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McCurdy JD, Crooks P, Gwaltney C, Krupnick R, Cadogan KA, Karki C. Development of a new patient-reported outcome measure for complex cryptoglandular fistulas (20-Item complex cryptoglandular fistula questionnaire ™): a qualitative study. J Patient Rep Outcomes 2024; 8:99. [PMID: 39172310 PMCID: PMC11341802 DOI: 10.1186/s41687-024-00729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/01/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND There are limited tools to measure the burden of disease and effectiveness of medical/surgical interventions in patients with cryptoglandular fistulas. The aim of this study was to explore concepts that are relevant and important to patients with complex cryptoglandular fistulas (CCF) and to develop a patient-centred, disease-specific, patient-reported outcome measure (PROM) to assess symptom burden and impacts of CCF. METHODS A targeted literature review was conducted, followed by one-to-one telephone interviews with five colorectal surgeons (USA, n = 3; UK, n = 1; Spain, n = 1) and 20 US adult patients with CCF to inform the development of a conceptual model and a CCF-specific PROM. The targeted literature review informed the development of the preliminary conceptual model and identified a PROM in the literature that was used as a reference to generate the draft CCF-specific PROM. The colorectal surgeon interviews provided insights on the experience of patients with CCF to refine the conceptual model, formulate probing questions for use in patient interviews, and to develop the draft CCF-specific PROM. Patients' descriptions of their experiences with symptoms and the impacts on their lives and evaluation of the draft CCF-specific PROM in concept elicitation and cognitive interviews were used to develop the final conceptual model and final CCF-specific PROM. RESULTS Ten symptoms (odour, pain during bowel movement, abscess, post-operative pain, discharge/drainage/leakage, anal/perianal pain, inflammation/swelling, skin irritation, bleeding and itchiness) and 11 impacts (discomfort, inability to exercise, embarrassment, difficulty sitting, worry about disease, adapted life to maintain hygiene, negatively impacted social life/isolation, inability to perform daily activities, reduced interest in sex, negatively impacted intimate relationships and negatively impacted mood) were reported as most salient by patients. The patient experience, clinician perspective, and literature review provided input to item generation. Evaluation of relevance and patient understanding through cognitive interviews with patients provided evidence for the content validity of the new patient-reported outcome measure: the 20-item Complex Cryptoglandular Fistula Questionnaire™ (CCFQ-20™). CONCLUSION The CCFQ-20™ is a new clinician-guided, patient-validated, disease-specific patient-reported outcome measure that measures disease impact and quality of life in patients with CCF.
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Affiliation(s)
- Jeffrey D McCurdy
- Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Box 206, Ottawa, ON, K1H 8L6, Canada.
| | - Patrick Crooks
- IQVIA Real World Solutions, Patient Centered Solutions, New York, NY, USA
| | | | - Robert Krupnick
- IQVIA Real World Solutions, Patient Centered Solutions, Cambridge, MA, USA
| | | | - Chitra Karki
- Takeda Pharmaceuticals USA Inc, Cambridge, MA, USA
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Ma X, Li Y, Xu S, Wang B, Wang C. The analysis of different types of anorectal abscesses was conducted using the MRI 3D reconstruction technique. Sci Rep 2024; 14:18473. [PMID: 39122753 PMCID: PMC11316023 DOI: 10.1038/s41598-024-66892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 07/05/2024] [Indexed: 08/12/2024] Open
Abstract
It has not yet been proven whether sepsis affects the tissue around the anal canal. To address this issue, we established three-dimensional models for various types of anorectal abscesses and utilize 3D reconstruction of Magnetic Resonance Imaging scans to assess the extent of muscle damage caused by anorectal abscesses. Patients diagnosed with anorectal abscess, selected from January 2019 to January 2022 underwent pre- and post-operative scanning of pelvic floor and perianal tissues. The aforementioned structures were segmented for the reconstruction of a three-dimensional visual model and measurement of volumes for the abscess as well as the internal and external sphincters and levator ani muscle. The study included a total of 42 patients. Three-dimensional visualization models were created for different types of anorectal abscesses, including perianal, intersphincteric, ischiorectal, and supralevator abscesses. No statistically significant differences were observed in the volume of the internal sphincter, external sphincter, and levator ani muscle between pre- and post-operative patients. The 3D model of anorectal abscess, reconstructed from MRI data, offers a precise and direct visualization of the anatomical structures associated with various types of anorectal abscesses. The infection did not result in any damage to the internal and external anal sphincter and levator ani muscle.
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Affiliation(s)
- Xutao Ma
- Proctology Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Shanghai, 200032, China
| | - Yikun Li
- Proctology Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Shanghai, 200032, China
| | - Siming Xu
- Proctology Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Shanghai, 200032, China
| | - Bo Wang
- Shanghai Shumiao Health Cloud Co. Ltd, Shanghai, China
| | - Chen Wang
- Proctology Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Shanghai, 200032, China.
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Shehab M, De Marco D, Lakatos PL, Bessissow T. The potential for medical therapies to address fistulizing Crohn's disease: a state-of-the-art review. Expert Opin Biol Ther 2024; 24:733-746. [PMID: 39045643 DOI: 10.1080/14712598.2024.2383882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/25/2024] [Accepted: 07/20/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Crohn's disease (CD) is a chronic, relapsing immune mediated disease, which is one of the two major types of inflammatory bowel disease (IBD). Fistulizing CD poses a significant clinical challenge for physicians. Effective management of CD requires a multidisciplinary approach, involving a gastroenterologist and a GI surgeon while tailoring treatment to each patient's unique risk factors, clinical representations, and preferences. AREAS COVERED This comprehensive review explores the intricacies of fistulizing CD including its manifestations, types, impact on quality of life, management strategies, and novel therapies under investigation. EXPERT OPINION Antibiotics are often used as first-line therapy to treat symptoms. Biologics that selectively target TNF-α, such infliximab (IFX), have shown high efficacy in randomized controlled trials. However, more than 50% of patients lose response to IFX, prompting them to explore alternative strategies. Current options include adalimumab and certolizumab pegol combination therapies, as well as small-molecule drugs targeting Janus kinases such as Upadacitinib. Furthermore, a promising treatment for complex fistulas is mesenchymal stem cells such as Darvadstrocel (Alofisel), an allogeneic stem cell-based therapy. However, surgical interventions are necessary for complex cases or intra-abdominal complications. Setons and LIFT procedures are the most common surgical options.
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Affiliation(s)
- Mohammad Shehab
- Division of Gastroenterology, Department of Internal Medicine, Mubarak Al-Kabeer University Hospital, Kuwait University, Kuwait City, Kuwait
| | - Davide De Marco
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Canada
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Canada
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Kumar S, Chaudhary RK, Shah SS, Kumar D, Nepal P, Ojili V. Current update on the role of endoanal ultrasound: a primer for radiologists. Abdom Radiol (NY) 2024; 49:2873-2890. [PMID: 38580791 DOI: 10.1007/s00261-024-04300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024]
Abstract
Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and physiology of the anorectal region and has been used in pre-and post-operative settings of anorectal pathologies. EAUS is not only useful in the evaluation of benign pathologies but also in loco-regional staging of anal and rectal tumors. EAUS has several advantages over MRI, including reduced cost, better patient tolerance, and improved scope of application in patients with contraindications to MRI. Despite its benefits, EAUS is not widely performed in many centers across the globe. This article aims to educate radiologists, trainees, and surgeons about the indications, contraindications, patient preparation, imaging technique, and findings of EAUS. We will also highlight the technical difficulties, diagnostic challenges, and procedural complications encountered during EAUS, along with a comparative analysis of EAUS with other imaging approaches.
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Affiliation(s)
- Shruti Kumar
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR, 72205, USA.
| | - Ranjit K Chaudhary
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Samir S Shah
- Department of Radiology, Canpic Medical and Education Foundation, Pune, India
| | - Devendra Kumar
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | - Pankaj Nepal
- Department of Radiology, Inova Fairfax Hospital, Fairfax, VA, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
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Sun Y, Liang H, Hao S, Yin L, Pan Y, Wang C, Lu J. A case-control study of the risk factors for fistula-in-ano in infants and toddlers. BMC Pediatr 2024; 24:362. [PMID: 38783262 PMCID: PMC11118725 DOI: 10.1186/s12887-024-04826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives. OBJECTIVES The purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies. DESIGN AND SETTINGS A retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021. INDEPENDENT VARIABLES (a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors. RESULTS Mothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089). CONCLUSION Based on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.
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Affiliation(s)
- Yanting Sun
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongtao Liang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Shuang Hao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lu Yin
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yibin Pan
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingen Lu
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Ouboter LF, Lindelauf C, Jiang Q, Schreurs M, Abdelaal TR, Luk SJ, Barnhoorn MC, Hueting WE, Han-Geurts IJ, Peeters KCMJ, Holman FA, Koning F, van der Meulen-de Jong AE, Pascutti MF. Activated HLA-DR+CD38+ Effector Th1/17 Cells Distinguish Crohn's Disease-associated Perianal Fistulas from Cryptoglandular Fistulas. Inflamm Bowel Dis 2024:izae103. [PMID: 38776553 DOI: 10.1093/ibd/izae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Indexed: 05/25/2024]
Abstract
BACKGROUND Perianal fistulas are a debilitating complication of Crohn's disease (CD). Due to unknown reasons, CD-associated fistulas are in general more difficult to treat than cryptoglandular fistulas (non-CD-associated). Understanding the immune cell landscape is a first step towards the development of more effective therapies for CD-associated fistulas. In this work, we characterized the composition and spatial localization of disease-associated immune cells in both types of perianal fistulas by high-dimensional analyses. METHODS We applied single-cell mass cytometry (scMC), spectral flow cytometry (SFC), and imaging mass cytometry (IMC) to profile the immune compartment in CD-associated perianal fistulas and cryptoglandular fistulas. An exploratory cohort (CD fistula, n = 10; non-CD fistula, n = 5) was analyzed by scMC to unravel disease-associated immune cell types. SFC was performed on a second fistula cohort (CD, n = 10; non-CD, n = 11) to comprehensively phenotype disease-associated T helper (Th) cells. IMC was used on a third cohort (CD, n = 5) to investigate the spatial distribution/interaction of relevant immune cell subsets. RESULTS Our analyses revealed that activated HLA-DR+CD38+ effector CD4+ T cells with a Th1/17 phenotype were significantly enriched in CD-associated compared with cryptoglandular fistulas. These cells, displaying features of proliferation, regulation, and differentiation, were also present in blood, and colocalized with other CD4+ T cells, CCR6+ B cells, and macrophages in the fistula tracts. CONCLUSIONS Overall, proliferating activated HLA-DR+CD38+ effector Th1/17 cells distinguish CD-associated from cryptoglandular perianal fistulas and are a promising biomarker in blood to discriminate between these 2 fistula types. Targeting HLA-DR and CD38-expressing CD4+ T cells may offer a potential new therapeutic strategy for CD-related fistulas.
