SOLITARY RECTAL ULCER SYNDROME AND ITS RELATION TO SPECIFIC FOOD

Introduction: SRUS was rst identied as clinical identity in 1969. But the etiology is not known. Anal ssure, IBD, proctagia fugax and malignancy, rectal polyps, hemorrhoids, and infections. Rarely ischemia, trauma and cystic profunda colitis and Stercoral ulcers have to be excluded. Hence a careful history is important. Material and methods: Patients presenting with C/O constipation or straining at stools with difculty in passing motion with associated minimal bleeding per rectum on and off period less than a month were included in the study. All patients were investigated for stool for occult blood, Us abdomen, BMFT, CBP and exible sigmoidoscopy. Results:100 patients presenting with constipation and bleeding PR were investigated. Flexible sigmoidoscopy showed multiple pin point supercial ulcers on the anterior rectal wall without involvement of sigmoid colon. The incidence age group wise was seen very high between 20 to 60 years. M: F ratio 47:53. All were positive for stool for occult blood, negative for IBD and malignancy by biopsy. They responded to dietary changes i.e; veg, non spicy, non fried diet with antibiotic, mesalamine (400mg BD) and lactulose 15ml at bed time. 10 days after the test follow up sigmoidoscopy was found normal and patient asymptomatic even after 3 months. Discussion: The incidence of SRUS has become common irrespective of age and sex. The type of food used by all these patients was found to be more or less similar with majority of them using fast food, fried food, and spicy food. Stoppage of the above mentioned food with specic treatment for 10 days resulted in recovery with normal sigmoidoscopy. Conclusion: SRUS incidence is high in general population due to specic food type and evacuation behavior.

Rectal prolapse in children. Causes, diagnostics, treatment (a literature review)

Introduction. Rectal prolapse is evagination of the rectal wall outside the anal opening. It can be full-thickness, partial thickness or mucosal. Rectal prolapse is most often met in children from 1 to 4 years of age. This is due to their anatomical features: vertical position of the rectum (open anorectal angle), mobile sigmoid colon, increased mobility of the rectal mucous. Chronic constipation plays an important role in evagination as well as infection, parasitic diseases and cystic fibrosis.Material and methods. Literature searches were done in Scopus, PubMed, Google Scolar and eLibrary databases.Results. Diagnostics includes disease history and physical examination. It is important to differentiate rectal prolapse from hemorrhoids and prolapsing rectal polyps. Photos taken by parents at the moment of prolapse can benefit in making a rapid and correct diagnosis as at the moment of examination the prolapse has very often been corrected. Currently, there are three basic approaches for rectal prolapse care: conservative, sclerotherapy and surgical. The conservative treatment is aimed to reduce the prolapse and to treat the basic disease. Sclerotherapy is the injection of the preparation which causes local inflammation and fibrosis. The injection is made into the pararectal space. If the conservative treatment is ineffective and the patient suffers of frequent prolapses, strangulation, mucous bleedings, than surgical treatment may be indicated for children older than 4.Conclusion. The meta-analysis, performed recently, has demonstrated that conservative treatment is recommended for children before 4 because spontaneous prolapse correction is often seen in this age group. 70% ethyl alcohol is very effective as the sclerosant. Surgical interventions in case of the rectal prolapse are various; open and laparoscopic rectopexy is considered the most effective one. In some cases, rectum fixation with mesh is indicated. Currently, there is no any technique for rectal prolapse treatment which could guarantee no recurrences. Curative tactics is always individual.

Acquired Ano Rectal Conditions (AARC) in Children Seen at Gezira National Center for Pediatric Surgery (GNCPS-Sudan), Epidemiology, Management, and Outcome

The study's main objective is to determine the epidemiology, treatment, and outcome of the acquired anorectal conditions seen at the GNCPS. This study was a retrospective and prospective descriptive hospital-based study involving (131) child with Acquired anorectal conditions (AARC) who presented to GNCPS during the two-year study period. Data regarding the presentation, management, and post-operative course to look after complications and outcomes were collected. Data were collected using a formulated questionnaire and analyzed using (SPSS 17). Data considered statistically significant when P-value is less than 0.05. The study involved a total number of 131 children with AACS. The mean age of presentation is (5.78 years) with an overall 1.4:1 male to female ratio. Most of the study subjects are from rural areas, 66.4 percent. Most of them treated surgically, 83.2 percent, and 16.8 percent medically, with an overall complication rate of 24.4 percent. Conclusion Acquired Ano Rectal Conditions commonly seen at the preschooler age, mean (5.78 years). Rectal polyps and rectal prolapse were among the most frequently seen acquired anorectal conditions in children. Most of the cases treated surgically with an overall complication rate of 24.4 percent.

