RESUMO: O tumor de Buschke-Lowestein, também conhecido como condiloma acuminado gigante é uma lesão de aspecto verrucoso, extensa, envolvendo a região ano-genital. Não representa uma lesão maligna por critérios histológicos, embora exista claramente um potencial de malignização, e tenha um comportamento agressivo. Não existe um consenso sobre o seu tratamento, aventando-se o uso de drogas quimioterápicas aplicadas local ou sistematicamente, uso de imunoterapia, radioterapia e ressecções cirúrgicas amplas isoladas ou em combinação com outras terapias. Relatamos um caso onde a opção de tratamento foi o imiquimod creme 5%. A lesão envolvia musculatura esfincteriana e, sendo assim, a cirurgia acarretaria perda da continência fecal, causando ao paciente o ônus de um estoma definitivo. Após tratamento durante 20 semanas, o tumor apresentou regressão significativa de tamanho, sendo realizado excisão local da lesão residual com preservação esfincteriana. Descritores INTRODUÇÃOO condiloma acuminado gigante ou tumor de Buschke-Lowenstein (TBL) é uma forma rara de apresentação do condiloma acuminado anogenital, que por sua vez é uma doença sexualmente transmissível relacionada ao Papilomavírus humano (HPV) (1) . A descrição clássica do TBL é uma grande lesão vegetante, verrucosa, de aspecto exofítico. Possui um crescimento lento e a despeito das suas características histopatológicas demonstrarem tratar-se de um tumor benigno, tem um comportamento agressivo localmente (2) . Estas lesões podem ser consideradas também como lesões de risco para transformação e desenvolvimento de carcinoma escamo-celular. A melhor estratégia terapêutica no TBL não foi estabelecida. Têm sido usado agentes tópicos, imunoterapia, quimiorradioterapia e cirurgia. A cirurgia, isoladamente ou em conjunto com outros métodos, pode ocasionar ressecções extensas e a invasão do esfíncter anal pode levar a uma ressecção abdominoperineal. (4) Outra característica muito freqüente do TBL é a sua tendência em recidivar, com índices de recorrência em torno de 60%. O imiquimod é uma substância imunomoduladora que vem sendo usada no tratamento de lesões virais, capaz de potencializar a resposta imunológica ao HPV. (6) Por causa da extensão da doença deste paciente, optamos por iniciar o tratamento com imiquimod, e em de-

ObjectiveDetermine the variables associated with hospitalisations in patients with Crohn’s disease and those associated with surgery, intestinal resection, hospital readmission, need for multiple operations and immunobiological agent use.DesignA cross-sectional study was conducted from 2019 to 2021, using two centres for inflammatory bowel diseases in the Brazilian Public Health System.ResultsThis study included 220 patients. Only perianal disease was associated with hospitalisation (31.6% vs 13.0%, p=0.012). Stricturing or penetrating behaviour (35.8% vs 12.6%, p<0.001) and perianal disease (45.9% vs 9.9%, p<0.001) were associated with surgery. Ileal or ileocolonic location (80.0% vs 46.5%, p=0.044) and stricturing or penetrating behaviour (68.0% vs 11.2%, p<0.001) were associated with intestinal resection. Steroids use at first Crohn’s disease occurrence and postoperative complications were associated with hospital readmission and need for multiple operations, respectively. Age below 40 years at diagnosis (81.3% vs 62.0%, p=0.004), upper gastrointestinal tract involvement (21.8% vs 10.3%, p=0.040) and perianal disease (35.9% vs 16.3%, p<0.001) were associated with immunobiological agent use.ConclusionPerianal disease and stricturing or penetrating behaviour were associated with more than one significant outcome. Other variables related to Crohn’s disease progression were age below 40 years at diagnosis, an ileal or ileocolonic disease localisation, an upper gastrointestinal tract involvement, the use of steroids at the first Crohn’s disease occurrence and history of postoperative complications. These findings are similar to those in the countries with a high prevalence of Crohn’s disease.

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Background and Aims Fecal incontinence is an important complaint reported by patients with Crohn’s disease and it is associated with several disease-related mechanisms, including anorectal functional disorders. This study aimed to assess the anorectal function and clinical characteristics to identify parameters associated with fecal incontinence in Crohn’s disease patients. Methods This is a cross-sectional study of 104 patients with Crohn’s disease, aged 18 years or older, from a referral center between August 2019 and May 2021. Patients responded to a specific questionnaire, and underwent medical record review, proctological examination, and anorectal functional assessment with anorectal manometry. Results Of the 104 patients, 49% were incontinent. Patients with incontinence had a lower mean resting pressure (43.5 mmHg versus 53.1 mmHg; p = 0.038), lower mean squeeze pressure (62.1 mmHg versus 94.1 mmHg; p = 0.036), and lower maximum rectal capacity (140 ml versus 180 ml; p &lt; 0.001). Fecal incontinence was also associated with disease activity (p &lt; 0.001), loose stools (p = 0.02), perianal disease (p = 0.006), previous anoperineal surgery (p = 0.048), and the number of anorectal surgeries (p = 0.036). Conclusions This is the largest reported study describing manometric findings of Crohn’s disease patients with and without fecal incontinence. Our results identified an association between FI and functional disorders, in addition to clinical features in these patients. Functional assessment with anorectal manometry may help choose the best treatment for FI in patients with CD.

Objective: Currently, variables associated with Crohn’s disease progression remain insufficiently investigated in developing countries. Thus, this study aimed to determine the variables associated with hospitalizations in patients with Crohn’s disease and those associated with surgery, intestinal resection, hospital readmission, surgical recurrence, and immunobiological agent use.Results: A retrospective cross-sectional study was conducted from 2019 to 2021, using two centers for inflammatory bowel diseases in the Brazilian Public Health System. This study included 220 patients. Perianal disease was associated with hospitalization. Stricturing or penetrating behavior and perianal disease were associated with surgery. Ileal or ileocolonic location and stricturing or penetrating behavior were associated with intestinal resection. Furthermore, steroid use at first Crohn’s disease occurrence and postoperative complications were associated with hospital readmission and surgical recurrence, respectively. Age below 40 years at diagnosis, upper gastrointestinal tract involvement, and perianal disease were associated with immunobiological agent use. These findings are similar to those in the countries with a high prevalence of Crohn’s disease, and could be applicable in other developing countries. Knowing these variables is useful in identifying the severity profile of Crohn’s disease and selecting the most appropriate management and treatment.