Rectal Bleeding Research Articles

Patterns of Care Following a Positive Fecal Blood Test for Colorectal Cancer: A Mixed Methods Study.

Multilevel barriers to colonoscopy after a positive fecal blood test for colorectal cancer (CRC) are well-documented. A less-explored barrier to appropriate follow-up is repeat fecal testing after a positive test. We investigated this phenomenon using mixed methods. This sequential mixed methods study included quantitative data from a large cohort of patients 50-89years from four healthcare systems with a positive fecal test 2010-2018 and qualitative data from interviews with physicians and patients. Logistic regression was used to evaluate whether repeat testing was associated with failure to complete subsequent colonoscopy and to identify factors associated with repeat testing. Interviews were coded and analyzed to explore reasons for repeat testing. A total of 316,443 patients had a positive fecal test. Within 1year, 76.3% received a colonoscopy without repeat fecal testing, 3% repeated testing and then received a colonoscopy, 4.4% repeated testing without colonoscopy, and 16.3% did nothing. Among repeat testers (7.4% of total cohort, N = 23,312), 59% did not receive a colonoscopy within 1year. In adjusted models, those with an initial positive test followed by a negative second test were significantly less likely to receive colonoscopy than those with two successive positive tests (OR 0.37, 95% CI 0.35-0.40). Older age (65-75 vs. 50-64years: OR 1.37, 95% CI 1.33-1.41) and higher comorbidity score (≥ 4 vs. 0: OR 1.75, 95% CI 1.67-1.83) were significantly associated with repeat testing compared to those who received colonoscopy without repeat tests. Qualitative interview data revealed reasons underlying repeat testing, including colonoscopy avoidance, bargaining, and disbelief of positive results. Among patients in this cohort, 7.4% repeated fecal testing after an initial positive test. Of those, over half did not go on to receive a colonoscopy within 1year. Efforts to improve CRC screening must address repeat fecal testing after a positive test as a barrier to completing colonoscopy.

Case Report of Multiple Rectosigmoid Adenomatous Polyps and Its Management i.e. Transanal Endoscopic Microsurgery

Adenomatous polyps in the colorectal region are prevalent. On account of its rarity and effective excision using Transanal Endoscopic Microsurgery (TEM) with assistance from a Covidien Small Incision Laparoscopic System (SILS) Port, we present this case of an adenomatous polyp wherein the patient complaints of per rectal bleed. Most frequently asymptomatic, adenomatous polyps are the most prevalent. In the present case, five to six polyps were found in the rectosigmoid area during colonoscopy. Rectal bleeding, stomach pain, and changes in bowel function that have a high malignant potential are the most typical symptoms associated with polyps. Large rectal adenomas should only be treated with TEM at this time, and traditional Trans Endoscopic (EMR/ESD) should be stopped. Despite the availability of newer procedures like endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), TEM is still the method of choice. TEM is not recorded in our country up till now. This is the first time it is performed in our country. Keywords: Adenomatous Polyp; Transanal Endoscopic Microsurgery; Small Incision Laparoscopic System; Endoscopic Mucosal Resection; Endoscopic Submucosal Dissection

Aegeline attenuates TNBS-induced colitis by suppressing the NFƙB-mediated NLRP3 inflammasome pathway in mice.

A chronic inflammatory condition of the intestine, ulcerative colitis (UC), is challenging to successfully manage once diagnosed. Currently, available medical therapies for UC exhibit minimal efficacy with unacceptable side effects, while inventive biological agents are expensive and yetnotwell accepted by patients. Discovering more effective and safer treatments to treat UC is therefore essential. One of the primary alkaloids found in Aegle marmelos, aegeline, has anti-inflammatory and antioxidant properties as well as being able to suppress severalpro-inflammatory cytokines responsible for inflammation. The study aimed to investigate the effectiveness of aegeline in alleviating 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis through the NFƙB-mediated NLRP3 inflammasome pathway. Mice were randomly allocated into six groups, Normal control (NC), Model control (MC-TNBS, 2,4,6-trinitrobenzene sulfonic acid), STD (TNBS + sulfasalazine 100mg/kg), AG1, AG2, and AG3 (TNBS + aegeline 5, 10, 20mg/kg) respectively. Physical parameters such as a change in body weight, stool consistency, rectal bleeding, colon length, myeloperoxidase (MPO) levels and nitric oxide (NO) levels, and disease activity index (DAI) were assessed and supporting gene expression studies of various pro-inflammatory cytokines and enzymes were evaluated and histopathological changes observed. Administration of aegeline (10, 20mg/kg) was found to be effective in colon protection by lowering the disease activity score and myeloperoxidase level and improving other physical parameters. Aegeline in high dose significantly downregulated the gene expression of NFƙB, iNOS, COX-2, NLRP3, IL-1β, and IL-18, conferring great anti-inflammatory potential. Suggestive of the findings, aegeline reduced the damage to the colon by downregulating transcriptional genes and enzymes leading to inflammation and mitigated TNBS-induced colitis probably through the NFƙB-mediated NLRP3 inflammasome pathway.

