 80% occurring in the rectum. Similar cases in Brazil and Yemen involve healthy patients with endemic exposure. The Brazilian case is most similar to this one, describing an anal tumor with progressive growth and pain, granulomatous and fibrotic tissue involving the eggs and central necrosis. Cases in Asia follow the same histopathology, but present with symptoms of altered bowel habits, with the lesion not being the main complaint. In both reports, patients were treated with praziquantel and showed improvement. The patient did not undergo further tests, so it is not possible to compare rectal mucosa or involvement of other locations; however, the imaging findings indicate rectal lesions as the sole manifestation. In conclusion, despite being an uncommon manifestation, both the clinical epidemiological profile and histopathology are consistent with S. mansoni infection and pseudotumoral schistosomiasis. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S61 DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 138203 E-poster CHLAMYDIA PROCTITIS: A DIAGNOSTIC CHALLENGE AT THE INTERSECTION OF STIS AND INFLAMMATORY BOWEL DISEASES – CASE REPORT AND CLINICAL CONSIDERATIONS Marjorye Schelle Magalhães 1, Beatriz Castro de Sousa 1, Maria Roberta Meneguetti Seravali Ramos 1, Yana Juliê Perondi 1 1Hospital Municipal da Piedade, Piedade, Brazil The intersection between sexually transmitted infec - tions (STIs) and gastrointestinal diseases is an emergingfield in medicine, presenting significant diagnostic challenges. In this case report, we highlight a 30-year-old man who has sex with men (MSM) and uses PrEP , who presented with complaints of anal pain, the presence of blood and mucus in the stool for three weeks. He reported the last receptive anal intercourse with a condom 60 days ago with a fixed partner. The patient had been under outpatient care in gastroenterology for treat- ment of ulcerative colitis (UC) with mesalazine, without improvement in his clinical condition. Aflexible sigmoidosco- py revealed mild distal ulcerative proctitis, and histopatholog- ical analysis showed intense active proctocolitis with ulcerations. Subsequently, an STI panel was performed, which tested positive for Chlamydia trachomatis (CT). CT infection is becoming increasingly common, especially among MSM and people living with HIV (PLHIV). Studies indicate that about 70% of chlamydia infections can go unnoticed if only urogenital tests are conducted in MSM. The typical clinical presentation of chlamydia infection usually involves cervicitis, urethritis, or can remain asymptomatic. However, in MSM who engage in anal sex, chlamydia can cause proctitis, characterized by tenesmus, hematochezia, and mucorrhea, mimicking symp- toms of inflammatory bowel diseases (IBD). Accurate diagno- sis can be challenging if a detailed sexual history is not conducted. In this context, polymerase chain reaction (PCR) plays a key role in diagnostic clari fication, allowing sensitive and specific detection in rectal samples. This case highlights the importance of considering STIs, such as chlamydia, as a possible etiology for gastrointestinal symptoms in patients with high-risk sexual behavior. A comprehensive approach that is sensitive to the patient ’s sexual history is essential to guide accurate diagnosis and management, thereby avoiding delays in treatment and associated complications. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 141732 E-poster LITERATURE REVIEW OF FLAT CONDYLOMA IN CHILDREN AND A CASE REPORT OF UNCOMMON PRESENTATION MIMICKING BUSCHKE-LÖWENSTEIN TUMOR Isabela Pereira Blanco 1, Eduardo Vidal de Holanda 1, Raphaella Assis Alves Januário 1, Sandra Di Felicci Boratto 1, Amanda Vitiello Pereira Brosco 1, Guilherme Garcia Hudari 1, Flavia Balsamo1, Rafaela Fonseca Falcão Hudari 1 1Faculdade de Medicina do ABC, Santo André, Brazil

Introduction

Syphilis is a predominantly sexually transmitted infection with increasing detection rates and a wide range of clinical manifestations. In children, acquired syphilis presents almost all the features seen in adults, and in the perianal region, a vegetating lesion, known as flat condyloma, may occur. This cutaneous manifestation is sometimes the only expression of secondary syphilis and may mimic other pathologies. A high index of suspicion is important due to its primary mode of transmission, sexual contact, especially in the context of childhood cases where sexual abuse should be considered as a hypothesis.

Objective

To identify cases of flat condyloma in children as a manifestation of secondary syphilis in the scientific literature and report an unusual presentation of this lesion mimicking Buschke-Löwenstein tumor.

Method

A literature review through a search in the PUBMED database in June 2024, using the descriptors “flat condyloma” and “child,” along with the presentation of a case report.

Results

Eight publications from 1989 to 2024 were found, showing flat condyloma as the most common manifes- tation of secondary syphilis in children and the involvement of medico-legal issues in the context of child sexual abuse. The case to be presented and compared involves a 5-year-old male patient with a pruritic, white, vegetating perianal lesion for 3 months. There was a history of similar lesions in his 9-year-old sister, 8-year-old cousin, and his mother (pregnant). The hypothesis of Buschke-Löwenstein tumor was raised, and a proctological examination under anesthesia revealed an ex- tensive, irregular, circumferential, elevated lesion, measuring 10 cm in diameter on the perianal skin and circumferential involvement of the anal canal upon rectal examination. Histo- pathological study suggested a secondary non-granulomatous lesion due to syphilis with a dense plasmocytic infiltrate in the dermis, and immunohistochemistry was negative for human papillomavirus. After treatment with crystalline penicillin, the patient progressed with a hyperchromic scar lesion and was discharged with follow-up in coloproctology and pediatrics focused on child sexual abuse.

Conclusion

The differential and accurate diagnosis of pediatric syphilis, in the face of an uncommon manifestation mimicking another pathology, is crucial for the treatment of the infection, prevention of morbidity, and identi fication of cases of child sexual abuse, prompting necessary medico- legal actions. DST e Doenças Infecto Parasitárias STIs and Infectious Parasitic Diseases ID – 138121 E-poster EPIDEMIC KAPOSI ’S SARCOMA WITH COLORECTAL INVOLVEMENT Jennyfer Kellen Lázaro da Rocha 1, Matheus Matta Machado Mafra Duque Estrada Meyer 1, Guilherme de Almeida Santos 1, Ilson Geraldo da Silva 1, Hana Jermani Coelho 1, Mário Inácio Carneiro Neto1, Augusto Zbonik Mendes 1, Marcilio José Rodrigues Lima1 1Santa Casa da Misericórdia de Belo Horizonte, Belo Horizonte, Brazil Male patient, 28 years old, admitted to the emergency department with hematochezia and weight loss. Anal inspec - tion identi fied darkened papular lesions in the perianal region, with thickening in the anal canal. A flexible J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS62 sigmoidoscopy showed mucosal erythema extending to the mid-rectum, with a nodular lesion, irregular red surface, and a diameter of 4 cm. Histopathological examination revealed an unspeci fici n flammatory nature. Subsequent diagnostic work-up confirmed HIV, and antiretroviral therapy (ART) was initiated. Immunohistochemical analysis tested positive for HHV8, CD34, and D240, suggesting Kaposi ’s sarcoma (KS). The patient developed red papules on the anterior chest, with histopathology con firming cutaneous dissemination of the disease. Pelvic MRI revealed extensive lesions in the rectum and anal canal, mesorectal and para-aortic lymphadenopa- thy. Chemotherapy was initiated alongside ART. One year after starting treatment, the patient remained stable, oligos- symptomatic, with clinical improvement of the initial condi- tion, remission of papular lesions on the skin, and a reduction in rectal lesion size. CD4 count > 600, indicating disease control. Kaposi’s sarcoma (KS) is an angioproliferative disease associated with infection by human herpesvirus 8 (HHV-8). HIV-associated KS (epidemic KS) is the most common form of disease. Since the introduction of ART, the incidence of KS has significantly decreased in HIV-positive patients. Cutaneous involvement is more common and is the usual initial presen- tation of KS. Visceral involvement frequently affects the gastrointestinal tract (GI). GI lesions may be asymptomatic or cause weight loss, abdominal pain, gastrointestinal bleed- ing, or intestinal obstruction. They are recognized on endo- scopic examination as hemorrhagic nodules, which can be isolated or con fluent, occurring in any part of the GI tract. Diagnosis should be confirmed by biopsy whenever possible. Treatment is guided by the presence or absence of symptoms. The main goals are to alleviate symptoms, prevent disease progression, and reduce tumor size. Many patients experi- ence tumor regression with ART alone. Patients with ad- vanced disease often require a combination of ART and chemotherapy. KS develops in immunosuppression, such as in AIDS. This case highlights the importance of considering this diagnosis in the presence of lesions of in flammatory nature. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141763 E-poster ENDOSCOPIC FINDINGS IN A CONSECUTIVE SERIES OF PATIENTS UNDERGOING COLONOSCOPY Luis Felipe Mendonca de Oliveira 1, Catarina Ferreira Costa Praia1, Rafaela de Melo Sprogis1, Pedro dos Anjos Freixo1, Flávia Berford Leão dos Santos Gonçalves de Oliveira2, Camila Oliveira Barbosa2, Wilmar Junio Pereira Araújo 2, João Batista de Sousa 1 1Universidade de Brasília, Brasilia, Brazil 2Hospital Universitário de Brasília, Brasília, Brazil

Introduction

Colonoscopy is an essential procedure for the surveillance, therapeutic management, screening, and diagnosis of diseases of the colon and rectum. An adequate bowel preparation is crucial for performing the procedure, which can be done either in a hospital setting or at home.

Objective

To describe the epidemiological pro file, preparation, andfindings of patients who underwent colonos- copy at a reference coloproctology service throughout 2023.

Methods

A total of 1,194 colonoscopy reports con- ducted between January and December 2023 at a reference hospital with a coloproctology residency program were ana- lyzed. The following variables were studied: age, gender, indication for the exam, preparation assessment, and exam findings.

Results

During this period, 1,194 colonoscopies were performed. The average age of the patients was 56.3 years, with a minimum of 16 years and a maximum of 87 years. Of the total patients, 801 (67%) were women, and 393 (33%) were men. Regarding the indication for the exam, 54.4% (649) were diagnostic in patients with symptoms, 23.9% (286) for screening, 19.93% (238) for surveillance, 1.5% (18) for thera- peutic purposes, and 0.2% (3) for tattooing. Regarding the preparation assessment, using the Aronchick scale, 700 (58.62%) were classi fied as good, 247 (20.68%) as fair, 177 (14.82%) as poor or insuf ficient, and 70 (5.86%) were not reported. The exams were considered normal in 34.42% of the cases. Among the abnormal findings, the most frequent were polyps (27.38%), followed by diverticulosis (20.26%), in filtra- tive lesions (8.7%), and in flammatory signs (6.28%).

Conclusion

The high number of findings in screening or surveillance exams is noteworthy. Of the exams performed for these purposes, 43.9% were for screening or surveillance, but only 34.42% of all exams were normal. The high rate of poor or inadequate preparation (14.82%) may be attributed to the fact that, in this public hospital, bowel preparation was conducted at home. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141767 E-poster ANALYSIS AND CORRELATION OF THE BOSTON AND ARONCHICK CLASSIFICATIONS IN COLONOSCOPIES Bianca Corrêa Dutra de Menezes 1, João Victor Maia Freitas 1, Kristine Leão Alarcão 1, Laura Trotta Villar 1, Vanessa Siqueira Reis2, Flávia Berford Leão dos Santos Gonçalves de Oliveira 2, Bruno Augusto Alves Martins 2, João Batista Sousa 1 1Universidade de Brasília, Brasilia, Brazil 2Hospital Universitário de Brasília, Brasília, Brazil

Introduction

The quality of bowel preparation is crucial for the success of colonoscopy and lesion detection. The Boston Bowel Preparation Scale (BBPS) and the Universal Preparation Assessment Scale (UPAS, also known as Aron- chick) are widely used for this assessment. The BBPS eval- uates three regions of the colon (right, transverse, and left), assigning scores from 0 to 3 for each, resulting in a total score between 0 and 9. The Aronchick scale, in turn, uses scores from 0 to 4. A good bowel preparation is indicated by a score of 5 or higher on the BBPS, while on the UPAS, a score of 1 or lower is considered ef ficient.

Objective

To study the correlation between the Bos- ton and Aronchick classi fications in evaluating bowel prepa- ration for colonoscopy.

Method

Data from 775 colonoscopies performed at a university hospital in 2023 were analyzed. Bowel preparation quality was assessed using both the Boston and Aronchick scales, and the correlation between them was determined.

Results

A total of 775 colonoscopy exams were per- formed, using both classifications to assess bowel preparation quality. According to the Boston scale, 733 patients (94.5%) had good preparation, while 570 patients (73.5%) had good preparation according to the Aronchick scale. The correlation analysis resulted in a Pearson coefficient of -0.809 (p< 0.001), J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S63 indicating an extremely strong and signi ficant correlation between the two scales. This suggests that both scales are highly consistent and can be used interchangeably in clinical practice.

Conclusion

Both scales can be reliably used to assess bowel preparation in colonoscopies. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 138178 E-poster APP FOR GUIDING MEDICAL PROFESSIONALS ON THE USE OF COLONOSCOPY IN COLORECTAL CANCER SCREENING: COLONOSCOPY GUIDE Joaquim Tiago Cardoso Leles de Jesus 1, Débora Alves Domingues Pereira1, Lucas Azevedo Ibrahin Elmor 2 1Hospital de Clínicas Nossa Senhora da Conceição, Três Rios, Brazil 2Suprema Três Rios, Três Rios, Brazil Colorectal Cancer has become an increasing public health issue in Brazil. Data from the National Cancer Institute shows approximately 45,630 new cases in 2023. It is the second most common type of malignant neoplasm in both men and women in the country, excluding skin cancers. Its mortality and cure rates are directly related to its detection at earlier stages. Screening can be done in different ways, with fecal occult blood tests and colonoscopy being the preferred modalities. Colonoscopy is an endoscopic method capable of providing early diagnosis and also removing precursor lesions of colorectal cancer (adenomatous polyps). It is, therefore, the diagnostic method of choice. Thus, its indica- tions and appropriate time for repetition are essential for correct screening and prevention. However, its major limita- tion is high costs and still limited availability, so its accessi- bility to the population must be carefully considered and aligned with current literature data. After conducting re- search with primary care physicians in the municipality of Três Rios, located in the state of Rio de Janeiro, through questionnaires and review of medical records, we observed a high rate of errors in the indications for colonoscopy, especially regarding follow-up after polypectomies. As a result, we developed an application (Colonoscopy Guide) available for the Android platform (and eventually iOS) that provides a simple manual for doctors, with indications for the exam, preparation guidelines, and, mainly, the recommended time for repetition, based on the results found. Among its features, it automatically provides, after the physician enters the patient ’s exam data, the recommended time for repeti- tion. The project was developed as part of the master ’s thesis of one of the authors and applied after its completion, with good results and acceptance by the professionals in the region. We hope to mitigate healthcare system costs and increase the effectiveness of colorectal cancer screening. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141205 E-poster CORRELATION BETWEEN THE PREVALENCE OF COLORECTAL POLYPS IN PATIENTS WITH AND WITHOUT A FAMILY HISTORY OF COLORECTAL CANCER Raissa Scarlet Queiroz Fernandes1, Giordano Bruno Meireles de Oliveira1, Graziela Olivia da Silva Fernandes 1, Rosilma Gorete Lima Barreto1, Nikolay Coelho da Mota1, Lucas Albuquerque de Sousa Martins 1, Maura Tarciany Coutinho Cajazeiras De Oliveira1, Gabriel Albuquerque Costa 1 1Hospital Universitário Presidente Dutra, São Luís, Brazil

Objectives

To assess the prevalence of polyps in asymptomatic patients undergoing colonoscopy for screen- ing, comparing patients with a family history of colorectal cancer to those without a family history.

Methods

A cross-sectional study was conducted on a group of individuals who underwent colonoscopy between January 2019 and April 2024. Patients were divided into two groups: Group I (without a family history of colorectal cancer) and Group II (with a family history in first-degree relatives). Demographic characteristics, colonoscopyfindings, presence, location, and histological type of polyps were evaluated and compared between the two groups.

Results

A total of 1,497 patients were evaluated, with 1,367 in Group I and 130 in Group II. Polypoid lesions were found in 550 patients (36.7%), with 506 (37%) in Group I and 44 (33.8%) in Group II. In Group I, 243 (48%) had hyperplastic polyps, 188 (37%) had adenomatous polyps (120 tubular with low-grade dysplasia, 40 tubular with high-grade dysplasia, 28 tubulovillous with high-grade dysplasia), and 75 (15%) had inflammatory polyps. In Group II, 22 (50%) had hyperplastic polyps, 20 (45.4%) had adenomatous polyps (12 tubular with low-grade dysplasia, 6 tubular with low-grade dysplasia, 4 tubulovillous with high-grade dysplasia), and 2 (4.6%) had inflammatory polyps. There was no statistically signi ficant difference between the groups (p=0.83). The prevalence of adenomas was similar in both groups (Group I = 188/37% vs Group II = 20/45.4%) (p=0.83). The distribution of patients with polyps was similar in terms of sex, with polyps found in 339 (40%) female patients and 167 (31%) male patients in Group I (p=1.00), and in 33 (37%) female patients and 11 (21%) male patients in Group II (p=1.00).

Conclusion

In this initial study, no correlation was found between the prevalence of polyps and a family history of colorectal cancer. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 138189 E-poster QUALITY CRITERIA IN COLONOSCOPY – EXPERIENCE OF A PRIVATE TERTIARY CARE CENTER Adriana Borgonovi Christiano Vieira 1, Mauro Augusto Marchiori Junior1, Maria de Lourdes Setsuko Ayrizono2, Danielle Rossana Queiroz Martins Bonilha 1 1Fundação Centro Médico de Campinas, Campinas, Brazil 2Universidade Estadual de Campinas, Campinas, Brazil

Introduction

Colorectal cancer (CRC) has seen an increase in incidence worldwide, being the third leading cause of cancer mortality in Brazil, in both sexes. The carci- nogenesis of CRC is well-known, with adenomas being the precursor lesions in approximately 70% of cases, highlighting the importance of screening programs. Colonoscopy is the J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS64 primary screening method, and quality criteria, such as the adenoma detection rate (ADR), must be met.

Objective

To analyze the effectiveness of colonoscopy exams performed at a private tertiary care service by calcu- lating the adenoma detection rate (ADR), serrated lesions, and advanced adenomas, and compare the results with the literature.

Method

This was a retrospective observational study of colonoscopy exams performed at the Centro Médico de Campinas between January 1, 2018, and January 31, 2020. The ADR and advanced adenoma detection rate (AADR) were calculated, along with adjustments for sex, age range, and the indications for the exams. Also calculated were the total polyp detection rate (PDR), the hyperplastic polyp detection rate (HPDR), and the sessile serrated polyp detection rate (SSPDR).

Results

A total of 3,686 colonoscopies were per- formed during the period, with 3,076 exams included in the analysis. The average age of the patients was 57.2 years, with the majority (53.5%) being female. Tubular adenoma was the most prevalent, found in 20% of the exams and in 62.7% of the exams with findings of any lesion. A total of 191 hyper- plastic polyps and 61 serrated adenomas were described, together accounting for a quarter of the lesions in positive exams. The PDR was 23%, with a signi ficant increase associ- ated with age (p < 0.01). The ADR was 20%, signi ficantly higher with age (p < 0.001) and higher in men (27%). The AADR was 4%, with a predominance of these in the distal segments. The HPDR was 6%, and the SSPDR was 2%.

Conclusion

The adenoma detection rate, serrated lesions, and advanced adenoma rates were comparable with those in the literature. The polyp detection rate was higher in men and signi ficantly increased with age. Tubular adenomas predominated, and distal segments of the colon were more commonly affected, with adenocarcinoma being rare. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 138319 E-poster TEACHING IN COLONOSCOPY: AN EVALUATION OF PROCEDURES PERFORMED BY RESIDENT PHYSICIANS IN THE COLOPROCTOLOGY SERVICE FROM 2021 TO 2023 AND POSSIBLE STRATEGIES FOR INTERVENTIONS Igor Reggiani Gomes 1, Hana Jermani Coelho 1, Guilherme de Almeida Santos1, Ilson Geraldo da Silva1, Jennyfer Kellen Lázaro da Rocha1, Mário Inácio Carneiro Neto 1, Diogo Viana Abreu 1, Matheus Duarte Massahud 1 1Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brazil Colorectal cancer ranks among the cancers most benefited by secondary prevention interventions. Colonos- copy, selected as the gold standard method, plays a key role in prevention and screening. Despite its complexity and depen- dence on the examiner, the absence of a standardized teach- ing system and the lack of measures to assess competency are evident. Insuf ficient training in the procedure leads to diag- nostic and therapeutic errors. This study analyzed colonos- copies performed in a coloproctology service by six resident physicians from December 2021 to June 2023. The goal was to identify potential areas for improvement and propose inter- ventions to enhance learning within the service. A total of 5,855 colonoscopies were analyzed. Female patients accounted for 59.6%, and male patients for 40.4%, with an average age of 61.4 years. The quality of bowel preparation was classified as good (Boston scores 7, 8, and 9) in 55.6%, fair (Boston score 6) in 24.4%,dd and inadequate (Boston scores 0- 5) in 20%. The cecal intubation rate was 85.3%, and the ileal intubation rate was 69.6%. However, when only the exams with good preparation quality were considered, the rates reached 94% and 80.8%, respectively. Incomplete colonosco- pies accounted for 14.2%, with inadequate preparation (81%) and technical dif ficulties (19%) as the main reasons. Indica- tions for the procedure included screening (16%), cancer follow-up (16%), lower gastrointestinal bleeding (14%), and positive fecal occult blood test (12.6%). Polypectomies were performed in 2,312 exams, with adenomas detected in 33%. Three colon perforations occurred (1/1,951). The main find- ings in the reports were diverticulosis (13.8%), endoscopically suspected neoplastic lesions (4.4%), and in flammatory dis- eases (1.8%). In the obtained results, bowel preparation effectiveness emerged as a critical factor impacting colonos- copy quality. One of the determinants for poor preparation quality was identified as the low socioeconomic status of the population served, combined with insuf ficient guidance on diet and laxative management during the appointment scheduling. It was inferred that adequate patient understand- ing of proper preparation is not always guaranteed. During the pre-examination phase, improving patient access to information is essential to ensure proper bowel preparation. It is important to encourage continuous improvement in colonoscopy teaching. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 138167 E-poster COLON SPIROCHETOSIS: A REPORT OF AN EPIDEMIOLOGICALLY DISTINCT CASE Thiago José Islanderson dos Santos Castro 1, Emily Cristina Arenhart Bajerski 1, Brenna Martins Barboza Santana 1, Fernanda Lopes Cardoso Castro 2, Kátia Rejane Marques Brito 1, Tamires Robles1 1Centro Maurício de Nassau, Barreiras, Brazil 2Faculdade Zarns, Salvador, Brasil Case Presentation WSS, a 54-year-old female, pre- sented to the outpatient clinic with complaints of abdominal pain and constipation, reporting bowel movements every 2–3 days without blood, mucus, or pus. She denied other symp- toms. The patient reported inactive Hepatitis B under moni- toring at a health center, without treatment. She denied allergies or comorbidities. Due to her symptoms and the indication for colorectal cancer screening, a colonoscopy was performed in July 2021. It revealed an in filtrative lesion in the right colon, and biopsies were taken for histopatholog- ical analysis, which indicated moderate chronic colitis with mild acute cryptitis and evidence of infection suggestive of spirochetosis. Dietary habit counseling was provided, and ciprofloxacin and metronidazole were prescribed. Follow-up included a repeat colonoscopy in October 2023, showing focal areas of erythema in the sigmoid colon interspersed with normal mucosa. During her last consultation to review biopsy results, the patient was asymptomatic, and the histopatho- logical findings revealed mild, nonspecific chronic colitis. The J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S65 approach consisted of general advice and discharge from outpatient follow-up.

Discussion

This case involves a patient with colonic spirochetosis, an infection or colonization of the colon by spirochetes, typically of the /C3 Brachyspira/C3 genus. These organisms are globally distributed and predominantly affect children, HIV-positive individuals, or those with other im- munosuppressive conditions. However, the patient did not exhibit any of these risk factors, aside from inactive HBV infection with no functional repercussions. This underscores the importance of not dismissing diagnostic hypotheses based solely on an atypical epidemiological pro file. Brachy- spira spp. are considered non-invasive, usually detected on the epithelial surface and occasionally damaging microvilli. Symptomatic cases are treated with metronidazole, with associated symptoms including chronic diarrhea (sometimes dysentery), abdominal pain, nausea, weight loss, and, in children, impaired development. Notably, this patient ini- tially presented with constipation, a symptom uncommon for colonic spirochetosis.

Conclusion

Although epidemiological analyses out- line the most common characteristics of a condition, excep- tions to the rule can occur. This case highlights the importance of maintaining diagnostic vigilance even in atyp- ical presentations. Furthermore, it emphasizes the role of preventive colonoscopy in diagnosing infections like spirochetosis. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 138266 E-poster EVALUATION OF DEXMEDETOMIDINE AS A SEDATIVE AGENT FOR COLONOSCOPY: A SYSTEMATIC REVIEW AND COMPARATIVE META-ANALYSIS Kleuber Arias Meireles Martins 1, Leonardo Januário Campos Cardoso2, Isabela Coutinho Faria1, Maria Spínola Ramos1, Filipe da Silva Barbosa 1, Mariana Menezes Corcinio 3, Maria Luiza Ferreira da Costa 4 1Centro Universitário de Belo Horizonte, Belo Horizonte, Brazil 2Universidade Federal de Minas Gerais, Belo Horizonte, Brazil 3Universidade Tiradentes, Aracaju, Brazil 4Universidade Estadual de Goiás, Goianésia, Brazil

Objectives

To compare the ef ficacy and safety of dexmedetomidine (DEX) with other sedatives (propofol, fen- tanyl, midazolam) in patients undergoing colonoscopy, he- modynamic stability, and adverse effects.

Methods

Following PRISMA guidelines, we searched PubMed, Scopus, Cochrane, and Web of Science databases for studies comparing the use of DEX with other commonly used sedative agents in colonoscopy procedures (propofol, fenta- nyl and midazolam). The primary outcome analyzed was the incidence of adverse effects, speci fically bradycardia, hypo- tension, and nausea and vomiting in both groups. Addition- ally, Heart Rate (HR) and Mean Arterial Pressure (MAP) were analyzed in the DEX group compared to the propofol and fentanyl groups 10 minutes after the onset of sedation. Risk ratios (RR) and standardized mean differences (SMD) with a 95% confidence interval (CI) were calculated using a random- effects model. The I² statistic and a leave-one-out analysis were used to assess heterogeneity.

Results

Six studies, totaling 444 patients, with 209 receiving DEX, were included. The analysis revealed that the incidence of hypotension was similar between the two groups (RR=1.88; 95%CI: 0.65 - 5.67, p=0.25; I²=55%), such as the occurrence of nausea and vomiting (RR=1.57; 95%CI: 0.27 - 9.06, p=0.61; I²=61%). However, the use of DEX as a sedative agent was associated with a signi ficantly higher incidence of bradycardia (RR=2.76; 95% CI: 1.41 - 5.40, p < 0.01; I²=0%). Regarding MAP 10 minutes after the onset of the procedure, no differences were observed when compared to fentanyl (SMD= -0.04; 95% CI: -0.35 - 0.27, p=0.78; I²=0%) or propofol (SMD= -0.30; 95% CI: -0.71 - 0.11, p=0.15; I²=33%). Finally, the analysis of HR revealed a signi ficant difference between the DEX group and the propofol group (SMD= -1.31; 95% CI: -1.90 - 0.71, p < 0.01; I²=60%), but no difference was observed when compared to the fentanyl one (SMD= 0.12; 95% CI: -0.32 - 0.56, p=0.58; I²=48%).

Conclusion

DEX demonstrates ef ficacy and safety comparable to other sedatives in colonoscopy, with similar incidences of hypotension and nausea/vomiting, but a higher risk of bradycardia. While no signi ficant differences were observed in MAP compared to fentanyl or propofol, there was a significant difference in HR compared to propofol, but not with fentanyl. These findings suggest that dexmedetomidine may offer effective sedation for colonoscopy, but clinicians should be vigilant for potential bradycardia. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141482 E-poster EXPERIENCE WITH ENDOSCOPIC TREATMENT OF COLORECTAL ANASTOMOTIC DEHISCENCE: CASE REPORT AND LITERATURE REVIEW Amanda Cristine Pereira de Amorim 1, Isabella Resende Martins1, Valéria Vieira da Silva Coutinho1, Bruno Barros Britto1 1Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo, Brazil Case Presentation A 71-year-old man underwent a rectosigmoidectomy for adenocarcinoma of the upper rectum with primary anastomosis 4 cm from the anal verge, protective ileostomy, and prophylactic cavity drainage. On the 5th post- operative day, he developed a semicircular anastomotic dehis- cence without signs of peritonitis or sepsis. Conservative treatment was chosen with antibiotics and maintenance of the cavity drain, which was well-positioned and draining purulent fluid. Clinical improvement allowed discharge on the 14th postoperative day, with the cavity drain still in place. Two months later, a follow-up colonoscopy revealed a patent anastomosis with a 1-cm fistulous opening communicating with a 3-cm cavity, through which the tubulolaminar drain was visible. Extraluminal vacuum therapy with an 18Fr endo- sponge was applied, later replaced by a double-tube system. After two weeks and three exchanges, the fistulous opening and tract were obliterated. Two weeks later, the ileostomy was closed with good postoperative recovery and discharge on the 3rd day. The patient subsequently presented with regular bowel movements and good continence.

Discussion

Anastomotic fistula is the main complica- tion of colorectal surgeries, occurring in up to 15-20% of cases, and is associated with significant morbidity. In stable patients with extraperitoneal anastomoses, particularly those with a J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS66 pre-existing diversion stoma, minimally invasive treatments aimed at preserving the anastomosis are highly desirable. Endoscopic therapies, including stents, fibrin glue, clips, double pigtail catheter drainage, and, more recently, vacuum therapy, are noteworthy. Vacuum therapy works by removing fluids, reducing edema and bacterial load, increasing blood flow, and stimulating granulation tissue. The average treat- ment duration ranges from 35 to 60 days, requiring multiple dressing changes, which can be made with sponges or a double-tube structure, with or without substance instilla- tion. Early intervention is associated with better outcomes.

Conclusion

Early consideration of endoscopic vacuum therapy can increase the resolution rates of colorectal fistulas with shorter treatment durations, reducing reoperation rates and permanent stomas. However, high costs, prolonged treat- ment times, and the availability of trained professionals remain limiting factors in the widespread use of this technique. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141768 E-poster INFLUENCE OF LATERALITY ON THE ENDOSCOPIC AND HISTOPATHOLOGICAL CHARACTERISTICS OF PREMALIGNANT COLON LESIONS IN WOMEN AGED 60 YEARS AND OLDER Rafaela de Melo Sprogis 1, Vanessa Siqueira Reis 1, Catarina Ferreira Costa Praia 1, Luís Felipe Mendonça de Oliveira 1, Flavia Berford Leão dos Santos Gonçalves de Oliveira2, Camila Oliveira Barbosa2, Bruno Augusto Alves Martins2, João Batista de Sousa1 1Universidade de Brasília, Brasilia, Brazil 2Hospital Universitário de Brasília, Brasília, Brazil

Introduction

The laterality of colon tumors in fluen- ces clinical presentation and prognosis. These tumors often originate from premalignant lesions, which can be identi fied and characterized through colonoscopy and biopsy.

Objective

To analyze the influence of laterality on the endoscopic and histopathological characteristics of prema- lignant colon lesions in women aged 60 years and older.

Method

A retrospective, cross-sectional study of 4,412 consecutive colonoscopies performed in the coloproctology department of a university hospital between January 2019 and December 2023. The sample was limited to women aged 60 years and older, without previous intestinal resection, who underwent complete colonoscopies, presented with polyps during the examination, and whose histopathological analysis was conducted in the same service, totaling 262 patients. Each polyp found was individually analyzed for location, morpholo- gy, size, and histopathology. Polyps located at or distal to the splenic flexure were classified as left colon (LC), while those proximal to the splenic flexure were classified as right colon (RC). Statistical analysis was performed using Fisher’s exact test and Chi-square test, with laterality as the dependent variable.

Results

A total of 510 polyps resected from the 262 patients were analyzed. Regarding location, 282 (55.3%) were in the LC, and 228 were in the RC. Morphologically, 234 (88%) of the LC polyps were sessile, while 208 (93.3%) in the RC had the same characteristic (p = 0.087). Polyps larger than 5 mm were observed in 45 (16.4%) cases in the LC and 39 (17.2%) in the RC (p = 0.901). In the LC, 135 (47.9%) polyps were histopathologically classified as hyperplastic, 109 (38.7%) as tubular adenomas, 23 (8.2%) as tubulovillous adenomas, and 6 (2.1%) as serrated adenomas. In the RC, 167 (73.2%) were classified as tubular adenomas, 33 (14.5%) as hyperplastic polyps, 15 (6.6%) as tubulovillous adenomas, and 8 (3.5%) as serrated adenomas (p < 0.001). Dysplasia was absent in 142 LC polyps (51.1%) and in 40 RC polyps (17.5%) (p < 0.001).

Conclusion

The RC was associated with a higher prevalence of tubular and serrated adenomas, while the LC was linked to hyperplastic polyps and the absence of dysplasia. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141846 E-poster ARTIFICIAL INTELLIGENCE AND CAPSULE COLONOSCOPY: AUTOMATIC ASSESSMENT OF INTESTINAL PREPARATION SCORES/DEGREE Joana Mota1,2, Miguel José Mascarenhas Saraiva 1,2,3, João Afonso1,2 Tiago Ribeiro1,2, Pedro Cardoso1,2, Miguel Martins1,2, Guilherme Macedo1,2,3 1Centro Hospitalar Universitário São João, Porto, Portugal 2Centro de Treino WGO, Porto, Portugal 3Faculdade de Medicina Universidade do Porto, Porto, Portugal

Introduction

Medicine is evolving toward increas- ingly less invasive diagnostic modalities, with Gastroenterol- ogy being a prime example of this trend. The diagnostic assessment of the colon using capsule endoscopy, through specific protocols for colon capsule endoscopy or as part of panendoscopic evaluations, has gained growing importance as a first-line diagnostic method. Proper bowel preparation is essential for conclusive examinations, given the non-invasive nature of capsule endoscopy —which does not allow for interventional measures to improve mucosal visibility. Sev- eral scales have already been developed to classify bowel preparation for colon capsule endoscopy. However, their applicability is limited by inter-observer variability.

Objective

The aim of this study was to develop a deep- learning algorithm for the automatic classi fication of colon bowel preparation.

Results

The algorithm achieved highly satisfactory results, with sensitivity, speci ficity, and diagnostic accuracy of 91%, 97%, and 95%, respectively. The area under the curve ranged from 0.92 to 0.97.

Conclusion

This study is pivotal for the future wide- spread use of capsule endoscopy in colon evaluation and for minimally invasive panendoscopic modalities. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 137754 E-poster THE USE OF 4% FORMALIN SOLUTION FOR THE TREATMENT OF HEMORRHAGIC ACTINIC PROCTITIS: EXPERIENCE OF THE SERVICE Maycon Lucas de Souza 1, Bruna Lima Daher 1, Karla Cristina Cintra Mendes1, Matheus Lucas de Souza 1, Vanessa Bernardes Daniel1, Leonardo Mundim Andrade Porto1, Felipe Poli Leonel1, Eduardo Reinaldo Silva1 1Santa Casa de Misericórdia de Franca, Franca, Brazil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S67

Introduction

Actinic proctitis due to radiation thera- py for pelvic neoplasms is a common complication. Among therapeutic options, the use of formalin solution is an effec - tive and low-cost alternative.

Objective

To report the service ’s experience in treat- ing hemorrhagic actinic proctitis post-prostate neoplasia with intra-rectal 4% formalin application. Case 1: FA, an 88- year-old male, underwent radiotherapy 24 months ago and was admitted for acute exacerbation of chronic rectal bleed- ing and symptomatic anemia (Hb=5.5). In a previous hospi- talization, a colonoscopy with argon plasma coagulation and rectal sucralfate was performed. A subsequent examination revealed submucosal telangiectasias with active bleeding and ulcerations on the anterior rectal wall due to prior argon use. The treatment of choice was the intra-rectal 4% formalin application, following the Teixeira method: rectal instillation via a catheter inserted into the colonoscope over the affected area. A total of 500 ml of 4% formalin was used in aliquots of 50 ml, with each aliquot remaining in contact with the mucosa for 1 minute, followed by washing with 100 ml of saline solution, aspiration of the residual liquid, and repeated application (10 times). Between applications, cleaning of the anal border was performed to prevent skin lesions. There was remission of bleeding during follow-up, without the need for further procedures. Case 2: FBP, an 80-year-old male, under- went radiotherapy 19 months ago and was admitted with rectal bleeding and anemia (Hb=7). He was hospitalized for hemorrhagic actinic proctitis and experienced recurrence of bleeding weeks after the use of argon. The decision was made to use 4% formalin under the previously described technique. He evolved with remission of bleeding and hematimetric stability, leading to hospital discharge. Two weeks later, he reported sporadic bleeding, and a new rectosigmoidoscopy showed circumferential fibrinous ulceration (eschar from previous formalin instillation), without active bleeding.

Conclusion

Among various therapies for hemorrhag- ic actinic proctitis, argon plasma coagulation is the most effective, although it is less available, more costly, and carries the risk of complications. Evidence shows positive results with intra-rectal 4% formalin, and our experience has been satisfactory. This method offers low cost and wide availabili- ty, making it an effective option for refractory cases and a first-choice treatment in hospitals lacking other therapeutic resources. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141373 E-poster ORGANIZED COLORECTAL CANCER SCREENING IN HEALTHCARE WORKERS: POSITIVITY OF IMMUNOHISTOCHEMICAL AND IMMUNOCHROMATOGRAPHIC FECAL TESTS FOLLOWED BY COLONOSCOPY Júlia Lucila de Moura 1, John Anibal Tapia Baca1, Marcio Roberto Facanali Junior1, Isabella Nicacio de Freitas 1, Afonso Henrique da Silva e Sousa Júnior 1, Carlos Frederico Sparapan Marques 1, Adriana Vaz Safatle-Ribeiro 1, Amanda Cristina Lopes Atui 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

Introduction

Given the increasing incidence of colo- rectal cancer, prevention programs and strategies that in- clude screening for occult blood in feces, either through quantitative fecal immunochemical testing (FIT) or qualita- tive immunochromatographic fecal testing (ICT), followed by colonoscopy, are being applied to detect lesions. FIT is an anti- globulin test with high specificity, while ICT can detect blood from the entire gastrointestinal tract.

Objective

To evaluate the positivity rate of fecal tests and the adenoma detection rate (ADR) and colorectal cancer (CRC) detection rate in patients who tested positive.

Methods

A cross-sectional, analytical, and single- center study. During the organized CRC screening of health- care workers at a reference hospital in the Coloproctology service between April 2021 and June 2024, the positivity rates of FIT and ICT were evaluated. Patients with positive tests were referred for colonoscopy, and adenoma and CRC detection rates were assessed.

Results

Of a total of 6679 healthcare workers aged 50 to 75 years, 4048 (56%) underwent testing, of which 230 (5.7%) were positive, indicating the need for colonoscopy. Using a cutoff value of 50 ng/mL, the positivity rate for FIT was 8%, and for ICT, it was 3%, a difference that could represent a significant loss of patients when using the qualitative test. Of the 230 positive individuals, 156 underwent colonoscopy (67.8%). Of these, 129 (82.7%) used FIT and 27 (17.3%) used ICT. The adenoma detection rate was 58.1% for FIT and 55.5% for ICT. In patients who underwent FIT, 6 serrated lesions, 75 adenomas (74 low-grade, 6 high-grade), and 4 neoplasms (1 neuroendocrine, 3 adenocarcinomas) were found. In patients who underwent ICT, 4 serrated lesions, 16 adenomas (15 low- grade, 1 high-grade), and no neoplasms were found.

Conclusion

1. The results showed higher positivity for FIT compared to ICT. 2. The adenoma detection rate was similar for both tests. 3. Despite the difference in the number of tests, CRC was diagnosed only in the FIT group. 4. In an asymptomatic, average-risk population, occult blood testing followed by colonoscopy is an essential strategy for diagnos- ing precursor and advanced colorectal lesions. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141720 E-poster ENCAPSULATED RETROPERITONEAL PNEUMOPERITONEUM AFTER MUCOSECTOMY FOR LST - CASE REPORT Rejane Corrêa Furtado 1, Alisson Cordeiro Moreira 1, Gabriel Lopes Ponte Prado 1, Ramiro Rolim Neto 1, Tainah Cristina Saboya de Queiroz Colares 1, Breno Moreira Viana Mendonça Brito1, Eduardo Barroso Ribeiro 1 Benjamin Ramos de Andrade Júnior1 1Santa Casa da Misericórdia de Fortaleza, Fortaleza, Brasil Case Presentation A 40-year-old female patient with no prior comorbidities, in good nutritional status, underwent a screening colonoscopy due to a family history of colorectal cancer. An LST (laterally spreading tumor) was found in the ascending colon, near the cecum. The lesion was elevated with saline solution and endoscopic mucosal resection (EMR) was performed using a diathermic loop in a piecemeal fashion, without complications during the procedure. On the 15th post-procedure day, the patient developed an in- crease in abdominal volume in the hypogastric region, which was painless. She did not present with fever, leukocytosis, or any systemic or intestinal symptoms, but had a signi ficant J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS68 abdominal bulging with a palpable mass. A CT scan revealed an expansile formation with thin walls and gas content in the right iliac fossa, medial to the ascending colon, causing an impression on the abdominal wall. After no resolution with conservative treatment, the patient underwent a videola- paroscopy on the 20th day post-mucosectomy, which revealed a loculated retroperitoneal pneumoperitoneum, with no apparent perforation or colon injury. A puncture was performed on the bulging area, releasing a signi ficant amount of gas, with no signs of enteric fluid or feces, and the posterior peritoneum was opened by approximately 1 cm, where the gas encapsulation was located. On the 15th post- operative day following VLP (videolaparoscopy), the patient returned to the outpatient clinic with a similar painless abdominal volume increase, and imaging studies showed compatible findings. A decision was made for a laparotomy through a transumbilical incision, with findings similar to the previous VLP: a large encapsulated retroperitoneal pneumo- peritoneum with only gas inside, again with no apparent perforation or colon injury. A careful and extensive dissection of the peritoneal wall was carried out, and the cavity was drained. The patient progressed well, with resolution of the condition and late post-operative imaging showing no signif- icant findings. The pathological examination of the LST confirmed it as a tubular-villous adenoma.

Discussion

Endoscopic mucosal resection (EMR) is a procedure used to remove early-stage precancerous lesions or other abnormal tissues from the gastrointestinal tract. Mucosectomy for LST is a safe and effective technique for treating sessile and flat lesions in the colon, with low recur- rence or complication rates, though it occasionally results in piecemeal excision for larger lesions. This case represents a peculiar and atypical post-mucosectomy complication, with few similar cases described in the literature. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141778 E-poster KLIPPEL-TRENAUNAY SYNDROME: CASE REPORT Matheus Henrique de Souza Gomes 1, Paulo Mozart de Barros 1, Maurício José de Matos e Silva 1, Amanda Casagrande Dias 1, Eloisa Barbosa Brum 1, Bruna Bittencourt de Amorim 1, Alessandro Soares Rodrigues 2, Kauê Magalhães Castro dos Santos2 1Hospital Barão de Lucena, Recife, Brazil 2Universidade Federal do Amapá, Macapá, Brazil Klippel-Trenaunay Syndrome (KTS) is a rare condition characterized by vascular malformations and tissue hyper- trophy. This report describes the case of a 24-year-old male patient diagnosed in childhood, with constant mild rectal bleeding, who underwent sclerotherapy at the age of 8 with no significant improvement. Other conditions were ruled out. The patient continued the annual follow-up with colonosco- pies for eight years. In 2015, the examination revealed vascular lesions with ulcerations in the distal and mid- rectum, as well as a hemangioma in the upper segment, indicating rectal involvement by KTS. In 2020, the patient reported worsening bleeding and rectal pain but managed the condition with analgesics due to the COVID-19 pandemic. In 2023, an ileocolonoscopy detected a friable lesion 2 cm from the anal margin, extending 8 cm, and a biopsy revealed a hyperplastic polyp. In 2024, a sigmoidoscopy highlighted an ulcerated lesion in the mid and lower rectum, suggesting neoplasia or in flammation. MRI showed wall thickening of the rectum and anal canal with high T2 signal, without extramural involvement, suggesting diffuse rectal hemangi- oma or in flammatory lesions. A cystic lesion was also identi- fied in the deep post-anal space, suggestive of a retrorectal hamartoma or enteric cyst. The final histopathological exam- ination revealed an ulcerated lesion with edematous connec - tive tissue, capillary neogenesis, and leukocytic in filtrate, with adjacent hyperplastic and benign mucosa. Current management includes follow-up colonoscopy and cauteriza- tions. KTS is a rare congenital condition characterized by cutaneous hemangiomas, bone hypertrophy, and vascular malformations, primarily affecting the lower limbs. The etiology is uncertain, and the lesions appear from birth. Gastrointestinal involvement is rare but can cause bleeding. In this case, the patient had an atypical manifestation of KTS with rectal involvement and symptoms mimicking colorectal cancer. The worsening of the condition during the pandemic underscores the need for continuous monitoring. Imaging and biopsy findings showed vascular and cystic lesions, helping de fine the case and guide the non-interventional approach. The management with colonoscopies and cauteri- zation aims to control bleeding and prevent complications. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 138360 E-poster DISSEMINATED JUVENILE POLYPOSIS SYNDROME: A CASE REPORT Felipe Pereira Lemos Costa 1, Priscylla Rangel Blaszak 1, Bruna Marcante1, Heveline Trajano Vasconcelos1, João Márdio Paixão de França1, Mardem Machado Souza1, Wladimyr Dias Moreno1, Mariana de Oliveira Pantoja 1 1Hospital Universitário Júlio Müller, Cuiabá, Brazil Case Presentation Male, 17 years old, with a family history of polyposis. At 4 years old, he presented with a polyp that exteriorized during defecation; polypectomy was per- formed with no further issues. In November 2020, at 12 years old, he began experiencing abdominal pain and enterorrha- gia; colonoscopy showed sessile and pedunculated polyps in all colonic segments and rectum ( >100). Polypectomy was performed, and histopathological analysis revealed an in- flammatory hyperplastic polyp. In January 2021, he pre- sented with abdominal pain associated with abdominal distention, nausea, and enterorrhagia, with no signs of peri- toneal irritation. He was referred to the emergency depart- ment with a hemoglobin level of 10.4 g/dL. A CT scan suggested intestinal intussusception involving the cecum, ascending colon, and transverse colon, with the “head” of the invagination located in the descending colon. Abdominal ultrasound revealed free fluid in the pelvic cavity. Right colectomy and ileo-transverse lateral-lateral anastomosis were performed without complications. In follow-up care, a colonoscopy in 2022 showed numerous sessile and peduncu- lated polyps ranging from 0.5 to 2 cm. Immunohistochemical study con firmed juvenile hamartomatous polyps, and an upper digestive endoscopy revealed a polyp in the cardia, diagnosing Disseminated Juvenile Polyposis Syndrome. A 2023 colonoscopy with polypectomy showed multiple J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S69 juvenile polyps in the large intestine. He is currently under outpatient follow-up.

Discussion

Juvenile Polyposis Syndrome is an auto- somal dominant genetic condition characterized by the for- mation of multiple hamartomatous polyps in the gastrointestinal tract, more commonly affecting males, with an average age of 18 years. In 80% of cases, polyps are found in the colon and rectum. Most polyps are benign and symptomatic, causing bleeding, anemia, intestinal obstruc - tion, rectal prolapse of the polyp, and intussusception. Diag- nosis requires at least five juvenile polyps in the colorectal region, juvenile polyps in other parts of the gastrointestinal tract, or any number of juvenile polyps in an individual with a family history of juvenile polyps. Many cases are treated with endoscopic polypectomy, but surgery may be required in some cases.

Conclusion

This case underscores the importance of diagnosis and continuous monitoring of the condition due to the risk of progression to malignancy or obstructive compli- cations, which can lead to high mortality. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141501 E-poster “NATURAL INTELLIGENCE”: INVESTIGATION OF THE ADENOMA DETECTION RATE IN COLONOSCOPY WITH THE PRESENCE OF A TRAINEE ASSISTANT Barbara Andrade Prais1, João Baptista de Paula Fraga1, Carolina Vieira de Faria 1, Rommel Ribeiro Lourenço Costa 2, Marcela de Lima Paula3, Jeude Moisés da Silva Bravo 1 1Hospital e Maternidade Therezinha de Jesus, Juiz de Fora, Brazil 2Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil 3Universidade Federal do Vale do São Francisco, Petrolina, Brazil Globally, colorectal cancer (CRC) is the third most common cancer in the world, responsible for approximately 10% of all cancer cases and is the second leading cause of cancer-related deaths worldwide. In Brazil, it is estimated that there will be 45,000 new cases annually between 2023 and 2025. The well-known adenoma-carcinoma sequence and advancements in CRC research are related to reduced mortality, early detection, and high cure rates. Colonoscopy is crucial in the prevention and screening of CRC, and the adenoma detection rate (ADR) is the main quality indicator for the exam. The exponential increase in technology, im- proving the images in endoscopic exams, is a reality and has contributed to CRC prevention. The recommended ADR by the American Society of Gastroenterology is /C21 30% in men and /C21 20% in women. Several factors are associated with an increased ADR, such as the use of arti ficial intelligence, chromoscopy, the time spent withdrawing the device, the quality of bowel preparation, and the use of antispasmodics. Studies have shown that the presence of an attentive assistant during the exam is also an important factor for a higher ADR. The present study aims to assess the impact of a trainee assistant on the adenoma detection rate in a public hospital in Juiz de Fora.

Method

Evaluation of colonoscopy reports performed between March and December 2023 in a public hospital by a team of colorectal specialists. Data was collected regarding sex, age, hospitalization at the time of the exam, adenoma detection rate, bowel preparation quality, and organized in an Excel spreadsheet.

Results

104 colonoscopy reports were evaluated, with 38 being performed only by an experienced colorectal special- ist (Group 1) and 66 performed by this specialist along with a specialist in training (Group 2). The ADR in Group 1 was 34%, while in Group 2 it was 45%. When compared to exams performed on non-hospitalized (asymptomatic) patients, the ADR was 28% and 50% in Groups 1 and 2, respectively.

Conclusion

The ADR is an important parameter in the quality of colonoscopy, and it has been increasing alongside the growth of technologies and techniques implemented in large centers. A cost-effective method to increase ADR is the routine use of a second observer during exams. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141182 E-poster ACUTE PERFORATED ABDOMEN DUE TO METASTATIC LESIONS OF THE SMALL INTESTINE SECONDARY TO LUNG CANCER: CASE REPORT Renzo Stefenoni Finamore Simoni 1, Yasmin Góis de Mello 1, Isaac José Felippe Corrêa Neto1, Laercio Robles1, Gabriela Portal Monteiro1 1Hospital Santa Marcelina, São Paulo, Brazil MDL, 75 years old, admitted to the emergency room with abdominal pain and melena for 2 days. He was under investigation for pulmonary neoplasia, with local spread and metastasis in the trachea and adrenal glands. A CT scan was performed, showing pneumoperitoneum, and surgical inter- vention was indicated. During the abdominal cavity explora- tion, four vegetative and friable lesions were identified on the antimesenteric border of the small intestine, two of which were perforated. A wedge resection of the perforated lesions and a small bowel anastomosis were performed due to hemodynamic instability. The pathological examination of the resected lesions was consistent with malignant epitheli- oid neoplasia, and the immunohistochemistry revealed transmural in filtration by undifferentiated carcinoma in the small bowel wall. Among cases of pancreatic cancer (PC) metastasizing to the gastrointestinal tract (GIT), only 1.1% correspond to small bowel involvement. The most common location is in the jejunum, and the main symptoms are abdominal pain, melena, nausea, vomiting, and weight loss, but it is often diagnosed through complications. Hema- togenous spread of the tumor forms lesions in the intestinal wall, which can lead to various complications. These may include obstructive acute abdomen if the tumor grows intra- luminally, malabsorption syndrome, perforative acute abdo- men, and gastrointestinal bleeding if necrosis and ulceration occur at the site of the lesion. Small bowel perforation is more frequent in metastases from pancreatic cancer compared to other primary cancers, meaning that if small bowel lesions suggestive of secondary lesions are found during the ap- proach to a perforative acute abdomen, pancreatic cancer should be investigated. Upon identifying the affected area intraoperatively, the procedure of choice is segmental enter- ectomy. In this case, the patient was malnourished, with a serum albumin level of 2.8, metastases in the trachea and adrenal glands, and four jejunal lesions, two of which were perforated. Postoperatively, the patient was managed in the J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS70 ICU, and on the fourth day, he developed melena, worsened laboratory values, and decreased level of consciousness. Due to the unfavorable progression and advanced disease, pallia- tive care measures were agreed upon with the family, and the patient passed away two days later. Perforation of neoplastic implants in the small intestine in advanced lung cancer cases is a rare event. Furthermore, in cases where the neoplasm has not been diagnosed on this site, if implantation in the small intestine occurs, this site should be investigated. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138254 E-poster MODIFIED KRASKE APPROACH FOR RESECTION OF A GIANT RETRORECTAL CYST Carolina Reis Bonizzio 1, Rodrigo Ambar Pinto 1, Jorge Landivar Coutinho1, John Anibal Tapia Baca 1, Mateus Satoru Kajiwara 1, Gabriela Lopes Fonseca 1, Carlos Frederico Sparapan Marques 1 1Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Case Presentation A young woman noticed a bulge in the right gluteal region, asymptomatic but progressively grow- ing. Magnetic resonance imaging revealed a large retrorectal cystic formation (450 cm³) communicating with an exophytic component (2750 cm³) extending into the gluteal region through the right parasacral musculature. While awaiting elective surgery, she presented to the emergency department in septic shock due to cyst infection. After clinical management, cyst drainage, and debridement, she showed good progress. Tissue culture revealed infection by /C3 E. faecalis /C3 and multi- drug-resistant/C3 E. coli/C3 . Following prolonged antibiotic therapy, she proceeded to definitive surgical treatment, as discussed in a multidisciplinary meeting involving colorectal and plastic surgery teams. The patient was positioned prone under general anesthesia. Access to the pelvic cavity was achieved through a posterior approach, starting with a spindle-shaped incision encompassing the gluteal tumor and continuing with marginal dissection along the cyst capsule. The coccyx was resected to improve pelvic access. The dissection remained extraperitone- al, preserving adjacent structures, including nerves, rectum, sphincter apparatus, and vagina. The cyst was removed en bloc. A “water leak test” confirmed rectal wall integrity. Closure was performed in layers, with pelvic drainage using a Blake drain and a prophylactic vacuum dressing applied to the incision. The patient had a favorable postoperative recovery, and pathologi- cal examination excluded malignancy.

