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Akinmoladun O, Hatch QM. Anal Cryptoglandular Suppuration: Evidence-Based Management. Surg Clin North Am 2024; 104:491-501. [PMID: 38677815 DOI: 10.1016/j.suc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Anal suppurative processes are commonly encountered in surgical practice. While the initial therapeutic intervention is philosophically straightforward (incision and drainage), drainage of the appropriate space and treatment of the subsequent fistula in ano require a thorough understanding of perianal anatomy and nuanced decision making. Balancing the risk of fecal incontinence with simple fistulotomy versus the higher risk of fistula recurrence with all sphincter-sparing fistula treatments can be a challenge for surgeons and patients alike.
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Affiliation(s)
- Oladapo Akinmoladun
- Department of Surgery, Madigan Army Medical Center General Surgery, Joint Base Lewis-McChord, WA 98431, USA
| | - Quinton M Hatch
- Department of Surgery, Madigan Army Medical Center General Surgery Residency, Joint Base Lewis-McChord, WA 98431, USA.
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Yano T, Nakano K, Yoshimitsu M, Idani H, Okajima M. Successful resection of rectal cancer and perirectal abscess following systemic chemotherapy and chemoradiotherapy: A case report. Int J Surg Case Rep 2023; 108:108403. [PMID: 37329610 PMCID: PMC10382744 DOI: 10.1016/j.ijscr.2023.108403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Perirectal abscesses are uncommon in colorectal cancer. Although abscess infection should be controlled before colorectal cancer treatment, abscess formation makes surgical resection and preoperative treatment difficult. There is currently no established treatment for colorectal cancer with perirectal abscesses. Here, we present a case of rectal cancer with a perirectal abscess that was resected after systemic chemotherapy followed by chemoradiotherapy. CASE PRESENTATION A 73-year-old man presented to the outpatient clinic with complaints of weight loss and general malaise. Colonoscopy revealed a circumferential tumor 3 cm from the anal verge, and examination of the endoscopic biopsy specimen indicated a well-differentiated tubular adenocarcinoma. Pelvic magnetic resonance imaging revealed a perirectal abscess on the ventral aspect of the rectum. After sigmoid colostomy was performed to control the infection, 4 cycles of panitumumab and modified fluorouracil, leucovorin, and oxaliplatin were administered. After the perirectal abscess disappeared, chemoradiotherapy to the whole pelvis (radiotherapy 45Gy/25 fractions plus tegafur-gimeracil-oteracil) was administered. Total pelvic exenteration with an ileal conduit was performed via open surgery. The pathological diagnosis was well-differentiated tubular adenocarcinoma with complete resection and negative resection margins. No recurrence of cancer has been observed 26 months after surgery. CLINICAL DISCUSSION Treatment of colorectal cancer with perirectal abscess is difficult to define the extent of resection due to the spread of inflammation. We believe that treatment should address high risk of local recurrence. CONCLUSION After sigmoid colostomy, complete resection of colorectal cancer with perirectal abscess could be achieved by systemic chemotherapy followed by chemoradiotherapy.
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Affiliation(s)
- Takuya Yano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan.
| | - Kanyu Nakano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan
| | - Hitoshi Idani
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Saha B, Dang J, Kahili-Heede M, Grobe J. Rectal Adenocarcinoma Presenting as a Perirectal Abscess. Case Rep Gastroenterol 2023; 17:204-211. [PMID: 37091834 PMCID: PMC10116390 DOI: 10.1159/000528950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/29/2022] [Indexed: 04/25/2023] Open
Abstract
Classic symptoms of rectal cancer (RC) such as hematochezia, tenesmus, rectal pain, and bowel habit changes are well known but can be nonspecific and misdiagnosed. Rare presentations, in combination with these conventional symptoms, can occur warranting a higher degree of clinical suspicion. Here, we report a case of rectal adenocarcinoma presenting as a perirectal abscess. A 52-year-old male with uncontrolled diabetes mellitus presented with a 2-year and 2-month history of rectal bleeding and changes in bowel habits, respectively, which were attributed to other conditions. He initially presented with left buttock pain and severe sepsis. Subsequent workup for suspected Fournier's gangrene and perirectal abscess led to the discovery of a rectal adenocarcinoma (pT4N0M0, stage IIB/C). A combination of debridement, antibiotic therapy, neoadjuvant chemoradiation, and abdominoperineal resection resulted in improvement of the patient's condition and remission. In conclusion, rare presentations of RC, such as a perirectal abscess, especially if present in conjunction with conventional RC symptomology, may necessitate the workup of RC.
