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Johnston WR, Hwang R, Mattei P. Ostomy Management for Pediatric Perianal Crohn's Disease. J Pediatr Surg 2024; 59:1108-1112. [PMID: 38104035 DOI: 10.1016/j.jpedsurg.2023.11.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Pediatric patients with perianal Crohn's Disease (CD) suffer recalcitrant fistulas, abscesses, and strictures. Fecal diversion is a palliative last resort, but the expected clinical course and long-term management of the ostomy for this population is unclear. We sought to identify factors predictive of ostomy takedown and establish management recommendations for fistulizing and stenosing disease. METHODS We reviewed our institutional registry for patients aged 1-18 years with CD who received perianal surgery from 2011 to 2021. We analyzed medical therapy, examinations under anesthesia (EUA), fistula and stenosis response, and rates of fecal diversion and reversal. RESULTS There were 109 patients with fistulizing CD and 21 with stenosing CD. There were 8 diverted for fistula and 4 due to stricture [8/109 (7 %) vs 4/21 (19 %), p = 0.213]. Three patients with fistulizing disease had their ostomy reversed at an average of 1.46 years. Each demonstrated consistent CD control and with no additional perianal flares. The remainder have been diverted 3.15 ± 4.57 years with 2.1 ± 2.8 EUAs. Only one patient with stricture was durably reversed, but they still require serial anal dilation. Two were reversed but required re-diversion due to stricture progression. CONCLUSION Reversal rates after fecal diversion for pediatric perianal CD remain disappointingly low and diversion does not obviate the possibility of future EUAs. While reversal was successful for medically responsive patients with fistulizing disease, those with stenosing disease remained dependent on anal dilations and were more likely to fail reversal. Fecal diversion does nothing to reverse an established stricture and such patients will likely need to decide between indefinite dilations or permanent ostomy. LEVEL OF EVIDENCE IV. TYPE OF STUDY Retrospective review.
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Affiliation(s)
- William R Johnston
- General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Rosa Hwang
- General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter Mattei
- General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; FAAP, USA
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Gadepalli SK, Adler J. Perianal disease: Updates and controversies in closing the gaps. Semin Pediatr Surg 2024; 33:151402. [PMID: 38603820 DOI: 10.1016/j.sempedsurg.2024.151402] [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: 04/13/2024]
Abstract
Perianal complications are common and morbid in children with Crohn's disease. In this review, we describe the epidemiology, the presentation and diagnosis, evaluation and management. We focus on updates such as the increasing frequency of biologic medications and MRI for evaluation. We also highlight controversies on the timing and approaches to surgical techniques. Finally, perianal disease requires the coordination of multidisciplinary care with nursing, radiology, gastroenterology, and surgery to optimize outcomes - both medical and patient-centered.
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Affiliation(s)
- Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States; Susan G. Meister CHEAR Center, University of Michigan, Ann Arbor, MI, United States.
| | - Jeremy Adler
- Susan G. Meister CHEAR Center, University of Michigan, Ann Arbor, MI, United States; Division of Pediatric Gastroenterology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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Sanchez-Haro E, Vela E, Cleries M, Vela S, Tapiolas I, Troya J, Julian JF, Parés D. Clinical characterization of patients with anal fistula during follow-up of anorectal abscess: a large population-based study. Tech Coloproctol 2023; 27:897-907. [PMID: 37548781 PMCID: PMC10484809 DOI: 10.1007/s10151-023-02840-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Approximately 15-50% of patients with an anorectal abscess will develop an anal fistula, but the true incidence of this entity is currently unknown. The aim of the study was to determine the incidence of anorectal abscess and development of a fistula in a specific population area and to identify potential risk factors associated with demographic, socioeconomic and pre-existing disease (e.g. diabetes and inflammatory bowel disease). METHODS A longitudinal observational study was designed including a large cohort study in an area with 7,553,650 inhabitants in Spain 1st january 2014 to 31st december 2019. Adults who attended for the first time with an anorectal abscess and had a minimum of 1-year follow-up were included. The diagnosis was made using ICD-10 codes for anorectal abscess and anal fistula. RESULTS During the study period, we included 27,821 patients with anorectal abscess. There was a predominance of men (70%) and an overall incidence of 596 per million population. The overall incidence of anal fistula developing from abscesses was 20%, with predominance in men, and a lower incidence in the lowest income level. The cumulative incidence of fistula was higher in men and in younger patients (p < 0.0001). On multivariate analysis, patients aged 60-69 years (hazard ratio 2.0) and those with inflammatory bowel disease (hazard ratio 1.8-2.0) had a strong association with fistula development (hazard ratio 2.0). CONCLUSIONS One in five patients with an anorectal abscess will develop a fistula, with a higher likelihood in men. Fistula formation was strongly associated with inflammatory bowel disease.
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Affiliation(s)
- E Sanchez-Haro
- Section of Colorectal Surgery, Department of General Surgery, Hospital Germans Trias I Pujol School of Medicine, Universitat Autònoma de Barcelona, C/ Canyet S/N 08916, Badalona, Barcelona, Spain
| | - E Vela
- Àrea de Sistemes d'informació, Servei Català de la Salut (CatSalut), Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - M Cleries
- Àrea de Sistemes d'informació, Servei Català de la Salut (CatSalut), Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - S Vela
- Section of Colorectal Surgery, Department of General Surgery, Hospital Germans Trias I Pujol School of Medicine, Universitat Autònoma de Barcelona, C/ Canyet S/N 08916, Badalona, Barcelona, Spain
| | - I Tapiolas
- Section of Colorectal Surgery, Department of General Surgery, Hospital Germans Trias I Pujol School of Medicine, Universitat Autònoma de Barcelona, C/ Canyet S/N 08916, Badalona, Barcelona, Spain
| | - J Troya
- Section of Colorectal Surgery, Department of General Surgery, Hospital Germans Trias I Pujol School of Medicine, Universitat Autònoma de Barcelona, C/ Canyet S/N 08916, Badalona, Barcelona, Spain
| | - J-F Julian
- Section of Colorectal Surgery, Department of General Surgery, Hospital Germans Trias I Pujol School of Medicine, Universitat Autònoma de Barcelona, C/ Canyet S/N 08916, Badalona, Barcelona, Spain
| | - D Parés
- Section of Colorectal Surgery, Department of General Surgery, Hospital Germans Trias I Pujol School of Medicine, Universitat Autònoma de Barcelona, C/ Canyet S/N 08916, Badalona, Barcelona, Spain.