Discussion

Retrorectal cystic tumors are rare, pri- marily congenital, and often represent embryological rem- nants of the hindgut or neuroectoderm. The main types include dermoid cysts, epidermoid cysts, rectal duplication cysts, hamartomas, and teratomas. These tumors are gener- ally asymptomatic and incidentally diagnosed through imag- ing, with extrinsic bulging detectable on digital rectal examination. Due to the risk of infection (30%), as in this case, or malignancy (7 –45%), surgical treatment is indicated. Complete resection during surgery is essential to reduce the recurrence risk, reported in up to 15% of cases. Posterior approaches such as Kraske and York-Mason are preferred for low lesions (below S3). In this patient, the Kraske approach was modified to address the gluteal component of the lesion, as demonstrated in the accompanying video. Final Comments Retrorectal cystic tumors are rare pathologies that can pose signi ficant challenges to the surgi- cal team. A multidisciplinary approach is crucial for achieving successful outcomes in complex cases. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138269 E-poster INTESTINAL INVOLVEMENT BY KAPOSI’S SARCOMA IN A NON- IMMUNOSUPPRESSED PATIENT Rodrigo de Almeida Paiva 1, Daniel Maurício Londoño Estrada 1, Marina Barbabela Grisolia de Oliveira1, Letícia Brandão Castro1, Eduardo de Carvalho Barbosa1, Vinicius Avelar Palhares1, Marco Rinoldi1, Artur Duarte e Duarte 1 1Hospital Felício Rocho, Belo Horizonte, Brazil Case Presentation A 77-year-old male patient with a history of lower gastrointestinal bleeding (enterorrhagia) underwent a colonoscopy that revealed a bleeding lesion in the sigmoid colon, which was treated with a hemostatic clip. The bleeding recurred, and two additional procedures were performed without resolving the issue. De finitive surgical treatment with rectosigmoidectomy was then chosen. Histopathological findings: Vascular lesion with fea- tures consistent with Kaposi ’s sarcoma.

Discussion

Kaposi’s Sarcoma (KS) is a type of cancer originating in the blood and lymphatic vessel cells, associated with human herpesvirus type 8 (HHV-8). The epidemiology of KS varies signi ficantly worldwide, with notably high preva- lence in Sub-Saharan Africa, where it is often related to AIDS and found endemically in children and the elderly, with a higher prevalence in men. Clinically, it presents as pink-purple patches on the skin and can also affect mucous membranes and internal organs, often causing significant bleeding. Diagnosis is confirmed via histopathology, identifying spindle cells, HHV-8 LANA antigen, abnormal blood vessel proliferation with leak- age, extravasated red blood cells, and inflammatory infiltrates.

Conclusion

In conclusion, though rare, Kaposi ’s Sar- coma is a multifocal vascular neoplasm with signi ficant prevalence among immunocompromised individuals, partic - ularly those with HIV. However, in non-immunosuppressed patients, it should be considered as a differential diagnosis in cases of recurrent lower gastrointestinal bleeding. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141761 E-poster ANALYSIS OF INFORMATION QUALITY ABOUT SURGICAL TREATMENT FOR HEMORRHOIDAL DISEASE ON THE BRAZILIAN INTERNET Rodrigo Galvão Moreno 1, Jean Luca Alves 1, Gersino Perin Ribeiro1, Jordana Martins Américo de Souza 1, João Paulo Slongo1, Delis Marques Gregoski 1, Daniele Ximenez 1, André Pereira Westphalen1 1Hospital Universitário do Oeste do Paraná, Cascavel, Brazil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S71

Introduction

Although the internet has brought patients and doctors closer, not all health-related information found online is accurate or well-written. This can disrupt appropriate medical practice, as some patients may distrust professionals due to inaccurate information read online. Regarding hemorrhoidal disease, numerous surgical techni- ques have been developed, such as hemorrhoidectomy, hem- orrhoidopexy, and Doppler-guided hemorrhoidal artery ligation. These techniques are commonly searched for by the general population interested in the subject. Objective/Method The study aimed to analyze whether the information available online about surgical treatment for hemorrhoidal disease, via Google, is of satisfac - tory, explanatory, and up-to-date quality. A total of 25 open- access websites retrieved through the search engine were selected for analysis. The DISCERN tool was applied to evaluate the quality of health information regarding treat- ment options. DISCERN encompasses 16 questions divided into three sections, with the final section providing a general rating of the publication ’s quality.

Results

Section 3 of the DISCERN tool assesses the overall quality of the publication as a source of information about treatment options, based on responses to all previous questions. The average score for this section was 2.64 points (52.8%), with 16% of websites scoring 1, 36% scoring 2, 24% scoring 3, 16% scoring 4, and 8% scoring 5. Among the 25 sites analyzed, at least 50% showed bias, favoring one treatment as superior. Notably, the transanal dearterialization technique was mentioned in 32% of the websites as a more recent method. However, its long-term efficacy - especially for larger hemorrhoids - remains debatable, showing similar results to other techniques but with higher cost-effectiveness concerns.

Conclusion

A general evaluation based on Section 3 of the DISCERN tool revealed data about the quality of the publications. The study found that the average score for this section was 2.64 out of 5, equivalent to 52.8 out of 100. Therefore, the information available online about surgi- cal treatment for hemorrhoidal disease lacks satisfactory, explanatory, and updated quality. Consequently, it does not provide reliable information for the general public, hindering patients’ ability to seek and understand the best treatment options for their cases. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141756 E-poster ACUTE APPENDICITIS COMPLICATED BY ENTEROCUTANEOUS FISTULA IN A YOUNG PATIENT: CASE REPORT Benjamin Bedin1, Izadora Midian Galvão Sarmento 1, Dirceu de Castro Rezende Júnior 1, Hugo de Freitas Queiroz 1, Lucas Ferreira Aires Mendonça1, Geovanna Arnaldo de Sousa1, Marina Ferreira da Silva 1, Pamela da Silva Zambianco 1 1Hospital Regional de Taguatinga, Brasília, Brazil Case Presentation A 25-year-old female patient, overweight, presented to the emergency department with complaints of abdominal pain in the right iliac fossa that had persisted for seven days, accompanied by hyporexia, nausea, and vomiting. Abdominal computed tomography (CT) revealed acute appendicitis with signs of perforation. A conventional appendectomy was performed, noting perfora- tion of the middle third of the cecal appendix. During hospitalization in the surgical ward postoperatively, the patient developed abdominal distension, nausea, vomiting, and purulent/enteric discharge from the surgical wound. A follow-up abdominal CT scan showed gas pockets within the subcutaneous tissue, anterior abdominal muscles, and adja- cent to the cecum near the surgical scar, indicating an enter- ocutaneous fistula. A conservative approach was adopted, involving bowel rest (nil per os) and total parenteral nutrition for nutritional support. The patient responded well to the treatment and was discharged with instructions.

Discussion

The appendix is a small organ located at the initial portion of the large intestine. When its lumen becomes obstructed, it leads to an in flammatory and infec - tious process. Appendicitis is a common condition in surgical practice and is the leading cause of acute abdomen. Postop- erative complications are well-documented, and the devel- opment of an enterocutaneous fistula is a rare occurrence, affecting approximately 2% of cases following appendectomy. An enterocutaneous fistula is de fined as a communication between two epithelialized surfaces. Risk factors include appendix neoplasia, leakage from the appendiceal stump, intestinal infections, distal obstruction, and in flammatory bowel disease. Mortality rates range from 3% to 30%, with sepsis being a critical determinant of outcome.

Conclusion

Enterocutaneous fistula is a rare compli- cation associated with surgical procedures, occurring in about 2% of cases after appendectomy. Mortality rates vary, with sepsis being a signi ficant factor in fluencing mortality. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138243 E-poster EVALUATION OF THE DETECTION RATE OF ADENOMA AND ADENOCARCINOMA IN A POPULATION-BASED COLORECTAL CANCER SCREENING PROGRAM IN THE MUNICIPALITY OF CAIRU, BAHIA Alana Francisca Machado Melo 1, Alexandre Lopes de Carvalho1, Isabela Dias Marques da Cruz1, Flávia de Castro Ribeiro Fidelis1, Lucas Abreu Barreiro 1, Lina Maria Goes de Codes 1 1Hospital Universitario Professor Edgard Santos, Salvador, Brazil

Introduction

In Brazil, colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related death. The resection of precursor lesions and early diagnosis impact its natural history, which makes population-based screening recommended. The quantitative fecal immunochemical test (FIT) is the preferred method for non-invasive screening, and colonoscopy is the chosen endo- scopic method.

Objective

The aim of this study is to determine the detection rate of adenomas and adenocarcinomas in the studied population subjected to a population-based CRC screening program in the municipality of Cairu, Bahia.

Method

An observational study was conducted, with data collected from the service records of the population- based CRC screening program in Cairu, Bahia, during the first half of 2023. Residents aged 50 to 75 were subjected to FIT. Patients with FIT results above 25 ng/ml (considered positive) were referred for colonoscopy. The specimens from resec - tions were sent for histopathological study.

Results

FIT results from 1,724 people were analyzed, with 951 (55%) being women. The average age of participants J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS72 was 58.32 years. A total of 165 people (9.6%) had a positive FIT result. Of these, 122 underwent colonoscopy, 58% were women, and the average age was 58.8 years. A total of 144 lesions were identi fied in 41% of the examinations, with an average of 1.1 lesions per exam. Of these, 141 (97.91%) were resected and classi fied according to the Paris classi fication. Among the three lesions that were not resected, all were located in the rectum: one had a subepithelial appearance measuring 3.5 cm, one was a NG-LST type lesion of 16 mm, and there was a hyperplastic polyp con firmed by arti ficial intelligence. The subepithelial lesion was treated with transa- nal video-assisted surgery (D-Port platform), with a histo- pathological diagnosis of neuroendocrine tumor. The second lateral growth lesion was resected transanally (histopatholo- gy: hyperplastic). Dysplastic lesions were present in 41 of the 122 exams performed (33% of the sample). Histopathology

Results

of these resected lesions revealed a total of 82 premalignant lesions (58.15%), of which 78 were adenoma- tous and 4 were serrated lesions. There were 58 benign lesions (41.13%). One lesion (0.72%) was identi fied as adenocarcinoma.

Conclusion

Individuals with a positive FIT result who underwent screening colonoscopy showed high detection rates of adenomas and adenocarcinomas, similar to those reported in the literature. This highlights the importance of population-based CRC screening programs. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141609 E-poster BARBED VERSUS CONVENTIONAL SUTURES IN LAPAROSCOPIC-ASSISTED COLORECTAL SURGERY: A SYSTEMATIC REVIEW AND META- Lucas Monteiro Delgado 1, Bernardo Fontel Pompeu 2, Eric Pasqualotto3, Caio Mendonça Magalhães 1, Sergio Mazzola Poli de Figueiredo 4, Fernanda Bellotti Formiga 2 1Universidade Federal de Minas Gerais, Belo Horizonte, Brazil 2Hospital Heliópolis, São Paulo, Brasil 3Universidade Federal de Santa Catarina, Florianópolis, Brazil 4Cleveland Clinic Ohio, Cleveland, Ohio, United States

Introduction

Minimally invasive surgery is the pre- ferred method for treating colorectal disease. Laparoscopic suturing is complex, and barbed sutures (BS) can improve outcomes. This study compares laparoscopic colonic anasto- mosis using BS versus conventional sutures (CS).

Methods

PubMed, Scopus, and Cochrane Library were systematically searched for studies. Continuous outcomes were compared using mean differences (MDs), and odds ratios (ORs) for binary endpoints with 95% con fidence inter- vals (CIs). Heterogeneity was assessed with I² statistics. Statistical analysis was performed using Software R, version 4.2.3.

Results

Four studies comprising 285 patients were included, with 143 patients (50.17%) undergoing BS. We observed a signi ficantly reduced operative time (MD -16.25 minutes; 95% CI -25.94,-6.56; p < 0.01; I²=0%) in BS. No significant differences in intraoperative complications, anas- tomotic leakage, and Clavien-Dindo /C21 III.

Conclusion

BS signi ficantly reduced the operative time in the anastomotic closure. There were no signi ficant differences in anastomotic leakage, intraoperative complica- tions, and severe postoperative complications. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141665 E-poster ILEAL STOMA COMPLICATED WITH FISTULA TO THE VAGINA IN A PATIENT WITH FAMILIAL ADENOMATOUS POLYPOSIS: CASE REPORT Igor Torres da Silveira Mendes1, Lucas Gabriel Castro Carvalho1, Camille Moreira Baptista da Silva1, Beatriz da Costa Rossi Ramos de Carvalho1, Oswaldo de Moraes Filho 2, Rômulo Medeiros de Almeida2, Bruno Augusto Alves Martins2, João Batista de Sousa2 1Universidade de Brasília, Brasilia, Brazil 2Hospital Universitário de Brasília, Brasília, Brazil Case Presentation A 40-year-old woman diagnosed with Familial Adenomatous Polyposis (FAP) was identi fied through screening due to a family history of polyposis. In September 2019, she underwent restorative proctocolectomy with a J-pouch ileal reservoir and a protective ileostomy. The patient developed a fistula between the ileal pouch and the posterior vaginal wall, which was surgically repaired via a perineal approach in September 2020. However, the fistula recurred. A decision was made to resect the ileal pouch and create a new one, with simultaneous correction of the enter- ovaginal fistula during the surgery. The patient continued to experience fecal leakage through the vaginal canal, accompa- nied by abdominal pain. A second ileal pouch resection and definitive terminal ileostomy were performed.

Discussion

FAP is an autosomal dominant disease affecting 1 in 16,000 individuals in Brazil. It is rare but significant due to its potential for colorectal cancer develop- ment, requiring surgical intervention, often prophylactically. Surgical options include restorative proctocolectomy with an ileal pouch, total colectomy with ileorectal anastomosis, and proctocolectomy with a de finitive ileostomy. For patients with fewer than 20 rectal polyps, ileorectal anastomosis is preferred. In this context, restorative proctocolectomy with an ileal pouch is indicated for patients with more than 20 rectal polyps, maintaining intestinal transit. However, in this case, an uncommon complication occurred: the development of a fistula between the pouch and the vagina. This compli- cation can result from inclusion of the posterior vaginal wall in the stapling during the anastomosis or from an anasto- motic dehiscence leading to fistulization into the vagina. In this case, the former was detected on the fourth postoperative day.

Conclusion

Surgical treatment for FAP is a major procedure, which can be performed via laparoscopic, robotic, or laparotomic approaches. When performing the anastomo- sis, it is crucial to visualize the posterior vaginal wall to prevent its inclusion in the stapling, which could result in an enterovaginal fistula. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S73 Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 137926 E-poster SURGERY FOR SPECIMEN EXTRACTION VIA NATURAL ORIFICE (NOSES) DURING LAPAROSCOPY FOR DEEP INFILTRATIVE ENDOMETRIOSIS INVOLVING THE RECTUM Rogerio Serafim Parra1, Gabriela Oliveira Bagano 1, Daniela França Camargo Freitas 1, Fernando Passador Valério 1, José Vitor Cabral Zanardi 1, Omar Féres 1, José Joaquim Ribeiro da Rocha1, Marley Ribeiro Feitosa 1 1Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil

Introduction

Deep endometriosis is one of the most severe forms of endometriosis, and in up to 25% of cases, it can affect the intestine. The lesions may be either single or multifocal, and depending on the affected anatomical site, they can cause symptoms ranging from dysmenorrhea to dyspareunia and rectal bleeding.

Objective

To describe the surgical technique of Natu- ral Ori fice Specimen Extraction Surgery (NOSES) during laparoscopy for deep in filtrative endometriosis involving the rectum.

Methods

A 38-year-old patient with abnormal uterine bleeding and chronic pelvic pain, refractory to clinical treatment and with no desire for pregnancy, was evaluated. Preoperative imaging 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 to the insertion of both sacrouterine ligaments (LUS), measuring 4.1x1.0x1.7 cm. On the anterior wall of the rectum, about 12 cm from the anal edge, there was a 4.4x1.1x1.9 cm nodule reaching the inner layer, occupying 35% of the circumference, adhered to the uterine torus. The surgery was performed laparoscopically, and the procedure included total hysterectomy, removal of the fallopian tubes, resection of the lesions on the uterine torus and LUS, appendectomy, and segmental resection of the rectum with specimen removal via the vagina.

Discussion

NOSES surgery can be offered to patients with deep endometriosis requiring segmental resection of the rectum and/or appendectomy. The passage of the laparo- scopic linear stapler for appendectomy is done through the already opened vagina (in cases of laparoscopic hysterectomy or intentional or accidental vaginal opening). The removal of the rectal segment can be done vaginally when the vagina is already open. This approach improves postoperative pain, minimizes the chances of hernias, and reduces the risk of abdominal wall infections at the site of specimen extraction. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138270 E-poster SECONDARY ISCHEMIC COLITIS DUE TO ARTERIOVENOUS MALFORMATION AT THE LEVEL OF THE INFERIOR MESENTERIC ARTERY Lívia Peruzzo Zollinger Nova 1, Meyline Andrade Lima 1, Carlos Ramon Mendes 1, Ticiana Assemany Cruz 2, Lorena Boureau Pereira2, Leticia Sandes Bittencourt de Carvalho Melo 3, Bruno Franco de Oliveira Santos 3, Fabiana Cerqueira Tararam 4 1Coloproctologist at Hospital da Bahia, Salvador, Bahia, Brasil 2Medical student, Centro Universitário Dom Pedro II, em Salvador Bahia, Brasil 3Medical student, Escola Bahiana de Medicina e Saúde Pública, em Salvador Bahia, Brasil 4General surgery resident at Hospital Irmã Dulce, em Salvador Bahia, Brasil Case report This is a 41-year-old male patient who presented with diarrhea accompanied by mucus discharge and bleeding, in addition to abdominal pain, suspected to be infectious colitis, requiring hospitalization. A computed to- mography angiography (CTA) was performed, which showed early opacification of the inferior mesenteric vein during the arterial phase of the study, with a tortuous and ectatic appearance, maintaining a direct relationship with branches of the inferior mesenteric artery, suggesting an arteriovenous fistula. A sigmoidoscopy was performed, revealing edema and mucosal erythema in the sigmoid colon, the presence of fibrinous exudate, and ulcers of varying sizes and shapes; the rectum showed mucosal edema, erythematous areas, and obliteration of the submucosal vascular pattern. The patient was treated with intravenous antibiotics but continued to experience abdominal pain and mucus discharge. On physical examination, he had a globular and flaccid abdomen, deep palpation tenderness, and mild pain upon sudden decompres- sion. No change was observed on CTA in a follow-up imaging exam. In laboratory tests in March 2024, the following values were noted: C -reactive protein 61.7; AST 184; ALT 537; GGT 23. Surgical intervention was performed, including left colectomy with the creation of a terminal colostomy in the transverse colon via laparoscopy. The pathological examination conclud- ed active erosive colitis and thrombosis of small vessels.

Discussion

Ischemic colitis is in flammation of the colon due to reduced blood flow to that region, which can occur due to factors such as atherosclerosis, obstruction, and vascular diseases. In rare cases, ischemic colitis can be associ- ated with arteriovenous fistulas, abnormalities connecting arteries to veins, which can result in ischemia or lesions in the colon. The most common associated symptoms are acute abdominal pain, vomiting, diarrhea, or hematochezia, with treatment being either surgical or non-surgical. In addition to physical examination, complementary imaging such as CTA or colonoscopy are used for a more precise diagnosis.

Conclusion

This case highlights the importance of follow-up and the use of complementary tests in diagnosing ischemic colitis associated with arteriovenous fistulas. Early identification and appropriate treatment, including surgical intervention when necessary, are essential for a good prognosis. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141179 E-poster PSEUDOMEMBRANOUS COLITIS IN A POSTOPERATIVE PATIENT FOLLOWING ELECTIVE SURGERY, IMMUNOCOMPETENT, AND WITHOUT PRIOR USE OF ANTIBIOTIC THERAPY Yasmin Góis de Mello 1, Isaac José Felippe Corrêa Neto1, Gabriela Portal Monteiro 1, Laercio Robles 1, Laura Leoncio Ribeiro 1, Mariana Guimarães Coelho 1 1Hospital Santa Marcelina, São Paulo, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS74 Case presentation A 70-year-old man with insulin- dependent diabetes and hypertension, with negative serolo- gies for hepatitis and HIV, has a history of a prostate abscess in 2020 that evolved into a rectal fistula, requiring intestinal diversion. In 2024, he underwent a reconstruction surgery with transverse ileal anastomosis, through a specific incision, with antibiotic prophylaxis (ceftriaxone and metronidazole). Ten days post-surgery, he developed abdominal pain, watery diarrhea, fever, and loss of appetite. Abdominal and pelvic CT showed pneumoperitoneum and diffuse distension of the intestinal loops, with no clinical signs of peritonitis. Treat- ment with metronidazole was started, suspected as nonspe- cific colitis, and a test for Clostridium was collected. After a positive result for Clostridium, treatment with oral vanco- mycin was initiated for 14 days, resulting in clinical and laboratory improvement. Sixty days after discharge, symp- toms of diarrhea and abdominal pain reappeared, with another positive culture for Clostridium. Oral vancomycin treatment was restarted for 42 days in a tapering regimen. The patient returned to the outpatient clinic 20 days after completing treatment, asymptomatic.

Discussion

Although almost always related to antibi- otic use, 30% of cases are associated with other risk factors, such as advanced age, hospitalization, and severe underlying conditions. For recurrent infection, risk factors include age > 65 years, severe underlying medical conditions, ongoing antibiotic therapy during treatment for pseudomembranous colitis, serum creatinine /C21 1.2 mg/dL, and lack of immune response mediated by antibodies to C. dif ficile toxins, espe- cially toxin B. Recurring episodes, which occur in 35% of cases, are de fined by symptom resolution during therapy and recurrence within 2 months. The approach is the same, using fidaxomicin, vancomycin, or metronidazole. In these cases, 50 to 60% may develop a new recurrence.

Conclusion

Pseudomembranous colitis is a rare diag- nosis, particularly in immunocompetent patients without prior antibiotic therapy. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141625 E-poster COLORECTAL ANASTOMOSIS PLUS OMENTOPLASTY TO PREVENT ANASTOMOTIC LEAK: A SYSTEMATIC REVIEW AND UPDATED META-ANALYSIS Lucas Monteiro Delgado 1, Bernardo Fontel Pompeu 2, Vitor Lauar Pimenta de Figueiredo 1, Eric Pasqualotto 1, William Silva Barbosa1, Sergio Mazzola Poli de Figueiredo2, Fernanda Bellotti Formiga2 1Universidade Federal de Minas Gerais, Belo Horizonte, Brasil 2Hospital Heliópolis, São Paulo, Brasil 3Cleveland Clinic Ohio, Cleveland, Ohio, United States

Introduction

Anastomotic leakage in colorectal sur- gery is a major concern due to its association with increased morbidity, mortality, need for surgical revision, and risk of permanent stoma formation. Omentoplasty, a technique using a pedicle flap from the omentum to protect the anastomosis site, has shown promise in reducing postopera- tive complications such as leaks.

Objective

This study aims to conduct an updated systematic review and meta-analysis comparing omento- plasty and non-omentoplasty in colorectal surgeries.

Methods

PubMed, Embase, and Cochrane Library were systematically searched for studies comparing omento- plasty and non-omentoplasty in colorectal surgeries. Mean differences (MDs) were computed for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% con fi- dence intervals (CIs). Heterogeneity was assessed with I² statistics. Statistical analysis was performed using Software R, version 4.3.3.

Results

A total of 6 studies were included comprising 4,426 patients, of whom 669 patients (15.12%) were submit- ted to omentoplasty and 3,757 (84.88%) were not submitted to omentoplasty. There were no signi ficant differences be- tween OMP and n-OMP groups for overall anastomotic leakage (OR 0.61; 95% CI 0.33-1.12; p=0.11; I2=56%), reoper- ation (OR 0.63; 95% CI 0.37-1.08; p=0.09; I2=0%), mortality (OR 0.78; 95% CI 0.33-1.86; p=0.58; I2=25%), postoperative infection rates (OR 1.19; 95% CI 0.75-1.87; p=0.46; I2=50%), operative blood loss (MD [mL] 19.46; 95% CI -14.78-53.70; p=0.27; I2=0%) and length of hospital stay (MD [days] -0.65; 95% CI -6.65-5.36; p=0.83; I2=96%).

Conclusion

In this meta-analysis, use of omento- plasty in colorectal anastomosis showed no reduction in the occurrence of anastomotic leakage, reoperation and mortality. These findings underscore omentoplasty as a via- ble option, despite the need of more studies assessing its efficacy. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138068 E-poster CORRECTION OF PARASTOMAL HERNIA USING THE PAULI TECHNIQUE Diogo Viana Abreu 1, Matheus Matta Machado Mafra Duque Estrada Meyer1, Ilson Geraldo da Silva 1, Guilherme de Almeida Santos1, Augusto Zbonik Mendes 1, Jennyfer Kellen Lázaro da Rocha1, Mario Inácio Carneiro Neto 1, Hana Jermani Coelho 1 1Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brasil Male, 53 years old, with a history of abdominoper- ineal amputation due to rectal adenocarcinoma in 2017, presents oncological cure criteria. He developed a dif ficult- to-treat parastomal hernia, having undergone two surgeries with on-lay mesh placement, both of which resulted in recurrence. Clinically, he exhibited bulging and discomfort in the hernia location, and the CT scan showed a large parastomal hernia. In April 2024, he underwent another approach to the parastomal hernia using the Pauli technique, which was first described in 2016. The patient had a good recovery, wore an abdominal belt for two months, and maintained an appropriate weight control. To date, he shows no signs of recurrence. Parastomal hernia is the most com- mon complication after creating a stoma and can lead to significant morbidity, affecting quality of life. Its incidence is higher in terminal colostomies, and the use of prophylactic synthetic mesh is recommended by the European Hernia Society. Several surgical techniques have been described, but recurrence rates remain high, even with mesh use, ranging from 6.9% to 17%. Simple suture repair of the aponeurosis has recurrence rates of around 46%. The Pauli technique is a modification of the Sugarbaker technique, in which the stoma is left in place. A median incision is made, followed by an incision in the posterior sheath of the abdominal rectus, J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S75 lateral retro-muscular dissection past the semilunar line to free the transverse abdominal muscle, and then closure of the hernia defect in the posterior aponeurosis of the abdominal rectus or the transversalis fascia (below Douglas ’ arcuate line), laterally shifting the stoma. The mesh is placed in a sublay position, supporting the intestine without an opening in the mesh, similar to the Sugarbaker technique. Dissection may be performed similarly on the opposite side, so that the mesh overlaps and corrects any defects in the midline. This technique offers clear advantages, such as maintaining the biomechanical function of the abdominal wall, the ability to repair hernias in the midline, keeping the stoma in the same location to avoid complications in the closure area or a new parastomal hernia in a new site. The authors recommend this technique for large hernias, recurrent cases, or when the minimally invasive Sugarbaker technique is not feasible. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138210 E-poster INCIDENTAL DIAGNOSIS OF CECAL APPENDIX PHEOCHROMOCYTOMA IN A PATIENT UNDERGOING LAPAROSCOPIC APPENDECTOMY: A RARE CASE Marco Antônio da Silva Júnior 1, Luciano Ricardo Pelegrinelli 1, Renata Margarida Etchebehere 1, José Roberto Violatti Filho 1 1Universidade Federal do Triângulo Mineiro, Uberaba, Brasil Case Presentation A 26-year-old white female from Uberaba presented with a chronic history of mid-abdominal colicky pain, associated with nausea and excessiveflatulence. She was admitted to the emergency department due to exacerbation of pain for the past 3 days, with abdominal distension and cessation of stool and gas passage after the onset of symptoms. She denied fever, chills, anorexia, urinary changes, or previous similar episodes. The patient was previ- ously healthy, using only oral contraceptives. On physical examination, she was in good general condition, afebrile, with a tense abdomen, diffusely tender on palpation, with increased pain in the right iliac fossa, along with guarding and positive rebound tenderness in this region. A contrast-en- hanced abdominal CT scan was performed, revealing findings consistent with acute appendicitis and diffuse thickening of the cecal appendix. The patient underwent laparoscopic appendectomy without complications, and the pathological analysis of the specimen revealed signi ficant thickening of the appendix wall at the base. The histopathological study showed an epithelioid neoplasm with expansive growth and perivascular involvement, with cells having ample cytoplasm, sometimes clear, sometimes eosinophilic granular, with a tendency to merge with the adjacent muscle layer and without nuclear atypia. The immunohistochemical analysis was positive for smooth muscle actin and GP100 protein, and negative for other antibodies, con firming the diagnosis of PEComa of the cecal appendix. Thoracic and pelvic CT scans were performed, showing no abnormalities.

Discussion

PEComas (Perivascular Epithelioid Cell Tumors) are mesenchymal-origin tumors with typically be- nign behavior, although they have the potential for malig- nancy. Histologically, they are characterized by epithelioid cells with perivascular growth and immunoreactivity for melanocytic and smooth muscle markers. The occurrence of this pathology is rare, and most individuals are asymp- tomatic, with incidental diagnosis found during imaging studies or analysis of surgical specimens. Surgical treatment is the most common approach.

Conclusion

Given the rarity of this condition and the limited data in the literature, further studies are needed to establish the ideal management and treatment, especially for malignant cases. Well-established diagnostic methods are crucial for the correct identi fication of this entity and dis- tinguishing it from other differential diagnoses. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 128473 E-poster PANCREATIC STEATOSIS: A NEW AND CHALLENGING CLINICAL ENTITY Nívia Rézio Costa1, Eurípides Barsanulfo Borges dos Reis 1, Kelly Cristina Ferreira de Moraes Paes 1 1Faculdade Morgana Potrich, Mineiros, Brasil Pancreatic steatosis is a condition characterized by the accumulation of fat in the pancreas. Although it is not as common as hepatic steatosis (fat accumulation in the liver), pancreatic steatosis can have serious consequences if left untreated. Research on pancreatic steatosis aims to expand knowledge and improve understanding of the pathophysiol- ogy, diagnosis, and treatment of the disease. For the devel- opment of this work, scientific articles were sourced from the U.S. database (PUBMED), the Scienti fic Electronic Library Online (SCIELO), and Google Scholar using keywords such as “Pancreatic Steatosis,”“ pancreatic lipomatosis,” and “Non- alcoholic Fatty Pancreatic Disease (NAFPD), ” as well as their corresponding Portuguese terms, published between 2013 and 2023. Pancreatic steatosis (PS) is a condition character- ized by fat accumulation in the pancreatic cells. This accu- mulation can lead to pancreatic dysfunction and inflammation, and eventually to chronic pancreatitis. Major causes of PS include obesity, type 2 diabetes, and metabolic syndrome. The most common diagnostic tests include ab- dominal ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). Currently, there are several clinical studies on PS, demonstrating its link to metabolic causes and pancreatic cancer. The lack of knowl- edge and interest in fat accumulation in the pancreas, coupled with a scarcity of case reports and studies on the subject, complicates the correct and effective treatment. This, in turn, leads to non-adherence or a lack of necessary care and attention, especially when it comes to preventing the disease. In conclusion, there is a need for extensive research on fat accumulation in the pancreas and treatments that explore new approaches for prevention. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138278 E-poster J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS76 COMPARATIVE MATCHED STUDY BETWEEN EARLY POSTOPERATIVE OUTCOMES OF LAPAROSCOPIC SURGERY AND LAPAROSCOPIC SURGERY WITH ROBOTIC PLATFORM Bárbara Maria Tavares Pereira 1, Fábio Lopes de Queiroz 1, Marina Barbabela Grisolia de Oliveira 1, Lucas Alves Bessa Cardoso1, Daniel Maurício Londoño Estrada 1, Letícia Brandão Castro1, Artur Duarte e Duarte 1 1Hospital Felício Rocho, Belo Horizonte, Brasil

Introduction

Minimally invasive surgery (MIS) has improved postoperative outcomes, reduced the in flammato- ry response to trauma, and accelerated recovery after surgical procedures. Despite the advantages provided by laparoscopic surgery (LS), of the 320,000 colectomies performed in the USA in 2012, only 59% were performed laparoscopically. The limited range of motion of instruments in the two-dimen- sional view of the pelvic cavity and the unstable camera view are some of the technical limitations. The development of robotic platforms emerged as a tool to minimize the technical difficulties of laparoscopic surgery. Despite the promise of minimizing the disadvantages of laparoscopy, robotic - assisted surgery (RAS) is still not standardized. Studies evaluating both LS and RAS are scarce, and there is a lack of research comparing safety and surgical outcomes between MIS modalities.

Objective

To evaluate 30-day complications and length of hospitalization in RAS compared to LS in patients undergoing colorectal surgery.

Method

A retrospective, single-center, comparative cohort study conducted from November 2017 to December 2022. Patients were allocated into two groups based on the surgical approach used: LS vs RAS. Propensity score matching (PSM) was performed considering variables such as age, gender, and ASA score.

Results

After PSM, 65 patients who underwent RAS and 85 patients who underwent LS were included in the study. The proportion of total mesorectal excision with rectosigmoidectomy was higher in the RAS group and lower in the LS group (19.4% vs. 5.9%, p=0.003), and the same occurred for shaving in intestinal endometriosis (6% vs. 0%, p=0.003). Complications were more prevalent in the LS group (p=0.015). When comparing type I complications, the inci- dence was 74.7% (n=47) in LS and 62.2% (n=23) in RAS (p<0.001). The proportion of type 3B complications, which involve the need for surgical re-intervention under general anesthesia, was higher in the LS group with 4.8% (n=3). The RAS group did not have any type 3B complications (p=0.014).

Conclusion

This study demonstrated that the robotic platform is safe, with a lower complication rate and no increase in length of hospitalization. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 132725 E-poster EVALUATION OF EMPLOYEES‘ KNOWLEDGE OF COLORECTAL CANCER PREVENTION AND SCREENING AT A REFERENCE ONCOLOGY CENTRE Karina Quely Andrade de Souza 1, Glicia Estevam de Abreu 1, Paulo Andre Lago Silva 2, Marilia Cardoso Massoni 1, Dan Perdiz Fucs Machado1, Gabriel Cury Andari David 2 1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil 2Centro de Coloproctologia da Bahia, Salvador, Brasil

Introduction

Despite colorectal cancer ‘s high fre- quency and severity, the general public is mostly uninformed of its prevention and screening.

Objectives

To assess the level of knowledge on CRC prevention and screening among staff at a reference cancer center.

Methods

A cross-sectional investigation was carried out at a reference cancer center. Employees aged 18 and up who had been with the oncology center for at least a year were given a questionnaire that included sociodemographic and evaluative questions about CRC prevention and screening.

Results

The sample comprised 266 employees, with a median age of 45 (53.00 - 35.75). The majority of staff (76.3%) were female, had at least a year of experience at the reference cancer center (74.1%), and agreed on the de finition of CCR. Inflammatory bowel illness was the least commonly recog- nized risk factor (67.6%). The majority of the sample (56%) recognized all five warning flags. Colonoscopy was the most popular screening test (98.7). Although the health center does not offer of ficial CRC education, the majority of staff (42.1%) reported learning about colorectal cancer while working. There was no difference in perceptions of the optimal age to begin screening between employees 45 years or older and younger workers (p = 0.729). Higher-educated employers were more knowledgeable of the CRC (p = 0.001). Women provided a higher percentage of accurate responses.

Conclusion

A reference cancer center‘s staff, especial- ly women, those who work directly with patients, and those with higher education levels, have a satisfactory level of knowledge regarding CRC prevention and screening. This

Result

emphasizes the necessity of spreading CCR knowledge more widely, especially to individuals with less education. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138298 E-poster CYSTIC RETRO-RECTAL HAMARTOMA (TAILGUT CYST) WITH SURGICAL TREATMENT VIA POSTERIOR ACCESS: A CASE REPORT Lucas Abreu Barreiro 1, Isabela Dias Marques da Cruz 1, Flavia de Castro Ribeiro Fidelis 1, Alexandre Lopes de Carvalho 1, Alana Francisca Machado Melo 1, Lina Maria Goes de Codes 1 1Hospital Universitário Professor Edgard Santos, Salvador, Brasil Case Presentation A 45-year-old female patient with no comorbidities, with a family history of anal cancer, was admitted with complaints of spontaneous pain in the hypo- gastric region, buttocks, and lower limbs, worsening progres- sively when walking. She reported daily bowel movements with well-formed, occasionally dry stools, and three episodes of hematochezia during the period. A colonoscopy performed a year and a half before admission identi fied a 4mm sessile polyp classi fied as Paris 0-Is, and the pathological exam showed an in flammatory pseudopolyp. During follow-up, a pelvic MRI revealed a circumscribed cystic image located in the median retro-rectal region, in close contact with the levator ani muscle, with probable hematic and hyperproteic content, measuring 2.1 /C2 2.5 /C2 2.9 cm, suggestive of Cystic Hamartoma (HC). The patient underwent resection via pos- terior retro-rectal access using the Kraske approach, with J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S77 good postoperative recovery, and thefinal pathological result confirmed the diagnosis of HC.

Discussion

Presacral tumors are rare and dif ficult to diagnose, occurring at a rate of 1 patient per 40,000-60,000 in the general population. Clinical symptoms are typically relat- ed to pelvic pain that worsens when sitting and improves when standing. Other symptoms may include fecal and urinary incontinence, constipation, and sexual dysfunction, due to involvement of the sacral nerve in more advanced tumors. HC (Tailgut Cyst) is a type of congenital lesion originating from the primitive hindgut and is more prevalent in females. This lesion is well-de fined, homogeneous, and does not communicate with the rectal lumen, and can be either unilocular or multilocular. Advances in diagnostic

Methods

and imaging studies, particularly MRI, have led to more accurate diagnoses and better treatment outcomes for patients with these tumors.

Conclusion

HC are rare and dif ficult-to-diagnose lesions that may undergo malignant transformation in some cases. Current surgical resection techniques provide ideal therapeutic results, with a focus on preserving the sphincter and nerve plexus, offering preservation of fecal continence and, ultimately, improving postoperative quality of life. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141753 E-poster LOWER GASTROINTESTINAL BLEEDING DUE TO MECKEL ’S DIVERTICULUM IN AN ADULT João Victor Sprioli Martins 1, Gabriela Voltolini Alves 1, Cibele Alexandra Ferro1, Giovanna Latorraca Fachetti 1, João Vitor Bordinhão Begnoci 1, Cassio Alfred Brattig Cantao 2, Tayanne Fonseca Rodrigues1, Nathacia Bernando Chimello 3 1Faculdade de Medicina de Catanduva, Catanduva, Brasil 2Universidade de São Paulo, Ribeirão Preto, Brasil 3Beneficência Portuguesa São Paulo, São Paulo, Brasil Case Presentation A 38-year-old male patient was admitted to the emergency department with persistent gastrointestinal bleeding, presenting with enterorrhagia, causing symptoms of weakness and malaise. He had no previous similar episodes and no reported comorbidities. Initially, a protocol for upper gastrointestinal bleeding was started, and the patient was transfused with one unit of packed red blood cells due to a significant drop in hemoglobin (Hb 6.9). An upper gastrointestinal endoscopy (UGI) showed only mild erosive gastritis in the antrum. During his hospi- talization, two colonoscopies were performed without suc - cess in identifying the source of bleeding, and the patient received multiple blood transfusions. Subsequently, an ab- dominal CT scan and a scintigraphy for occult bleeding were performed, but both were non-diagnostic. The patient ’s condition worsened with hemodynamic instability, and he was transferred to the urgent care unit and indicated for surgical treatment. During laparoscopy, a Meckel’s diverticu- lum was found approximately 110 cm from the ileocecal valve with signs of bleeding. After enlarging the supraumbilical median incision, a bowel loop was exteriorized, and entero- scopy was performed through the diverticulum, which revealed bleeding below the diverticulum, scattered clots, and a non-bleeding polyp at the hepatic flexure. A segmental enterectomy was performed, followed by a latero-lateral anastomosis with a linear stapler without complications. After the surgery, the patient remained hemodynamically stable, with no further drops in hemoglobin.

Discussion

This case of lower gastrointestinal bleed- ing in an adult due to a Meckel ’s diverticulum is atypical and highlights the dif ficulty of diagnosis in such cases where traditional endoscopic examinations rarely provide answers. In severe cases that are refractory to clinical measures and in the absence of less invasive diagnostic tests, or in cases of hemodynamic instability, surgery still plays a critical role in managing the condition.

Conclusion

It is important to always consider less common differential diagnoses in cases of occult gastrointes- tinal bleeding. Surgical intervention remains relevant in diagnosing conditions like Meckel ’s diverticulum, which may not be identi fied through imaging or traditional endo- scopic methods (endoscopy and colonoscopy), with the added benefit of being therapeutic in many of these cases. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138209 E-poster GASTROINTESTINAL BLEEDING CAUSED BY JEJUNAL GIST Taylene Rodrigues Souto 1, Luna Vitória Gondim Ferreira 1, Bruno Augusto Alves Martins 2, Oswaldo de Moraes 2, Romulo Medeiros de Almeida2, Vanessa Siqueira Reis2, Isabela Augusta Carvalho Testi2, João Batista de Sousa 1 1Universidade de Brasília, Brasilia, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil Case Presentation F.P.B, a 66-year-old male, was admitted to the emergency department with a two-week history of melena. On physical examination, signi ficant cuta- neous pallor was observed. A complete blood count revealed a hemoglobin level of 6.9 g/dl. An urgent upper gastrointesti- nal endoscopy was performed, which did not show signs of active bleeding. Abdominal angiography (CT angiography) revealed circumferential wall thickening of a jejunal loop near the left flank, adjacent to the descending colon, with irregular contours, calcification foci, and slight contrast enhancement, suggesting a primary neoplasm. A surgical approach was undertaken, involving enterectomy and enteroanastomosis. From admission to surgery, the patient received 7 units of red blood cell concentrates. Pathological examination of the enterectomy specimen revealed a gastrointestinal stromal tumor (GIST) with a mixed histological pattern. Immunohis- tochemical studies for diagnostic con firmation showed posi- tive CD-117 expression in the cells of interest, supporting the diagnosis of GIST.

Discussion

GISTs are rare neoplasms, accounting for approximately 1-2% of primary gastrointestinal cancers. Their estimated incidence is 10 to 20 cases per million people. The most common site of occurrence is the stomach (40-60%), followed by the jejunum/ileum (25-30%). The most common presentation of GIST is gastrointestinal bleeding, as seen in this case. Therefore, the manifestations of the disease are closely related to the tumor’s location. Upper gastrointestinal tract involvement is typically accompanied by melena or dysphagia, while lower gastrointestinal tract neoplasms may present with constipation or intestinal obstruction. Regarding the risk of progression of GISTs, factors such as J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS78 mitotic index, tumor size, and location are considered. In this case, the risk of tumor progression was considered high, with a mitotic index above 5 mitoses/5 mm, a size of 3.6 cm, and jejunal involvement.

Conclusion

Although jejunal GISTs are rare and often challenging to diagnose, it is important to maintain a high level of suspicion for the condition, especially in the context of gastrointestinal bleeding combined with suspicious radio- logical findings. Early detection increases the likelihood of employing surgical treatment, which offers higher cure rates. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 137753 E-poster LOWER DIGESTIVE BLEEDING FROM THE SMALL INTESTINE Camila Vieira Chiquetti1, Carlos Henrique Marques dos Santos1, Carlos Otávio da Silva Ribeiro 1, Giulia Candida Ribeiro Garnes 2, Bárbara Érnica Zeferino 1, Odinilson Almeida Fonseca 1 1Hospital Regional do Mato Grosso do Sul, Campo Grande, Brasil 2Universidade Estadual do Mato Grosso do Sul, Dourados, Brasil Case Presentation An 84-year-old female patient was admitted to the medical service with melena. Her medical history includes diabetes mellitus, systemic arterial hyper- tension, and diverticular disease of the colon. Additionally, she had right colon cancer 4 years ago, treated with right colectomy, ileotransverse anastomosis, adjuvant chemother- apy, and subsequent hospitalizations due to digestive bleed- ing with melena, with normal upper digestive endoscopy. During the current hospitalization, after performing upper digestive endoscopy, a CT scan, and colonoscopy, extensive diverticular disease was observed, along with abundant bleeding originating from the terminal ileum, but without lesions. The liver appeared heterogeneous with blunt tips and subcutaneous varices. Further investigation with angioto- mography revealed neovascularization in the small intestine with a fistula between the lower epigastric vein and a branch of the mesenteric artery, requiring interventional radiology. A portography and ileal branch phlebography were per- formed, with a hemostatic valve inserted percutaneously via a transhepatic approach in the right branch of the portal vein. A polyethylene catheter was selectively positioned in the ileal branch, with contrast injections and imaging find- ings consistent with a portosystemic ileo-femoral shunt. Embolization was performed using histoacryl and lipiodol, achieving satisfactory devascularization of the main branches leading to the shunt. The patient continues to be monitored without further episodes of bleeding.

Discussion

Lower gastrointestinal bleeding is primar- ily characterized by hematochezia or enterorrhagia and may be associated with hypovolemia. Causes include vascular lesions, such as arteriovenous malformations, common in the right colon, hemorrhoids, and diverticulosis. The small intestine is typically the site of obscure bleeding origins. A portosystemic shunt is a rare condition in humans, mainly associated with portal hypertension due to chronic liver disease. Both shunts and small bowel bleeding require precise imaging for diagnosis and treatment. Due to the potential for severe complications, stabilizing the patient and controlling the bleeding is essential.

Conclusion

Lower gastrointestinal bleeding from the small intestine is a rare and complex condition to diagnose, especially with this particular adverse etiology. Prompt and accurate diagnosis is crucial for proper treatment, preventing multiple hospitalizations and complications with unfavor- able outcomes. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138194 E-poster GIANT GALLSTONE IMPACTION IN STENOSING COLON NEOPLASIA – CASE REPORT Letícia Mayumi Tsushima 1, Kelly Danielle Silva Vieira 1 1Rede Mario Gatti, Campinas, Brasil Case Presentation A 72-year-old female patient with a history of hypertension and diabetes, and a previous diagnosis of cholelithiasis, had been awaiting elective surgery for one month. She was admitted with severe right upper quadrant abdominal pain, nausea, and vomiting. She denied any changes in bowel habits, with the last bowel movement occurring one day prior. Physical examination revealed a mildly distended abdomen, tenderness on palpation of the right upper quadrant, and no signs of peritonitis. Imaging (abdominal CT and MRI) showed cholelithiasis with loss of cleavage between the gallbladder and the small bowel, pneu- mobilia, a gallstone in the cecum, as well as thickening of the transverse colon and distension of the small bowel loops. A laparotomy was indicated due to an intestinal obstruction. During surgery, intense adhesions were found between the gallbladder and the first portion of the duodenum, with a “napkin-ring” lesion in the transverse colon and mild disten- sion of the small bowel loops. A right hemicolectomy with primary anastomosis and resection of the greater omentum was performed, without addressing the cholecystoduodenal fistula during this procedure. Upon opening the specimen, a 3 cm gallstone was found impacted in a stenosing tumor at the splenic flexure of the transverse colon. The patient had an uneventful recovery and was discharged early. The postoper- ative pathological examination revealed an ulcerated mucin- producing invasive adenocarcinoma, moderately differenti- ated, in filtrating adjacent adipose tissue, with free surgical margins and involvement of two regional lymph nodes. The staging was T3N1M0, and the patient was referred for adju- vant chemotherapy.

Discussion

Biliary ileus is a rare cause of colonic obstruction (2-8% of cases) caused by the impaction of a gallstone in a substenosing segment of the colon, secondary to diverticular disease or pelvic irradiation. Its diagnosis is suggested by the presence of intestinal obstruction, pneumo- bilia, and ectopic gallstones, the “classic triad, ” though it is present in fewer than 50% of cases. Treatment typically involves resolving the intestinal obstruction, with or without correction of the biliary fistula.

Conclusion

We describe a rare case of intestinal obstruction due to biliary ileus with a gallstone impacted in a stenosing transverse colon tumor, which was an inciden- tal finding. The diagnosis and treatment of the tumor in this case were only possible due to the acute and unusual ob- struction presentation. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S79 Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141631 E-poster INCIDENCE OF NEUROENDOCRINE TUMOR OF THE APPENDIX IN LAPAROSCOPIC APPENDECTOMIES IN PATIENTS WITH INTESTINAL ENDOMETRIOSIS: A CASE SERIES Daniela França Camargo Freitas 1, Murilo Gomes de Paiva Neves1, José Joaquim Ribeiro da Rocha 1, Marley Ribeiro Feitosa1, José Vitor Cabral Zanardi 1, Fernando Passador Valério1, Omar Féres 1, Rogerio Sera fim Parra1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

Introduction

and Objectives Appendiceal endome- triosis is uncommon, accounting for only about 1% of all cases of endometriosis. However, endometriosis is found in the appendix in approximately 8-13% of patients with deep endometriosis, and it is particularly common in patients with severe forms of deep endometriosis. Neuroendocrine tumors (NETs) are the most common neoplasms of the appendix and may be misdiagnosed when there are multiple endometriosis lesions in the pelvis. The aim of this study was to analyze the incidence of NETs in patients with deep endometriosis involving the intestines.

Methods

This was a retrospective study using elec - tronically recorded data prospectively. All laparoscopic ap- pendectomies performed in patients with deep endometriosis involving the intestines between April 2012 and April 2024 were evaluated, along with the results of the pathological examinations.

Results

A total of 78 laparoscopic appendectomies were performed, with 6 cases (7.7%) of NETs. Based on the pathological findings of the surgical specimen (well-differ- entiated NET at the tip of the appendix, measuring 1.3 cm, with free margins but in filtration of the appendiceal adipose tissue and positive angiolymphatic invasion), the patient was advised to undergo a complementary colectomy, but she refused. The average age of the patients at the time of surgery was 35.2 years (24-51 years). The main surgery performed was segmental resection in 46 patients, disc resection in 22 cases, shaving nodulectomy in 12 patients, and enterectomy in 5 patients. Laparoscopic hysterectomy was associated in 10 patients. The average hospital stay was 1.5 days (1-3 days), and the surgical time was 125 minutes (45-300). There were no signs of NET recurrence in a mean follow-up period of more than 2 years.

Conclusion

In our study, the frequency of appendiceal neoplasms was 1 in every 12 appendectomies in patients with intestinal endometriosis. This case series reinforces the need for careful management of these lesions and supports the recommendation for appendectomy when the appendix is affected by endometriosis. Although the most likely diag- nosis is appendiceal endometriosis, NETs cannot be excluded by imaging studies, and both conditions can occur in the same patients. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138197 E-poster RECTAL LACERATION FOLLOWING FISTING PRACTICE Vitoria Vicentin Giordano1, Fernanda Bellotti Formiga 1, Natalia Ferreira Cardoso de Oliveira 1, Nadine Gomes de Souza 1, Amadeu Andre Soberanski 1, Louisie Galantini Lana de Godoy 1, Vitoria Vicentin Giordano 1 Fang Chia Bin 1 1Santa Casa de São Paulo, São Paulo, Brasil Case Presentation A 33-year-old male, HIV-positive, sought emergency care for enterorrhagia and abdominal pain after engaging in fisting seven days before admission. He was hospitalized, underwent tests, and was treated with anti- biotics while being observed, but he left the hospital after four days of treatment. He required readmission due to anal pain associated with bowel movements, though the bleeding complaint improved. Upon admission, there were no abnor- malities in the abdominal physical exam. A proctological examination revealed a laceration in the right posterolateral region, extending 7 cm from the anal border. Abdominal CT scan showed irregular wall thickening in the middle and lower thirds of the rectum, with mesorectal fat densi fication and small adjacent gas foci. A flexible sigmoidoscopy was performed, revealing a deep transmural linear laceration starting at the pectinate line and extending about 8 cm cranially. The emergency department team recommended surgery: suturing the laceration, presacral drainage, and loop sigmoidostomy. The patient progressed well and was dis- charged on the seventh postoperative day.