Case report: the role of transcatheter arterial embolization in the management of gastrointestinal bleeding

Introduction: Rectal bleeding is a common cause of chronic bleeding in hospitals. It can lead to anemia and affect a person's quality of life. To treat chronic hemorrhoidal disease, rectal artery embolization is safe, efficient, and minimally invasive, allowing for arterial rectal embolization. In this case report, we aimed to present a rectal bleeding case that has been well managed by using transcatheter arterial embolization. Case Presentation: A 20-year-old male patient came with complaints of haematochezia and anemia that had been felt for 2 days. The patient came to the emergency department of Prof. Ngoerah General Hospital, and lab tests and vital signs were carried out, which resulted in a hemoglobin of around 2.5 g/dl and a significantly decreased blood pressure of 95/65mmHg. If necessary, the patient was referred to interventional radiology for digital subtraction angiography and embolization. Conclusion: Transcatheter arterial embolization is an effective treatment option. It has few side effects, causes minimal blood loss, and shortens hospital stays.

Factors Associated with Cytomegalovirus (CMV) Procto-Colitis in Immunocompetent Adults: A Systematic Review

Objective: The pathophysiology of CMV procto-colitis in immunocompetent adults is poorly understood. We aimed to systematically review the literature to explore factors, presenting symptoms and endoscopy findings associated with CMV procto-colitis in immunocompetent adults. Methods: Following PRISMA guidelines, we conducted a narrative systematic review by searching MEDLINE, EMBASE, EMCARE and CINAHL for manuscripts published up to August 2023. One author screened manuscript abstracts; two authors independently conducted a full text review. We included manuscripts which included primary data of immunocompetent adults with CMV procto-colitis except case reports. Quality and risk of bias was assessed independently by two authors using the Joanna Briggs institute critical appraisal tools. Results: 8 manuscripts were included in the final review from the USA (n=2), China (n=2), Korea (n=2), India (n=1) and Brazil (n=1) and consisted of 6 case series, one case-control study and one cross-sectional study published between 1988-2022. We identified demographic and behavioural factors (older age, lower BMI, receptive anal sex), infection factors (urinary tract infections, shigellosis, Hepatitis C, COVID-19, sepsis, antimicrobial use), medical conditions (cardiovascular disease, respiratory disease, renal disease, auto-immune disease, diabetes) and hospitalisation factors (intensive care admission, longer length of hospital stay) associated with CMV procto-colitis in immunocompetent adults. Patients presented with rectal bleeding, diarrhoea, melaena, fever, nausea/vomiting, abdominal pain/bloating and constipation. Large bowel endoscopy findings were ulcers, erosions, and erythema and polyp/mass lesions. Conclusion: We have highlighted factors, presenting symptoms and endoscopy findings associated with CMV procto-colitis in immunocompetent patients which provides insight for clinical guideline development and future research.

Snapshot Audit Early Onset Colorectal Cancer (EOCC) – What is the Current Situation in Switzerland?