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Dong S, Chen B, Zhang J. Study on the factors influencing the prognosis after perianal abscess surgery. BMC Gastroenterol 2023; 23:334. [PMID: 37759161 PMCID: PMC10537581 DOI: 10.1186/s12876-023-02959-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE To study the influence of clinical characteristics and diagnosis and treatment methods of perianal abscess on postoperative recurrence or formation of anal fistula to provide a basis for selecting appropriate surgical and inspection methods for clinical treatment of perianal abscess in the future. METHODS The clinical data of 394 patients with perianal abscesses were collected, the influencing factors were investigated, and univariate analysis and multivariate logistic regression analysis were performed to further determine the risk factors affecting the prognosis of perianal abscess. RESULTS The results showed that the rate of preoperative blood routine results in the uncured group was higher (51.16%) than in the cured group (35.61%); the rate of high abscess space in the uncured group (23.26%) was higher than in the cured group (9.11%); the proportion of patients in the uncured group who underwent magnetic resonance imaging (MRI) before surgery (27.90%) was lower than in the cured group (45.30%); the proportion of patients in the uncured group who underwent simple drainage (51.16%) was higher than in the cured group (28.49%). The two groups had significant differences in perineal MRI examination, surgical method, preoperative blood routine, and abscess space (p = 0.030, p = 0.002, p = 0.047 and p = 0.010, respectively). Based on the results of univariate analysis and multivariate logistic regression analysis, the extent of the abscess cavity (OR = 2.544, 95%CI = 1.087-5.954, p = 0.031) and the surgical method (OR = 2.180, 95%CI = 1.091-4.357, p = 0.027) were independent influencing factors for postoperative recurrence of perianal abscess or anal fistula. CONCLUSION Preoperative assessment of the abscess range and precise intraoperative methods to resolve the infection of the abscess glands in the internal mouth can effectively improve the cure rate.
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Affiliation(s)
- Shujiang Dong
- Department of anus-intestines, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 68 Gehu Middle Road, Wujin District, 213000, 213000, Changzhou, China.
| | - Bingxue Chen
- Department of anus-intestines, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 68 Gehu Middle Road, Wujin District, 213000, 213000, Changzhou, China
| | - Jian Zhang
- Department of Medical Imaging, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, 213000, China
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Basgoz N, Brown CM, Smole SC, Madoff LC, Biddinger PD, Baugh JJ, Shenoy ES. Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash. N Engl J Med 2022; 387:547-556. [PMID: 35704401 DOI: 10.1056/nejmcpc2201244] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Nesli Basgoz
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Catherine M Brown
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Sandra C Smole
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Lawrence C Madoff
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Paul D Biddinger
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Joshua J Baugh
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Erica S Shenoy
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
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Affiliation(s)
- Pankaj Garg
- Chief Colorectal Surgeon, Indus International Hospital, Mohali, Punjab, India
| | - Baljit Kaur
- Chief Radiologist, SSRD MRI Center, Chandigarh, India
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Goddard GR, Lim IIP, Cheng YC, Velazco CS, Jenkins T, Rosen NG, Kotagal M, Garrison AP, Falcone R, Rymeski B, Frischer JS. A child presents with perianal symptoms - how often is this Crohn's disease? J Pediatr Surg 2021; 56:1618-1622. [PMID: 33280851 DOI: 10.1016/j.jpedsurg.2020.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/05/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The cumulative incidence and predictors of future diagnosis of Crohn's disease (CD) following presentation with perianal symptoms, such as anorectal abscess, fistula or fissure, is unknown. METHODS A 5-year retrospective review of children presenting with perianal symptoms without prior CD diagnosis was performed. Institutional cumulative incidence of CD was calculated to determine the risk of CD presenting with perianal symptoms. RESULTS 1140 children presented for evaluation of an anorectal abscess (n = 232), fistula (n = 49), or fissure (n = 859). Thirty-five were later diagnosed with CD, resulting in an incidence of 3%. Prognostic indicators of future CD diagnosis included increased age per every additional year (RR 1.19, 95% CI: 1.14-1.25, p < 0.001), male sex (RR 2.12, 95% CI 1.07-4.22, p = 0.024), or perianal fistula (RR 4.67, 95% CI 2.26-9.67, p = 0.022). Among those diagnosed with CD, 57% experienced and had a documented history of a CD-associated symptom prior to perianal symptom onset. Absence of symptoms resulted in delayed diagnosis (43 vs 3 days, p < 0.02). CONCLUSION Of children presenting with a perianal symptom, three percent will eventually be diagnosed with CD. At highest risk (35%) were males aged 10 years or older with a perianal fistula; which should prompt expeditious workup.
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Affiliation(s)
- Gillian R Goddard
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Irene Isabel P Lim
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States.
| | - Yu-Chia Cheng
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Cristine S Velazco
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Todd Jenkins
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Nelson G Rosen
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Meera Kotagal
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Aaron P Garrison
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Richard Falcone
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Beth Rymeski
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
| | - Jason S Frischer
- Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States
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Halligan S, Tolan D, Amitai MM, Hoeffel C, Kim SH, Maccioni F, Morrin MM, Mortele KJ, Rafaelsen SR, Rimola J, Schmidt S, Stoker J, Yang J. ESGAR consensus statement on the imaging of fistula-in-ano and other causes of anal sepsis. Eur Radiol 2020; 30:4734-4740. [PMID: 32307564 PMCID: PMC7431441 DOI: 10.1007/s00330-020-06826-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
Objectives To develop imaging guidelines for patients with fistula-in-ano and other causes of anal sepsis. Methods An expert group of 13 members of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) used a modified Delphi process to vote on a series of consensus statements relating to the imaging of patients with potential anal sepsis. Participants first completed a questionnaire to gather practice information and to help frame the statements posed. Results In the first round of voting, the expert group scored 51 statements of which 45 (88%) achieved immediate consensus. The remaining 6 statements were redrafted following input from the expert group and consensus achieved for all during a second round of voting, including an additional statement drafted. No statement was rejected due to a lack of consensus. After redrafting to improve clarity, 53 individual statements were presented. Conclusion These expert consensus statements can be used to guide appropriate indication, acquisition, interpretation and reporting of medical imaging for patients with potential fistula-in-ano and other causes of anal sepsis. Key Points • Medical imaging, notably magnetic resonance imaging, is used widely for the diagnosis and monitoring of fistula-in-ano and other causes of anal and perianal sepsis. • While the indexed medical literature is clear that diagnostic accuracy is potentially excellent, this depends on competent image acquisition and interpretation. • In order to facilitate this, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) has produced expert consensus guidelines regarding the imaging of fistula-in-ano and related conditions. Electronic supplementary material The online version of this article (10.1007/s00330-020-06826-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Halligan
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
| | - D Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - M M Amitai
- Department of Radiology, Sackler Faculty of Medicine, Tel Aviv University, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - C Hoeffel
- Department of Radiology, Hôpital Robert-Debré, Reims, France
| | - S H Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - F Maccioni
- Department of Radiological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - M M Morrin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - K J Mortele
- Division of Abdominal Imaging, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S R Rafaelsen