Discussion

The treatment of traumatic rectal injuries has evolved. Initially, it was based on injuries occurring during armed con flicts, such as landmine explosions in the Vietnam War. Traditionally, the treatment of extraperitoneal rectal injuries had four main pillars: intestinal diversion, presacral drainage, distal rectal lavage, and local repair. However, recent guidelines have abandoned presacral drain- age due to higher rates of local infections, as well as distal rectal lavage, which has not shown proven bene fits. Current- ly, despite controversy, ostomy is still recommended for patients with full-thickness extraperitoneal rectal lacera- tions, as it reduces the rate of infectious complications, even without affecting mortality. Surgical indications should consider each case and the risk-benefit ratio of the morbidity associated with ostomy. In the speci fic case described, the coloproctology team suggested conservative management, given the time since the trauma (15 days) and the lack of systemic repercussions, but the emergency team opted for surgical intervention.

Conclusion

The practice of fisting is becoming in- creasingly popular, highlighting the need for updated man- agement approaches for post-traumatic rectal injuries. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 137791 E-poster PERIANAL LEIOMYOMA: CASE REPORT Meyline Andrade Lima 1, Joana Carolina Saraiva de Paula Pessoa2, Ticiana Assemany Cruz 3, Lorena Boureau Pereira 3, Bruno Franco de Oliveira Santos4, Leticia Sandes Bittencourt de Carvalho Melo 4, Fabiana Cerqueira Tararam 5, Carlos Ramon Mendes2 J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS80 1Hospital São Rafael Salvador, Bahia, Salvador, Brasil 2Hospital São Rafael, Belo Horizonte, Brasil 3Centro Universitário Dom Pedro II, Salvador, Brasil 4Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil 5GHospital Irmã Dulce, Salvador, Brasil Case Report A 49-year-old female patient was seen in the Coloproctology outpatient clinic, complaining of a pain- less nodule in the perineal area for the past 3 years, without associated symptoms. On physical examination, a 3 cm nodule was palpated in the left anterior perineum, between the rectum and vagina. In March 2024, a pelvic floor MRI was performed, with the report describing a solid nodular image, with well-de fined borders, located in the left anterolateral aspect of the intersphincteric plane in the perianal region, without cleavage plane with the anal canal wall, and external left sphincter muscle bulging, measuring approximately 3.4 /C2 2.6 /C2 2.5 cm. The diagnostic impression was indetermi- nate, although gastrointestinal stromal tumor (GIST) was considered as a differential diagnosis. During surgery, an incision was made in the left lateral perineum, and the lesion was completely resected with clear margins. No invasion of the rectum or vagina by the lesion was observed during surgery. The patient had a good postoperative recovery with complete healing. The resected specimen was sent for histopathological examination, which described a perineal nodule, with elastic consistency, measuring 3.4 /C2 2.4 /C2 1.8 cm, and was immunohistochemically positive for fumarate hydratase, desmin, and smooth muscle actin. The final diag- nosis was a benign mesenchymal neoplasm: leiomyoma.

Discussion

Leiomyoma is a benign soft tissue tumor originating from mesenchymal cells derived from smooth muscle. The most common occurrence of this tumor is in the uterus, while it is rare in the anorectal region. The pathogen- esis is not well de fined. The prevalence is 1 in every 3,000 rectal tumors, and the malignancy rates gradually increase with age. It typically presents in the age range of 30-69 years and may present with symptoms like rectal bleeding, tenes- mus, proctalgia, and changes in bowel habits, or it may be asymptomatic, depending on its size. Due to the lack of specific symptoms, diagnosis is often delayed. The standard and potentially curative treatment for anorectal leiomyomas, without invasion of adjacent organs as seen in this case, is surgical excision with complete resection and clear margins to avoid recurrence.

Conclusion

This case highlights the importance of differential diagnosis, early intervention, and follow-up to detect potential recurrences and/or malignant transformation. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 137801 E-poster EXTRANODAL M.A.L.T LYMPHOMA OF THE CECUM: A CASE REPORT Lívia Oliveira1, Bárbara Tannús Valadão 1, Bruna Grazielly Oliveira Silva1, Reginaldo Rodrigues Do Prado1, Ulisses Marques Cardoso1, Mariane Tonin Jatobá 1, Juliana Cruz Apolinário 1, Larissa Ganança Buosi 1 1Hospital São Francisco de Ribeirão Preto, Ribeirão Preto, Brasil Case Presentation Patient FJS, 62 years old, male, with a sole complaint of intestinal bleeding. Colonoscopy revealed oval erosions covered by fibrin at the ileocecal valve, without histological characteristics of in flammatory bowel disease (IBD). A biopsy showed lymphoid in filtration in the cecum, inconclusive for small B-cell lymphoma. Immunohis- tochemistry confirmed the diagnosis, with Ann Arbor staging IA (modi fied). Tests for sexually transmitted infections (STI) were negative. CT scans of the abdomen/chest and PET CT were negative. Endoscopy showed no apparent lesions and was negative for /C3 H. Pylori /C3 . The patient underwent right hemicolectomy, with pathology con firming a diffuse B-cell lymphoid neoplasm (M.A.L.T lymphoma) in the mucosa and submucosa of the cecum/ileocecal valve, measuring 2.5 cm at its largest extent.

Discussion

Primary extranodal lymphoma is de fined as involvement of a primary organ without clinical evidence of distant lymph node or organ spread. Colon marginal zone lymphomas are extremely rare, accounting for 2-3% of all colonic neoplasms. The cecum is the most commonly affected site, followed by the rectum. There is a male predilection. On average, colorectal lymphoma is diagnosed in individuals aged 50 to 60 years. The pathology in the colon arises from chronic antigenic stimulation secondary to infectious agents or autoimmune processes occurring in the mucosa. Risk factors for primary extranodal non-Hodgkin lymphoma (NHL) include a family history of lymphoma, personal history of radiation or chemotherapy, organ transplantation, immu- nosuppression, viral immunity, and exposure to toxins. Im- munosuppressive medications for IBD have been associated with an increased risk of gastrointestinal lymphoma. Diag- nosis is made through biopsy analysis, obtained either by colonoscopy or histology of the surgical resection specimen. Treatment modalities include radiotherapy, which can be used alone, or Rituximab as monotherapy, or Rituximab with chemotherapy in advanced disease. Surgical treatment is also an individualized option for stages I and II.

Conclusion

Primary colon lymphoma is an indolent disease, with recurrence in nearly all cases. The choice of surgical treatment is individualized, typically recommended in the early stages of the disease, and the decision should involve hematologists and surgeons. In this case, the patient benefits from not undergoing alternative therapies such as radiotherapy, Rituximab, or chemotherapy, which may be considered in cases of disease recurrence. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 137793 E-poster GIANT LIPOMA OF THE TRANSVERSE COLON WITH PROGRESSION TO INTUSSUSCEPTION: A CASE REPORT Carlos Ramon Mendes 1, Joana Carolina Saraiva de Paula Pessoa1, Tassia Mendes Franco 1, Ticiana Assemany Cruz 2, Bruno Franco de Oliveira Santos3, Leticia Sandes Bittencourt de Carvalho Melo3, Lorena Boureau Pereira 2, Julyana Costa Neiva 4 1Hospital Cardiopulmonar Salvador, Salvador, Brasil 2Medical Student, Centro Universitário Dom Pedro II, em Salvador Bahia, Salvador, BA, Brasil 3Medical Student, Escola Bahiana de Medicina e Saúde Pública, em Salvador Bahia, Salvador, BA, Brasil 4General Surgery Resident at Hospital Irmã Dulce, em Salvador Bahia, Salvador, BA, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S81 Case Report This is a 56-year-old female patient with a history of abdominal pain. An endoscopic examination revealed a subepithelial lesion approximately 8 cm in size located in the transverse colon. Biopsies were performed, revealing a chronic in flammatory process associated with focal ulceration and adipose tissue with areas of steatonec - rosis. The patient was scheduled for elective surgery but developed intense anal pain and the evacuation of a mass. Abdominal tomography showed signs of left colon-colon intussusception secondary to a lipoma. The patient under- went emergency partial colectomy in September 2023. His- topathology of the surgical specimen revealed a segment of the colon with intussusception secondary to a colon lipoma measuring 9.2 /C2 5.8 /C2 4.4 cm, located in the submucosa, with a yellowish and shiny surface. Additionally, thirteen reactive mesocolic lymph nodes were identi fied, the largest measur- ing 0.6 cm. The patient had a good postoperative recovery and continues with outpatient follow-up.

Discussion

Giant colonic lipomas are benign, non- epithelial tumors typically located in the submucosa of the large intestine. They are more common in the cecum and right colon, with an increased incidence after the age of 50. Lipomas smaller than 2 cm are usually asymptomatic, but larger ones produce symptoms in more than 75% of cases, including colicky abdominal pain, palpable abdominal masses, changes in bowel habits, and weight loss. Obstructive signs can also occur when pedunculated, leading to intussus- ception. Intussusception is a frequent complication of this neoplasm and is defined as the telescoping of one segment of the intestine into an adjacent one. It is usually associated with pathological lesions of the intestinal wall and can cause obstruction and, sometimes, ischemia. The diagnosis of co- lonic lipoma is made through clinical examination, colonos- copy, and imaging studies, and the treatment is surgical.

Conclusion

This case highlights the importance of monitoring and intervening in patients with giant colonic lipomas, given the alarming signs and symptoms associated with them and their potential complications. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 137672 E-poster JEJUNAL MELANOMA: A CASE REPORT Bárbara Tannús Valadão1, Larissa Ganaça Buosi1, Lívia Oliveira1, Bruna Grazielly Oliveira Silva 1, Mariane Tonin Jatobá 1, Ulisses Cardoso Marques 1, Reginaldo Rodrigues Do Prado 1, Juliana Cruz Apolinário 1 1Hospital Sao Francisco, Leiria, Portugal Case Presentation Patient C.E.C., 82 years old, with a history of melanoma removal in 2021 and no follow-up after the surgical procedure. She sought medical attention in October 2022 due to asthenia, black stools, and signi ficant anemia (hemoglobin [hb] 6.2). She received two blood trans- fusions and underwent an upper digestive endoscopy (diag- nosed with hiatal hernia and erythematous gastritis). She was discharged for outpatient follow-up after controlling the lower gastrointestinal bleeding. The patient did not attend follow-up visits and, in June 2023, returned to the emergency room with asthenia and melena, with a hemoglobin level of 6.9. She received two blood transfusions and underwent colonoscopy (diagnosed with colonic diverticulosis). She began follow-up with the coloproctology team in October 2023, where a scintigraphy was requested, detecting non- active gastrointestinal bleeding: intermittent bleeding in the projection of the small intestine (duodenum and jejunum). Surgical intervention was then requested. A proximal jejunal enterectomy was performed due to the identification of three tumor masses. The histopathological report con firmed nod- ular melanoma with necrosis signs in the mucosa, submuco- sa, and invasion of the muscularis propria. Fifteen mesenteric lymph nodes were dissected and the classi fication was TNM (AJCC 8th edition) pT2mpN0. Currently, the patient is under- going oncology follow-up, diagnosed with skin melanoma with metastasis to the central nervous system, retroperito- neum, small intestine, and lungs.

Discussion

Melanoma represents about one-third of metastatic neoplasms detected in the gastrointestinal tract, but it is diagnosed in only 1.5 to 4.4% of cases. Most cases are concentrated in the small intestine (60%), and metastases to solid organs occur in 55% of cases, predominantly in the liver (55%) and brain (45%). Around 60% of patients present with acute obstructive abdomen, 15% with perforative abdomen, 10% with epigastric pain and heartburn, 5% with intense abdominal pain, 5% with melena, and 5% with obstructive jaundice. Treatment of metastasis in hollow organs consists of excising the lesion. The survival after metastasis treatment ranges from 1 to 36 months.

Conclusion

The prognosis for these patients is poor. According to the literature, survival is usually no more than 36 months. A thorough medical history is essential for early detection and intervention. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 136549 E-poster SCLEROSING MESENTERITIS – A CASE REPORT André Figueiredo Accetta 1, Italo Accetta 2, Ronaldo Vianna Silva2, Giovanna Jurcunas de Oliveira Gaeta1, Angelica Freitas da Silva Kneipp 1, José Antonio Dias da Cunha e Silva 1, Leonardo Santos de Almeida Alves 1, Eduardo Cortez Vassallo 1 1Universidade Federal Fluminense, Niterói, Brasil 2Hospital Estadual Alberto Torres, São Gonçalo, Brasil Case Presentation A 50-year-old male was admitted with abdominal pain, vomiting, and cessation of bowel move- ments for 2 days. He was previously healthy and denied alcohol consumption, smoking, or medication use. His medi- cal history included an appendectomy 37 years ago, two laparotomies for intestinal obstruction, and other episodes of subocclusion treated clinically. Upon examination, his abdomen was distended, painful, and hyperresonant. Labo- ratory tests were normal. A CT scan suggested mechanical intestinal obstruction, and conservative treatment was initi- ated but was unsuccessful. A laparotomy was performed with the release of firm adhesions, and he was discharged on the 5th day. He returned 48 hours later with subocclusion and a palpable mass on the left. A new CT scan showed diffuse distension, mesenteric fat densi fication, deviation, and ecta- sia of some vessels. A second surgery was performed with adhesion release, peritoneostomy, and biopsies of the mes- entery, confirming sclerosing mesenteritis (SM). The patient was started on total parenteral nutrition (TPN), prednisone, and tamoxifen, which were maintained for 60 days J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS82 postoperatively. At that point, the abdomen became flaccid, allowing for closure, and the patient was discharged.

Discussion

Sclerosing mesenteritis (SM) is a condi- tion affecting the mesentery, characterized by necrosis, chronic in flammatory in filtration, and fibrosis. Its etiology is not well established, but it may have an autoimmune origin or be associated with abdominal surgeries and neoplasms. Lipodystrophy and panniculitis are considered early and intermediate stages, while mesenteritis is the advanced stage, marked by fibrosis and vascular ectasia. It is more common in men over 50 years old. Symptoms are nonspeci fic, including recurrent abdominal pain, anorexia, weight loss, changes in bowel habits, and fever, with some patients presenting normal physical exams. In advanced stages, a fixed, painful abdominal mass with ill-defined borders and firm consisten- cy occurs due to the entrapment of bowel loops and retraction of the mesentery, which may lead to obstruction, chylous ascites, and thrombosis. CT scans show a heterogeneous expanding mass with fat density, ectatic vessels, fibrotic retraction of the mesentery, and pseudocapsular tumor-like structures delimiting affected and unaffected parts. The diagnosis is presumptive and con firmed by histopathology. Although there is no consensus, prednisone, tamoxifen, aza- thioprine, or colchicine, alone or in combination, appear to provide good responses.

Conclusion

Sclerosing mesenteritis is a rare disease with an uncertain etiology and dif ficult diagnosis for clini- cians, surgeons, radiologists, and pathologists. Its treatment is primarily conservative, and surgical intervention is indi- cated for cases of intestinal obstruction without satisfactory resolution or when malignancy is suspected in the affected mesenteric area. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138226 E-poster ECTOPIC GASTRIC MUCOSA IN RECTAL LST: A CASE REPORT Luna Vitória Gondim Ferreira 1, Taylene Rodrigues Souto 1, Vanessa Siqueira Reis 2, Marccus Antônio Tolentino de Jesus 2, Wilmar Junio Pereira Araújo 2, Antônio Carlos Nóbrega dos Santos2, Bruno Augusto Alves Martins 2, João Batista de Sousa 2 1Universidade de Brasília, Brasilia, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil Case Presentation A 47-year-old male patient pre- sented at the coloproctology outpatient clinic with a one-year history of hematochezia and the need for manual reduction of a nodule during bowel movements. During the first consul- tation in August 2023, a proctological examination revealed a soft 2 cm lesion, flat, not adhering to deeper planes, located 4 cm from the anal verge. A colonoscopy performed in the same month showed a laterally spreading lesion (LST) on the posterior wall of the distal rectum, measuring approximately 3 cm. Based on the diagnosis, the patient underwent transa- nal resection of the LST. The histopathological findings revealed gastric mucosa heterotopia in the colonic -type mucosa of the rectal LST, with deep margins free of hetero- topia but with a compromised peripheral margin. In February 2024, the patient underwent Milligan-Morgan hemorrhoi- dectomy due to persistent complaints of hematochezia and nodulation in the anal canal. In subsequent consultations, the patient reported significant improvement in symptoms, with the surgical wound in advanced healing and no signs of bleeding.

Discussion

The presence of ectopic gastric mucosa in the rectum is an extremely rare and uncommon finding, standing out in the medical literature as a pathological curiosity. Gastric heterotopia is typically found in locations such as the esophagus and small intestine, being very rare in the large intestine, particularly the rectum. LSTs in the rectum typically present histological features that may include ser- rated adenomas, hyperplasia, and dysplasia, but not typically gastric mucosa. This discovery raises questions regarding the etiology and development of this condition, suggesting the possibility of an anomaly in embryological development or abnormal metaplasia.

Conclusion

Finally, the case illustrates a challenging clinical presentation leading to an unusual histopathological finding. The presence of ectopic gastric tissue can lead to ulceration and bleeding due to acid production, increasing the complexity of management. Thus, the clinical implica- tions of this heterotopia are signi ficant, requiring careful and individualized treatment. This case highlights the importance of detailed histopathological evaluation in atypical rectal lesions, contributing to a better understanding and manage- ment of rare coloproctological conditions. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 137722 E-poster -YEAR-OLD PATIENT WITH AN INCIDENTAL DIAGNOSIS OF A RETRORECTAL LESION: A CASE REPORT João Victor Batista Ferreira 1, Amanda Karolyne Batista Ferreira1, Emerson Abdulmassih Wood da Silva 1, Carlos Eduardo Oliveira Sodero 1, José Roberto Violatti Filho 1, Luciano Ricardo Pelegrinelli1 1Universidade Federal do Triângulo Mineiro, Uberaba, Brasil Case Presentation An 11-year-old patient presented with intense colicky abdominal pain that worsened during defecation, along with a 4 kg weight loss over the past month. She had a prior hospitalization for abdominal pain, no family history of in flammatory bowel disease, but a maternal histo- ry of constipation and hard stools. Imaging exams, including ultrasound (US) and CT, revealed signi ficant small bowel distension, an enlarged right adnexa for her age with multiple follicular cysts, and a thick-walled cystic lesion with regular contours located posterior to the rectum, displacing its lower third anterolaterally to the right. MRI was performed for surgical planning and con firmed a solid-cystic extraperito- neal lesion in the presacral region, with no evidence of invasion into adjacent structures. Surgical excision of the lesion was conducted using a posterior approach with coccyx fracture during the procedure. Histopathological examina- tion con firmed the diagnosis of a retrorectal hamartoma ("tail gut cyst"). Postoperatively, the patient reported con- trolled pain, functional bowel habits, but complained of weakness.

Discussion

Retrorectal hamartomas ("tail gut cysts") are rare congenital lesions originating from embryological remnants of the hindgut. They are more common in middle- aged women, typically between 30 and 60 years. Clinical presentation ranges from asymptomatic to signi ficant proctological symptoms, depending on the lesion ’s size and J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S83 location. In this case, the patient experienced symptoms such as intense abdominal pain, vomiting, and signi ficant weight loss. Surgical resection, crucial to prevent future complica- tions such as infections, bleeding, or malignant transforma- tion, was performed via a posterior approach (Kraske incision) with coccyx fracture to access the lesion site.

Conclusion

This case highlights the importance of a comprehensive differential diagnosis in pediatric proctologi- cal patients with chronic abdominal pain and weight loss. Advanced imaging techniques combined with histopatholog- ical evaluation are essential for accurate diagnosis and thera- peutic planning. Complete surgical removal of retrorectal hamartomas is recommended due to their potential for complications, and adequate postoperative management is crucial for the patient ’s full recovery. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138231 E-poster ROLE OF VENOUS SCLEROSIS THROUGH EMBOLIZATION IN THE TREATMENT OF ANORECTAL VASCULAR MALFORMATION Mirtes Okawa Essashika Do Nascimento 1, Maria Inez Machado Fernandes1, Alexandre Souto de Moraes Morgado 1, Lucas Moretti Monsignore 1, Marley Ribeiro Feitosa 1, Omar Féres 1, José Joaquim Ribeiro da Rocha 1, Caroline Geraldo 1 1Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil Case Presentation A 5-year-old female patient pre- sented with small amounts of blood in her stool since thefirst months of life. At age 3, her mother sought medical attention due to increased bleeding, which necessitated blood trans- fusions. A colonoscopy revealed submucosal bluish bulges in the rectum. Pelvic computed tomography (CT) showed cir- cumferential thickening of the rectal wall with minimal enhancement and calci fications (phleboliths), consistent with venous malformation. Magnetic resonance imaging (MRI) demonstrated mild, gradual enhancement of the ano- rectal wall extending to the upper third of the rectum, along with multiple serpiginous structures in the perirectal fat, confirming the diagnosis of vascular malformation (VM). Conservative treatment with sclerotherapy via intervention- al radiology was chosen. The patient underwent partial embolization through portal venous access with the injection of lipiodol, polidocanol, and bleomycin into branches of the inferior mesenteric vein and superior rectal vein. Follow-up showed a signi ficant reduction in episodes of hematochezia, with no further need for transfusions.

Discussion

Vascular malformations of the gastroin- testinal tract are among the causes of gastrointestinal bleed- ing, requiring differential diagnosis from rectal hemangiomas. They are classified based on histological com- ponents and flow characteristics. Most cases are found in the colon or small intestine, with rectal involvement being rare. The main symptom of rectal vascular malformations is anal bleeding associated with anemia. MRI is the preferred imag- ing modality to de fine the extent of the lesion and its relationship to adjacent structures. CT, while less speci fic, is useful for identifying thrombotic foci and calci fications. Among therapeutic options, vascular embolization has prov- en to be an effective alternative to surgery, particularly in fragile or high-risk patients. Embolization can be repeated if recurrence occurs, and symptom control can be achieved quickly, as demonstrated in this case.

Conclusion

Diffuse rectal vascular malformations are rare, and early diagnosis is crucial for implementing appro- priate treatment. Vascular embolization is a viable and safe alternative in cases where clinical conditions or anatomical site constraints make surgery challenging. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141560 E-poster PARTICIPATION OF WOMEN IN THE BRAZILIAN SOCIETY OF COLOPROCTOLOGY OVER THE LAST 10 YEARS: WHAT IS THE FEMALE REPRESENTATION IN LEADERSHIP ROLES AND THE ANNUAL CONGRESS OF THIS SPECIALTY? Eduarda Alvarez Silva 1, Glicia Estevam de Abreu 1, Marilia Cardoso Massoni1 1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil

Introduction

Despite the evident growth in the num- ber of female physicians over the last decades, the underrep- resentation of women in surgical specialties and scienti fic events related to this field is a topic that has been little discussed. There is a lack of references and scienti fic data to foster discussions about this issue.

Objective

This study aims to evaluate the participa- tion of women in the Brazilian Society of Coloproctology (SBCP), analyzing the percentage of leadership positions held by women as well as their participation in the annual congress of this specialty.

Methods

Data on the number of women in leadership positions and their participation in the specialty ’s congress (main sessions, awards received, and secondary sessions) were collected from the online platform of the SBCP. These data were organized in an Excel spreadsheet and subsequent- ly analyzed to verify frequencies. Information on leadership positions and congresses held between 2013 and 2023 was gathered.

Results

Among the 9 presidents across 11 leadership terms (including one three-year term), only 2 (22.2%) were women. Regarding leadership positions during the evaluated period, of the 618 positions available, women held 139 (22.49%). Concerning awards at congresses during the evalu- ated period, of the 79 awards given, women received 40 (50.6%). Evaluating presentations in plenary sessions (main sessions), women were responsible for 213 (24.8%) of the 857 presentations conducted. For secondary sessions held in 2022-2023, women delivered 34 (29.82%) of the 114 presentations.

Conclusion

Although the number of female physi- cians in the SBCP has increased and women received more than half of the awards for scienti fic work, men continue to dominate prominent spaces in scienti fic discussions and occupy the majority of leadership positions. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS84 Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141784 E-poster EPIDEMIOLOGICAL PROFILE OF COLORECTAL CANCER CASES REPORTED IN BRAZIL FROM 2013 TO 2024 Ana Luísa dos Santos Pires 1, Caio Resende da Costa Paiva 1, Giovanna Oliveira Lial 2, Ana Carolina Sampaio Freire 1 1Universidade de Brasília, Brasilia, Brasil 2Centro Universitário de Brasília, Brasilia, Brasil

Introduction

Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide and the most frequent malignancy of the gastrointestinal tract. In Brazil, CRC presents a signi ficant burden of morbidity and mortality, ranking third in incidence, with approximately 40,000 new cases diagnosed annually.

Objective

To describe the number of reported cases and the demographic pro file of colorectal cancer in Brazil between 2013 and 2024.

Methods

This is a descriptive, retrospective, popula- tion-based epidemiological study conducted in July 2024. It utilized secondary data recorded in the Oncology Panel available on the website of the Department of Informatics of the Brazilian Uni fied Health System (DATASUS). The sam- ple included all reported cases of colorectal cancer in Brazil between January 2013 and December 2024.

Results

During the study period, CRC incidence varied by region, with the Southeast leading, followed by the South and Northeast regions. In 2024, 5,441 new cases of colorectal cancer were diagnosed, with the Southeast region accounting for the highest absolute number of cases (2,717 cases, 49.93%), followed by the South (1,665 cases, 30.6%), Northeast (652 cases, 12.05%), Midwest (292 cases, 5.36%), and North (115 cases, 2.11%). Diagnosis was most common in individu- als over 50 years of age, ranging from 77.3% in the North to 84.28% in the Southeast in 2024. Between 2013 and 2024, a total of 182,847 cases of colorectal cancer were reported in Brazil. The Southeast region was the most affected, with 89,798 cases (49.11%), followed by the South (49,535 cases, 27.09%) and Northeast (27,485 cases, 15.03%). The Midwest and North regions had fewer cases, with 11,572 (6.32%) and 4,457 (2.43%), respectively. Similarly, diagnosis was predom- inantly observed in individuals over 50 years of age, with the Southeast showing 80.76% of cases in this age group.

Conclusion

This study highlights the high prevalence of colorectal cancer during the analyzed period, particularly among individuals over 50 years old across all regions of Brazil, with a predominance in the Southeast. These findings underscore the importance of raising awareness about screening exams, such as colonoscopies, especially for this age group, to ensure early detection, reduce underreporting, and achieve better clinical outcomes. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138201 E-poster COLONIC PERFORATION SECONDARY TO TOXIC EPIDERMAL NECROLYSIS Vitoria Vicentin Giordano 1, Vitoria Vicentin Giordano 1, Fernando Cascelli Oliva 1, Natalia Ferreira Cardoso de Oliveira 1, Gabriela de Carvalho Simoes da Fonseca 1, Fernanda Bellotti Formiga1, Louisie Galantini Lana de Godoy 1, Fang Chia Bin 1 1Santa Casa de São Paulo, São Paulo, Brasil Case Presentation A 59-year-old male patient pre- sented with a diffuse rash, blistering lesions across the body and buccal mucosa, fever, tremors, and tachypnea, progres- sively worsening for five days prior to admission. Thirty days earlier, he had started lamotrigine for drug-resistant epilepsy. Toxic epidermal necrolysis (TEN) secondary to lamotrigine was diagnosed. Three days after admission, the patient developed abdominal pain and distension. An abdominal X- ray revealed a hyperlucent area above the liver, and a computed tomography (CT) scan con firmed a large pneumo- peritoneum. Exploratory laparotomy identi fied a pinpoint perforation in the transverse colon and localized peritonitis, leading to the decision to perform a transverse colostomy. The patient showed good clinical recovery and was dis- charged on the 12th postoperative day with signi ficant improvement in skin and mucosal lesions. During outpatient follow-up, intestinal continuity was restored 21 months after the colostomy.

Discussion

TEN is a severe, rare delayed hypersensi- tivity reaction to medication, characterized by purpuric exanthema with mucosal involvement, blisters, and detach- ment of more than 30% of the body surface area. The disease’s pathogenesis involves a delayed type IV hypersensitivity immune reaction, resulting in keratinocyte apoptosis medi- ated by CD8 þ cytotoxic T cells. Aromatic anticonvulsants, such as lamotrigine, are the leading cause of TEN in Latin American patients. TEN is part of the Stevens-Johnson syn- drome spectrum but involves a larger body surface area and has a more lethal progression. The epidermal detachment in TEN typically affects the skin or mucosa, most commonly ocular and respiratory epithelium. Mortality rates can reach 40%, primarily due to sepsis caused by skin barrier loss and respiratory involvement. Intestinal mucosal involvement is rare, with only six cases of colonic necrosis secondary to TEN reported in the literature. This case, involving focal necrosis and a pinpoint perforation, represents a highly atypical presentation.

Conclusion

TEN is a severe drug reaction, and colonic perforation secondary to it is extremely rare. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138341 E-poster INTESTINAL PERINEUROMA IN DESCENDING COLON: A CASE REPORT Lara Cristina Silva Inácio 1, Michaela Helena Moretto Alves 1, Eduardo Alves Canedo 1, Guilherme Bussola Carazzatto 2, Matheus Zanelato Cavalleri 1, Letícia Isper 2, Pedro Henrique Bauth Silva 1, André Antônio Abissamra 1 1Hospital Regional de Presidente Prudente, Prudente, Brasil 2Universidade do Oeste Paulista, Prudente, rasil Man, 41 years old, presents with anal pain and bleeding, characterizing hemorrhoidal disease. His personal J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S85 history shows no comorbidities or family history of colorectal cancer. He was surgically treated for hemorrhoids, and during a screening colonoscopy, a sessile polyp approximately 3mm in size was detected in the descending colon, where poly- pectomy was performed. The pathological result showed colonic mucosa with stromal expansion due to low-grade fusocellular proliferation, with a morphologically normal glandular component and no malignancy. Following this, the immunohistochemistry result diagnosed the polyp as a perineuroma, revealing focal positivity for EMA, and claudin- 1, and negativity for S-100. Perineuromas are rare benign tumors of the peripheral nerve sheath, and through reports, they have also been identified in variants of soft tissues, with the gastrointestinal tract being one such site. Literature on the elucidation of the evolutionary characteristics and fol- low-up of patients diagnosed and treated with perineuromas is still scarce. In the literature, using published articles as references, a total of 157 cases of colorectal perineuromas have been reported, with a female predominance (F:M = 1.3). Based on the reports, it is still unclear whether symptoms such as abdominal pain, diarrhea, gastrointestinal bleeding, and a history of previous colorectal carcinoma are related or if they are coincidental. The immunohistochemical character- istics of colorectal perineuromas allow for their identification and differentiation from other gastrointestinal neoplasms through speci fic markers. There are descriptions of GLUT1 and claudin-1, which showed strong and diffuse immunore- activity in 88% and 85% of cases, respectively. The expression of EMA, though present in 78% of cases, was weak and focal. The expression of CD34 was observed in 23% of cases, but was reported as limited and focal. Desmin and C -Kit (CD117) were negative, which aids in the differential diagnosis with in- flammatory myoglandular polyps and gastrointestinal stro- mal tumors, respectively. The expression of S100 protein was reported in one case. Therefore, it is necessary to have more reports in the literature on these rare origin benign polyps. Like the majority of intestinal perineuromas reported in the literature, this one appeared distal to the splenic flexure and is described as a sessile polyp. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138216 E-poster PRIMARY ENCAPSULATING SCLEROSING PERITONITIS: A RARE CAUSE OF INTESTINAL OBSTRUCTION - CASE REPORT Débora Alves Domingues Pereira1, Joaquim Tiago Cardoso Leles de Jesus1, Lucas Azevedo Ibrahin Elmor 2, Giselle Fonseca Sales Maia1, Thais Tavares Rezende 1 1Hospital de Clínicas Nossa Senhora da Conceição, Três Rios, Brasil 2Suprema Três Rios, Três Rios, Brasil Patient BFS, 34 years old, male, was referred to the emergency department with a presentation of cessation of gas and stool elimination, abdominal distention, and fecaloid vomiting that started approximately 48 hours prior. He denied comorbidities and had no previous history of abdom- inal surgeries. He also did not report weight loss, hemato- chezia, changes in bowel habits, or other symptoms suggestive of neoplastic disease. He denied a family history of colorectal cancer. An abdominal CT scan showed moderate distention of intestinal loops clustered in the mesogastric region, free abdominal fluid, and loculated collections. Given the acute obstructive abdominal picture, exploratory lapa- rotomy was chosen, during which encapsulating sclerosing peritonitis was identi fied, with a fibrous, thick membrane surrounding all the small bowel loops. The capsule was carefully resected to avoid injury to the intestinal loops, and the material was sent for histopathological analysis. The patient had a satisfactory postoperative evolution, with good progress on diet starting from the third day, being discharged on the seventh day after the procedure. The biopsy of the specimen showed chronic in flammatory processes without signs of malignancy. Encapsulating sclerosing peri- tonitis is a very rare case of intestinal obstruction. It can be primary or secondary, with the latter being more common, particularly arising as a result of peritoneal dialysis. The primary form is even rarer, with a few cases reported in women, and retrograde menstruation has been proposed as a possible cause. Treatment is primarily surgical, with the therapeutic approach being the resection of the fibrous membranes and lysis of adhesions. The literature lacks descriptions of cases like this, with its primary manifestation in men being even rarer and anecdotal, which is why we believe this case report is relevant. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138287 E-poster CASE REPORT: TREATMENT OF COLOSTOMY STENOSIS IN A CRITICAL PATIENT THROUGH EXCORPOREAL STAPLING Rodrigo de Almeida Paiva 1, Daniel Maurício Londoño Estrada 1, Letícia Brandão Castro 1, Artur Duarte e Duarte 1, Marina Barbabela Grisolia de Oliveira 1, Lucas Alves Bessa Cardoso 1, Eduardo Carvalho Barbosa 1 1Hospital Felício Rocho, Belo Horizonte, Brasil Case Presentation A male patient, 83 years old, with a history of hypertension, diabetes mellitus, coronary artery disease, mild cognitive decline, and partial dependency, underwent a retossigmoidectomy and primary anastomosis due to colon adenocarcinoma. On the 5th postoperative day (DPO), he developed an anastomotic leak and was referred for another surgical approach, resulting in a Hartmann colosto- my. He had a prolonged hospitalization with slow recovery and mobility restriction. After returning home, he developed abdominal pain and loss of appetite. During outpatient follow-up, an anastomotic stenosis was detected. Attempts at dilation were made, but without a de finitive resolution. During this period, the patient developed deep vein throm- bosis (DVT) in the lower limbs, requiring therapeutic anti- coagulation, followed by a severe case of dengue, requiring intensive care for management of electrolyte disturbances and acute renal failure. In this context, the patient experi- enced worsening pain and an obstructive condition due to retraction and near-complete stenosis of the ostomy, along with skin healing over the stoma. Given the worsening overall clinical condition, a local approach to the ostomy was chosen, and extracorporeal stapling was proposed and performed. A skin incision was made to expose the colonic mucosa, a colostomy bag was placed in the terminal colostomy, and adjacent tissues (mucosa and skin) were approximated. Stapling was done with a 28 mm circular stapler, re- fixing the ostomy at the same site. Post-procedure, gas release was observed on the 1st DPO, with proper function up to 60 days. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS86

Discussion

Colostomy creation is a common proce- dure in colorectal surgeries, and stenosis occurs in up to 15% of postoperative complications, causing signi ficant discom- fort to patients and often requiring re-surgical intervention. Periodic dilation is commonly used but often worsens the condition. Thus, when there is no plan for reconstructive surgery, especially in more severe clinical contexts, local ostomy revision seems to be a viable alternative.

Conclusion

Extracorporeal stapling proved to be a good alternative for treating colostomy stenosis in a patient with increased surgical risk and no planned reconstructive surgery. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141649 E-poster REMOVAL OF SURGICAL SPECIMEN VIA NATURAL ORIFICE (NOSES) VERSUS MINI-ABDOMINAL INCISION IN THE LAPAROSCOPIC SURGICAL TREATMENT OF INTESTINAL ENDOMETRIOSIS Rogerio Serafim Parra 1, José Vitor Cabral Zanardi 1, Fernando Passador Valério1, Marley Ribeiro Feitosa1, José Joaquim Ribeiro da Rocha1, Omar Féres 1, Matheus Couto Furtado Albuquerque 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

Introduction

and Objective Natural Ori fice Speci- men Extraction (NOSES) emerged as an alternative to mini- abdominal incision (MIA) for segmental resection (RES) in patients with intestinal endometriosis. This study aims to compare the surgical outcomes of the two techniques.

Methods

Patients who underwent RES of the rectum and/or sigmoid for endometriosis between January 2021 and May 2024 were assessed. Data regarding operative time, hospitalization duration, early discharge (within 24 hours after surgery), major postoperative complications (Clavien Dindo II or III), and mortality were collected and compared.

Results

A total of 88 RES procedures were performed, with 76 (86.4%) involving specimen removal via mini-ab- dominal incision (MIA) and 12 (13.6%) via NOSES. The average age at the time of surgery was lower in the MIA group compared to the NOSES group (36.5 vs. 40.1 years), as was the operative time (155.1 vs. 187.5 minutes). In the NOSES group, laparoscopic hysterectomy was performed in 5 cases (41.7%), vaginal dome lesions requiring intentional vaginal opening occurred in 6 cases (50%), and specimen removal via vaginal opening was done in 1 case (8.3%). In the MIA group, 9 out of 76 cases (11.8%) required concomitant laparoscopic hysterectomy. The hospitalization duration was similar in both groups (1.97 vs. 2.00 days), as was the rate of early discharge (n=24, 31.6% vs. n=4, 33.3%). The frequency of major postoperative complications within 30 days of discharge was significantly higher in the NOSES group compared to the MIA group (n=4, 33.3% vs. n=8, 10.5%). However, 3 of the 4 patients with complications (75%) had vaginal nodules, and only 1 (25%) required vaginal opening due to hysterectomy. There were no deaths.

Conclusion

NOSES was associated with a higher rate of major postoperative complications and longer surgical time compared to MIA. However, the majority of vaginal openings in the NOSES group were due to in filtrative lesions in the vaginal dome. Hospitalization duration and early discharge rates were similar. Randomized clinical trials are needed to further evaluate NOSES as an alternative to MIA in minimally invasive colectomy for the treatment of intestinal endometriosis. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141727 E-poster GIANT PELVIC SCHWANNOMA OPERATED VIA COMBINED POSTERIOR AND ANTERIOR APPROACH Artur Cury Féres 1, Thomaz Lucas Féres 2, Aryssa Aniello Sakai 1, Matheus Couto Furtado Albuquerque1, Rogério Serafim Parra1, Marley Ribeiro Feitosa1, José Joaquim Ribeiro da Rocha 1, Omar Féres1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil 2Centro Universitário Estácio de Ribeirão Preto, Ribeirão Preto, Brasil Case Presentation A 47-year-old male presented in 2020 at the oncology orthopedic clinic with complaints of constipation for 3 years, rectal tenesmus, the need to use suppositories, sharp stools, and urinary retention with a weak stream, requiring occasional bladder catheterization. On physical examination, there was pain upon palpation of the lower lumbar spine and sacral region, with a positive bilateral straight leg raise sign. A computed tomography scan performed the previous year showed an expansive lesion (10.4x11.4x12.8 cm) pre-sacral in location, likely of blastom- atous nature. The lesion displaced pelvic structures —the sigmoid colon and bladder (displaced to the antero-superior region). A biopsy guided by CT and MRI was performed, revealing a 14x10.5x9 cm sacral expansive lesion that pushed adjacent structures without invading the bladder or intesti- nal loops, with a relationship to the right neural foramen of S3-S4. The biopsy result was a benign mesenchymal neo- plasm—schwannoma. Surgical intervention was carried out by a joint team from orthopedics and coloproctology. Initially, a transverse posterior incision and sacrectomy at the S3 level were performed with tumor dissection by the orthopedic team. Then, a laparotomy approach was undertaken by the coloproctology team to remove the tumor intact, with no damage to the bowel or other structures. The patient had a favorable recovery and was discharged after 8 days. On his final follow-up with coloproctology, he continued to experi- ence constipation, requiring lavage treatments.

Discussion

Schwannoma is a rare tumor originating from Schwann cells and is the most common benign tumor of the peripheral nerve sheath. It presents a variety of morpho- logical forms and rarely manifests malignantly. Most schwan- nomas are idiopathic, but they can occur in association with genetic syndromes. It is more common in individuals be- tween the ages of 20 and 60. Complete surgical excision is the treatment of choice, but dif ficulties are often encountered due to the location and proximity to important nerves and blood vessels.

Conclusion

Schwannomas is most often presented as retro-rectal tumors, and the approach is typically via the posterior (sacral) route. More complex cases may require combined surgical approaches, as seen in this case. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S87 Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141117 E-poster LAPAROSCOPIC SURGICAL TREATMENT OF DEEP ENDOMETRIOSIS WITH INTESTINAL INVOLVEMENT: EXPERIENCE OF A REFERRAL CENTER Rogerio Serafim Parra1, Matheus Couto Furtado Albuquerque1, Marley Ribeiro Feitosa 1, Daniela França Camargo Freitas 1, José Vitor Cabral Zanardi 1, Fernando Passador Valério 1, José Joaquim Ribeiro da Rocha 1, Omar Féres 1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

Objective

This study aimed to describe the experience of a referral center in the laparoscopic surgical treatment of deep endometriosis with involvement of the rectosigmoid.

Methods

A retrospective study using prospectively recorded electronic data. The following parameters were evaluated: type of surgery, operative time, length of hospi- talization, conversion rate to open surgery, need for stoma, and postoperative complications Clavien Dindo /C21 2. The study was approved by the Ethics and Research Committee.

Results

A total of 290 surgeries were performed between March 2012 and April 2024. The average age was 36.1/C6 5.7 years (range, 20-55). There were 172 segmental resections (RES) of the rectosigmoid (59.3%), 81 disc resections (DIS) (29.9%), and 40 shavings (nodule excisions) (SHA) of the rectum (13.8%). Three patients (1.0%) had both DIS and RES in the same operative session. Additional procedures were per- formed in 123 patients (42.4%) and included appendectomy (n=71, 24.5%), hysterectomy (n=45, 15.5%), ileo-cecectomy (n=13, 10.5%), and segmental enterectomy (n=8, 2.8%). In 13 patients undergoing RES (7.5%), the surgical specimen was removed via the vagina (NOSES). There were 4 conversions to open surgery (1.4%). The mean surgical time was 134 /C6 55.9 minutes (range, 45-380 minutes), significantly shorter for SHA compared to DIS and RES (p <0.001) and shorter for DIS compared to RES (p <0.001). The average length of hospitali- zation was 1.6 /C6 0.9 days (range, 1-12 days), signi ficantly shorter for SHA compared to DIS or RES (p<0.001) and shorter for DIS compared to RES (p <0.001). Thirty-three patients (11.4%) had Clavien Dindo complications grade 2 (n=19, 6.6%) or 3 (n=14, 4.8%), with no statistical difference in comparisons between SHA vs DIS or RES (p=0.592), DIS vs SHA or RES (p=0.416), and RES vs SHA or DIS (p=0.259). Thirty- six patients (12.4%) required rehospitalization, and 11 patients (3.8%) needed reoperation within 60 days post-surgery, with no differences between SHA, DIS, or RES. Eight patients required a stoma (2.8%), 3 for protection and 5 due to postop- erative complications. No deaths occurred.

Conclusion

The laparoscopic surgical treatment of intestinal endometriosis presents low morbidity and low rates of stoma formation. Patients undergoing SHA or DIS have shorter surgical times, shorter hospital stays, and no differences in rehospitalization or reoperation rates. Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 138274 E-poster PRIMARY RETROPERITONEAL NEUROENDOCRINE TUMOR PRESENTING WITH SEGMENTAL SMALL INTESTINAL ISCHEMIA: CASE REPORT Letícia Brandão Castro 1, Artur Duarte e Duarte 1, Marina Barbabela Grisolia de Oliveira 1, Vinícius Avelar Palhares 1, Eduardo de Carvalho Barbosa 1, Marco Rinoldi 1, Fábio Lopes de Queiroz1, Breno Xaia Martins da Costa 1 1Hospital Felício Rocho, Belo Horizonte, Brasil Case Presentation An 89-year-old female patient presented with a three-month history of colicky abdominal pain, unmeasured weight loss, and anorexia. She visited the emergency department where a CT scan revealed segmental ileal wall thickening, prominent mesenteric vascular en- gorgement, and extensive adjacent lymphadenopathy. One week later, she developed intestinal ischemia in the ileal region and underwent exploratory laparotomy. The patholo- gy report revealed a retroperitoneal tumor with morpholog- ical features consistent with a neoplasm of uncertain histogenesis affecting a fibroadipose tissue fragment. Surgi- cal margins were free, with no angiolymphatic or perineural invasion. Metastasis was found in 2 of the 29 dissected lymph nodes. The immunohistochemical profile was consistent with a well-differentiated, low-grade (G1) neuroendocrine tumor, affecting fibroadipose tissue (positive for Chromogranin A, Synaptophysin, and Ki 67 positive in 2%).

Discussion

The retroperitoneum is not a typical site for primary neuroendocrine tumors, with its presence com- monly indicating metastatic disease originating from the gastrointestinal tract. These tumors are often discovered incidentally on routine exams, and they are oligossympto- matic in their early stages. When symptomatic, they often represent advanced disease with metastatic potential. They are classified into two subtypes based on their composition: neural, expressing neuro filaments (paragangliomas), and epithelial, expressing keratin (carcinoid). In elderly patients, the main cause of intestinal ischemia is thromboembolic events. Literature reports of neuroendocrine tumors causing intestinal ischemia are rare, with symptoms typically linked to carcinoid syndrome. A literature search revealed no reports of primary retroperitoneal neuroendocrine tumors presenting with intestinal ischemia. Most cases present with abdominal pain, palpable masses on physical examination, and symptoms due to compression of adjacent organs/ structures.

Conclusion

The diagnosis of a retroperitoneal neuro- endocrine tumor presents challenges in case management, as symptoms may have atypical manifestations. Surgical resec - tion may be necessary, or in speci fic cases, chemotherapy for undifferentiated or unresectable tumors. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS88 Temas Gerais Dentro da Especialidade General Topics Within the Specialty ID – 141744 E-poster USE OF GLP-1 ANALOGUE AS A CAUSE OF COMPLICATED ACUTE OBSTRUCTIVE ABDOMEN WITH PERFORATION – CASE REPORT AND LITERATURE REVIEW Euler de Medeiros Azaro Filho 1, Flávio de Castro Feitosa 1, Lina Maria Góes de Codes 1, Flávia de Castro Ribeiro Fidelis 1, Thamy Cristine Santana Marques 1 Rafaella Alcântara Alves Melo 1, Sabrina Queron Silva Bacelar Boudoux 1, Mayara Maraux Maranhão1 1Hospital Aliança, Salvador, Brasil Case Presentation A 38-year-old female patient with Myasthenia Gravis, using Azathioprine and injectable Sem- aglutide, was admitted to the emergency unit with abdomi- nal pain, distension, and diarrhea. She had leukocytosis without deviation and no other signs of in flammatory re- sponse. Fecal calprotectin, fecal leukocytes, and rotavirus tests were negative. An abdominal CT scan revealed wall thickening in the left colon, with adjacent fat densi fication and liquid layers in between, suggesting colitis. Antibiotic therapy was initiated, but on the second day of hospitaliza- tion, the patient showed worsening abdominal pain and distension, with peritoneal irritation, though without hemo- dynamic repercussions or laboratory worsening. A rectosig- moidoscopy showed no alterations and was stopped at 25 cm from the anal margin due to the presence of rock-like stool. On the third day of hospitalization, the abdominal pain and distension did not improve, and a new abdominal CT scan revealed pneumoperitoneum and stool outside the loop, adjacent to the colprostasis seen in the previous examination. The patient underwent exploratory laparotomy, which iden- tified a perforation in the sigmoid colon measuring about 2 cm, with necrotic edges. A Hartmann ’s procedure was per- formed with rectosigmoidectomy. The pathological anatomy showed wall necrosis, abscess in the subserosa, acute fibri- noleukocytic peritonitis, and hypertrophy of the muscularis propria.

Discussion

Patients with Myasthenia Gravis can pres- ent with intestinal dysmotility; however, what stands out in this case is that the onset of the obstructive condition occurred after the use of Semaglutide. The mechanism of action of GLP-1 receptor analogs involves decreased gastro- intestinal motility. Literature describes an increased risk of intestinal obstruction among both diabetic and non-diabetic patients using these drugs.

Conclusion

Identifying risk factors for intestinal ob- struction among patients who are candidates for GLP-1 receptor analog therapy and contraindicating the use in such cases could help prevent serious adverse effects related to this drug class. However, current data indicate that even among previously healthy individuals, there is an increased risk of various gastrointestinal complications. With the recent increase in Semaglutide and other GLP-1 analog prescrip- tions, adverse effects have been reported more frequently than expected. Long-term studies are necessary to identify potentially severe complications related to these drugs. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138291 Open Topics (oral presentation) THE INFLUENCE OF IMMUNOHISTOCHEMISTRY ON HISTOPATHOLOGICAL PREDICTORS OF LYMPH NODE METASTASIS IN T1 COLORECTAL CANCER Fábio Lopes de Queiroz 1, Artur Duarte e Duarte 1, Letícia Brandão Castro1, Marina Barbabela Grisolia de Oliveira 1, Eduardo de Carvalho Barbosa 1, Marco Rinoldi 1, Vinicius Avelar Palhares1 1Hospital Felício Rocho, Belo Horizonte, Brasil

Introduction

There are different approaches for the proper management of T1 colorectal cancer after local resec - tion. The identi fication of lymph node metastasis usually requires subsequent colorectal resection, and some histo- pathological factors can predict its presence. The depth of invasion of the submucosal layer is no longer considered an independent risk factor for predicting lymph node spread. Over the years, studies have shown that other histopatholog- ical factors, such as angiolymphatic invasion, are more relevant.

Objective

To evaluate histopathological risk factors for lymph node metastasis in T1 colorectal cancer, comparing

Methods

using Hematoxylin and Eosin (HE) with immuno- histochemistry. Speci fically, to evaluate angiolymphatic in- vasion, perineural invasion, and tumor budding, determining higher detection rates of these factors.

Methods

The study will investigate patients who underwent resection of lesions by endoscopic methods and were histologically diagnosed with T1 colorectal cancer. These patients are under follow-up with the Coloproctology team at Felício Rocho Hospital, Belo Horizonte - MG. The slides that determined the diagnosis using hematoxylin and eosin were also subjected to immunohistochemical analysis using antibodies such as D2-40, CD-34, Cytokeratins, and S- 100, and these results were compared.

Results

During the period from January 2024 to June of the same year, 14 patients with T1 colorectal adenocarci- noma were identified from colonoscopy or TEO, under follow- up with the team. Only 2 of these patients underwent surgery, and the others are being followed with conservative treat- ment. The degree of differentiation found was either well or moderately differentiated. Only 2 patients with angiolym- phatic invasion were detected by HE and were consistent with immunohistochemical methods. None showed positivi- ty for perineural invasion. The distinguishing factor was tumor budding, with two patients showing moderate and high grades by immunohistochemistry, in contrast to the low grade (Grade I) identi fied by HE for both.

Conclusion

Although this is an ongoing study with preliminary results, immunohistochemistry appears to be a more effective and easier method to detect poor prognostic factors in T1 colorectal cancer, thus facilitating the manage- ment of these tumors, in which only 10% actually present lymph node metastasis. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S89 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141167 Open Topics (oral presentation) HIGH RECTAL ADENOCARCINOMA BEHAVES LIKE COLON: PREMISE OR REALITY? Fernanda Bellotti Formiga 1, Iana Faine Saran 1, Janaina Giotti 1, Pedro Piassaroli de Abreu 1, André Luigi Pincinato 1, Odilon Victor Porto Denardin1, Daniele Evaristo Vieira Alves1, Bernardo Fontel Pompeu1 1Hospital Heliópolis, São Paulo, Brasil

Introduction

Extraperitoneal rectal adenocarcinoma has a distinct prognosis and treatment compared to other colorectal locations. The risk of local recurrence is higher in these tumors due to the anatomical characteristics of the pelvis, mesorectum, its lymph nodes, blood supply, the technical challenges of the surgical procedure, and the desire for sphincter preservation. Since the introduction of neo- adjuvant therapy as a differential treatment for middle and low rectal tumors, the treatment of high rectal tumors (RA) has been considered similar to distal colon tumors. However, there is little research on whether the behavior of these two sites differs. High rectal tumors have particularities: a narrow pelvis, risk of a derivative stoma, mesorectal lymph nodes, and partial mesorectal resection.

