Complications after Stapled Hemorrhoidectomy: A Single Center Experience

Background: A circumferential strip of mucosa about 1.5 to 2 centimetres above the dentate line is removed in stapled hemorrhoidectomy, a new technique for haemorrhoids treatments. Objective: The aim of the study was to evaluate complications after stapled hemorrhoidectomy.Methods:A total of 101 patients between the age group 20 to 70 years were diagnosed with grade 3 and grade 4 haemorrhoids. Patients are included in stapled haemorrhoidectomy. The questionnaire focused on stapled hemorrhoidectomy procedures performed in the period July 2018 to June 2020. Descriptive analysis was done based on the student’s T-test using SPSS 24 software version. The level of significance was set at 5% (p < 0.05).Results:In the 2-years timeframe, out of 101 patients in the Immediate (within 1 week) complications of stapled hemorrhoidectomy, 84.16% were in None, 5.94% were severe pain, 3.96% were bleeding, 1.98% were Thrombosis, 0.99% were urinary retention, 1.98% were Anastomotic dehiscence 0.99% were Fissure, 0.99% were perineal intramural hematoma and 0.99% were submucosal abscess. Out of 90.09% were in none, 1.98% were Recurrent hemorrhoids, 0.99% were Severe pain, Stenosis, Fissure, Skin tag, Thrombosis, Staples problems, Intramural abscess and Intussusception.Conclusion:Although stapled hemorrhoidectomy appears to be promising, we believe that a multicenter randomized controlled trial with a long-term follow-up comparing stapled hemorrhoidectomy and banding is required before the treatment can be recommended. The majority of difficulties can be avoided by following the rectal wall anatomy during the surgery.

Successful surgical treatment of intractable post-radiation rectal bleeding

Patients will typically present symptoms of chronic post-radiation colitis and proctitis 8-12 months after finishing their treatment. Endoscopic methods play the main role the treatment of bleeding caused by post-radiation colitis and proctitis. Surgical treatment is required for remained approximately 10% of patients. Here we present a 64 year old female with metastatic breast cancer, who was referred to us for intractable rectal bleeding. Total colonoscopy and rigid rectosigmoidoscopy revealed proctitis, rectal and sigmoidal telangiectasis, multiple necrotic ulcers between 15 to 30 cm from the anal verge, and also huge ishemic ulcer with patchy necrotic areas about 10 cm from the anal verge. This abnormal irradiated part was resected and then mucosectomy of the remnant rectum, both transabdominally and transanally was done. We performed pull-through technique of normal proximal colon to anal region through the remnant rectal wall and finally did coloanal anastomosis. Diverting stoma was not made because of anastomosis in anal region. With this technique we can achieve benefits such as avoidance of harsh dissection in a frozen pelvis and its consequences, we can avoid intra-abdominal anastomosis, there is no need to a diverting stoma and, most important of all, definite bleeding control.

Case Report: Role of an Iodinated Rectal Hydrogel Spacer, SpaceOAR Vue™, in the Context of Low-Dose-Rate Prostate Brachytherapy, for Enhanced Post-Operative Contouring to Aid in Accurate Implant Evaluation and Dosimetry

We present a case series of 13 consecutive patients with prostate cancer treated with low-dose-rate (LDR) brachytherapy, utilizing SpaceOAR Vue™, the recent iodinated iteration of the SpaceOAR™ hydrogel rectal spacer. Low- and favorable intermediate-risk patients receiving monotherapy and unfavorable intermediate- and high-risk patients undergoing a brachytherapy boost were included. Permanent brachytherapy can result in subacute and late rectal toxicity, and precise contouring of the anterior rectal wall and posterior aspect of the prostate is essential for accurate dosimetry to confirm a safe implant. Clearly visible on non-contrast CT imaging, SpaceOAR Vue™ can substantially aid in post-implant contouring and analysis. Not previously described in the literature in the context of LDR brachytherapy, we demonstrate the added clinical benefit of placing a well-visualized rectal spacer.