- Colorectal Centre of Excellence, University Hospital of Southern Denmark, Vejle, Denmark
| | - J Rimola
- Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - S Schmidt
- Department of Radiology, University Hospital, CHUV, Lausanne, Switzerland
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Yang
- Department of Radiology, Concord Hospital, Sydney, Australia
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González Salazar E, Cano Busnelli V, Mentz R. [Retroperitonitis secondary to intersphincteric perianal abscess]. Medicina (B Aires) 2020; 80:577. [PMID: 33048810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
| | | | - Ricardo Mentz
- Sección de Coloproctología, Hospital Italiano de Buenos Aires, Argentina
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Rencz F, Stalmeier PFM, Péntek M, Brodszky V, Ruzsa G, Gönczi L, Palatka K, Herszényi L, Schäfer E, Banai J, Rutka M, Gulácsi L, Lakatos PL. Patient and general population values for luminal and perianal fistulising Crohn's disease health states. Eur J Health Econ 2019; 20:91-100. [PMID: 31102158 PMCID: PMC6544586 DOI: 10.1007/s10198-019-01065-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/13/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND In patients with Crohn's disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Health utility values are not available from patients with CD that reflect the health loss associated with both luminal and perianal CD. OBJECTIVE To generate utilities for luminal and concomitant perianal fistulising CD health states directly from patients and from members of the general public. METHODS A cross-sectional survey was undertaken enrolling CD patients and a convenience sample of members of the general population. Respondents were asked to evaluate four common CD heath states [severe luminal disease (sCD), mild luminal disease (mCD), severe luminal disease with active perianal fistulas (sPFCD), and mild luminal disease with active perianal fistulas (mPFCD)] by 10-year time trade-off (TTO). In addition, patients assessed their current HRQoL by the TTO method. RESULTS Responses of 206 patients (40.8% with perianal fistulas) and 221 members of the general population were analysed. Mean ± SD utilities among patients for sPFCD, sCD, mPFCD and mCD states were 0.69 ± 0.33, 0.73 ± 0.31, 0.80 ± 0.29 and 0.87 ± 0.26. Corresponding values in the general public were: 0.59 ± 0.31, 0.65 ± 0.29, 0.80 ± 0.26 and 0.88 ± 0.25. Patients with active perianal fistulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse (p < 0.05). CONCLUSIONS TTO is a feasible method to assess HRQoL in patients with perianal fistulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fistulas.
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Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary.
- Premium Postdoctoral Research Program, Hungarian Academy of Sciences, Nádor u. 7, 1051, Budapest, Hungary.
| | - Peep F M Stalmeier
- Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Gábor Ruzsa
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University of Sciences, Izabella u. 46, 1064, Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Lóránt Gönczi
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, 1083, Budapest, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Nagyerdei krt. 98, 4032, Debrecen, Hungary
| | - László Herszényi
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - Eszter Schäfer
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - János Banai
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - Mariann Rutka
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720, Szeged, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, 1083, Budapest, Hungary
- Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
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Wu J, Lu W, Yu K, Liu H. Clinical study of external application of liuhe dan in the treatment of anal edge edema after mixed hemorrhoid operation. Pak J Pharm Sci 2019; 32:1431-1435. [PMID: 31551227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To observe the therapeutic efficacy of external application of Liuhe Dan in the treatment of anal edge edema after mixed hemorrhoid operation. A total of 160 patients who had been treated for lotion anal edge edema from January 2016 to August 2018 were enrolled research ojbects. They were divided into control group accepting routine nursing methods (80 cases) and research group accepting external application of Liuhe Dan (80 cases). The therapeutic efficacies of two groups were compared. The anal edge edema score and wound pain score of the research group were significantly lower than those of the control group (p<0.05). Meanwhile, the length of hospital stay and wound healing time of the research group were significantly shorter than those of the control group (p<0.05). External application of Liuhe Dan in the treatment of anal edge edema after mixed hemorrhoid operation could significantly improve the therapeutic efficacy and alleviate the patient's pain, which is of great application value.
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Affiliation(s)
- Jing Wu
- The Department of Integrated Traditional Chinese Medicine and Western Medicine in West China Hospital, Sichuan University, Chengdu, China
| | - Wenzhu Lu
- The Department of Integrated Traditional Chinese Medicine and Western Medicine in West China Hospital, Sichuan University, Chengdu, China
| | - Keqiang Yu
- The Department of Integrated Traditional Chinese Medicine and Western Medicine in West China Hospital, Sichuan University, Chengdu, China
| | - Hong Liu
- The Department of Integrated Traditional Chinese Medicine and Western Medicine in West China Hospital, Sichuan University, Chengdu, China
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12
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Kanstrup C, Perregaard H, Bertelsen CA. [Perianal abscess after anal intercourse should raise suspicion of rectal gonorrhoeae infection]. Ugeskr Laeger 2019; 181:V10180736. [PMID: 30799811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Neisseria gonorrhoeae infection is a sexually transmitted disease. Rectal gonorrhoea is often asymptomatic, the most common symptoms are anal pain, bleeding and purulent discharge. This case report describes a younger man, who experienced increasing anal pain and later fever after anal intercourse. N. gonorrhoeae infection was verified, before a clinical examination revealed a perianal abscess. During incision of the abscess an anal fistula was suspected, and six weeks after primary surgery and treatment with relevant antibiotics, transanal ultrasonography showed perianal scarring and no signs of anocutaneous fistula.
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Feisthammel J, Mössner J. [Proctology for internists]. Internist (Berl) 2019; 58:1053-1064. [PMID: 28884323 DOI: 10.1007/s00108-017-0318-9] [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: 10/18/2022]
Abstract
In proctology patients can often be helped with very little effort. With knowledge of the most common disease symptoms the treating physician can in many cases correctly recognize the cause of the complaints and initiate the appropriate therapy or arrange referral to a proctological institution. This article aims to briefly and succinctly present the most common diseases in proctology (e.g. mariscae, hemorrhoids, anal fissures, perianal venous thrombosis, abscesses and fistulas, condyloma acuminatum and anal carcinoma) and to provide the treating internist, even outside of gastroenterology, assistance with the management of proctological symptoms.
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Affiliation(s)
- J Feisthammel
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
- Proktologische Sprechstunde, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - J Mössner
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
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14
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Abstract
BACKGROUND AND AIMS Fistulas in patients with inflammatory bowel disease (IBD) pose a key challenge in the management of these patients. We aimed to describe a novel endoscopic method to treat patients with IBD who have fistulas. METHODS A cohort of 29 consecutive patients with fistulas and IBD were identified in the registry of our interventional IBD unit. An endoscopic fistulotomy with needle-knife was performed. The primary outcome was healing of the fistula without the need for surgical intervention. RESULTS A total of 29 patients underwent endoscopic fistulotomy; and the mean (± standard deviation) age of patients undergoing the procedure was 44.2 ± 14.6 years. Thirteen patients were male (44.8%), and 16 were female (55.2%). Twenty-six patients (89.6%) achieved complete resolution of the fistula as confirmed by endoscopy with a guidewire and/or cross-sectional abdominal imaging, with 10 patients (34.4%) requiring a single endoscopic treatment session. Three patients (10.3%) had a persistent fistula and required surgical intervention. One patient had postoperative bleeding requiring blood transfusion and hospitalization. CONCLUSION Endoscopic fistulotomy with a needle-knife appears to be safe and effective in treating IBD-related fistulas.