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Affiliation(s)
- Laura F Ouboter
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Immunology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ciska Lindelauf
- Department of Immunology, Leiden University Medical Center, Leiden, the Netherlands
| | - Qinyue Jiang
- Department of Immunology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mette Schreurs
- Department of Immunology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tamim R Abdelaal
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Bioinformatics Lab, Delft University of Technology, Delft, the Netherlands
- Systems and Biomedical Engineering Department, Faculty of Engineering Cairo University, Giza, Egypt
| | - Sietse J Luk
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke C Barnhoorn
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Willem E Hueting
- Department of Surgery, Alrijne hospital, Leiderdorp, the Netherlands
| | | | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Fabian A Holman
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits Koning
- Department of Immunology, Leiden University Medical Center, Leiden, the Netherlands
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Nasir MT, Anwar K, Hussain H, Solkar M, Ullah S. Management of Rectal Wall Abscess: A Rare Case Report. Cureus 2023; 15:e50759. [PMID: 38125696 PMCID: PMC10731143 DOI: 10.7759/cureus.50759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
A 34-year-old male presented with spontaneous rectal pain. He was diagnosed with a posterior rectal wall abscess 7 cm proximal to the anal verge that was confirmed on an MRI (magnetic resonance imaging) pelvis. This abscess was drained through a transrectal route. Rectal wall abscess is an exceedingly rare pathology compared to perianal abscess; therefore, this case highlights the key aspects of its management.
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Affiliation(s)
- Muhammad Talal Nasir
- General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, GBR
| | - Kehkashan Anwar
- General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, GBR
| | - Hareem Hussain
- Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, GBR
| | - Mamoon Solkar
- Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, GBR
| | - Sana Ullah
- General and Colorectal Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, GBR
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Liang S, Ma W, Jia S, Zhao G, Li Y, Li Y, Wang L, Liu Z, Liu J, Gao H, Wang H. Application of platelet-rich-plasma in the postoperative treatment of perianal abscess pseudohealing: A case report. Medicine (Baltimore) 2023; 102:e35996. [PMID: 37986293 PMCID: PMC10659616 DOI: 10.1097/md.0000000000035996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023] Open
Abstract
RATIONALE Perianal abscess is a common disease of the anus and intestine. Surgery is an important treatment option for perianal abscess. However, some patients have a long healing time, poor healing effect after surgery, or even pseudo-healing. Platelet-rich plasma (PRP) is rich in platelets that can release a large number of factors when activated and promote wound healing. Moreover, there are few reports on the use of PRP for wounds that are difficult to heal after perianal abscess surgery. PATIENT CONCERNS The patient had reported a complaint of perianal swelling and discomfort associated with anal pain, which was considered a perianal abscess. Ceftriaxone, fumigation, and sitz bath were administered after mixed hemorrhoid and perianal abscess surgeries were performed; however, the wound remained unhealed for more than 3 months, and there was a fistula under the skin. DIAGNOSIS Perianal color ultrasonography revealed perianal abscess. INTERVENTIONS Autologous PRP treatment was performed 5 times for each patient. OUTCOMES The postoperative wound healed within 15 days after 5 times PRP treatments. LESSONS PRP is a novel treatment option for pseudo-healing.
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Affiliation(s)
- Shuang Liang
- Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Department of Clinical Laboratory, Zhangdian District People’s Hospital of Zibo City, Zibo, Shandong, China
| | - Weijuan Ma
- Department of Quality Management, Qingdao Blood Center, Qingdao, Shandong, China
| | - Sihui Jia
- Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Gang Zhao
- Department of Anorectal Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ying Li
- Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yaxin Li
- Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Licun Wang
- Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zheng Liu
- Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiao Liu
- Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hairui Gao
- Department of Anorectal Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haiyan Wang
- Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Redman IA, Panahi P, Gill M, Drymousis P. Postoperative packing of perianal abscesses following incision and drainage. Br J Hosp Med (Lond) 2023; 84:1-6. [PMID: 38019208 DOI: 10.12968/hmed.2023.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound healing and abscess recurrence? The literature search identified 159 papers on Ovid, Embase and Medline and 48 on PubMed. These were independently screened, and three articles were included in this review as these offered the best information to answer the question. One was a systematic review without meta-analysis, one was a randomised controlled trial and one was a multicentre observational study. Review of these articles led the authors to conclude that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain and confers no protection against recurrence of abscesses or formation of fistulae.
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Affiliation(s)
- Ishtar A Redman
- Department of General Surgery, Ealing Hospital, London North West University Healthcare, NHS Foundation Trust, London, UK
| | - Pedram Panahi
- Department of General Surgery, Hillingdon Hospital, Hillington Hospitals NHS Foundation Trust, London, UK
| | - Moneet Gill
- Department of Plastic Surgery, Queen Victoria Hospital, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Panagiotis Drymousis
- Department of General Surgery, Ealing Hospital, London North West University Healthcare, NHS Foundation Trust, London, UK
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Gnanadev R, Malkoc A, Nguyen A, Weaver T, Lebedevskiy O, Hussain F, Kim E. The Impact of Computed Tomography Scans on the Management and Wait Times in Perianal Abscess Diagnoses. Cureus 2023; 15:e49417. [PMID: 38149138 PMCID: PMC10750221 DOI: 10.7759/cureus.49417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/28/2023] Open
Abstract
Background Diagnosis and management of perianal abscesses (PAA) are based on history and clinical examination. Imaging is not indicated except in complicated cases, as determined by the surgical team. The monetary, ionizing radiation, and resource utilization costs of a computed tomography (CT) scan in the emergency room must be considered when used for diagnostic purposes of PAAs. Methods A retrospective analysis of 129 patients diagnosed with a diagnosis of PAA between 2015-2020 was performed. The primary endpoints included length of stay, CT performed, time from patient presentation to CT, and CT scan completion prior to surgical consultation. Data is reported as n (%) or median (IQR). Results Of the 129 patients diagnosed with PAA, 81 underwent CT, and 48 did not. General surgery was consulted in 88% of cases. There were no statistically significant differences in age (p=0.562), sex (p=0.531), or ethnicity (p=0.356). The median hospitalization time was two days when CT was performed (p=0.001). The median time elapsed from presentation to the emergency department and CT scan performed was 16 hours (p=0.001). CT scans were ordered before the surgical consultation in 65% of cases (p=0.001) and 17% after a surgical consultation was placed (p=0.009). Conclusion Performing CT scans prior to surgical evaluation for the diagnosis of PAA is not a responsible practice. The cost, resources, and radiation exposure must be considered. This study demonstrated that more CT scans are ordered prior to surgical consultation for PAA, resulting in a prolonged wait time in the emergency department.
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Affiliation(s)
- Raja Gnanadev
- General Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Aldin Malkoc
- General Surgery, Arrowhead Regional Medical Center, Colton, USA
| | | | - Tara Weaver
- General Surgery, Arrowhead Regional Medical Center, Colton, USA
| | | | - Farabi Hussain
- General Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Edwin Kim
- General Surgery, Arrowhead Regional Medical Center, Colton, USA
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11
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Lv P, Liu P, Zhou X, Liu J. A case of reactive arthritis caused by a perianal abscess. SAGE Open Med Case Rep 2023; 11:2050313X231177764. [PMID: 37359279 PMCID: PMC10285606 DOI: 10.1177/2050313x231177764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/07/2023] [Indexed: 06/28/2023] Open
Abstract
Reactive arthritis is an immune-mediated aseptic arthritis resulting from either genitourinary or intestinal tract in a genetically susceptible host. Reactive arthritis is not uncommon, and the most common infectious agents are Chlamydia trachomatis, Salmonella, Yersinia, and Shigella, some new infectious agents include Staphylococcus lugdunensis, Rothia mucilaginosa, and umbilical cord-derived Wharton's jelly, as well as the SARS-CoV-2 virus, which has been more studied in recent years. We found that reactive arthritis caused by infection of perianal abscesses is very rare and few cases have been described in the medical literature. We report a 21-year-old man with polyarticular swelling and pain, and subcutaneous hematoma at his right ankle joint; he was considered reactive arthritis. After treating with non-steroidal anti-inflammatory drugs, sulfasalazine, surgery, and antibiotics, the patient's arthralgia gradually improved and the symptoms largely disappeared at the 1-month follow-up.
