Sweet’s syndrome and mucosal prolapse polyps in a male patient with ulcerative colitis

Background Sweet’s syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare neutrophilic dermatitis characterized by pyrexia, neutrophilia and painful papulonodular lesions with a neutrophilic dermal infiltrate. Case presentation We presented a case report of classical SS associated with ulcerative colitis (UC) and mucosal prolapse polyps (MPPs) in a male patient. Conclusions The particularity of this case is the occurrence of MPPs in a male patient with UC and classical SS. We also discussed whether this patient with concurrent Epstein–Barr virus infection could be treated with corticosteroids.

Early results of different types of anorectoplasty for anorectal malformations

Objective: To document our experience with the technique of surgical repair in anorectal malformations (ARM) and the short term anatomical and functional outcomes. Methods: This study included total 31 babies. Fourteen were perineal fistula cases with age range between 1 to 4 days. Ten patients had vestibular fistula and seven had rectourinary fistula. Primary diverting colostomy was done for vestibular and rectourinary fistula patients. On the other hand low imperforate anus with anoperineal fistula without associated major anomalies had undergone fistulectomy and simple anoplasty. Results: Simple anoplasty was done for fourteen perineal fistula cases. Anterior sagittal anorectoplasty (ASARP) was done for 10 vestibular fistulae and posterior sagittal anorectoplasty (PSARP) was done in 10 recto-urinary fistula cases. Simple anoplasty and vestibular anus scored good (5-6) in 70% to 71% while PSARP scored fair in 58% of the cases. Postoperative mucosal prolapse, anal stenosis and retraction occurred in two, six and one patient respectively. Redo surgery was done in mucosal prolapse and retraction cases. Four responded to anal dilation and the other needed redo surgery by a simple cutback technique for anal stricture. Continence was assessed in 23 patients whose follow-up periods were longer than 3 years. Twenty one patients had a good score and two had a fair score. No patients had a poor score. Conclusion: Our approach has the following advantages: (i) The operative technique is simple and easy to perform. (ii) Minimal complication rate with good cosmetic results. Mediscope 2021;8(2): 75-79

Prolapsus Muqueux de L’urètre au Centre Hospitalo-Universitaire Départemental de Borgou -Parakou, Bénin

Introduction: Le prolapsus muqueux de l’urètre est l’éversion circonférentielle de l’épithélium de la muqueuse urétrale congestive à travers le méat urinaire. L’objectif de cette étude était de rapporter la prise en charge des prolapsus muqueux de l’urètre. Méthodes: Il s’est agi de 7 dossiers de patientes prise en charge pour de prolapsus muqueux de l’urètre colligés rétrospectivement sur 4 ans dans le service de chirurgie du centre hospitalier universitaire départemental de Borgou à Parakou, au Nord du Bénin Résultats: L’âge moyen des patients, tous de sexe féminin, était de 4±0,8 ans avec des extrêmes de 2 ans et de 08 ans. Le principal motif de la consultation a été l’hémorragie génitale. A l’examen physique on retrouvait une tuméfaction sous-clitoridienne centrée par le méat urétral. La prise en charge a été chirurgicale. Nous avons procédé dans tous les cas en une excision de la muqueuse prolabée suivie d’une suture muco-muqueuse sur une sonde de Foley pour 48 heures. Les suites opératoires étaient simples et aucune récidive n'est observée après un recul moyen de 7 mois. Conclusion: Le prolapsus urétral est une affection rare qui se rencontre chez les fillettes prépubères. Le traitement chirurgical donne de résultats cliniques et esthétiques satisfaisants. Background: Mucosal prolapse of the urethra is the circumferential eversion of the epithelium of the congestive urethral mucosa across the urinary meatus. The objective of this study was to report our experience in the management of mucosal prolapse of the urethra. Methods: We reviewed 7 cases of patients treated for mucosal prolapse of the urethra, collected retrospectively over 4 years in the surgical department of the departmental university hospital of Borgou in Parakou, northern Benin. Results: The mean age of the patients, all female, was 4±0.8 years with extremes of 2 years and 08 years. The main reason for consultation was genital hemorrhage. Physical examination revealed a subclitoral swelling centered on the urethral meatus. The management was surgical. We proceeded in all cases with an excision of the prolapsed mucosa followed by a muco-mucosal suture on a Foley catheter for 48 hours. The postoperative course was simple and no recurrence was observed after a mean follow-up of 7 months. Conclusion: Urethral prolapse is a rare condition that occurs in prepubertal girls. The surgical treatment gives satisfactory clinical and aesthetic results.

Long-Term Outcomes of Sectorial Longitudinal Augmented Prolapsectomy for Asymmetric Muco-hemorrhoidal Prolapse: An Observational Study of 433 Consecutive Patients

Purpose. Hemorrhoidal disease (HD) is a widespread condition severely influencing patients’ quality of life. Recently, the large diffusion of stapled hemorrhoidopexy has revealed a new unexpected pathological entity: the asymmetric mucosal prolapse. We aimed to assess the outcomes of the sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse, in terms of HD symptoms, prolapse recurrence, and rectal stenosis. Methods. Patients affected by III–IV-degree symptomatic HD with asymmetric mucosal prolapse undergone SLAP of 1 or 2 hemorrhoidal columns (SLAP1 or SLAP2) were retrospectively assessed. The severity of hemorrhoid symptoms and fecal continence status were evaluated before and after surgery. Mean outcome was evaluation of medium–long-term outcomes as the occurrence of recurrence and anal or rectal stenosis. Secondary outcome was the evaluation of postoperative bleeding, reoperation rate, length of hospitalization, fecal urgency, and time to return to work. Results. We enrolled 433 patients (277 SLAP1 and 156 SLAP2). Hemorrhoidal symptoms recurrence was reported in 9 patients undergone SLAP1 and 4 patients undergone SLAP2, while prolapse recurrence occurred, respectively, in 4 and 2 patients. No major intraoperative complications occurred. An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2. Fecal incontinence occurred in 8 and 4 cases of patients treated with SLAP1 and SLAP2. Conclusions. The combination of a simple hemorrhoidectomy to a mucosal rectal prolapsectomy should be part of every coloproctologist background. Promising and satisfying results can be achieved using SLAP for HD associated with asymmetric prolapse.

POSTERIOR SAGITTAL ANORECTOPEXY FOR PAEDIATRIC RECTAL PROLAPSE

Introduction: Rectal prolapse is a very common and self limiting condition amongst the paediatric age group in India. Majority of the cases respond to conservative management. The various modalities of management of the same include surgical as well as medical modalities. Surgical namely Thierschs anal circlage, laparoscopic suture rectopexy, and posterior sagittal rectopexy Aim - To evaluate the safety and efcacy of posterior sagittal rectopexy in children with rectal prolapse. Patients and Methods: Twenty patients aged between 1 and 7 years presented with rectal prolapse. These patients underwent posterior sagittal anorectopexy after pre anaesthetic check up. These patients were followed up at 1week, 15days and 1month for 3 months. Results: Constipation improved in 18 out of 20 patients, who had a history of constipation before surgery. Partial mucosal prolapse recurrence occurred in two patients. Conclusion: Posterior Sagittal Rectopexy is a good option in cases of rectal prolapse in children once all the conservative methods have failed. The technique is safe and effective. It has satisfactory functional results.