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Affiliation(s)
- Gursimran Kochhar
- The Interventional IBD Unit, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bo Shen
- The Interventional IBD Unit, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Abstract
A study of 350 women with lichen sclerosus, originally made to elucidate the relationship between lichen sclerosus and autoimmunity, led to the amassing of a considerable amount of clinical material. Our review is confined to those with anogenital lesions (342), supplemented by some new cases (15), giving a total of 357 women with biopsy proven lichen sclerosus. It demonstrates the wide age range of the condition, the association with morphoea and lichen planus and the occurrence of squamous cell carcinoma in some cases. It also shows that inappropriate surgery has continued to be carried out for benign disease.
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Affiliation(s)
- R H Thomas
- Salisbury District Hospital, Wiltshire, England
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Chiarelli M, Guttadauro A, Maternini M, Lo Bianco G, Tagliabue F, Achilli P, Terragni S, Gabrielli F. The clinical and therapeutic approach to anal stenosis. Ann Ital Chir 2018; 89:237-241. [PMID: 30588920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Anal stenosis is a fibrous narrowing of the anal channel. It develops, in most cases, in the aftermath of proctologic surgical procedures with extensive anoderm excision or in the presence of chronic anal inflammation in patients with Crohn Disease. However rare, this condition is thoroughly debilitating for the patients. Symptoms include constipation, pain and bleeding with defecation and a reduction of the caliber of stools. Diagnosis is essentially clinical. Prevention of postsurgical stenosis is based on a scrupulous surgical technique and on an extensive and carefully- planned follow up. Treatment is based on an initially conservative approach with regularization of stool transit through hydration, dietary fibers and bulk-forming laxatives. The role of mechanical dilatation in the treatment of AS is still debated. For severe cases and cases that are not responsive to conservative treatment we must resort to surgery. Surgical approach is tailored on the severity, position and extension. The most severe cases require anoplasty procedures with mucosal or anal flaps. KEY WORDS: Anal stenosis, Anal stricture,Proctology.
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Makris GM, Charalampopoulos A, Siristatidis C, Fexi D, Chrelias C, Battista MJ, Papantoniou N. Y-type Anovulvar Fistula Complicating Inflammatory Bowel Disease. Am Surg 2016; 82:305-307. [PMID: 28206918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Georgios-Marios Makris
- Gynecological Oncology Unit, Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", University of Athens, Athens, Greece
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Murayama M, Nakashima O, Murakami S, Yamazaki K, Koizumi K, Shimazaki A, Asaka S, Yamaguchi K, Yokomizo H, Shiozawa S, Yoshimatsu K, Shimakawa T, Katsube T, Naritaka Y. [A Case of Malignant Colonic Obstruction Bearing Another Synchronous Obstructive Lesion in the Anal Side of the Colon]. Gan To Kagaku Ryoho 2016; 43:2283-2285. [PMID: 28133296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There are several reasons for failure in the insertion of a self-expandable metallic stent(SEMS)into a malignant colonic obstruction(MCO)including difficulty in insertion of the catheter or guidewire through the stenotic lumen into the oral side or perforation relatedto the technique. Herein, we report a case of MCO bearing another synchronous obstructive lesion in the anal side of the colon that couldhave explainedthe difficulty in the insertion of the SEMS into the stenosis locatedin the oral side, which might have indicated the need for an emergency operation for relieving the obstruction. A 76-year-oldman with epigastralgia andmelena was admittedto our hospital andhe was diagnosedwith a MCO in the ascending colon. A series of examinations performedafter admission revealedthat the patient hadanother synchronous obstructive lesion in the descending colon, which made colonoscope insertion at the oral side difficult. The next day after admission, we observed that fasting relievedthe patient from abdominal pain causedby obstruction; therefore, we performedSEMS insertion into the MCO of the descending colon followed by SEMS insertion into the ascending colon after 6 days. These serial SEMS insertions facilitated the oral administration of the diet and the patient was discharged 15 days after admission. The patient was readmittedto our hospital andhe underwent a radical operation for both lesions in June 2015.
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Affiliation(s)
- Minoru Murayama
- Dept. of Surgery, Tokyo Women's Medical University Medical Center East
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20
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Abstract
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Tae Hee Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Inflammatory bowel disease is a conglomeration of disorders of unclear etiology and pathogenesis. Confirming the diagnosis of active disease may be difficult but is critical to judicious therapy. Sulfasalazine (Azulfidine) and its newer derivatives mesalamine (Asacol, Rowasa) and olsalazine sodium (Dipentum) are used for treatment of mild disease and maintenance. Corticosteroid therapy controls moderate disease in most patients, but withdrawal may be difficult. Immunosuppression or surgery may be necessary in severe or refractory cases. The risk of cancer as a complication of inflammatory bowel disease is often exaggerated but cannot be ignored.
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Affiliation(s)
- J H Butt
- Gastrointestinal Section, Harry S Truman Memorial Veterans Affairs Medical Center, Columbia, Missouri
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23
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Abstract
Pediatric inflammatory bowel disease is a chronic gastrointestinal disease consisting of Crohn's disease (CD) and ulcerative colitis (UC). Both disease processes can share similar clinical symptoms including abdominal pain, diarrhea, hematochezia, and weight loss; CD can also be complicated by penetrating and fistulizing disease. Perianal skin tags, perianal abscesses, recto-cutaneous fistulae, and rectal stenosis are among the phenotypic characteristics of perianal CD. Current treatment strategies are focused on the surgical drainage of abscesses and the closure of fistulous tracts as well as controlling intestinal inflammation with the use of immunomodulators (6-mercaptopurine and methotrexate) and biologics (infliximab and adalimumab). Current guidelines by the American Gastroenterology Association and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommend a combination of surgical intervention and medical management for the treatment of perianal CD.
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Saleem N, Ahmed TA, Bashir M. Chronic granulomatous disease. J PAK MED ASSOC 2016; 66:97-100. [PMID: 26712191] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic granulomatous disease is a rare inherited disorder characterised by inability of phagocytes to generate reactive oxygen species needed for intracellular killing of phagocytosed microorganisms. We report the case of an 8-month-old male child with recurrent chest infections and perianal abscess that had no response to conventional antibiotic treatment. His two elder brothers died due to similar complaints at the ages of 4 and 5 months. Four elder sisters were healthy and alive. This history indicated that the patient might have X-linked chronic granulomatous disease. A definite absence of superoxide activity in the patient's granulocytes detected by dihydrorhodamine test and nitroblue tetrazolium dye reduction test confirmed this diagnosis.