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Affiliation(s)
- Pan Lv
- Department of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Pingdan Liu
- Department of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaoqin Zhou
- Department of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jianping Liu
- Department of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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12
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Carroll D, Kavalukas S. Evaluation and Management of Supralevator Abscess. Dis Colon Rectum 2023; 66:626-628. [PMID: 37574986 DOI: 10.1097/dcr.0000000000002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Dylan Carroll
- Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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Iglay K, Bennett D, Kappelman MD, Zhang X, Aldridge M, Karki C, Cook SF. A Systematic Review of Epidemiology and Outcomes Associated with Local Surgical and Intersphincteric Ligation Procedures for Complex Cryptoglandular Fistulas. Adv Ther 2023; 40:1926-1956. [PMID: 36905499 PMCID: PMC10129974 DOI: 10.1007/s12325-023-02452-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/01/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION This systematic literature review (SLR) assessed incidence/prevalence of cryptoglandular fistulas (CCF) and outcomes associated with local surgical and intersphincteric ligation procedures for CCFs. METHODS Two trained reviewers searched PubMed and Embase for observational studies evaluating the incidence/prevalence of cryptoglandular fistula and clinical outcomes of treatments for CCF after local surgical and intersphincteric ligation procedures for CCF. RESULTS In total 148 studies met a priori eligibility criteria for all cryptoglandular fistulas and all intervention types. Of those, two assessed incidence/prevalence of cryptoglandular fistulas. Eighteen reported clinical outcomes of surgeries of interest in CCF and were published in the past 5 years. Prevalence was reported as 1.35/10,000 non-Crohn's patients, and 52.6% of non-IBD patients were found to progress from anorectal abscess to fistula over 12 months. Primary healing rates ranged from 57.1% to 100%; recurrence occurred in a range of 4.9-60.7% and failure in 2.8-18.0% of patients. Limited published evidence suggests postoperative fecal incontinence and long-term postoperative pain were rare. Several of the studies were limited by single-center design with small sample sizes and short follow-up durations. DISCUSSION This SLR summarizes outcomes from specific surgical procedures for the treatment of CCF. Healing rates vary according to procedure and clinical factors. Differences in study design, outcome definition, and length of follow-up prevent direct comparison. Overall, published studies offer a wide range of findings with respect to recurrence. Postsurgical incontinence and long-term postoperative pain were rare in the included studies, but more research is needed to confirm rates of these conditions following CCF treatments. CONCLUSION Published studies on the epidemiology of CCF are rare and limited. Outcomes of local surgical and intersphincteric ligation procedures show differing success and failure rates, and more research is needed to compare outcomes across various procedures. (PROSPERO; registration number CRD42020177732).
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Affiliation(s)
- Kristy Iglay
- CERobs Consulting, LLC, 2612 North Lumina Ave., Wrightsville Beach, NC 28480 USA
| | - Dimitri Bennett
- Takeda Pharmaceuticals, Cambridge, MA 02139 USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Michael D. Kappelman
- Pediatric Gastroenterology, University of North Carolina, Chapel Hill School of Medicine, Chapel Hill, NC 27599 USA
| | - Xinruo Zhang
- CERobs Consulting, LLC, 2612 North Lumina Ave., Wrightsville Beach, NC 28480 USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Molly Aldridge
- CERobs Consulting, LLC, 2612 North Lumina Ave., Wrightsville Beach, NC 28480 USA
| | | | - Suzanne F. Cook
- CERobs Consulting, LLC, 2612 North Lumina Ave., Wrightsville Beach, NC 28480 USA
- Takeda Pharmaceuticals, Cambridge, MA 02139 USA
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Principe DR, Cataneo JL, Dorman MJ, Koch RM, Studniarek A, Rana A, Gantt G, Nordenstam J. Serum Depletion of Complement Component 5a Is Associated With Increased Inflammation and Poor Clinical Outcomes in Patients With Perianal Fistulas. Dis Colon Rectum 2023; 66:288-298. [PMID: 35724247 DOI: 10.1097/dcr.0000000000002378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Persistent disease is a significant issue in the management of perianal fistulas, with up to 50% of patients requiring additional treatment after surgery. OBJECTIVE This study aimed to identify a novel prognostic modality in hopes of risk-stratifying patients for persistent disease following corrective surgery. DESIGN This was a retrospective study based on prospectively collected data using a combination of histopathology, high-throughput proteomic arrays, and ELISA-based methods. SETTINGS This study used data obtained from patients who underwent corrective surgery for perianal fistulas at the University of Illinois Hospital between June 2019 and July 2020. PATIENTS A cohort of 22 consecutive patients who had corrective surgery for perianal fistulas were included in this study. The patients were divided into 2 groups: those with resolving fistulas (N = 13) and those with persisting fistulas (N = 9). MAIN OUTCOME MEASURES Nonresolving fistulas were determined by disease representation within 2 months of corrective surgery. RESULTS Serum samples from patients with persistent perianal fistulas displayed a consistent decrease in the expression of complement pathway component C5a compared with either healthy controls or patients with resolving forms of disease. This was paralleled by an increase in the fistula expression of C5a and an associated increase in tissue infiltrating leukocytes and interleukin-1β expression. LIMITATIONS This study was limited by its retrospective design, relatively small sample size, and single-center data analysis. CONCLUSIONS These results suggest that C5a is modestly depleted in patients with nonresolving forms of disease and traffics to the site of tissue damage and inflammation. Accordingly, serum C5a warrants continued investigation as a prognostic biomarker and predictor of recurrence in patients presenting with perianal fistulas. See Video Abstract at http://links.lww.com/DCR/B982 . LA DEPLECIN SRICA DEL COMPONENTE A DEL COMPLEMENTO SE ASOCIA CON UN AUMENTO DE LA INFLAMACIN Y MALOS RESULTADOS CLNICOS EN PACIENTES CON FSTULAS PERIANALES ANTECEDENTES:La persistencia de la enfermedad es un problema significativo en el manejo de las fístulas perianales, presente hasta en el 50 % de los pacientes después de la cirugía y que requieren tratamiento adicional.OBJETIVO:DISEÑO:Se trata de un estudio retrospectivo basado en datos recolectados prospectivamente usando una combinación de histopatología, arreglos proteómicos de alto rendimiento y métodos basados en ELISA.ENTORNO CLÍNICO:Este estudio utilizó datos de pacientes que se sometieron a cirugía correctiva por fístulas perianales en el Hospital de la Universidad de Illinois entre junio de 2019 y julio de 2020.PACIENTES:Se incluyó en este estudio una cohorte de 22 pacientes consecutivos que se sometieron a cirugía correctiva de fístulas perianales. Los pacientes se dividieron en 2 grupos: aquellos con fístulas en resolución (N = 13) y aquellos con fístulas persistentes (N = 9).PRINCIPALES MEDIDAS DE VALORACIÓN:Las fístulas que no se resuelven fueron determinadas por la reaparición de la enfermedad dentro de los 2 meses posteriores a la cirugía correctiva.RESULTADOS:Las muestras de suero de pacientes con fístulas perianales persistentes mostraron una disminución constante en la expresión del componente C5a de la vía del complemento en comparación con controles sanos o pacientes con formas de resolución de la enfermedad. Esto fue paralelo a un aumento en la expresión de C5a en la fístula y un aumento asociado en los leucocitos que se infiltran en el tejido y la expresión de IL-1β.LIMITACIONES:El estudio estuvo limitado por su diseño retrospectivo, tamaño de muestra relativamente pequeño y análisis de datos de un solo centro.CONCLUSIONES:Estos resultados sugieren que C5a se reduce moderadamente en pacientes con formas de enfermedad que no se resuelven y se desplaza al sitio del daño tisular e inflamación. En consecuencia, el C5a sérico justifica una investigación continua como biomarcador pronóstico y predictor de recurrencia en pacientes que presentan fístulas perianales. Consulte Video Resumen en http://links.lww.com/DCR/B982 . (Traducción- Dr. Ingrid Melo ).
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Affiliation(s)
- Daniel R Principe
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, Illinois
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - José L Cataneo
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
- University of Illinois College of Medicine, Chicago, Illinois
- University of Illinois, Metropolitan Group Hospitals General Surgery Residency, Advocate Illinois Masonic Hospital, Chicago, Illinois
| | - Matthew J Dorman
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Regina M Koch
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Adam Studniarek
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ajay Rana
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
- Jesse Brown VA Medical Center, Chicago, Illinois
| | - Gerald Gantt
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Johan Nordenstam
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Hasan ZAIY, Mohamed B, AlSayegh R, AlMarzooq R. Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain. Ann Coloproctol 2023; 39:27-31. [PMID: 34376025 PMCID: PMC10009068 DOI: 10.3393/ac.2020.00962.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/16/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice. METHODS A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software. RESULTS The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas. CONCLUSION The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.
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Affiliation(s)
| | - Bayan Mohamed
- Department of Surgery, Salmaniya Medical Complex, Kingdom of Bahrain
| | - Rawaa AlSayegh
- Department of Surgery, Salmaniya Medical Complex, Kingdom of Bahrain
| | - Raed AlMarzooq
- Department of Surgery, Salmaniya Medical Complex, Kingdom of Bahrain
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Crohn's Disease-Associated and Cryptoglandular Fistulas: Differences and Similarities. J Clin Med 2023; 12:jcm12020466. [PMID: 36675403 PMCID: PMC9860571 DOI: 10.3390/jcm12020466] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Perianal fistulas are defined as pathological connections between the anorectal canal and the perianal skin. Most perianal fistulas are cryptoglandular fistulas, which are thought to originate from infected anal glands. The remainder of the fistulas mainly arises as complications of Crohn's disease (CD), trauma, or as a result of malignancies. Fistulas in CD are considered as a consequence of a chronic and transmural inflammatory process in the distal bowel and can, in some cases, even precede the diagnosis of CD. Although both cryptoglandular and CD-associated fistulas might look similar macroscopically, they differ considerably in their complexity, treatment options, and healing rate. Therefore, it is of crucial importance to differentiate between these two types of fistulas. In this review, the differences between CD-associated and cryptoglandular perianal fistulas in epidemiology, pathogenesis, and clinical management are discussed. Finally, a flow chart is provided for physicians to guide them when dealing with patients displaying their first episode of perianal fistulas.