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Affiliation(s)
- Bibek Saha
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jared Dang
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Melissa Kahili-Heede
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - James Grobe
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- The Queen’s Medical Center, Honolulu, HI, USA
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Zinicola R, Cracco N, Rossi G, Giuffrida M, Giacometti M, Nicholls RJ. Acute supralevator abscess: the little we know. Ann R Coll Surg Engl 2022; 104:645-649. [PMID: 35133205 PMCID: PMC9685962 DOI: 10.1308/rcsann.2021.0257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Acute supralevator abscess (SLA) is an uncommon and complicated form of anorectal sepsis. Its correct management is crucial to avoid complex iatrogenic fistula formation. A comprehensive review of the literature was conducted to determine the incidence of SLA and the surgical outcome with particular reference to the direction of drainage. METHODS A search of Medline, PubMed and the Cochrane Library was performed to identify all studies reporting surgical drainage of SLA. FINDINGS A total of 19 studies were identified, including 563 patients. The only two prospective studies reported an incidence of SLA of 10% and 3% in 68 and 100 patients, respectively, with anorectal sepsis. In 17 retrospective studies, the incidence ranged from 0% to 28%. Magnetic resonance imaging (MRI) was performed routinely in only one study. The surgical anatomical classification of the abscess was described in six studies diagnosed at surgery. The direction of surgical drainage whether 'inwards' (into the lumen) or 'outwards' (into the ischioanal fossa) was stated in only six studies. In two of these, the direction of drainage was contradictory to the recommendation made by Parks et al. Recurrent sepsis was reported in eight studies and ranged from 0% to 53%. CONCLUSIONS Detailed and prospective data on acute SLA are lacking. Its real incidence is unclear and it is not possible to analyse surgical outcomes conclusively according to different direction of drainage. The routine use of MRI in complicated anorectal sepsis would specify the surgical anatomy of SLA before any drainage is carried out.
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Affiliation(s)
| | - N Cracco
- IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | | | | | - M Giacometti
- General Surgery San Biagio Hospital, Domodossola, Italy
| | - RJ Nicholls
- Imperial College London and St Mark’s Hospital, UK
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Pehlivanli F, Aydin O, Karaca G, Aydin G, Erden Daphan Ç. An Extremely Rare Complication of Widespread Retroperitoneal Abscess Originating from Anorectal Horseshoe Abscess. Bull Emerg Trauma 2019; 7:72-75. [PMID: 30719470 PMCID: PMC6360016 DOI: 10.29252/beat-0701011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Faruk Pehlivanli
- Kirikkale University School of Medicine, Department of General Surgery, Kirikkale, Turkey
| | - Oktay Aydin
- Kirikkale University School of Medicine, Department of General Surgery, Kirikkale, Turkey
| | - Gökhan Karaca
- Kirikkale University School of Medicine, Department of General Surgery, Kirikkale, Turkey
| | - Gülçin Aydin
- Kirikkale University School of Medicine, Department of Anesthesiology and Reanimation, Kirikkale, Turkey
| | - Çağatay Erden Daphan
- Kirikkale University School of Medicine, Department of General Surgery, Kirikkale, Turkey
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Choi EK, Kim JH, Jeong SU, Na SY, Boo SJ, Kim HU, Song BC. Endoscopic Ultrasound-Guided Perirectal Abscess Drainage without Drainage Catheter: A Case Series. Clin Endosc 2017; 50:297-300. [PMID: 28395397 PMCID: PMC5475510 DOI: 10.5946/ce.2016.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/30/2017] [Accepted: 02/11/2017] [Indexed: 11/17/2022] Open
Abstract
A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. We report four cases of perirectal abscess that were successfully treated with only one or two 7 F double pigtail plastic stent placements and without a drainage catheter for irrigation.
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Affiliation(s)
- Eun Kwang Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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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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