OF ANAL PROLAPSE

Thus, good results were obtained in 90% of patients. Results of 3 patients were satisfactory. Total colectomy and ileorectostomy shall be widely used for surgical correction of chronic colostasis conditioned by dolichocolon. Surgical treatment should be preceded by full examination for the exclusion of other causes of chronic constipation.

E. A. JAVADOV, A. D. KHALILOV, L. F. KHALILOVA

Scientific center of Surgery named after M. A. Topchibashev; Baku, AZERBAIJAN

Anal prolapse or mucosal prolapse often accompany hemorrhoidal disease at the IV stage s often accompany the disease stage IV, but can also occur as an independent state. Up to date, majority of proctologists have practiced traditional hemorroidectomy with stitching of vascular legs and excess mucous. However, noted tactic is accompanied by a significant number of postoperative complications: bleeding in early cutting of crura, early discharge of ligatures, pain due to excessive tissue gathering, cicatricial strictures of the anal canal. In recent years the method of circular resection of muco - submucous within subampullar rectum has been practiced in order to lift prolapse tissues according to the Longo method. However, inherent experience of applying noted method has revealed the following deficiencies: excessive tissue bleeding during the procedure in patients with hemorrhoidal disease at stage IV, post-surgery swelling of the tissues (possibly due to the crushing with anoscope of large diameter), the impossibility of visual control of the cutting degree of tissue with a knife of apparatus, need for additional excision of hemorrhoidal tissue. According to us, success of the intervention can be provided under the stipulation of rational excision of not only greater mass of hemorrhoidal tissue, but of excess mucous of anal canal and subampullar rectum. During the past 7 years we have given preference to utilization of linear suturing devices in cases with anal prolapse. Interventions have been conducted at 87 patients different age category 35 - 70. There were 60 men and 27 women. The main complaints corresponded to permanent soiling of underwear, recurrent pain, anal itching, bleeding episodes, loss of nodes, discomfort when walking, permanent attempts of tissue reposition. Isolated prolapse was observed in 7 patients. The combination of mucosal prolapse with circular hemorrhoidal tissue weight gain, episodes of thrombosis and thrombophlebitis has been observed in 80 patients. For all patients linear stapler UO-40 has been used. The intervention has been performed as following.After excision of the external vascular conglomerates according to 3-7-11 of clock dial, in some cases to 2-5-7-11 over the dentate line stapler is attached to the longitudinally to the entire length of the vascular stem and wide portion of the mucous prolapses, with cutting of and excision of the tissues by preservation of tissue bridges. Anal canal is set correctly here immediately gaining cylindrical shape. Duration of the intervention is 15 - 20 minutes. The post-surgery period did not differ from those in the standard hemorrhoidectomy. Allocation have ceased in the fourth week. Recurrences of the disease and strictures of anal canal were not observed. Thus, the use of linear staplers in the surgical treatment of anal prolapse is adequately efficient in terms of achieving good results and ease of use.

RESULTS OF SURGICAL CORRECTION OF CHRONIC LARGE INTESTINE STATIS IN PATIENTS WITH DOLICHOCOLON

E.A. JAVADOV, N.J. IMANOVA, Kh.T. ABBASOVA, N.A. MAMMADOVA

Scientific Center of Surgery named after acad. M.A.Topchubashev, Baku, AZERBAIJAN

Introduction.Chronic large intestine stasis (CLIS)remains one of the main problems of modern coloproctology. According to majority of authors, CLIS is observed in up to 40% of patients with dolichocolon.

Objective of the investigation is to study deeply the significance of dolichocolon in the emergence of CLIS and improve the results of its surgical treatment.

Materials and methods of investigation.Results of examinations and treatment of 64 patients (10 males, 54 females) at the age of 14-71 years (mean age - 38±1,5 years), treated at the clinic with the diagnosis of dolichocolon, CLIS. In 21 of them CLIS was subcompensated, in others – (42 p. - 67,18%) - decompensated. Outpatient and hospital patients found in the result of casual examination and having not complaints of constipation, and patients with dolichocolon found during surgical invention, with proctogenic, coloproctogenic type of constipation were included to the investigation.Based on anamnestic data, it was found that in all the patients constipation lasted from 6 months to 47 years and was not compensated in the majority of cases. 4-day and more delay in interstina transit was observed in 59,1% of patients.During pre-surgical examination, in addition to standard examinations, all the patients were exposed to irriography, and 37 patients to colonoscopy, in all the patients there was observed large intestinal lengthening, formation of additional intestinal loop, various degrees of disorders of the evacuatory function of the right, left and both sides of the intestine (hypomotoricdystonia), in 34 patients there was observed Bauhin's valve insufficiency, pain and meteorism in the right half of the abdomen. Cologenic type constipation was proved in all the patients. Before the surgery, all the patients were instituted anti-constipation therapy, as a result of therapy in a part of patients the was reached daily defecation, however, after completion of drug therapy, immediate recurrence of constipation was observed. In other patients, drug therapy had random or no effect.

