{"id":4546,"date":"2018-05-25T09:00:41","date_gmt":"2018-05-25T09:00:41","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=4546"},"modified":"2024-06-04T19:41:14","modified_gmt":"2024-06-04T19:41:14","slug":"pseudolipomatose-de-colon","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/pseudolipomatose-de-colon\/","title":{"rendered":"Pseudolipomatose de c\u00f3lon"},"content":{"rendered":"

Introdu\u00e7\u00e3o e etiopatologia<\/strong><\/h2>\n

A pseudolipomatose do c\u00f3lon foi descrita pela primeira vez em 1985(1) e desde ent\u00e3o, diferentes patogenias foram postuladas para esta condi\u00e7\u00e3o, incluindo penetra\u00e7\u00e3o intramucosa do ar durante insufla\u00e7\u00e3o (barotrauma), bi\u00f3psias ou outros procedimentos.<\/p>\n

No entanto, evid\u00eancias mostraram sua associa\u00e7\u00e3o com colite qu\u00edmica causada pelo per\u00f3xido de hidrog\u00eanio (H2<\/sub>O2<\/sub>) ap\u00f3s desinfec\u00e7\u00e3o com \u00e1cido perac\u00e9tico. Quando o \u00e1cido perac\u00e9tico se dissolve em \u00e1gua, ele se decomp\u00f5e em per\u00f3xido de hidrog\u00eanio e \u00e1cido ac\u00e9tico, que, por sua vez, se transforma em \u00e1gua, oxig\u00eanio e di\u00f3xido de carbono. Assim, o per\u00f3xido de hidrog\u00eanio resultante induz colite qu\u00edmica causada pela irrita\u00e7\u00e3o direta da mucosa(2).<\/p>\n

Entretanto, h\u00e1 dois relatos na literatura que descreveram seu aparecimento ap\u00f3s desinfec\u00e7\u00e3o de alto n\u00edvel com \u00e1gua \u00e1cida eletrolisada(3) e Sterilox\u00a0(\u00e1gua super oxidada)(4); sua patog\u00eanese \u00e9 incerta, pois sabe-se, que, em ambos, n\u00e3o h\u00e1 produ\u00e7\u00e3o do per\u00f3xido de hidrog\u00eanio.<\/p>\n

Endoscopia<\/strong><\/h2>\n

Endoscopicamente, caracterizam-se por placas elevadas, tipicamente esbranqui\u00e7adas ou branco-amareladas, aderentes, m\u00faltiplas e isoladas, tamb\u00e9m denominadas de \u201csnow white sign\u201d ou \u201cfrozen sign\u201d. Seus tamanhos variam de mil\u00edmetros a cent\u00edmetros e s\u00e3o encontradas tanto no c\u00f3lon esquerdo quanto no direito.<\/p>\n

\"\"<\/a>\"\"<\/a><\/p>\n

Mecanismos de contato<\/strong><\/h2>\n

H\u00e1 dois mecanismos poss\u00edveis de contato da subst\u00e2ncia com a mucosa, ambos em decorr\u00eancia da utiliza\u00e7\u00e3o de aparelhos n\u00e3o enxaguados adequadamente:<\/p>\n

    \n
  1. ap\u00f3s irriga\u00e7\u00e3o de \u00e1gua pelos canais de \u00e1gua\/ar, de trabalho, de corantes (colonosc\u00f3pios Fujinon) ou pelo canal acess\u00f3rio (colonosc\u00f3pios Olympus);<\/li>\n
  2. em decorr\u00eancia da insufla\u00e7\u00e3o de ar durante a inser\u00e7\u00e3o do aparelho no paciente, na qual ocorre pulveriza\u00e7\u00e3o do vapor de per\u00f3xido de hidrog\u00eanio.<\/li>\n<\/ol>\n

    Na primeira situa\u00e7\u00e3o, as les\u00f5es aparecem imediatamente sob vis\u00e3o direta e tem aspecto efervescente; na segunda, elas podem ser desencadeadas \u00e0 dist\u00e2ncia, antes mesmo do aparelho chegar ao local, simulando les\u00f5es pr\u00e9-existentes e confundindo o colonoscopista.<\/p>\n

    Histologia<\/strong><\/h2>\n

    A histologia mostra criptas aparentemente preservadas, por\u00e9m espa\u00e7adas por numerosos vac\u00faolos vazios, que correspondem a gases sequestrados (setas), semelhantes a adip\u00f3citos. A imuno-histoqu\u00edmica e an\u00e1lise ultraestrutural confirmam aus\u00eancia de conte\u00fado lip\u00eddico, o que originou o termo \u201cpseudolipomatose\u201d. Estes achados foram reproduzidos em laborat\u00f3rio ap\u00f3s instila\u00e7\u00e3o de H2<\/sub>O2 <\/sub>em c\u00f3lon de cobaias(5).<\/p>\n