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Affiliation(s)
- Nida Saleem
- Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi
| | | | - Mukarram Bashir
- Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi
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25
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Galanakis CG, Bouzakis I, Polakis P. Severe anal pain · perianal swelling · no history of injury to the area · Dx? J Fam Pract 2016; 65:39-40. [PMID: 26845163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - Ilias Bouzakis
- Private Family Practice Unit, myFamilyDoctor.gr, Chania, Crete, Greece
| | - Pavlos Polakis
- Private Family Practice Unit, myFamilyDoctor.gr, Chania, Crete, Greece
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Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen KÅ. Forceps delivery is associated with increased risk of pelvic organ prolapse and muscle trauma: a cross-sectional study 16-24 years after first delivery. Ultrasound Obstet Gynecol 2015; 46:487-495. [PMID: 25920322 DOI: 10.1002/uog.14891] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/16/2015] [Accepted: 04/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery. METHODS This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery. RESULTS Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery. CONCLUSIONS We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery.
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Affiliation(s)
- I Volløyhaug
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway
| | - S Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Service, Trondheim University Hospital, Trondheim, Norway
| | - Ø Salvesen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Å Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
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27
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Anthony P, Feinn R, Brenner B, Dieckhaus KD, Chirch LM. The Addition of High-Risk HPV Testing to Anal Cytology Increases the Identification of Anal Dysplasia in HIV-Infected Patients. Conn Med 2015; 79:389-394. [PMID: 26411174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Anal dysplasia (AD) is prevalent in HIV-infected patients. Screening for AD is recommended for high-risk groups, including HIV-infected patients. We evaluated screening algorithms for AD using cytology, high-risk human papillomavirus (HRH) testing, or both. METHODS HIV-infected patients were offered AD screening by both anal cytology and PCR-based detection of HRH. Patients with abnormal cytology (AC) or HRH genotypes were referred to the same oncologic surgeon for high-resolution anoscopy (HRA). RESULTS Ninety patients underwent screening (84% men who have sex with men). Forty-four patients (52.6%) had abnormal screens (31.5% AC, 46% HRH). Twenty-six patients with AC and/or positive HRH had HRA. AC and nadir CD4+ cell count of < 200 cells/mm3 were predictors of abnormal histology on HRA by univariate analysis (OR 4.5 and 2.5, respectively). Using a log-linear model, we estimated that for every 49 cases with two normal screening tests, one case of AD would be missed. Conclusions: Universal screening for AD in an HIV+ population yielded a high percentage of abnormal findings. Addition of HRH to cytology screening increased positive screens by 24%. Larger studies are needed to determine the ideal screening method.
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28
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Sullivan PS, Moreno C. A Multidisciplinary Approach to Perianal and Intra-Abdominal Infections in the Neutropenic Cancer Patient. Oncology (Williston Park) 2015; 29:581-590. [PMID: 26281844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The chemotherapeutic treatment of both hematologic and solid organ malignancies has increased in recent decades, resulting in increased neutropenia-related perianal and intra-abdominal infections. Nearly 30% of neutropenia-related infections arise in the gastrointestinal tract. The management of these patients is often not straightforward, and the indications for and timing of surgical intervention continue to be unclear. The management strategy must take into account such factors as recent chemotherapy toxicity, stage and prognosis of the malignancy, performance status, comorbidities, degree of neutropenia, immunosuppression, thrombocytopenia, and corticosteroid use. The degree and duration of neutropenia is a key determinant of infection resolution. The focus of this review will be the multidisciplinary approach to management of anorectal infection, neutropenic enterocolitis, appendicitis, and cholecystitis in the neutropenic cancer patient.
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30
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Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV is associated with a significant burden of disease and cancer, including anogenital warts and recurrent respiratory papillomatosis, and anogenital and oropharyngeal cancers. Effective prevention is available, including primary prevention of cancers and anogenital warts through HPV vaccination, and secondary prevention of cervical cancer through screening and treatment of precancer. This article focuses on HPV infection and the clinical consequences of infection, with attention to cervical and anogenital squamous intraepithelial neoplasia and anogenital warts.
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Affiliation(s)
- Eileen F Dunne
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-02, Atlanta, GA 30030, USA.
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Moya P, Arroyo A, Lacueva J, Polo FC, Rico RC. Sacral nerve stimulation in patients with severe fecal incontinence after delivery sphincter injury. Am Surg 2014; 80:E66-E68. [PMID: 24480206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Pedro Moya
- Department of Surgery, University General Hospital of Elche, Alicante, Spain
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Bekkali N, El Benaye J. Protrusion pyramidale périanale. Pan Afr Med J 2014; 18:224. [PMID: 25422699 PMCID: PMC4239451 DOI: 10.11604/pamj.2014.18.224.4758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/07/2014] [Indexed: 11/25/2022] Open
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Jaafoura NG, Thaljaoui W, Atig A, Bouker A, Khalifa M, Bahri F. Ulcérations buccales et péri-anales : un mode de révélation inhabituel d’une granulomatose avec polyangéite - à propos d’un cas. Pan Afr Med J 2014; 18:121. [PMID: 25404981 PMCID: PMC4232196 DOI: 10.11604/pamj.2014.18.121.3984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 02/18/2014] [Indexed: 11/15/2022] Open
Abstract
La granulomatose avec polyangéite, est une vascularite systémique rare qui touche avec prédilection les voies aériennes supérieures, les poumons et les reins. L'atteinte cutanéo-muqueuse ainsi que l'atteinte digestive ne sont pas inhabituelles mais elles sont rarement inaugurales de la maladie. Nous rapportons l'observation d'une femme âgée de 57 ans, ayant une granulomatose avec polyangéite multi-systémique avec comme premières manifestations une atteinte cutanéo-muqueuse à type de nécrose de la langue et d'ulcérations péri-anales ainsi que des rectorragies. La présence de signes radiologiques orientant vers une hémmorragie intra-alvéolaire, l'atteinte rénale, l'atteinte neurologique périphérique ainsi que la positivité des C-ANCA de type anti-PR3 ont permis de rattacher les manifestations dermatologiques à cette vascularite. Des manifestations cutanéo-muqueuses atypiques, au cours d'une granulomateuse avec polyangéite, doivent être connues par le clinicien pour un diagnostic et une prise en charge adéquate.
