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Introducción: El prolapso rectal completo es la invaginación de las capas del recto a través del canal anal y su protrusión fuera de este. Su incidencia es de 2,5 por 100 000 habitantes con predominio en mujeres de edad avanzada. Es una afección de curso crónico y benigno, cuya presentación clínica y endoscópica es tan variable que puede confundirse con otras entidades como con el cáncer colorrectal. Objetivo: Presentar el caso de una paciente femenina, operada de prolapso rectal completo en la provincia de Cienfuegos. Presentación de caso: Se presenta una paciente femenina de 76 años de edad, blanca, de procedencia rural que acude a la consulta y refiere que lleva 12 días sin defecar. Además, presenta dolor, sangramiento rectal no activo y una masa que protruía a través de la región anal sugestiva al examen físico de un prolapso rectal completo. El tacto rectal confirma el diagnóstico. Se realiza reducción quirúrgica del prolapso por técnica de Delorme. Actualmente lleva 6 meses de operada con evolución favorable. Por lo poco frecuente de esta entidad se considera de interés científico su publicación. Conclusión: Esta entidad es poco común en el entorno médico, el gran cambio que causa en el nivel de vida de aquellos que la portan y sus complicaciones hace que requiera un tratamiento rápido y oportuno(AU)

Introduction: Complete rectal prolapse is the invagination of the rectal layers through the anal canal and its protrusion out of it. Its incidence is 2.5 per 100,000 inhabitants, predominantly in elderly women. It is a chronic and benign condition, whose clinical and endoscopic presentation is so variable that it can be confused with other entities, such as colorectal cancer. Objective: To present the case of a female patient who underwent surgery for complete rectal prolapse in the province of Cienfuegos. Case presentation: A 76-year-old female patient, white, from a rural area, came to the clinic and reported that she had not defecated for 12 days. In addition, she presents pain, nonactive rectal bleeding and a mass protruding through the anal region suggestive, on physical examination, of a complete rectal prolapse. Digital rectal examination confirmed the diagnosis. Surgical reduction of the prolapse was performed using the Delorme technique. She has undergone surgery for 6 months now, with favorable evolution. Due to the rarity of this entity, its publication is considered as scientifically interesting. Conclusion: This entity is uncommon in the medical environment. The great change that it causes in the living standards of those who carry it and its complications make it require a quick and timely treatment(AU)

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AIM: Transanal transabdominal proctosigmoidectomy (TATA) with a coloanal anastomosis is an alternative to abdominoperineal excision of the rectum (APR) for low rectal cancer. Neorectal prolapse is an unusual complication following TATA. This study aimed to determine the incidence of neorectal prolapse after TATA for low rectal cancer. METHOD: This cohort study was conducted in a tertiary referral colorectal centre. From a prospectively maintained database including 1093 patients treated for rectal cancer between 1984 and 2016 we identified those who underwent sphincter-preserving surgery. Data regarding the incidence, management and outcomes of neorectal prolapse were analysed. RESULTS: A total of 409 patients were identified, of whom 185 underwent open surgery and 224 a minimally invasive surgical procedure (MIS). All received neoadjuvant chemoradiation. Neorectal prolapse occurred in 4.6% (n = 19) with an incidence of 2.2% in the open and 6.7% in the MIS group (P = 0.023), with no difference between MIS techniques. There was one recurrence of neorectal prolapse (5.9%). The incidence of neorectal prolapse was higher in women (9.5%) than men (2.5%) (P = 0.011). There were no differences in local recurrence rates between the neorectal prolapse group (5.3%) and our population without prolapse (3.4%) (P = 0.79). CONCLUSION: Neorectal prolapse is a rare occurrence following minimally invasive sphincter-saving surgical procedures performed for rectal cancer. It appears to be more frequent in patients who undergo MIS procedures and in women.

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Objectives: To assess the epidemiological profile of children and adolescents with intestinal stoma, assisted at the Presidente Dutra University Hospital (HUPD), São Luís (MA). Methods: Observational, descriptive, retrospective, and individuated study. Data were collected from 110 children and adolescents with elimination intestinal stoma, from January 2006 to February 2013. The following variables were analyzed: age, gender, patient origin, and stomata indication, type, and temporal character. After data collection, descriptive analysis was made by Bioestat 5.0 program. Results: Of 110 patients, 78.2% were male and 21.8% female. The average age was 9.4 years old. 55.5% came from the Maranhão state countryside, and 44.5% from the capital, São Luís. Regarding stoma type, colostomies made up 88.2%, and were 11.8% ileostomies, all temporary stoma. The main cause was trauma (42.7%), with firearm abdominal puncture being the most frequent cause (71.5% of the category); followed by congenital anomalies (38.2%), and obstructive (5.4%) and inflammatory (4.5%) causes. Conclusion: Studied children and adolescents were mostly male, from Maranhão state countryside. The main cause was trauma, and colostomy was the most common stoma type.

Objetivos: Avaliar o perfil epidemiológico de crianças e adolescentes portadores de estomas intestinais atendidos no Hospital Universitário Presidente Dutra (HUPD) em São Luís (MA). Métodos: Estudo observacional, descritivo, retrospectivo e individuado em que foram coletados dados de 110 crianças e adolescentes com estomas intestinais de eliminação de janeiro de 2006 a fevereiro de 2013. Analisaram-se as variáveis: idade, sexo, procedência dos pacientes, indicação, tipo e caráter temporal dos estomas. Após coleta dos dados, foi feita análise descritiva pelo programa Bioestat 5.0. Resultados: Dos 110 pacientes, 78,2% eram do sexo masculino e 21,8% do sexo feminino. A idade média foi de 9,4 anos. 55,5% era procedente do interior do Estado do Maranhão e 44,5% da capital, São Luís. Com relação ao tipo: 88,2% eram colostomias e 11,8% ileostomias, todos os estomas temporários. A causa principal foi o trauma (42,7%), sendo a perfuração abdominal por arma de fogo a mais frequente (71,5% da categoria); seguido pelas anomalias congênitas (38,2%), causas obstrutivas (5,4%) e inflamatórias (4,5%). Conclusão: As crianças e adolescentes estudados eram, em sua maioria, do sexo masculino, proveniente do interior do Estado do Maranhão, tendo como principal causa a traumática e a colostomia como o tipo de estoma mais comum.

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BACKGROUND AND AIMS: Optimal treatment for rectal prolapse is controversial. We describe a novel alternative treatment for high-risk patients with complete rectal prolapse. PATIENTS AND METHODS: Sixteen high-risk patients over 60 years old with complete rectal prolapse were examined. All patients had significant past medical history and were classified as grade III (ASA) surgical risk. The helicoidal suture technique is described. Postoperative parameters evaluated were morbidity, mortality, postoperative symptoms, recurrence and anal incontinence score. Median follow-up was 60 months. RESULTS: There were no operative complications or mortality in the series; one patient experienced recurrence. Median postoperative anal incontinence score was 6.06 (range 1-30; preoperative 23.6). CONCLUSION: This technique provides adequate functional outcomes and could be an effective therapeutic strategy against rectal prolapse in high-risk patients.

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