Patient acceptability and quality of self-administered intravaginal gel for pelvic MRI

Background: MRI of the pelvis can be limited for infiltrating lesions or those of same signal intensity as surrounding structures. Vaginal distension using aqueous gel counters this by defining the fornices, cervix and anterior rectal wall. This increases the accuracy of diagnosis and staging of various pelvic pathology, however, there is currently neither a universally accepted protocol for using gel nor focus on patient self-administration. Aims: To improve patient expectations regarding pelvic MRI with intravaginal gel, as well as the service we provide should they prefer self-administration and this produces vaginal distension of radiological quality equivalent to doctor-administration. Methods: Illustrated information explaining the benefits of gel and the technique of self-administration was sent to patients scheduled for pelvic MRI between March 2020 and April 2021 at our study centre. This included a questionnaire to assess understanding and preference for self-administration. Vaginal distension achieved on imaging was analysed using TeraRecon and compared between self and doctor-administered cases. Results: 38 of 45 patients opted for self-administration of gel. Those who identified as White British were more likely to self-administer. There was comparable quality of vaginal distension between self and doctor administered cases, with no significant difference between orthogonal measurements and retained gel volume. Conclusion: Self-administration of intravaginal gel for pelvic MRI is acceptable to patients and frees a doctor of this duty. It is a well tolerated technique which produces high quality vaginal distention on imaging. We recommend wider use of intravaginal and even rectal gel in the investigation of complex endometriosis and pelvic tumours.

Morphological prerequisites for the formation of fascial duplication in the elimination of damage to the anterior rectal wall during prostatectomy

Background Intraoperative rectal injury in prostatectomy patients is an uncommon but severe complication. Particular attention is paid to improving the results of healing damage to the anterior rectal wall during prostatectomy.Objective To study the morphological features of the parietal pelvic fascia and the rectal wall to substantiate the possibility of the formation of fascial duplication in the elimination of damage to the anterior rectal wall during prostatectomy.Material and Methods The authors carried out an intravital morphological analysis of the parietal pelvic fascia covering the levator rectum muscle and the anterior rectal wall in 10 men.Results The parietal pelvic fascia contains more powerful bundles of collagen fibers, which in certain areas are partially woven into the fibers of striated muscle tissue. The adventitia of the rectum is characterized by a looser arrangement of the interacting components of the formed connective and smooth muscle tissue. In the studied formations of the small pelvis, the thickness of collagen fibers separately and in the composition of bundles, as well as the cells of the differon and each fiber separately did not differ, which indicated the identity of their tinctorial properties in the compared zones.Conclusion Morphological analysis showed that when juxtaposing and touching the edges of the healing area of the surgical wound without tension, a stable and continuous scar of the fascial duplication is formed, which ensures reliable fusion of the stitched anatomical structures.

Perineal Rectosigmoidal Resection for Complete Rectal Prolapse

BACKGROUND: Rectal prolapse (RP) (rectal Providencia) is a disorder manifest by full-thickness intussusceptions of the rectal wall that protrudes externally through the anus. AIM: A retrospective study was done to evaluate the outcome of rectosigmoidal resection for complete rectal prolapse (CRP) in our hospital from 2008 to 2020. METHODS: This study analyzes the data of post-operative outcomes for 25 patients with CRP treated by perineal rectosigmoidal resection; eight patients were male and 17 were female. RESULTS: A total of 25 patients enrolled with the median age of 50 years. There was an improvement in the general condition of patients regarding constipation, bleeding per rectum, incontinence, and perineal discomfort. There were no mortality, no major complication, and a low recurrence rate. CONCLUSION: Altemier’s procedure for CRP improves patients’ general condition regarding constipation and incontinence, no mortality, low complication rate, and negligible rate of recurrence.

Solitary Fibrous Tumor of the Prostate: A Case Report and Literature Review

Solitary fibrous tumors (SFTs) usually occur in the pleura and account for two-thirds of all cases; however, SFTs occurring in the prostate are extremely rare. Approximately 25 cases have been reported in the literature to date. This study reports the case of a 43-year-old man referred to our hospital with the chief complaint of a pelvic tumor after careful examination. The tumor marker levels were within normal limits. T2-weighted magnetic resonance imaging revealed a tumor, demonstrating primarily low signal intensity. It showed a capsule-like rim at the left lobe of the prostate, suggesting that the tumor was partially invading the rectal wall. Histopathological examination of needle-core biopsies showed spindle cell neoplasm with small and fusiform cells, strongly expressing signal transducer and activator of transcription 6 (STAT6) with a ramifying vascular network. Therefore, the clinical diagnosis of the patient was SFT of the prostate and robot-assisted radical prostatectomy was performed. Histopathological examination revealed that the tumor was composed of spindle cells with patternless and staghorn patterns. Immunohistochemical analysis showed a strong expression of STAT6. Furthermore, the tumor was partially positive for CD34. Therefore, the patient was diagnosed with SFT of the prostate. Two years after the initial diagnosis, the patient was alive with normal erectile function, continence status, and no evidence of the disease.

