BACKGROUND: In recent decades, magnetic resonance imaging (MRI) has gained prominence as a standard diagnostic method for preoperative assessment in patients with anorectal malformations and a colostomy, with the potential to replace the classic fluoroscopic distal pressure colostogram (FDPC). Three MRI techniques are available: MRI-distal pressure colostogram with gadolinium (MRI-DPCG) or saline (MRI-DPCS) instillation into the colostomy and native MRI without colostomy instillation. OBJECTIVE: To evaluate and compare the diagnostic accuracy of MRI (native MRI, MRI-DPCG and MRI-DPCS) in the preoperative workup of boys with an anorectal malformation and a colostomy and to compare it to FDPC. MATERIALS AND METHODS: Sixty-two boys with preoperative MRI using one of the three approaches and 43 with FDPC met the inclusion criteria for this retrospective study. The presence and localization of rectal fistulas according to the Krickenbeck classification were evaluated and compared with intraoperative findings. RESULTS: The accuracy of fistula detection for MRI in general (regardless of the technique), MRI-DPCS, MRI-DPCG, native MRI and FDPC was 95% (59/62, P<0.001), 100% (12/12, P=0.03), 100% (30/30, P<0.001), 85% (17/20, P=0.41) and 72% (31/43, P=0.82), respectively. The accuracy of describing fistula type in patients with a correctly detected fistula using these methods was 96% (45/47, P<0.001), 100% (9/9, P<0.001), 100% (23/23, P<0.001), 87% (13/15, P<0.001) and 67% (13/21, P=0.002), respectively. CONCLUSION: MRI is a reliable method for detecting and classifying fistulas in boys with an anorectal malformation and a colostomy and can be considered the modality of first choice for preoperative workup.

• MeSH
• Anorectal Malformations * diagnostic imaging   surgery   MeSH
• Colostomy MeSH
• Humans MeSH
• Magnetic Resonance Spectroscopy MeSH
• Magnetic Resonance Imaging methods   MeSH
• Rectal Fistula * surgery   MeSH
• Rectum diagnostic imaging   surgery   abnormalities   MeSH
• Retrospective Studies MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND AND OBJECTIVE: The benefits of the detection of clinically significant prostate cancer (csPCa) and safety of magnetic resonance imaging (MRI)-targeted transperineal (TP) prostate biopsy (TP-Tbx) versus transrectal (TR) approaches are still a matter of debate. This review aims to compare the efficacy and safety of TP-Tbx and MRI-targeted TR biopsy (TR-Tbx). METHODS: A systematic literature search was performed in PubMed/Medline, Scopus, and Web of Science to identify records of prospective randomized controlled trials (RCTs) comparing TP-Tbx and TR-Tbx published until May 2024. The primary outcomes included detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥2) and rates of complications. KEY FINDINGS AND LIMITATIONS: Three RCTs (PREVENT, ProBE-PC, and PERFECT) met the inclusion criteria. The TR technique was commonly administered with antibiotic prophylaxis to mitigate infection risks or after a rectal swab. No difference was found between TP-Tbx and TR-Tbx in terms of either csPCa (odds ratio [OR] 0.9, 95% confidence interval [CI]: 0.7-1.1) or ISUP 1 prostate cancer (PCa; OR 1.1, 95% CI: 0.8-1.4) detection. Postprocedural infection (OR 0.8, 95% CI: 0.4-1.8), sepsis (OR 0.6, 95% CI: 0.1-4.5), and urinary retention rates (OR 0.5, 95% CI: 0.1-1.6) were similar. Pain during the TP approach was slightly higher than during the TR approach, but after 7 d of follow-up, the differences between the two approaches were minimal. Variations in biopsy numbers per patient, patient selection, use of 5-alpha reductase inhibitors, needle sizes, TP techniques, and pain scores (reported in only one RCT), along with the multicenter nature of RCTs, limit the study. CONCLUSIONS AND CLINICAL IMPLICATIONS: TP-Tbx and TR-Tbx show similar results in detecting PCa, with comparable rates of infections, urinary retention, and effectiveness in managing biopsy-associated pain. TP-Tbx can safely omit antibiotics without increasing infection risk, unlike TR-Tbx. The tendency to exclude from practice TR-Tbx with prophylactic antibiotics due to infection concerns could be moderated; however, the directionality of some key outcomes, as infections and sepsis, favor the TP approach despite a lack of statistical significance. PATIENT SUMMARY: There were no significant differences in the prostate biopsy approaches (transperineal [TP] vs transrectal [TR]) for prostate cancer detection and complications. However, the MRI-targeted TP prostate biopsy approach may be advantageous as it can be performed safely without antibiotics, potentially reducing antibiotic resistance.