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Khan MTA, Patnaik R, Huang JY, Campi HD, Montorfano L, De Stefano F, Rosenthal RJ, Wexner SD. Leukopenia is an independent risk factor for early postoperative complications following incision and drainage of anorectal abscess. Colorectal Dis 2022; 25:717-727. [PMID: 36550093 DOI: 10.1111/codi.16447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
AIM Few data are available regarding the management of anorectal abscess in patients with leukopenia. The aim of this study was to investigate the impact of leukopenia among patients undergoing incision and drainage for anorectal abscess. METHOD A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients from 2015 to 2020. Perianal fistulas and supralevator abscesses were excluded. Patients were grouped based on white blood cell (WBC) count: WBC < 4.5 cells/μl, WBC = 4.5-11.0 cells/μl and WBC > 11.0 cells/μl. The 30-day overall complications and outcomes were compared using regression models, accounting for demographics and comorbidities. RESULTS Ten thousand two hundred and forty (70.3% male) patients were identified. Univariate analysis showed that, compared with patients with leukocytosis (WBC > 11.0 cells/μl) and normal WBC count (WBC = 4.5-11.0 cells/μl), patients with leukopenia (WBC <4.5 cells/μl) had higher rates of overall (p < 0.001), pulmonary (p < 0.001) and haematological complications (p < 0.001). They also had higher rates of readmission (p < 0.001), reoperation (p = 0.005), discharge to a care facility (p = 0.003), increased length of hospital stay (p = 0.004) and death (p < 0.001). Multivariable analysis identified leukopenia as an independent risk factor for overall complications [odds ratio (OR) 2.31, 95% CI 1.65-3.24; p < 0.001], pulmonary complications (OR 5.65, 95% CI 1.88-16.97; p = 0.002), haematological complications (OR 4.30, 95% CI 2.94-6.28; p < 0.001), unplanned readmission (OR 2.20, 95% CI 1.43-3.40; p < 0.001), reoperation (OR 1.80, 95% CI 1.10-2.93; p = 0.019) and death (OR 2.77, 95% CI 1.02-7.52; p = 0.046). Discharge to a care facility and length of stay were not significant on multivariable analysis. CONCLUSION Leukopenia is associated with increased risk for pulmonary and haematological complications, readmissions, reoperations, discharge to a care facility and death after incision and drainage for anorectal abscess.
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Affiliation(s)
| | - Ronit Patnaik
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jian Yu Huang
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Haisar Dao Campi
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Lisandro Montorfano
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Felice De Stefano
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Raul J Rosenthal
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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18
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Parwez M, Huda T, Yadav MS, Gupta K, Mital K, Pandya B. A PILOT STUDY on the Clinical and Functional Outcomes of an Improvised Technique of Core-cut Fistulectomy for Fistula-in-ano. Surg Innov 2022; 29:426-437. [PMID: 35341401 DOI: 10.1177/15533506221081134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anal fistulae are difficult to treat entities and minimally invasive procedures are evolving with promises. Our improvised technique is a simple and easy day-care procedure for simple fistulae. AIM To evaluate the outcomes of a technical modification in the procedure of core-cut fistulectomy in simple cryptoglandular fistula-in-ano. METHODS 47 patients of fistula-in-ano presenting to the out-patient of the General Surgery department at All India Institute of Medical Sciences, Bhopal, from November 2018 to March 2020 were selected. A complete history, physical examination followed by relevant investigations were meticulously performed and recorded. They were operated using an improvised core-cut technique, under a pudendal nerve block. Patients were kept on follow-up for a minimum of 6 months period to note the outcome of the surgery. RESULTS The mean age was 37 ± 13.17 years with a male: female ratio of 5.1:1. The most common clinical presentation was perianal discharge in 96% of patients followed by pain and pruritus ani in 45% and 32%, respectively. 93.62% were inter-sphincteric, and 6.38% were trans-sphincteric. Extra-sphincteric and supra-levator fistulae were excluded from the study. The mean operative time was 17 ± 10.19 minutes. The mean healing time was 19.21 ± 5.99 days. The success rate of this novel technique of core-cut was calculated to be 89.37%. The rate of recurrence was calculated to be 10.63% (5 out of 47 patients). None of our patients developed incontinence. CONCLUSION Our pilot study results for simple fistulae-in-ano had less morbidity, postoperative pain, better wound healing, patient satisfaction, and compliance with low risk of recurrence, and no incontinence. It could hence be recommended for larger groups and more complicated fistulae in the future.
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Affiliation(s)
- Masoom Parwez
- Department of General Surgery, 390706AIIMS Bhopal, Bhopal, India
| | - Tanweerul Huda
- Department of General Surgery, 390706AIIMS Bhopal, Bhopal, India
| | - Moorat S Yadav
- Department of General Surgery, 390706AIIMS Bhopal, Bhopal, India
| | - Kamal Gupta
- Department of General Surgery, Karan Hospital, Jalandhar, India
| | - Kushal Mital
- Department of General Surgery, Rajeev Gandhi Medical College, Thane, India
| | - Bharati Pandya
- Department of General Surgery, 390706AIIMS Bhopal, Bhopal, India
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Porwal A, Kundu GC, Bhagwat G, Butti R. Herbal medicine AnoSpray suppresses proinflammatory cytokines COX-2 and RANTES in the management of hemorrhoids, acute anal fissures and perineal wounds. Exp Ther Med 2021; 23:86. [PMID: 34938368 PMCID: PMC8688930 DOI: 10.3892/etm.2021.11009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/30/2021] [Indexed: 12/03/2022] Open
Abstract
Hemorrhoids, anal fistula and fissure are common anorectal complications. Anorectal diseases are associated with severe pain, inflammation, swelling, itching and bleeding. These diseases may be managed with different medical treatments or surgical procedures, depending on their severity. Surgical procedures, however, are highly invasive and are associated with higher costs and the possibility of recurrence. In addition, surgical removal of fistula-in-ano leads to the formation of perineal wounds. Therefore, developing therapeutic interventions that are effective in alleviating inflammation and pain are desirable for the effective management of anorectal diseases. Herbal compounds have previously been indicated to suppress inflammation and pain in different pathological conditions. The aim of the present study was to examine the effects elicited by a polyherbal formulation, AnoSpray®, on the migration of inflammatory cells and on the expression of inflammatory cytokines in anorectal diseases. The effect of AnoSpray on cell viability and migration was studied using MTT and wound-migration assays, respectively. Furthermore, the effects of AnoSpray on the expression of the inflammatory cytokines regulated upon activation, normal T cell expressed and presumably secreted (RANTES) and VEGF, as well as on cyclooxygenase-2 (COX)-2, were investigated using western blot analysis. The expression of RANTES and COX-2 in human hemorrhoid specimens was also analyzed to corroborate the in vitro findings. The results obtained revealed that AnoSpray did not exhibit any cytotoxic effects; however, it did lead to a significant suppression in the migration of RAW 264.7 and BJ cells. Furthermore, the results suggested that AnoSpray suppressed the expression of the inflammatory cytokines RANTES and VEGF, and also the expression of COX-2. In addition, RANTES and COX-2 were significantly downregulated in the clinical specimens of AnoSpray-treated hemorrhoids compared with the controls. Taken together, the results of the present study suggested that AnoSpray may be a potential therapeutic agent in the treatment of bleeding hemorrhoids, anal fissures and perineal wounds.
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Affiliation(s)
- Ashwin Porwal
- Healing Hands Clinic, Pune, Maharashtra 411001, India
| | - Gopal C Kundu
- Laboratory of Tumor Biology, Angiogenesis and Nanomedicine Research, National Centre for Cell Science, Pune, Maharashtra 411007, India.,School of Biotechnology and Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Institute of Eminence, Bhubaneswar, Odisha 751024, India
| | - Gajanan Bhagwat
- R&D Center, Healing Hands & Herbs Pvt. Ltd., Pune, Maharashtra 411002, India
| | - Ramesh Butti
- Laboratory of Tumor Biology, Angiogenesis and Nanomedicine Research, National Centre for Cell Science, Pune, Maharashtra 411007, India.,R&D Center, Healing Hands & Herbs Pvt. Ltd., Pune, Maharashtra 411002, India
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20
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Gender-based analysis of the characteristics and outcomes of surgery for anal fistula: analysis of more than 560 cases. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2018.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Background Fistula-in-ano commonly affects males more than females. Some differences in the characteristics of fistula-in-ano between both genders have been recognized, yet the impact of these differences on the outcomes of surgery for fistula-in-ano is still unclear. The present study conducted a gender-specific analysis aiming to assess the characteristics and the outcomes of surgery of fistula-in-ano in each gender.
Patients and methods The records of patients with fistula-in-ano were retrospectively reviewed and the following variables were extracted: patients’ demographics, type of fistula-in-ano, position of the external opening, operation performed, incidence of recurrence and complications, particularly fecal incontinence. Gender-based analysis of the characters and outcomes of surgery for fistula-in-ano was performed.
Results 565 (491 males) patients of a mean age of 41.7 years were included. Females had a significantly higher percentage of low fistula-in-ano than males (70.2% vs. 50.3%, p = 0.002). Males had a significantly higher percentage of high trans-sphincteric fistula-in-ano (48.5% vs. 29.7%; p = 0.003). Anterior fistula-in-ano was more common in female patients (69% vs. 16.3%; p < 0.0001). Recurrence of fistula-in-ano was detected in 42 (7.4%) patients. Males had higher recurrence rate than females (7.9% vs. 4%; p = 0.34). Fecal incontinence developed in 1.7% of patients with higher incidence observed in females (4% vs. 1.4%).