Abstract Background Early onset colorectal cancer (EOCC), defined as colorectal cancer (CRC) ≤ 50 years, has seen an alarming rising incidence in western countries. Aims This research aims to determine the current state of incidence, symptoms, diagnostic methods, and treatment approach in EOCC compared to late onset CRC (LOCRC) in the extended Northwestern Switzerland. Methods Patients seeking care for CRC between April-November 2023 were enrolled in a prospective multicenter (11 hospitals within extended Northwestern Switzerland) observational cohort study. Information was collected using questionnaires and patient charts. Results We included 315 patients, thereof 38 (10.8%) EOCC. In total 211 (58.9%) patients were male, mean age was 42.5 and 71.2 years, respectively. Rectal bleeding was the main symptom in both groups (60.5% vs 37.0%), followed by change in bowel habits in EOCC and fatigue in LOCRC without reaching significance. Rectal bleeding and mucous, abdominal pain, change of bowel habits and bloating were significantly more often in EOCC. Significantly more LOCRC patients stated that their physical condition affected sexual erection and social interaction, whereas in EOCC, family life was significantly affected. For both groups, endoscopy was the leading diagnostic tool. EOCC had a diagnostic delay of 6.5 weeks compared to their counterparts. No difference in frequency of neoadjuvant treatment, surgical approach or need for emergency surgery was observed. In EOCC, a trend to more lymph node retrieval was observed and significantly more EOCC received an ostomy. Postoperatively, significantly more EOCC than LOCRC patients received adjuvant chemotherapy (55.6 % vs 28.6 %). Conclusion Our analysis illustrates the current standard-of-care of EOCC in the extended Northwestern Switzerland. EOCC compared to LOCRC patients present themselves differently to the medical community, leading to a different approach to their symptoms, which eventually results in a delayed diagnosis. Based on these results, it is time to foster awareness and start redefining national screening criteria.

Colonic Cancer in Occlusion: A Case Report of 70 Patients Experience of the Visceral Surgery Department at the Moulay Ismail Military Hospital in Meknes, Sidi Mohamed Ben Abdallah University in Fez

Occlusive colon cancer is a serious condition, as it combines two very serious pathologies: cancer and acute intestinal obstruction. Colon cancer is a malignant proliferative neoformation developed at the expense of the colonic wall. Colonic obstruction is defined as the interruption of normal intestinal transit, and represents the mode of revelation in 8 to 29% of colon cancers. Occlusion is the most common complication of colonic cancer, either as a result of the disease or as it progresses, accounting for 15-30% of cases. Occluded colon cancer poses a twofold problem:  On the one hand, occlusion and its potential repercussions, particularly of a general or upstream intestinal nature.  On the other hand, it reveals a late diagnosis most often associated with a locally advanced or metastatic tumour. Our study concerns 70 cases of colonic cancer in occlusion diagnosed and treated in the visceral surgery department of the Moulay Ismail Military Hospital in Meknes, over 5 years from 01 January 2019 to 31 December 2023. The aims of our retrospective study are:  Evaluate the proportion of this complication that is indicative of colonic tumour pathology.  To review the range of surgical and non-surgical techniques available.  To establish guidelines for dealing with this type of complication in order to minimise morbidity and mortality. Our series includes 46 men and 24 women with a sex ratio of 1.9 aged between 35 and 86 years, who presented to the emergency department after an average delay of 07 days with extremes of 03 days and 08 days, with an occlusive syndrome (78.6%), sub-occlusive syndrome (21.4%), abdominal pain (95.7%), transit disorders (82.9%), vomiting (75.7%) and rectal bleeding (72.9%). The clinical examination revealed weight loss in 49 patients (70%); abdominal distension in all our patients (100%); and an empty rectal ampulla in all our patients (100%). All our patients underwent PSA, which revealed colonic NHA in 81.4% of cases, .......

The Role of Artificial Intelligence in the Diagnosis and Treatment of Ulcerative Colitis.