• MeSH
• Humans MeSH
• Magnetic Resonance Imaging, Interventional methods   MeSH
• Magnetic Resonance Imaging methods   MeSH
• Prostatic Neoplasms * pathology   MeSH
• Perineum * MeSH
• Prospective Studies MeSH
• Prostate * pathology   diagnostic imaging   MeSH
• Randomized Controlled Trials as Topic MeSH
• Rectum pathology   diagnostic imaging   MeSH
• Image-Guided Biopsy * methods   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Review MeSH
• Comparative Study MeSH
• Systematic Review MeSH

BACKGROUND AND OBJECTIVE: A notable paradigm shift has emerged in the choice of prostate biopsy approach, with a transition from transrectal biopsy (TRBx) to transperineal biopsy (TPBx) driven by the lower risk of severe urinary tract infections. The impact of this change on detection of clinically significant prostate cancer (csPCa) remains a subject of debate. Our aim was to compare the csPCa detection rate of TRBx and TPBx. METHODS: Patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies for clinically localized PCa at 15 European referral centers from 2016 to 2023 were included. A propensity score matching (PSM) analysis was performed to minimize selection biases. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). KEY FINDINGS AND LIMITATIONS: Of 3949 patients who met the study criteria, 2187 underwent TRBx and 1762 underwent TPBx. PSM resulted in 1301 matched pairs for analysis. Patient demographics and tumor characteristics were comparable in the matched cohorts. TPBx versus TRBx was associated with greater detection of csPCa, whether defined as International Society of Urological Pathology grade group ≥2 (51% vs 45%; OR 1.37, 95% CI 1.15-1.63; p = 0.001) or grade group ≥3 (29% vs 23%; OR 1.38, 95% CI 1.13-1.67; p = 0.001). Similar results were found when considering MRI-targeted biopsy alone and after stratifying patients according to tumor location, Prostate Imaging-Reporting and Data System score, and clinical features. Limitations include the retrospective nature of the study and the absence of centralized MRI review. CONCLUSIONS: Our findings bolster existing understanding of the additional advantages offered by TPBx. Further randomized trials to fully validate these findings are awaited. PATIENT SUMMARY: We compared the rate of detection of clinically significant prostate cancer with magnetic resonance imaging (MRI)-guided biopsies in which the sample needle is passed through the perineum or the rectum. Our results suggest that the perineal approach is associated with better detection of aggressive prostate cancer.

• MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging, Interventional methods   MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Prostatic Neoplasms * pathology   diagnostic imaging   MeSH
• Perineum * MeSH
• Prostate pathology   diagnostic imaging   MeSH
• Rectum * pathology   diagnostic imaging   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Image-Guided Biopsy * methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

• MeSH
• Leukemia, Myeloid, Acute * drug therapy   complications   MeSH
• Anti-Bacterial Agents adverse effects   therapeutic use   MeSH
• Drug Resistance, Microbial MeSH
• C-Reactive Protein analysis   MeSH
• Chemotherapy-Induced Febrile Neutropenia etiology   drug therapy   MeSH
• Soft Tissue Infections drug therapy   pathology   MeSH
• Carbapenems therapeutic use   MeSH
• Humans MeSH
• Adolescent MeSH
• Treatment Failure MeSH
• Disease Progression MeSH
• Pseudomonas aeruginosa * pathogenicity   drug effects   MeSH
• Rectum diagnostic imaging   pathology   MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Kolorektální trauma se v soudobých válečných konfliktech vyskytuje v 5–10 %. Nejčastější příčinou je střelné nebo střepinové poranění, kontuzně-lacerační mechanismus je ve válečné zóně ojedinělý. I přes moderní léčebné postupy je ale zatíženo vysokou mírou morbidity, zejména pokud není včas diagnostikováno a léčeno. Management chirurgické léčby upřesňují jednoduchá skórovací schémata – colon injury scale, rectal injury scale a Flintův skórovací systém. Resekční výkony tračníku s primární nebo odloženou anastomózou nemají vyšší riziko komplikovaného hojení a v dnešní době jsou upřednostňovány před konstrukcí terminálních stomií. Ty jsou indikovány při závažné oběhové nestabilitě při hemoragicko-traumatickém nebo septickém šoku s pokročilou difuzní peritonitidou. K traumatu intraperitoneálního segmentu rekta se přistupuje stejně jako k tračníku. Poranění extraperitoneálního rekta bez devastace měkkých tkání může být ošetřeno transanální suturou nebo i bez ní. Naopak devastující poranění rekta spolu s měkkými tkáněmi pánve se mají primárně zajistit derivační stomií a odloženou rekonstrukcí. Presakrální drenáž nebo laváž rekta již nejsou doporučovány.