Objective

To compare the oncological behavior of high rectal adenocarcinoma and distal colon (DC) adenocarcinoma.

Method

A longitudinal prognostic study using retro- spective data from medical records of patients with RA, rectosigmoid transition, and sigmoid adenocarcinoma treated with curative intent from January 2020 to May 2024. Patients receiving treatment during this period were included, even if surgery had been performed earlier. Exclu- sion criteria included patients with unresectable tumors, synchronous metastases, resections after mucosectomies, postoperative death, and those who received neoadjuvant treatment. The RA and DC groups were compared using the chi-square test, and Kaplan-Meier survival curves were used, compared with the Log-rank test, with p <0.05.

Results

The RA group included 35 patients, while the DC group included 111 patients. Regarding outcomes, the groups differed in the location of tumor progression, with the DC group having a higher rate of metastatic disease (M1), while the RA group had a higher rate of local disease (DC 18% M1 and 3.6% local vs RA 5.7% M1 and 11.4% local, p=0.02). Additionally, the RA group had a higher rate of de finitive stoma (DC 16.2% vs RA 31.4%, p=0.04). However, overall and disease-free survival at two and five years did not differ between the groups (Log-rank overall survival p=0.52 and disease-free survival p=0.59).

Conclusion

High rectal adenocarcinoma and distal colon adenocarcinoma do not differ in overall and disease- free survival; however, the de finitive stoma rate is higher in high rectal tumors, and tumor progression to metastatic disease is higher in distal colon tumors. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138325 Open Topics (oral presentation) ANALYSIS OF PATIENTS OPERATED ON FOR RECTAL CANCER AFTER NEOADJUVANT THERAPY WITH NO RESIDUAL TUMOR IN THE PATHOLOGICAL EXAMINATION Mayara Marina Sousa Senzano1, Carlos Augusto Real Martinez1, Raquel Franco Leal 1, Claudio Saddy Rodrigues Coy 1, Michel Gardere Camargo 1, João José Fagundes 1, Maria de Lourdes Setsuko Ayrizono1 1Universidade Estadual de Campinas, Campinas, Brasil

Introduction

Around 10-25% of patients who under- go surgery for rectal cancer (RC) after neoadjuvant therapy show a complete pathological response in the surgical speci- men. However, it is dif ficult to predict this response with certainty based on the available exams, such as colonoscopy, magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT).

Objective

To evaluate patients with rectal cancer who underwent neoadjuvant treatment followed by surgery for incomplete response, and who did not present viable tumor in the pathological examination.

Method

Retrospective analysis of medical records of patients operated between 2015 and 2023 at the Hospital das Clínicas, Unicamp, who had a complete pathological response after surgery.

Results

During this period, 227 patients with rectal cancer were operated after neoadjuvant treatment, with 20 of them showing no viable tumor in the pathological exami- nation. Half received the Mayo regimen, and the other half received Xelox and radiotherapy. The average age was 56.8 years, with 70% being male. Of the 18 patients who under- went PET-CT, 9 (50%) showed residual neoplasia; of the 15 colonoscopies, 11 (73.33%), and of the 17 MRIs, 12 (70.50%). The average interval between the end of radiotherapy and surgery was 29.8 weeks.

Conclusion

Identifying patients with a complete pathological response after neoadjuvant therapy remains a challenge, and there is currently no exam capable of precisely determining this condition. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141641 Open Topics (oral presentation) ANALYSIS OF REPORTED CASES OF COLORECTAL CANCER IN THE STATE OF GOIÁS, BRAZIL (2013-2024) Stephanie Souza Firmo 1, Ana Carolina Oliveira Guaritá Marquez1, Danielle Toledo Gomes 1, Kethlen Torres Cavinato 1, Heron Kairo Saboia Sant ‘anna Lima 2 1Universidade Nove de Julho, São Paulo, Brasil 2Conjunto Hospitalar do Mandaqui, São Paulo, Brasil

Introduction

Colorectal cancer is one of the main malignant neoplasms in the state of Goiás, representing a significant challenge for local public health. In Goiás, it is the J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS90 third most prevalent type of cancer, surpassed only by breast and prostate cancer. The high incidence and severity of the disease demand a detailed analysis to better understand its distribution.

Objective

To analyze the distribution and pro files of colorectal cancer cases diagnosed in the state of Goiás.

Method

This is an analytical observational ecological study using data from the Oncology Panel available on the Department of Informatics of the Uni fied Health System (DATASUS) website. The sample included all cases of colorec - tal cancer (ICD codes C18, C19, C20, and C21) diagnosed in the state of Goiás between 2013 and 2024.

Results

During the period, 8,405 new cases of the disease were reported in Goiás, representing 2.6% of all colorectal cancer cases in Brazil (314,635). The gender distri- bution was 50.5% in women and 49.5% in men, re flecting the national distribution with similar numbers between genders. There was a reduction in new diagnoses in 2020 and 2021, possibly due to the Covid-19 pandemic, which led to a decline in seeking medical care. The age distribution shows the highest incidence in the 50 to 69 age group (51.4%) and the lowest incidence in individuals under 29 years of age (0.5%). The most common treatment types were chemotherapy, followed by surgery and radiotherapy. This distribution is inconsistent with the recommended guidelines for colorectal cancer treatment, which prioritize surgical resection of the tumor. However, when compared to other studies, a similari- ty in therapeutic strategies adopted is observed. The majority of diagnoses were made at stages 3 and 4, which is concerning as advanced-stage diagnoses are associated with worse prog- noses and lower survival rates.

Conclusion

This study revealed a high prevalence of colorectal cancer in the state of Goiás, particularly in the 50 to 69 age group and in both sexes. Chemotherapy and surgery were the most commonly used treatments, and most diagno- ses were made in advanced stages. The epidemiological information provided is essential for the promotion of public health measures and underscores the need for future and more detailed studies on the subject. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138234 Open Topics (oral presentation) EPIDEMIOLOGICAL ANALYSIS OF COLORECTAL MALIGNANT NEOPLASMS IN THE YOUNG BRAZILIAN POPULATION Eloisa Elena Xavier de Oliveira Ligoski 1, Lincólin Bardini Goulart1, Gabriele Eckerdt Lech 1, Giovanna Barcellos Gemelli 1, Brenda de Lima Louzada Pires 2 1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil 2Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil

Introduction

Colorectal cancer has a higher inci- dence among the elderly population, with most diagnoses concentrated in individuals aged 50-60 years. However, there has been a noticeable increase in this neoplasm among young people, where diagnosis may be delayed due to nonspeci fic symptoms, negatively impacting the disease prognosis. To date, no recent epidemiological analysis of colorectal cancer in the young population has been conducted.

Objective

To analyze the cases of colorectal malignant neoplasm diagnoses in the young population in Brazil. Methodology This ecological study utilized data extracted from the Department of Informatics of the Uni fied Health System (DATASUS) through the Oncology Panel — Brazil, covering the period from 2018 to 2023. Participants included males and females aged 0 to 19 years. The variables analyzed were malignant neoplasm of the colon (ICD10-C18), malignant neoplasm of the rectosigmoid junction (ICD10- C19), malignant neoplasm of the rectum (ICD10-C20), gen- der, and age group. The analysis was conducted using de- scriptive statistics.

Results

During the analyzed period, 4,676 cases of malignant neoplasms of the colon, rectosigmoid junction, and rectum were recorded in individuals aged 0 to 19 years of both sexes. Throughout this period, diagnoses were more frequent among males. In 2021, the highest number of colon cancer cases was recorded, with a total of 1,243 cases, 787 among males and 456 among females. There was a 280.1% increase in cases from 2018 (327 cases) to 2021 (1,243 cases). However, from 2021 (1,243 cases) to 2023 (562 cases), a 54.8% reduction was observed. Over the six-year period, 2018 presented the greatest proportional difference in cases between males (224) and females (103), with a ratio of 2.17. Meanwhile, 2023 showed the smallest male-to-female ratio, with 329 cases in males and 233 in females, representing a ratio of 1.41.

Conclusion

The study corroborates findings in the literature, confirming an increase in the prevalence of colo- rectal cancer in recent years, with a continued higher pro- portion of cases in males compared to females. Although the absolute number of cases was higher in 2023 compared to 2018, the growth trend in prevalence did not remain constant over the six-year period. This analysis includes data from before and after the 2020 pandemic, which may have in flu- enced the increased demand for healthcare and diagnostic imaging, particularly the post-pandemic peak in 2021. This study is highly relevant as it highlights the need for early detection of this neoplasm in young individuals. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138239 Open Topics (oral presentation) EPIDEMIOLOGICAL ANALYSIS OF MALIGNANT NEOPLASM OF THE RECTOSIGMOID JUNCTION IN BRAZIL BETWEEN 2018 AND 2023 Giovanna Barcellos Gemelli 1, Lincólin Bardini Goulart 1, Eloisa Elena Xavier de Oliveira Ligoski1, Isadora Medeiros de Almeida1, Brenda de Lima Louzada Pires 2 1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil 2Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil

Introduction

In 2022, approximately 20 million new cancer cases were reported globally. Colorectal cancer ranks third in prevalence and holds the same position in mortality for both genders.¹ Between 2023 and 2025, 45,000 annual cases of colorectal cancer are projected in Brazil.² Malignant neoplasm of the rectosigmoid junction is one of the types of colorectal cancer. Therefore, it is crucial to assess the current epidemiological scenario of this neoplasm to improve the reach of primary care. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S91

Objective

The current summary aims to evaluate the epidemiological pro file of malignant neoplasm of the recto- sigmoid junction in Brazil between 2018 and 2023.

Method

This is an ecological study based on data collected from the Department of Informatics of the Uni fied Health System (DATASUS) regarding diagnoses related to ICD- 19 (malignant neoplasm of the rectosigmoid junction) regis- tered between March 2018 and 2023. The data of interest included the total number of recorded cases, year of diagno- sis, origin, and gender of the patients. Data collection took place on June 10, 2024.

Results

Between 2018 and 2023, 12,899 cases of malignant neoplasm of the rectosigmoid junction were recorded, with a slight prevalence among women (6,516 women diagnosed compared to 6,383 men). Over the years, there was an approximate 82.7% increase in the total number of cases. The increase was 87.6% (638 cases) among women and 77.8% (560 cases) among men. A plateau in the total number of cases was observed between 2019 and 2021 (2,150 and 2,183 cases, respectively). During this period, the gender distribution pattern remained consistent, with an increase 5.6 times higher in women (28 cases) compared to men (5 cases). After this period, the growth became progressive, with an increase of 129 and 335 cases recorded in 2022 and 2023, respectively.

Conclusion

The findings indicate that the incidence of malignant neoplasm of the rectosigmoid junction has fol- lowed an increasing trend over the past five years, with progressive growth in the last two years. These data highlight the need for resources, material, and human allocation to meet the growing demand. Women are the most affected group, emphasizing the need for enhanced primary health- care attention regarding diagnosis and continued treatment for this population. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141723 Open Topics (oral presentation) CLINICAL PRESENTATION, PATHOLOGICAL STAGING, AND DISEASE-FREE SURVIVAL OF COLORECTAL CANCER IN YOUNG ADULTS Maria Beatriz Souza Nascimento 1, Carla dos Santos Porto 1, Lucas Gabriel Castro Carvalho 1,S o fia Arrais Haidar 1, Vanessa Siqueira Reis2, André Araújo de Medeiros Silva2, Bruno Augusto Alves Martins 2, João Batista de Sousa 2 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil

Introduction

Colorectal cancer is the second most frequent malignant tumor in men and women in Brazil and ranks as the second leading cause of mortality from malig- nant neoplasms worldwide. Additionally, its incidence has been increasing among young adults.

Objective

To study the clinical presentation, patho- logical staging, and disease-free survival of colorectal cancer in young adults.

Method

This case series study analyzed 41 oncology patients up to 45 years of age who were diagnosed and treated between 2010 and 2022. The variables collected included sex, age, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, and smoking), American Society of Anesthesiologists (ASA) classi fication, tumor loca- tion, staging, postoperative complications, follow-up, and disease-free survival outcomes.

Results

The study included 41 patients with a median age of 40 years (range: 23–45), of whom 24 were women (58.5%) with an average BMI of 23.13 kg/m². One patient had systemic arterial hypertension, two had diabetes mellitus, and one was a smoker. According to the ASA classification, 17 patients were classified as ASA 1, 17 as ASA 2, and 7 as ASA 3. The cases included 4 right colon adenocarcinomas, 17 left colon adeno- carcinomas, and 20 rectal adenocarcinomas. Regarding staging, 11 patients were stage I, 5 were stage II, 20 were stage III, and 5 were stage IV. Surgical approaches included 21 open surgeries and 20 laparoscopic surgeries. Postoperative complications occurred in 15 patients (36.5%), including urinary retention (6 patients), paralytic ileus (3 patients), pelvic abscess (3 patients), wound dehiscence (1 patient), pancreaticfistula (1 patient), and fever (1 patient), with no reported deaths. The average follow- up period was 35.59 months, and the disease-free survival rate for stage I to III patients was 87.8%.

Conclusion

This case series analyzed 41 young oncol- ogy patients. Despite a 36.5% rate of postoperative compli- cations, surgical intervention proved to be the gold standard treatment, with no operative mortality reported. Further- more, the disease-free survival rate for patients in stages I, II, and III was 87.8%. These findings underscore the importance of appropriate management for favorable prognoses in colo- rectal cancer patients. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141525 Open Topics (oral presentation) EVALUATION OF PURINERGIC MARKER EXPRESSION IN COLORECTAL CANCER PATIENTS Daniel de Barcellos Azambuja 1, Cristina Calloni 2, Gabriela Roliano1, Elizandra Braganhol 1 1Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil 2Universidade Feevale, Novo Hamburgo, Brasil

Introduction

Colorectal cancer (CRC) is associated with an in flammatory response characterized by a cellular infiltrate, with the relationship between in flammation and cancer being recognized. The role of purinergic signaling in determining the immune response to tumors has been a subject of discussion. The enzyme CD73 is emerging as a potential new therapeutic target.

Objective

The aim of this study was to evaluate the expression of genes related to immunosuppression in PBMCs isolated from the peripheral blood of patients with colorectal cancer and compare them with healthy individuals.

Method

Three patients diagnosed with primary CRC were selected. Blood samples were collected during the preoperative phase and subjected to a PBMC (Peripheral Blood Mononuclear Cells) isolation protocol, which separates different blood cells by density differences. qPCR was per- formed for the genes: CD73, CD39, Ab2, and MCP-1.

Results

The patients were of both genders, over 50 years old, white, with a positive family history of cancer and a diagnosis of colon adenocarcinoma. The analysis of the PBMCs revealed an increase in the expression of the enzymes CD39 and CD73 in the patient samples, which are responsible for degrading ATP, ADP, and AMP, and generating adenosine in J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS92 the extracellular medium, an immunosuppressive molecule that blocks the immune response against the tumor. An increase in the expression of the A2b receptor, which has selective speci ficity for adenosine and is also involved in immunosuppressive processes in CRC, was also observed. The MCP-1 gene (Monocyte Chemoattractant Protein-1) had in- creased expression and is associated with increased macro- phage infiltration in CRC.

Conclusion

The three patients with CRC presented an immunosuppressive profile, evidenced by the increased gene expression of purinergic markers compared to the control individuals. These results suggest that there is modulation of immune cells at the level of the peripheral blood system of the patients. Further analyses are necessary to con firm how these findings may help predict prognosis and metastasis development in patients. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141764 Open Topics (oral presentation) EVALUATION OF THE ONCOLOGICAL OUTCOME OF PATIENTS WITH DISTAL RECTAL ADENOCARCINOMA UNDERGOING MANUAL COLOANAL ANASTOMOSIS FROM 2015 TO 2020 Pedro Costa Moreira 1, Marcos Vinicius Araújo Denadai 1, Luis Gustavo Capochin Romagnolo 1, Felipe Daldegan Diniz 1, Rodrigo Giacomini Bregeiro 1, Carlos Augusto Rodrigues Veo 1 1Hospital de Amor Barretos, Barretos, Brasil This study investigates the effectiveness of manual coloanal anastomosis in patients diagnosed with distal rectal adenocarcinoma, with the main objective of evaluating over- all survival, disease-free survival, and postoperative compli- cations. This retrospective study analyzed 37 patients who underwent rectosigmoidectomy with total mesorectal exci- sion followed by manual coloanal anastomosis, between January 2015 and December 2020, at the Hospital de Amor Barretos/SP. The results indicate that, although this anasto- mosis presents technical challenges, when performed cor- rectly and applied to appropriately selected patients, it can

Result

in favorable oncological outcomes, comparable to or even surpassing current literature, while minimizing postop- erative complications. It is concluded that manual coloanal anastomosis is a feasible and safe approach in properly selected patients with distal rectal adenocarcinoma, but further studies are emphasized to con firm these findings and optimize patient selection and surgical techniques. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 137865 Open Topics (oral presentation) EVALUATION OF SURGICAL AND ONCOLOGICAL OUTCOMES OF INTERSPHINCTERIC RESECTION AND MANUAL COLOANAL ANASTOMOSIS IN THE TREATMENT OF DISTAL RECTAL ADENOCARCINOMA Lucas Faraco Sobrado 1, Fernando Noboru Cabral Mori 1, Yuri Tebelskis Nunes Dias 1, Bruno Massanori Matsumura 1, Guilherme Cutait de Castro Cotti 1, Caio Sergio Rizkallah Nahas1, Carlos Frederico Sparapan Marques 1, Ulysses Ribeiro Junior1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

Introduction

Historically, tumors in the distal rec - tum, close to the anal sphincter, were treated with abdom- inoperineal amputation to achieve wide, clear margins. Recently, it has been shown that margins of one centimeter are acceptable after chemoradiotherapy (CRT). Thus, for tumors without involvement of the intersphincteric plane, resection of the internal sphincter followed by manual coloa- nal anastomosis can be performed. Although some series show the safety of this procedure, it is still rarely performed outside specialized centers, making the treatment of distal rectal adenocarcinoma quite heterogeneous.

Objective

To evaluate the surgical and oncological outcomes of intersphincteric resection and manual coloanal anastomosis in patients with localized distal rectal adenocarcinoma.

Results

A total of 97 patients were included, with T1/ T2 tumors (44.3%), T3 (54.6%), and T4 (2.1%). Of these, 48.5% had suspicious mesorectal lymph nodes and 22.7% had lateral pelvic lymph nodes. Pre-neoadjuvant treatment, the inter- sphincteric plane was at risk or involved in 25%, and tumors were located 0.4 /C6 0.9 cm from the anorectal ring. A total of 90.7% underwent neoadjuvant treatment, and 10.2% were initially treated under a watch and wait protocol. Upon restaging, 14.1% still had the intersphincteric plane at risk. The surgical approach was laparoscopic (68%), open (19.6%), and robotic (5.2%). In 12.4%, pelvic lateral lymphadenectomy was performed, and in 6.2%, resection of another organ in a single block. The average hospital stay was 9.4 days, and there was one early reoperation due to internal hernia. The histo- pathological exam showed clear margins in 90.7%. During long-term follow-up, 7.2% had local recurrence and 24.7% had distant metastasis. A total of 7.2% required a de finitive stoma due to pelvic recurrence (n=3), chronic anastomotic compli- cations (n=3), and severe anal incontinence (n=1). After an average follow-up of 1563 days, 67% of the patients were alive without disease.

Conclusion

Intersphincteric resection with manual coloanal anastomosis for low rectal tumors has proven to be a safe procedure with satisfactory oncological outcomes. The incidence of local recurrences and distant metastases high- lights the importance of continuous and rigorous follow-up. Standardizing this procedure could contribute to a more homogeneous approach to the treatment of distal rectal adenocarcinoma. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138339 Open Topics (oral presentation) PRACTICAL EVALUATION OF MRI IN RECTAL CANCER: WHAT THE SURGEON NEEDS TO KNOW Mayra Veloso Ayrimoraes Soares 1,S ofia Arrais Haidar 2, Tiago Vasques Bertoncini2, Alexandre Sérgio de Araujo Bezerra 2, Aline Martins Oliveira 3, Fabio Pittella Silva 2, Romulo Medeiros de Almeida 2, João Batista de Sousa 2 1Universidade de Brasilia, Rede DASA, Hospital Sirio Libanes, São Paulo, Brasília J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S93 2Universidade de Brasilia, Brasil 3Rede DASA, Hospital Sirio Libanes, Brasil

Introduction

Magnetic resonance imaging (MRI) is the imaging method of choice for the characterization and staging of rectal cancer. Through it, preoperative anatomical study of the pelvic compartments can be performed, recog- nizing potential compromise of surgical planes and adjusting the operative strategy. MRI also allows the identi fication of high-risk criteria, aiding in the decision of whether to use neoadjuvant treatment for potential tumor downstaging and improved surgical outcomes.

Objective

The objective of this work is to demon- strate, in a practical way, in seven steps, how to: - recognize a technically adequate MRI; - map the main characteristics related to TNM staging, as well as signs of locoregional involvement and adjacent structure compromise; - recognize patterns of mesorectal invasion; - recognize the mesorectal fascia and its potential tumor involvement; - identify lymph node suspicion criteria and locate the main affected chains on MRI; - screen for factors indicating poor oncological progno- sis; - establish the involvement of important anatomical structures, impacting the decision of surgical and oncological strategy.

Method

Evaluation of MRI exams of patients in different tumor stages, to practically demonstrate the main anatomical repairs, the manifestations of rectal cancer on MRI, and imaging findings in various clinical scenarios (TNM).

Results

Systematic evaluation of MRI findings in rectal cancer, in seven steps: 1. Recognizing a technically adequate exam 2. Anatomy of the rectum on MRI 3. Meso- rectal fat and mesorectal fascia 4. Evaluating the T stage 5. The challenge of lymph node evaluation 6. Extramural vascular invasion and its significance 7. Tumor resection planning with MRI

Conclusion

Magnetic resonance imaging is currently an indispensable tool in the diagnosis and reassessment of patients with rectal cancer. It enables pre-treatment tumor staging, defining the best therapeutic strategy for each sce- nario, and contributes signi ficantly to post-neoadjuvant tu- mor reassessment. It is essential, therefore, that the colorectal surgeon masters the concepts of imaging for the de finition of the most appropriate surgical and oncological therapeutic strategy and for better communication with the multidisci- plinary team. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141658 Open Topics (oral presentation) ROBOTIC SURGERY VERSUS LAPAROSCOPIC SURGERY FOR RECTAL CANCER TREATMENT. COMPARATIVE ANALYSIS BETWEEN THE METHODS IN AN ONCOLOGICAL CENTER IN BRAZIL Marcos Vinícius Araújo Denadai 1, Camila Lima Alves 1, Luís Gustavo Capochin Romagnolo 1, Felipe Daldegan Diniz 1, Rodrigo Giacomini Bregeiro 1, Carlos Augusto Rodrigues Véo 1, João Pedro Pinto Cordeiro de Miranda Coutinho 1, Alejandro Delfos Hermoza1 1Hospital de Amor de Barretos, Barretos, Brasil

Introduction

Minimally invasive surgeries have grown substantially worldwide, and today they are one of the main access routes for abdominal surgeries. The increas- ing number of cancer cases leads to a rise in the number of surgeries, highlighting the importance of expanding less invasive surgical techniques in the colorectal field, with improvements in patient outcomes and quality of life. The use of advanced technology, such as robotics, raises the question of whether this is currently the best access route for better surgical results. There is a lack of long-term studies with a larger number of patients comparing the two techni- ques used (videolaparoscopy vs. robotics) and thus demon- strating the real bene fit of using robotic technology for oncological treatment and accelerating postoperative recovery.

Objectives

The aim of this study is to evaluate the benefits of robotic surgery compared to videolaparoscopic access in patients with rectal adenocarcinoma, who under- went minimally invasive surgery between 2018 and 2022, in a reference oncological center in Brazil.

Materials and methods

A retrospective study was conducted evaluating 878 patients operated on for rectal tumors between 2018 and 2022 in a reference oncology service in Brazil. A database platform, RedCap, was used to assess the data.

Results

During the analyzed period, a total of 505 videolaparoscopic surgeries (VLP) and 373 robotic surgeries (RS) were performed. The robotic group had patients with a younger age (58 þ/- 12 vs. 61 þ/- 12; p = 0.002), lower body weight (72 kg vs. 76 kg; p = 0.025), higher frequency of neoadjuvant therapy (p < 0.001), and longer surgery time (p < 0.001). However, there were no statistical differences in postoperative diet initiation, length of stay, conversion rates, postoperative complications, or oncological outcomes.

Conclusion

The present study, comparing minimally invasive techniques for rectal cancer surgery, showed similar postoperative complication rates and oncological outcomes between the robotic and videolaparoscopic approaches, with both being safe and bene ficial for patients with colorectal neoplasms. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141079 Open Topics (oral presentation) CONVENTIONAL RIGHT HEMICOLECTOMY VS. COMPLETE MESOCOLON EXCISION: ANALYSIS OF LOCOREGIONAL RECURRENCE Rodrigo Moisés de Almeida Leite 1, Lucas Pilotto Ramos 1, Lucas Soares Gerbasi1, Giovana Moreira Minchillo 1, Francisco Tustumi1, Rafael Vaz Pandini 1, Victor Edmond Seid 1, Sergio Eduardo Alonso Araujo 1 1Hospital Israelita Albert Einstein, São Paulo, Brasil

Introduction

Complete mesocolon excision may be associated with lower rates of lymph node recurrence in right colectomy for colon adenocarcinoma. The objective of this study was to compare conventional right colectomy with complete mesocolon excision (CME) for right colon adeno- carcinoma. A retrospective cohort study was conducted at the Vila Santa Catarina Hospital (Sociedade Bene ficente Israelita Brasileira Albert Einstein), São Paulo , Brazil .

Methods

Adult patients ( >18 years) diagnosed with right colon adenocarcinoma were included. Only minimally invasive right colectomies (laparoscopic or robotic) were J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS94 considered. The inclusion period was from 2019 to 2024. CME was de fined as right colectomy with central ligation of the ileocolic, right colic, and right branch of the colon arteries; mesenteric dissection through the embryonic layer; and D3 lymphadenectomy. Our primary outcome was locoregional recurrence, defined as nodal disease or local recurrence after the start of follow-up for cancer. Disease-free survival was defined as the absence of locoregional or distant recurrence after surgery. We performed survival analysis for disease-free survival and multivariate Poisson regression to obtain risk ratios for locoregional recurrence between the groups after adjustment for: - Age; - Sex; - BMI ; - Pathological T stage ; - Pathological N stage; - Mismatch repair protein de ficiency; - Neoadjuvant chemotherapy; - Adjuvant chemotherapy; - First postoperative CEA level; - Hypertension; - Diabetes Mellitus; - ASA score.

Results

A total of 154 cases were included for analysis, 26 in the CME cohort and 128 in the conventional cohort. No local recurrences were observed in either group. Nodal recurrence was observed in 6 patients in the conventional cohort (incidence of 9.52%). No nodal recurrence was ob- served in the CME group. The mean time to nodal recurrence was 28 months (SD 10 months). The main predictors of nodal recurrence were pT4 and pN2 stages. After adjusting for multiple confounding factors, CME was associated with a significant reduction in the risk of nodal recurrence (adjusted RR = 0.08; 95% CI: 0.05 to 0.09; p < 0.001) and a signi ficant increase in disease-free survival (HR = 0.03; 95% CI: 0.003 to 0.27; p = 0.002). Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141617 Open Topics (oral presentation) COMPLETE MESOCOLIC EXCISION VERSUS CONVENTIONAL D2 LYMPHADENECTOMY IN RIGHT HEMICOLECTOMY: A META-ANALYSIS OF PROPENSITY SCORE MATCHED STUDIES AND RANDOMIZED CONTROLLED TRIALS Bernardo Fontel Pompeu 1, Eric Pasqualotto 2, Patrícia Marcolin3, Lucas Monteiro Delgado4, Beatriz D’andrea Pigossi1, Sergio Mazzola Poli de Figueiredo 5, Fernanda Bellotti Formiga 1 1Hospital Heliópolis, São Paulo Brasil 2Universidade Federal de Santa Catarina, Florianópolis, Brasil 3Universidade Federal Fronteira do Sul Passo Fundo, Passo Fundo, Brasil 4Universidade Federal de Minas Gerais, Belo Horizonte, Brasil 6Cleveland Clinic, Ohio, United States

Introduction

The complete mesocolic excision (CME) in right-sided hemicolectomy could result in higher lymph node yield and decreased local recurrence. However, this approach could increase intraoperative and postoperative complications.

Objective

Our meta-analysis aims to demonstrate the outcomes of CME versus D2 conventional lymphadenectomy for right-sided colon cancer.

Methods

We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and EMBASE for studies published until April 2024. Odds ratios (OR) with 95% con fidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the Cochran Q test and I² statistics, with p-values 25% considered sig- nificant. Statistical analysis was performed using R Software, version 4.1.2.

Results

Three randomized controlled trials and four observational studies comprising 2,296 patients were includ- ed, of whom 1,138 (49.6%) were submitted to the CME and 1,158 (50.4%) to the conventional D2 lymphadenectomy. CME was associated with decreased local recurrence rates (OR 0.07; 95% CI 0.01 to 0.36; p=0.002). There were no signi ficant differences between groups in overall complications, severe complications, intraoperative complications, blood loss, and 30-day mortality. No difference between groups was observed in distance metastasis and 3-year disease-free survival.

Conclusion

In this meta-analysis, CME signi ficantly decreased local recurrence rates and increased the number of harvested lymph nodes compared with D2 lymphadenecto- my in patients with right-side colon cancer. No difference was observed between groups in rates of overall complications, severe complications, intraoperative complications, blood loss, and 30-day mortality. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141739 Open Topics (oral presentation) CORRELATION BETWEEN DIGITAL RECTAL EXAMINATION AND MAGNETIC RESONANCE IMAGING IN ASSESSING THE DISTANCE OF RECTAL TUMORS FROM THE ANAL MARGIN IN PATIENTS FROM A UNIVERSITY HOSPITAL Catarina Ferreira Costa Praia 1, Luís Felipe Mendonça de Oliveira1, Rafaela de Melo Sprogis 2, Pedro dos Anjos Freixo 2, Mayra Veloso Ayrimoraes Soares 1, Bruna Stefany Bento de Sousa Teles2, Rômulo Medeiros de Almeida 1, João Batista de Sousa1 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil

Introduction

The evaluation of distal rectal cancer (RC) includes digital rectal examination (DRE), endoscopic examination, and staging by magnetic resonance imaging (MRI). In clinical practice, specialists use DRE to assess the tumor’s distance from the anal margin. MRI is employed for staging to indicate the degree of invasion in the mesorectal fascia layers, the presence of lymph nodes, and the tumor ’s distance from the sphincter complex and anal margin.

Objective

To evaluate whether the distance of rectal tumors from the anal margin measured by DRE correlates with the distance measured by MRI.

Method

We reviewed 65 patient records with rectal tumors who underwent DRE and MRI to measure the tumor’s distance from the anal margin between 2019 and 2024 at a university hospital. Forty-one records were selected for evaluation based on the inclusion criterion of explicitly stating the tumor ’s distance from the anal margin in both DRE and MRI exams. The respective measurements were assessed using Pearson’s correlation coefficient (r) and Intra- class Correlation Coef ficient (ICC), as well as paired T-tests.

Results

The mean distance of tumors from the anal margin measured by DRE and MRI were 5.3 cm and 6.9 cm, respectively, with standard deviations of 2.45 and 2.67. The analysis revealed a moderately strong positive correlation between the measurements of both exams (r = 0.673), suggesting that tumor size can be measured similarly by DRE and MRI. The Intraclass Correlation Coef ficient (ICC(3k)) J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S95 for the agreement between the two exams was calculated to be 0.80 (95% CI: 0.67-0.88), showing substantial agreement between them, indicating robust consistency in the measure- ments and ensuring reliable clinical evaluations. The com- parison of the measured distances showed a statistically significant difference between DRE and MRI (Paired t-test: t (40) = 3.0348, p < 0.005), with an approximate mean differ- ence of 0.985 (95% CI: 0.33-1.64), suggesting that although the distances are not identical, the magnitude of the differ- ence should be interpreted in the clinical context.

Conclusion

Based on the data obtained in this study, it can be concluded that the measurement of the rectal tumor’s distance from the anal margin by DRE has a good correlation with the measurement by magnetic resonance imaging, although there is signi ficant variability. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141775 Open Topics (oral presentation) CORRELATION BETWEEN CIRCULATING FREE DNA LEVELS AND PREOPERATIVE SERUM CARCINOEMBRYONIC ANTIGEN LEVELS IN PATIENTS WITH COLORECTAL CANCER Pedro dos Anjos Freixo 1, Beatriz Regis da Cunha 1, Catarina Ferreirra Costa Praia1, Luís Felipe Mendonça de Oliveira1, Bruna Stéfany Bento de Sousa 1, André Araújo de Medeiros Silva 1, Bruno Augusto Alves Martins 1, João Batista de Sousa 1 1Universidade de Brasília, Brasília, Brasil

Introduction

Colorectal cancer is the third most common malignancy and the second leading cause of can- cer-related deaths worldwide, accounting for over 930,000 deaths annually. Given the signi ficance of this public health issue, early detection and effective monitoring are crucial for improving clinical outcomes. New potential tumor markers are being widely studied for this purpose. CEA is a marker traditionally used in clinical practice, despite its limitations, such as low speci ficity. cfDNA, on the other hand, is an emerging approach that promises greater precision in detect- ing recurrences and monitoring treatment responses.

Objective

To investigate the correlation between pre- operative serum CEA levels and cfDNA levels in patients with colorectal cancer, while evaluating their relationship and the influence of comorbidities and clinical characteristics.

Methods

This prospective study included 22 patients with colorectal adenocarcinoma. Preoperative cfDNA was collected through liquid biopsy immediately before surgery. CEA was collected immediately after diagnosis. Clinical and epidemiological variables were extracted from medical records. Variables collected included age, gender, diabetes mellitus, alcoholism, smoking, number of medications used, hypertension, and body mass index (BMI). Nine patients were male, and 13 were female, with a mean age of 51 years. Thirteen patients had hypertension (59%). Continuous vari- ables with normal distribution were presented as mean /C6 standard deviation, while non-parametric continuous varia- bles were presented as median and interquartile range. The direct correlation between cfDNA and CEA was analyzed using Pearson, Spearman, and Kendall tests.

Results

47% of patients presented CEA levels higher than 5, while cfDNA levels ranged from 0.52 to 58.2. The direct correlation between cfDNA and CEA, according to the tests, was positive but weak. Hypertension emerged as a significant variable with a negative effect on the likelihood of positive CEA levels. Other clinical characteristics did not show significant importance.

Conclusion

Considering the limitations of the study, particularly the small sample size, and based on the results obtained, it is reasonable to conclude that preoperative circulating cfDNA serum levels do not correlate with CEA levels. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141750 Open Topics (oral presentation) CORRELATION BETWEEN SERUM CIRCULATING TUMOR DNA LEVELS AND LYMPH NODE RATIO IN PATIENTS WITH COLORECTAL CANCER Beatriz Regis da Cunha1, Pedro dos Anjos Freixo 1, Kristine Leão Alarcão1, André Araújo de Medeiros Silva2, Bruna Stéfany Bento de Sousa Teles 2, Mayra Veloso Ayrimoraes Soares 2, Fabio Pittella Silva 2, João Batista de Sousa 1 1Universidade de Brasília, Brasília, Brasil 2Hospital Universitário de Brasília, Brasília, Brasil

Introduction

Colorectal cancer (CRC) is the most prevalent malignancy worldwide. Colonoscopy is the gold standard for CRC screening and diagnosis, but it is costly and requires preparation and sedation. Therefore, the identi fica- tion of biomarkers to aid in CRC diagnosis is a pressing need in clinical practice. Among these, circulating free DNA (cfDNA) stands out. The detection of cfDNA involves a blood sample, which potentially increases patient adherence. Beyond its diagnostic role, this tool can be used in staging, assessing treatment response, and early detection of recurrences.

Objective

To evaluate the relationship between se- rum cfDNA levels and the lymph node ratio in patients with CRC.

Methods

A longitudinal and prospective study with molecular analysis of cfDNA liquid biopsy from 25 patients with CRC. Clinical and epidemiological data were collected from medical records. Continuous data with normal distri- bution were presented as mean /C6 standard deviation and compared using covariance analysis adjusted for age and gender. Data with non-parametric distribution were pre- sented as median and interquartile range. Categorical varia- bles were compared using the chi-square test.

Results

The sample included 25 patients, of which 9 were male and 14 were female. Male sex (Odds Ratio - OR 0.045) and diabetes (OR 0.0000155) tended to be protective factors. However, hypertension was associated with more advanced staging. A higher lymph node ratio predominated in the third tertile of cfDNA levels. The estimated coefficient was 94.423 with a p-value of 0.000712, indicating a positive, linear, and statistically signi ficant relationship between the lymph node ratio and cfDNA levels. In the adjusted chi-square analysis, approximately 43.28% of the variance in cfDNA levels was explained by the lymph node ratio. In the normal model, there was a trend suggesting that Body Mass Index (BMI) influenced staging, and when cfDNA levels were added to the analysis, the impact of BMI was reinforced.

Conclusion

In this study, cfDNA was not shown to be a predictive factor for invasion depth or staging in CRC patients, but there was a strong relationship between this serum marker and lymph node involvement. Furthermore, BMI J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS96 was the variable that demonstrated a statistically signi ficant association with cfDNA levels. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141126 Open Topics (oral presentation) CHALLENGES IN ACCESS TO ROBOTIC SURGERY IN RIO GRANDE DO SUL Bruna Oliveira Trindade 1, Cristina Calloni 2, Fares Hassan Hamaoui3, Antônio Nocchi Kalil 3, Daniel de Barcellos Azambuja3 1Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil 2Universidade Feevale, Novo Hamburgo, Brasil 3Santa Casa de Porto Alegre, Porto Alegre, Brasil

Introduction

With technological advancements, ro- botic surgery has gained prominence in the treatment of colorectal cancer. However, Brazil still has limited robotic platforms. The geographic distribution of people and these technologies creates inequalities in access to medical care.

Objective

To analyze the distribution of robotic sur- gery centers in Rio Grande do Sul (RS) and estimate the number of patients without access to this service.

Method

Data from the DataSUS Oncology Panel was used to gather information on the number of patients diag- nosed with colorectal cancer (ICD C18 to C21) in each municipality of RS and how many underwent surgical treat- ment. Municipal sociodemographic data were obtained from IBGE. Geospatial analysis was performed using ArcGIS Online software, considering a 2-hour driving limit to robotic sur- gery centers.

Results

In RS, there are seven hospitals with robotic platforms: three in Porto Alegre, one in Santa Maria, one in Caxias do Sul, one in Novo Hamburgo, and one in Passo Fundo. Approximately 134 (26.85%) municipalities in RS fall within the 2-hour travel zone to a robotic surgery center, covering around 6,610,119 (60.75%) of the state ’s population. In 2023, 5,488 patients were diagnosed with colorectal cancer via the SUS, with 1,118 undergoing surgical treatment. Considering two access scenarios for robotic surgery, 2,111 (38.47%) of the patients diagnosed with colorectal cancer and 383 (34.26%) of those treated surgically are located more than 2 hours away from a robotic surgery center. Geographical analysis revealed that most municipalities with the highest prevalence of colorectal cancer are within the 2-hour travel zone, but there is a lack of access in the southwestern part of the state. Sociodemographic data showed an average schooling rate of 87.18% for children aged 6 to 14 years, a mean human development index of 0.62, and a per capita GDP of R $51,558.60 outside the 2-hour travel zone, compared to 78.45%, 0.59, and R$52,624.12, respectively, within the travel zone. Only schooling showed a signi ficant difference (p = 0.0009).

Conclusion

Most of the population and colorectal cancer patients are near cities with robotic surgery centers, but a significant portion remains underserved. The state data only accounts for the SUS network, while current robotic surgery users are predominantly private healthcare patients. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141678 Open Topics (oral presentation) IMPACTO DA OBESIDADE NA INCIDÊNCIADE CÂNCER COLORRETAL NO BRASIL IMPACT OF OBESITY ON THE INCIDENCE OF COLORECTAL CANCER IN BRAZIL Higor Roberto Spegiorin 1, Rafael Lopes Mendes Silveira 2, Klaus Gonçalves Souza Menezes 3, Otávio Lotti Paulino 1 1Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brasil 2Universidade Barão de Mauá, Ribeirão Preto, Brasil 3Universidade de Ribeirão Preto, Ribeirão Preto, Brasil Obesity is widely recognized as a signi ficant risk factor for various chronic diseases, including colorectal can- cer (CRC). In Brazil, the rising prevalence of obesity represents an additional public health challenge, especially considering its influence on CRC incidence. Excess adipose tissue has been shown to promote chronic in flammation and hormonal imbalances, contributing factors to carcinogenesis. This study aims to evaluate the relationship between obesity and CRC incidence in Brazil, using recent epidemiological and clinical data. The research was conducted through an analysis of articles addressing this issue in Brazil. Data were extracted from hospital records and national databases, focusing on the relationship between obesity indices and CRC cases. The analyzed studies demonstrated a signi ficant correlation be- tween obesity and CRC incidence. In Alagoas, data indicated that obese patients (OP) had a higher incidence of CRC compared to those with normal weight. Similarly, an increase in CRC mortality rates was observed in populations with a high prevalence of obesity. The analysis revealed signi ficant regional disparities. In Rio Grande do Sul and Mato Grosso, the association between obesity and CRC was also evident, with elevated incidence and mortality rates. The following state-specific correlations between obesity and CRC were identified: AL: CRC incidence in 25% of OP compared to normal-weight patients. RS: CRC mortality rate was 30% higher in OP. MT: CRC mortality was 20% higher in OP . SP: OP had a 15% higher CRC incidence. MG: CRC mortality in OP was 18% higher. BA: CRC incidence was 22% higher in OP. PR: Obesity was associated with a 28% increase in CRC mortality. PE: CRC incidence was 19% higher in OP . Notably, obesity is associated with delayed diagnoses and worse prognoses due to the complexity of treating obese patients. In conclusion, obesity has a substantial impact on CRC incidence and mortality in Brazil. Evidence suggests that obesity not only increases the risk of developing CRC but also complicates disease management and treatment. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S97 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141629 Open Topics (oral presentation) IMPACT OF PREOPERATIVE WEIGHT LOSS ON MUSCLE MASS AND FUNCTION IN PATIENTS WITH COLORECTAL CANCER Márcia Fábia Andrade 1, Fernanda Bellotti Formiga 2, Jaline Zandonato Faiad1, Joyce Cristina Ferreira de Resende1, Gabriela Salim de Castro 1, Bernardo Fontel Pompeu 3, Fang Chia Bin 4, Marília Seelaender1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo, Brasil 2Santa Casa de São Paulo e Hospital Heliópolis, São Paulo, Brasil 3Hospital Heliópolis, São Paulo, Brasil 4Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brasil

Introduction

Patients with colorectal cancer often experience significant weight loss, primarily involving a loss of muscle mass, which is directly linked to increased com- plications in oncological treatment, whether systemic or surgical. In patients undergoing colorectal resection, myope- nia (low muscle mass) and muscle weakness (low function) are associated with longer hospitalization, anastomotic com- plications, a higher risk of infection at the surgical site, poorer quality of life, and higher morbidity and mortality. Bioimpe- dance (BIA) is commonly used in studies as a good parameter for evaluating muscle mass. Additionally, handgrip strength (HGS) is one of the most used methods for assessing muscle strength and function.

Objective

To correlate preoperative weight loss and the impact of muscle mass loss in colorectal cancer patients with postoperative clinical outcomes.

Method

This multicenter study was approved by the Ethics Committees of the partnering institutions. Non-meta- static patients with colorectal adenocarcinoma were recruited during their preoperative consultation. Bioimpe- dance, anthropometry, handgrip strength, and laboratory tests were performed on 16 patients of both sexes. The patients were divided into two groups: those with weight loss and those with stable weight. After the surgical proce- dure, data related to hospitalization time and postoperative complications, classi fied according to the Clavien-Dindo classification, were collected.

Results

The included patients had a mean age of 67.75/C6 12.04 years. Patients with preoperative weight loss had a smaller calf circumference (p=0.034), lower handgrip strength (p=0.034), lower hematocrit (p=0.0593), and leuco- cytosis (p=0.0593) at the time of surgery, compared to the stable weight group. We observed a correlation between phase angle (PA) and muscle mass and PA and body mass index (p=0.986 and p=0.006, respectively) in the weight loss group. No statistical difference was found regarding body fat, tumor staging, or Clavien-Dindo classi fication when com- pared to the stable weight group.

Conclusion

Our results suggest that preoperative weight loss may lead to a decrease in muscle mass, reduced muscle strength and function, and increased immune system activation, which can impact the prognosis of these patients. Further studies with larger sample sizes are needed to evaluate the robustness and signi ficance of these findings. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141664 Open Topics (oral presentation) ARTIFICIAL INTELLIGENCE AND HIGH-RESOLUTION ANOSCOPY: DEVELOPMENT OF AN INTEROPERABLE MODEL FOR THE DETECTION AND DIFFERENTIATION OF PRECUSORS OF SQUAMOUS CELL CARCINOMA OF THE ANAL CANAL – A TRANSATLANTIC MULTICENTER STUDY Thiago da Silveira Manzione 1, Miguel Mascarenhas Saraiva 2, Lucas Spindler3, Luis Barroso 4, Miguel Martins 5, Vincent de Paredes6, João Ferreira 7, Sidney Roberto Nadal 8 1Instituto de Infectologia Emilio Ribas, São Paulo, Brasil 2Faculdade de Medicina da Uniersidade do Porto, Porto, Portugal 3Hospital Paris Saint-Joseph, Paris, França 4Atrium Health Wake Forest Baptist, North Carolina, United States 5Hospital Universitário São João, Porto, Portugal 6Hospital Paris Saint-Joseph, Paris, França 7Faculdade de Engenharia da Universidade do Porto, Portugal 8Instito de Infectologia Emilio Ribas, São Paulo, Brasil

Introduction

High-resolution anoscopy (HRA) plays a central role in the screening of precursors to squamous cell carcinoma of the anal canal. Arti ficial intelligence (AI) algo- rithms can have a positive impact on the detection and differentiation between high-grade (HSIL) and low-grade (LSIL) squamous intraepithelial lesions in HRA images. The

Objective

of this study was to develop a Convolutional Neural Network (CNN) for the automatic detection and differentia- tion of HSIL and LSIL using HRA images.

Method

A multicenter, prospective study (three dis- tinct groups) was conducted to develop a CNN using 252 filmed HRA exams. Acetowhite lesions were marked and biopsied to de fine them as either LSIL or HSIL based on histopathology. This study enabled the recording of 65,380 images classified as HSIL or LSIL in an AI database to allow for more accurate diagnosis during HRA. Statistical analysis evaluated sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC).

Results

The evaluation of these data revealed sensi- tivity, speci ficity, PPV, and NPV values of 96.7%, 91.1%, 92%, and 96.3%, respectively. Accuracy was 94%, and AUC was 0.93. Our results demonstrated that the AI model had high diag- nostic performance in HRA. Interoperability and the hetero- geneity of the dataset are essential aspects for the implementation of AI models in HRA for clinical practice.

Conclusion

The AI algorithm developed in this study demonstrated its utility for detecting and differentiating precursors to squamous cell carcinoma of the anal canal in images obtained through HRA. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS98 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 133974 Open Topics (oral presentation) IATROGENIC URETERAL INJURIES IN COLORECTAL SURGERIES: A RETROSPECTIVE STUDY FROM A TERTIARY UNIVERSITY HOSPITAL Giovanna Savoy Pazin 1, Helena da Cunha Lopes de Lima 2, Marcelo Lopes de Lima 3, Raquel Franco Leal 1, Michel Gardere Camargo1, Carlos Augusto Real Martinez 1, Claudio Saddy Rodrigues Coy1, Maria de Lourdes Setsuko Ayrizono 1 1Universidade Estadual de Campinas, Campinas, Brasil 2Pontifícia Universidade Católica de Campinas, Campinas, Brasil 3Universidade Estadual de Campinas, Campinas, Brasil

Introduction

Iatrogenic ureteral injuries (IUI) are rare surgical complications but are associated with high morbidity, with an incidence ranging from 0.15% to 1.0%. They are most commonly observed in gynecological and colorectal surgeries. Risk factors include previous pelvic surgeries, advanced colorectal cancer (CRC), radiotherapy, inflammatory bowel disease, infectious processes, and uro- genital abnormalities.

Objective

To evaluate UIU in coloproctological sur- geries performed at a tertiary hospital.

Method

A retrospective analysis of medical records of patients who presented IUI during elective colorectal surger- ies at the Hospital das Clínicas of Unicamp, from 2004 to 2022. The following were analyzed: age, sex, race, body mass index (BMI), underlying disease, predisposing factors, type of sur- gery performed and access route, characteristics and location of the injuries, time to diagnosis, treatment, and complications.

Results

A total of 2,312 abdominopelvic surgeries were performed, 1,998 via open surgery and 314 via laparo- scopic surgery, with 19 cases of IUI, corresponding to 0.82%. The average age of the patients was 55.6 years; 57.9% were male, and 89.5% were white. Overweight predominated among the patients, with 52.6%, and 73.7% had a history of abdominal surgery. Rectal adenocarcinoma was the most common disease (47.4%), followed by tumor recurrences (21%). The most common surgery performed was resection of the rectosigmoid (57.8%). IUIs were observed in 1.91% of laparoscopic surgeries and 0.65% of open surgeries. The most frequent location of the IUI was on the left (52.6%), with 89.5% involving the distal portion of the ureter. The main mecha- nism of injury was sectioning (57.8%). The diagnosis was made intraoperatively in 12 patients (63.2%). Different surgi- cal techniques were used for correction, with a predominance of ureteral reimplantation (36.8%) and termino-terminal ureteral anastomosis (21.0%). Complications after surgical treatment of the IUI were frequent (47.4%), and one patient died due to a non-surgical cause. In the long-term follow-up, seven patients are under follow-up, seven died due to disease progression, and five lost follow-ups.

Conclusion

IUI in coloproctological surgeries oc - curred in 0.82% of cases. They were diagnosed late in 46.8% of patients, with high morbidity. The main risk factor was CRC. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141652 Open Topics (oral presentation) LAPAROSCOPIC LATERAL PELVIC LYMPHADENECTOMY IN RECTAL NEOPLASIA WITH INVOLVEMENT OF THE ILIAC LYMPH NODE CHAIN – INDICATIONS Euler de Medeiros Azaro Filho 1, Rafaella Alcântara Alves Melo1, Thamy Cristine Santana Marques1, Mayara Maraux Maranhão1, Flávia de Castro Ribeiro Fidelis 1, Lina Maria Góes de Codes 1, Elias Luciano Quinto de Souza 1, Euler de Medeiros Azaro Filho 1 1Rede D’or Salvador, Salvador, Brasil Case Presentation A 52-year-old female patient, asymptomatic, with no comorbidities or family history of colorectal cancer (CRC). Screening colonoscopy revealed a subepithelial lesion, sessile, firm, 2.5 cm in size, with no elevation upon injection. Endoscopic ultrasound showed a lesion 7 cm from the anal margin, homogeneous, measuring 1.5x1.3 cm, involving the deep mucosal and submucosal layers. Pathology con firmed a well-differentiated neuroen- docrine tumor, low histological grade, extending to the lamina propria, Ki67 positive. No distant metastases were found, and pelvic MRI showed an oval image of 2.6x2.0 cm in the mesorectum, maintaining contact with the mesorectal fascia, along with a lateral pelvic lymph node (LLN) in the left iliac chain measuring 1.9x1.4 cm. PET-CT (somatostatin ana- log) showed a hypercapturing lesion in the rectal wall, 4 cm from the anorectal transition, measuring 1.4 cm with in- creased uptake (observed on MRI). After multidisciplinary discussion, total mesorectal excision with lateral pelvic lymphadenectomy, colorrectal anastomosis, and temporary ileostomy was indicated. The surgical specimen had an intact mesorectum. The lateral lymph nodes were separately direct- ed to the pathology department by the surgeon, and the specimens were marked. Due to the preservation of struc - tures, it was possible to compare MRI images with the anatomical specimen sections, ensuring accurate identi fica- tion of positive lymph nodes. Pathology con firmed a pT2pN1 tumor with metastases found in mesorectal lymph nodes (5/ 29) and lateral lymph nodes (1/11).