This review aims to delve into the role of artificial intelligence in medicine. Ulcerative colitis (UC) is a chronic, inflammatory bowel disease (IBD) characterized by superficial mucosal inflammation, rectal bleeding, diarrhoea and abdominal pain. By identifying the challenges inherent in UC diagnosis, we seek to highlight the potential impact of artificial intelligence on enhancing both diagnosis and treatment methodologies for this condition. A targeted, non-systematic review of literature relating to ulcerative colitis was undertaken. The PubMed and Scopus databases were searched to categorize a well-rounded understanding of the field of artificial intelligence and its developing role in the diagnosis and treatment of ulcerative colitis. Articles that were thought to be relevant were included. This paper only included articles published in English. Artificial intelligence (AI) refers to computer algorithms capable of learning, problem solving and decision-making. Throughout our review, we highlighted the role and importance of artificial intelligence in modern medicine, emphasizing its role in diagnosis through AI-assisted endoscopies and histology analysis and its enhancements in the treatment of ulcerative colitis. Despite these advances, AI is still hindered due to its current lack of adaptability to real-world scenarios and its difficulty in widespread data availability, which hinders the growth of AI-led data analysis. When considering the potential of artificial intelligence, its ability to enhance patient care from a diagnostic and therapeutic perspective shows signs of promise. For the true utilization of artificial intelligence, some roadblocks must be addressed. The datasets available to AI may not truly reflect the real-world, which would prevent its impact in all clinical scenarios when dealing with a spectrum of patients with different backgrounds and presenting factors. Considering this, the shift in medical diagnostics and therapeutics is coinciding with evolving technology. With a continuous advancement in artificial intelligence programming and a perpetual surge in patient datasets, these networks can be further enhanced and supplemented with a greater cohort, enabling better outcomes and prediction models for the future of modern medicine.

Solitary rectal ulcer syndrome in a teenage patient, an unrecognized cause of rectal bleeding: A case report

Not available

Lactobacillus paracasei Jlus66 relieves DSS-induced ulcerative colitis in a murine model by maintaining intestinal barrier integrity, inhibiting inflammation, and improving intestinal microbiota structure.

Ulcerative colitis (UC) is a serious health problem with increasing morbidity and prevalence worldwide. The pathogenesis of UC is complex, currently believed to be influenced by genetic factors, dysregulation of the host immune system, imbalance in the intestinal microbiota, and environmental factors. Currently, UC is typically managed using aminosalicylates, immunosuppressants, and biologics as adjunctive therapies, with the risk of relapse and development of drug resistance upon discontinuation. Therefore, further research into the pathogenesis of UC and exploration of potential treatment strategies are necessary to improve the quality of life for affected patients. According to previous studies, Lactobacillus paracasei Jlus66 (Jlus66) reduced inflammation and may help prevent or treat UC. We used dextran sulfate sodium (DSS) to induce a mouse model of UC to assess the effect of Jlus66 on the progression of colitis. During the experiment, we monitored mouse body weight, food and water consumption, as well as rectal bleeding. Hematoxylin-eosin staining was performed to assess intestinal pathological damage. Protein imprinting and immunohistochemical methods were used to evaluate the protein levels of nuclear factor-kappa B (NF-κB), mitogen-activated protein kinase (MAPK), and tight junction (TJ) proteins in intestinal tissues. Fecal microbiota was analyzed based on partial 16S rRNA gene sequencing. Jlus66 supplementation reduced the degree of colon tissue damage, such as colon shortening, fecal occult blood, colon epithelial damage, and weight loss. Supplementation with Jlus66 reduced DSS-induced upregulation of cytokine levels such as TNF-α, IL-1β, and IL-6 (p < 0.05). The NF-κB pathway and MAPK pathway were inhibited, and the expression of TJ proteins (ZO-1, Occludin, and Claudin-3) was upregulated. 16S rRNA sequencing of mouse cecal contents showed that Jlus66 effectively regulated the structure of the intestinal biota. In conclusion, these data indicate that Jlus66 can alter the intestinal biota and slow the progression of UC, providing new insights into potential therapeutic strategies for UC.

Chronic radiation proctitis refractory to steroid enema was successfully treated by metformin and sodium butyrate: a case report

BackgroundRadiation proctitis (RP) is a significant complication of pelvic radiation. Effective treatments for chronic RP are currently lacking. We report a case where chronic RP was successfully managed by metformin and butyrate (M-B) enema and suppository therapy.Case presentationA 70-year-old Asian male was diagnosed with prostate cancer of bilateral lobes, underwent definitive radiotherapy to the prostate of 76 Gy in 38 fractions and six months of androgen deprivation therapy. Despite a stable PSA nadir of 0.2 ng/mL for 10 months post-radiotherapy, he developed intermittent rectal bleeding, and was diagnosed as chronic RP. Symptoms persisted despite two months of oral mesalamine, mesalamine enema and hydrocortisone enema treatment. Transition to daily 2% metformin and butyrate (M-B) enema for one week led to significant improvement, followed by maintenance therapy with daily 2.0% M-B suppository for three weeks, resulting in continued reduction of rectal bleeding. Endoscopic examination and biopsy demonstrated a good therapeutic effect.ConclusionsM-B enema and suppository may be an effective treatment for chronic RP.