The rate of colorectal trauma is 5–10 % in modern war conflicts. The most common causes include gunshots or shrapnel injuries; the contusion-laceration mechanism occurs in sporadic cases in the war zone. Despite modern surgical procedures, however, it is associated with a high rate of morbidity, especially if it is not diagnosed and treated in time. Surgical management is specified by simple scoring schemes – the colon injury scale, rectal injury scale and the Flint grading system. Colonic resection with primary or delayed anastomosis is not associated with a higher risk of complicated healing and is nowadays preferred over the construction of terminal stomas. These are indicated only for cases with severe hemodynamic instability in traumatic-hemorrhagic or septic shock with severe diffuse peritonitis. Trauma to the intraperitoneal segment of the rectum is treated in the same way as trauma to the colon. An extraperitoneal rectal injury without soft tissue devastation can be treated with or without a transanal suture. On the contrary, devastating injuries to the rectum including the pelvic soft tissues should be primarily controlled with a stoma with delayed reconstruction. Presacral drainage or rectal stump lavage are no longer recommended.

• MeSH
• Anastomosis, Surgical MeSH
• Colon surgery   diagnostic imaging   injuries   MeSH
• Humans MeSH
• Wounds, Penetrating * surgery   diagnostic imaging   MeSH
• Abdominal Injuries surgery   diagnostic imaging   MeSH
• Rectum surgery   diagnostic imaging   injuries   MeSH
• War-Related Injuries * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

1: ESGE suggests performing segmental biopsies (at least two from each segment), which should be placed in different specimen containers (ileum, cecum, ascending, transverse, descending, and sigmoid colon, and rectum) in patients with clinical and endoscopic signs of colitis.Weak recommendation, low quality of evidence. 2: ESGE recommends taking two biopsies from the right hemicolon (ascending and transverse colon) and, in a separate container, two biopsies from the left hemicolon (descending and sigmoid colon) when microscopic colitis is suspected.Strong recommendation, low quality of evidence. 3: ESGE recommends pancolonic dye-based chromoendoscopy or virtual chromoendoscopy with targeted biopsies of any visible lesions during surveillance endoscopy in patients with inflammatory bowel disease. Strong recommendation, moderate quality of evidence. 4: ESGE suggests that, in high risk patients with a history of colonic neoplasia, tubular-appearing colon, strictures, ongoing therapy-refractory inflammation, or primary sclerosing cholangitis, chromoendoscopy with targeted biopsies can be combined with four-quadrant non-targeted biopsies every 10 cm along the colon. Weak recommendation, low quality of evidence. 5: ESGE recommends that, if pouch surveillance for dysplasia is performed, visible abnormalities should be biopsied, with at least two biopsies systematically taken from each of the afferent ileal loop, the efferent blind loop, the pouch, and the anorectal cuff.Strong recommendation, low quality of evidence. 6: ESGE recommends that, in patients with known ulcerative colitis and endoscopic signs of inflammation, at least two biopsies be obtained from the worst affected areas for the assessment of activity or the presence of cytomegalovirus; for those with no evident endoscopic signs of inflammation, advanced imaging technologies may be useful in identifying areas for targeted biopsies to assess histologic remission if this would have therapeutic consequences. Strong recommendation, low quality of evidence. 7: ESGE suggests not biopsying endoscopically visible inflammation or normal-appearing mucosa to assess disease activity in known Crohn's disease.Weak recommendation, low quality of evidence. 8: ESGE recommends that adequately assessed colorectal polyps that are judged to be premalignant should be fully excised rather than biopsied.Strong recommendation, low quality of evidence. 9: ESGE recommends that, where endoscopically feasible, potentially malignant colorectal polyps should be excised en bloc rather than being biopsied. If the endoscopist cannot confidently perform en bloc excision at that time, careful representative images (rather than biopsies) should be taken of the potential focus of cancer, and the patient should be rescheduled or referred to an expert center.Strong recommendation, low quality of evidence. 10: ESGE recommends that, in malignant lesions not amenable to endoscopic excision owing to deep invasion, six carefully targeted biopsies should be taken from the potential focus of cancer.Strong recommendation, low quality of evidence.