Conclusion The majority of fistula-in-ano in males were posterior and high trans-sphincteric whereas most fistula-in-ano in females were low and anteriorly based. Despite the different characteristics of fistula-in-ano; no significant differences in the rates of fistula recurrence and fecal incontinence between males and females could be recorded.
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Abstract
Abstract
Background Perianal fistula is among the most common anorectal diseases encountered in adults, men are more prone to be affected than women. There is a close relationship of abscess and fistula in etiology, anatomy, pathophysiology, therapy, complications and morbidity, it is appropriate to consider them as one entity.
Aim of study To determine the incidence of fistula formation and recurrent abscess in a sample of Iraqi patients in Baghdad and decide whether primary fistulotomy should be performed at the time of incision and drainage of perianal abscesses.
Patients and methods A retrospective study of 68 patients with perianal abscess operations conducted in Baghdad. They underwent incision and drainage under either local or general anesthesia at Al-Kindy Teaching Hospitals and private hospitals over a 15-year period from January 2000 to December 2015. Their ages ranged from 20 to 68 years (40.21 ± 1.34) males (63/68) (92.64%) were more than females (5/68) (7.35%). Patients were treated with incision over the abscess under anesthesia and drainage of the abscess was done. The patients were followed up for an average 18 months (range 12–24 months) after abscess drainage or until a fistula appeared and abscess recurrence.
Results The study group comprised of 68 (92.64%) patients with perianal abscess with a median age 39 years (range 20–68 years). The mean follow-up period was identified to be 18 months (range 12–24 months). Males (63/68) (92.64%) were more than females (5/68) (7.35%). The incidence of fistula formation after follow up, the patients with perianal abscess after incision and drainage was 31/68 (45.58%) and males (30/31) (44.11%) were more than females (1/31) (1.47%). The most common site was posterior then left lateral position. The percentage of patients with recurrent abscess n = 6 (8.82%)were lower than fistula formation n = 31 (45.58%). The percentage of males n = 4/6 (5.88%) were more than females 2/6 (2.94%).
Conclusions The incidence of anal fistula in a sample of Iraqi patients with perianal abscess was 45.58% and percentage of recurrence of perianal abscess was 8.82%. To avoid division of anal sphincter muscle, secondary fistulotomy is advised to be done later when anal fistula will be formed.
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22
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Youssef AT. Significance and Impact of the Intersphincteric Plane Sepsis in the Management of the Perianal Sepsis: Ultrasound Study. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1722356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Background The intersphincteric plane (ISP) is a potential space between the external and the internal anal sphincters. About 90% of the perianal sepsis is caused by an obstruction of the ducts of anal glands with subsequent secondary bacterial infection. The imaging modalities used to diagnose perianal sepsis are the ultrasound via endoanal and transperineal routes and magnetic resonance imaging.
Objective The study aimed to identify the various patterns of the ISP sepsis and their incidence among our study group and to clarify the significance of ISP in the pathogenesis of anorectal abscesses and various types of perianal fistula tracts, to optimize the surgical management.
Methods Retrospective descriptive study in which 57 patients with an ISP sepsis were evaluated with full medical history, clinical exam, and ultrasound; the final diagnosis was based on combining the results of ultrasound, digital rectal examination under anesthesia, and the operative results.
Results The current study showed many patterns of the ISP sepsis and estimated the incidence of each pattern among our study group; such patterns could be fistula tracts, sinus tracts, abscesses, intersphincteric abscess with supralevator extension, sinus with abscess formation, fistula with abscess formation, distension of the ISP with free pus, and other complex patterns like horse abscess, abscess with transsphincteric sinus, and ISP fistula/sinus with transsphincteric branches.
Conclusion Understanding the role of the ISP in the pathogenesis of anorectal abscesses and perianal fistula tracts can help in reaching the optimum way of management.
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Updike SW, Sletten Z. Occult Perirectal Abscess Causing Acute Urinary Retention. Cureus 2021; 13:e12461. [PMID: 33552778 PMCID: PMC7854337 DOI: 10.7759/cureus.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Acute urinary retention (AUR) is a common symptom evaluated in the emergency department. It is generally due to an obstructive process such as benign prostatic hyperplasia (BPH) and can be treated simply with an indwelling foley catheter and urological follow up. Perirectal abscess is a relatively rare cause of urinary retention with no documented prevalence but when present is almost universally accompanied by perirectal pain. We present a 53-year-old male with a four-day history of urinary retention without perirectal pain or additional symptoms, who was found to have a perirectal abscess on digital rectal exam (DRE) and confirmed on computed tomography (CT) imaging.
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Affiliation(s)
- Steve W Updike
- Emergency Medicine, San Antonio Military Medical Center, San Antonio, USA
| | - Zachary Sletten
- Emergency Medicine, San Antonio Military Medical Center, San Antonio, USA
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Dimopoulou D, Dimopoulou A, Fessatou S, Zavras N, Papaevangelou V. Perianal Abscess With Stellate Lacerations in a 3.5-year-old Previously Healthy Boy. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-2044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mantoo S, Mandovra P, Goh S. Using preoperative three-dimensional endoanal ultrasound to determine operative procedure in patients with perianal fistulas. Colorectal Dis 2020; 22:931-938. [PMID: 31991037 DOI: 10.1111/codi.14993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
AIM Accurate preoperative identification of perianal fistula tracts and internal openings can facilitate the choice of surgical procedure and may lead to improved healing rates. Our aim was to explore the effectiveness of three-dimensional endoanal ultrasound (3D-EAUS) in determining the type of perianal fistula and planning operative management. METHOD This was a cohort longitudinal study. Patients with perianal fistulas from January 2017 to January 2018 who underwent 3D-EAUS and subsequent surgery were included. Intra-operative findings were considered as standard for comparison with clinical examination and 3D-EAUS findings. The primary outcome measure was to evaluate the concordance between 3D-EAUS and intra-operative findings and the secondary outcome measure was healing rates. RESULTS Sixty-eight patients with a mean age of 43.1 ± 14.1 years were included. Twenty-eight patients had inter-sphincteric (41.2%) and 40 (14 high and 26 low) trans-sphincteric fistulas (58.8%). 3D-EAUS, clinical examination and intra-operative exploration could predict the location of internal openings in 62/68 (91.2%), 48/68 (70.5%) and 56/68 (82.4%) patients, respectively. Hydrogen peroxide (H₂O₂)-enhanced 3D-EAUS accurately predicted the location of internal openings when compared with 3D-EAUS without H₂O₂ (concordance K = 0.963, P = 0.05). High concordance rates were seen between intra-operative and 3D-EAUS findings on the type of perianal fistula. No significant difference was seen between the suggested surgical treatment based on 3D-EAUS and the eventual surgical treatment (P > 0.05). Study limitations were the small sample size and lack of randomization. CONCLUSION 3D-EAUS may be considered as a first-line investigation for patients with perianal fistulas because of high concordance with intra-operative assessment and facilitation of surgical planning.
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Affiliation(s)
- S Mantoo
- Department of Surgery, Khoo Teck Puat Hospital, Singapore City, Singapore
| | - P Mandovra
- Department of Surgery, Khoo Teck Puat Hospital, Singapore City, Singapore
| | - S Goh
- Department of Surgery, Khoo Teck Puat Hospital, Singapore City, Singapore
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Sahnan K, Adegbola S, Iqbal N, Twum-Barima C, Reza L, Lung P, Warusavitarne J, Hart A, Tozer P. Managing non-IBD fistulising disease. Frontline Gastroenterol 2020; 12:524-534. [PMID: 34712471 PMCID: PMC8515280 DOI: 10.1136/flgastro-2019-101234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kapil Sahnan
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Samuel Adegbola
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Nusrat Iqbal
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Charlene Twum-Barima
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Lillian Reza
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Phillip Lung
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Janindra Warusavitarne
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Ailsa Hart
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
- IBD Unit, St Mark's Hospital, Harrow, UK
| | - Phil Tozer
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
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Premjeyanth V, Shipman AR, Shipman KE. Faecal calprotectin in dermatology practice. Clin Exp Dermatol 2020; 45:831-835. [DOI: 10.1111/ced.14307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - A. R. Shipman
- Dermatology Department St Mary’s Hospital Portsmouth UK
| | - K. E. Shipman
- Department of Clinical Chemistry St Richards Hospital Chichester UK
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Fukuzako S, Maeda H, Koyoshi N, Fujita H, Kuroki H, Uemura S, Hanada N, Urakado T, Ido A. Perirectal abscess with dysuria. JGH OPEN 2020; 4:548-549. [PMID: 32514469 PMCID: PMC7273732 DOI: 10.1002/jgh3.12307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/12/2019] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
Perirectal abscesses often occur in the dorsal portion of the perirectal tissues. We report a patient who presented with fever, pain on defecation, and dysuria. He was found to have a perirectal abscess in the anterior perineum pressing on the urethra. After emergency surgery to drain the abscess, the symptoms improved.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Akio Ido
- Digestive and Lifestyle Diseases Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
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Perianal abscess in children: A paediatric infectious disease perspective. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Wang JP, Cai C, Du JL, Shi HQ, Liu QW, Dai ZH, Zhong ZF. Role of interleukin-17 in the pathogenesis of perianal abscess and anal fistula: a clinical study on 50 patients with perianal abscess. ANZ J Surg 2018; 89:244-247. [PMID: 30362208 DOI: 10.1111/ans.14874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/06/2018] [Accepted: 08/23/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To investigate the role of interleukin (IL)-17 in tissue and peripheral blood of perianal abscess and anal fistula. METHODS Patients with primary perianal abscess (n = 50) admitted to Jinhua Municipal Central Hospital between March 2003 and August 2004 were enrolled. Fifty patients with mixed haemorrhoids, who showed no perianal abscess or anal fistula, were also recruited as the control. After surgery, patients were followed up for 6 months. Protein and gene expression of IL-17 was determined in surgically harvested anal tissues and peripheral blood, respectively. The relationship between IL-17 and clinical pathological features were analysed. RESULTS As shown by immunohistochemistry of anorectal tissues, the positive rate of IL-17 protein was higher in the perianal abscess group than in the control group. In patients with perianal abscess, the expression of IL-17 significantly correlated with the diameter of the abscess (P = 0.013), the wound surface healing time (P = 0.010) and the progression into anal fistula (P = 0.003). For the gene expression of IL-17 in peripheral blood cells, the level was significantly higher in patients with perianal abscess comparing to the control group (0.4350 ± 0.1190 versus 0.1785 ± 0.1230, P ≤ 0.001). Comparing to the recovery group, patients with their perianal abscess progressed to anal fistula showed higher levels of IL-17 gene expression (P = 0.014). CONCLUSIONS Expression of IL-17 was increased in the anorectal tissues and peripheral blood of patients with perianal abscess and anal fistula. IL-17 may play an important role in the pathogenesis of perianal abscess and anal fistula.