Anorectal Melanoma: A Case Report

Anorectal melanoma is a rare and aggressive form of mucosal melanoma that is difficult to diagnose early due to nonspecific symptoms like rectal/anal bleeding, anal pain, or the presence of an anal mass. Its prognosis is generally poor, with most cases already metastasized at diagnosis. A case report is presented of a patient initially presenting with anaemia, painful defecation and rectal bleeding, later diagnosed with stage IV anorectal melanoma. There is limited literature on this disease, leading to a lack of comprehensive understanding. Surgical resection is the main treatment, but over 80% of patients die within five years due to distant metastasis. The 5-year survival rate is estimated to be between 6% and 22%. Keywords: Anorectal, Melanoma, mucosa

MiR-146a alleviates inflammatory bowel disease in mice through systematic regulation of multiple genetic networks.

Inflammatory bowel disease (IBD) is a chronic disease involving multiple genes, and the current available targeted drugs for IBD only deliver moderate efficacy. Whether there is a single gene that systematically regulates IBD is not yet known. MiR-146a plays a pivotal role in repression of innate immunity, but its function in the intestinal inflammation is sort of controversy, and the genetic regulatory networks regulated by miR-146a in IBD has not been revealed. RT-qPCR was employed to detect the expression of miR-146a in IBD patients and in a mouse IBD model induced by dextran sulfate sodium (DSS), and then we generated a miR-146a knock-out mouse line with C57/Bl6N background. The disease activity index was scored in DSS-treated miR-146a deficiency mice and their wild type (WT) littermates. Bulk RNA-sequencing, RT-qPCR and immunostaining were done to illustrate the downstream genetic regulatory networks of miR-146a in flamed colon. Finally, the modified miR-146a mimics were used to treat DSS-induced IBD in miR-146a knock-out and WT IBD mice. We showed that the expression of miR-146a in the colon was elevated in dextran sulfate sodium (DSS)-induced IBD mice and patients with IBD. DSS induced dramatic body weight loss and more significant rectal bleeding, shorter colon length, and colitis in miR-146a knock-out mice than WT mice. The miR-146a mimics alleviated DSS-induced symptoms in both miR-146a-/- and WT mice. Further RNA sequencing illustrated that the deficiency of miR-146a de-repressed majority of DSS-induced IBD-related genes that cover multiple genetic regulatory networks in IBD, and supplementation with miR-146a mimics inhibited the expression of many IBD-related genes. Quantitative RT-PCR or immunostaining confirmed that Ccl3, Saa3, Csf3, Lcn2, Serpine1, Serpine2, MMP3, MMP8, MMP10, IL1A, IL1B, IL6, CXCL2, CXCL3, S100A8, S100A9, TRAF6, P65, p-P65, and IRAK1 were regulated by miR-146a in DSS induced IBD. Among them, MMP3, MMP10, IL6, IL1B, S100A8, S100A9, SERPINE1, CSF3, and IL1A were involved in the active stage of IBD in humans. Our date demonstrated that miR-146a acts as a top regulator in C57/BL6N mice to systematically repress multiple genetic regulatory networks involved in immune response of intestine to environment factors, and combinatory treatment with miR-146a-5p and miR-146a-3p mimics attenuates DSS-induced IBD in mice through down-regulating multiple genetic regulatory networks which were increased in colon tissue from IBD patients. Our findings suggests that miR-146a is a top inhibitor of IBD, and that miR-146a-5p and miR-146a-3p mimics might be potential drug for IBD.

Resolution of rectal bleeding by day 7 in acute severe ulcerative colitis is prognostic for post-discharge corticosteroid free clinical remission and endoscopic improvement.