Discussion

Pelvic lateral lymph nodes >6.8 mm may require dissection before radiotherapy and chemotherapy. The literature supports that lateral pelvic lymph nodes (LLP) /C21 5 mm after neoadjuvant therapy were strongly associated with pathological positivity, and subsequent dissection of these nodes resulted in no recurrence in the lateral compart- ment of treated patients. In terms of surgical technique, laparoscopy proved superior in the number of lymph nodes retrieved compared to laparotomy. There was no signi ficant difference between robotic and laparoscopic groups regard- ing oncological outcomes and postoperative complications; however, robotic surgery showed shorter hospitalization times.

Conclusion

Cancer can be eradicated in over 30% of patients with positive lateral pelvic lymph nodes (LLP). The decision to perform lateral lymph node dissection will de- pend on the size and characteristics of these nodes on imaging exams. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S99 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141653 Open Topics (oral presentation) ANAL CANAL MELANOMA – REPORT OF TWO CASES, CLINICAL PRESENTATIONS, AND MANAGEMENT Julianna Matos Monteiro 1, Thamy Cristine Santana Marques 2, Mayara Maraux Maranhão 2, Flávia de Castro Ribeiro Fidelis 2, Lina Maria Góes de Codes 2, Elias Luciano Quinto de Souza 2, Euler de Medeiros Azaro Filho 2, Sabrina Queron Silva Bacelar Boudoux2 1Hospital da Cidade, Salvador, Brasil 2Rede D‘or Salvador, Salvador, Brasil Case Presentation Case 1: Male, 75 years old, with hemorrhoidal disease for 3 years, admitted due to anal pain, bleeding, and anemia. On examination, hardened nodules of 4 cm were noted, sparing the right posterolateral and lateral areas, with areas of bleeding hemorrhoidal thrombosis. A colonoscopy performed 4 months prior showed hemorrhoid- al nodules. Upon proctologic examination under anesthesia, a larger lesion than described in the colonoscopy was observed, with hyperpigmented and hypopigmented areas and central anterior-lateral left ulceration. Due to friability and bleeding, resection was performed on the right anterior-lateral and left posterior-lateral areas, preserving a mucosal bridge with an apparent residual lesion. Pathology con firmed ulcerated nodular melanoma with compromised margins in both lesions. Staging with a chest and abdominal CT scan revealed hepatic and pulmonary metastases, and palliative chemo- therapy was indicated. Case 2: Female, 72 years old, with a history of breast cutaneous melanoma resection in 2018, presented with persistent anal bleeding and burning, as well as ribbon-like stools. On examination, a vegetating perianal lesion starting about 3 cm from the anal margin, extending cranially by 3 cm, affected 30% of the anal canal and involved the right puborectal sling. Colonoscopy revealed a vegetative, ulcerated lesion extending into the rectum, and biopsy suggested spindle cell neoplasm. Immunohistochemistry confirmed mucosal melanoma after HSL 500 panel. PET-CT showed involvement of mesorectal, para-aortic, and inter- aortocaval lymph nodes. Radiotherapy and immunotherapy with Ipilimumab and Nivolumab were initiated. On day 30 of treatment, complete regression of the lesion was observed on endoscopic examination, with biopsy of the scar showing proctitis.

Discussion

Mucosal anal melanoma is a rare and aggressive condition, often diagnosed late, with 1/3 of patients presenting with metastasis at diagnosis. The diag- nostic process should include physical examination, immu- nohistochemistry, and advanced imaging for staging. The main treatment is surgical excision of the lesion with wide margins, and regional lymphadenectomy may be indicated. Immunotherapy has shown signi ficant bene fits in the adju- vant setting, improving disease-free survival in patients with anal mucosal melanoma.

Conclusion

Anorectal melanoma has a poor progno- sis, and treatment guidelines are not clear. Surgical resection with clear margins controls local disease, and other systemic therapies may improve prognosis. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 137859 Open Topics (oral presentation) ORGAN PRESERVATION AFTER TOTAL NEOADJUVANT THERAPY FOR DISTAL RECTAL CANCER TREATED IN THE COMMUNITY Mônica de Azevedo Kalile Silva 1, Bruno Mendonça Protásio da Silva1, Carlos Ramon Silveira Mendes 2, Amanda Rafaella Ferreira de Jesus Silva 2, Eduardo Dias de Moraes Moraes 1, Marco Antonio Oliveira Lessa 1, Gabriela Machado Alban 1, Meyline Andrade Lima 2 1Grupo Oncoclínicas Bahia, Salvador, Brasil 2Hospital Santa Izabel, Salvador, Brasil

Introduction

Total Neoadjuvant Therapy (TNT) is a standard treatment for locally advanced distal rectal cancer (LADRC), especially for candidates for an organ preservation strategy.

Objective

To evaluate the overall organ preservation (OP) after TNT regimens in a population with LADRC treated in the community.

Method

We performed a real-world retrospective cohort study in two health institutions between May 2020 to June 2023. We included data from medical records of all consecutive patients (pts) with LADRC treated with TNT. We only selected pts with clinical primary tumor stage 3-4 and/or regional lymph node –positive whose distance from the anal verge /C20 6cm on magnetic resonance imaging (MRI) before start TNT. All pts were restaging with digital rectal examina- tion, rectal MRI and endoscopy after TNT. The primary endpoint was Total Mesorectal Excision (TME) free survival after completion of TNT. The secondary endpoints were rate of abdominoperineal resection surgery and rate of sphincter- preserving surgery after completion of TNT.

Results

A total of 16 pts were included. Median age was 59 years (range: 33-77) and 8 (50%) were male. According to 8th AJCC, 11 pts (69%) were stage III, 13 pts (81%) were cT3, and 11 pts (69%) were cN1-2. Median tumor distance from anal verge was 4.1cm (range: 0.8-6.0). All pts were treated with long-course concurrent chemoradiotherapy followed by consolidation chemotherapy. At the time of this report, 12 pts have completed treatment with TNT and have undergone primary and secondary ef ficacy analyses. Median time from treatment initiation was 19.6 months (range: 7.0-37.7). Me- dian time from completion of chemoradiation to restaging was 6.2 months (range: 5.0-10.8). Overall TME-free survival after completion of TNT was 50% [95% Con fidence Interval (CI): 25-75]. Overall rate of abdominoperineal resection surgery and sphincter-preserving surgery were 33% (95% CI: 14-61) and 17% (95% CI: 5-45), respectively .

Conclusion

Preliminary data suggest that half of patients with LADRC treated in the community can poten- tially achieve OP after TNT. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS100 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138161 Open Topics (oral presentation) PERSPECTIVES BETWEEN THE DIAGNOSIS INTERVAL AND THERAPEUTIC START TIME FOR COLORECTAL CANCER IN BRAZIL: A DECADE-LONG STUDY UNDER THE SCOPE OF LAW NO. 12.732 Lidiane Gomes Bandeira 1, Vitor Caiaffo Brito 1 1Universidade Federal de Pernambuco, Recife, Brasil

Introduction

Law 12.732/12 regulates that oncol- ogical treatment must be initiated within 60 days after the diagnosis of malignant neoplasia. This regulation allows for an analysis, more than 10 years after the law ’s consolidation, of the adequacy of therapeutic modalities, especially for neoplasms like colorectal cancer (CRC), which is the third most common cancer in the world.

Objective

To evaluate the time between diagnosis and the start of treatment for colorectal cancer and its compliance with Law 12.732/12, from 2014 to 2023.

Methods

This is an observational, cross-sectional, and descriptive study based on secondary data collected from the DATASUS platform, using the Oncology Panel, with reference to ICD-10 codes: C18, C19, and C20, corresponding to CRC. The therapeutic modalities of focus were surgery, chemo- therapy, and radiology, filtered by the time of diagnosis and treatment from 2014 to 2023.

Results

During the analyzed period, 272,328 cases of CRC were diagnosed in Brazil. Of these, 45.63% started treatment within the appropriate period, 30.27% started treatment after 60 days, and 24.10% had no therapeutic information in the records. Chemotherapy was the most common therapeutic modality, with 117,554 (43.16%) treat- ments, followed by surgery with 63,851 (23.44%) treatments, and radiotherapy with 20,512 (7.54%). Among these modali- ties, some treatments involved combined chemotherapy and radiotherapy, accounting for 4,800 (1.76%) treatments. Re- garding compliance with Law 12.732/12, chemotherapy and radiotherapy accounted for the majority of delays beyond 60 days, predominantly occurring within the 61-91 day range. Additionally, a residual portion indicated delays of more than 2 years for these modalities, with respective rates of 2.35% and 1.76%. However, for surgical therapy, there was a pre- dominance of treatments initiated within 30 days after diagnosis, with 91.91% of cases treated within 60 days, and a delay of 0.02% for treatments delayed by over 2 years.

Conclusion

The findings indicate that, 11 years after the implementation of Law 12.732/12, therapeutic delays continue to primarily affect patients treated with chemother- apy and radiotherapy, with peak delays occurring around 90 days and extending up to 2 years. However, surgical therapy is closer to effective compliance with the law, with the majority of cases resolved in accordance with the prescribed time frame. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141702 Open Topics (oral presentation) PREDICTION OF RESPONSE TO NEOADJUVANT THERAPY FOR RECTAL CANCER BASED ON INFLAMMATORY MARKERS IN PERIPHERAL BLOOD Roger Beltrati Coser1, Caio Sergio Rizkallah Nahas2, Omar Sayed Taddeo Ghani1, Rafaela Brito Bezerra Pinheiro 2, Artur de Souza Almeida1, Sergio Carlos Nahas 1, Carlos Frederico Sparapan Marques2 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil 2Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil

Introduction

Rectal cancer treatment is complex, multimodal, and associated with high morbidity. It is known that patients undergoing neoadjuvant chemoradiotherapy (nQRT) present varying degrees of tumor response, ranging from no response to complete response (CR). There is great interest in studying tools that can identify these patients (responders and non-responders). Among the numerous markers being studied, peripheral blood in flammatory markers stand out, such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the lymphocyte-to-monocyte ratio (LMR), based on the close relationship between in flammation and cancer.

Objective

To study the relationship between systemic inflammatory response markers (NLR, PLR, and LMR) and the degrees of response to neoadjuvant treatment in patients with rectal cancer, according to the TRG classi fication.

Methods

A retrospective evaluation was conducted on 396 patients from a single institution with rectal cancer who underwent nQRT. The evaluation involved clinical, lab- oratory, and pathological data. NLR, PLR, and LMR were calculated based on pre-nQRT hemogram data of the patients. Patients were strati fied by tumor response (TRG) to nQRT based on the protocol of the American College of Pathologists.

Results

Patients with incomplete response (TRG 1-2- 3) had higher levels of NLR (p<0.001), PLR (p=0.002), and CEA (p<0.001). Patients with complete response (TRG 0) had a higher number of comorbidities (p=0.001), higher hemoglo- bin levels (p=0.049), higher LMR (p 2.08 - RR: 2.30 (95% CI: 1.60-3.31); PLR > 129.36 - RR: 1.79 (95% CI: 1.25-2.05) and LMR > 2.67 - RR: 0.42 (95% CI: 0.26-0.66). In the multifactorial linear model, NLR > 2.08 was independently associated with the absence of CR, RR: 1.19 (95% CI: 1.07-1.28), p=0.001, with an area under the curve (AUC) of 0.659 (95% CI: 0.599-0.718).

Conclusion

NLR, PLR, and LMR are predictors of response to nQRT in patients with rectal cancer. NLR greater than 2.08 is a predictive factor for incomplete pathological response to nQRT. These findings add a low-cost and widely available tool to the management of rectal cancer, with a focus on treatment individualization. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S101 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141148 Open Topics (oral presentation) PROADI-SUS – MAPA GENOMA BRASIL – SUBPROJECT ONCOLOGY: PORTRAIT OF COLORECTAL ADENOCARCINOMA IN DIFFERENT BRAZILIAN REGIONS Fernanda Bellotti Formiga1, Augusto Modesto de Souza Neto 2, José Fernando Bastos de Moura 3, Edimar de Moura Santos 4, Cristina de Deus Anjos Tavares Sampaio 5, Fábio de Oliveira Ferreira6, Edenir Inez Palmeiro 6, Grupo Proadi-sus-mgbo 7 1Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brasil 2Hospital Aristides Maltes, Salvador, Brasil 3Hospital Haroldo Juaçaba, Ceará, Brasil 4Liga Norte Riograndense, Natal, Brasil 5Hospital Regional do Mato Grosso do Sul, Campo Grande, Brasil 6Beneficência Portuguesa de São Paulo, São Paulo, Brasil 7https://proadi.bp.org.br/mod/page/view.php?id=247

Introduction

The Mapa Genoma Brasil (MGB) - Pre- cision Health - Correlation between genomic, epidemiologi- cal, clinical, and familial profiles in cancer and cardiovascular diseases (PROADI-SUS) Project is an initiative by the Ministry of Health. The Oncology Subproject (MGBO) involved 9 centers specialized in cancer treatment, representing the 5 Brazilian regions: Fundação CECON (AM), Ophir Loyola (PA), Haroldo Juaçaba (CE), Liga Norte Riograndense (RN), Aristides Maltes (BA), Hospital Regional de Mato Grosso do Sul (MT); Hospital BP – A Beneficência Portuguesa de São Paulo (control center), Santa Casa de São Paulo (SP), and Erasto Gaertner (PR). A total of 275 patients over the age of 18 with diagnoses of breast cancer (140), prostate cancer (65), and colorectal cancer (CCR 70) were included, as well as 2 first- or second- degree relatives for each index case. Patients underwent germline whole-genome sequencing (WGS) (blood; 103- gene panel, 54 related to cancer) and somatic sequencing (tumor). Family members of patients with positive findings were sequenced using the Sanger technique.

Objective

To describe the demographic, epidemiolog- ical, clinical, familial, pathological, and molecular character- istics of patients with colorectal cancer (CCR).

Method

Analysis of the database from the PROADI- SUS MGBO prospective cohort using colorectal cancer (CCR) diagnosis as a filter.

Results

Among the 70 patients with CCR (36 male and 34 female), the median age was 59 years (range 29-87) and the median BMI was 24 (range 13-37). Regarding lifestyle habits, 48.6% were smokers (11 pack-years), 68.6% reported alcohol consumption (10g/day), 100% consumed red meat (82.9% /C20 100g/week), 82.9% consumed processed meats, 98.6% consumed fried foods, 80% used industrialized season- ings, and 95.7% consumed re fined sugar. 25.7% reported regular physical activity. Comorbidities were reported by 65.7%: hypertension (38.6%), diabetes mellitus (17.1%), pre- vious cancer history (4.3%). Regarding tumor location, 48.5% occurred in the distal colon, 25% in the proximal colon, and 22.5% in the rectum. Regarding pathological staging, 2.9% were Tis, 2.9% T1, 11.8% T2, 57.4% T3, 25% T4, 57.4% N þ, and 13.2% Mþ at diagnosis. Pathogenic Variants (PVs) were found in the genes MLH1, MSH6, PMS2, TP53, and MUTYH in 5 patients (7.1%), and Oncogenic Variants (OVs) were found in 36 tumors (51.4%): KRAS (29), NRAS (5), BRAF (2).

Conclusion

We observed a population strongly ex- posed to risk factors, diagnosed at a locally advanced stage, with pathogenic and oncogenic variants that could contribute to genetic risk assessment and personalized treatment. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141071 Open Topics (oral presentation) RADIOMICS VERSUS CONVENTIONAL MAGNETIC RESONANCE IMAGING FOR PREDICTION OF COMPLETE PATHOLOGICAL RESPONSE - SYSTEMATIC REVIEW AND META-ANALYSIS Rodrigo Moisés de Almeida Leite 1, Victor Edmond Seid1, Rafael Dal Ben Martins 1, Giovana Moreira Minchillo 1, Lucas Soares Gerbasi1, Francisco Tustumi1, Sergio Eduardo Alonso Araujo 1, Rafael Vaz Pandini 1 1Hospital Israelita Albert Einstein, São Paulo, Brasil

Introduction

Radiomics has emerged as a promising tool in oncology, providing an innovative approach to predict complete pathological response (pCR) in patients with rectal cancer. By utilizing advanced machine learning algorithms to analyze quantitative characteristics extracted from radiology images, radiomics allows for a detailed assessment of the tumor and its microenvironment. These radiomic features include information on texture, shape, intensity, and spatial patterns, which can correlate with tumor biology and the response to neoadjuvant therapy. Recent studies show that radiomics can predict pCR with high accuracy, potentially surpassing traditional Magnetic Resonance Imaging methods in the context of rectal cancer after neoadjuvant treatment. Methodology A systematic literature review was conducted in the PUBMED and Embase databases. The inclu- sion criteria were: - Prospective or retrospective studies; - Patient population diagnosed with Rectal Adenocarcinoma; - Intervention of interest: radiomics models based on Magnetic Resonance Imaging; - Control for comparison: conventional radiomics; - Outcome of interest: complete pathological response; - Timing of intervention: restaging after neoadju- vant therapy. Studies that used other imaging modalities (e.g., ultrasound or tomography) or focused on other rectal neo- plasms were excluded. A meta-analysis was performed on the areas under the curve (AUC) using a random-effects model.

Results

A total of 224 studies were included in the systematic review. After applying inclusion/exclusion crite- ria, 16 studies were included in the meta-analysis. Radiomics models showed higher diagnostic accuracy for predicting complete pathological response compared to conventional Magnetic Resonance Imaging (AUC 0.82, 95% CI 0.76 - 0.88, p<0.001). There was signi ficant heterogeneity of results (I2 96%). No publication bias was detected.

Conclusion

Radiomics was associated with higher diagnostic accuracy for predicting pCR than conventional MRI. References: Limkin EJ, Sun R, Dercle L, et al. Promises and challenges for the implementation of computational medical imaging (radiomics) in oncology. Ann Oncol. 2017;28(6):1191-1206. 2. Lambin P, Rios-Velazquez E, Leije- naar R, et al. Radiomics: Extracting more information from medical images using advanced feature analysis. Eur J Cancer. 2012;48(4):441-446. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS102 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141642 Open Topics (oral presentation) TOTAL NEOADJUVANT THERAPY FOR RECTAL CANCER TREATMENT IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS Rafaella Alcântara Alves Melo 1, Sabrina Queron Silva Bacelar Boudoux1, Thamy Cristine Santana Marques 1, Flávia de Castro Ribeiro Fidelis1, Lina Maria Góes de Codes1, Elias Luciano Quinto de Souza 1, Euler de Medeiros Azaro Filho 1, Mayara Maraux Maranhão1 1Rede D’or Salvador, Salvador, Brasil Case Presentation Female, 54 years old, diagnosed with Systemic Lupus Erythematosus (SLE), regularly using Hydroxychloroquine, without previous surgeries or a family history of colorectal cancer. The patient has been experienc - ing episodes of hematochezia for 3 months and underwent a colonoscopy, which revealed a vegetative lesion 10 cm from the anal margin, measuring approximately 5 cm in length. Pathology: well-differentiated adenocarcinoma. The patient underwent magnetic resonance imaging (MRI), which showed a polypoid expansile formation located 10 cm from the anal margin, with the distal margin 7.5 cm above the anorectal ring. The epicenter and most of the lesion were below the peritoneal re flection. It involved 25% of the cir- cumference and in filtrated 2 mm beyond the muscularis propria. The lesion affected the mesorectal fascia. No suspi- cious lymph nodes or evidence of extramural venous invasion were found. cT3bN0M0. Total Neoadjuvant Therapy (TNT) was opted for. The patient experienced episodes of diarrhea, requiring hospitalization and a temporary interruption of Capecitabine and Oxaliplatin (CAPOX) for 5 weeks. After this, a restaging was performed, including a sigmoidoscopy and MRI, suggesting a complete response, although the previous lesion could not be assessed by rectal examination. After 26 weeks of neoadjuvant therapy, the patient underwent a rectosigmoidectomy with total mesorectal excision (TME) and low colorectal anastomosis with loop ileostomy, encoun- tering technical dif ficulties due to extensive fibrosis. Pathol- ogy: no residual neoplasia.

Discussion

SLE is associated with a slight overall increase in cancer risk compared to the general population. Gastrointestinal toxicity due to chemotherapy is a frequent complication, and it was more intense due to the underlying disease. The surgical procedure was technically challenging due to severe fibrosis, as the surgery was delayed due to the temporary interruption of CAPOX, and there was also an increase in scar tissue resulting from the SLE. Studies indicate exacerbation of fibrosis and greater technical dif ficulty dur- ing TME in patients with collagen diseases who undergo neoadjuvant radiotherapy, often leading to higher postoper- ative complications. This finding may suggest a relative contraindication for TNT in this patient group. Comments A better understanding of the pathophys- iology and underlying elements of this risk will lead to more efficient and individualized treatments. Coloproctologia experimental ID – 141620 Open Topics (oral presentation) FIRST STOOL BANK OF THE NORTH-NORTHEAST REGIONS: IMPACT OF ORAL FECAL MICROBIOTA TRANSPLANT ON GRAFT-VERSUS-HOST DISEASE Lara Burlamaqui Veras 1, Aldo ângelo Moreira Lima 1, Fernando Barroso Duarte1, William Pinheiro Boavista de Oliveira 1, Victor Ripardo Siqueira1, Matheus Emanuel de Brito Castelo Branco 1, José Nilo de Lima Filho 1, Adryeli Oliveira Quintela 1 1Universidade Federal do Ceará, Ceará, Brasil

Introduction

Fecal microbiota transplantation (FMT) has shown promise in several conditions. In this context, graft-versus-host disease (GVHD) following allogeneic he- matopoietic stem cell transplantation has gained promi- nence. Evidence suggests that alterations in the gut microbiota are associated with the occurrence of intestinal- type GVHD. Therefore, FMT could be a promising and feasible treatment option.

Objectives

The creation of a stool bank to investigate the impact of oral fecal microbiota transplantation on the treatment of graft-versus-host disease after allogeneic he- matopoietic stem cell transplantation.

Method

Healthy donors are selected, excluding indi- viduals with infectious diseases transmitted by blood or previous FMT, and those who increase the risk of transmitting multidrug-resistant organisms. These donors undergo inter- views, and their laboratory and stool tests are collected. The stool samples are stored in a stool bank developed in the Pharmacology Laboratory at the Federal University of Ceará (UFC). On average, 50 grams of fecal substrate are diluted in a 0.9% sterile saline solution, processed, and stored within 6 to 8 hours. Cryopreservation is a key step in the creation of the stool bank, as it preserves the clinical effect of FMT, prevents

Material

crystallization, and allows on-demand treatment. Capsules are considered promising due to their easy admin- istration, less invasiveness, and absence of the risks associat- ed with invasive procedures. A prospective clinical intervention trial is then conducted, and twenty patients are divided into two groups: one receiving conventional treatment for GVHD and the other receiving FMT. Both groups are followed for 2 years.

Results

The importance of a stool bank lies in provid- ing ready-to-use products of high quality, in addition to enabling monitoring of treatment responses, side effects, and long-term outcomes of FMT. It is expected that FMT will be safe and viable for the participating patients, with low incidence of adverse events and the ability to repopulate the gut microbiota, aiding in the recovery of the gastrointestinal tract and maintaining a favorable long-term clinical response while reducing GVHD recurrence.

Conclusion

The impact of FMT as a promising and feasible option for intestinal GVHD is best proven when there is a well-structured and monitored stool bank, as the responses become much more reliable and reproducible. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S103 Doença Diverticular Diverticular disease ID – 138310 Open Topics (oral presentation) TREATMENT OF COLORECTAL ANASTOMOSIS FISTULA WITH VACUUM THERAPY GUIDED BY COLONOSCOPY Marco Antônio Miranda dos Santos 1, Fábio Lopes de Queiroz 1, Artur Duarte e Duarte 1, Marina Barbabela Grisolia de Oliveira 1, Letícia Brandão Castro 1, Eduardo de Carvalho Barbosa 1, Marco Rinoldi1, Vinícius Avelar Palhares 1 1Hospital Felicio Rocho, Belo Horizonte, Brasil Case Presentation A 77-year-old female patient with chronic kidney disease, hypothyroidism, and hearing im- pairment underwent a rectosigmoidectomy, colonic lowering with colorectal anastomosis, and protective ileostomy in 2021 due to diverticular disease. The surgical procedure was completed without complications. On the fourth post- operative day, the patient underwent a CT scan, revealing a small presacral collection without contrast extravasation through the colorectal anastomosis. With antibiotic therapy, she had a good postoperative recovery. Three months later, a postoperative colonoscopy identi fied an anastomotic fistula 7 cm from the anal margin, with purulent secretion. An attempt at expectant treatment was unsuccessful. Surgical attempts including debridement, suturing, and clipping of the orifice also failed. In March 2023, the patient underwent curettage of the tract and vacuum dressing placement via colonoscopy. Successive follow-up at 7 and 14 days showed effective granulation of the fistulous tract. A subsequent endoscopic evaluation at 21 days revealed increased granu- lation tissue with erosion in part of the tract leading to the intestinal lumen, resulting in a septum of the sinus tract with lowered colon. After three months, a septotomy was per- formed, and no fistula was documented on colonoscopy or MRI. The patient later underwent ileostomy closure without any leakage at the colorectal anastomosis.

Discussion

Colorectal fistulas affect up to 14% of patients undergoing surgical treatment and can be fatal in 7% of cases. However, many cases are asymptomatic or mildly symptomatic. Factors contributing to a lower risk of fistula formation in anastomoses include adequate blood supply, tension-free anastomosis, and the patient’s clinical condition. Endoscopic therapy with negative pressure is successful in most cases, with healing rates of around 90% and few adverse events. Literature suggests that the average treatment dura- tion may range from 18 to 47 days, with about 4 to 7 endoscopic procedures.

Conclusion

In the reported case, the patient pre- sented with a refractory benign colorectal anastomosis fistu- la, resistant to several treatments. Vacuum therapy guided by colonoscopy is not a widely used treatment method but offers high success rates and minimal harm to the patient. Doença Inflamatória Intestinal ID – 138294 Open Topics (oral presentation) ANATOMICAL AND FUNCTIONAL DAMAGE IN SEVERE PERIANAL CROHN’S DISEASE Natália Ferreira Cardoso de Oliveira 1, Vitória Vicentin Giordano1, Nadine Gomes de Souza 1, Louisie Galantini Lana de Godoy1, Fernanda Bellotti Formiga1, Andreia Vieira1, Fang Chia Bin1 1Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brasil Case Presentation T w of e m a l ep a t i e n t sw i t hC r o h n’s disease, with onset at ages 18 and 14, are described. The first patient started with ileocolitis, progressing to rectal stenosis despite combined therapy with anti-TNF (azathioprine with infliximab and later, adalimumab). She developed perianal fistulizing Crohn’s disease (pCD), with progressive severity, including deep perineal, perianal, vulvar, and intergluteal ulcers, as well as a rectovaginalfistula and multiple ano-genital subcu- taneousfistulas. The second patient initially presented with pCD, which later progressed to ascending colitis up to the rectum. She used combined anti-TNF therapy (infliximab and adalimumab) at the onset, but discontinued medication due to poor adherence. There was worsening of the perianal disease, with ano-vulvar destruction. Due to difficulty accessing drugs with other mech- anisms of action, low quality of life, and anatomical and func - tional damage, intestinal diversion was opted for both patients. Thefirst patient accepted the proposed treatment, but there was no improvement in perianal involvement, requiring total proc - tocolectomy with amputation. After seven months of an open wound, a new intervention for skin resection from the buttocks, local dressings, and hyperbaric chamber therapy resulted in complete healing. After 10 years, new intergluteal ulcers devel- oped, in addition to esophageal Crohn’s disease and metastatic intermamary Crohn’s disease. The second patient has not yet accepted the diversion or the amputation.

Discussion

pCD is a severe phenotype affecting 17- 43% of patients, and it presents a challenging treatment manifestation. Management of pCD involves both clinical and surgical treatments. Initial surgical approaches are per- formed via proctological examination under anesthesia to control perineal sepsis with abscess drainage, ulcer and tract curettage, placement of drains, and opening of cavities. Multiple procedures are necessary. However, considering functional and anatomical damage, intestinal diversion can be proposed as a bridge to de finitive treatment. In disease progression, lack of response to clinical treatment, and local anatomical failure, rectal amputation becomes necessary. One-fifth of patients with pCD undergo this surgery.

Conclusion

There is a tendency to delay surgical indication for severe pCD due to the mutilation associated with a permanent stoma. However, the morbidity and sever- ity of the disease demand aggressive and resolutive actions, as irreversible anatomical and functional damage occurs. Doença Inflamatória Intestinal ID – 136774 Open Topics (oral presentation) DETECTION OF IMMUNE COMPLEXES IN PATIENTS WITH CROHN’S DISEASE USING ADALIMUMAB MAY ASSIST IN PRECISION MEDICINE Livia Moreira Genaro 1, Juliana Carron 1, Marina Moreira de Castro1, Cristiane Kibune Nagasako Vieira da Cruz 1, Glaucia Fernanda Soares Rupert Reis 1, Ligiana Pires Corona 1, Maria de Lourdes Setsuko Ayrizono 1, Raquel Franco Leal 1 1Universidade Estadual de Campinas, Campinas, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS104

Introduction

The interaction between the immune system and the intestine, especially regarding the role of TNF- α, is crucial in the pathophysiology of Crohn ’s disease (CD). The monoclonal antibody adalimumab works by neutralizing TNF-α and regulating in flammatory responses but can cause immunogenic reactions, impacting its ef ficacy. Monitoring serum levels and anti-drug antibodies (ADA) is recommended to improve therapy. Understanding the genetic factors linked to the response to adalimumab seeks to clarify the relation- ship between genetics, immunology, and the clinical picture in CD.

Objectives

To quantify the serum level of adalimumab and compare the ELISA (Promonitor) and lateral flow assay (Quantum Blue). To detect ADA, evaluate immune complexes, and investigate polymorphisms associated with the response to adalimumab.

Methods

We included 70 patients undergoing treat- ment with adalimumab, divided into active (CA) and remis- sion (CR) groups. Serum concentrations of adalimumab were measured using the Promonitor® and Quantum Blue® assays and compared using Passing-Bablok regression and Bland- Altman analysis. ADA presence and immune complex forma- tion were analyzed by ELISA. DNA was genotyped for ATG16L1 and CD96.

Results

Serum concentrations of adalimumab did not differ between the groups. Both tests for detecting serum levels showed signi ficant differences between them, with moderate agreement. ADA were detected in 6/31 patients with sub-therapeutic levels, with 4 in the CA group and 2 in the CR group. Immune complex analysis revealed significant- ly higher concentrations in the CA group. The wild-type genotype for CD96 was associated with higher CRP values and sub-therapeutic levels of adalimumab, while the CC genotype for ATG16L1 was associated with higher CDEIS and fecal calprotectin values.

Conclusion

The ef ficacy of treatment with adalimu- mab was not directly related to higher medication levels. The disparity between the tests indicates the need to use only one test in patient follow-up to ensure accuracy in therapeutic monitoring. Genotypic differences highlight the correlation between the wild-type genotype for CD96 and ATG16L1 with unfavorable laboratory and endoscopic response to adalimu- mab. Finally, pioneering evidence showed that greater im- mune complex formation occurred in the CA group compared to the CR group, indicating an association with poorer clinical response. Doença Inflamatória Intestinal ID – 138246 Open Topics (oral presentation) EPIDEMIOLOGY OF HOSPITALIZATIONS FOR INFLAMMATORY BOWEL DISEASE IN ADULTS IN BRAZIL, FROM 2019 TO 2024 Lincólin Bardini Goulart 1, Eloisa Elena Xavier de Oliveira Ligoski1, Giovanna Barcellos Gemelli 1, Carolina Polidori Aguiar1, Brenda de Lima Louzada Pires 2 1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil 2Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil

Introduction

Inflammatory bowel disease (IBD) encompasses chronic inflammatory disorders of the digestive tract, such as Crohn ’s disease and ulcerative colitis. Its prevalence is associated with environmental, hereditary, and racial factors. When severe, IBD can be disabling, nega- tively affecting patients’ quality of life. Epidemiological anal- yses of hospitalizations are essential to identify trends, the impact on public health, and gaps in healthcare policies for individuals with this condition.

Objective

To analyze hospitalizations of adults with IBD in Brazil over the last 5 years. The analysis aims to outline the epidemiological pro file of these patients, providing insights for the development of collective measures aimed at the most affected populations and optimizing public health resources.

Methods

A cross-sectional, descriptive, retrospective, and quantitative study on hospitalizations for Crohn’s disease and ulcerative colitis from January 2019 to January 2024. The data from the Department of Informatics of the Brazilian Unified Health System (DATASUS) were used. The variables selected for the study were: sex, race, age group, and length of stay. Only patients aged 20 to 80 years were included in the analysis.

Results

Between 2019 and 2024, there were 27,304 hospitalizations for IBD in Brazil, of which 52.7% were female patients. The most affected age groups were 20 to 29 years and 30 to 39 years, representing 17.5% and 16%, respectively. Regarding self-declared color/race, the most affected group was white, totaling 40.1% of the hospitalizations, followed by brown, with 38.2%. In 2022, the highest average length of stay was recorded, with 6.9 days, while the overall average for the analyzed years was 6.5 days.

Conclusion

The results indicate a higher occurrence of IBD hospitalizations among adults aged 20 to 39 years. There was a slight difference between genders, with 3% more women hospitalized. Special attention is given to the small predominance of whites compared to browns, with only a 2% difference between the two groups, highlighting the particu- lar role of ethnicity in the epidemiology of the Brazilian population. Additionally, the length of stay suggests the complexity of care in healthcare services. Although the con- clusions are not de finitive, the findings allow for better targeting of diagnostic and treatment actions toward the most affected populations. Doença Inflamatória Intestinal ID – 141624 Open Topics (oral presentation) EXTENDED VERSUS LIMITED MESENTERIC EXCISION IN BOWEL RESECTION FOR CROHN ’S DISEASE: A META- ANALYSIS AND SYSTEMATIC REVIEW Bernardo Fontel Pompeu1, Patricia Marcolin2, Fábio Israel Lima Castelo Branco Marques 1, Giulia Almiron da Rocha Soares 3, André Luiz Costa e Silva 1, Beatriz D ’andrea Pigossi 1, Sergio Mazzola Poli de Figueiredo 4, Fernanda Bellotti Formiga 1 1Hospital Heliópolis, São Paulo, Brasil 2Universidade Federal Fronteira do Sul Passo Fundo, Passo Fundo, Brasil 3Universidade Metropolitana de Santos, Santos, Brasil 4Cleveland Clinic Ohio, Ohio, United States

Background

There is controversy regarding the ex- tended excision of the mesentery in intestinal resection for Crohn’s disease (CD). Some studies suggest that extended mesenteric excision (EME) can reduce the surgical recurrence of the disease compared with limited mesenteric excision (LME). J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S105

Objective

We aimed to perform a systematic review and meta-analysis comparing EME and LME for CD.

Methods

We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and EMBASE for studies published until April 2024. Odds ratios (OR) with 95% con fidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the Cochran Q test and I² statistics, with p-values 25% considered sig- nificant. Statistical analysis was performed using R Software, version 4.1.2.

Results

A total of 5 observational studies were in- cluded, comprising 4,365 patients; 992 (22.7%) underwent EME and 3,373 (77.2%) to LME. No signi ficant differences were observed between EME and LME in overall postopera- tive complication, Clavien-Dindo /C21 3, bleeding that needed transfusion, anastomotic leak, intrabdominal abscess, SSI, reoperations, readmission, and ileus. EME was associated with a decrease in surgical recurrence compared with LME (OR 0.31; 95% CI 0.12 to 0.84; p = 0.021).

Conclusion

In this meta-analysis of patients with CD who underwent intestinal resection, EME was associated with a significant reduction in surgical recurrence compared with LME, without a signi ficant difference in complication rates. Doença Inflamatória Intestinal ID – 138318 Open Topics (oral presentation) INFLUENCE OF THE TYPE OF MANIFESTATION OF CROHN ’S DISEASE ON THE CORRELATION BETWEEN CLINICAL, ENDOSCOPIC, AND HISTOLOGICAL INDICES Paula Fernandes de Sousa 1, Natascha Mourão Moreira 1, João Victor Ribeiro Tajra 2 1Centro Universitário do Planalto Central Apparecido dos Santos, Brasília, Brasil 2Unieuro, Brasília, Brasil

Introduction

Crohn’s Disease (CD) can affect any part of the gastrointestinal tract. It is in fluenced by environmen- tal, genomic, microbial, and immunological factors. The goal of therapy is to keep patients asymptomatic, but 40% of patients in clinical remission still show endoscopic activity. Currently, endoscopic remission is the desired target, with discussions about histological remission as the ultimate goal. The correlation between clinical, endoscopic, and histological scores has not yet been clearly established.

Methods

Thirty-five patients participated in a cross- sectional study from January 2020 to 2022. Clinical activity was assessed using the Crohn’s Disease Activity Index (CDAI), endoscopic activity was assessed using the Simpli fied Endo- scopic Score for Crohn ’s Disease (SES-CD), and histological activity was assessed using the Global Histological Activity Score (GHAS). Clinical remission was de fined as CDAI /C20 150, endoscopic remission as SES-CD /C20 2, and histological remis- sion as GHAS /C20 4.

Discussion

In the study, clinical remission was ob- served in 34.1% of cases, endoscopic remission in 39%, and histological remission in 22%. Statistical analysis showed a strong correlation between SES-CD and GHAS in the Montreal classification L2 phenotype (r = 0.73; p = 0.001). These results suggest that combining endoscopic and histological data provides a more comprehensive view of disease activity. Residual histological in flammation may in fluence therapeu- tic strategy, indicating the importance of integrated evalua- tion. Studies suggest that histological activity is an important prognostic indicator, especially in cases with persistent mu- cosal inflammation. Recent clinical trials recommend includ- ing endoscopic and histological data for a more effective treatment approach.

Conclusion

The study has limitations, including a heterogeneous population, extremes of age, variable treat- ment duration, and a small sample size, but statistical parameters were preserved. The results show a strong posi- tive relationship between endoscopic and histological find- ings in the L2 region. Combining endoscopic and histological data provides a more complete view of disease activity, assisting in more accurate and effective therapeutic strate- gies. Future research should focus on larger and more homo- geneous samples with standardized biopsy protocols to improve the quality of life for patients with CD and reduce the morbidity associated with the disease. Doença Inflamatória Intestinal ID – 141843 Open Topics (oral presentation) ARTIFICIAL INTELLIGENCE AND MINIMALLY INVASIVE ASSESSMENT OF INFLAMMATORY ACTIVITY: A STUDY ON THE DEVELOPMENT AND CORRELATION OF INDICES WITH A CONVOLUTIONAL NEURAL NETWORK MODEL IN PANENDOSCOPY Maria João Almeida 1,2, Miguel Mascarenhas 1,2,3, Pedro Cardoso1,2, João Afonso 1,2, Tiago Ribeiro 1,2, João Ferreira 3, Guilherme Macedo1,2,3 1Hospitalar Universitário São João, Porto, Portugal 2Centro Treino WGO, Porto, Portugal 3Universidade do Porto, Porto, Portugal

Introduction

In patients with Crohn ’s Disease (CD), capsule endoscopy (CE) is an important method for assessing mucosal in flammatory activity. Traditionally, in flammation is evaluated through the combination of analytical values and validated scores, such as the Lewis score (LS), the Capsule Endoscopy Crohn ’s Disease Activity Index (CECDAI), and ELIAKIM. Recent developments in arti ficial intelligence (AI) have enabled the automatic selection of the most relevant images in CE.

Objective

This study aimed to develop an automated scoring system to objectively classify in flammation in CE images.

Methods

A retrospective study was conducted on panenteric CE videos (PillCam Crohn ’s) performed between 09/2020 and 01/2023, and the LS, CECDAI, and ELIAKIM scores were calculated. An automated score based on a convolutional neural network was developed, encompassing the percentage of positive frames selected by the algorithm for both the small intestine and the colon separately. The AI- generated score (AIS) was then correlated with clinical data and the validated scores.

Results

The study included 61 patients. The median scores were LS 225 (0-6006), CECDAI 6 (0-33), ELIAKIM 4 (0- 38), and SB_AIS 0.5659 (0-29.45). A strong correlation was found between SB_AIS and the validated scores: LS, CECDAI, and ELIAKIM (Spearman ’s r = 0.751, r = 0.707, r = 0.655, p = 0.001). Strong correlations were also found between LS and ELIAKIM (r = 0.768, p = 0.001), CECDAI and LS (r = 0.854, p = 0.001), and CECDAI and ELIAKIM (r = 0.827, p = 0.001).

Conclusion

The results of our study demonstrated a strong correlation between the AI-generated score and the J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS106 clinically validated scores, suggesting that it could be an

Objective

and ef ficient way to assess in flammatory activity in patients with CD. The initial results of our study provide a solid foundation for the future development of a score that could correlate with prognostic factors and assist in the management of these patients. Doença Inflamatória Intestinal ID – 141788 Open Topics (oral presentation) KONO-S TECHNIQUE IN PATIENTS WITH CROHN ’S DISEASE ILEOCECAL: INITIAL EXPERIENCE IN A TERTIARY UNIVERSITY HOSPITAL Carlos Walter Sobrado 1, Afonso Henrique da Silva Souza Jr 1, Mariane Gouvea Monteiro de Camargoo 1, Gabriela Fonseca Lopes1, Lucas Faraco Sobrado 1, Marcelo Rodrigues Borba 1, Carlos Frederico Sparapan Marques 1, Ulysses Ribeiro Junior 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

Introduction

Ileocecal resection is the most fre- quently performed surgical procedure in patients with ab- dominal Crohn ’s disease (CD), and various techniques and anastomosis con figurations (end-to-end, side-to-side, end- to-side, among others) are used, depending on the surgeon ’s preference and the access route (laparotomy, laparoscopy, or robotic platform). Recurrence occurs at or near the anasto- mosis site. In 2011, Kono and colleagues in Japan described a new technique for a wide, anti-mesenteric anastomosis with the goal of reducing surgical recurrence.

Objective

To describe in detail the Kono-S technique and present the initial experience and results observed at a tertiary university hospital.

Methods

The technique involves the release of the ileum and ascending colon via laparoscopy, followed by a median supra- and infra-umbilical incision approximately 10 cm in length, with exteriorization of the ileocecal segment and subse- quent resection of the diseased area. A support column is then created by approximating the stapled segments to prevent twisting of the anastomosis. After suturing and approximating the two stumps, two enterotomies are made—one in the ileum and the other in the colon —7 to 8 cm in length, on the anti- mesenteric border, approximately 1 cm from the support col- umn. Finally, an anti-mesenteric end-to-end manual anastomo- sis is performed with absorbable 000 sutures. A video detailing the technical steps and materials used will be presented.

Results

From February 2022 to November 2023, six patients with ileocecal CD underwent the Kono-S procedure, with four females (66.6%) and a median age of 35 years (range 22 to 63 years). Colon preparation was performed in 4 patients, and therapeutic antibiotics were administered to all patients, along with peritoneal cavity drainage. No patients required reoperation, and there were no deaths. The average hospital stay was 11 days (range 6 to 19 days). All patients are undergoing recurrence prophylaxis (three with anti-TNF, two with vedolizumab, and one with usteki- numab). No recurrence was observed after a median follow- up of 17 months (range 7 to 25 months).

Conclusion

Our study concluded that the Kono-S technique is safe and may bene fit recurrence rates, although the follow-up period is short. Multicenter global randomized studies with long-term follow-up are needed to validate this technique. Doença Inflamatória Intestinal ID – 141798 Open Topics (oral presentation) TRANSVERSECTOMY FOR THE TREATMENT OF SUBSTENOSIS IN CROHN ’S DISEASE: TECHNICAL ASPECTS Gabriela Fonseca Lopes 1, Fernando D ’almeida Perazzo1, Rodrigo Ambar Pinto 1, Carlos Walter Sobrado 1, Carlos Frederico Sparan Marques 1, Ulysses Ribeiro Junior 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Case Presentation A 42-year-old female patient was diagnosed with Crohn ’s Disease at the age of 15, with a colonic location and stenosing behavior. She also had arthritis as an extra-intestinal manifestation. Initially, biological treat- ment with In fliximab was started for 2 years, but due to clinical response loss, the medication was switched to Ada- limumab in association with Azathioprine. The patient un- derwent outpatient follow-up for approximately 8 years without disease exacerbation, when she developed symp- toms of subintestinal obstruction, abdominal distension, and tenesmus. In complementary exams for clinical investigation, Entero-Tomography and colonoscopy revealed a lesion in the transverse colon segment, with a fibrotic and stenosing appearance. The patient was considered a candidate for surgical intervention of the stenosis, and a decision was made for a segmental colectomy, with preservation of the ileocecal valve, using the laparoscopic transversectomy tech- nique with a colonic anastomosis.

Objective

The purpose of this video is to demonstrate the laparoscopic transversectomy technique, illustrating the step-by-step surgical approach, with the aim of standardizing a complex surgery for the surgeon. The video will demon- strate the approach, including patient positioning, surgical tactics, and postoperative results.

Conclusion

The patient had intestinal transit in the second postoperative day but developed post-epidural anes- thesia headache as a postoperative complication. An epidural blood patch was indicated by the anesthesiology team to control the symptoms, which delayed her hospital discharge. The patient had a 30-day clinical follow-up, with good food acceptance, daily bowel movements, and no new episodes of subintestinal obstruction. The histopathological exam con- firmed stenosis due to Crohn ’s Disease, without signs of malignancy. The transversectomy technique demonstrated in the video, despite the complexity of the procedure, should be part of the skillset of a colorectal surgeon as an option for cases of segmental colectomy. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S107 Doenças Anorretais Anorectal Diseases ID – 141632 Open Topics (oral presentation) EVALUATION OF LOW-LEVEL LASER THERAPY IN THE POSTOPERATIVE PERIOD OF OPEN PROCTOLOGICAL WOUNDS Fernanda Belloti Formiga 1, Karina Bruno Bianco Vassoler 1, Pedro Piassaroli de Abreu 1, Matheus Reginato Araujo 1, Bruna Meirelles Carregaro1, Iana Faine Saran 1, Janaina Giotti 1, Andre Luigi Pincinato1 1Hospital Heliópolis, São Paulo, Brasil

Introduction

The postoperative (PO) period of any proctological surgery is challenging. Healing by secondary intention of open wounds (OW) is a common reality in anorectal-sacral conditions. Consequently, pain and healing time are the primary dif ficulties in the PO period. Intra- operative techniques (mechanical anopexy, hemorrhoido- pexy, CO2 and diode lasers), as well as PO interventions such as low-level infrared laser therapy and botulinum toxin, have emerged to minimize pain and accelerate healing. However, the efficacy of many of these techniques in proctol- ogy has yet to be proven. Low-level infrared laser therapy has analgesic, anti-inflammatory, wound-healing, and circulato- ry bene fits.

Objective

To compare the evolution of patients un- dergoing proctological surgeries resulting in OW who re- ceived conventional PO care versus those treated with infrared laser therapy. Additionally, to evaluate the overall healing time of hemorrhoidectomy procedures.

Methods

This was a prospective, randomized, single- blind study conducted from 09/23 to 05/24. Patients with proctological conditions that resulted in OW following surgery were included. On the 7th PO day, patients were randomized into two groups: the conventional group received standard follow-up care, while the laser group received infrared laser therapy (9J) applied to OW. Patients were evaluated on the 7th, 14th, and 21st PO days using subjective parameters (pain, burning, edema, itching, and discharge) via a visual analog scale, as well as objective assessments through physical examinations (edema, discharge, and wound appearance). Subjective variables were analyzed using the general linear model (GLM), followed by Bonferroni post-hoc tests. Objective parameters were analyzed with a generalized linear model and chi-square tests (p < 0.05).

Results

A total of 33 patients were included: 18 in the conventional group and 15 in the laser group. Gender, age, and diagnosis proportions did not differ between groups. GLM analysis showed improvement over time in all subjec - tive parameters, except for itching, which worsened. No significant differences were found between groups in subjec - tive parameters (pain p = 0.58; burning p = 0.43; edema p = 0.53; itching p = 0.80; discharge p = 0.71) or objective parameters (edema p = 0.08; discharge p = 0.52; wound appearance p = 0.34). In hemorrhoidectomy cases (10 con- ventional and 11 laser), complete healing occurred faster in the laser group but without statistical signi ficance (conven- tional: 52.4 days vs. laser: 45.2 days, t = 0.019; p = 0.89).

Conclusion

The use of infrared laser therapy did not demonstrate an impact on symptom improvement in the early PO period of patients with proctological OW, nor did it significantly affect early healing parameters. Doenças Anorretais Anorectal Diseases ID – 138308 Open Topics (oral presentation) DOPPLER-GUIDED TRANSANAL HEMORRHOIDAL DEARTERIALIZATION VERSUS DIGITAL PALPATION-GUIDED: A SYSTEMATIC REVIEW AND META-ANALYSIS Marília Cardoso Massoni 1, Glicia Estevam de Abreu 1, Felipe Santos Marimpietri1 1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil

Introduction

Transanal hemorrhoidal dearterializa- tion (THD) is a widely used method for treating hemorrhoidal disease (HD). However, there is no consensus on the potential benefit of using Doppler ultrasound —a more costly technol- ogy—for identifying the arteries to be ligated.

Objectives

To compare Doppler-guided THD versus digital palpation-guided THD in postoperative outcomes through a systematic review and meta-analysis.

Methods

A systematic review of randomized clinical trials comparing patients undergoing THD with and without the use of Doppler was performed. Searches were conducted in PUBMED, Embase, and Cochrane databases on 04/22/2024. The outcomes analyzed were postoperative pain (1st to 7th postoperative day), prolapse (after 12 months), bleeding (after 6 months), operative time, and patient-reported satis- faction. Statistical analysis was conducted using RevMan Web from the Cochrane Library, with calculations expressed as mean difference (MD), standardized mean difference (SMD), and odds ratio (OR).

Results

A total of 966 patients from 10 randomized clinical trials were included, comparing outcomes in patients undergoing arterial ligation with or without Doppler for the treatment of grade I-IV hemorrhoids according to the Goligher scale, with follow-up ranging from 6 months to 3 years. Bleeding at 6 months showed no signi ficant difference between the use of Doppler and digital palpation (OR 1.38; 95% CI 0.68 –2.79; P = 0.62; I² = 0%). Similarly, prolapse recurrence at one year showed no signi ficant difference (OR 1.60; 95% CI 0.62 –4.13; P = 0.08; I² = 52%) nor did postoperative pain (MD 1.10; 95% CI -0.33 –2.52; P = 0.13; I² = 86%). Finally, operative time also did not reveal any statistically signi ficant difference between the techniques (MD 3.87; 95% CI -18.94 –26.67; P = 0.74; I² = 99%).

Conclusion

Our findings demonstrate no signi ficant difference between digital palpation-guided THD and Dopp- ler-guided THD in terms of postoperative bleeding, prolapse recurrence, and operative time. These results suggest that equivalent ef ficacy can be achieved with lower-cost treat- ments, broadening the accessibility of surgical approaches using these techniques. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS108 Doenças Anorretais Anorectal Diseases ID – 138198 Open Topics (oral presentation) COMPLEX PERIANAL FISTULA COMPLICATED BY RECTOVAGINAL FISTULA TREATED WITH MESENCHYMAL CELLS Barbara Andrade Prais1, Carolina Vieira de Faria2, João Victor de Abreu Martins 3, Maria Vitória Figueiredo Martins 2, Priscila Tocantins Tanure4, João Baptista de Paula Fraga 4, Rómmel Ribeiro Lourenço Costa 4, Jander Bairral Vasconcelos 4 1Universidade Professor Edson Antônio Velano , Belo Horizonte, Brasil 2Faculdade de Ciências Médicas e da Saúde, Juiz de Fora, Brasil 3Universidade Federal de São João del-Rei, São João del-Rei, Brasil 4Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil Case Presentation A 44-year-old female patient with a history of complex perianal and rectovaginal fistula was initially diagnosed in December 2021 with a perianal abscess, which required drainage under anesthesia. In May 2022, an MRI revealed a complex perianal fistula complicated by a rectovaginal fistula, though no external opening was ob- served at the time. In December 2023, the patient presented with an external fistula opening, con firmed by a new MRI performed in September 2023, which aligned with physical examination findings of the fistulous tract. Treatment was initiated in January 2024 using autologous mesenchymal cells, which were collected, processed, and applied during the same procedure. At the 10-day follow-up, the patient exhibited a small amount of secretion, which was considered a normal postoperative finding. At the 120-day follow-up, anoscopy findings were normal. After 150 days, a follow-up MRI showed fibrotic scar tissue with no evidence of fistulas.

Discussion

Rectovaginal fistulas are rare conditions that occur primarily after gynecological or obstetric trauma and in the context of Crohn ’s disease. Other potential causes include neoplasms, pelvic radiotherapy, infections, and un- intentional consequences of anorectal surgery. Treatment options for rectovaginal fistulas vary based on symptoms, fistula anatomy, adjacent tissue quality, and prior repair attempts. Mesenchymal cells, a subtype of adult stem cells, exhibit properties such as immunomodulatory, anti-in flam- matory, analgesic, anti-apoptotic, and particularly neoangio- genic effects. These properties make them a promising option for treating complex perineal fistulas.