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Affiliation(s)
- Jian-Ping Wang
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua, China
| | - Cheng Cai
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua, China
| | - Jin-Lin Du
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua, China
| | - Hong-Qi Shi
- Department of Pathology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Qing-Wei Liu
- Department of Pathology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Zhi-Hui Dai
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua, China
| | - Zhi-Feng Zhong
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua, China
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[Perianal abscess in children: A pediatric infectious disease perspective]. An Pediatr (Barc) 2018; 90:370-375. [PMID: 29880418 DOI: 10.1016/j.anpedi.2018.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There are limited data on the aetiology and management of perianal abscesses (PAs). The aim of this retrospective study was to define the characteristics of children with PAs; describe our experience with PA from the perspective of paediatric infectious medicine and determine the factors that influence clinical outcomes. METHODS We performed a retrospective review of cases of PA in children with no underlying disease managed in a tertiary referral hospital between January 2005 and July 2015. We collected data on demographic characteristics, symptoms, abscess size and location, abscess recurrences, laboratory and microbiological findings, treatment modalities, diagnosis of systemic illness at the end of the diagnostic workup and clinical outcomes. RESULTS We included a total of 47 patients in the study, with a predominance of male patients (93.6 vs 6.4%, P<.001). The median age was 7.7 months (IQR 1.8-13.7 months), and 40 children (85.1%) were younger than 2 years of age. Four PAs drained spontaneously and 7 healed without need of drainage (23.4%). Drainage by simple incision was applied to 36 patients (76.5%) and six PAs required fistulotomy (12.7%). Recurrent abscesses were found in 25 patients (53.1%). Three patients with recurrent PA were diagnosed with inflammatory bowel disease at the end of the diagnostic evaluation. CONCLUSIONS Based on the findings of our study, measurement of white blood cell counts and serum levels of acute phase reactants may be useful in the initial evaluation of children with PA. In light of the high relapse rates observed in surgically managed patients, it seems reasonable to use a conservative approach in patients aged less than 2 years.
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Emile SH, Elfeki H, Shalaby M, Sakr A. A Systematic review and meta-analysis of the efficacy and safety of video-assisted anal fistula treatment (VAAFT). Surg Endosc 2017; 32:2084-2093. [PMID: 29052068 DOI: 10.1007/s00464-017-5905-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/17/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Video-assisted anal fistula treatment (VAAFT) is a novel, minimally invasive technique for the treatment of fistula-in-ano (FIA). This review aimed to search the literature for the outcome of VAAFT regarding the recurrence and complication rates of the technique. METHODS A systematic literature search was conducted in compliance with the PRISMA screening guidelines. PubMed/MEDLINE and Scopus were searched for articles reporting the outcomes of VAAFT procedure from inception through April 2017. The main outcomes were patients' characteristics, technical aspects, operation time, recurrence, and complication rates. RESULTS Eleven studies (n = 788 patients) were included. The mean age of the patients was 39.5 years. 66.5% of patients had high or complex FIA and 18.4% underwent previous fistula surgery. The internal opening of the fistula was detected in 85.7% of patients. The mean operation time was 42 ± 14.2 min. The weighed mean rate of detection of internal opening was 93.3%. Recurrence occurred in 112 (14.2%) patients after a median follow-up of 9 months. Recurrence rates varied according to method of closure of internal opening from 15.3% after using staplers, 17.7% after suturing, to 25% after advancement flap. The weighted mean recurrence rate across the studies was 17.7%. The weighted mean complication rate was 4.8%. CONCLUSION VAAFT may be considered an effective diagnostic tool and a safe method for the treatment of complex and high FIA attaining satisfactory outcome and acceptably low complications. Recurrence after VAAFT may be related to previous fistula surgery and the method of closure of the internal opening.
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Affiliation(s)
- Sameh Hany Emile
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura City, Egypt.
| | - Hossam Elfeki
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura City, Egypt.,Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mostafa Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura City, Egypt
| | - Ahmad Sakr
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura City, Egypt
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Mastragostino P, Lee AD, Battaglia PJ. Perianal abscess mimicking levator ani syndrome: a case report and approach to the differential diagnosis of anorectal pain. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2017; 61:145-152. [PMID: 28928497 PMCID: PMC5596975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To present the clinical management and comprehensive differential diagnosis of a patient with anorectal pain from a perianal abscess. CLINICAL FEATURES A 41-year-old woman presented with pain localized to her perianal and gluteal region, accompanied by internal and external rectal pain. Prior to presentation, the patient had received a working diagnosis of levator ani syndrome. INTERVENTION AND OUTCOME An interdisciplinary management approach was utilized. Diagnostic imaging confirmed the clinical suspicion of a perianal abscess and the patient underwent surgical drainage. SUMMARY Anorectal pain is complex and multifactorial and a diagnosis such as an abscess should not be overlooked. This case emphasized that practitioners must be diligent in their evaluation and management of patients with anorectal pain, including recognizing situations that require further imaging and interdisciplinary management.
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Affiliation(s)
- Paul Mastragostino
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON
| | - Alexander D. Lee
- Clinical Faculty, Canadian Memorial Chiropractic College, Toronto, ON
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Butt UI, Bhatti S, Wadood A, Rehman UA, Changazi SH, Malik K, Fahad S, Chughtai A, Jadoon NA, Ayyaz M. A case report of pneumo-retro-peritoneum: An unusual presentation of ischio-rectal abscess. Ann Med Surg (Lond) 2017; 20:66-68. [PMID: 28702189 PMCID: PMC5496485 DOI: 10.1016/j.amsu.2017.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Ano-rectal abscesses are common. They however usually do not present with abdominal symptoms. CT although useful is not routinely carried out. Finding of Pneumo-retro-peritoneum with ischio-rectal abscess is rare. Case presentation We present the case of a diabetic gentleman who presented with abdominal pain and distension and was found to have ischio-rectal abscess on perianal examination. Although initially suspected to have acute abdomen due to perforated viscus, CT scan revealed pneumo-retro-peritoneum which appeared to arise due to the abscess. Patient underwent incision and drainage of the abscess followed by serial debridement. He made a complete recovery. Conclusion Abdominal symptoms are rare in ischio-rectal abscess, but they must be kept in mind. Proper diagnosis may avoid a negative laparotomy. Ischio-rectal abscess can present with abdominal symptoms of peritonism and peritonitis. Actual cause of these symptoms of peritonitis could be retro-peritoneal air which can be managed simply by incision and drainage of abscess alone. Vigilance on the part of treating surgeon/physician can avoid a negative laparotomy.
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Affiliation(s)
| | - Samiullah Bhatti
- Surgical Unit –II, Services Hospital, Lahore, Pakistan
- Corresponding author.
| | - Abdul Wadood
- Surgical Unit –II, Services Hospital, Lahore, Pakistan
| | | | | | - Kashif Malik
- Surgical Unit –II, Services Hospital, Lahore, Pakistan
| | - Shah Fahad
- Surgical Unit –II, Services Hospital, Lahore, Pakistan
| | | | | | - Mahmood Ayyaz
- Surgical Unit –II, Services Hospital, Lahore, Pakistan
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Bisset CN, Dick L, Chin YR, Summers L, Renwick A. Re: Bacteriological study in perianal abscess is not useful and not cost-effective. ANZ J Surg 2017; 87:420-421. [PMID: 28470701 DOI: 10.1111/ans.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Carly N Bisset
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Lachlan Dick
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Ye Ru Chin
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Louise Summers
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Andrew Renwick
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
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Abstract
Anorectal disorders are a common cause of presentation to the emergency department (ED). While the most frequently encountered anorectal conditions, such as hemorrhoids and anal fissures, are relatively benign and do not require imaging for diagnosis or management, there are multiple potentially life threatening anorectal conditions for which imaging is an important component of evaluation, diagnosis, and management. Although computed tomography (CT) is the most commonly used imaging modality for evaluation of anorectal pathology in the ED, magnetic resonance imaging (MRI) has an increasingly important role in the detection, characterization and management of specific anorectal conditions. This pictorial essay will review the imaging anatomy of the anorectum, summarize imaging protocols, and discuss the clinical presentation, imaging appearance, and differential diagnosis of anorectal conditions that may present to the emergency department, including infectious, inflammatory, malignant and vascular conditions.
