{"id":4917,"date":"2021-05-18T09:00:15","date_gmt":"2021-05-18T09:00:15","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/aspectos-endoscopicos-da-bolsa-ileal\/"},"modified":"2022-06-17T12:45:34","modified_gmt":"2022-06-17T12:45:34","slug":"aspectos-endoscopicos-da-bolsa-ileal","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/aspectos-endoscopicos-da-bolsa-ileal\/","title":{"rendered":"Aspectos endosc\u00f3picos da bolsa ileal"},"content":{"rendered":"

Introdu\u00e7\u00e3o<\/h2>\n

A confec\u00e7\u00e3o de bolsa (<\/span>pouch<\/span><\/i>) ileal \u00e9 realizada nas cirurgias de ressec\u00e7\u00e3o total do c\u00f3lon e est\u00e1 indicada na retocolite ulcerativa refrat\u00e1ria, c\u00e2ncer de intestino ou <\/span>polipose adenomatosa familiar<\/span><\/a>.<\/span><\/p>\n

A bolsa ileal pode ter conforma\u00e7\u00f5es em J, S ou W. A mais comum \u00e9 a bolsa em J, por ser tecnicamente mais f\u00e1cil e necessitar de segmento menor do \u00edleo terminal.<\/span><\/p>\n

O <\/span>pouch<\/span><\/i> \u00e9 formado por cerca de 40 cm do \u00edleo distal com anastomose manual ou por grampeamento para alinhar as bordas antimesent\u00e9ricas das al\u00e7as ileais.<\/span><\/p>\n

O tamanho ideal do reservat\u00f3rio \u00e9 de 15 a 20 cm. Al\u00e7as muito longas est\u00e3o associadas a esvaziamento incompleto e, quando curtas, cursam com frequ\u00eancia evacuat\u00f3ria bem aumentada.<\/span><\/p>\n

A pouchoscopia consiste na avalia\u00e7\u00e3o de:<\/span><\/p>\n

1. Canal anal<\/h3>\n

Realizar toque digital e avaliar presen\u00e7a de hipersensibilidade em canal anal e anastomose. A anastomose \u00e9 palp\u00e1vel e sentida como irregularidade ou anel fibroso. A dist\u00e2ncia estimada \u00e9 de 0,5 a 1 cm entre a anastomose e a linha denteada. \u00c9 comum encontrarmos algum estreitamento, e deve ser considerado normal quando transpon\u00edvel com o dedo indicador.<\/span><\/p>\n

2. Anastomose ileoanal<\/h3>\n

A anastomose pode ter sido confeccionada por sutura manual ou grampeador. Quando se opta pelo grampeamento, \u00e9 necess\u00e1rio deixar de 1 a 2 cm de um \u201ccuff\u201d retal. Inflama\u00e7\u00f5es localizadas abaixo da anastomose e com mucosa da bolsa normal s\u00e3o sugestivas de cuffite.<\/span><\/p>\n

\"\"<\/p>\n

Figura 1: Anatosmose ileoanal com visualiza\u00e7\u00e3o dos grampos met\u00e1licos (setas brancas) e do cuff retal (vermelho)<\/p>\n

3. Reservat\u00f3rio ileal<\/b><\/h3>\n

A mucosa do <\/span>pouch<\/span><\/i> deve ser cuidadosamente avaliada quanto a presen\u00e7a de inflama\u00e7\u00e3o, \u00falceras ou p\u00f3lipos<\/a>. O grau de inflama\u00e7\u00e3o deve ser documentado. Inflama\u00e7\u00f5es restritas \u00e0 linha da sutura s\u00e3o consequ\u00eancias de rea\u00e7\u00e3o normal a corpo estranho e n\u00e3o devem ser encaradas como bolsite.<\/span><\/p>\n

Quando a confec\u00e7\u00e3o \u00e9 em W, \u00e9 realizada com 4 al\u00e7as de \u00edleo, criando um reservat\u00f3rio maior. A pouchoscopia revela um \u00fanico amplo reservat\u00f3rio. A al\u00e7a aferente da bolsa, geralmente, est\u00e1 escondida e pode ser dif\u00edcil de localizar com o paciente em dec\u00fabito lateral esquerdo. Caso n\u00e3o se consiga o acesso ao \u00edleo pr\u00e9-pouch, pode-se tentar posicionar o paciente em posi\u00e7\u00e3o supina.<\/span><\/p>\n