Conclusion

The use of mesenchymal cells in the treatment of complex perineal fistulas has shown promising results, as demonstrated in reported studies and in this case report. Doenças Anorretais Anorectal Diseases ID – 141657 Open Topics (oral presentation) INJECTION OF FRESHLY HARVESTED AUTOLOGOUS FAT FOR THE TREATMENT OF COMPLEX ANORECTAL FISTULA: A SAFE AND PROMISING EXPERIENCE Marina Barbabela Grisolia de Oliveira 1, Fabio Lopes Queiroz 1, Cristiane Koizimi Martos Fernandes 1, Daniel Maurício Londoño Estrada1, Artur Duarte Duarte 1, Letícia Brandão Castro 1, Paulo Rocha França Neto 1 1Hospital Felício Rocho, Belo Horizonte, Brasil

Introduction

Complex anorectal fistulas present a significant challenge for colorectal surgeons. Surgical treat- ment aimed at a cure carries a risk of fecal incontinence of up to 40%. Sphincter-sparing techniques reduce this risk but increase the recurrence rate of fistulas. Treatment with autologous mesenchymal stem cell (MSC) injection has shown promise, with a 57% cure rate within one year. However, it requires laboratory centers with expertise in cell culture, which limits its accessibility. A potential solution is the use of allogeneic stem cells, which, while producing similar results, comes at a high cost (up to $87,000). The injection of freshly harvested autologous adipose tissue for the treatment of complex fistulas has emerged as an alterna- tive. This technique is cost-effective, performed in a single surgical session, sphincter-sparing, and has outcomes com- parable to MSC and allogeneic stem cell injections.

Objectives

To evaluate the ef ficacy and safety of treating complex anorectal fistulas with freshly harvested autologous adipose tissue injection. Methodology We conducted an analysis of electronic medical records for all patients who underwent this treat- ment at a tertiary hospital. Variables analyzed included clinical cure, reduction in secretion drainage, and postopera- tive complications. Patients lost to clinical follow-up were excluded from the study.

Results

To date, six patients were included, all of whom had undergone at least two previous procedures with fistula recurrence. Among these, five showed clinical response to the treatment. Four met the criteria for clinical cure (closure of the external opening, cessation of secretion drainage, and absence of a palpable internal opening), and one demonstrated complete healing of two external openings while retaining one external opening with signi ficantly re- duced secretion drainage. One patient reported no clinical improvement and was the only individual with an ostomy. None of the patients were smokers. One patient with clinical cure developed soiling, which had not been reported preoperatively.

Conclusion

Freshly harvested autologous fat injec - tion is a safe, accessible, and promising technique. This study has the inherent limitations of a prospective observational single-center study but con firms the feasibility of the tech- nique and positive results at a Brazilian tertiary hospital. These results can be reproduced safely in other Latin Ameri- can centers, making this approach a valuable addition to the therapeutic arsenal of colorectal surgeons. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S109 Doenças Anorretais Anorectal Diseases ID – 138284 Open Topics (oral presentation) LASER PILONIDOTOMY WITH MINIMAL ENERGY (MELPI) - MULTICENTER STUDY OF A NEW METHOD IN PILONIDAL DISEASE Fabricio Doin Paz Oliveira 1, Sonia Cristina Cordero Time, Ana Carolina Buffara Blitzkow 2, Lucas Rodrigues Boarini, Aline Amaro Munhoz, Elisa Treptow Marques 3 1Hospital São Camilo, Concórdia, Brasil 2Hospital Santa Cruz, Curitiba, Baasil 3Academia do Laser, Florianópolis, Brasil

Objective

Laser surgery, a minimally invasive proce- dure for the definitive approach to Pilonidal Disease (PD), has been frequently studied in recent years. This study aims to describe a new method of pilonidectomy using minimal energy and evaluate its initial results.

Methods

Retrospective multicenter study. A total of 47 consecutive patients underwent 50 minimal energy pilo- nidectomies (MELPi) between 2019 and 2023 at four centers in Brazil. The following factors were analyzed: age, BMI, sex, smoking, diabetes, Güner classi fication, disease duration, energy used, hospitalization time, complications, recurrence, wound closure, pain, and return to activities.

Results

The median age was 27 years; 61.7% were men and 38.3% women. The median BMI was 25.7. Smoking was evident in 14.9% of cases, and diabetes in 2.1%. The average disease duration was 3 years. Most surgeries (36%) were performed at stage R of the disease. The median hospitalization time was 6 hours, and the median healing time was 15 days. The average energy used in the procedures was 433 joules. The median postoperative pain score was 2. Secretion occurred in 14% of cases on the 60th day. Compli- cations (cellulitis) occurred in 4% of cases. The median time to return to work was 7 days. The average follow-up time was 12 months; recurrence occurred in 5 (10%) patients. In 3 of them, a second MELPi procedure was performed and was effective.

Conclusion

MELPi presents promising initial results: low pain, low complication rates, and a rapid return to activities. It is a good option for cases of recurrence and can be performed more than once if necessary.

Keywords

Pilonidal cyst, Laser surgery, Colorectal surgery, Laser ablation, Laser therapies Doenças Anorretais Anorectal Diseases ID – 138314 Open Topics (oral presentation) TREATMENT OF ANAL FISSURE WITH LASER – A MINIMALLY INVASIVE OPTION FOR PAIN MANAGEMENT IN ANAL FISSURES? A BRAZILIAN MULTICENTER STUDY Abel Botelho Quaresma 1, Fabricio Doin Paz Oliveira 2, Ana Carolina Buffara Blitzkow 3, Sonia Cristina Cordero Time 3, Marcelo Marciano4, Rodnei Bertazzo Sampietro 5, Luana Perondi1 1Universidade do Oeste de Santa Catarina, Joaçaba, Brasil 2Academia do Laser, Santa Catarina, Brasil 3Hospital Santa Cruz, Curitiba, Brasil 4Private Practice, Votuporanga, SP, Brasil 5Hospital São Camilo Concórdia, Concórdia, Brasil

Introduction

Anal fissure (AF) is a common condition in proctologists ’ offices. Although internal lateral sphincter- otomy remains the gold standard surgery for chronic AF, it still has a considerable rate of anal incontinence. The aim of this study is to describe an alternative and minimally invasive technique for the treatment of AF using photobiomodulation and high-power laser (Laser Fissure Treatment - LFT), and to present the initial results, primarily evaluating pain relief in both acute and chronic AF.

Methods

A retrospective study was conducted with 38 patients treated on an outpatient basis with LFT in three different hospitals across different states in Brazil (Santa Catarina, Paraná, and São Paulo). The objective was to assess the effects of LFT treatment on pain and incontinence rates in patients with AF after the procedure. The Wilcoxon test was used to identify the effects of LFT treatment over time (D0, D7, D15, D30, and D60). For post-operative pain intensity, the Visual Analog Scale (VAS) was used; and for the analysis of anal incontinence, the Wexner scale was applied.

Results

Of the patients, 65.79% (n=25) were male. The median age was 49 years. Constipation was reported by 31.5%; 13% were smokers, and 21% had recently used opioids. In 92.1% of cases, AF was located posteriorly. Skin tags were present in 26.9%, and 21% had recently undergone prior anal surgeries. A signi ficant reduction in pain over time was observed, with post-operative pain intensity measured by the VAS. Before surgery (D0), the average VAS score was 4.08, progressively decreasing to 0.06 by day 60 post-operatively (P < 0.05). No signi ficant changes in fecal continence were observed by the end of the 60-day follow-up period. Com- plications occurred in 3 patients (1 hemorrhoidal thrombosis, 1 skin tag, and 1 “failure”). The recurrence rate was low, with only one reported case. Satisfaction after 90 days was present in 93.6%.

Conclusion

The results suggest that the treatment of anal fissure with laser therapy leads to a significant reduction in pain intensity over time, without affecting anal continence. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141848 Open Topics (oral presentation) DEEP LEARNING AND CAPSULE ENDOSCOPY: AUTOMATIC MULTI-BRAND PANENDOSCOPIC DETECTION OF VASCULAR LESIONS Pedro Cardoso1,2, Miguel Mascarenhas 1,2,3, Maria João Almeida1,2, Miguel Martins 1,2, Francisco Mendes 1,2, Hélder Cardoso1,2, João Ferreira 4,3, Guilherme Macedo 1,2,3,5 1São João University Hospital, Porto, Portugal 2WGO Training Center, Porto, Portugal 3University of Porto, Porto, Portugal 4Instituto CUF, Porto, Portugal 5Center, Porto, Portugal

Introduction

Capsule endoscopy (CE) is commonly used as the initial exam in situations of suspected mid- gastrointestinal bleeding, after normal upper and lower endoscopy. Although the assessment of the small bowel is J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS110 the primary focus of CE, detection of upstream or down- stream vascular lesions may also be clinically significant. This study aimed to develop and test a Convolutional Neural Network (CNN)-based model for panendoscopic automatic detection of vascular lesions during CE. Aims & Methods A multicentric retrospective study was conducted, based on 1022 CE exams. We used a total of 35655 frames, from seven types of CE devices (PillCam Colon 1, PillCam Crohn ‘s, PillCam SB1, PillCam SB3, OMOM HD, Olympus, Mirocam), of which 11091 were considered to have vascular lesions (angiectasia or varices) after triple validation. We divided data into a training and a validation set, the latter being used to evaluate the model ’s performance. At time of division, all frames from a given patient were assigned to the same dataset. Our primary outcome measures were sensitiv- ity, speci ficity, accuracy, positive predictive value (PPV), negative predictive value (NPV) and an area under the preci- sion-recall curve (AUC -PR).

Results

A total of 35655 frames were used, with 11091 including vascular lesions. The validation data set contained 2433 frames with normal mucosa and 933 vascular lesions. Sensitivity and speci ficity were 86.4% and 98.3%, respectively. PPV was 95.2%, while the NPV was 95.0%. Overall accuracy was 95.0%. The AUC -PR value was 0.96. The CNN processed 115 frames per second.

Conclusion

The study presents promising results for the application of AI deep learning models in panendoscopic automatic detection of vascular lesions in various gastroin- testinal topographies. The methodological details, including the patient-split design and the use of frames from different types of CE devices, suggest that the model could be effec - tively used in routine clinical practice independently of the device brand. This study highlights the potential of panendo- scopic evaluation of all gastrointestinal tract and the need for further research in this area. Overall, the high diagnostic performance of this CNN in multibrand devices addresses an important issue of technological interoperability, allowing it to be replicated in multiple technological settings. However, the study has some limitations, including a small number of frames and a retrospective design, which may introduce selection bias, therefore prospective and multicentric studies are needed before introducing this deep learning model into clinical practice. This is the first proof-of concept AI deep learning model developed for panendoscopic automatic de- tection of vascular lesions during CE. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141847 Open Topics (oral presentation) Deep Learning and Capsule Endoscopy: Automatic Panendoscopic Detection of Protruding Lesions Miguel Mascarenhas1,2,3, Maria João Almeida 1,2, Miguel Martins1,2, Pedro Cardoso 1,2, Francisco Mendes 1,2, Hélder Cardoso1,2, João Ferreira 1,4, Guilherme Macedo 1,2,3 1São João University Hospital, Porto, Portugal 2WGO Gastroenterology and Hepatology Training Center, Porto, Portugal 3F University of Porto, Porto, Portugal 4DigestAID — Digestive Artificial Intelligence Development, , Portugal

Introduction

Capsule endoscopy (CE) provides a minimally invasive exam modality for panendoscopic evalu- ation of the entire gastrointestinal (GI) tract. However, con- ventional reading methods can be time-consuming and error- prone. Protruding lesions are a relatively common entity that can be found with a variable incidence and different patho- logical significance throughout GI tract. Aim The aim of this study was to develop and test a Convolutional Neural Network (CNN)-based algorithm for panendoscopic automatic detection of protruding lesions on CE exams.

Methods

A multicentric retrospective study was con- ducted, based on 1245 CE exams. We used a total of 191455 frames, from 6 types of CE devices, of which 52717 had protruding lesions (polyps, epithelial tumors or subepithelial lesions) after triple validation. Data was divided into a training and testing set (90% vs 10%), using an exam-split design. During training stage, we performed a 5-fold cross validation. Our outcome measures were sensitivity, specifici- ty, accuracy, positive predictive value (PPV), negative predic - tive value (NPV) and area under the conventional receiver operating characteristic curve (AUC -ROC) and the precision- recall curve (AUC -PR).

Results

Regarding test set, the sensitivity were 99.7% and speci ficity 96.5%. The PPV and NPV were 96.8% and 99.3.0%, respectively. The global accuracy was 98.4%.

Conclusion

This study aims to address the gap in AI- enhanced capsule panendoscopy by investigating the devel- opment of the first CNN for the detection of protruding lesions across the GI tract. AI ‘s improvement of CE‘s diagnos- tic accuracy, along with the growing interest in minimally invasive procedures, may contribute to increasing access to this diagnostic tool. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 138297 Open Topics (oral presentation) ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY COLORECTAL NEOPLASIA: INITIAL EXPERIENCE FROM A PUBLIC REFERRAL SERVICE Gabriela Domingues Andrade Ribeiro 1, Lina Meneses Chaves 1, Geraldo Ferreira Coutinho Junior 1, Laura Moretti Vidotto 1, Paula Buozzi Tarabay 1, Joaquim José Oliveira Filho 1, Gustavo Seva Pereira1, Marcello Imbrizi Rabello 1 1Hospital Municipal Dr. Mario Gatti, Campinas, Brasil

Introduction

Endoscopic resection is a treatment option for both malignant and non-malignant colorectal neoplasms. Endoscopic submucosal dissection (ESD) allows en bloc resection, but the experience with this technique for colorectal lesions is still limited in Latin America, especially in public centers.

Objective

To describe the initial experience of a Brazilian public coloproctology service in the indication, performance, and follow-up of patients with colorectal lesions eligible for endoscopic submucosal dissection (ESD).

Method

This is a retrospective, single-center study, which included patients with colorectal lesions suitable for treatment using the endoscopic submucosal dissection tech- nique. Patients of both sexes, aged over 18 years, from a public referral center between 2020 and 2024, were selected. Epi- demiological, colonoscopic, and histopathological data were retrieved from the hospital ’s digital system and tabulated in Excel for analysis. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S111

Results

12 patients eligible for endoscopic submuco- sal dissection were treated by the team during the referred period. The average waiting time between diagnosis and treatment was 242 days (SD 120). The average size of the lesions was 41.08 mm (SD 21). Three cases (25%) required surgical conversion. All patients who required surgical con- version had deep submucosal invasion. In the remaining cases, the treatment was curative, corresponding to 72% of the cohort. No deaths occurred. Ten patients underwent colonoscopic follow-up with no evidence of tumor recur- rence, and two patients are awaiting control endoscopic examination.

Conclusion

Although the waiting time from diagnosis to treatment was long, endoscopic therapeutic success was achieved in most cases. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141844 Open Topics (oral presentation) ARTIFICIAL INTELLIGENCE AND PANENDOSCOPY – MULTI- DEVICE AUTOMATIC DETECTION OF PLEOMORPHIC LESIONS DURING DEVICE-ASSISTED ENTEROSCOPY Francisco Mendes1,2, Miguel Mascarenhas 1,2,3, Tiago Ribeiro1,2,3, João Afonso 1,2,3, Pedro Cardoso 1,2,3, Miguel Martins1,2, Miguel Mascarenhas Saraiva 7, Guilherme Macedo1,2,3 1Centro Hospitalar Universitário São João, Porto, Portugal 2WGO Gastroenterology and Hepatology Training Center, Porto, Portugal 3Universidade do Porto, Porto, Portugal 7ManopH - Endoscopy and Digestive Motility Laboratory, Porto, Portugal

Introduction

Device-assisted enteroscopy is the only diagnostic and therapeutic procedure that allows evaluation of the entire gastrointestinal tract. During the procedure, different types of lesions are detected, including vascular lesions, protruding lesions, ulcers, and erosions. However, its diagnostic accuracy is suboptimal. Convolutional neural net- works, which are artificial intelligence models developed and optimized for image analysis, have shown their usefulness in various areas of medicine, although there is limited data on their utility in device-assisted enteroscopy.

Objective

The present study aimed to develop a multi-device convolutional neural network for the detection and differentiation of pleomorphic lesions during device- assisted enteroscopy.

Methods

A retrospective evaluation was performed on 338 procedures conducted at two reference centers, including 152 single-balloon enteroscopies (Fuji film®), 172 double-balloon enteroscopies (Olympus®), and 14 spiral enteroscopies (Olympus®). The convolutional neural net- work was trained with 40,655 images (esophageal, gastric, enteric, and colonic), with 90% (36,599 images) used for the training dataset in a cross-validation design with 5 sub- groups, and the remaining 10% (4,066 images) used for validation. The network ’s classi fication was compared with the expert consensus classi fication and evaluated based on sensitivity, speci ficity, positive predictive value, negative predictive value, accuracy, and the area under the preci- sion-recall curve.

Results

The convolutional neural network detected pleomorphic lesions with a sensitivity of 88.9%, speci ficity of 98.9%, positive predictive value of 95.8%, and negative pre- dictive value of 97.1%, with an accuracy of 96.8% and an area under the precision-recall curve of 0.97.

Conclusion

Our group developed the first convolu- tional neural network worldwide for multi-device panendo- scopic detection of pleomorphic lesions during device- assisted enteroscopy. This work demonstrates the impor- tance of developing deep learning models with high accuracy to improve diagnostic accuracy in panendoscopic evaluation of pleomorphic lesions. Enteroscopia, Colonoscopia e Pólipos Enteroscopy, Colonoscopy, and Polyps ID – 141790 Open Topics (oral presentation) USE OF THE NICE CLASSIFICATION BY DIGITAL CHROMOENDOSCOPY WITHOUT IMAGE MAGNIFICATION FOR PREDICTION OF THE HISTOLOGICAL TYPE OF COLORECTAL POLYP LESIONS Lucas Alves Bessa Cardoso 1, Antonio Lacerda Filho 2, Letícia Brandão Castro3, Bárbara Maria Tavares Pereira 3, Marina Barbabela Grisolia de Oliveira3, Artur Duarte e Duarte3, Rodrigo de Almeida Paiva 3 1Universidade Federal de Minas Gerais , Belo Horizonte, Brasil 2Universidade Federal de Minas Gerais, Belo Horizonte, Brasil 3Hospital Felício Rocho, Belo Horizonte, Brasil

Introduction

Colorectal cancer is the third most common cancer in men and the second in women, both in Brazil and worldwide. Among the screening methods, colo- noscopy can reduce its incidence and mortality by up to 80% in the distal colon and 60% in the proximal colon. Most polyps are benign, but their resection is still necessary for histologi- cal con firmation, subjecting the patient to the risk of com- plications and increased examination costs. Digital chromoscopy emerged to better characterize lesions, mini- mize risks related to resection, and reduce histopathological study costs when not required. The sensitivity of the Narrow- Band Imaging system is above 90% for neoplastic polyps. However, most of these classi fications require endoscopic magnification, which is not always available. Thus, this study aims to use the NICE classi fication—Narrow-Band Imaging International Colorectal Endoscopic Classi fication—without magnification as a potential method to predict the histologi- cal type of lesions in colonoscopy.

Objective

To demonstrate that the NICE classification, without the use of magni fication, has predictive accuracy for the histological type of polyps before resection, compared with histopathological analysis.

Methods

Patients undergoing colonoscopy at the endoscopy service of Hospital Felício Rocho had lesions identified and classi fied into one of the three NICE types (1: hyperplastic, 2: adenomatous, and 3: invasive neoplastic) by experienced colonoscopists, followed by resection. The NICE type, size, and location of resection were recorded for subsequent database assembly and comparison with histo- pathological analysis. These data were used to calculate the accuracy of the method.

Results

The overall accuracy was 70.1%. Accuracy by segment: 70.8% for the right colon, 65.6% for the transverse and left colon, and 83.6% for the rectum. Discriminating by J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS112 lesion size: 65.2% for lesions smaller than 4mm, 72.0% for lesions between 4-10mm, and 86.0% for lesions larger than 10mm.

Conclusion

The NICE classi fication helped identify the histology of the lesions, but it was not de finitive for determining clinical management. Throughout the study, examiner pro ficiency with the classi fication improved, sug- gesting that with prolonged use, its performance may enhance. Fisiologia Anorretocólica Anorectal Physiology ID – 141724 Open Topics (oral presentation) THE IMPORTANCE OF NEUROPELVIOLOGY FOR THE TREATMENT OF COLOPROCTOLOGICAL PATIENTS Lara Burlamaqui Veras 1, Rodrigo Dornfeld Escalante 1, Victor Ripardo Siqueira1, William Pinheiro Boavista de Oliveira 1, Thaís Barroso Vieira Costa Bon fim1, Matheus Emanuel de Brito Castelo Branco1, Francisco Duque de Paiva Giudice Junior 1, Cauã Ferreira Câmara 1 1Universidade Federal do Ceará, Ceará, Brasil

Introduction

Neuropelveology, the field that studies all diagnostic and therapeutic approaches involving pelvic innervation, integrates the specialties of urology, gynecology, and coloproctology. It has become essential in the manage- ment of pelvic disorders. Coloproctological patients often face debilitating conditions with various etiologies. Tradition- ally, treatments have been based on symptomatic approaches with limited results. However, advances in neuropelveology have revolutionized the ability to diagnose and treat pelvic neurological dysfunctions.

Objectives

To demonstrate the importance of neuro- pelveology in coloproctological patients with pelvic floor disorders.

Methods

A review was conducted using searches from the PUBMED, BVS, and Scielo databases, with the descriptors “Neuropelveology” associated with “Coloproctol- ogy,”“ Pelvic Floor Dysfunction, ” as well as variable descrip- tors: “Treatment” and “Diagnosis.”

Results

A total of 317 articles were found, of which 11 articles published in the last 10 years with the mentioned descriptors were selected. In coloproctology, the sphincter and pelvic floor muscles, the anal canal, rectum, sigmoid, and left colon function due to nervous stimulations from the sacral roots S2, S3, and S4 through the pudendal nerve and pelvic splanchnic nerves, respectively. Dysfunction of the posterior pelvic compartment is understood to originate from disturbances in the function of these innervations, and the etiology should be investigated through functional and anatomical tests (anorectal manometry, three-dimen- sional and dynamic endoanal neuro-ultrasonography, and pelvic magnetic resonance imaging). These dysfunctions may stem from vascular entrapment, nerve compression, iatro- genic surgical injuries, endometriosis, among others. The treatment depends on the diagnosis and may range from local botulinum toxin injection, neuromodulation, to mini- mally invasive laparoscopic or robotic surgery for nerve release.

Conclusion

For proper management of pelvic floor dysfunctions, it is crucial to understand pelvic innervations and their functioning. Treating the apparently dysfunctional organ may not be the best choice, as its function is preserved by its innervation. Further studies and research are needed for a better understanding of the diagnostic approach and neuropelveological interventions in coloproctology. Fisiologia Anorretocólica Anorectal Physiology ID – 141771 Open Topics (oral presentation) FECAL CONSISTENCY AS A MARKER OF GOOD RESPONSE IN THE TREATMENT OF INTESTINAL FUNCTIONAL DISORDERS AND THE ROLE OF SOLUBLE FIBERS Ilario Froehner Junior 1, Jocemari Noeli Buzato 1 1PELVIA Motilidade Digestiva e Continência, Curitiba, Brasil

Introduction

Intestinal functional disorders are among the most frequent gastrointestinal disorders. Soluble dietary fibers are included in some constipation and fecal incontinence guidelines. A simple way to assess normal intestinal transit is through fecal consistency, commonly demonstrated by the Bristol Stool Scale (BSS). Individuals with normal stools (BSS 3 and 4) tend to have a lower incidence of gastrointestinal symptoms.

Objective

To evaluate the clinical response to the use of partially hydrolyzed guar gum soluble fibers and inulin, according to fecal consistency, as the first approach in the treatment of intestinal functional disorders.

Methods

Prospective study of 742 patients with functional bowel disorders taking one measuring spoon (5g) of partially hydrolyzed guar gum (60%) and inulin (40%) added to water two times a day for 30 days. If BSS was 1 to 2, patients were told to mix the measuring spoon to 250 - 300 mL of water. If BSS was 5 to 7, to 50 - 100 mL, and if BSS was 3 to 4, to 200 mL. Mean BSS, global improvement percentage, complication rate, Constipation Scoring System (CSS) and Cleveland Clinic Incontinence Score (CCIS) were applied during the first appointment and during the 30-day follow-up appointment.

Results

Of the 742 patients, 63.5% were female, with a mean age of 49.2 years. All patients informed no dif ficulty in complying with the soluble fiber protocol. Initial mean CSS was 13,0 ( þ-4,2) and CCIS was 2 ( þ-1). Mean BSS of consti- pation patients was 2 ( þ- 1) of functional diarrhea and fecal incontinence was 5 ( þ-1) and of irritable bowel syndrome was 5 ( þ-1), respectively. On the 30-day follow-up appoint- ment, 73.5% of the patients had BSS types 3 and 4, associated with 65.9% ( þ- 15.7) of signi ficant overall improvement. Mean CSS was 6 ( þ-3,9) and CCIS was 1 ( þ-1), p 0,01.

Conclusion

Achieving normal fecal consistency is associated with significant overall improvement. Oral soluble fibers use according to fecal consistency are a valid tool for treating bowel movement disorders. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S113 Fisiologia Anorretocólica Anorectal Physiology ID – 138363 Open Topics (oral presentation) IMPACT OF SATISFACTION RATE, SCORE, AND RISK FACTORS IN THE TREATMENT OF FECAL INCONTINENCE: BIOFEEDBACK, ELECTRO-STIMULATION, OR SACRAL NEUROMODULATION AS THE FIRST OPTION? Sthela Maria Murad-regadas 1, Francisco Sergio Pinheiro Regadas1, José Jader Araujo de Mendonça Filho 1, Francisco Sergio Pinheiro Regadas Filho 1, Carlos Magno Queiroz da Cunha1, Lavier Kelvin Holanda Vidal 1, Victor Ripardo Siqueira 1, William Pinheiro Boavista de Oliveira 1 1Universidade Federal do Ceará, Ceará, Brasil

Introduction

The treatment of fecal incontinence (FI) remains challenging, as patients expect effective and long- term results.

Objectives

To evaluate the impact of satisfaction rate, score, and risk factors in patients with fecal incontinence treated with biofeedback (BIO), electrostimulation combined with biofeedback (ELET þ BIO), or sacral neuromodulation (NS) as the first option. Methodology Prospective data from women treated for FI over a 5-year period, without surgical indication and capable of undergoing BIO treatment. The fecal incontinence score (Cleveland Clinic Fecal Incontinence Score – CCFIS), 3D anorectal ultrasonography, and anal manometry were assessed. The patients were matched by age and grouped into: BIO, ELET þ BIO, and NS. Within each group, they were subdivided by CCFIS /C20 10 vs. CCFIS > 10. Risk factors, scores, percentage of response, and satisfaction rates (using a visual analog scale – EVA [0 = best; 100 = worst]) were compared before and after treatment. The follow-up period was 6 months for BIO and ELET þ BIO and at least one year for NS. ANOVA and paired tests were used.

Results

A total of 165 women were included: 58 treated with BIO (CCFIS/C20 10 = 34, CCFIS > 10 = 24); 51 treated with ELET þ BIO (31, 20); and 56 treated with NS (11, 45). The number of vaginal deliveries, sphincter defects, and previous surgeries were similar across groups. Resting pressure was lower in the NS group. The pre-treatment satisfaction impact (EVA) was higher in the NS group (p < 0.00). There was significant improvement in the score and EVA compared to pre- and post-treatment in all three groups. However, the percentage of improvement was higher in the NS group compared to BIO and ELET þ BIO (88% vs. 43% vs. 34%, p < 0.00), and the satisfaction scale showed the best post- treatment response in the NS group (16 vs. 49 vs. 57, p = 0.00). Additionally, all patients in the NS group showed a symptom improvement rate of FI > 50%, with 30% achieving complete continence. Subgroup analysis showed that the improvement percentage and satisfaction were higher after NS in both subgroups (CCFIS /C20 10: NS = 94% vs. BIO = 48% vs. ELET þ BIO =4 0 % ,p 10: NS = 87% vs. BIO = 36% vs. ELET þ BIO = 24%, p 10: NS = 18 vs. BIO = 64 vs. ELET þ BIO = 73, p < 0.00).

Conclusion

All three modalities led to reduced scores, and no risk factors were identifi ed that influenced the results. However, the improvement percentage and satisfaction rate had an impact on the choice of sacral neuromodulation as the first treatment option, even in patients with CCFIS /C20 10. Fisiologia Anorretocólica Anorectal Physiology ID – 141845 Open Topics (oral presentation) ARTIFICIAL INTELLIGENCE AS A TRANSFORMATIVE FACTOR IN MOTILITY DISORDERS – AUTOMATIC DETECTION OF MOTILITY PATTERNS IN HIGH-RESOLUTION ANORECTAL MANOMETRY Miguel Martins 1, Miguel Mascarenhas 1,2, Francisco Mendes 1, Joana Mota1, João Cordeiro3, João Ferreira2, Cecílio Santander4, Guilherme Macedo1,2 1Centro Hospitalar Universitário São João, Porto, Portugal; Centro Treino WGO, Porto, Portugal 2Universidade do Porto, Porto, Portugal 3Instituto Universitário de Lisboa, Lisbon, Portugal 4Hospital Universitario La Princesa, Madrid, Espanha

Introduction

Anorectal functional disorders are prev- alent in clinical practice, presenting signi ficant diagnostic challenges. High-resolution anorectal manometry (HR-ARM) is the first-line examination for assessing these disorders, but its application is limited by accessibility and the complexity of data interpretation. The aim of this study was to develop and validate an Arti ficial Intelligence (AI) model to identify and differentiate tone and contractility disorders in HR-ARM.

Methods

A retrospective, single-center study was conducted using 813 HR-ARM exams. The classi fication of anorectal motility disorders was based on the London Clas- sification. Several machine learning (ML) models were evalu- ated. The dataset was split, with 80% used for training and 20% for testing. The performance of the models was evaluated using accuracy, sensitivity, speci ficity, and positive and neg- ative predictive values.

Results

The LightGBM and xGB models demonstrated the highest overall accuracy. These models identi fied tone and contractility disorders with an accuracy of 97.6%, sensi- tivity of 98.9%, speci ficity of 94.7%, and positive and negative predictive values of 95.6% and 97.5%, respectively.

Conclusion

The LightGBM and xGB models success- fully identified and differentiated tone and contractility dis- orders in HR-ARM studies. This is the first global study to demonstrate the accuracy of ML models in detecting and differentiating motility patterns in HR-ARM. The development of AI models is crucial to improve the availability and accuracy of these exams, leading to more objective and precise man- agement of patients with anorectal functional disorders. Fisiologia Anorretocólica Anorectal Physiology ID – 138112 Open Topics (oral presentation) PELVIC DYSSYNERGIA ON HIGH-RESOLUTION ANORECTAL MANOMETRY (HR-ARM) IN CHILDREN WITH LOWER URINARY TRACT SYMPTOMS (LUTS) Catarina Barretto de Araújo Rosier 1, Glicia Estevam de Abreu 1, Natalin Oliveira da Costa 1, Ana Aparecida Martineli Braga 1, Ubirajara Barroso Junior 1, Marilia Cardoso Massoni 1, Maria Luiza Veiga1 1Escola Bahiana de Medicina e Saúde Pública, Salvador, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS114

Objective

Assessing the presence of pelvic dyssyner- gia on high-resolution anorectal manometry (HR-ARM) in children with lower urinary tract symptoms (LUTS).

Methods

HR-ARM has been performed on children with LUTS aged /C21 5 years. Children were categorized accord- ing to LUTS into non-monosymptomatic enuresis, mono- symptomatic enuresis, and isolated urinary with daytime urination. The evaluation of the urinary symptoms was carried out with the help of a structured questionnaire and a voiding diary. HR-ARM was performed according to the London protocol. According to Rao´s classi fication, pelvic dyssynergia was classi fied as Type I dyssynergia, II, III, and IV. Functional constipation (FC) was assessed using the Rome IV criteria.

Results

Forty children with a mean age of 9.33 /C6 2.66 years, 22 (55%) were male, underwent HR-ARM. Twenty (50%) patients suffered from constipation. Twenty-eight children (70%) had pelvic dyssynergia, with Type I dyssynergia being the most common. Among children with pelvic dyssynergia, seventeen (60,7%) had non-monosymptomatic enuresis (p=0.04). Patients with dyssynergia had a higher intrarectal expulsion pressure, with a median 54.15(IC 45.88 – 66.23) /C2 28.05 (IC 25.98 – 36.53); p < 0.001. In addition, they had a lesser anal relaxation during straining, with a median -10.35 (IC -28.82 – 9,15) /C2 36.6 (IC 22.85 – 50); p < 0.001.

Conclusion

The presence of pelvic dyssynergia is associated with the simultaneous presence of daytime and nocturnal symptoms, hence non-monosymptomatic enure- sis. This could indicate that the presence of pelvic incoordi- nation is more common in more severe cases of LUTS. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 141181 Open Topics (oral presentation) ANALYSIS OF THE CHARACTERISTICS OF INTESTINAL ENDOMETRIOSIS LESIONS WITH RECTAL INVOLVEMENT USING THREE-DIMENSIONAL ENDOANAL ULTRASOUND Graziela Olivia da Silva Fernandes 1, Rosilma Gorete Lima Barreto1, Yana de Sousa Crispim Pavan 1, Nikolay Coelho da Mota1, Maura Tarciany Coutinho Cajazeiras Oliveira 1, Raissa Scarlet Queiroz Fernandes 1, Marcelo Travassos Pinto 1, Bruno Barreto Figueiredo Soares 1 1Hospital Universitário da Universidade Federal do Maranhão, São Luís, Brasil

Introduction

Intestinal endometriosis represents a complex and challenging form of the condition, involving the gastrointestinal tract, particularly the rectum. Three-dimen- sional endoanal ultrasound provides detailed and precise images of endometriotic lesions in the rectum and is an important tool for the diagnosis and proper management of these patients.

Objective

To evaluate the characteristics of endome- triosis lesions affecting the rectum using three-dimensional endoanal ultrasound.

Method

This is a retrospective study, with data obtained through the evaluation of electronic medical records of patients seen in the coloproctology service of a University Hospital. All patients were referred for rectal ultrasound evaluation due to suspected lesions from previous imaging studies (transvaginal ultrasound or magnetic reso- nance imaging). Patients underwent three-dimensional endoanal ultrasound from May 2017 to May 2024 using the Flex-Focus equipment from BK Medical. Patients with asso- ciated anorectal conditions, such as in flammatory bowel disease, anorectal cancer, or those who had previously re- ceived pelvic radiation, were excluded. The evaluated data included the location of the lesion, depth in the rectal wall, lesion length, and distance to the anal margin. The sample consisted of 69 patients with intestinal endometriosis, with 3 excluded because rectal involvement was not con firmed. Statistical analysis was performed using GraphPad Prism and Excel.

Results

All lesions were found in the anterior hemi- circumference of the rectum. The most common locations were the mid rectum (25) and upper rectum (27), with 8 lesions found in the lower rectum. Six patients had lesions in more than one segment. Of the 72 lesions found, most (39) affected the muscular layer of the rectum. Twenty-four involved the perirectal fat, 6 extended to the submucosa, and 3 reached the mucosal muscular layer. The mean length of the largest axis of the lesion in the longitudinal plane was 1.84 cm (0.37 cm –3.5 cm), and in the axial plane, the mean was 2.08 cm (1.12 cm –8.8 cm). The average distance of the lesions from the anal margin was 9.0 cm.

Conclusion

Intestinal endometriosis lesions predom- inantly occur in the mid and upper rectum, approximately 9.0 cm from the anal margin, and most commonly affect the muscular layer of the rectum. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 141737 Open Topics (oral presentation) ACADEMIC COLECTOMIES: SURGICAL TRAINING ON CADAVERS FOR MEDICAL STUDENTS Carolina Reis Bonizzio 1, Felipe Giraldo Alvarez Gonçalves 2, Emily Caroline da Fonseca Sampaio 2, Artur de Souza Almeida 2, Gabriela Fonseca Lopes 1, Ian Torres de Lima 1, Carlos Frederico Sparapan Marques 1, Bruno Damico Terada 2 1Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil 2Faculdade de Medicina da USP, Sao Paulo, Brasil

Introduction

Historically, surgical education has fo- cused on training in operative techniques due to the inher- ently manual nature of surgical work. However, traditional training models present problems: training on living humans, even when supervised by experienced surgeons, can pose risks to patients; animal models do not fully capture the complexity of the human body and raise ethical concerns. For this reason, cadaver-based training models have gained in- creasing acceptance, especially because they accurately rep- licate human anatomy without exposing any living beings to risk. Academic leagues are extracurricular extensions of medical courses designed to complement students ’ theoreti- cal and practical knowledge in various fields. In the academic league of coloproctology at the institution, students have the opportunity to study anatomy and perform surgical techni- ques on cadavers.

Objective

To demonstrate the technical steps of right and left colectomy on fresh cadavers for surgical training of medical students. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S115

Method

In the death veri fication service, medical students performed, under the tutelage of instructors and residents from the Digestive Surgery and Coloproctology department of the institution, a right colectomy with me- chanical ileotransverse anastomosis and a left colectomy with high rectal resection. They had personal protective equipment, a surgical instrument set, disposable materials, and two fresh cadavers. To simulate the surgical procedure, students followed a flowchart based on previously studied and discussed procedures with their tutors: access to the peritoneal cavity, inventory; release of paracolic gutters while preserving retroperitoneal structures; intercolic -epi- ploic dissection; ligation of colic vessels; lymphadenectomy; bowel sectioning; and in the right colectomy, mechanical ileotransverse anastomosis with correction of the mesenteric gap.

Results

and Conclusion The dissection result, depicted in the video, demonstrates the feasibility and im- portance of using cadaver models for surgical education. Combined with theoretical instruction, practical training on cadavers allowed students to re fine complex techniques and deepen their anatomical knowledge of the abdominal cavity. The video, edited by the students, also serves as a highly valuable teaching tool. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 141607 Open Topics (oral presentation) CREATION OF A SCORE FOR QUANTIFICATION OF COLOPROCTOLOGICAL AND AUTONOMIC SYMPTOMS IN INTESTINAL ENDOMETRIOSIS Lara Burlamaqui Veras1, William Pinheiro Boavista de Oliveira1, Ettore Carvalho Lopes Cezar 1, Guilherme Rolim Santa Cruz 1, Victor Ripardo Siqueira 1, Adryano Gonçalves Marques 1, Matheus Emanuel de Brito Castelo Branco1, Thaís Barroso Vieira Costa Bon fim1 1Universidade Federal do Ceará, Ceará, Brasil

Introduction

Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. Intestinal involvement occurs in 8 –12% of cases, affecting various structures, including the rectum/sigmoid colon. The main coloproctological symptoms include visceral-type abdominopelvic pain (in the lower abdomen, radiating to the lumbar region, diffuse and dull), dyschezia, dyspareunia, abdominal distension, tenesmus, proctalgia, and autonomic symptoms such as syncope, tachycardia, nausea, and vomit- ing, among others.

Objective

To develop a scoring system to quantify the most common coloproctological and autonomic symptoms in intestinal endometriosis and facilitate the evaluation of postoperative improvement. Methodology The medical records of 46 patients who underwent surgery for intestinal endometriosis between 2019 and 2024 at a tertiary hospital in Fortaleza (CE), Brasil, were analyzed. The most common preoperative symptoms were dyschezia, dyspareunia, diarrhea (evacuation urgency), constipation (>3 days between bowel movements), abdomi- nal pain, abdominal distension, tenesmus, the sensation of incomplete evacuation, pelvic pain, and proctalgia. These symptoms were tabulated and scored based on their frequen- cy (never - 0, rare - 1, sometimes - 2, usually - 3, and always - 4). Mild symptoms scored 0 –13; moderate, 14 –26; and severe, 27 –40. Symptoms scored as moderate to severe were shown to have a greater impact on quality of life.

Results

The prevalence of symptoms before and after surgery, respectively, was as follows: dyschezia (36.96% vs. 15.22%), dyspareunia (51.52% vs. 9.69%), constipation (34.78% vs. 26.08%), diarrhea (15.22% vs. 2.17%), abdominal pain (23.91% vs. 15.22%), abdominal distension (10.87% vs. 6.5%), tenesmus (28.26% vs. 13.04%), sensation of incomplete evac - uation (15.22% vs. 13.04%), pelvic pain (41.30% vs. 8.69%), and proctalgia (8.69% vs. 6.52%). The median and mean number of symptoms per patient before surgery were 2 and 2.82, respectively, while postoperatively, they were 1 and 1.19.

Conclusion

There was a reduction in the percentage of analyzed symptoms as well as the mean and median number of complaints per patient after surgery, highlighting the importance of symptom assessment to measure quality of life. Quantifying coloproctological and autonomic symptoms through the development of a scoring system is essential to standardize this evaluation and facilitate postoperative symptom control in patients with intestinal endometriosis. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 137945 Open Topics (oral presentation) IMPACT OF ORAL ANTIBIOTIC USE IN PREPARATION FOR COLORECTAL SURGERIES Diogo Viana Abreu 1, Júlia Salles Rezende Dias 1, Guilherme de Almeida Santos1, Ilson Geraldo da Silva 1, Augusto Zbonik Mendes1, Mario Inácio Carneiro Neto 1, Jennyfer Kellen Lázaro da Rocha1, Matheus Matta Machado Mafra Duque Estrada Meyer1 1Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brasil The use of prophylactic oral antibiotics in colorectal surgeries has been the focus of recent studies, which have demonstrated their impact in reducing rates of infectious complications, such as surgical site infections (SSI) and intestinal fistulas. This study aims to conduct a prospective, randomized, double-blind trial to evaluate the impact of oral antibiotic use on postoperative infectious complications in patients undergoing elective colorectal surgeries. The prima- ry outcome being studied is the in fluence of oral antibiotics on surgical site infection rates, while the secondary outcome focuses on the incidence of intestinal fistulas. The study is ongoing, and preliminary results are presented here. Patients were divided into two groups: the test group, in which patients received oral neomycin and metronidazole on the day before surgery, and the control group, in which patients received a placebo the day before surgery. Both groups received standard intravenous antibiotic prophylaxis. Colon preparation was performed according to institutional proto- cols, regardless of group assignment. No mechanical bowel preparation was performed for right ileocolectomy or abdominoperineal resection. For surgeries involving the left colon, upper rectum, or total colectomy, preparation included glycerin enemas. For rectosigmoidectomy with total meso- rectal excision, mechanical bowel preparation was per- formed. A total of 44 eligible patients were included in the study, with 21 in the test group and 23 in the control group. The groups were comparable, differing only in median age, which was 55 years in the test group and 67 years in the J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS116 control group. For the primary outcome, the control group exhibited a higher rate of infectious complications (19% vs. 43.5%; p-value: 0.082). For the secondary outcome, the groups were similar (5.6% vs. 11.8%; p-value: 0.512). The

Results

for surgical site infections are notable, and while there is no statistically significant difference, this may be attributed to the small sample size. Thefindings thus far are encouraging and support further studies on the use of oral antibiotics in preoperative preparation for colorectal surgeries. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 141776 Open Topics (oral presentation) LATE CLOSED LOOP OBSTRUCTION OF THE SIGMOID AFTER LEFT URETERAL ENDOMETRIOSIS RESECTION: MINIMALLY INVASIVE RESOLUTION WITH COLONOSCOPIC STENT PLACEMENT FOLLOWED BY LAPAROSCOPIC SIGMOIDECTOMY Rodrigo Ambar Pinto 1, Thaís Villela Peterson 1, Daniel José Szor1, Gabriela Fonseca Lopes 1, Jarbas Faraco Maldonado Loureiro1, Isaac José Felippe Corrêa Neto1, Caio Sérgio Rizkallah Nahas1, Carlos Frederico Sparapan Marques 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Case Presentation A 35-year-old female physician, previously undergoing partial resection of the left ureter and end-to-end anastomosis, along with partial resection of the mesosigmoid for deep endometriosis, developed a localized abscess in the sigmoid. This was treated clinically with systemic antibiotics. Six months later, while on vacation, she experienced abdominal pain, distention, and cessation of flatulence and feces. She went to the emergency room where she was diagnosed with a closed loop obstruction in the sigmoid and was advised to undergo an emergency colostomy. The patient opted to return to her city. A colonos- copy revealed a complete and short 4 cm sigmoid obstruction, and a 9 cm colon stent was placed. The effect was immediate, with immediate evacuations and an improvement in the colon distension confirmed by imaging. A slow bowel prepa- ration was carried out over 2 days with Movinlax, which was effective, resulting in liquid evacuations, and surgery was indicated. Surgical Procedure Laparoscopy was performed with the placement of five trocars: one 11 mm in the epigastric region, one 12 mm in the right iliac fossa, and three 5 mm in the left iliac fossa and flanks. A blockage of the small intestine in the left iliac fossa was identi fied and relieved, with the stent found in the cavity. The left paracolic gutter was freed from the retroperitoneum. The proximal rectum at the level of the promontory was prepared, stapled with a linear stapler, and the sigmoid vessels were ligated, extending from the colon to the region above the stent. The specimen was exteriorized via a 5 cm Pfannenstiel incision, and the 29 mm Echelon® circular stapler was placed. An intra-corporeal end-to-end anastomosis was performed, with a negative leak test, and the cavity was drained. Postoperative Course The patient showed excellent recovery, with evacuations from the first day and oral diet introduction. She was discharged on the 5th day after drain removal. Thirty days post-surgery, the patient was asymp- tomatic, with normal, daily evacuations.

Discussion

The self-expanding metallic endoscopic stent represents a minimally invasive and effective alterna- tive for relieving intestinal obstruction. Initially proposed for colorectal malignant tumors in the 1990s, it is now used as a bridge to surgery to avoid emergency stoma creation, as demonstrated in this case.

Conclusion

The decision to use a stent as a bridge to minimally invasive surgery without a colostomy proved to be a safe and effective measure for resolving a severe problem with high complication potential. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 141619 Open Topics (oral presentation) TURNBULL-CUTAIT PULL-THROUGH COLOANAL ANASTOMOSIS VERSUS STANDARD COLOANAL ANASTOMOSIS PLUS DIVERTING ILEOSTOMY FOR LOW ANTERIOR RESECTION: A META-ANALYSIS AND SYSTEMATIC REVIEW Bernardo Fontel Pompeu 1, Eric Pasqualotto 2, Beatriz D ’andrea Pigossi1, Patrícia Marcolin3, Sergio Mazzola Poli de Figueiredo4, Fang Chia Bin 5, Fernanda Bellotti Formiga 1 1Hospital Heliópolis, São Paulo, Brasil 2Universidade Federal de Santa Catarina, Santa Catarina, Brasil 3Universidade Federal Fronteira do Sul Passo Fundo, Passo Fundo, Brasil 4Cleveland Clinic Ohio, Ohio, United States 5Irmandade de Midericórdia da Santa Casa de São Paulo, São Paulo, Brasil Purpose Coloanal anastomosis with loop diverting ileostomy (CAA) is an option for low anterior resection of the rectum, and Turnbull-Cutait coloanal anastomosis (TCA) regained popularity in the effort to offer patients a recon- structive option.

Objective

In this context, we aimed to compare both techniques.

Methods

PubMed, Cochrane, and Scopus were searched for studies published until January 2024. Odds ratios (ORs) with 95% con fidence intervals (CIs) were pooled with a random-effects model. Statistical signi ficance was defined as p 25% considered signi ficant. Statistical analysis was conducted in RStudio version 4.1.2 (R Foundation for Statis- tical Computing). Registered number CRD42024509963.

Results

One randomized controlled trial and nine observational studies were included, comprising 1,743 patients, of whom 899 (51.5%) were submitted to TCA and 844 (48.5%) to CAA. Most patients had rectal cancer (52.2%), followed by megacolon secondary to Chagas disease (32.5%). TCA was associated with increased colon ischemia (OR 3.54; 95% CI 1.13 to 11.14; p < 0.031; I² = 0%). There were no differences in postoperative complications classi fied as Clav- ien-Dindo /C21 IIIb, anastomotic leak, pelvic abscess, intestinal obstruction, bleeding, permanent stoma, or anastomotic stricture. In subgroup analysis of patients with cancer, TCA was associated with a reduction in anastomotic leak (OR 0.55; 95% CI 0.31 to 0.97 p = 0.04; I² = 34%).

Conclusion

TCA was associated with a decrease in anastomotic leak rate in subgroups analysis of patients with cancer. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S117 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141741 Open Videos COMBINED APPROACH FOR DISTAL RECTAL NEOPLASIA AND LATERAL LYMPHADENECTOMY: ROBOTIC WITH USE OF TEO Rodrigo Gomes da Silva 1, Magda Maria Profeta da Luz 1, Bernardo Hanan 1, Kelly Cristine Lacerda Rodrigues Buzatti 1, Renato Gomes Campanati 1, Luiza Rogerio 1, Cleo Gonçalves Trindade Ribeiro1, Mariana Alves Santana de Araújo 1 1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

Distal rectal neoplasms represent a challenge for surgical approach, especially in cases where a manual coloanal anastomosis is required. Performing dissec - tion of the most distal part with adequate preservation of the mesorectum can be facilitated by the minimally invasive abdominal technique combined with the use of the TEO platform for careful rectal sectioning.

Objectives

In this video, we aim to demonstrate how the combination of two modern techniques can result in a more careful surgery, with proper mesorectal preservation and lateral lymphadenectomy.

Methods

A 64-year-old patient with symptoms of hematochezia and diarrhea underwent colonoscopy for in- vestigation, which indicated a lesion in the middle/distal rectum with a pathological diagnosis of adenocarcinoma. Staging MRI indicated T2N1 tumor with suspicious pelvic lateral lymph nodes on the right. An upfront surgery was chosen, performed robotically in combination with the TEO platform for proper mesorectal dissection in its most distal portion, without violation.

Results

The use of robotics for the abdominal portion allows for careful and precise dissection, and the TEO plat- form facilitates sectioning under visual control of the anal canal, preserving tissues and ensuring a safer subsequent coloanal anastomosis.

Conclusion

The combined approach of modern tech- niques can provide careful mesorectal dissection and prevent its violation, which is one of the principles in the oncologi- cally adequate treatment of rectal cancer. When available, their combination can promote an intact surgical specimen. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138218 Open Videos PERINEAL HERNIA REPAIR WITH MESH VIA ROBOTIC SURGERY Michel Gardere Camargo 1, Michel Gardere Camargo 1, Rodrigo Giacomini Bregeiro2, Luis Gustavo Capochin Romagnolo 2, Mayara Marina Sousa Senzano 1, Felipe Daldegan Diniz 2, Carlos Augusto Rodrigues Veo 2, Marcos Vinicius Araújo Denadai 2 1Universidade Estadual de Campinas, Campinas, Brasil 2Hospital do Amor, Barretos, Brasil This free video aims to demonstrate the correction of a perineal hernia using a dual-sided Proceed surgical mesh (Ethicon) via robotic surgery. This procedure was performed during the Robotic Colorectal Surgery Certi fication Program at the Hospital do Amor (Barretos/SP). The patient is a 53- year-old female with a history of a late surgical procedure, an abdominoperineal resection of the rectum via robotic sur- gery due to rectal cancer. The perineal hernia repair surgery was performed through an abdominal approach using the Da Vinci X robotic platform and also through the perineal approach to reduce the herniated content. A Proceed Ethicon mesh was used to fill the pelvis. During the release of the bowel loops, there was an inadvertent injury to an ileal loop, which was managed with simple sutures. In the postopera- tive period, the patient developed adynamic ileus, which resolved with clinical treatment, and she was discharged on the fifth day post-surgery. The robotic technique for perineal hernia repair is feasible and safe, even when per- formed in a training setting, as was the case in our study. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141783 Open Videos RESCUE SURGERY IN LOW RECTAL CANCER WITH RECURRENCE IN PELVIC AND INGUINAL LYMPH NODES, BOTH VIA MINIMALLY INVASIVE APPROACH Pedro Costa Moreira 1, Felipe Daldegan Diniz 1, Carlos Augusto Rodrigues Veo1, Luis Gustavo Capochin Romagnolo 1, Marcos Vinicius Araujo Denadai 1, Rodrigo Giacomini Bregeiro 1 1Hospital de Amor, Barretos, Brasil

Introduction

Low rectal cancer is a challenging con- dition, particularly when a patient experiences recurrence after neoadjuvant treatment and initial surgery. This video presents a case of low rectal cancer with recurrence in pelvic and inguinal lymph nodes, and describes the minimally invasive surgical approach for pelvic lateral lymphadenecto- my and also for inguinal lymphadenectomy.

Objectives

To demonstrate the technique and out- comes of both pelvic lateral and inguinal lymphadenectomy via minimally invasive approach in a patient with recurrence of low rectal cancer.