This study assesses two different disease activity measures, the MTWSI and the partial Mayo score, in hospitalized acute severe UC patients for prediction of post-discharge corticosteroid-free clinical remission and endoscopic improvement to help guide future considerations for disease activity assessment. In this post-hoc analysis from the TRIUMPH trial, these results suggest resolution of Mayo rectal bleeding sub-score may have high prognostic utility and could be considered as a primary endpoint for hospitalized UC trials. The study underscores the need for further research on patient-reported outcomes and endoscopic indices in larger populations for inpatient UC trials.

Differential efficacy of medical therapies for ulcerative colitis according to disease extent: patient-level analysis from multiple randomized controlled trials

Disease extent in Ulcerative Colitis (UC) has prognostic implications for disease course. It is unclear whether the efficacy of medical therapies for moderate to severely active UC vary according to disease extent at enrollment. We analyzed patient level data from 11 Phase 2 and 3 clinical trials of advanced therapies in patients with moderate-to-severe UC to assess modifications of advanced therapy effects by disease extent. Primary outcome was clinical response and secondary outcomes were clinical remission, endoscopic response/remission and endoscopic improvement, and Mayo clinic subscore for both induction and maintenance studies. Binary and continuous outcomes were analyzed using the modified Poisson regression model and the mixed-effects model, respectively, adjusting for age, sex, disease duration, concomitant steroid use and prior anti-TNF use. Effect modifications with binary outcomes were quantified by ratios of risk ratio for left-sided to that for extensive colitis while effect modifications with the Mayo subscores were quantified by differences of the differences between mean scores of the left-sided and extensive colitis. Results were presented with point estimates and 95% confidence intervals as well as p-values. Eleven clinical trials enrolling 5450 UC patients (infliximab=2, adalimumab=2, golimumab=2, vedolizumab=2, tofacitinib=3) were included. In induction trials, there was evidence to suggest effect modification by disease extent for clinical response with tofacitinib (the ratio of RRs 0.67, 95% CI [0.45, 0.99], p=0.049) and clinical remission with infliximab (ratio of RRs 0.33, 95% CI [0.13, 0.85], p=0.020) favoring patients with extensive colitis. There was no evidence to suggest effect modification for endoscopic improvement and clinical outcomes. There was evidence to suggest effect modification by disease extent for clinical remission with tofacitinib (ratio of RRs 0.44, 95% CI [0.22, 0.89], p=0.020) favoring patients with extensive colitis. For symptom subscores from the Mayo Clinic score, tofacitinib was associated with a greater reduction in both stool frequency (difference of differences 0.37, 95% CI [0.08, 0.65], p=0.012) and rectal bleeding scores (difference of differences 0.25, 95% CI [0.03, 0.47], p=0.026) in patients with extensive colitis compared to left sided. These findings underscore the possibility of differential efficacy of medical therapies according to disease distribution. These results warrant further exploration in forthcoming trials to better inform treatment strategies and consideration of disease distribution as a baseline stratification factor in clinical trials. This study did not receive any financial support.

Clinical Outcomes Before and After Prucalopride Treatment: An Observational Study in Patients With Chronic Idiopathic Constipation in the United States.

This real-world US-based claims study compared constipation-related symptoms and complications 6 months before and after prucalopride initiation in adults with chronic idiopathic constipation (CIC). This observational, retrospective cohort analysis used the IBM MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental Database (January 2015-June 2020). Prucalopride-treated patients (≥18 years old) who had ≥1 constipation-related International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD-10-CM ) diagnosis code during the baseline or study period were included. The proportions of patients with constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, perianal/perirectal abscess, and rectal bleeding) were examined. Constipation-related symptoms and complications were identified using ICD-10-CM , ICD-10 - Procedure Coding System , or Current Procedural Terminology codes. Data were stratified by age (overall, 18-64 years, and ≥65 years). This study included 690 patients: The mean (SD) patient age was 48.0 (14.7) years, and 87.5% were women. The proportions of patients overall with constipation-related symptoms decreased 6 months after prucalopride initiation (abdominal pain [50.4% vs 33.3%, P < 0.001]; abdominal distension [gaseous] [23.9% vs 13.3%, P < 0.001]; and nausea [22.6% vs 17.7%, P < 0.01]; no improvements observed for incomplete defecation). Similarly, the proportions of patients overall with constipation-related complications decreased 6 months after prucalopride initiation (intestinal obstruction [4.9% vs 2.0%, P < 0.001]; hemorrhoids [10.7% vs 7.0%, P < 0.05]; and rectal bleeding [4.1% vs 1.7%, P < 0.05]). This study suggests that prucalopride may be associated with improved constipation-related symptoms and complications 6 months after treatment initiation.