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Affiliation(s)
| | | | - Amira Atig
- Service de Médecine Interne, CHU Farhat Hached, Sousse, Tunisie
| | - Ahmed Bouker
- Service de Médecine Interne, CHU Farhat Hached, Sousse, Tunisie
| | - Mabrouk Khalifa
- Service de Médecine Interne, CHU Farhat Hached, Sousse, Tunisie
| | - Fathi Bahri
- Service de Médecine Interne, CHU Farhat Hached, Sousse, Tunisie
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Lepri G, Guiducci S, Bellando-Randone S, Giani I, Bruni C, Blagojevic J, Carnesecchi G, Radicati A, Pucciani F, Marco MC. Evidence for oesophageal and anorectal involvement in very early systemic sclerosis (VEDOSS): report from a single VEDOSS/EUSTAR centre. Ann Rheum Dis 2013; 74:124-8. [PMID: 24130266 DOI: 10.1136/annrheumdis-2013-203889] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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: 12/12/2022]
Abstract
BACKGROUND The oesophagus is the first gastrointestinal (GI) tract involved in systemic sclerosis (SSc), followed by the anorectum. OBJECTIVE Evaluation of oesophageal and anorectal involvement and their correlations in patients with very early diagnosis of SSc (VEDOSS). PATIENTS AND METHODS 59 patients with VEDOSS, evaluated with oesophageal and anorectal manometry and investigated with lung function tests and chest HRCT. Demographic data, oesophageal and anorectal symptoms, Raynaud's phenomenon, autoantibodies, videocapillaroscopy patterns, puffy fingers and digital ulcers were recorded for all patients. RESULTS In 4 patients oesophageal manometry and in 17 patients anorectal manometry was not performed because of scarce tolerance. Oesophageal peristalsis was absent in 14 patients; its pressure and speed were significantly lower in 41 patients (p<0.001 and p=0.005, respectively). The maximum pressure and mean pressure (Pmax and Pm) of lower oesophageal sphincter were significantly lower (p=0.012 and p=0.024, respectively). Patients with a diffusing capacity of the lung for carbon monoxide<80% presented a hypotonic lower oesophageal sphincter (p=0.008) and an abnormal peristalsis (p<0.001); patients with a diffusing capacity of the lung for carbon monoxide>80% showed only an abnormal peristalsis (<0.001). The anal resting pressure (ARP) at 4.3 cm and 2 cm from anal edge and the anal canal Pm were significantly decreased (p<0.001 and p=0.010, respectively). The maximum voluntary contraction was significantly abnormal in its Pmax and Pm (p=0.017 and p=0.005) and in its duration (p=0.001). In patients with a positive HRCT, the ARP and the canal Pmax and Pm were significantly lower; patients with negative HRCT presented only an abnormal ARP. CONCLUSIONS In patients with VEDOSS, oesophageal and anorectal disorders are frequently detected, showing that very early SSc is characterised by GI involvement.
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Affiliation(s)
- Gemma Lepri
- Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Cosimo Bruni
- Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Jelena Blagojevic
- Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Giulia Carnesecchi
- Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Alessandra Radicati
- Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Filippo Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Matucci-Cerinic Marco
- Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Abstract
Spontaneous rectal rupture with subsequent transanal evisceration is an unusual phenomenon that has been rarely reported in the literature. Owing to its infrequent occurrence, little is known about the aetiology of this event although a weakening of the anterior rectal wall has been proposed. This article describes the first reported case of spontaneous transanal evisceration occurring in a patient with chronic lymphocytic leukaemia.
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Affiliation(s)
- S J Walton
- North West London Hospitals NHS Trust, UK
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36
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Short SS, Dubinsky MC, Rabizadeh S, Farrior S, Berel D, Frykman PK. Distinct phenotypes of children with perianal perforating Crohn's disease. J Pediatr Surg 2013; 48:1301-5. [PMID: 23845622 PMCID: PMC4372139 DOI: 10.1016/j.jpedsurg.2013.03.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/08/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE Perianal perforating disease (PF) has been reported in approximately 15% of children with Crohn's disease (CD). It is unknown whether children who present with PF at the time of diagnosis have a different course than those that develop PF while on therapy. METHODS From a prospective, single institution observational registry of children diagnosed with CD, we identified children with perianal perforating CD, defined as perianal abscesses and/or fistulae. Patients who presented with perianal perforating CD (PF-CD0) were compared to those who developed perianal perforating CD (PF-CD1) after initial diagnosis. RESULTS Thirty-eight of 215 (18%) children with CD had PF-CD during a median follow up of 4.5 years. Patients with PF-CD0 (n=26) tended to be more likely male (81% vs. 50%, p=0.07) and younger (9.3 yrs vs. 12.5 yrs, p=0.02). PF-CD1 (n=12) patients were more likely to require diverting ileostomy (42% vs. 8%, p=0.02) and colectomy (33% vs. 4%, p=0.03). Multivariable analysis predicted increased rate of diverting ileostomy in the PF-CD1 group (p=0.007, OR 19.1, 95% CI 1.6-234.8). CONCLUSION Pediatric CD patients who develop PF while on therapy for CD have a more severe phenotype and are more likely to require diverting ileostomy or colectomy compared to those who present with PF-CD.
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Affiliation(s)
- Scott S. Short
- Division of Pediatric Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Marla C. Dubinsky
- Pediatric Inflammatory Bowel Disease Program, Division of Gastroenterology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Shervin Rabizadeh
- Pediatric Inflammatory Bowel Disease Program, Division of Gastroenterology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sharmayne Farrior
- Pediatric Inflammatory Bowel Disease Program, Division of Gastroenterology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Dror Berel
- Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Philip K. Frykman
- Division of Pediatric Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Corresponding author. (P.K. Frykman)
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37
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Mesina C, Vasile I, Valcea DI, Pasalega M, Calota F, Paranescu H, Dumitrescu T, Mirea C, Mogoanta S. Problems of diagnosis and treatment caused by ingested foreign bodies. Chirurgia (Bucur) 2013; 108:400-406. [PMID: 23790792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2013] [Indexed: 06/02/2023]
Abstract
An ingested foreign body often passes the gastrointestinal tract without any complications. Foreign bodies, such as fish bones, chicken bones and toothpicks, have been known to cause perforation of the gastrointestinal tract. We present 4 cases: the first 2 of a 27-year-old male and a 48-years-old female respectively, with acute abdomen, diffuse purulent peritonitis, with ileum perforation, both caused by accidentally ingesting a wire, 1 case of a 64-year-old male with sigmoid perforation, caused by accidentally ingesting a toothpick and 1 case of a 52-year-old female presented with left buttock painful swelling for 1 week associated with fever,physical examination revealed an ischiorectal abscess.During incision and drainage a 3 cm chicken bone was found inside the abscess cavity. Evolution was favorable in all 4 cases.
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Affiliation(s)
- C Mesina
- 2nd Surgical Department, County Clinical Emergency Hospital Craiova, University of Medicine and Pharmacy, Craiova, Romania .