MBFFNet: Multi-Branch Feature Fusion Network for Colonoscopy

Colonoscopy is currently one of the main methods for the detection of rectal polyps, rectal cancer, and other diseases. With the rapid development of computer vision, deep learning–based semantic segmentation methods can be applied to the detection of medical lesions. However, it is challenging for current methods to detect polyps with high accuracy and real-time performance. To solve this problem, we propose a multi-branch feature fusion network (MBFFNet), which is an accurate real-time segmentation method for detecting colonoscopy. First, we use UNet as the basis of our model architecture and adopt stepwise sampling with channel multiplication to integrate features, which decreases the number of flops caused by stacking channels in UNet. Second, to improve model accuracy, we extract features from multiple layers and resize feature maps to the same size in different ways, such as up-sampling and pooling, to supplement information lost in multiplication-based up-sampling. Based on mIOU and Dice loss with cross entropy (CE), we conduct experiments in both CPU and GPU environments to verify the effectiveness of our model. The experimental results show that our proposed MBFFNet is superior to the selected baselines in terms of accuracy, model size, and flops. mIOU, F score, and Dice loss with CE reached 0.8952, 0.9450, and 0.1602, respectively, which were better than those of UNet, UNet++, and other networks. Compared with UNet, the flop count decreased by 73.2%, and the number of participants also decreased. The actual segmentation effect of MBFFNet is only lower than that of PraNet, the number of parameters is 78.27% of that of PraNet, and the flop count is 0.23% that of PraNet. In addition, experiments on other types of medical tasks show that MBFFNet has good potential for general application in medical image segmentation.

Deep Learning-Based Automatic Detection of Rectal Polyps Using Abdominal CT Images Guided by Cold Snare Polypectomy

The study drew attention to the therapeutic effects of cold snare polypectomy guided by a deep convolutional neural network- (CNN-) based abdominal CT and hot snare polypectomy (HSP) on colonic and rectal polyps. Specifically, 90 patients were enrolled into a blank group, a control (Ctrl) group, and an experimental group. The blank group accepted HSP, the Ctrl accepted cold snare polypectomy, and the experimental group accepted cold snare polypectomy guided by deep CNN-based CT images. It was found that the experimental group had the lowest false-positive rate (9.2%) in polyp detection in contrast with the Ctrl (21.4%) and the blank group (52.3%) P < 0.05 . The complete resection rate of large polyps in the experimental group was the highest P < 0.05 , and its operation time (2.91 ± 0.75 min) was obviously shorter versus the blank group (6.18 ± 1.19 min) P < 0.05 . In conclusion, the cold snare polypectomy under the guidance of deep CNN-based CT has a relatively high complete resection rate and detection accuracy of polyps with a low complication rate, which can be adopted clinically.

Current Challenges for Education and Training in Transanal Surgery

Transanal endoscopic microsurgery (TEM) is a technique that was introduced in the 1980s for improved exposure to upper rectal polyps. This technique, though initially difficult to master due to new skill acquisition for surgeons, has spared many patients proctectomy. There are many benign indications for transanal endoscopic surgery which has led to in vivo operating room training with fewer undesirable effects to the patient. With the explosion of laparoscopic technology this transanal technique is no longer limited to intraluminal pathology, but is now being used to remove the entire rectum. In transanal total mesorectal excision (taTME), benign indications are less common, translating to potentially more severe oncologic patient consequences during the early phase of adoption. For this reason, strict training criteria consensus guidelines have been developed by the experts in taTME. The current consensus statements agree that training surgeons should have performed a minimum of 10 laparoscopic TME procedures and should have some experience with transanal surgery. Surgeons need to attend a formal training course and should start clinically on benign or early malignant pathology without threated circumferential resection margins. Surgeons also need to have their first cases proctored until deemed proficient by the proctor and monitor their morbidity, oncologic, and functional outcomes prospectively.

The clinical features of chronic intestinal schistosomiasis-related intestinal lesions

Background Chronic intestinal schistosomiasis has been reported to be associated with colonic polyps, colorectal cancer and ulcerative colitis. We aim to investigate the clinical characteristics of intestinal-related lesions caused by chronic intestinal schistosomiasis japonicum. Methods Patients with and without chronic intestinal schistosomiasis were retrospectively enrolled from the endoscopy center of Wuhan Union Hospital from September 1, 2014, to June 30, 2019 with a ratio of 4:1. The characteristics of infected intestinal segments were analyzed in patients with chronic intestinal schistosomiasis. We also compared the characteristics of intestinal-related lesions, including colorectal polyps, colorectal cancer (CRC), ulceration or erosion of the intestinal mucosa and hemorrhoids, between the two groups. Results A total of 248 patients with chronic intestinal schistosomiasis and 992 patients without chronic intestinal schistosomiasis were analyzed. The most common sites of chronic intestinal schistosomiasis were the sigmoid colon (79.0%) and rectum (84.7%). The frequency of intestinal polyps (64.5% vs. 42.8%, p < 0.001), especially rectal polyps (62.5% vs. 45.0%, p = 0.002), in the intestinal schistosomiasis group was significantly higher than that in the control group. Morphologically, type IIa polyps were more common in the schistosomiasis enteropathy group (68.5% vs. 60.7%, p = 0.001). Female patients with intestinal schistosomiasis had a higher detection rate of CRC than women in the control group (13.8% vs. 5.4%, p = 0.017). There was no significant difference in the incidence of ulcerative colitis between the two groups (0.8% vs. 0.6%, p = 0.664). In addition, the schistosomiasis enteropathy patients had a higher detection rate of internal hemorrhoids (58.9% vs. 51.0%, p = 0.027). Conclusions Chronic intestinal schistosomiasis mainly involved the rectum and sigmoid colon and was more likely to induce intestinal polyps, especially rectal polyps and internal hemorrhoids. Women with chronic schistosomiasis have a higher risk of colorectal cancer.