Small Cell Carcinoma of Rectum - An Infrequent Aggressive Tumor

We report the case of a 63 year old man with small cell carcinoma of rectum. He presented with occasional rectal bleed, anal verge pain and generalized weakness. Colonoscopy revealed an ulcerated growth in proximal rectum. Endoscopic biopsy revealed poorly differentiated carcinoma. Laparoscopic anterior resection was done and histopathogical examination along with IHC confirmed small cell carcinoma(SCC). Colorectal SCC is a rare and aggressive tumor.

Arterial Embolization as a Prominent Option in the Treatment of Hemorrhoid Diseases

Hemorrhoidal disease (HD) is the most common anorectal disease, affecting millions of people worldwide. The most common clinical picture is rectal bleeding, which significantly impairs the quality of life of patients. Treatment of HD varies from diet and lifestyle changes to radical surgery, depending on the degree and severity of symptoms. Endovascular embolization of superior rectal artery (SRA), known as emborrhoid technique, has recently emerged as a promising minimally invasive approach. Because hemorrhoidal plexuses are almost entirely fed through the SRA. They are also fed less by middle rectal artery (MRA) and rarely inferior rectal artery (IRA). Due to some anastomoses and unpredictable variations, vascular structures must be examined before the procedure. So far, there have been reports of studies involving a small number of patients regarding the use of coils and particles as embolization agents. Some of these used particles and coils alone, while others used a combination of particles and/or coils. The studies demonstrated similar clinical efficacy with satisfactory results, and no significant complications such as ischemic necrosis were observed. The use of liquid embolic agents such as N-butyl-cyanoacrylate (NBCA) and ethylene vinyl alcohol copolymer (EVOH) has also recently been suggested to be effective. In conclusion, the current data support the feasibility, effectiveness, and safety of rectal artery embolization for hemorrhoidal disease. However, there is no guideline or consensus in the selection of embolic materials. More randomized controlled studies are needed. This review aims to evaluate the effectiveness and feasibility of embolization applications in hemorrhoidal diseases.

Chronic diarrhea secondary to intestinal spirochetosis, should we think about it?

Abstract Human intestinal spirochetosis (HIS) is defined as a colonization of the apical membrane of the colonic mucosa and the appendix by spirochetes. It is a very rare finding, being more common in some populations (individuals living in villages and peri-urban environments in developing countries, recent immigrants from developing countries, men who have sex with other men and HIV positive patients), but the spirochete rarely is investigated as human enteric potential microorganism. It is a slow-growing microorganism and has specialized growth requirements, which is why it is not detectable in human fecal samples using routine diagnostic methods. However, it has been histologically identified attached to the colon and rectum in patients with conditions such as chronic diarrhea, rectal bleeding, and/or nonspecific abdominal discomfort. In this article we present the case of a patient with chronic diarrhea secondary to intestinal spirochetosis, highlighting the importance of considering this etiology in the differential diagnosis.

Neuroendocrine Carcinoma of the Rectum as a Cause of Acute Obstructive Abdomen. Case Report and Literature Review

Rectal neuroendocrine carcinoma, though rare, is experiencing an increase in its incidence, representing approximately 1% of all colorectal cancers. A growth in its incidence has been observed in recent decades, albeit with varying figures geographically. Research studies such as those by Dasari et al. (2017) and Scherübl et al. (2014) have indicated a significant rise in the incidence of these tumors, especially in the United States and Europe. Although it can manifest in different age groups, it is more common in middle-aged or older adults, without a clear gender predilection. Symptoms may include changes in bowel habits, rectal bleeding, abdominal pain, unexplained weight loss, and fatigue, varying according to the degree of tumor differentiation and the presence of metastasis. We present the case of a 65-year-old woman who presented with obstructive symptoms and was subsequently found to have neuroendocrine tumor post-surgery.