Results of the investigation.After the planned pre-surgical preparation 48,4% of patients (31 p.) were exposed to total colectomy, ileorectostomy, 25% - to subtotal colectomy, ileosigmoidostomy, and the remaining patients were exposed to hemicolectomies or sigmoidectomy. Recovery period in all the patients was satisfactory. In patients that underwent total colectomy complete elimination of constipation in long-term perspective, in 3 of the patients (18.8%) exposed to subtotal colectomy, in 8 of the patients (50%) exposed to hemocolectory and sigmoidectomy there was observed continuation of colostasis and use of evacuants by patients.

Summary.The abovementioned once more shows, that total colectomy is a method of choice in the surgical treatment of cologenic CLIS.

CEREBRAL VENOUS THROMBOSİS THAT APPEARED İN COURSE OF CROHN’S DİSEASE

E. KARATAY, İ. SHEN , H. ERDAL , M. ARHAN

Gazi University, Ankara, TURKEY

Abstract: Inflamatory bowel disease(IBD) may be associated with thromboembolic complications.Cerebral vein thrombosis is a rare complication of IBD.Pathogenesis of hypercoagulability in IBD contributing thromboembolic events is not well known.

Case: We presented a patient with Crohn ‘s Disease (CD) complicated with right sigmoid and superior sagittal sinus thrombosis,comfirmed in MR venography. A 37 year old man with a 1 year history of CD with bloody diarrhea and abdominal cramping was admitted to the hospital. Initiation of Methylprednisolone 40 mg/day and Azotioprin 50 mg/day and also discontinuation of Azotioprin, because of neutropenic fever was learned from history. He received Methylprednisolone 40 mg/day during admission. Patient had no smoking and no alcohol consumption without significant family history.Physical examination was normal except paleness.Initial laboratory examination, Hb:7.32 g/dl, platelets 78200/mm^3,C-Reactive protein 76.6mg/dl. On the second day of hospitalization, headache and aphasia were observed. Papil edema was revealed in neurological examination. MR venography was performed and revealed the right sigmoid sinus and superior sagittal sinus thrombosis.Thrombophilia panel, anti-cardiolipin IgM and G were negative, factor 5 Leiden and prothrombin gene mutation was not detected. MTHFR C677T polimorphism was found mutant, A1298C polimorphism was found normal. Homosistein level was 20.4 micromol (7-15 micromol/l). Hidration, acetazolamide and enoxaparine were given in treatment, Also folic acid and vitamin B12 support were started. Symptoms subsided within first week of treatment.

Discussion.There is a relationship between activity of inflamatory process and thromboembolic events but there were olso case reports describing the incidence of cerebral vein thrombosis (CVT) during the period of remission or preceding the diagnosis of disease by afew months.It is suggested that spesific coagulation abnormalities in IBD include elevated levels of Factor 5,7,8,fibrinogen and lipoprotein (a),reduction of antithrombin III ,protein C and S abnormalitiesand genetic factors, such as mutations in factor V Leiden ,prothrombin (G20210A) and methylenetetrahydfolate reductase(C677T) genes. Other risk factors that can contribute to the prothrombotic statein IBD nicotynism ,use of steroid,contraception,fluid depletion,prolonged immobilization,surgical treatment Vitamins B6,B12 and folate deficiency with secondary hyperhomocysteinemia.Accurate control of inflamatory process seems to be the key in reduction of the risk of thrombotic events.Additional reduction of modifiable risk factors suh as smoking is necessary.Treatment of thrombosis in IBD does not differ from standard therapy.Anticoagulants may lead to full revaskularization.Although CVT is a rare complication ,it may be devastating and therefore should be considered in a patient with focal neurological deficit and coexisting IBD.

COMPARISON OF THE POSSIBLE RISK FACTORS OF BONE MINERAL DENSITY IN PATIENTS WITH ULCERATIVE COLITIS AND HEALTHY SUBJECTS

G. KAYA,¹ E. KOÇAK,² E. AKBAL,² A. TAŞ,² S. KÖKLܲ

¹ Ankara Diskapi Education and Researching Hospital,

Date: 2014-12-28; view: 764