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Scientific Reports Sep 2022Perianal abscesses are frequent diseases in general surgery. Principles of standard patient care are surgical drainage with exploration and concomitant treatment of...
Perianal abscesses are frequent diseases in general surgery. Principles of standard patient care are surgical drainage with exploration and concomitant treatment of fistula. Antiinfective therapy is frequently applied in cases of severe local disease and perianal sepsis. However, the role of microbiologic testing of purulence from perianal abscesses is disputed and the knowledge concerning bacteriology and bacterial resistances is very limited. A retrospective cohort study was performed of consecutive patients (≥ 12 years of age) from a tertiary care hospital, who underwent surgical treatment for perianal abscess from 01/2008 to 12/2019. Subdividing the cohort into three groups regarding microbiological testing results: no microbiological testing of purulence (No_Swab, n = 456), no detection of drug resistant bacteria [DR(-), n = 141] or detection of bacteria with acquired drug resistances from purulence [DR(+), n = 220]. Group comparisons were performed using Kruskall-Wallis test and, if applicable, followed by Dunn´s multiple comparisons test for continuous variables or Fishers exact or Pearson's X test for categorical data. Fistula persistence was estimated by Kaplan Meier and compared between the groups using Log rank test. Corralation analysis between perioperative outcome parameters and bacteriology was performed using Spearman´s rho rank correlation. Higher pretherapeutic C-reactive protein (p < 0.0001) and white blood cell count (p < 0.0001), higher rates of supralevatoric or pararectal abscesses (p = 0.0062) and of complicated fistula-in-ano requiring drainage procedure during index surgery (p < 0.0001) reflect more severe diseases in DR(+) patients. The necessity of antibiotic therapy (p < 0.0001), change of antibiotic regimen upon microbiologic testing results (p = 0.0001) and the rate of re-debridements during short-term follow-up (p = 0.0001) were the highest, the duration until definitive fistula repair was the longest in DR(+) patients (p = 0.0061). Escherichia coli, Bacteroides, Streptococcus and Staphylococcus species with acquired drug resistances were detected frequently. High rates of resistances against everyday antibiotics, including perioperative antibiotic prophylaxis were alarming. In conclusion, the knowledge about individual bacteriology is relevant in cases of complex and severe local disease, including locally advanced infection with extended soft tissue affection and perianal sepsis, signs of systemic inflammatory response as well as the need of re-do surgery for local debridements during short-term and fistula repair during long-term follow-up. Higher rates of acquired antibiotic resistances are to be expected in patients with more severe diseases.
Topics: Abscess; Anti-Bacterial Agents; Anus Diseases; Bacteria; Humans; Retrospective Studies; Sepsis; Skin Diseases; Treatment Outcome
PubMed: 36050427
DOI: 10.1038/s41598-022-19123-6 -
The European Journal of Health... Jun 2019In patients with Crohn's disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Health...
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.
Topics: Adolescent; Adult; Age Factors; Anus Diseases; Crohn Disease; Cross-Sectional Studies; Digestive System Fistula; Female; Humans; Male; Middle Aged; Quality of Life; Severity of Illness Index; Sex Factors; Socioeconomic Factors; Young Adult
PubMed: 31102158
DOI: 10.1007/s10198-019-01065-y -
World Journal of Surgery Feb 2017This article provides a current overview on clinical anatomy, pathophysiology, workup and surgical management of anorectal abscesses. Based on the three-dimensional... (Review)
Review
This article provides a current overview on clinical anatomy, pathophysiology, workup and surgical management of anorectal abscesses. Based on the three-dimensional nature of anorectal abscesses, a novel treatment-based classification is proposed. It examines the basis of a philosophic shift from simple drainage to concomitant definitive treatment of abscesses and their underlying primary fistulous trajectories. Complications are discussed specifically in this context.
Topics: Abscess; Anus Diseases; Drainage; Humans; Rectal Fistula; Symptom Assessment
PubMed: 27766401
DOI: 10.1007/s00268-016-3767-8 -
Surgery Today Mar 2023Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including...
PURPOSE
Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn's disease.
METHODS
We enrolled 1218 Crohn's disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn's disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion.
RESULTS
After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn's disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03).
CONCLUSION
Fecal diversion for refractory anorectal Crohn's disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.
Topics: Humans; Crohn Disease; Anus Diseases; Retrospective Studies; Surgical Stomas; Ileostomy; Postoperative Complications
PubMed: 35867163
DOI: 10.1007/s00595-022-02556-x -
United European Gastroenterology Journal Feb 2020Disease heterogeneity, according to the age at onset, has been reported in Crohn's disease (CD). (Comparative Study)
Comparative Study
BACKGROUND
Disease heterogeneity, according to the age at onset, has been reported in Crohn's disease (CD).