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38
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Hayashi S, Inoue D, Sakuyama T, Tanifuji Y, Moriya K, Kawakubo T. [Usefulness of subarachnoid phenol-glycerin block therapy for enabling cancer patients with refractory anal pain to proceed to home-based care]. Gan To Kagaku Ryoho 2012; 39 Suppl 1:103-105. [PMID: 23268915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In recent years, the number of cancer patients and their families desiring palliative home-based care in Japan has increased. Subarachnoid phenol-glycerin block therapy is offered to relieve refractory anal pain in cancer patients, and to reduce the side effects of systemic administration of opioids, such as drowsiness. The effects of phenol-glycerin, which is a medicine used for neurodegenerative diseases, lasted for 1 week to 3 months. Eight patients with this manipulation showed a significant improvement in their pain level, calculated by the numerical rating scale(NRS). Five of these patients could proceed to homebased care. It is important to establish common guidelines for the management of phenol-glycerin. The participation of pharmacists in the palliative care team will contribute to further growth of home-based care.
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39
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Lin HC, Ren DL, He QL, Peng H, Xie SK, Su D, Wang XX. Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III-IV prolapsing hemorrhoids: a two-year prospective controlled study. Tech Coloproctol 2012; 16:337-43. [PMID: 22402919 DOI: 10.1007/s10151-012-0815-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/12/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Circular stapled hemorrhoidopexy (CSH) is an effective technique for treating prolapsing hemorrhoids; but urgency and anal stenosis are common postoperative complications. The aim of this study was to assess the efficacy and postoperative outcomes of partial stapled hemorrhoidopexy (PSH), compared with CSH. METHODS Seventy-two consecutive patients with grade III and IV hemorrhoids who met the inclusion/exclusion criteria were divided in a non-randomized manner to undergo either PSH (n = 34) or CSH (n = 38). Intraoperative and postoperative parameters in both groups were collected and compared. RESULTS The postoperative visual analog score for pain at first defecation was significantly lower in the PSH group than that in the CSH group (P = 0.001). Fewer patients in the PSH group experienced postoperative urgency, compared with those in the CSH group at 12 h, 1 day, and 7 days after surgery (P = 0.025, P = 0.019, and P = 0.043, respectively). Gas incontinence occurred in 3 patients (7.9%) in the CSH group, but in none of patients in the PSH group (P = 0.242). Postoperative anal stenosis developed in one patient (2.6%) in the CSH group, but in none of the patients in the PSH group (P = 1.0). The 2-year recurrence rate was 2.9 and 5.3%, respectively, in the PSH and CSH groups (P = 1.0). CONCLUSIONS The 2-year recurrence rate is similar in patients with grade III-IV hemorrhoids treated with PSH or CSH. However, PSH is associated with less postoperative pain, fewer episodes of urgency, and no anal incontinence or anal stenosis.
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Affiliation(s)
- H-C Lin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University (Gastrointestinal and Anal Hospital), 26 Yuancun Er Heng Rd, Guangzhou, 510655, People's Republic of China
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40
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Zur E. Gastrointestinal mucositis: focus on the treatment of the effects of chemotherapy and radiotherapy on the rectum. Int J Pharm Compd 2012; 16:117-124. [PMID: 23050323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In an article published in the January/February 2012 issue of the International Journal of Pharmaceutical Compounding, damage to the oral mucosa, commonly referred to as oral mucositis, as a result of chemotherapy, radiotherapy, or a combination of both therapies was discussed. his article continues that discussion but in respect to the injury that these rapies cause to the gastrointestinal tract. Like oral mucositis, gastrointestinal mucositis is a significant problem in oncology, as it causes very serious pathologies along the alimentary tract, damaging the quality of life of the oncologic patient, and sometimes the damages are life-threatening. The most vulnerable organs of the gastrointestinal tract to radiation and chemotherapy toxicities are the small intestine, colon, and rectum. This article concentrates on the chronic rectum and anus toxicities of radiotherapy and escribes two compounding preparations to treat chronic radiation induced proctitis with rectal bleeding. As in oral mucositis, although substantial scientific progress has been made in learning more about this pathology, current treatments to manage gastrointestinal mucositis is inadequate.
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Affiliation(s)
- Eyal Zur
- Yarkon Center, Petach-Tikvah, Israel.
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41
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Frutos MD, Luján JA, Hernández Q, Maestre M, Valero G, Gil J, Parrilla P. Perforation and expulsion through the anus of catheter after gastric banding. Am Surg 2011; 77:1264-1265. [PMID: 21944637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Maria Dolores Frutos
- Servicio de Cirugía General y Digestivo Hospital Universitario Virgen de la Arrixaca Murcia, Spain.
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Sartini A, Castellani L, Buonfiglioli F, Roda G, Belluzzi A, Roda E. Update on Crohn's disease: a polymorphic entity. MINERVA GASTROENTERO 2011; 57:89-96. [PMID: 21372773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Crohn's disease is a chronic transmural inflammatory disease that most commonly affects the intestinal wall, but may also occur in any part of the gastrointestinal tract; its incidence is higher in industrialized countries, urban areas and upper socioeconomic classes. Various environmental risk factors have been associated with the pathogenesis of Crohn's disease and possible infectious agents (viruses, bacteria, yeasts) have also been considered. However, none of these factors alone leads to the development of the disease, which may occur only when there is a genetic predisposition and/or an abnormal function of the intestinal immune system. Histopathology demonstrates mucosal hyperemia, with small superficial ulcers in mild forms of the disease; in moderate-to-severe forms, serpiginous ulcerations demarcating areas of edematous mucosa produce the characteristic "cobblestone" appearance. The earliest microscopic lesions appear as neutrophil-mediated cryptic damage, with the formation of focal cryptic abscesses and granulomas throughout the layers of the intestinal wall. In addition to weight loss, patients mainly refer chronic diarrhea and recurrent right iliac fossa abdominal pain. Extraintestinal manifestations include ocular or articular complications. There are several drugs classes available for treating Crohn's disease, but the therapeutic approach depends on the clinical picture and differs from patient to patient. The broad clinical and the histopathological features of Crohn's disease make it a highly polymorphic entity. Diagnostic tests and a thorough knowledge of its various aspects are essential for guiding diagnosis and treatment.
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Affiliation(s)
- A Sartini
- Department of Clinical Medicine, University of Bologna, Bologna, Italy.