• MeSH
• Endoscopy, Gastrointestinal * MeSH
• Colon diagnostic imaging   MeSH
• Humans MeSH
• Precancerous Conditions * MeSH
• Rectum diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: To demonstrate the use of a single-stapler technique during rectosigmoid resection in women with deep infiltrating endometriosis (DIE). DESIGN: A step-by-step video demonstration of rectosigmoid resection and end-to-end anastomosis using two circularly placed sutures and one circular stapler. SETTING: Institute for the Care of Mother and Child, Prague, Czech Republic. PATIENT(S): A 39-year-old woman presented with primary sterility and deep infiltrating endometriosis, and an EZIAN score of A2,B2,C3. A nodule was located 9 cm from the anus and was 38 × 9 mm in size. This included an intramural fibroma of 6 cm and a left-sided ovarian endometriotic cyst of 6 cm. Her pain on the visual analogue scale were dysmenorea 6, dyspareunia 5-6, dyschezie 7, dysuria 0, and acyclic pain 5. INTERVENTIONS: The primary objective was to replace the linear-stapler resection with two simple, strictly circularly placed sutures, to cut the intestinal wall between them, and to form the end-to-end anastomosis with a circular stapler. The one-stapler technique consisted of the following steps: intestinal wall cleansing as in the limited segmental resection; placement of one strictly circular suture just below the DIE nodule, without fixation; placement of the first circular suture just below the DIE nodule, ideally with at least three full-thickness "bites" of the intestinal wall; placement of the second circular stitch approximately 2 cm below the first one in a similar manner (three full-thickness "bites"); interruption of the intestinal wall with a harmonic scalpel; end-to-end intestinal anastomosis with a circular stapler; and airtightness test of the anastomosis. This results in only one incision line and therefore a lower risk of leakage. Intestinal resection time was on average 10 minutes longer compared to that for the linear stapler technique. So far, we have successfully performed the procedure in 25 women. Perioperative leakage was observed in two of these 25 patients in the classical procedure group and in none of the 25 patients in the group with the one-stapler technique. There were no differences in C-reactive protein (CRP) on third and fifth postoperative days or in other complications such as bleeding and pyrexia). The cost of procedure is lowered by the decrease in the number of staplers from 3 to 1. The patients' postoperative follow-up was uneventful, and they were discharged from the hospital at the same time as the women in whom the classical stapler technique was performed. MAIN OUTCOME MEASURES(S): The primary outcome was the development of a new surgical approach to resection rectosigmoid endometriotic nodules that would decrease the number of incision lines on the intestine. The secondary outcome measures were peri- and postoperative complications (i.e., bleeding, intestinal leakage, postoperative infection, CRP), length of the surgery and hospitalization, and cost of the procedure. CONCLUSION: Multiple incision lines following resection of the rectosigmoid colon and end-to-end anastomosis are risk factors for postoperative intestinal leakage. Therefore, a single incision line formed with two circular sutures, and one circular stapler may reduce the risk of postoperative complications and also financial expenses of the procedure. We believe that this method is suitable and easiest for nodules located less than 6 cm from the anal verge because of possible complications with angulation of linear stapler.

• MeSH
• Colon, Sigmoid diagnostic imaging   surgery   MeSH
• Adult MeSH
• Endometriosis diagnostic imaging   surgery   MeSH
• Laparoscopy methods   MeSH
• Humans MeSH
• Rectum diagnostic imaging   surgery   MeSH
• Suture Techniques * MeSH
• Sutures * MeSH
• Video-Assisted Surgery methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Video-Audio Media MeSH
• Journal Article MeSH
• Case Reports MeSH