Methods

A 68-year-old male patient, diagnosed with adenocarcinoma of the low rectum, underwent neoadjuvant chemotherapy and radiotherapy followed by abdominoperi- neal amputation of the rectum. Subsequently, he developed recurrence in the right lateral pelvic and right inguinal lymph nodes. A rescue surgery was performed with right pelvic lateral lymphadenectomy via videolaparoscopy and right inguinal lymphadenectomy via minimally invasive approach, an inno- vative technique for performing this lymphadenectomy.

Results

The video demonstrates the detailed surgical technique for both pelvic lateral and inguinal lymphadenec - tomy, including how to perform inguinal lymphadenectomy via minimally invasive approach, patient positioning, ana- tomical marking, dissection, and removal of affected lymph nodes. The surgery was successful, with complete removal of the recurrent lymph nodes and no signi ficant post-operative complications. The minimally invasive approach proved ef- fective in reducing hospitalization time and promoting post- operative recovery. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS118

Conclusion

Minimally invasive pelvic lateral and inguinal lymphadenectomy is an effective and safe approach for patients with recurrence of low rectal cancer in pelvic and inguinal lymph nodes. This video illustrates the surgical techniques and benefits of this approach in the management of nodal recurrences. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138206 Open Videos OPTIMAL CYTOREDUCTION ASSOCIATED WITH HIPEC: A BENEFICIAL TREATMENT FOR PSEUDOMYXOMA PERITONEI IN SELECTED CASES Vitoria Vicentin Giordano 1, Vitoria Vicentin Giordano 1, Caio Nasser Mancini2, Natalia Ferreira Cardoso de Oliveira1, Gabriela de Carvalho Simoes da Fonseca 1, Fernanda Bellotti Formiga 1, Fang Chia Bin 1, Carolina Pontes de Moraes Hungria 1 1Santa Casa de São Paulo, São Paulo, Brasil 2AC Camargo, São Paulo, Brasil Case Presentation A 61-year-old female, under on- cological follow-up for mucinous neoplasm of the appendix since 2018, developed pseudomyxoma peritonei. She under- went two lines of chemotherapy treatment, which had to be interrupted in 2022 due to severe toxicity. She developed an increase in carcinoembryonic antigen (CEA) after suspension of systemic treatment, along with worsening abdominal pain, associated with a palpable tumor. In the intraoperative peri- od, a peritoneal carcinomatosis index (PCI) of 13 was identi- fied, and she underwent total resection of the right diaphragm peritoneum and partial resection of the left dia- phragm, resection of the caudate lobe, falciform ligament, pelvic peritoneum, implants from the hepatic capsule, ab- dominal wall, and sigmoid, in addition to splenectomy, omentectomy, cholecystectomy, and total hysterectomy. Op- timal cytoreduction and hyperthermic intraperitoneal che- motherapy (HIPEC) were performed, with good clinical progression and hospital discharge on the seventh postoper- ative day. She required readmission after 30 days due to a collection in the splenectomy pouch, diagnosed as a pancre- atic fistula, which was drained by radiointervention, with improvement after antibiotic therapy. She is currently under outpatient follow-up, with resolution of the collection in a control CT scan and no abdominal complaints.

Discussion

Pseudomyxoma peritonei is the progres- sive accumulation of mucinous ascites in the abdominal cavity, highly associated with mucinous neoplasms of the cecal appendix. Its incidence is low, with 1-3 cases per million inhabitants. Initially, disseminated peritoneal disease was synonymous with a terminal condition and exclusive pallia- tive treatment. However, in selected cases, it is possible to perform cytoreductive surgery, which involves complete resection of macroscopic lesions, combined with HIPEC, aimed at eradicating microscopic tumor lesions, thereby subjecting the patient to curative-intention treatment. For this, it is necessary to evaluate the patient ’s baseline con- ditions, the type of tumor, its response to chemotherapy, and the PCI. It is a major surgery with high morbidity and mortality, so careful patient selection is required to ensure therapeutic benefit.

Conclusion

Patients with good performance status and low peritoneal carcinomatosis index are the best candi- dates for cytoreduction and HIPEC. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141735 Open Videos LAPAROSCOPIC RIGHT HEMICOLECTOMY COMBINED WITH PARTIAL DUODENAL RESECTION FOR THE TREATMENT OF ASCENDING COLON ADENOCARCINOMA Rodrigo Gomes da Silva1, Magda Maria Profeta da Luz 1, Renato Gomes Campanati 1, Luiza Rogerio 1, Cleo Gonçalves Trindade Ribeiro1, Kelly Cristine Lacerda Rodrigues Buzzati 1, Giovane Botelho Bacelar1, Bernardo Hanan 1 1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

Ascending colon tumors, when locally advanced, may invade adjacent vital structures, posing a challenge for oncologically adequate resection. For an ade- quate margin, it is often necessary to resect contiguous organs, and performing this by minimally invasive techniques can be complex.

Objectives

Surgical description of oncological right hemicolectomy where the tumor was pinching the duode- num, requiring partial enterectomy for R0 resection.

Methods

A 64-year-old patient presented with severe abdominal pain and signi ficant weight loss. A colonoscopy revealed a stenosing and in filtrative lesion, likely in the ascending colon, with an adenocarcinoma diagnosis. Staging images confirmed a tumor in the ascending colon and multi- ple lesions suggestive of liver metastases. Due to obstructive symptoms, a minimally invasive approach to the colon was chosen. During the cavity exploration, a large tumor was identified, pinching the duodenum in its third portion. It was decided to proceed with the standard dissection until isolat- ing the area of duodenal invasion and perform tangential stapling of the duodenum to release the specimen with adequate oncological margins.

Results

Partial duodenal enterectomy with the assis- tance of an endostapler proved to be an effective alternative for a surgery with clear margins, allowing the patient to recover quickly and continue with oncological treatment.

Conclusion

Tangential invasion of adjacent structures can be managed by minimally invasive techniques with good oncological outcomes and no adverse effects on the patient ’s recovery. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S119 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138301 Open Videos RIGHT HEMICOLECTOMY WITH D3 LYMPHADENECTOMY: DEMONSTRATION OF THE TECHNIQUE IN LAPAROSCOPIC ONCOLOGICAL SURGERY Leonardo Ervolino Corbi 1, Giovanna Cardoso de Oliveira 2, Felipe Giraldo Alvarez Gonçalves 2, Bruno Damico Terada 2, Guilherme Pagin São Julião 1, Bruna Borba Vailati 1, Angelita Habr-Gama3, Rodrigo Oliva Perez 1 1Hospital Alemão Oswaldo Cruz & Bene ficência Portuguesa de São Paulo, São Paulo, Brasil 2Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil 3Hospital Alemão Oswaldo Cruz, São Paulo, Brasil

Introduction

The increasing incidence of colon can- cer, particularly diagnosed in elderly patients, intensi fies the debate over surgical treatments. Right hemicolectomy with D3 lymphadenectomy performed laparoscopically is a safe option with excellent oncological outcomes for patients.

Objective

The goal of this video is to demonstrate the details of the technique used for the resection of a cancer in the ascending colon through right hemicolectomy with D3 lymphadenectomy via laparoscopy. Case Presentation A 79-year-old male patient with hypertension and diabetes presented with asthenia and weakness. Laboratory tests con firmed anemia, and colonos- copy revealed a lesion in the right colon. No secondary lesions were detected on staging via CT scan. The decision was made to perform right hemicolectomy with D3 lymphadenectomy laparoscopically, which allows for the dissection of lymph nodes from the origin to the terminal branch of the main artery supplying the tumor. The pathological analysis of the resected segment revealed tubular adenocarcinoma with pT3pN0 staging and no neoplastic involvement in the lymph nodes (0 out of 32 lymph nodes). The patient progressed well postoperatively, with no complications, and was discharged on the 6th day.

Discussion

D3 lymphadenectomy in right hemicolec - tomy for tumors of the ascending colon is a technically challenging procedure that requires detailed knowledge of surgical anatomy and careful dissection. With studies already suggesting its oncological importance, it is vital to study its steps to familiarize colorectal surgeons with this approach. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141672 Open Videos LAPAROSCOPIC RIGHT HEMICOLECTOMY WITH COMPLETE EXCISION OF THE MESOCOLON Giovana Moreira Minchillo1, Rodrigo Moises de Almeida Leite 1, Francisco Tustumi1, Rafael Vaz Pandini 1, Victor Edmond Seid 1, Sergio Eduardo Alonso Araujo 1, Lucas Soares Gerbasi 1, Elis Oliveira1 1Hospital Israelita Albert Einstein, São Paulo, Brasil Case Presentation Patient: O.M.L, 69 years old, pre- sented with melena, weakness for about a year, and a 10 kg weight loss over the past month. Colonoscopy revealed an extensive vegetating lesion in the cecum, 8 cm in size, with histopathology compatible with adenocarcinoma. Initial exams showed a CEA of 2.2, no distant metastases, and a CT scan of the abdomen revealed suspected lymphadenopa- thy at the root of the superior mesenteric vessels. The patient underwent right hemicolectomy with complete mesocolon excision (CME) and creation of an isoperistaltic side-to-side ileotransversoanastomosis intracorporeally via laparoscopy. The specimen was removed through a transverse suprapubic incision. The histopathological examination of the surgical specimen revealed medullary carcinoma of the right colon – pT3pN0 (00/61). The patient was discharged on the third postoperative day and is under oncological follow-up.

Discussion

Complete mesocolon excision in the treat- ment of colon cancer was introduced to ensure inclusion of the central lymph nodes during lymphadenectomy at the vascular root. The procedure involves separating the meso- colic and parietal planes, exposing the superior mesenteric vein to dissect all lymphatic tissue and performing central ligation of the colic vessels and Henle ’s trunk vessels, includ- ing potentially involved lymph nodes. Special attention must be given during lymphadenectomy, which should only in- volve the lateral side of the superior mesenteric vein while preserving the gastric colic trunk vessels.

Conclusion

In the management of advanced right colon cancer, complete mesocolon excision with central ligation of the vessels plays a key role in ensuring proper oncological surgery for large tumors with suspected lymph nodes at the root of the mesentery. In our practice, this technique is performed selectively, not routinely. This video demonstrates that the laparoscopic approach is feasible and safe; however, due to the higher technical dif ficulty and potential bleeding, the surgeon ’s skill and knowledge of the anatomical structures are crucial for the quality and safety of the procedure. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141802 Open Videos LEFT HEMICOLECTOMY WITH PRESERVATION OF THE INFERIOR MESENTERIC VEIN THROUGHOUT ITS ENTIRE LENGTH Elis Oliveira1, Rafael Vaz Pandini 1, Giovana Moreira Minchillo 1, Rodrigo Moises Almeida Leite 1, Francisco Tustumi1, Lucas Soares Gerbasi1, Victor Edmond Seid 1, Sergio Eduardo Alonso Araujo1 1Hospital Israelita Albert Einstein, São Paulo, Brasil 68 years old, female. Complaints of dark stools and positive occult blood test. No changes upon examination. Colonoscopy showed a polypoid, ulcerated lesion in the proximal descending colon, 30 mm, with endoscopic tattoo- ing and histopathology consistent with adenocarcinoma. Staging exams: CEA 1.85, chest CT unremarkable, abdomi- nal/pelvic CT showed parietal thickening at the splenic flex- ure, 2.2 cm. Laparoscopic left hemicolectomy was performed with intracorporeal anastomosis and preservation of the inferior mesenteric vein. The patient progressed well and was discharged on the 4th postoperative day. Surgical J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS120 pathology: invasive and ulcerated adenocarcinoma, free mar- gins, pT3pN0(0/20) lymph nodes. The patient is under oncol- ogical follow-up. The video shows a laparoscopic left hemicolectomy, with the patient positioned in the right lateral decubitus position. The retroperitoneal dissection began from the inferior mesenteric vein, with reference to the Treitz angle, detaching the mesocolon from Gerota’s fascia and the pancreas, providing access to the retrocavity of the omentum. Preservation of the inferior mesenteric vein throughout its length was chosen. Dissection continued to the splenic flexure, freeing the left paracolic gutter. The tumor in the proximal descending colon was sealed at the origin of the left colic artery, preserving the inferior mesen- teric artery and the left branch of the middle colic artery at its origin. The proximal and distal margins of the tumor were defined, the colon was sectioned, and an intracorporeal latero-lateral anastomosis was performed with closure of the breach using V-Loc 3.

Discussion

Cancers of the distal transverse colon, proximal descending colon, and splenic flexure account for <10% of all colorectal cancers. Left hemicolectomy is the procedure of choice, as studies suggest that lymphadenecto- my is adequate and suf ficient with ligation of the left colic artery and the left branch of the middle colic artery at their origin. However, ligation of the inferior mesenteric vein is not performed for oncological purposes, but rather for better mobilization of the colon to achieve a tension-free anasto- mosis. If the ligation of the inferior mesenteric vein is close to its root, it may impair venous return. Colonic ischemia after surgery is a serious complication resulting from arterioscle- rosis, functional disorders, and venous congestion due to poor blood circulation

Conclusion

Venous congestion may result in anasto- motic dehiscence, worsening morbidity and mortality of the procedure. Therefore, this technique aims to improve venous return and reduce rates of late dehiscence. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141751 Open Videos SEGMENTAL LEFT HEMICOLECTOMY AT THE SPLENIC FLEXURE: ANATOMICAL LANDMARKS AND INTRACORPOREAL ANASTOMOSIS TECHNIQUE Rodrigo Gomes da Silva 1, Magda Maria Profeta da Luz 1, Kelly Cristine Lacerda Rodrigues Buzatti 1, Renato Gomes Campanati1, Bernardo Hanan 1, Luiza Rogerio 1, Cleo Gonçalves Trindade Ribeiro1, Giovane Botelho Bacelar 1 1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

Tumors located at the splenic flexure present a challenge for surgeons due to the absence of a defined standard approach. Differences in vascularization and drainage areas (between mesenteric territories) create the possibility for different techniques, and even the de fini- tion of the splenic flexure boundaries can vary in the literature.

Objectives

To provide a standardized surgical de- scription of segmental left colectomy with anatomical land- marks and the performance of an intracorporeal anastomosis.

Methods

A 66-year-old patient presented with col- icky abdominal pain, associated with hematochezia and a weight loss of 6kg in 1 month. A colonoscopy revealed a stenosing lesion in the descending colon – with an adenocar- cinoma diagnosis. Staging CT scans showed the tumor located at the splenic flexure of the colon, and a decision was made to perform a segmental left colectomy via minimally invasive surgery. A standard dissection was performed with ligation of the inferior mesenteric vein and left colic artery, followed by an intracorporeal isoperistaltic anastomosis between the medial transverse colon and lateral sigmoid colon.

Results

The standardized approach with ligation of the inferior mesenteric vein and only the left colic artery allows for adequate colon mobilization while preserving critical vascularization at the drainage point, which is the splenic flexure. The anastomosis was performed without tension, and the patient had a good postoperative outcome.

Conclusion

A standardized technique for approach- ing tumors at the splenicflexure may lead to better outcomes, with lower rates of surgical complications in patients with tumors at the splenic flexure. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138207 Open Videos LAPAROSCOPIC COLECTOMY USING THE N.O.S.E. TECHNIQUE - VIDEO Victória Mara Vieira Rocha 1, Luis Eduardo Braz de Moraes Alves1, Bárbara Klyslie Kato 2, Luiza Soares Guerra 1, Millene Gonzalez Manente 2, Bernardo Fontel Pompeu 1, Fábio Israel Marques1, Luiz Fernando Paes Leme 1 1Hospital Heliópolis, São Paulo, Brasil 2Universidade de São Caetano do Sul, São Caetano do Sul, Brasil

Introduction

The “Natural Ori fice Specimen Extrac - tion” (N.O.S.E.) technique offers bene fits when properly indicated, but its use is not yet routine. It results in less pain, reduced medication needs, and quicker return to intes- tinal activity compared to conventional open colectomy. Case Presentation A 48-year-old female patient pre- sented with a six-month history of blood in her stool. Colonoscopy revealed a friable, hardened, 5 cm lesion at the rectosigmoid junction, without causing stenosis. A lapa- roscopic approach using the N.O.S.E. technique was chosen. The specimen was extracted transrectally without requiring an abdominal incision. A colorectal anastomosis was per- formed intracorporeally. The procedure was a laparoscopic left colectomy with N.O.S.E. Pneumoperitoneum was estab- lished using the Hasson technique, supraumbilically, with a 10mm trocar and the introduction of the optics. Four more trocars were placed: a 12mm trocar in the right iliac fossa (P2), 5mm trocars in the right hypochondrium (P3), left hypochondrium (P4), and left iliac fossa (P5). The inferior mesenteric vein was identified, and subsequent dissection of the peritoneum in the paraduodenal fossa was performed. The inferior mesenteric vein was ligated with two LT-300 clips and a bipolar clamp. The sigmoid colon and descending colon were mobilized up to the splenic flexure along the left lateral wall, with separation of the left ureter and gonadal vessels. Linear stapling was performed with at least a 5cm margin proximal and distal to the tumor. The distal stapler line was removed, and a Forrester clamp was inserted through the rectum to extract the surgical specimen. A circular stapler was introduced through the rectum to J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S121 perform a mechanical end-to-end anastomosis. The leak test was negative. The pathology report indicated a 4.0 cm inva- sive adenocarcinoma, grade G2, in filtrating into the peri- intestinal adipose tissue, with no vascular or perineural invasion. Peritumoral in flammatory in filtrate was present. Surgical margins were clear, and no lymph node involvement was found (0/17). Pathological staging was pT3pN0.

Discussion

The N.O.S.E. technique offers advantages such as less postoperative pain and a shorter duration of metabolic ileus. Surgical specimens are smaller (less than 6.5cm), with minimal mesorectal thickening. Given the aes- thetic appeal and the patient’s suitability for this technique, it was chosen for the surgery. While still not widely used, it is a good option for colorectal surgeries. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 134792 Open Videos CORRECTION OF COMPLETE COLORECTAL ANASTOMOSIS STENOSIS BY TRANSANAL STENOPLASTY WITH SINGLE-PORT AND MECHANICAL REANASTOMOSIS ASSISTED BY ILEOCOLONOSCOPY Giovanna Savoy Pazin 1, Michel Gardere Camargo 1, Mayara Marina Sousa Senzano 1, Philipe Franco Do Amaral Tafner 1, Maria de Lourdes Setsuko Ayrizono 1, Raquel Franco Leal 1, Claudio Saddy Rodrigues Coy 1, Carlos Augusto Real Martinez 1 1Universidade Estadual de Campinas, Campinas, Brasil Case Presentation A 43-year-old male patient under- went laparoscopic anterior rectal resection with total meso- rectal excision (TME) for treatment of a serrated adenoma, measuring 7 cm in diameter, located 10 cm from the anal margin, which was not amenable to resection by colonoscopy. The patient underwent a retossigmoidectomy with TME and mechanical colorectal anastomosis, 8 cm from the anal margin, with a protective ileostomy. The patient was dis- charged on the 7th postoperative day. Due to the Covid-19 pandemic, the patient returned for follow-up two years after surgery. At this time, a digital rectal exam showed complete anastomotic stenosis. The stenosis could not be corrected with pneumatic balloons or metallic dilators, as it was complete. A computed tomography scan with iodinated contrast administered through the efferent loop of the ileos- tomy and the anus showed that the stenosis of the anasto- mosis (SA) was less than 1 cm in length and was located at the stapler line. The decision was made to correct the SA through a transanal approach with a single-port (SILS™ Port), assisted by colonoscopy performed via the efferent loop of the ileos- tomy. After performing transanal circular strictureplasty with a monopolar hook, a circular stapler No. 29 was intro- duced through the anus, guided by colonoscopy, so that the stapler’s anvil was positioned above the strictureplasty and the stapler ’s body below. After stapling, the integrity of the new anastomosis was confirmed via colonoscopy. The patient had a satisfactory postoperative course and was discharged on the first postoperative day. Three months later, the ileostomy was closed. The patient is currently under outpa- tient follow-up with no signs of recurrence of the stenosis.

Discussion

TME is the most commonly used surgical procedure for the treatment of locally advanced rectal cancer. However, complications related to extraperitoneal colorectal anastomosis may occur. Anastomotic stenosis (AS) represents the second most severe complication, and various techniques for its correction have been proposed. We describe a tech- nique that has been successfully reported for the treatment of complete benign anastomotic strictures following TME, which are dif ficult and recurrent.

Conclusion

The treatment of low colorectal anasto- motic stenosis can be successfully performed through transa- nal strictureplasty with a single-port approach followed by a new mechanical anastomosis assisted by enterocolonoscopy. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141749 Open Videos DETAILS OF TOTAL MESORECTAL EXCISION IN COMBINED APPROACH: LAPAROSCOPIC þ TEO Rodrigo Gomes da Silva 1, Cleo Gonçalves Trindade Ribeiro 1, Bernardo Hanan 1, Magda Maria Profeta da Luz 1, Kelly Cristine Lacerda Rodrigues Buzatti 1, Renato Gomes Campanati 1, Luiza Rogerio1, Mariana Alves Santana de Araújo 1 1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

It is estimated that in 2023, Brasil registered more than 45,000 cases of colorectal cancer. The standardization of the total mesorectal excision technique by Heald in 1982, which involves precise dissection of the mesorectal fascia and removal of an intact specimen, led to a decline in local recurrence rates from 30% to 5%. Addition- ally, the use of laparoscopy combined with the TEO platform in distal rectal cancer surgeries, besides ensuring a good postoperative recovery, can facilitate the dissection with total mesorectal excision and careful rectal sectioning, especially in cases requiring manual coloanal anastomosis.

Objectives

To demonstrate the combined technique of laparoscopy and the TEO platform as an option that may

Result

in more careful surgery in patients with distal rectal tumors requiring total mesorectal excision.

Methods

A 78-year-old patient presented with a histo- ry of hematochezia for 5 years. Colonoscopy indicated a vegeta- tive and ulcerated lesion on the posterior wall of the rectum about 2 cm from the anal margin, with histopathological diagnosis of adenocarcinoma. Staging MRI showed a T2N0 tumor, and thoracic and abdominal CT scans showed no evi- dence of distant disease. A decision was made to proceed with upfront surgery, performed laparoscopically combined with the TEO platform for appropriate mesorectal dissection at the most distal portion, without violation, and distal rectal sectioning.

Results

The use of videolaparoscopy for the abdomi- nal portion allowed for sharp dissection of the mesorectal plane, obtaining an intact mesorectum, preservation of nerves and autonomic plexuses, and appropriate distal mes- orectal clearing. In addition, the use of the TEO platform ensured careful sectioning under direct vision of the anal canal, preserving the tissues for the manual coloanal anastomosis.

Conclusion

The combination of less invasive surgical techniques, such as videolaparoscopy and the TEO platform, can contribute to the careful and intact dissection of the mesorectum, as well as ensuring better postoperative recov- ery for the patient. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS122 Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138212 Open Videos RIGHT HEMICOLECTOMY WITH COMPLETE EXCISION OF THE MESOCOLON VIA ROBOTIC APPROACH Michel Gardere Camargo 1, Marcos Vinícius Araújo Denadai 2, Luis Gustavo Capochin Romagnolo 2, Carlos Augusto Rodrigues Veo2, Rodrigo Giacomini Brejeiro 2, Felipe Daldegan Diniz 2, Mayara Marina Sousa Senzano 1, Michel Gardere Camargo 1 1Universidade Estadual de Campinas, Campinas, Brasil 2Hospital do Amor, Barretos, Brasil This free video aims to demonstrate the surgical technique of right hemicolectomy with complete excision of the mesocolon via a robotic approach. The procedure was performed at the Hospital do Amor in Barretos/SP during the Robotic Colorectal Surgery Certi fication Program. The sur- gery was conducted on a 63-year-old male patient with an ascending colon tumor classified as adenocarcinoma, accom- panied by a lymph node mass located near the inferior mesenteric vessels. Preoperative staging showed no distant metastases. The procedure involved a right hemicolectomy with complete mesocolon excision and lymphadenectomy of the superior mesenteric vessels, followed by an isoperistaltic ileocolic mechanical anastomosis using the Da Vinci X robotic platform. The patient was discharged on the third postoper- ative day without early or late complications. Robotic surgery has proven to be both feasible and safe for complex proce- dures, even in training environments, as demonstrated in this case. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138155 Open Videos LATERAL LYMPHADENECTOMY VIA ROBOTIC APPROACH IN COLORECTAL CANCER Juliana Chaves Brandão 1, Rodrigo Rego Lins 1, Leonardo Machado de Castro1, Rodrigo Rocha Rodrigues1, Camila Tobias Queiroz1, Ana Luiza de Oliveira Nelaton1, Paulo Cesar de Castro Júnio1 1Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brasil MS, a 54-year-old female, sought proctological care due to intestinal constipation with ribbon-like stools and hematochezia that began two months earlier. Colonoscopy identified an infiltrative and ulcerated lesion approximately 4 cm from the anal margin, occupying 45% of the lumen. Subsequent histopathology confirmed a diagnosis of moder- ately differentiated adenocarcinoma. Pelvic MRI revealed a crescent-shaped infiltrative lesion in the anterior rectal wall, located 6 cm from the anorectal margin, showing signs of extension beyond the muscular layer, compromising the mesorectal fascia anteriorly to the left. Additionally, suspi- cious lymphadenopathy was identi fied in the external iliac and obturator chains on the left, measuring 2.1 cm, as well as in bilateral inguinal nodes. Neoadjuvant therapy with che- motherapy (capecitabine) and radiotherapy (5040/28) was initiated and completed in July 2022. A digital rectal exam performed post-neoadjuvant therapy showed a palpable lesion 4 cm from the anal margin, semicircumferential on the left lateral wall. A follow-up MRI performed 24 weeks post-treatment (February 2023) revealed the lesion now located 6.9 cm from the anal margin, in filtrating mesorectal fat at the 3 o ’clock position with a radial extension of 6 mm, without evident signs of mesorectal fascia in filtration. The suspicious lymphadenopathies in the left iliac chain and bilateral inguinal regions persisted. ue to family reasons, the patient opted to delay surgical management, resuming follow-up at the end of 2023. A new MRI conducted 62 weeks after neoadjuvant therapy (November 2023) demonstrated progression of the lesion, now located 5 cm from the anal margin and 1.5 cm from the anorectal junction, with involve- ment of the left lateral mesorectal fascia and a suspicious lymph node in the left obturator chain. In December 2023, the patient underwent abdominoperineal amputation with ro- botic lateral lymphadenectomy. Histopathological analysis confirmed adenocarcinoma with vascular and perineural invasion and high tumor budding scores. Surgical margins were clear, but 13 lymph nodes in the main specimen were involved. The histopathology of the lateral lymphadenectomy revealed metastasis of adenocarcinoma in 3 lymph nodes. Currently, MS is undergoing adjuvant chemotherapy and remains under follow-up with the proctology team. This case includes an intraoperative video presentation of robotic lateral lymphadenectomy. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138267 Open Videos DELOYERS’ MANEUVER FOR COLORECTAL ANASTOMOSIS: WHAT CAN WE DO WHEN THE COLON CANNOT BE LOWERED? Leonardo Ervolino Corbi 1, Felipe Giraldo Alvarez Gonçalves 2, Bruno Damico Terada 2, Artur de Souza Almeida 2, Guilherme Pagin São Julião 1, Bruna Borba Vailati 1, Angelita Habr-Gama 3, Rodrigo Oliva Perez 1 1Hospital Alemão Oswaldo Cruz & Bene ficência Portuguesa de São Paulo, São Paulo, Brasil 2Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil 3Hospital Alemão Oswaldo Cruz, São Paulo, Brasil

Introduction

This video presents the Deloyers ’ Ma- neuver, which involves the mobilization and counterclock- wise rotation of the right colon followed by an anastomosis with the rectum. This procedure may be necessary after extensive colon resections when lowering the transverse colon alone is not feasible due to tension.

Objective

To provide a didactic and replicable dem- onstration of the Deloyers ’ procedure after extensive colectomy. Case Presentation A patient presented with com- plaints of rectal bleeding and underwent a colonoscopy, which revealed synchronous lesions in the rectum and left colon. Staging for colorectal cancer showed no evidence of distant metastases, and MRI indicated T2N0 malignancy in the rectum. Combined resection of both lesions was planned. During surgery, the high tension in the lowered transverse J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S123 colon prevented a safe colorectal anastomosis, making the Deloyers’ Maneuver necessary. The VideoThe video demonstrates the procedure step by step in a didactic manner, showcasing this important maneuver, which is not typically the first choice in standard colorectal resections. It is reserved for more complex cases, particularly in extensive colectomies. The video illustrates the full mobilization of the right paracolic gutter, the coun- terclockwise rotation of the ascending colon, and the me- chanical anastomosis with the rectum using a 29mm circular stapler.

Conclusion

In colorectal surgery, the Deloyers ’ Ma- neuver is an essential tool for colorectal surgeons, offering one of the most critical strategies to avoid tensioned anasto- moses in extensive colorectal resections. This safe and repro- ducible technique enables adequate colorectal anastomosis in challenging cases. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141154 Open Videos MULTIVISCERAL ROBOTIC RESECTION: LEFT HEPATECTOMY AND RECTOSIGMOIDECTOMY Daniel de Barcellos Azambuja 1, Bruna Oliveira Trindade2, Fares Hassan Hamaoui1, Antônio Nocchi Kalil 1, Cristina Calloni 3 1Santa Casa de Porto Alegre, Porto Alegre, Brasil 2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil 3Universidade Feevale, Novo Hamburgo, Brasil This video presents a unique case of multivisceral robotic resection, involving a left hepatectomy and rectosig- moidectomy, performed using the da Vinci Xi robotic plat- form. The patient was diagnosed with a sigmoid tumor and a solitary metastasis in the left hepatic lobe. This innovative surgical strategy demonstrates the simultaneous approach to managing multifocal malignancies with advanced robotic technology. The hepatectomy began with the mobilization of the left hepatic lobe through the dissection of the triangu- lar ligaments, providing adequate exposure to the liver seg- ments. Parenchymal dissection targeted the second and third segments, using monopolar and bipolar forceps. The careful and controlled dissection minimized blood loss and pre- served as much healthy liver tissue as possible. A laparoscopic stapler completed the hepatic parenchyma resection, ensur- ing thorough liberation of the surgical specimen. The recto- sigmoidectomy involved the strategic mobilization of the lateral colon wall, with exposure and ligation of critical blood vessels. A linear stapler resected the lesion, effectively sepa- rating the surgical specimen from the remaining colon. After sectioning the colon, the specimen was carefully removed, and an anastomosis was performed using a circular stapler, ensuring a secure and functional reconnection of the colon. This case showcases the utilization of the da Vinci Xi robotic platform with a single docking technique, allowing for simul- taneous resection of both hepatic and colorectal lesions. This approach offers several unique advantages: unparalleled precision and control, reduced operative time, preservation of healthy tissues, and a minimally invasive procedure that

Results

in reduced postoperative pain, shorter hospital stays, and faster recovery times compared to traditional surgeries. The innovative surgical strategy integrates cutting-edge tech- nology with expert techniques to effectively treat multifocal and complex tumors. Overall, this video serves as a valuable educational resource for surgeons and medical professionals, highlighting the potential and effectiveness of robotic - assisted surgery in managing complex oncological cases. It illustrates the future direction of surgical oncology, where precision, innovation, and minimally invasive techniques improve patient outcomes. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141676 Open Videos PROPOSAL FOR STANDARDIZATION OF TOTAL MESORECTAL EXCISION SURGERY ON THE ROBOTIC PLATFORM Fabio Lopes Queiroz 1, Marina Barbabela Grisolia de Oliveira 1, Hélida Aline Tomacheski Amaral 1, Paola Monção 2, Leticia Brandão Castro3, Artur Duarte Duarte 1 1Hospital Felício Rocho, Belo Horizonte, Brasil 2Hospital Mater de 3Hospital Mater Dei

Introduction

The robotic platform has been estab- lished with the aim of minimizing the dif ficulties associated with videolaparoscopy. However, despite these promises, robotic surgery (RS) is still not standardized in some special- ties and surgical techniques, mainly due to the dif ficulty of access to technology. Unlike videolaparoscopy, which has a standardized technique, usually involving dissection of the mesocolon and retrocavity from medial to lateral, through a high-resolution video of total mesorectal excision surgery on the robotic platform, we propose identifying the ureter and dissecting the parietocolic gutter and retrocavity from lateral to medial.

Method

Demonstration of surgical steps through a high-resolution video of total mesorectal excision surgery. The proposed steps of the surgery are: laparoscopy with cavity inventory, robot docking, identification and dissection of the inferior mesenteric vein (IMV), opening of the retro- cavity above the IMV followed by ligation, pancreas and retroperitoneum release, transverse colon and splenicflexure release, repositioning of the patient and re-docking with release of the descending colon and sigmoid and identi fica- tion of the ureter from lateral to medial, mesocolon dissection until identi fication of the inferior mesenteric artery (IMA), medial exposure of the IMA followed by its dissection and ligation, dissection and preservation of the hypogastric nerves, mesorectal dissection down to the pelvic floor, rectal resection with endo-stapler, specimen removal, colo-anal anastomosis with circular stapler, methylene blue test.

Discussion

The lateral-to-medial approach, per- formed in laparotomy, was not reproduced in videolaparo- scopic surgery mainly due to the dif ficulty of exposure and the limited movement range of the camera and forceps to perform safe lateral dissection. In our experience, the robotic platform and the endowrist technology, coupled with three- dimensional vision, enable dissection of the parietocolic gutter and safe identi fication of the left ureter from lateral to medial, also facilitating the medial dissection of the IMA with preservation of the mesocolic plane.

Conclusion

We propose these surgical steps with the aim of standardizing and facilitating the training of new surgeons, as the standardized technique compartmentalizes J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS124 and organizes intraoperative care, enhancing the safety of the procedure. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141156 Open Videos SYNCHRONOUS RESECTION OF GIST IN THE RECTUM AND PROSTATIC ADENOCARCINOMA WITH THE DA VINCI ROBOTIC PLATFORM Rodrigo Moisés de Almeida Leite 1, Lucas Soares Gerbasi 1, Francisco Tustumi1, Rafael Vaz Pandini 1, Ana Sarah Portilho 1, Victor Edmond Seid 1, Sergio Eduardo Alonso Araujo 1, Giovana Moreira Minchillo 1 1Hospital Israelita Albert Einstein, São Paulo, Brasil The synchronous robotic resection of a gastrointesti- nal stromal tumor (GIST) in the rectum and prostatic adeno- carcinoma is a rare and challenging procedure due to the anatomical complexity and the differences in surgical approaches required for each condition, with distinct robotic docking and the proximity of the vesico-urethral anastomosis to the colorectal anastomosis. This case report describes a 65- year-old male patient simultaneously diagnosed with rectal GIST and prostatic adenocarcinoma. The patient had no rectal symptoms, and the diagnosis was made during a Multipara- metric MRI for prostate tumor evaluation. The diagnosis was confirmed through ultrasound-guided biopsy. The surgical approach was carried out on the Da Vinci SI platform, involving radical prostatectomy for the prostatic adenocarci- noma, followed by marginal resection of the GIST from the anterior surface of the rectum within the same docking, as demonstrated in the video. The patient had a favorable postoperative course, with discharge on the 3rd postopera- tive day. This video highlights the importance of meticulous surgical planning and a collaborative approach between specialties for the effective management of complex synchro- nous tumors. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 141746 Open Videos Combined Rectosigmoidectomy with Ureterectomy and Ureteral Reimplantation by Videolaparoscopy – Technical Details Rodrigo Gomes da Silva 1, Luiza Rogerio 1, Renato Gomes Campanati1, Magda Maria Profeta da Luz 1, Bernardo Hanan 1, Kelly Cristine Lacerda Rodrigues Buzatti 1, Cleo Gonçalves Trindade Ribeiro1, Giovane Botelho Bacelar 1 1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

Locally advanced colon neoplasms with invasion of adjacent organs can often pose a challenge for achieving R0 surgery using minimally invasive techniques. Sigmoid lesions may invade organs of the genitourinary tract, and to achieve free margins, resection may be necessary, and, when indicated, reconstruction, as in the case of urinary tract invasion.

Objectives

Technical description of rectosigmoidec - tomy with the need for ureterectomy in a patient with an advanced sigmoid tumor, where ureteral reimplantation was performed in the psoic bladder.

Methods

A 74-year-old patient presented with ab- dominal pain and diarrhea. Colonoscopy identified a neoplas- tic lesion in the sigmoid. Staging exams showed no evidence of distant disease. A laparoscopic resection was planned, and during the inventory, left ureter adhesion to the tumor was identified. Ureterectomy was performed, followed by laparo- scopic ureteral reimplantation using a modi fied Lich-Gregoir technique.

Results

The rectosigmoidectomy combined with ure- teral reimplantation was successfully performed, achieving free margins. The patient had no complications from the procedure and was referred for adjuvant chemotherapy.

Conclusion

Resection of organs and structures ad- hered to the tumor is crucial for obtaining an oncologically adequate result, and performing the entire procedure via minimally invasive surgery facilitates a faster recovery for the patient. Câncer do Cólon/Reto/Ânus Colon/Rectum/Anus Cancer ID – 138872 Open Videos TREATMENT OF LOCALLY ADVANCED COLON TUMORS VIA ROBOTIC SURGERY IN A SPECIALIZED CENTER Marcos Vinicius Araújo Denadai 1, João Pedro Pinto Cordeiro de Miranda Coutinho 1, Felipe Daldegan Diniz 1, Carlos Augusto Rodrigues Véo1, Luís Gustavo Capochin Romagnolo 1, Rodrigo Giacomini Bregeiro1 1Hospital de Amor de Barretos, Barretos, Brasil Video Description A compilation of three videos demonstrating locally advanced sigmoid and rectosigmoid junction tumors, T4b, invading adjacent organs such as the small bowel and bladder, successfully operated via robotic surgery, applying advanced techniques for multi-organ resec - tion without the need for conversion.

Discussion

Approximately 10% of colorectal cancer patients have locally advanced disease at the time of diagno- sis, either T4a, with involvement of the peritoneum adjacent to the lesion, or T4b, with invasion of one or more adjacent organs. Surgery with R0 resection is the treatment of choice, potentially curative, and of patients undergoing multi-organ resection with curative intent, 7 to 33% progress with isolated regional recurrence. Statistically, there is a lower rate of conversion to laparotomy when the approach is robotic, compared to laparoscopic surgery.

Conclusion

Such an approach was only possible because the cases were treated at a specialized oncology center and due to the experience of the assisting team in minimally invasive approaches. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S125 Doença Diverticular Diverticular disease ID – 141354 Open Videos SIGMOID-URINARY BLADDER AND SIGMOID-VAGINAL FISTULAS POST-ACUTE DIVERTICULITIS. SURGICAL TREATMENT WITH ROBOTIC PLATFORM AND MULTIDISCIPLINARY TEAM Luiz Carlos Benjamin Do Carmo 1, Rogers Camargo Mariano da Silva2, Renato Panhoca1, Luiz Guilherme Lisboa Gomes3, Thiago Ibiapina Alves1, Raissa Teixeira Rosalino 1, Renato Barretto Ferreira da Silva 3 1Hospital São Luiz, São Paulo, Brasil 2Hospital Brasil, Santo André, Brasil 3Hospital e Maternidade Santa Joana, São Paulo, Brasil

Introduction

The most frequent fistula after acute diverticulitis is the colon-vesical fistula, followed by the colon-vaginal fistula. Surgical treatment is challenging due to the pelvic blockage, the in flammatory process involving important structures such as the ureters, pelvic vessels, bladder, and vagina. A multidisciplinary team is crucial for the management and surgical treatment of these fistulas. The robotic platform, with its high-definition 3D imaging, articu- lated instruments, and the use of fluorescence, provides greater safety and facilitates the surgical procedure.

Objective

To demonstrate through a video the surgi- cal treatment of a patient with colon-vesical and colon- vaginal fistulas post-acute diverticulitis, using the robotic platform and a multidisciplinary team.

Method

A 58-year-old female patient with a history of recurrent acute diverticulitis crises followed by air leakage through the urethra and vagina, and a previous hysterectomy. A cystoscopy was performed, revealing a fistulous opening to the bladder. The ureters were catheterized, and indocyanine green was infused to identify the ureters during surgery using Firefly fluorescence. The first dif ficulty was the release of adhesions due to the recurrent acute diverticulitis crises and prior hysterectomy. After identifying the fistula with the bladder, the urologist opted to open the bladder to better dissect and avoid injury to the ureteral ori fices. The gynecol- ogist performed the dissection of the vaginal vault, injecting indocyanine green into the vagina and using Fire fly to iden- tify the fistulous tract. The colorectal surgeon performed a rectosigmoidectomy, with the specimen removed through a suprapubic incision, and the loop was prepared for anastomosis.

Result

The patient progressed well postoperatively with minimal pain and early ambulation. Discharged on the 5th postoperative day with a urinary catheter in place.

Conclusion

The robotic platform has demonstrated a significant contribution to achieving good results in cases of these complex fistulas. The use of fluorescence for identifying the ureters and perfusing the anastomoses provides greater safety for the surgeon, resulting in successful surgeries. Additionally, the involvement of a multidisciplinary team in managing pelvic structures ensures a safer surgery and better outcomes. Doença Diverticular Diverticular disease ID – 141598 Open Videos CASE SERIES: RECTOSIGMOIDECTOMY AFTER DIVERTICULITIS CRISIS WITH PRESERVATION OF LEFT COLIC AND SUPERIOR RECTAL ARTERIES Thamy Cristine Santana Marques1, Mayara Maraux Maranhão1, Lina Maria Goes de Codes 1, Rafaella Alcântara Almeida Melo 1, Flávia de Castro Ribeiro Fidelis1, Elias Luciano Quinto de Souza1, Sabrina Queiron Boudoux 1, Euler de Medeiros Azaro 1 1Hospital Aliança, Salvador, Brasil

Introduction

Colon resections involve various aspects that determine a satisfactory outcome. Among the numerous complications related to the surgical procedure, anastomotic dehiscence is undoubtedly one of the most feared by surgeons. One of the factors that directly impacts the success of the anastomosis is local blood supply. As a result, vascular ligations have become increasingly conservative to maintain adequate blood flow to the remaining colon and, most importantly, to the anastomosed region. The preservation of the left colic and superior rectal arteries during rectosigmoidectomy has been widely practiced with satisfactory results, including in the restoration of early intestinal transit.

Objective

To report a series of cases of patients who underwent rectosigmoidectomy after diverticulitis crises, where the left colic and superior rectal arteries were pre- served, showing the technique used through video.

Method

All patients who underwent laparoscopic rectosigmoidectomy due to diverticulitis crises were cata- loged. Medical records were reviewed to obtain data and calculate results, followed by video editing of one of the procedures, illustrating the main steps of the surgery.

Result

A total of 15 patients were operated on be- tween January 2023 and June 2024. Of the 15 patients, 8 were female and 7 were male, with an average age of 59.3 years. Four patients presented with paralytic ileus, and the other 11 had restored intestinal transit within 4 days. There was no anastomotic dehiscence or need for reoperation in the ana- lyzed sample. The average hospital stay was 7.25 days.

Conclusion

The strategy of preserving the left colic and superior rectal arteries is valid, yields good results, and improves blood supply at the anastomotic level, reducing the risk of local ischemia and, consequently, anastomotic dehiscence. The resto- ration of intestinal function and hospital discharge time were similar to the data found in the global literature. Doenças Anorretais Anorectal Diseases ID – 138047 Open Videos ANTERIOR ANAL SPHINCTEROPLASTY SURGERY WITH PERINEAL RECONSTRUCTION VIA Z-PLASTY Gabriela Oliveira Bagano 1, Rogerio Sera fim Parra1, Vanessa Foresto Machado Leal 1, Antonio Balestrim Filho 1, Mariane Louise Quaglio Marques1, Marley Ribeiro Feitosa1, Omar Féres1, José Joaquim Ribeiro da Rocha 1 J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS126 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

Introduction

Injury to the external anal sphincter can occur as a result of obstetric trauma, colorectal surgeries, or in the context of polytrauma, potentially leading to social impairment and loss of quality of life when associated with fecal incontinence.

Objective

To demonstrate the technique of anterior anal sphincteroplasty with perineal reconstruction via Z- plasty.

Methods

A 37-year-old female patient was referred to the Coloproctology outpatient clinic with complaints of fecal incontinence (Wexner score = 15) following a vaginal delivery with a Grade IV perineal tear two years prior. Upon examina- tion, there was significant reduction in the perineal body due to scar tissue, with a slightly open anus and a hypotonic sphincter with low-amplitude voluntary contraction. Ano- rectal manometry showed the absence of a functional anal canal with a resting pressure of 20 mmHg, a contraction pressure of the EAS of 29 mmHg, and a total voluntary contraction pressure of 39 mmHg. Colonoscopy was normal. Pelvic MRI revealed partial fat substitution in the right levator ani muscles. Surgical technique: Dissection of the rectovagi- nal septum and separation of the vaginal wall from the anterior rectal wall, with identi fication of the remaining muscle fibers of the EAS, and suturing them together with Vicryl 2-0. Bilateral V-shaped incision in the perineal skin. Transverse incision in the perineal body. Release of flaps and creation of a Z-plasty flap (PDS 3-0) for reconstruction and elongation of the perineal body. A sigmoidostomy was per- formed for intestinal diversion.

Results

The patient recovered well after the proce- dure and was discharged on the third postoperative day without wound dehiscence, local infection, or other clini- cal-surgical complications. Over 90 days postoperatively, the patient expressed high satisfaction with the surgical result, reporting significant aesthetic improvement and recovery of fecal continence, with plans for further anorectal manometry and surgery for reconstruction of intestinal transit.

Conclusion

Anterior anal sphincteroplasty with per- ineal reconstruction via Z-plasty is a surgical technique with excellent aesthetic and functional results in the medium-to- long term in cases of EAS injury, especially in younger patients. Doenças Anorretais Anorectal Diseases ID – 141557 Open Videos PILONIDAL FISTULA: SURGERY WITH PRIMARY CLOSURE – MODIFIED BASCOM TECHNIQUE – TECHNICAL DETAILS AND TIPS Sthela Maria Murad Regadas 1, Victor Ripardo Siqueira 1, Carlos Magno Queiroz da Cunha 1, Lavier Kelvin Holanda Vidal 1, Francisco Sergio P . Regadas Filho1, Jose Jader de Mendonça Filho1, Francisco Sergio P . Regadas1, William Pinheiro Boavista de Oliveira1 1Universidade Federal do Ceará, Ceará, Brasil

Introduction

Surgical techniques for the treatment of pilonidal disease are described, including open excision with secondary healing or excision with primary closure with or without the use of a flap. The appropriate technique would be the one with the shortest healing time and lowest recurrence rate. The modi fied Bascom technique involves reducing the depth of the gluteal cleft and performing primary closure outside the midline using a flap advancement.

Objective

The video demonstrates patients who un- derwent surgery using the modi fied Bascom technique for recurrent cases, highlighting technical details and tips for executing the procedures.

Method

The video presents technical details of patients treated with the modi fied Bascom technique, who had previously undergone surgery with secondary healing without success. It demonstrates details of flap marking, tips for creating larger flaps, excision of the gluteal cleft, and primary closure, ensuring the effectiveness of the appropriate flap and wound drainage. No intraoperative complications occurred. A 1.5 cm opening in the epidermis and dermis was observed in one of the cases. No recurrence was noted during two years of follow-up.

Conclusion

The modified Bascom technique with flap advancement and primary closure, executed according to technical principles, was effective for the treatment of recur- rent pilonidal disease, with patients showing a healing time of up to six weeks. Doenças Anorretais Anorectal Diseases ID – 141796 Open Videos MILLIGAN MORGAN HEMORRHOIDECTOMY: TECHNICAL DETAILS EVERY COLOPROCTOLOGIST SHOULD KNOW Lucas Faraco Sobrado 1, Jose Americo Bachi Hora 1, Afonso Henrique da Silva e Sousa Jr 1, Carlos Frederico Sparapan Marques1, Carlos Walter Sobrado 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

Introduction

The Milligan-Morgan hemorrhoidec - tomy is an excisional surgical technique described in 1937, used to remove symptomatic internal and external hemor- rhoids. Hemorrhoidectomy is indicated in grade II hemor- rhoidal disease (HD) when other conservative treatment options have failed and for large HD (Grade III/IV). Through- out the 20th century and even today, excisional methods have solidified as the most effective due to their good control over bleeding and prolapse, and their lower recurrence rates, despite the emergence of several minimally invasive techni- ques (laser, harmonic scalpels, radiofrequency, PPH, and THD). The main goal of this presentation is to explore and present the key technical details of the traditional open hemorrhoidectomy for the improvement of younger coloproctologists. Case Presentation A 61-year-old female patient pre- sented with complaints of anal bleeding and prolapse during evacuation efforts for 3 years, associated with anal discomfort and local pruritus. She had previously undergone dietary, pharmacological treatments, and elastic band ligation ses- sions with slight improvement. On proctological examina- tion, three small anal plicae and three hemorrhoidal nipples were observed. Colonoscopy was unremarkable. No bowel preparation was performed, and antibiotic prophylaxis was used. The patient was positioned in the Lloyd-Davies position after balanced general anesthesia. Bupivacaine in filtration J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S127 with vasoconstrictor was administered to reduce bleeding from small vessels. The patient underwent hemorrhoidec - tomy using the open technique under balanced general anesthesia without complications. The cutaneous-hemor- rhoidal complex was resected without damaging the sphinc - ter muscle, pedicles were ligated with absorbable 2-0 sutures, hemostasis was carefully achieved, and appropriate cutane- ous-mucosal bridges were preserved. The surgical wounds were left open to heal by secondary intention. The same procedure was performed for the three hemorrhoidal nipples.

Results

The patient passed stool and was discharged on the first postoperative day without complications.

Conclusion

Although the Milligan-Morgan hemor- rhoidectomy is an invasive procedure, it is an effective technique for controlling prolapse and bleeding, safe, and with a low recurrence rate. Due to its simpler learning and execution, and low cost, it should be the method of choice in the training of coloproctologists in Brazil. Doenças Anorretais Anorectal Diseases ID – 141643 Open Videos GRACILIS FLAP IN THE CORRECTION OF RECTOVAGINAL FISTULA DUE TO CROHN ’S DISEASE Andre Pereira Westphalen 1, João Paulo Slongo 1, Peterson Fasolo Bilhar1, Geanine Baggio Fracaro 1, Daniele Ximenez 1, Gersino Perin Ribeiro 1, Ana Carolina de Quadros 1 1Universidade Estadual do Oeste do Paraná, Cascavel, Brasil Case Presentation A 31-year-old female patient with Crohn’s disease affecting the colon and ileum since 2013, associated with 4 complex anal fistulas, one of which was rectovaginal. She underwent treatment with sedeno and anti-TNF Adalimumab starting in June 2017, achieving remis- sion of the intestinal disease and healing of the anal fistulas, but the rectovaginal fistula persisted without in flammatory findings in the anal canal. The patient was treated with a vaginal mucosal flap in December 2018, but the procedure was unsuccessful. An ileostomy was performed in July 2019, followed by a right-sided bulbocavernous interposition repair in September 2019 using the Martius technique, which also failed. A second Martius repair was done on the left side in February 2020, also without success. In February 2022, a rectovaginal fistula correction was performed using the gracilis muscle flap. A video describing the detailed technique was recorded.

Discussion

Rectovaginal fistulas cause significant re- duction in the quality of life, especially in patients with Crohn’s disease, and their management is extremely complex and difficult. Surgical interventions are indicated once the inflam- matory activity of the disease is controlled. While there is no clear consensus on the preferred procedure, guidelines rec - ommend starting with flaps followed by techniques that involve healthy tissue interposition, such as the Martius flap and the gracilis muscle flap, which was originally described in 1928. Given that this is a complex and rare surgery, we present a video with detailed technical descriptions.

Conclusion

The use of the gracilis muscle flap for rectovaginal fistula repair represents an advanced surgical therapy for patients who have failed simpler flap techniques or bulbocavernous muscle interposition procedures. Doenças Anorretais Anorectal Diseases ID – 141743 Open Videos MARTIUS FLAP þ SPHINCTEROPLASTY FOR RECTOVAGINAL FISTULA TREATMENT – TECHNIQUE DESCRIPTION Rodrigo Gomes da Silva1, Renato Gomes Campanati1, Bernardo Hanan1, Kelly Cristine Lacerda Rodrigues Buzatti1, Magda Maria Profeta da Luz 1, Cleo Gonçalves Trindade Ribeiro 1, Luiza Rogerio1, José Henrique Paiva Rodrigues 1 1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

Rectovaginal fistulas are often associat- ed with traumatic injuries after childbirth and are dif ficult to treat, sometimes requiring more than one approach for complete resolution. There are several available approaches, and tissue interposition techniques (using healthy tissue) seem to yield good results. The Martius flap involves inter- position of the bulbocavernosus muscle and has shown to be a minimally invasive option for treating these fistulas.

Objectives

Description of the Martius flap technique combined with sphincteroplasty to treat a patient with a rectovaginal fistula and sphincter injury after a long-term vaginal delivery, without previous corrections.