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Tursi A, Papa A, Maiorano M. Onset of severe perianal disease in Crohn's disease under treatment with infliximab: successful treatment with adalimumab and setons drainage. Inflamm Bowel Dis 2011; 17:676-8. [PMID: 20848475 DOI: 10.1002/ibd.21292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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44
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Ghosh SK, Bandyopadhyay D, Ghosh A, Biswas S, Mandal RK, Zamadar NS. Perianal dermatoses among men who have sex with men: A clinical profile of 32 Indian patients. Dermatol Online J 2011; 17:9. [PMID: 21272500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION A wide range of perianal dermatoses including different forms of sexually transmitted infections can occur in men who have sex with men (MSM). OBJECTIVE To determine the relative frequencies and types of perianal lesions in a group of men from eastern India who had a history of receptive anal intercourse. METHODS This was a cross-sectional clinical observational study. Consecutive MSM, presenting with perianal symptoms to the Sexually Transmitted Disease clinic of a tertiary care hospital of eastern India were studied. RESULTS A total of 32 patients (age 15-54 years, mean 38.5 years) were evaluated. Perianal wart was the most common (16, 50%) lesion detected, followed by fissure (3, 9.4%), herpes simplex infection (2, 6.2%), molluscum contagiosum (2, 6.2%), abscess (1, 3.1%), condyloma lata (1, 3.1%), candidiasis (1, 3.1%), furuncle (1, 3.1%), gonococcal infection (1, 3.1%), irritant contact dermatitis (1, 3.1%), and perianal psoriasis (1, 3.1%). Two patients had perianal tuberculosis. Four patients (12.5%) were HIV positive and syphilis was found in one. CONCLUSION A variety of dermatoses and infections can present in the perianal area of MSM, the most common being perianal wart. A thorough genital and perianal exam should be a part of a physical examination in these patients.
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Affiliation(s)
- Sudip Kumar Ghosh
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College, Kolkata, India.
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45
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Zboril P, Vyslouzil K, Klementa I, Starý L, Skalický P, Růzicka V. [Ambulatory excision of perianal duplicatures]. Rozhl Chir 2010; 89:774-779. [PMID: 21404520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
For successful outpatient treatment of perianal duplicatures, it was necessary to solve two main problems. First was bleeding from wounds following excision of perianal duplicatures, which is often marked and "pulsating", as well as to accelerate defect healing after excision so as to eliminate or minimize sick leave following this outpatient procedure. To effectively stop acute bleeding we use Traumacel powder, which after applying to a tampon we apply to the bleeding site and by compression we facilitate its effect. Traumacel spray also has a significant haemostatic effect, which we spray directly onto the bleeding site, where it reacts and creates a strongly adhering coagulum, which has significant haemostatic properties. This effect may also be potentiated by applying compression in the form of tampon or longuette. After cessation of acute bleeding, as prevention against future seepage, surgical haemostatic materials are used, which adhere to the wound, or bleeding lesion, and are left in situ for approximately 12 hours. After stopping the bleeding, hydrocortisone and epithelializing cream is applied to the defects to support healing by significantly decreasing secretion from the wound and also significantly decreasing healing time by facilitating epithelization. At outpatient check-ups, wound surfaces treated as such are cleanly granulated without necrotic coating and with minimal surrounding redness. The total healing time is generally 2 weeks, whereas after 4 days the patients are almost without troubles. This effective healing not only lessens the patient's pain, but also improves the comfort of the patient and allows a more rapid return to daily activities.
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Affiliation(s)
- P Zboril
- I. Chirurgická klinika LF UP a FN Olomouc
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46
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Shvetsov YB, Hernandez BY, Wilkens LR, Thompson PJ, Franke AA, Zhu X, Goodman MT. Plasma micronutrients and the acquisition and clearance of anal human papillomavirus infection: the Hawaii HPV cohort study. Cancer Res 2010; 70:9787-97. [PMID: 20935226 PMCID: PMC2999639 DOI: 10.1158/0008-5472.can-10-1374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anal human papillomavirus (HPV) infection is common among women and the cause of most anal malignancies. The incidence of anal cancer has been increasing among U.S. women, yet few cofactors for the natural history of anal HPV infection have been identified. We examined the hypothesis that plasma carotenoid, retinol, and tocopherol concentrations are associated with the acquisition and clearance of anal HPV infection in a cohort of 279 Hawaiian residents followed at 4-month intervals for a mean duration of 16 months. At each visit, interviews were conducted and biological specimens were obtained, including anal cell specimens for HPV DNA detection and genotyping, and a fasting blood sample to measure 27 micronutrients. Cohort participants acquired 189 anal HPV infections, 113 of which cleared during the study period. The most frequently acquired HPV genotypes were HPV-52, -53, -84, and -16. Women in the highest quartile of trans-zeaxanthin, trans -anhydro-lutein, and trans-, cis-, and total β-carotene had significant 43% to 50% reduction in the risk of acquisition of any HPV infection compared with women in the lowest quartile. Few associations were observed between micronutrient levels and clearance of transient (≤ 150 days) anal HPV infections. However, clearance of persistent (> 150 days) infections was associated with higher levels of β-tocopherol + γ-tocopherol and lower levels of carotenoids and retinol. Our findings suggest that several carotenoids can reduce the risk and clearance of anal HPV infections that contribute to anal cancer.
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Affiliation(s)
- Yurii B Shvetsov
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, Hawaii 96813, USA.
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47
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Opar SP. Photo quiz. Painful perianal lesions. Am Fam Physician 2010; 82:419-421. [PMID: 20704174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Susan P Opar
- Madigan Army Medical Center, Department of Family Medicine, Tacoma, Washington, USA.
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48
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Altomare DF, Rinaldi M, Sallustio PL, Armenise N. Giant fecaloma in an adult with severe anal stricture caused by anal imperforation treated by proctocolectomy and ileostomy: report of a case. Dis Colon Rectum 2009; 52:534-7. [PMID: 19333059 DOI: 10.1007/dcr.0b013e318199db36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although fecalomas are relatively common in patients who are elderly, constipated, or who have spinal injuries, a giant fecaloma formation unresponsive to conservative treatment is a rare condition that sometimes requires surgery for complications. Herein we report a case of a long-lasting (46 years) giant fecaloma associated with severe anal stricture after surgery for anal atresia and resulting in severe malnutrition, bone structural changes, and severe impairment of quality of life. Eight months after treatment by total proctocolectomy and ileostomy, the patient was on a free diet and had gained more than 10 percent of his postoperative body weight; improvements were observed in the tone of the abdominal muscles and in his quality of life.
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Affiliation(s)
- Donato F Altomare
- Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University of Bari, Bari, Italy.
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49
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Semb S, Nordgaard-Lassen I. [Treatment of fistulating pouchitis with tumour necrosis factor-alpha-inhibitor (infliximab)]. Ugeskr Laeger 2008; 170:4134-4135. [PMID: 19091194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The surgical first choice treatment for patients with ulcerative colitis (UC) involves total proctocolectomy with ileal pouch-anal anastomosis (IPAA). Postoperative development of pouch-related fistula is a rare complication, but it is associated with significant morbidity, a high recurrence rate and is a major cause of pouch failure. We report the use of infliximab, a monoclonal antibody to tumour necrosis factor-alpha, in three patients who developed pouch-related fistula after undergoing IPAA surgery for UC.
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Affiliation(s)
- Synne Semb
- Gastroenheden, Medicinsk Sektion, afsnit 439, Hvidovre Hospital, DK-2650 Hvidovre.
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