OBJECTIVE: The TLR3/cGAS-STING-IFN signaling has recently been reported to be disturbed in colorectal cancer due to deregulated expression of the genes involved. Our study aimed to investigate the influence of potential regulatory variants in these genes on the risk of sporadic colorectal cancer (CRC) in a Czech cohort of 1424 CRC patients and 1114 healthy controls. METHODS: The variants in the TLR3, CGAS, TMEM173, IKBKE, and TBK1 genes were selected using various online bioinformatic tools, such as UCSC browser, HaploReg, Regulome DB, Gtex Portal, SIFT, PolyPhen2, and miRNA prediction tools. RESULTS: Logistic regression analysis adjusted for age and sex detected a nominal association between CRC risk and three variants, CGAS rs72960018 (OR: 1.68, 95% CI: 1.11-2.53, P-value = .01), CGAS rs9352000 (OR: 2.02, 95% CI: 1.07-3.84, P-value = .03) and TMEM173 rs13153461 (OR: 1.53, 95% CI: 1.03-2.27, P-value = .03). Their cumulative effect revealed a threefold increased CRC risk in carriers of 5-6 risk alleles compared to those with 0-2 risk alleles. Epistatic interactions between these genes and the previously genotyped IFNAR1, IFNAR2, IFNA, IFNB, IFNK, IFNW, IRF3, and IRF7 genes, were computed to test their effect on CRC risk. Overall, we obtained nine pair-wise interactions within and between the CGAS, TMEM173, IKBKE, and TBK1 genes. Two of them remained statistically significant after Bonferroni correction. Additional 52 interactions were observed when IFN variants were added to the analysis. CONCLUSIONS: Our data suggest that epistatic interactions and a high number of risk alleles may play an important role in CRC carcinogenesis, offering novel biological understanding for the CRC management.

• MeSH
• Adult MeSH
• Epistasis, Genetic * MeSH
• Genotyping Techniques MeSH
• Interferons genetics   MeSH
• Polymorphism, Single Nucleotide MeSH
• Carcinogenesis genetics   MeSH
• I-kappa B Kinase genetics   MeSH
• Cohort Studies MeSH
• Colon diagnostic imaging   pathology   MeSH
• Colonoscopy MeSH
• Colorectal Neoplasms diagnosis   genetics   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Membrane Proteins genetics   MeSH
• Adolescent MeSH
• Young Adult MeSH
• Nucleotidyltransferases genetics   MeSH
• Protein Serine-Threonine Kinases genetics   MeSH
• Gene Expression Regulation, Neoplastic * MeSH
• Rectum diagnostic imaging   pathology   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Signal Transduction genetics   MeSH
• Case-Control Studies MeSH
• Toll-Like Receptor 3 genetics   MeSH
• Computational Biology MeSH
• Healthy Volunteers MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH

PURPOSE: We aimed to evaluate the diagnostic performance of computed tomography colonography (CTC) in the detection of internal hemorrhoids. METHODS: Three gastroenterologists systematically reported on the presence of internal hemorrhoids in patients with incomplete colonoscopy, for whom they considered a subsequent CTC. For 44 patients with internal hemorrhoids revealed by optical colonoscopy, an age- and gender-matched cohort of 66 patients with normal findings in the rectum was selected. Endoluminal and transaxial CTC views of the rectum were evaluated for the presence of internal hemorrhoids, the anal verge prominence, asymmetry, and cushion-like appearance on a Likert scale by two experienced radiologists and two gastroenterologists. RESULTS: The sensitivity, specificity, and AUC for identification of internal hemorrhoids were 0.61 (95% CI, 0.53-0.68), 0.69 (95% CI, 0.63-0.75) and 0.66 (95% CI, 0.62-0.70), respectively. The radiologists showed a better specificity, the gastroenterologists a slightly better sensitivity. When only the rating "very likely" was considered as positive, the specificity rose to 0.89 (95% CI, 0.81-0.94) with a sensitivity of 0.50 (95% CI, 0.38-0.62). The interobserver agreement was fair. The best predictor of the presence of hemorrhoids was a prominent anal verge in the supine position (OR=1.789, 95% CI, 1.267-2.525). The difference between supine and prone positions in the evaluated features in patients with internal hemorrhoids was not significant. CONCLUSION: CTC has low sensitivity but high specificity in the detection of internal hemorrhoids, if the rater is confident in detecting them. Internal hemorrhoids do not substantially change their shape between prone and supine positions.

• MeSH
• Hemorrhoids diagnostic imaging   MeSH
• Colonography, Computed Tomographic methods   MeSH
• Humans MeSH
• Prospective Studies MeSH
• Rectum diagnostic imaging   MeSH
• Reproducibility of Results MeSH
• Aged MeSH
• Sensitivity and Specificity MeSH
• Sex Factors MeSH
• Age Factors MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Anorectal Malformations diagnostic imaging   MeSH
• Diagnostic Imaging methods   MeSH
• Child MeSH
• Hirschsprung Disease diagnostic imaging   MeSH
• Inflammatory Bowel Diseases diagnostic imaging   MeSH
• Humans MeSH
• Rectum * diagnostic imaging   MeSH
• Intestinal Obstruction diagnostic imaging   MeSH
• Intestine, Large * diagnostic imaging   MeSH
• Constipation diagnostic imaging   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Review MeSH