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Smith SR, Newton K, Smith JA, Dumville JC, Iheozor‐Ejiofor Z, Pearce LE, Barrow PJ, Hancock L, Hill J. Internal dressings for healing perianal abscess cavities. Cochrane Database Syst Rev 2016; 2016:CD011193. [PMID: 27562822 PMCID: PMC8502074 DOI: 10.1002/14651858.cd011193.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND A perianal abscess is a collection of pus under the skin, around the anus. It usually occurs due to an infection of an anal gland. In the UK, the annual incidence is 40 per 100,000 of the adult population, and the standard treatment is admission to hospital for incision and drainage under general anaesthetic. Following drainage of the pus, an internal dressing (pack) is placed into the cavity to stop bleeding. Common practice is for community nursing teams to change the pack regularly until the cavity heals. Some practitioners in the USA and Australia make a small stab incision under local anaesthetic and place a catheter into the cavity which drains into an external dressing. It is removed when it stops draining. Elsewhere in the USA, simple drainage is performed in an outpatient setting under local anaesthetic. OBJECTIVES To assess the effects of internal dressings in healing wound cavities resulting from drainage of perianal abscesses. SEARCH METHODS In May 2016 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trial registries to identify ongoing and unpublished studies, and searched reference lists of relevant reports to identify additional studies. We did not restrict studies with respect to language, date of publication, or study setting. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) comparing any type of internal dressing (packing) used in the post-operative management of perianal abscess cavities with alternative treatments or different types of internal dressing. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment, and data extraction. MAIN RESULTS We included two studies, with a total of 64 randomised participants (50 and 14 participants) aged 18 years or over, with a perianal abscess. In both studies, participants were enrolled on the first post-operative day and randomised to continued packing by community district nursing teams or to no packing. Participants in the non-packing group managed their own wounds in the community and used absorbant dressings to cover the area. Fortnightly follow-up was undertaken until the cavity closed and the skin re-epithelialised, which constituted healing. For non-attenders, telephone follow-up was conducted.Both studies were at high risk of bias due to risk of attrition, performance and detection bias.It was not possible to pool the two studies for the outcome of time to healing. It is unclear whether continued post-operative packing of the cavity of perianal abscesses affects time to complete healing. One study reported a mean time to wound healing of 26.8 days (95% confidence interval (CI) 22.7 to 30.7) in the packing group and 19.5 days (95% CI 13.6 to 25.4) in the non-packing group (it was not clear if all participants healed). We re-analysed the data and found no clear difference in the time to healing (7.30 days longer in the packing group, 95% CI -2.24 to 16.84; 14 participants). This was assessed as very low quality evidence (downgraded three levels for very serious imprecision and serious risk of bias). The second study reported a median time to complete wound healing of 24.5 days (range 10 to 150 days) in the packing group and 21 days (range 8 to 90 days) in the non-packed group. There was insufficient information to be able to recreate the analysis and the original analysis was inappropriate (did not account for censoring). This second study also provided very low quality evidence (downgraded four levels for serious risk of bias, serious indirectness and very serious imprecision).There was very low quality evidence (downgraded for risk of bias, indirectness and imprecision) of no difference in wound pain scores at the initial dressing change. Both studies also reported patients' retrospective judgement of wound pain over the preceding two weeks (visual analogue scale, VAS) as lower for the non-packed group (2; both studies) compared with the packed group (0; both studies); (very low quality evidence) but we have been unable to reproduce these analyses as no variance data were published.There was no clear evidence of a difference in the number of post-operative fistulae detected between the packed and non-packed groups (risk ratio (RR) 2.31, 95% CIs 0.56 to 9.45, I(2) = 0%) (very low quality evidence downgraded three levels for very serious imprecision and serious risk of bias).There was no clear evidence of a difference in the number of abscess recurrences between the packed and non-packed groups over the variable follow-up periods (RR 0.72, 95% CI 0.22 to 2.37, I(2) = 0%) (very low quality evidence downgraded three levels for serious risk of bias and very serious imprecision).No study reported participant health-related quality of life/health status, incontinence rates, time to return to work or normal function, resource use in terms of number of dressing changes or visits to a nurse, or change in wound size. AUTHORS' CONCLUSIONS It is unclear whether using internal dressings (packing) for the healing of perianal abscess cavities influences time to healing, wound pain, development of fistulae, abscess recurrence or other outcomes. Despite this absence of evidence, the practice of packing abscess cavities is commonplace. Given the lack of high quality evidence, decisions to pack may be based on local practices or patient preferences. Further clinical research is needed to assess the effects and patient experience of packing.
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Affiliation(s)
- Stella R Smith
- North Western DeaneryGeneral Surgery4th Floor3 PiccadillyManchesterUKM1 3BN
| | - Katy Newton
- North Western DeaneryGeneral Surgery4th Floor3 PiccadillyManchesterUKM1 3BN
| | - Jennifer A Smith
- North Western DeaneryGeneral Surgery4th Floor3 PiccadillyManchesterUKM1 3BN
| | - Jo C Dumville
- University of ManchesterSchool of Nursing, Midwifery and Social WorkManchesterUKM13 9PL
| | - Zipporah Iheozor‐Ejiofor
- University of ManchesterCochrane Wounds GroupJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Lyndsay E Pearce
- Central Manchester University Hospitals NHS Foundation TrustDepartment of SurgeryOxford RoadManchesterUKM13 9WL
| | - Paul J Barrow
- North Western DeaneryGeneral Surgery4th Floor3 PiccadillyManchesterUKM1 3BN
| | - Laura Hancock
- North Western DeaneryGeneral Surgery4th Floor3 PiccadillyManchesterUKM1 3BN
| | - James Hill
- Central Manchester University Hospitals NHS Foundation TrustDepartment of SurgeryOxford RoadManchesterUKM13 9WL
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Pearce L, Newton K, Smith SR, Barrow P, Smith J, Hancock L, Kirwan CC, Hill J. Multicentre observational study of outcomes after drainage of acute perianal abscess. Br J Surg 2016; 103:1063-8. [DOI: 10.1002/bjs.10154] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 12/31/2022]
Abstract
Abstract
Introduction
Management of perianal abscesses has remained largely unchanged for over 50 years. The evidence for postoperative wound packing is limited and may expose patients to painful procedures with no clinical benefit and at considerable increased cost.
Methods
Patients were recruited in 15 UK centres between December 2013 and October 2014. Outcome measures included number of dressing (pack) changes, healing, recurrence, return to work/normal function, postoperative fistula in ano and health utility scores (EQ-5D™). Pain was measured before, during and after dressing change on a visual analogue scale.
Results
Some 141 patients were recruited (median age 39 (range 18–86) years). The mean number of dressing changes in the first 3 weeks was 13 (range 0–21), equating to an annual cost to the National Health Service of €6 453 360 in England alone per annum. Some 43·8 per cent of wounds were healed by 8 weeks after surgery and 86 per cent of patients had returned to normal function. Some 7·6 per cent of abscesses had recurred and 26·7 per cent of patients developed a fistula in ano by 6 months following surgery. Patients reported a twofold to threefold increase in pain scores during and after dressing changes.
Conclusion
Recurrent abscess is rare and fistula occurs in one-quarter of the patients. Packing is painful and costly.
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Affiliation(s)
- L Pearce
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - K Newton
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - S R Smith
- Department of General Surgery, University Hospital South Manchester, Manchester, UK
| | - P Barrow
- Department of General Surgery, Salford Royal Hospital, Salford, UK
| | - J Smith
- Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK
| | - L Hancock
- Department of General Surgery, Salford Royal Hospital, Salford, UK
| | - C C Kirwan
- Department of General Surgery, University Hospital South Manchester, Manchester, UK
- Department of General Surgery, Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - J Hill
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
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Pang LM, Kong FB, Wang XT, Li DG, Li YB, Sun PL, Huang HY, Liu CQ, Wei M. Efficacy of Vacuum Sealing Drainage after Incision of Perianal Abscess: Preliminary Experience. Am Surg 2015. [DOI: 10.1177/000313481508101114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Li-Ming Pang
- Departments of Surgery The First Affiliated Hospital of Guangxi University of Chinese Medicine Nanning, People's Republic of China
| | - Fan-Biao Kong
- Departments of Surgery The First Affiliated Hospital of Guangxi University of Chinese Medicine Nanning, People's Republic of China
| | - Xiao-Tong Wang
- Departments of Gastrointestinal and Peripheral Vascular Surgery People's Hospital of Guangxi Zhuang Autonomous Region Nanning, People's Republic of China
| | - De-Gang Li
- Departments of Surgery The First Affiliated Hospital of Guangxi University of Chinese Medicine Nanning, People's Republic of China
| | - Yu-Bo Li
- Departments of Surgery The First Affiliated Hospital of Guangxi University of Chinese Medicine Nanning, People's Republic of China
| | - Ping-Liang Sun
- Departments of Surgery The First Affiliated Hospital of Guangxi University of Chinese Medicine Nanning, People's Republic of China
| | - Hua-Yong Huang
- Departments of Surgery The First Affiliated Hospital of Guangxi University of Chinese Medicine Nanning, People's Republic of China
| | - Chun-Qiang Liu
- Departments of Surgery The First Affiliated Hospital of Guangxi University of Chinese Medicine Nanning, People's Republic of China
| | - Mai Wei
- Departments of Gastrointestinal and Peripheral Vascular Surgery People's Hospital of Guangxi Zhuang Autonomous Region Nanning, People's Republic of China
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Adapting fistula surgery to fistula tract and patient condition: towards a tailored treatment. Eur Surg 2015. [DOI: 10.1007/s10353-015-0357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Endoscopic Ultrasound and Anal Pain: The Key to Diagnosis. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:228-229. [PMID: 28868413 PMCID: PMC5580132 DOI: 10.1016/j.jpge.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/01/2015] [Indexed: 11/25/2022]
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CT of acute perianal abscesses and infected fistulae: a pictorial essay. Emerg Radiol 2014; 22:329-35. [PMID: 25421387 DOI: 10.1007/s10140-014-1284-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/11/2014] [Indexed: 12/12/2022]
Abstract
Computed tomography (CT) is an effective, readily available diagnostic imaging tool for evaluation of the emergency room (ER) patients with the clinical suspicion of perianal abscess and/or infected fistulous tract (anorectal sepsis). These patients usually present with perineal pain, fever, and leukocytosis. The diagnosis can be easy if the fistulous tract or abscess is visible on inspection of the perianal skin. If the tract or abscess is deep, then the clinical diagnosis can be difficult. Also, the presence of complex tracts or supralevator extension of the infection cannot be judged by external examination alone. Magnetic resonance imaging (MRI) is the best imaging test to accurately detect fistulous tracts, especially when they are complex (Omally et al. in AJR 199:W43-W53, 2012). However, in the acute setting in the ER, this imaging modality is not always immediately available. Endorectal ultrasound has also been used to identify perianal abscesses, but this modality requires hands-on expertise and can have difficulty localizing the offending fistulous tract. It may also require the use of a rectal probe, which the patient may not be able to tolerate. Contrast-enhanced CT is a very useful tool to diagnose anorectal sepsis; however, this has not received much attention in the recent literature (Yousem et al. in Radiology 167(2):331-334, 1988) aside from a paper describing CT imaging following fistulography (Liang et al. in Clin Imaging 37(6):1069-1076, 2013). An infected fistula is indicated by a fluid-/air-filled soft tissue tract surrounded by inflammation. A well-defined round to oval-shaped fluid/air collection is indicative of an abscess. The purpose of this article is to demonstrate the usefulness of contrast-enhanced CT in the diagnosis of acute anorectal sepsis in the ER setting. We will discuss the CT appearance of infected fistulous tracts and abscesses and how CT imaging can guide the ER physician in the clinical management of these patients.