OBJECTIVE
This study aimed to compare natural history in CD patients diagnosed ≤17 (early onset (EO)) versus ≥60 (late onset (LO)) years old.
METHODS
EO CD and LO CD patients referred to two Italian inflammatory bowel disease (IBD) centres were included. Relevant data comprised sex, current smoking, disease location and behaviour, IBD family history, extra-intestinal manifestations and use of medical/surgical therapy during the follow-up period.
RESULTS
Among 2321 CD patients, 160 met the inclusion criteria: 92 in the EO and 68 in the LO group (mean follow-up 11.7 ± 7.7 years). Family history of IBD was more frequent in EO compared to LO CD (26% vs. 4%; < 0.0001). Ileocolonic, upper gastrointestinal and perianal involvement occurred more frequently in EO compared to LO CD (56% vs. 21%, < 0.0001; 17% vs. 3%, < 0.01; and 38% vs. 19%, < 0.01, respectively). Progression to complicated disease occurred more frequently in EO CD (40% vs. 10% < 0.005), with an increased use of corticosteroids and anti-tumour necrosis factor alpha agents within 10 years since diagnosis (81% vs. 58%, = 0.004, and 36% vs. 16%, = 0.01, respectively), while the cumulative probability of surgery did not differ between the two groups.
CONCLUSIONS
Patients with EO CD are more likely to develop a more aggressive disease with perianal involvement and a greater use of drug treatment compared to those with LO CD, without carrying an increased need for surgery.
Topics: Adolescent; Age of Onset; Aged; Aged, 80 and over; Anus Diseases; Biological Products; Child; Child, Preschool; Crohn Disease; Digestive System Surgical Procedures; Disease Progression; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Infant; Infant, Newborn; Italy; Medical History Taking; Middle Aged; Retrospective Studies; Risk Factors; Severity of Illness Index; Smoking; Tumor Necrosis Factor-alpha
PubMed: 32213053
DOI: 10.1177/2050640619860661 -
Zhonghua Wei Chang Wai Ke Za Zhi =... Dec 2014In recent years, researches regarding benign anorectal diseases have experienced unprecedented boom in China, but also exposed a series of problems, such as lack of...
In recent years, researches regarding benign anorectal diseases have experienced unprecedented boom in China, but also exposed a series of problems, such as lack of attention of medical professionals and patients on benign anorectal diseases, lack of basic and clinical researches, and lack of standard diagnosis and treatment etc. This article discusses the problems of current diagnosis and treatment of benign anorectal diseases in China. Clinician should pay close attention to the diagnosis and treatment of benign anorectal disease.
Topics: Anus Diseases; Humans; Rectal Diseases
PubMed: 25529942
DOI: No ID Found -
Journal of Cutaneous Pathology Mar 2022
Topics: Anus Diseases; Anus Neoplasms; Condylomata Acuminata; Diagnosis, Differential; Humans; Male; Skin Neoplasms; Syphilis, Cutaneous; Young Adult
PubMed: 33470447
DOI: 10.1111/cup.13865 -
La Revue Du Praticien Feb 2017
Topics: Anus Diseases; Emergencies; Humans; Rectal Diseases
PubMed: 30512846
DOI: No ID Found -
Presse Medicale (Paris, France : 1983) Oct 2016
Topics: Aged; Anus Diseases; Humans; Male; Pemphigus
PubMed: 27371358
DOI: 10.1016/j.lpm.2016.05.013 -
Der Hautarzt; Zeitschrift Fur... Oct 2016The oral allergy syndrome is one of the most common form of food allergy and manifests as contact urticaria of the oral mucosa after consumption of cross reacting foods.... (Review)
Review
The oral allergy syndrome is one of the most common form of food allergy and manifests as contact urticaria of the oral mucosa after consumption of cross reacting foods. Whereas allergic contact stomatitis often occurs due to dental materials, allergic contact cheilitis is usually a reaction due to topical therapeutics like herpes ointments or lip care products. As late type reactions are more frequent than immediate type reactions in the anogenital mucosa, contact dermatitis in this area should be identified via epicutaneous testing. In case of contact urticaria at the genital mucosa, a semen allergy or a latex allergy should be given due consideration as a possible cause. Angioedemas, which are mostly common histamine mediated, usually prefer skin areas with loose connective tissue such as the oral or genital mucosa. Fixed drug eruption also occurs preferentially in these areas. Bullous drug-induced skin reactions (e.g., SJS and TEN) are characterized by severe hemorrhagic, erosive affections of mucous membranes.
Topics: Allergy and Immunology; Anus Diseases; Dermatitis, Allergic Contact; Evidence-Based Medicine; Food Hypersensitivity; Humans; Immunosuppressive Agents; Mucous Membrane; Pemphigoid, Benign Mucous Membrane; Stomatitis; Treatment Outcome
PubMed: 27580724
DOI: 10.1007/s00105-016-3866-3