Quando a confec\u00e7\u00e3o \u00e9 em J, precisamos avaliar a mucosa do reservat\u00f3rio e acessar a al\u00e7a cega e a aferente. Uma bolsa em J de conforma\u00e7\u00e3o normal lembra muito um olho da coruja, em que as duas bocas est\u00e3o no mesmo plano e perpendiculares \u00e0 linha de grampeamento.<\/span><\/p>\n

 <\/p>\n

 <\/p>\n

\"\"<\/p>\n

Figura 2: Reservat\u00f3rio ileal com visualiza\u00e7\u00e3o da boca da al\u00e7a aferente (\u00e0 esquerda), da al\u00e7a eferente (\u00e0 direita) e da linha de grampeamento (linha branca).<\/p>\n

4. \u00cdleo pr\u00e9-pouch<\/h3>\n

O \u00edleo terminal deve ser entubado, e a profundidade deste deve ser descrita. Quando h\u00e1 disfun\u00e7\u00e3o do <\/span>pouch<\/span><\/i>, \u00e9 necess\u00e1rio avaliar presen\u00e7as de estenoses ou \u00falceras. A extens\u00e3o do \u00edleo acometido deve ser documentada.<\/span><\/p>\n

Considera\u00e7\u00f5es finais<\/h2>\n

A proctocolectomia total com confec\u00e7\u00e3o de bolsa ileal \u00e9 o tratamento cir\u00fargico de elei\u00e7\u00e3o para retocolite refrat\u00e1ria, al\u00e9m de ser op\u00e7\u00e3o em casos de c\u00e2ncer colorretal com implanta\u00e7\u00e3o muito baixa e de <\/span>polipose<\/span><\/a> adenomatosa familiar com reto acometido.<\/span><\/p>\n

A colonoscopia para avalia\u00e7\u00e3o da bolsa ileal (pouchscopia) \u00e9 importante para avaliar presen\u00e7a de les\u00f5es e complica\u00e7\u00f5es, al\u00e9m da pr\u00f3pria vigil\u00e2ncia do c\u00e2ncer colorretal.<\/span><\/p>\n

Precisamos estar familiarizados com os marcos anat\u00f4micos para se ter uma boa avalia\u00e7\u00e3o endosc\u00f3pica.<\/span><\/p>\n

Como citar este artigo<\/h3>\n

Carlos AS. Aspectos endosc\u00f3picos da Bolsa Ileal. Endoscopia Terap\u00eautica; 2021. Dispon\u00edvel em: <\/span>https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/aspectos-endoscopicos-da-bolsa-ileal<\/span><\/p>\n

Refer\u00eancias<\/h3>\n
    \n
  1. World J Gastroenterol 2007 June 28; 13(24): 3288-3300<\/span><\/li>\n
  2. Inflamm Bowel Dis. 2009 Aug;15(8):1256-63<\/span><\/li>\n
  3. Inflamm Bowel Dis. 2015 Jun;21(6):1459-71<\/span><\/li>\n<\/ol>\n

    Acesse o <\/span>Endoscopia Terap\u00eautica<\/span><\/a> para tomar contato com mais <\/span>artigos comentados<\/span><\/a>, <\/span>assuntos gerais<\/span><\/a>, <\/span>casos cl\u00ednicos<\/span><\/a>, <\/span>quizzes<\/span><\/a>, <\/span>classifica\u00e7\u00f5es<\/span><\/a> e mais!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    Introdu\u00e7\u00e3o A confec\u00e7\u00e3o de bolsa (pouch) ileal \u00e9 realizada nas cirurgias de ressec\u00e7\u00e3o total…<\/p>\n","protected":false},"author":142,"featured_media":7727,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[262],"tipo":[156],"volume":[263],"class_list":["post-4917","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-262","tipo-colonoscopia","volume-volume-i"],"yoast_head":"\nAspectos endosc\u00f3picos da bolsa ileal • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/aspectos-endoscopicos-da-bolsa-ileal\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" 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