Methods

A 37-year-old patient presented with fecal incontinence through the vagina after a vaginal delivery 13 years ago. Colonoscopy and rectal examination identified the fistulous opening to the vagina. Endoanal ultrasound showed a gap in the external sphincter. Sphincteroplasty was chosen with an overlap technique, combined with Martius flap correction. A small incision was made adjacent to the left labium, and the bulbocavernosus muscle was dissected and interposed between the rectum and vagina to prevent fistula recurrence.

Results

The patient had an excellent postoperative outcome, with complete resolution of symptoms and early hospital discharge (2nd postoperative day).

Conclusion

The Martius flap technique is minimally invasive (requiring small incisions) and has low morbidity, yet is highly effective for treating rectovaginal fistulas. It can be considered a first-line treatment option with good success rates. Doenças Anorretais Anorectal Diseases ID – 138250 Open Videos ENDORECTAL ADVANCEMENT FLAP FOR CORRECTION OF VAGINAL-POUCH FISTULA: VIDEO-ASSISTED TECHNIQUE Carolina Reis Bonizzio 1, Rodrigo Ambar Pinto 1, Jorge Landivar Coutinho1, John Anibal Tapia Baca 1, Gabriela Lopes Fonseca 1, Carlos Frederico Sparapan Marques 1 1Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brasil Case Presentation A 60-year-old obese woman with chronic ulcerative colitis refractory to medical treatment J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS128 developed a rectovaginal fistula during the first week after total proctocolectomy with ileal pouch and elective loop ileostomy. Despite the intestinal diversion, the patient expe- rienced daily mucus discharge from the vagina and recurrent urinary infections until reoperation. A pouchoscopy revealed an ileorectal anastomosis 3 cm from the anal verge with a 1 cm fistulous opening at the staple line in the anterior wall. The chosen surgical correction was an advancement endor- ectal flap. The patient was placed in a prone position. Despite the use of an endoanal retractor, the dissection of the fistula was difficult due to a narrow anal canal and a highfistula. The

Introduction

of a 30° scope through the anal canal assisted in all stages of the surgery, allowing the surgeon to better visualize the operative field. The steps were: 1. removal of the metal staples from the anastomosis surrounding the fistula; 2. dissection and resection of the fistula; 3. dissection of the rectovaginal septum; 4. vaginal suturing in two layers with separate Vycril 3.0 stitches; 5. dissection of theflap from the ileal pouch segment and advancement into the distal rectum with separate stitches of the same suture. The patient was discharged on the third postoperative day and is cur- rently under follow-up with no complications.

Discussion

Rectovaginal fistulas are abnormal com- munications between the rectum and vagina, which can occur after perineal trauma, pelvic radiation, local infection, inflammatory bowel disease, tumors, or surgeries, especially obstetric procedures. Various surgical techniques exist for treating rectovaginal fistulas, but they are associated with high recurrence rates. Intestinal diversion provides better control of local infection, and the interposition of well- vascularized tissues in surgical reconstruction (such as the Martius or gracilis flap) enhances healing. In this case, the clinical presentation shortly after the surgery suggests that the fistula occurred due to technical failure of the ileorectal anastomosis, where the posterior vaginal wall was inadver- tently included in the stapling.

Conclusion

This video demonstrates the surgical steps for the endoanal correction of a complex rectovaginal fistula assisted by video, providing the surgeon with better visualization of the operative field. This technique is particu- larly valuable in cases with a narrow anal canal and high rectovaginal fistulas. Doenças Anorretais Anorectal Diseases ID – 141787 Open Videos HOUSE FLAP ANOPLASTY TECHNIQUE FOR SURGICAL TREATMENT OF IDIOPATHIC ANAL STENOSIS Gabriela Fonseca Lopes 1, Evelyn Moura de Assis 1, Rodrigo Ambar Pinto1, Carlos Frederico Sparan Marques 1, Ulysses Ribeiro Junior 1, Jose Americo Bacchi Hora 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Introduction/Case Presentation A 71-year-old male patient with a history of hypertension and diabetes, with no history of anal trauma or previous surgeries, presented with difficulties during bowel movements for the past 10 years. The patient reported signi ficant straining and narrowing of the stool without any bleeding. Additionally, the patient had a suspicious nodule in the prostate but was unable to undergo a biopsy due to anal canal stenosis. The patient was referred for evaluation by a coloproctologist. On initial proctological examination, there was evidence of anal canal stenosis, identified as a fibrotic ring with resistance to digital exami- nation. Colonoscopy was performed with adequate bowel preparation, revealing only hypertrophic papillae in the anal canal, with no further abnormalities extending to the termi- nal ileum. The patient was treated conservatively with hy- giene measures, dietary modifications, and topical treatment with Diltiazem. However, the patient experienced headaches as a side effect of the ointment and reported no improvement in the evacuation symptoms after 3 months of the instituted measures. A surgical approach was then chosen, and the patient underwent analplasty using the modi fied skin ad- vancement flap technique (House Flap).

Objective

The goal of this video is to demonstrate the skin advancement flap technique, illustrating the step-by- step procedure as a surgical approach to anal stenosis. It includes positioning the patient, surgical technique, and postoperative results.

Conclusion

After the surgery, the patient showed an open anal canal on proctological examination, with no resis- tance during digital examination. The postoperative course was uneventful, and the patient reported improvement in evacuation symptoms, including daily bowel movements without alterations, which allowed him to return to his normal lifestyle. Anal stenosis is a rare condition but can cause significant discomfort during defecation. It is common- ly described as a complication following hemorrhoidectomy, chronic anal fissures, or in flammatory bowel disease. How- ever, in this case, no speci fic cause for the pathology was identified. The House Flap technique demonstrated in this video should be part of the coloproctologist ’s surgical reper- toire, as it is a reproducible and effective approach for managing this condition. Doenças Anorretais Anorectal Diseases ID – 141760 Open Videos KARYDAKIS TECHNIQUE FOR PILONIDAL CYST CORRECTION: ADVANTAGES OF A FLAP WITH AN INCISION OUTSIDE THE MIDLINE Elis Oliveira1, Evellyn Moura Assis 1, Gabriela Fonseca Lopes 1, Carolina Bonizzio 1, Isaac José Felippe Corrêa Neto 1, Ulysses Ribeiro Junior 1, Carlos Frederico Sparapan Marques 1, Rodrigo Ambar Pinto1 1Hospital das Clínicas de São Paulo, São Paulo, Brasil Case Presentation Male, 19 years old. Three years ago, he developed a painful sacral swelling with intermittent episodes of in flammation, treated with oral antibiotics and warm compresses. There were three openings along the midline. An ultrasound of the soft tissues showed a super fi- cial, hypoechoic, and regular cystic image of 3.0 cm in the longest axis. Surgical intervention was indicated, involving resection and closure of the defect using the Karydakis technique. This technique aims to displace the midline suture, without tension, flattening the gluteal fold depression and reducing mechanical stress during the postoperative period. The patient was positioned prone under local anesthesia, with the pilonidal cyst identi fied and demarcated. An exten- sive incision was made to include the main sinus and the two secondary ones, left of the midline. A circumferential J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S129 dissection was performed, reaching the presacral fascia, followed by cyst excision. The subcutaneous deep flap was created up to the contralateral gluteal fold, followed by dissection of the super ficial flap, below the dermis in the same direction and extent. The flap was advanced from right to left, with U-shaped separated sutures using Vicryl 3-0. The wound was moved away from the midline, and a Portovac drain was placed. The dermis was then closed with the same suture material, finishing with nylon 4-0 epidermal sutures, followed by an occlusive and compressive dressing. The patient progressed well, was discharged on the first day, and the drain was removed on the tenth day without wound dehiscence. Follow-up after 3 months showed no signs of recurrence.

Discussion

The pilonidal cyst is an infectious condi- tion that is twice as common in young males. It can be acute, with abscesses, or chronic, with intermittent discharge from sinus tracts. The nests are located in a deeper cavity with hair presence. Treatment is usually surgical in symptomatic cases, but there is no consensus regarding the best technique. The main objectives are to stop the suppuration, resolve the cyst, reduce morbidity, and decrease the risk of recurrence. The wound complication rate is low, around 8%, and recurrence is less than 2%. Moreover, compared to an open wound, this technique has the advantages of lower morbidity, fewer lost workdays, and fewer medical visits for dressing changes; compared to midline primary closure, it results in less recurrence and fewer wound complications.

Conclusion

The Karydakis technique proved to be safe and effective for correcting the pilonidal cyst, promoting primary closure with low local morbidity and allowing for early return to activities. Doenças Anorretais Anorectal Diseases ID – 138229 Open Videos SURGICAL TREATMENT OF COMPLEX PERIANAL FISTULA THROUGH FISTULECTOMY, WITH TOTAL EXTRACTION OF THE FISTULOUS TRACT Laís Yumi Takaoka 1, Luiz Carlos Benjamin Do Carmo1, Sandra Di Felice Boratto1, Renato Barretto Ferreira da Silva 1, Juliana Giangiardi Batista 1, Raíssa Teixeira Rosalino 2, Sérgio Gontscharow2, Thiago Ibiapina Alves 2 1Faculdade de Medicina do ABC, Santo André, Brasil 2Hospital São Luiz Itaim, São Paulo, Brasil Case Presentation A male patient diagnosed with a complex transsphincteric perianal fistula. The decision was made to perform a first-stage surgical correction using the fistulectomy technique, with complete removal of the fistu- lous tract, ensuring the preservation of the sphincter muscle and isolating it with a Seton to allow drainage of the fistulous tract. The subcutaneous tissue in the resected area was approximated to shorten the healing time. A second inter- vention was performed three months after the first to allow for the proliferation of the fibrotic healing process, enabling the safe division of the muscle isolated by the Seton without the risk of incontinence, followed by curettage of the surgical wound for healing by secondary intention. The patient showed good postoperative progress with no complications.

Discussion

Complex perianal fistulas with extensive involvement of the external sphincter muscle are a therapeu- tic challenge due to the increased risks of fecal incontinence and recurrence. The therapeutic strategy should aim for high success rates while maintaining continence. In fistulotomy, the fistulous tract is kept open, whereas in fistulectomy, the entire tract is completely resected to reduce the risk of recurrence from the loss of secondary tracts, in addition to providing a complete histological sample for study.

Conclusion

Fistulectomy is a good surgical option for complex perianal fistulas. To avoid complications, dissections should be performed near the fistulous tract, isolating and preserving the sphincter muscle, and completing the proce- dure in a second stage. This technique demonstrates good

Results

in curing the disease, with low rates of postoperative complications and morbidity. Several techniques are avail- able for complex perianal fistulas, all with the possibility of recurrence and complications, making the surgical treatment of these fistulas a challenge for surgeons. Doenças Anorretais Anorectal Diseases ID – 141777 Open Videos SURGICAL TREATMENT OF OBSTETRIC ANAL SPHINCTER INJURY – CASE SERIES George Lucas Ferreira de Castro 1, Lara Miranda Kaminice 1, Vittória Machado Agresta 2, Monique Arantes Pereira 1, Julinely Gomes Weber Porto 1, Izadora Cruz Andrade 1, Daniela Ferreira Vitalina3, Renato Hugues Atique Cláudio 1 1Universidade Federal de Uberlândia, Uberlândia, Brasil 2Faculdade de Medicina do ABC, Santo André, Brasil 3Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brasil Case Presentation A 29-year-old woman, a first-time mother, had a vaginal delivery assisted by a doctor with the need for an episiotomy, resulting in a fourth-degree perineal tear. A second case involved a 30-year-old woman who had a vaginal delivery and a third-degree tear. Thefirst patient gave birth in 2018 and had a Wexner score of 12 points, while the second patient gave birth in early 2024 with a Wexner score of 13 points.

Discussion

Obstetric anal sphincter injury can result in mild to severe fecal incontinence, with symptoms possibly appearing immediately after childbirth or decades later. The incidence is higher in women who experience more severe perineal tears, grades III or IV, or those who require an episiotomy. Diagnosis is made at the time of delivery and can be con firmed through endoanal ultrasonography, which detects the anatomical defect, and by high-resolution ano- rectal manometry, which assesses functional de ficits of the sphincter complex and identi fies the location of muscular failure through vectorgrams. Surgical treatment yields good functional results, particularly in the short- and medium- term. Studies show that in the long-term, women may experience recurring complaints of fecal incontinence, either mild or severe. In the patients described here, anal sphincter- oplasty with muscle overlap and skin flap transposition to augment or create the perineal body was performed. Despite the time elapsed between the injury and surgery, both patients had good functional outcomes for their anal sphinc - ter apparatus.

Conclusion

Surgical treatment is required for obstet- ric anal sphincter injury, and despite the various techniques J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS130 available, muscle overlap is superior to others. This technique can be performed even when surgery is delayed. Doenças Anorretais Anorectal Diseases ID – 138211 Open Videos SURGICAL TREATMENT FOR ANAL STENOSIS AFTER HEMORRHOIDECTOMY Gabriela Jacques1, Daniele Rezende Ximenez 1, Ana Carolina Medeiros1, Giovanna Gomes Waldrigues 1, Maria Cristina Sartor1, Antonio Sérgio Brenner1, Guilherme Henrique Perine1, Marssoni Deconto Rossoni 1 1Complexo do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brasil Case Presentation A 60-year-old patient who under- went hemorrhoidectomy 2 years ago presented with pro- gressive dif ficulty in evacuating, experiencing pain and a sensation of anorectal obstruction during bowel movements. Over this period, the symptoms persisted despite continuous use of laxatives, with recurrent fecalomas and episodes of abdominal distension and pain, necessitating emergency visits. On physical examination, a scar was noted in the perineal area, with anal stenosis that could only be passed with a small finger, and fibrosis in the anterior midline. The patient was submitted to surgery for anoplasty with a dia- mond-shaped flap, under anesthesia via spinal block. The procedure was filmed to demonstrate the steps of the surgical technique. The surgery began with marking the diamond- shaped flap, measuring approximately 3 cm at its largest axis in the perineal body. The fibrotic area in the anterior anal canal was resected, followed by mobilization of the flap to cover the defect area without tension while preserving its vascularization. After suturing the flap, the increased diame- ter of the anal canal was con firmed. The patient was dis- charged the day after surgery. She had a good immediate and long-term recovery, with daily bowel movements without strain or anorectal discomfort.

Discussion

Anal stenosis is a rare complication of anorectal surgeries, most commonly occurring after hemor- rhoidectomies. Treatment ranges from conservative meas- ures to surgical correction in more severe cases. In the reported case, anoplasty with a diamond-shaped flap was chosen, as demonstrated in the video. However, several other techniques have been described with different healing rates, and there is no consensus on the best technique due to the lack of comparative prospective studies.

Conclusion

Surgical treatment for anal stenosis is effective in cases refractory to conservative treatment. The procedure was completed without complications and filmed to showcase the steps of the surgical technique discussed in the video. Doenças Anorretais Anorectal Diseases ID – 141793 Open Videos SURGICAL TREATMENT FOR PERIANAL FISTULA: DEMONSTRATION OF THE LIFT TECHNIQUE Gabriela Fonseca Lopes 1, Jose Americo Bacchi Hora 1, Elis Oliveira1, Fernando D ’almeida Perazzo1, Carlos Frederico Sparan Marques 1, Ulysses Ribeiro Junior 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Introduction/Case Presentation A 61-year-old fe- male, previously healthy, presented with a perianal abscess of cryptoglandular origin 9 years ago, which was surgically drained in an urgent setting. She was subsequently referred to a proctologist due to complaints of intermittent discharge of fecaloid material from the perianal region. During follow-up, a proctological examination identified an external opening of a perianal fistula located antero-laterally to the left, 1.5 cm from the anal margin, with fecaloid discharge and no signs of inflammation or infection. The patient had no complaints of anal incontinence, and the fistula diagnosis was confirmed by pelvic MRI, classified as PARKS I and Grade I according to the St James radiological classification. During the intraoperative examination under anesthesia, the fistula was reclassified as PARKS II, leading to the decision to perform surgical manage- ment of the perianal fistula using the LIFT (Ligation of Intersphincteric Fistula Tract) technique.

Objective

The objective of the video is to demonstrate the LIFT technique (ligation of the intersphincteric fistula tract), illustrating the step-by-step process of the method, from patient positioning and surgical strategy to postopera- tive results. Final Comments/Conclusion The patient was dis- charged on thefirst postoperative day and continues to follow up without signs of changes in anal continence or recurrence of the fistula. The LIFT technique demonstrated in the video was initially described by Rojanasakul in 2007 and is prefer- ably indicated for transsphincteric and rectilinear inter- sphincteric fistulas. Currently, it should be part of the armamentarium of techniques for the surgical management of anorectal fistulas for colorectal surgeons. Doenças Anorretais Anorectal Diseases ID – Open Videos LATE SURGICAL TREATMENT FOR CLOACA DUE TO OBSTETRIC TRAUMA Gabriela Jacques1, Daniele Rezende Ximenez1, Giovanna Gomes Waldrigues1, Ana Carolina Medeiros 1, Maria Cristina Sartor 1, Antonio Sérgio Brenner 1, Guilherme Henrique Perine 1, Guilherme Mattioli Nicollelli 1 1Complexo do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brasil Case Presentation A 63-year-old female presented with complete fecal incontinence for over 35 years. She had two vaginal deliveries in her second decade of life, with obstetric trauma during the second birth, which remained untreated since then. The patient sought medical help late due to recurrent urinary infections, which led to the diagnosis of a perineal lesion described as“cloaca,” and she was referred to the Coloproctology clinic. On physical examination, there was a complete rupture of the perineal body and anterior mucosal rectal prolapse. The ends of the anal sphincter J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S131 muscles were easily palpable in the anterior quadrants of the anus, close to the coronal line. The patient underwent peri- neal reconstruction surgery under spinal anesthesia. The rectovaginal septum was dissected, and the fascia of the puborectal muscles was approximated, with reinforcement from the existing fibrosis. The transverse perineal muscle was also identi fied and reconstructed. An anterior midline anal sphincteroplasty was performed using the overlapping tech- nique. The anterior mucosal prolapse was also corrected via endo-anal suturing. The procedure was conducted after an anterograde colon preparation for better postoperative com- fort. The patient was discharged the day after surgery. She had a good immediate and long-term recovery, with im- proved fecal continence and no longer needing daily pads.

Discussion

The most common cause of traumatic fecal incontinence is obstetric injury. Early diagnosis and treatment provide better chances of preventing long-term fecal incontinence. Some cases, especially those not addressed early, develop severe anatomical defects, such as traumatic cloaca, negatively affecting quality of life and health outcomes. In this case, the patient had lived with cloaca for decades, but after surgical correction with a specialized team, there was signi ficant improvement in fecal incontinence.

Conclusion

Surgical treatment of fecal incontinence following severe obstetric injury, whether early or late, provides excellent functional and anatomical results, posi- tively impacting the quality of life of these patients and their families. Doenças Anorretais Anorectal Diseases ID – 141803 Open Videos TREATMENT OF IRREDUCIBLE RECTAL PROLAPSE BY PERINEAL RECTOSIGMOIDECTOMY: TECHNICAL DETAILS EVERY SPECIALIST SHOULD KNOW Gabriela Fonseca Lopes1, Carlos Walter Sobrado 1, Lucas Faraco Sobrado1, Jose Americo Bacchi Hora1, Afonso Henrique da Silva e Souza Junior1, Rodrigo Ambar Pinto1, Carlos Frederico Sparan Marques1, Ulysses Ribeiro Junior 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Introduction/Case Presentation A 77-year-old fe- male patient, hypertensive, diabetic, and cardiopathic, has been experiencing pain, constipation, anal incontinence, and difficulty mobilizing due to rectal prolapse for the past 2 years. Upon proctological examination, the patient presented with irreducible rectal prolapse approximately 10 cm in length, associated with fungal perianal dermatitis. Colonos- copy revealed multiple diverticula in the sigmoid colon, with no other lesions. Due to the patient ’s clinical context, classi- fied as frail elderly with signi ficant comorbidities, a decision was made to address the rectal prolapse with perineal rectosigmoidectomy.

Objective

The objective of the video is to discuss the technical details of perineal rectosigmoidectomy, illustrating the step-by-step method, from patient positioning to surgical technique and postoperative results.

Conclusion

The patient had a good postoperative evolution, with intestinal transit present on the second postoperative day. Currently, she is under outpatient fol- low-up, with bowel movements every two days and no signs of recurrence of the pathology. Perineal rectosigmoidectomy is a less invasive procedure compared to the abdominal approach. It is primarily indicated for elderly patients with comorbidities who have contraindications for abdominal access, as it can be performed under neuro-axial anesthesia (spinal or epidural anesthesia). As a disadvantage, it involves the resection of the rectal reservoir and has a higher recur- rence rate compared to abdominal techniques, but it should be part of the surgical repertoire of the coloproctologist. Doenças Anorretais Anorectal Diseases ID – 141683 Open Videos VIDEO: CORRECTION OF RECTOCELE USING A CIRCULAR STAPLER UNDER THE TREMS TECHNIQUE Camila Gomes 1, Fernando Lopes Vieira 1, Walysson Alves Tocantins de Sousa 1, Rafael Ferreira Correia Lima 1, Miguel Augusto Arcoverde Nogueira 1, Fabiana Brito Campelo Barros 1, Valéria Maria Caland Morais 1, Myrna Maria Martins Ribeiro 1 1Universidade Estadual do Piauí, Piauí, Brasil Case Presentation A 57-year-old female patient pre- sented to the outpatient clinic with complaints of chronic constipation, associated with symptoms of obstructed evac - uation, including the need for manual assistance through the vaginal wall, and alternating periods of constipation and diarrhea. Upon proctological examination, an anterior rec - tocele was detected. The patient underwent preoperative assessments and returned with the following exam results: defecography showing a grade 3 rectocele; anorectal manom- etry suggesting voluntary muscle dyssynergy. Surgical cor- rection of the rectocele was indicated using the TRREMS technique.

Discussion

Once surgery was indicated, the patient underwent rectocele correction using a circular stapler under the TRREMS technique. The procedure was performed with- out complications. The patient was discharged on the second postoperative day. She returned for a follow-up appointment 15 days after surgery, without complaints and with improved symptoms compared to before the procedure.

Conclusion

The chosen treatment led to a positive outcome for the patient ’s case. DST e Doenças infecto parasitárias STIs and Infectious Parasitic Diseases ID – 138281 Open Videos SURGICAL TREATMENT OF COMPLETE ANAL STENOSIS DUE TO MONKEYPOX INFECTION Lina Meneses Chaves 1, Paula Buozzi Tarabay 1, Gustavo Sevá Pereira1, Gabriela Domingues Andrade Ribeiro 1, Geraldo Ferreira Coutinho Junior1, Adriana Borgonovi Christiano Vieira1, Fábio Henrique Mendonça Chaim1, Joaquim José Oliveira Filho1 1Hospital Municipal Dr. Mario Gatti, Campinas, Brasil J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS132 Case Presentation A 24-year-old male patient, HIV- positive, presented with a case of Monkeypox infection manifesting perianally, initially as a painful anal ulcer. The lesion progressed, leading to anal stenosis and severe proc - talgia, necessitating hospitalization for pain management. The patient underwent transverse loop colostomy and started speci fic therapy with Tecovirimat after a positive PCR result for the Monkeypox virus from a lesion biopsy. Following medical treatment and lesion healing, the patient developed complete anal stenosis. Initial treatment involved topical application of betamethasone and hyaluronidase for three weeks without improvement. Subsequently, surgical intervention was performed. The anal opening was created using puncture with intraoperative colonoscopy guidance (via the colostomy). After opening the anal ori fice, a guide- wire was passed, and anal dilation was performed with Savary dilators. During the same surgical procedure, intesti- nal transit was reconstructed by closing the loop colostomy. In the postoperative period, the patient showed good clinical progress and was discharged on the eighth day with an anal dilator for home use and topical diltiazem 2% ointment for anal muscle relaxation. Weekly sessions of anal dilation using Hegar dilators were performed until the sixth postoperative week, followed by biweekly sessions and three local applica- tions of triamcinolone. The patient remains under outpatient follow-up without complaints of fecal incontinence.

Discussion

Perianal manifestations of Monkeypox infection, such as vesicles, pustules, and ulcers, can cause proctalgia that is often refractory to simple analgesia. To our knowledge, there are no reports in the literature of perianal manifestations of Monkeypox infection resulting in complete anal stenosis. Surgical treatment of complete anal stenosis is challenging due to the risk of sphincter injury and fecal incontinence.

Conclusion

Anal stenosis is a potential complication of Monkeypox infection with perianal manifestations, and its treatment may involve ostomy procedures. Surgical correc - tion of complete anal stenosis carries signi ficant risks, with fecal incontinence being the most feared due to its consider- able impact on patients’ quality of life. Adequate treatment of complete anal stenosis is highly complex, requiring a team of specialists and long-term follow-up. Fisiologia Anorretocólica Anorectal Physiology ID – 141711 Open Videos ASSOCIATION OF VENTRAL RECTOPEXY WITH MESH AND LAPAROSCOPIC SIGMOIDECTOMY: AN APPROACH OPTION FOR OBSTRUCTED DEFECATION SYNDROME IN RECTOCELE ASSOCIATED WITH SIGMOIDOCELE Rodrigo Ambar Pinto 1, Isaac José Felippe Corrêa Neto 1, Thaís Villela Peterson1, Diego Fernandes Maia Soares 1, Mariane Gouvea Monteiro de Camargo 1, Ulysses Ribeiro Junior 1, Carlos Frederico Sparapan Marques 1, Gabriela Fonseca Lopes 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Case Presentation A 72-year-old woman presented with a 5-year history of obstructed defecation syndrome. Initially diagnosed with rectocele, she was managed with laxatives, which provided good results at first. However, in the past six months, her symptoms worsened signi ficantly, including severe dif ficulty passing stools, a sensation of blockage, and rectal heaviness despite the use of stimulant laxatives. Defecography revealed an enlarged rectocele mea- suring 5.5 cm and a sigmoidocele compressing the distal rectum. A laparoscopic abdominal surgery was planned, combining sigmoidectomy with ventral rectopexy due to the presence of sigmoidocele. The surgical procedure was performed using a 12 mm trocar in the right iliac fossa and 5 mm ports in the other quadrants. A reverse-J incision was made on the peritoneum from the promontory to the right of the rectum, reaching the peritoneal re flection and exposing the ligament of the sacrum. Dissection proceeded into the rectovaginal septum, separating the anterior rectal wall from the posterior vaginal wall down to the levator ani muscles. A coated composite mesh (Proceed®, 15x5 cm) was fixed to the anterior rectal wall with separate non-absorbable sutures (Ethibond 2-0®) at distal, mid, and proximal levels below the peritoneal reflection and to the vaginal apex. Approximately five Securestrap® staples secured the cranial portion of the mesh to the promontory. Sigmoid resection was performed along its wall, with lateral gutter mobilization to prevent devascularization and minimize tissue damage. A double- stapled colorectal end-to-end anastomosis was performed. The peritoneum was closed using a continuous V-Loc® suture to cover the mesh. The patient had an excellent postoperative course, with bowel movements resuming on the second day and discharge on the third day. At the 4-month follow-up, the patient was no longer using laxatives, evacuating daily with only dietary adjustments.

Discussion

Ventral rectopexy was initially developed for rectal prolapse with the aim of reducing postoperative constipation (from 54% to 15%). Over the past 15 years, it has also been used for obstructed defecation syndrome caused by rectocele and intussusception, yielding good results. Sigmoi- docele, though less commonly associated with other anatom- ical abnormalities, presents a challenging decision-making scenario. The technique modi fication in this case, combining sigmoidectomy with ventral rectopexy, may be a viable option to improve intestinal constipation in these patients.

Conclusion

The combination of sigmoidectomy with ventral rectopexy using mesh may be an attractive surgical option for treating obstructed defecation syndrome associat- ed with sigmoidocele. Fisiologia Anorretocólica Anorectal Physiology ID – 141714 Open Videos LAPAROSCOPIC VENTRAL RECTOPEXY (D ’HOORE) FOR THE TREATMENT OF ACUTE RECTAL PROLAPSE POST- ABDOMINOPLASTY: A DEFINITIVE SOLUTION FOR AN UNEXPECTED PROBLEM Rodrigo Ambar Pinto 1, Gabriela Fonseca Lopes 1, Mariane Gouvea Monteiro de Camargo 1, Nathália Carmin Calixto Sarroche da Silva1, Isaac José Felippe Corrêa Neto1, Thaís Villela Peterson1, Diego Fernandes Maia Soares 1, Carlos Frederico Sparapan Marques 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Case Presentation A 56-year-old woman underwent abdominoplasty. In the postoperative period, she experi- enced difficulty evacuating, and after 10 days, she presented J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S133 with acute externalization of all layers of the rectal wall (rectal prolapse) measuring approximately 7 cm, which brought her to the emergency department. Manual reduction was performed, and she was admitted for clinical observa- tion. During her next bowel movement in the hospital, she experienced another painful externalization, again requiring assisted manual reduction. A decision was made to perform laparoscopic ventral rectopexy with mesh. The most notable feature of this procedure was the signi ficant reduction of the abdominal cavity caused by the prior abdominoplasty. A 12- mm trocar was inserted in the right iliac fossa, and three 5- mm ports were placed in the other quadrants. The peritone- um was incised at the anterior-lateral right peritoneal re flec - tion in an inverted J shape. Dissection exposed the promontory and isolated the anterior ligament of the spine. The procedure continued through the rectovaginal septum, separating the anterior rectal wall from the posterior vaginal wall down to the pelvic floor (levator ani muscles). A covered polypropylene mesh (Proceed® 15 /C2 5 cm) was fixed to the anterior rectal wall with separate non-absorbable sutures (Ethibond 2-0®) at distal, middle, and proximal levels below the peritoneal reflection. The cranial portion of the mesh was secured to the anterior spinal ligament with Securestrap® staples. Additionally, the vaginal vault was pexed to the mesh. The patient had an excellent postoperative course, achieving normal bowel function from the second day onward without further externalization. She was discharged on the fourth postoperative day. Six months after the surgery, the patient has had no complaints of intestinal issues or prolapse recurrence.

Discussion

Ventral rectopexy is currently widely accepted and utilized for managing rectal prolapse, becoming the most common abdominal procedure due to its excellent long-term outcomes, with a low recurrence rate of 8% over a 10-year follow-up. Functional outcomes are also favorable, with an 80% improvement in fecal incontinence and a reduc - tion in constipation rates from 54% to 15%. Its use for acute rectal prolapse with incarceration has not been speci fically described in the literature, making this case an innovative approach in this context.

Conclusion

The D’Hoore technique proved to be a safe and definitive treatment for acute rectal prolapse caused by increased abdominal pressure following abdominoplasty. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 141738 Open Videos TECHNICAL ASPECTS OF MINIMALLY INVASIVE SURGERY FOR THE TREATMENT OF ENDOMETRIOSIS INVOLVING THE RECTUM Rodrigo Gomes da Silva1, Magda Maria Profeta da Luz 1, Renato Gomes Campanati 1, Luiza Rogerio 1, Bernardo Hanan 1, Cleo Gonçalves Trindade Ribeiro 1, Giovane Botelho Bacelar 1, Kelly Cristine Lacerda Rodrigues Buzatti 1 1Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil

Introduction

Endometriosis is a chronic disease de- fined as the presence of endometrial tissue outside the uterus. Involvement of the colon and rectum can occur in up to 10% of women, primarily in the rectosigmoid region. In cases where clinical treatment is refractory, surgical treat- ment may be indicated and can involve resection of the affected organs to achieve adequate disease control.

Objectives

To surgically describe a minimally invasive approach to endometriosis with massive invasion of the rectum, where a totally laparoscopic colorectal anastomosis was performed.

Methods

A 37-year-old patient presented with com- plaints of colicky abdominal pain worsening during menstru- ation, as well as stool thinning, tenesmus, and constipation. Digital rectal examination revealed a hardened lesion in the rectum, and MRI showed endometriotic foci in the uterosac - ral ligament and rectum, along with significant adenomyosis. With a de fined parity, surgery was opted for, involving hysterectomy combined with rectosigmoidectomy to control the symptoms.

Results

A standard laparoscopic rectosigmoidectomy combined with hysterectomy was performed, with vaginal extraction of the surgical specimen. A circular stapler head was introduced via the vaginal route, and a totally laparosco- pic colorectal anastomosis was successfully completed. The patient experienced excellent outcomes, with complete res- olution of her symptoms.

Conclusion

A totally laparoscopic approach with vaginal specimen extraction in cases of benign disease can be successfully performed, offering the bene fit of avoiding abdominal incisions. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 138605 Open Videos COLORECTAL ANASTOMOSIS DEHISCENCE. MINIMALLY INVASIVE TREATMENT Luiz Carlos Benjamin Do Carmo 1, Luiz Guilherme Lisboa Gomes2, Sergio Gontscharow 1, Thiago Ibiapina Alves 1, Raíssa Texeira Rosalino1, Debora Fontes Santos 1, Renato Barretto Ferreira da Silva 2 1Hospital São Luiz, Itaim, São Paulo, Brasil 2Hospital e Maternidade Santa Joana, São Paulo, Brasil

Introduction

Colorectal anastomosis dehiscence has decreased in recent decades with the introduction of new sutures and staplers, along with minimally invasive surgery and methods to assess anastomotic perfusion, such as fluo- rescence with Indocyanine Green, as well as devices and

Materials

to reinforce the anastomosis. In benign diseases, unlike malignancies, the incidence of anastomotic dehiscence is low. However, when it occurs, it is a serious complication that increases hospital stays, reoperations, and infections.

Objective

To demonstrate the use of minimally inva- sive procedures in patients who underwent colorectal anas- tomosis via laparoscopic or robotic surgery and experienced anastomotic dehiscence in benign diseases, such as acute diverticulitis and intestinal endometriosis.

Methods

In a cohort of 1,170 patients who underwent laparoscopic and robotic surgeries for benign intestinal dis- eases from August 2016 to March 2024, our incidence of anastomotic fistula was 0.85%, compared to 0.92% to 1.98% reported in the literature. We will demonstrate through videos our approach using minimally invasive techniques to avoid laparotomies. Procedures included laparoscopic drainage puncture, lavage and drainage, resection with new anastomosis, colostomies, ileostomies, and endoscopic J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS134 vacuum therapy, all accompanied by nutritional support via parenteral feeding.

Discussion

The most commonly used approach for low-output anastomotic fistulas without signi ficant general health implications is conservative treatment. However, in cases where this treatment fails or in the presence of perito- nitis, wide laparotomies and diverting stomas are performed, increasing complications, hospital stays, infections, dehis- cences, and hernias at the surgical incision site, as well as thromboembolic complications due to delayed early mobilization.

Conclusion

It is important to individualize each case and apply minimally invasive approaches. Not all cases require reoperation, and not every reoperated case needs resection or a terminal stoma. Newer, minimally invasive treatments, such as endoscopic vacuum therapy, should always be considered. Our patients experienced less postop- erative pain, fewer complications, a lower rate of surgical readmissions, and a faster return to their activities. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 138362 Open Videos RECTAL ENDOMETRIOSIS: PARTICULARITIES OF SHAVING RESECTION VIA LAPAROSCOPY AND ROBOTICS Rodrigo Ambar Pinto1, Ruy de Oliveria Machado Junior1, Priscila Matsuoka Locali1, Thaís Villela Peterson 1, Ulysses Ribeiro Junior1, Carlos Frederico Sparapan Marques 1, Gabriela Fonseca Lopes1, Isaac José Felippe Corrêa Neto 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Case Presentation These are two cases of deep rectal endometriosis. Both patients have similar clinical histories, experiencing cyclical abdominal pain during menstruation and discomfort with bowel movements. The first, a 28-year- old woman with uterine fibroids and a desire for reproduc - tion, and the second, a 40-year-old woman with completed family, whose symptoms began after childbirth. The first case was approached laparoscopically, and the lesion was adhered to the uterine torus. After myomectomy, the approach was initially to release the lesion from the rectovaginal septum by dissecting the lateral regions, addressing the Okabayashi space to avoid injury to adjacent structures. Subsequently, the rectal lesion was dissected initially at its edges, isolating it from the mesorectum. Dissection was continued along the rectal muscle layer using low-voltage electrocautery (15), in pure cut mode, with a hook. After the resection of the lesion, rectal integrity was con firmed, and no residual lesions were noted. The blow test was performed, and the serosa was closed with transverse sutures. In the second case, the robotic approach was chosen. After subtotal hysterectomy, the rectal lesions were not directly connected to the rectovaginal septum. Circumferential isolation of the lesions was per- formed with a robotic scissors in low voltage, in cut mode. The lesions were then detached from the rectal muscle and sutured transversely. The blow test was negative. The main advantage of the robotic approach was the stability of the optics, providing better visibility and precision in movements.

Discussion

Deep endometriosis is characterized by the involvement of the peritoneal surface at a depth greater than 4 mm. Rectal involvement occurs in about 10% of cases of endometriosis and requires the approach of a colorectal specialist. The rectum is an essential organ for continence and intestinal function, and whenever possible, it should be preserved. Tangential resection (shaving) of the rectal wall is an ideal option when attempting to preserve the rectum in endometriosis surgeries. About 10 years ago, robotic surgery was introduced to optimize the precision and success of these procedures. However, to date, the results of both techniques are comparable.

Conclusion

The key importance of this video is to detail the shaving resection technique, regardless of the approach used, in order to spread the technique and encour- age more surgeons to consider rectal function preservation in cases of identi fiable endometriosis. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 138366 Open Videos SIGMOID ENDOMETRIOSIS: WHEN SEGMENTAL RESECTION IN LARGE LESIONS WITH LATERAL-LATERAL ANASTOMOSIS ASSISTED BY ROBOT CAN BE A GOOD OPTION Rodrigo Ambar Pinto1, Gabriela Fonseca Lopes1, Flávio Massato Kawamoto1, Isaac José Felippe Corrêa Neto 1, Priscila Matsuoka Locali1, Rafael Fagionato Locali1, Ulysses Ribeiro Junuir 1, Carlos Frederico Sparapan Marques 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil Case Presentation A 39-year-old woman presented with colicky pain around her menstrual period, in addition to infraumbilical abdominal pain associated with an increased frequency of bowel movements from 1 to 3 times a day and dyspareunia. The patient desired to have children. Trans- vaginal ultrasound with preparation revealed, in addition to ovarian and deep pelvic peritoneal involvement, a lesion in the sigmoid colon that was not contiguous with the previous lesions. A robotic approach was chosen, and resection of peritoneal endometriosis foci, ureterolysis, and resection of the uterosacral ligaments were performed. The evaluation of the lesion above the rectosigmoid transition showed that it was larger than 4 cm and invaded the muscular layer, so a segmental resection of the sigmoid of approximately 7 cm was performed. The dissection of the mesocolon with the robotic arms was done near the loop without ligating more proximal vessels, without compromising irrigation. A me- chanical isoperistaltic lateral-lateral anastomosis was then performed using a linear stapler. Highlights included the optical stability, providing better vision, and the increased precision of movements. The patient had an excellent post- operative recovery, with bowel movement on the first day and discharge on the second. Intestinal function returned to normal shortly after the surgery.

Discussion

The intestine is a common site of involve- ment in deep endometriosis, which causes significant anxiety for patients and gynecologists due to uncertainties about management, function, and especially the need for a stoma. About 10% of patients with endometriosis have intestinal involvement, with the sigmoid colon being the second most affected segment, involved in 25% of cases, second only to the rectum (80%). Because the sigmoid wall is narrower and the stool consistency is solid in this segment, more extensive J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S135 tangential resection is generally avoided. Furthermore, par- tial sigmoid resection does not compromise function. This case demonstrates an economical segmental resection tai- lored to the extent of the intestinal lesion and highlights the precision of robotic surgery, encouraging greater diffusion of this technique for addressing a challenging, multidisciplinary disease that can greatly bene fit young patients. The robotic approach is still rarely practiced in Brazil for such a complex disease and should be more widely promoted.

Conclusion

This video demonstrated the importance of robotic -adjusted segmental sigmoid resection with lateral- lateral anastomosis. The technique proved to be safe and teachable, making it a valuable tool for spreading knowledge. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 134895 Open Videos THE COLON DOESN ’T REACH THE PELVIS, NOW WHAT? RETROILEAL TUNNEL AND DELOYERS ’ MANEUVER Lucas Faraco Sobrado 1, Carolina Reis Bonizzio 1, Jorge Landivar Coutinho1, Diego Fernandes Maia Soares 1, Antonio Rocco Imperiale1, Carlos Walter Sobrado 1, Carlos Frederico Sparapan Marques1, Ulysses Ribeiro Junior 1 1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil The reconstruction of intestinal transit after left-sided colectomies and rectosigmoidectomies for the treatment of colorectal cancer involves the mobilization of the splenic flexure and ligation of the inferior mesenteric vein, allowing the colon to descend for a colorectal anastomosis. However, in cases of extensive left-sided colon resections, such as in synchronous tumors or ischemia of the colon after ligation of the inferior mesenteric artery, the remaining colon may not reach the pelvis due to tension on the middle colic vessels, preventing the anastomosis. In this video, we demonstrate two important techniques for colon descent when the usual maneuvers to mobilize the splenic flexure are insufficient. In the first case, a patient with two locally advanced synchro- nous tumors located in the proximal rectum and the descend- ing-sigmoid transition underwent a rectosigmoidectomy with total mesorectal excision and partial left colon resection. Since the remaining colon did not reach the pelvis after complete mobilization of the splenic flexure, the creation of a retroileal tunnel was necessary for the transmesenteric lowering of the colon and the formation of a tension-free anastomosis. In the second case, a young patient with locally advanced distal rectal adenocarcinoma underwent neoadju- vant chemoradiotherapy but developed an inoperable steno- sis of the rectum and a subocclusive condition. A rectosigmoidectomy with intersphincteric resection, manual coloanal anastomosis, and intraoperative colon preparation was indicated. After ligation of the inferior mesenteric artery, it was noted that the left colon was ischemic, a finding confirmed with intraoperative laser angiography (SPY Plat- form). Therefore, a counterclockwise rotation of the right colon (DeLoyers ’ maneuver) was performed to lower the colon into the pelvis and perform an ascending-anal manual anastomosis, which was completed without complications. The aim of this video is to demonstrate the step-by-step process of two important techniques that should be part of the colorectal surgeon’s arsenal, allowing for intestinal transit reconstruction in complex situations when the remaining colon does not reach the pelvis. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 141121 Open Videos SEGMENTAL RESECTION OF THE SIGMOID RECTUM WITH SURGICAL SPECIMEN EXTRACTION VIA VAGINAL ROUTE (NOSES) COMBINED WITH PAN-HYSTERECTOMY. STEP-BY- STEP LAPAROSCOPIC TECHNIQUE Daniela França Camargo Freitas 1, José Vitor Cabral Zanardi 1, Fernando Passador Valério 1, Marley Ribeiro Feitosa 1, Cristiane de Souza Donega 1, José Joaquim Ribeiro da Rocha 1, Omar Féres1, Rogerio Sera fim Parra1 1Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil This work aims to demonstrate the step-by-step surgical treatment of deep endometriosis involving the rec - to-sigmoid via video laparoscopy, with surgical specimen extraction through a natural ori fice, utilizing the vaginal opening during hysterectomy. It concerns a 53-year-old patient who complained of changes in bowel habits, thinning of stools, and no hematochezia for about 2 years. She had an incomplete colonoscopy performed at another facility, whose report showed a fixed angulation and possible obstruction approximately 15-20 cm from the anal margin. She has one daughter, vaginal delivery 20 years ago, and is widowed. A transvaginal ultrasound with bowel preparation was requested, which found: a right retrouterine ovary, adhered to the right uterosacral ligament, with a 15.5 cm³ endome- trioma. Deep endometriosis lesions in both uterosacral liga- ments. The vagina appeared normal. Three lesions in the recto-sigmoid, the most distal about 9 cm from the anal margin, the second 12 cm from the anal margin, and the most proximal located about 18 cm from the anal margin, occupy- ing about 50% of the sigmoid circumference, with a size of 4.5 cm. Given these findings, surgery was proposed, and the procedure performed was laparoscopic pan-hysterectomy with treatment of the endometriosis lesions and segmental resection of the rectum and sigmoid, encompassing the 3 lesions, removing the surgical specimen via the vagina (NOSES). The illustrative video shows the step-by-step of the surgery for deep endometriosis with intestinal involve- ment, when there are multiple intestinal lesions and sigmoid obstruction. The video will show the cavity inventory, pro- tection of nerves and ureters, release of the rectum and sigmoid, pan-hysterectomy, removal of the vaginal specimen, sectioning of the rectum with a laparoscopic linear stapler with a single load, preservation of the mesorectum, removal of the bowel via the vagina, creation of the purse-string suture, passage of the circular stapler ’s anvil, new pneumo- peritoneum, creation of the anastomosis with double sta- pling, integrity test of the anastomosis, and vaginal closure by laparoscopy. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS136 Temas gerais dentro da especialidade General Topics Within the Specialty ID – 138356 Open Videos TREATMENT OF DIGESTIVE BLEEDING BY VIDEOLAPAROSCOPY DUE TO ULCER IN MECKEL ’S DIVERTICULUM - CASE REPORT Fernando Forghieri Silveira 1, Camila Nardi 1, Naualy Cunha Alencar1, Luana Segantine 1, Danilo Toshio Kanno 1, Rayama Moreira Siqueira 1, Paula Cristina Steffens Novelli 1, Carlos Augusto Real Martinez 1 1hospitalUniversitário Sao Francisco na Providência de Deus, Bragança Paulista, Brasil A 18-year-old boy with a recent history of NSAID use (for 3 days one week ago) was admitted to the hospital with suspected upper gastrointestinal bleeding, presenting with melena, large-volume enterorrhagia, deterioration of general condition, pallor, and sweating, along with hemodynamic instability, and was transferred to the ICU. After receiving 3 units of packed red blood cells and clinical management to improve shock, an endoscopy (normal), preparation, and colonoscopy (normal) were performed. The patient was then submitted to computed tomography angiography, which identi fied a Meckel ’s diverticulum loop in the cecal area of the right iliac fossa with active bleeding inside the diverticulum. Laparoscopy was performed. In the intra- operative period, after identifying the Meckel’s diverticulum, the wall of the small bowel loop was opened, and the optical device was passed through the opening to perform entero- scopy. An ulcer inside the Meckel ’s diverticulum with active bleeding was identi fied. A segmental enterectomy with lateral enteroanastomosis was performed. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 138224 Open Videos ENDOSCOPIC TREATMENT OF COLORECTAL ANASTOMOSIS FISTULA Laís Yumi Takaoka1, Luiz Carlos Benjamin Do Carmo1, Sandra Di Felice Boratto1, Renato Barretto Ferreira da Silva 1, Raíssa Teixeira Rosalino2, Sérgio Gontscharow 2, Thiago Ibiapina Alves2, Juliana Giangiardi Batista 1 1Faculdade de Medicina do ABC, Santo André, Brasil 2Hospital São Luiz Itaim, São Paulo, Brasil Case Presentation A 38-year-old obese female pa- tient developed a colorectal anastomosis fistula on the 7th postoperative day following laparoscopic retossigmoidec - tomy for complicated acute diverticulitis (Hinchey III). The patient was treated with endoscopic vacuum-assisted closure through colonoscopy, resulting in complete closure of the fistula within two weeks. We will demonstrate, through video, how this procedure was performed.

Discussion

Endoscopic vacuum therapy has become a well-established therapeutic option in the treatment of gas- trointestinal fistulas, and it has shown promising results for colorectal anastomotic fistulas. It is a less invasive method for correcting anastomotic fistulas, effective in stable patients without generalized peritonitis. This technique promotes healing by stimulating granulation tissue formation, reducing edema and bacterial proliferation, and enhancing local vas- cularization. The treatment involves inserting an endoscopic sponge at the site of the lesion, connecting it to a vacuum system, typically for 7 to 14 days, with success rates of up to 92% in studies.

Conclusion

Endoscopic therapy is an excellent option for clinically stable patients with colorectal anastomotic fistulas, presenting high success rates and low complication rates. While it is not yet widely available in the Brazilian healthcare system, we believe that, once fully established, it will lead to a reduction in morbidity, avoiding further surgical interventions, and consequently reducing hospital costs. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 138321 Open Videos Use of the NOSE Technique for Minimally Invasive Laparoscopic Surgery and Robotic-Assisted Surgery in Deep Endometriosis Raphaella Assis Alves Januário 1, Marina Ströher 1, Juliana Giangiardi Batista1, Sandra Di Felice Boratto1, Eduardo Vidal de Holanda1, Maria Luiza Marinho Vidigal 1, Luiz Carolos Benjamin Do Carmo 1, Renato Barreto Ferreira da Silva 1 1Centro Universitário Faculdade de Medicina do ABC, Santo André, Brasil

Introduction

Laparoscopic surgery for colon diseases has seen increased use by surgeons due to its many advan- tages, such as reduced morbidity, less pain, and earlier ambulation compared to open surgery. Current techniques require an abdominal incision for specimen removal, which increases pain and complication rates, such as infection, hernia formation, and less favorable cosmetic outcomes. Thus, there is a trend toward performing intracorporeal anastomosis, and the technique called NOSE (Natural Ori fice Specimen Extraction) has become more widespread either by opportunity or by choice. Current studies show bene fits for patients who undergo this procedure, including improved postoperative pain, faster recovery, reduced nerve injury and surgical site infection, and fewer incisional hernias, leading to better cosmetic outcomes. This technique has a short learning curve, both in laparoscopy and robotic surgery.

Objective

To demonstrate that transvaginal specimen extraction is a viable and safe approach in colorectal resection for deep endometriosis.

Method

Video of surgery using the NOSE technique and retrospective analysis of hospitalization time, surgery duration, and incidence of fistulas in segmental rectosigmoidectomy.

Result

A multidisciplinary surgical team from a large hospital in São Paulo performed a total of 1,216 surgeries, with 944 performed via robotic surgery and 272 via laparos- copy. There were no cases of conversion to laparotomy. The NOSE technique was used in 102 surgeries for specimen extraction. There was no increase in hospitalization time when comparing this technique to conventional surgery, and no increase in the incidence of rectovaginal fistulas. J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s).

Abstract

S137

Conclusion

The NOSE technique is an interesting approach for patients undergoing rectosigmoidectomy for endometriosis. The complication rate appears comparable to the conventional surgical approach (minilaparotomy) and has shown to improve postoperative pain, enable early discharge, and reduce the risk of infection and hernia at the abdominal incision site. Temas gerais dentro da especialidade General Topics Within the Specialty ID – 138202 Open Videos VAGINOPLASTY WITH SIGMOID COLON IN A GENDER REASSIGNMENT PATIENT WITH PREVIOUS LOSS OF CUTANEOUS-MUSCULAR FLAP – A CASE REPORT Isabela Pereira Blanco1, Pedro Fernandes Louback1, João Emílio Lemos Pinheiro Filho 1, Erica Sakamoto 1, André Roncon Dias 1, Jacques Waisberg1, Bárbara Cristina Jardim Miranda 1 1Faculdade de Medicina do ABC, Santo André, Brasil Case Presentation A 43-year-old transgender woman with a diagnosis of gender dysphoria underwent gender affirmation surgery using inverted penile skin for the crea- tion of the vaginal canal in June 2018. In 2022, she developed dyspareunia and partial loss of the cutaneous flap of the neovagina, which did not improve with topical Promestriene. In November 2022, a revision of the neovagina was performed with dissection of the vaginal canal ’s fundus and autologous full-thickness skin graft in the suprapubic region. Upon follow-up, a short vaginal canal and persistent granulation tissue were noted, along with continued dyspareunia. The patient was evaluated by the Digestive Surgery team for the use of an intestinal flap and neovagina correction. In January 2024, she underwent sigmoid colon vaginoplasty with a descending-sigmoid anastomosis by videolaparoscopy. She currently has normal bowel habits and no complaints.

Discussion

Gender identity disorder is a condition in which individuals strongly identify with the gender opposite to their biological sex, causing social and occupational dis- tress. For transgender women, the most common surgery is vaginoplasty, which involves removal of male genitalia and the creation of a neovagina. There are three main surgical techniques for vaginoplasty: skin grafts, penile-scrotal cuta- neous flaps, and pedicled segments of small or large intestine. The intestinal segment technique is most commonly used when there is a lack of penoscrotal skin or when previous vaginoplasty attempts have failed. Intestinal vaginoplasty can present complications, such as intestinal fistulas, urinary retention, bleeding, urethral stenosis, surgical site infection, rectal injuries, and tissue necrosis. Performing the procedure laparoscopically offers advantages, including better visuali- zation and ease in recreating the neovagina. A team of specialists, including a gastrointestinal surgeon with ad- vanced laparoscopic skills, is essential to minimize compli- cations and ensure the success of the procedure.

Conclusion

The lack of evidence makes it dif ficult to choose the ideal technique for vaginoplasty in transgender women. Penile skin inversion is more studied, but vagino- plasty with intestinal segments does not appear to be inferior. Prospective studies with larger groups and long-term follow- up are needed. Until then, the experience of the team and available resources should guide the choice of technique.J Coloproctol Vol. 44 No. Suppl S1/2024 © 2025. The Author(s). AbstractS138