    Evolu\u00e7\u00e3o cl\u00ednica<\/strong><\/h2>\n

    Os pacientes geralmente evoluem sem sintomas, mas podem apresentar, em raras exce\u00e7\u00f5es, dor abdominal leve e sangramento retal. As les\u00f5es regridem espontaneamente, n\u00e3o havendo necessidade de tratamento espec\u00edfico ou hospitaliza\u00e7\u00e3o. N\u00e3o \u00e9 achado exclusivo do c\u00f3lon; pode ocorrer em qualquer mucosa do trato digest\u00f3rio. Portanto, todo cuidado deve ser dado durante o enxague dos aparelhos, para que o \u00e1cido perac\u00e9tico e o per\u00f3xido de hidrog\u00eanio sejam completamente eliminados da superf\u00edcie e dos canais dos aparelhos, especialmente o dos corantes dos colonosc\u00f3pios da Fujinon(6,7).<\/p>\n

    \"\"<\/a>

    Aspecto histol\u00f3gico de pseudolipomatose do c\u00f3lon (A- HE, 40x e B- HE, 250 x), com gl\u00e2ndulas c\u00f3licas aparentemente preservadas, espa\u00e7adas pela presen\u00e7a de numerosos vac\u00faolos vazios, que correspondem a gases sequestrados (setas), simulando \u201cadip\u00f3citos\u201d.<\/p><\/div>\n

    Conclus\u00e3o:<\/strong><\/h2>\n

    A pseudolipomatose do c\u00f3lon \u00e9 condi\u00e7\u00e3o iatrog\u00eanica rara, benigna e autolimitada, que, geralmente, se apresenta de forma assintom\u00e1tica, com raros quadros de dor abdominal leve e sangramento retal. N\u00e3o \u00e9 achado exclusivo do c\u00f3lon; pode ocorrer em qualquer mucosa do trato digest\u00f3rio. O aspecto endosc\u00f3pico e os achados histopatol\u00f3gicos s\u00e3o caracter\u00edsticos e as les\u00f5es regridem espontaneamente, n\u00e3o havendo necessidade de tratamento espec\u00edfico ou hospitaliza\u00e7\u00e3o.<\/p>\n

    Refer\u00eancias:<\/strong><\/h2>\n

    (1)\u00a0 Snover DC, Sandstad J, Hutton S. Mucosal pseudolipomatosis of the colon. Am J Clin Pathol 1985; 84:575-580.<\/p>\n

    (2)\u00a0 Kara M, Turan I, Polat Z, Dogru T, Bagci S. Chemical colitis caused by peracetic acid or hydrogen peroxide: a challenging dilemma. Endoscopy 2010;42 Suppl 2:E3-4.<\/p>\n

    (3)\u00a0 Souza JLS, Ribeiro TM, Borges LV, da Silva JGN. Electrolyzed acid water can cause colitis? Endoscopy 2008;40(7):620.<\/p>\n

    (4)\u00a0 Suzuki N, Talbot IC, Saunders BP. The \u201cfrost sign\u201d: an inadvertent minor complication of endoscopic mucosal resection. Endoscopy 2004;36(9):835.<\/p>\n

    (5)\u00a0 Zullo A., Hassan C., Guarini A., Lorenzetti R., Campo S., Morini S. Chemical Colitis due to Peracetic Acid: a case report and review of Literature. Journal of Digestive Endoscopy 2011; 2(1):15-17.<\/p>\n

    (6)\u00a0 Cammarota G, Cesaro P, Cazzato A, Fedeli P, Riccioni ME, Sparano L, Vitale G, Costamagna G, Gasbarrini G, Larocca LM. Hydrogen peroxide-related colitis (previously known as “pseudolipomatosis”): a series of cases occurring in an epidemic pattern. Endoscopy 2007; 39:916-919.<\/p>\n

    (7)\u00a0 Coriat R, Chaput U, Ismaili Z, Chaussade S. What induces colitis? Hydrogen peroxide or peracetic acid. Endoscopy 2008;40(3):231.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Introdu\u00e7\u00e3o e etiopatologia A pseudolipomatose do c\u00f3lon foi descrita pela primeira vez em 1985(1)…<\/p>\n","protected":false},"author":1598,"featured_media":4545,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[270],"tipo":[156],"volume":[263],"class_list":["post-4546","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-270","tipo-colonoscopia","volume-volume-i"],"yoast_head":"\nPseudolipomatose de c\u00f3lon • Endoscopia Terapeutica<\/title>\n<meta name=\"description\" content=\"A pseudolipomatose do c\u00f3lon \u00e9 condi\u00e7\u00e3o rara, benigna e autolimitada, que geralmente se apresenta de forma assintom\u00e1tica, com raros casos de dor abdominal e sangramento retal\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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