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Deeply infiltrating endometriosis is the clinical form of the disease that is generally associated with conditions of more intense pain and may require more complex surgical management, consequently resulting in greater risks to the patient. In recent years, various investigators have confirmed the usefulness of methods such as magnetic resonance imaging (MRI), transrectal ultrasound and transvaginal ultrasound (TVUS) for the diagnosis of deep endometriotic lesions. The objectives of the present study are to describe the method used to perform TVUS for the detection of deeply infiltrating endometriosis, and to discuss the clinical benefits that the data obtained may offer clinicians providing care for patients suspected of having this type of endometriosis.

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The hamartomatous polyps of Peutz-Jeghers Syndrome (PJS) can cause repeated episodes of rectal bleeding and intestinal subocclusion. Laparoscopic treatment of intussusception is rarely reported and must be considered for this clinical condition. We described a 35-year-old male with PJS who presented with rectal bleeding and abdominal pain. One duodenal polyp and two others in the jejunum, which caused intussusception, were visualized on preoperative investigation. Polyps were identified by laparoscopy and removed extracorporeally through enterotomies. All lesions were hamartomas. The patient was discharged on the third postoperative day and has been asymptomatic for more than 2 years. Laparoscopy allows an adequate access to explore and treat small bowel polyps and avoid the classic laparotomy.

Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. Robotic surgery is an attractive mode in performing minimally-invasive surgery once it has several advantages if compared to standard laparoscopic surgery. The aim of this paper is to report the first known case of colorectal resection surgery using the robotic assisted surgical device in Brazil. A 35-year-old woman with deep infiltrating endometriosis with rectal involvement was referred for colorectal resection using da Vinci surgical system. The authors also reviewed the most current series and discussed not only the safety and feasibility but also the real benefits of robotic colorectal surgery.

BACKGROUND: There are several therapeutic options for symptomatic hemorrhoids, from hygienic and dietary measures to conventional surgery. The best technique adopted for alternative and non-surgical treatment for intermediate grade (II and III) hemorrhoidal disease is rubber band ligation. More recently, the technique has been used with the aid of a gastroscope and a kit of elastic rubber bands for esophageal varices. This technique was called Endoscopic Rubber Band Ligation of hemorrhoids (ERBL). OBJECTIVE: The objective is Compare the results and the incidence of the immediate and late complications in patients undergoing ERBL. The satisfaction with the treatment of patients undergoing different number of rubber band ligatures were also analyzed. METHODS: This is a cohort study included patients undergoing ERBL from 2007 to 2014 at the hospital. The incidence of early and late complications and the satisfaction with the treatment of patients undergoing until two ligatures and patients undergoing three or more ligatures in the same procedure were compared. RESULTS: The study included 116 patients. The most frequently reported symptom was anal bleeding (n=72; 62.1%). The number of rubber band ligatures performed during the ERBL procedure varied from one to six; 84 (72,4%) patients had three or more rubber band ligatures performed during the procedure. No significant associations were observed between the incidence of early or late complications and satisfaction with ERBL among the group subjected until two rubber band ligatures or three or more rubber band ligatures. CONCLUSION: The endoscopic elastic ligation method proved to be a feasible, safe and efficient for the treatment of symptomatic hemorrhoidal disease grades II and III. The technique had moderate rates of immediate and late complications, but most of the complications are considered of low magnitude, easily resolved and without clinical repercussions, no matter how much ligations were performed in the same procedure.

-Background -Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. Aim -To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. Methods -Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. Results -Total colonoscopy was possible in 98.03% and ileum intubation in 88.23% of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54%, an inflammatory process of the mucosa in 21.56% and 5.88% of the patients mucosa was endoscopically normal. Conclusion -Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea. HEADINGS -Acquired immunodeficiency syndrome. Colitis. Cytomegalovirus infections. Diarrhea. Colonoscopy.

RESUMO -Racional -O envolvimento do septo retovaginal, reto e sigmóide pela endometriose pode causar sintomas intensos como dismenorréia, dor pélvica, dispareunia de profundidade, tenesmo e proctorragia cíclicos, em mulheres em idade reprodutiva. O diagnóstico pode ser suspeitado diante da história clínica típica e exame ginecológico adequado, ou ainda através de exame retal, enema opaco ou colonoscopia, entre outros. As indicações cirúrgicas, em geral, estão relacionadas à intensidade dos sintomas e falha no tratamento conservador. No entanto, o tratamento de escolha, para este tipo de endometriose, é a ressecção cirúrgica do tecido acometido, a fim de aliviar os sintomas e evitar progressão da doença. A localização correta assim como a avaliação da presença de extensão do processo em direção ao reto, ligamentos uterossacros ou septo retovaginal é extremamente importante para se garantir um tratamento cirúrgico eficaz. Objetivo -Descrever os principais aspectos relacionados à endometriose de septo retovaginal e fornecer aos cirurgiões gerais algumas informações específicas sobre esta enigmática doença. Conclusão -A endometriose de septo retovaginal é doença freqüente, de diagnóstico e tratamento específicos. DESCRITORES INTRODUÇÃOA endometriose é definida como a presença de tecido endometrial fora da cavidade uterina e afeta cerca de 10% a 15% das mulheres em idade reprodutiva (16) . Na década de 1990, o estudo da endometriose foi alvo de modif icações estratégicas a partir de sua crescente prevalência e complexidade que envolve seu diagnóstico e tratamento. A partir da descrição em 1992 da classificação da endometriose conforme sua profundidade (11) e da classificação em doenças distintas localizadas em ovário, peritônio e septo retovaginal (14) , atenção específica tem sido dada aos aspectos diagnósticos e terapêuticos da moléstia envolvendo esses três sítios.O acometimento do septo retovaginal representa o principal alvo de preocupações na atualidade com essa doença, uma vez que a intensidade dos sintomas e a dificuldade terapêutica são maiores com acometimento deste local. Tal fato motivou BROSENS e BROSENS (6) a sugerirem que a endometriose do septo retovaginal, assim como a doença que infiltra a bexiga ou até a própria adenomiose uterina, possui características diferentes do acometimento do peritônio e ovário, sendo lesões menos freqüentes, mais profundas, desenvolvem-se por metaplasia e não por implante, são em geral, mais sintomáticas, progressivas e menos responsivas à terapêutica hormonal.O conhecimento médico sobre endometriose é sustentado principalmente pelos estudos clínicos, laboratoriais, incluindo os imunológicos e os obtidos pela videolaparoscopia. Vários estudos têm tentado encontrar critérios prognósticos para a abordagem da doença. ENDOMETRIOSE DE SEPTO RETOVAGINALA endometriose do septo retovaginal foi inicialmente relatada por SAMPSON (20) , no início do século, que descreveu um processo aderencial extenso no fundo de saco posterior, obliterando sua porção inferior e unindo a cérvice ute...