Trypanosoma cruzi infection follow-up in a sylvatic vector of Chagas disease: Comparing early and late stage nymphs

Chagas disease is caused by Trypanosoma cruzi and transmitted by the triatomine Mepraia spinolai in the southwest of South America. Here, we examined the T. cruzi-infection dynamics of field-caught M. spinolai after laboratory feeding, with a follow-up procedure on bug populations collected in winter and spring of 2017 and 2018. Bugs were analyzed twice to evaluate T. cruzi-infection by PCR assays of urine/fecal samples, the first evaluation right after collection and the second 40 days after the first feeding. We detected bugs with: the first sample positive and second negative (+/-), the first sample negative and second positive (-/+), and with both samples positive or negative (+/+; -/-). Bugs that resulted positive on both occasions were the most frequent, with the exception of those collected in winter 2018. Infection rate in spring was higher than winter only in 2018. Early and late stage nymphs presented similar T. cruzi-infection rates except for winter 2017; therefore, all nymphs may contribute to T. cruzi-transmission to humans. Assessment of infection using two samples represents a realistic way to determine the infection a triatomine can harbor. The underlying mechanism may be that some bugs do not excrete parasites unless they are fed and maintained for some time under environmentally controlled conditions before releasing T. cruzi, which persists in the vector hindgut. We suggest that T. cruzi-infection dynamics regarding the three types of positive-PCR results detected by follow-up represent: residual T. cruzi in the rectal lumen (+/-), colonization of parasites attached to the rectal wall (-/+), and presence of both kinds of flagellates in the hindgut of triatomines (+/+). We suggest residual T. cruzi-infections are released after feeding, and result 60–90 days after infection persisting in the rectal lumen after a fasting event, a phenomenon that might vary between contrasting seasons and years.

MSBC-Net: Automatic Rectal Cancer Segmentation from MR Scans

<div>Accurate segmentation of rectal cancer and rectal wall based on high-resolution T2-weighted magnetic resonance imaging (MRI-HRT2) is the basis of rectal cancer staging. However, complex imaging background, highly characteristics variation and poor contrast hindered the research progress of the automatic rectal cancer segmentation. In this study, a multi-task learning network, namely mask segmentation with boundary constraints (MSBC-Net), is proposed to overcome these limitations and to obtain accurate segmentation results by locating and segmenting rectal cancer and rectal wall automatically. Specifically, at first, a region of interest (RoI)-based segmentation strategy is designed to enable end-to-end multi-task training, where a sparse object detection module is used to automatically localize and classify rectal cancer and rectal wall to mitigate the problem of background interference, and a mask and boundary segmentation block is used to finely segment the RoIs; second, a modulated deformable backbone is introduced to handle the variable features of rectal cancer, which effectively improves the detection performance of small objects and adaptability of the proposed model. Moreover, the boundary head is fused into the mask head to segment the ambiguous boundary of the target and constrain the mask head to obtain more refined segmentation results. In total, 592 annotated rectal cancer patients in MRI-HRT2 are enrolled, and the comprehensive results show that the proposed MSBC-Net outperforms state-of-the-art methods with a dice similarity coefficient (DSC) of 0.801 (95\% CI, 0.791-0.811), which can be well extended to other medical image segmentation tasks with high potential clinical applicability.</div>

MSBC-Net: Automatic Rectal Cancer Segmentation from MR Scans

<div>Accurate segmentation of rectal cancer and rectal wall based on high-resolution T2-weighted magnetic resonance imaging (MRI-HRT2) is the basis of rectal cancer staging. However, complex imaging background, highly characteristics variation and poor contrast hindered the research progress of the automatic rectal cancer segmentation. In this study, a multi-task learning network, namely mask segmentation with boundary constraints (MSBC-Net), is proposed to overcome these limitations and to obtain accurate segmentation results by locating and segmenting rectal cancer and rectal wall automatically. Specifically, at first, a region of interest (RoI)-based segmentation strategy is designed to enable end-to-end multi-task training, where a sparse object detection module is used to automatically localize and classify rectal cancer and rectal wall to mitigate the problem of background interference, and a mask and boundary segmentation block is used to finely segment the RoIs; second, a modulated deformable backbone is introduced to handle the variable features of rectal cancer, which effectively improves the detection performance of small objects and adaptability of the proposed model. Moreover, the boundary head is fused into the mask head to segment the ambiguous boundary of the target and constrain the mask head to obtain more refined segmentation results. In total, 592 annotated rectal cancer patients in MRI-HRT2 are enrolled, and the comprehensive results show that the proposed MSBC-Net outperforms state-of-the-art methods with a dice similarity coefficient (DSC) of 0.801 (95\% CI, 0.791-0.811), which can be well extended to other medical image segmentation tasks with high potential clinical applicability.</div>