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Abstract
Abscess and perirectal fistulas are common in humans but not so in animals. Fistulas located in tissues surrounding the anus are usually described in the course of furunculosis in dogs. This study presents the case of a one-year-old cat in which two rectocutaneous fistulas had formed. This process was a result of the chronic inflammation of tissues around the base of the tail due to the drainage of an abscess. The animal was referred for radiological examination with clinical signs of dyschezia. Faecal material was discharged only through the fistulas situated on both sides of the tail. The aim of the radiological examination was to preoperatively determine the course of the fistula tract and to identify their internal openings. Fistulography revealed that both fistulas were connected with each other and with the rectal lumen. Their external opening was located at the height of the 4th caudal vertebra, 1.5 cm (fistula on the right) and 2 cm (fistula on the left) from the wall of the rectum. The fistula located on the right side branched cranially. The rectal lumen in this area was significantly narrowed. Abscess formation resulting in the development of rectocutaneous fistulas has not yet been described in dogs or cats. In the present case, fistulography made it possible to identify directly the source and course of the fistula canal. This examination should be complemented by other diagnostic modalities, such as a contrast examination of the gastrointerstinal tract, ultrasound evaluation, and magnetic resonance imaging.
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Abstract
Anal problems are pervasive, embarrassing and vexing to patients. Primary care providers should be well versed in addressing these concerns, which uncommonly require referral for specialty care. Additionally, anal symptoms and findings may herald previously undiagnosed underlying illness.
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Affiliation(s)
- Jared Wilson Klein
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA.
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Clancy C, Iqbal Z, Sheehan M, Joyce MR. An unusual ischiorectal fossa mass. Int J Surg Case Rep 2013; 5:79-81. [PMID: 24440981 PMCID: PMC3921645 DOI: 10.1016/j.ijscr.2013.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Peri-anal fistulae commonly present with collections requiring surgical intervention. The most common cause of a peri-anal mass is abscess formation secondary to anal gland sepsis. In certain patient groups such as those over 65 or with atypical presenting symptoms there are other important considerations. PRESENTATION OF CASE A 70-year old male was referred by his general practitioner with symptoms of obstructed defaecation and a palpable mass in the ischiorectal fossa. He had previously undergone three operations for complex peri-anal fistulae in another hospital. Due to the previous history of surgery, seroma formation was considered and computed tomography guided drainage of the lesion was performed unsuccessfully. Given symptoms of obstructed defecation and need for histological diagnosis excision was undertaken. The approach was through a right pararectal incision over the bulk of the mass. Skin and pararectal tissue were divided revealing a mucinous lesion with multiple lobules adherent to pararectal tissue. Following histopathological examination a diagnosis of low grade mucinous neoplasm was made. DISCUSSION Primary mucinous neoplasm in the ischiorectal fossa is very rare. Diagnostic criteria for adenocarcinoma arising from perianal fistulae have previously been established by Rosser et al. but this lesion does not fall into this category. It is categorised as a mucinous cystic neoplasm of uncertain malignant potential. The differential diagnoses are discussed. CONCLUSION Consideration should be given to a range of pathologies in cases of atypical peri-anal masses.
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Affiliation(s)
- Cillian Clancy
- Department of Colorectal Surgery, University College Hospital Galway, Ireland.
| | - Zafar Iqbal
- Department of Colorectal Surgery, University College Hospital Galway, Ireland
| | - Margaret Sheehan
- Department of Histopathology, University College Hospital Galway, Ireland
| | - Myles R Joyce
- Department of Colorectal Surgery, University College Hospital Galway, Ireland
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Anterior ilioinguinal incision for drainage of high-located perianal abscess. Tech Coloproctol 2012; 17:455-8. [PMID: 23053443 DOI: 10.1007/s10151-012-0902-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 09/11/2012] [Indexed: 12/17/2022]
Abstract
Most perianal abscesses originate from infected anal glands at the base of the anal crypts. Most abscesses below are usually drained through perianal incision and can be treated successfully. However, when perianal abscesses extend to the high intrapelvic cavity, it may be inadequate treatment through a single route incision through a perianal approach. The aim of this technical note is to show that combined anterior ilioinguinal and perianal incisions may provide optimal surgical field and multiple drainages. Here, we report a 56-year-old male patient with perianal-originating parapsoas abscesses. Residual abscess still remained after initial perianal incision and drainage after 1-month treatment. We presented combined anterior ilioinguinal and perianal incision technique methods for proper drainage in this complicated case. No recurrent or residual abscess remained after 2 weeks of operation. So, combined anterior ilioinguinal incision is feasible for high-located perianal abscess.
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Ghahramani L, Bananzadeh AM, Izadpanah A, Hosseini SV. Late results of endorectal flap in management of high type perianal fistula. Middle East J Dig Dis 2012; 4:163-7. [PMID: 24829651 PMCID: PMC3990115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/18/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fistula-in-ano is a problematic perianal disease for physicians and patients because of its occasional difficulty in management. Due to the different types of fistulas seen in patients, careful approach is necessary to correctly choose from among the various surgical techniques. One surgical method for complex fistula is the endorectal advancement flap which has been frequently performed because of its low complication rate. METHODS This study enrolled 40 (33 males, 7 females) patients who suffered from high type fistula (greater than 30%-50% involvement of the external sphincter) as noted on digital rectal examination and endoanalsonography. Patients were seen at Shahid Faghihi Hospital, affiliated with Shiraz University of Medical Sciences, between 2007 and 2011. All enrolled patients received similar preoperational preparation. We used the jackknife operative position and determined the internal orifice of the fistula by inserting a probe, with injection of methylene blue or oxygen peroxide. Endorectal advancement flap included the mucosa, submucosa and thin portion of the muscle that completely covered the sutured internal orifice area. The external orifice was opened to adjust the external border of the external sphincter to allow for effective drainage. RESULTS All enrolled patients were followed for 36 months, which was noticeable statistically when compared with other study findings of high type fistula. The location of the external orifice, age, sex and bowel habits were not related to recurrence rate. CONCLUSION Endorectal advancement flap in selected patients who suffer from high type fistula seems to have beneficial effects with a low recurrence rate. Therefore, management of complex high type fistulas remains a challenging topic.
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Affiliation(s)
- Ladan Ghahramani
- Colorectal Research Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Center
| | - Ali Mohammad Bananzadeh
- Colorectal Research Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Center
| | - Ahmad Izadpanah
- Colorectal Research Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Center
| | - Seyed Vahid Hosseini
- Colorectal Research Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Center
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Abstract
BACKGROUND The incidence of anal abscess is relatively high, and the condition is most common in young men. METHODS A systematic review of the literature was undertaken. RESULTS This abscess usually originates in the proctodeal glands of the intersphincteric space. A distinction is made between subanodermal, intersphincteric, ischioanal, and supralevator abscesses. The patient history and clinical examination are diagnostically sufficient to establish the indication for surgery. Further examinations (endosonography, MRI) should be considered in recurrent abscesses or supralevator abscesses. The timing of the surgical intervention is primarily determined by the patient's symptoms, and acute abscess is generally an indication for emergency treatment. Anal abscesses are treated surgically. The type of access (transrectal or perianal) depends on the abscess location. The goal of surgery is thorough drainage of the focus of infection while preserving the sphincter muscles. The wound should be rinsed regularly (using tap water). The use of local antiseptics is associated with a risk of cytotoxicity. Antibiotic treatment is only necessary in exceptional cases. Intraoperative fistula exploration should be conducted with extreme care if at all; no requirement to detect fistula should be imposed. The risk of abscess recurrence or secondary fistula formation is low overall, but they can result from insufficient drainage. Primary fistulotomy should only be performed in case of superficial fistulas and by experienced surgeons. In case of unclear findings or high fistulas, repair should take place in a second procedure. CONCLUSION In this clinical S3 guideline, instructions for diagnosis and treatment of anal abscess are described for the first time in Germany.
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