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Diseases of the Colon and Rectum Dec 2020Anorectal stricturing is a particularly morbid manifestation of Crohn's disease resulting in a diminished quality of life related to pain, incontinence, and recurrent... (Review)
Review
BACKGROUND
Anorectal stricturing is a particularly morbid manifestation of Crohn's disease resulting in a diminished quality of life related to pain, incontinence, and recurrent operative interventions.
OBJECTIVE
To determine the role of medical therapy, endoscopic dilation, and surgical intervention for the treatment of isolated anorectal stricturing.
DATA SOURCES
An organized search of MEDLINE, PubMed, EMBASE, Scopus, and the Cochrane Database of Collected Reviews was performed from January 1, 1990 through May 1, 2020.
STUDY SELECTION
Full text papers which included management of isolated anorectal strictures in the setting of Crohn's disease.
INTERVENTION(S)
Medical and surgical management.
MAIN OUTCOME MEASURES
Symptomatic relief, need for proctocolectomy.
RESULTS
Our search identified a total of 553 papers; after exclusion based on title (n = 430) and abstract (n = 47), 76 underwent full text review with 65 relevant to the management of anorectal strictures. A summary of the retrospective reports suggests that medical therapy can help control luminal inflammation, but fibrosis may ultimately set in resulting in a need for endoscopic or surgical intervention. Surgical options are limited in the anal canal due to inflammation and ulceration and concomitant perianal fistulizing disease. While fecal diversion can provide symptomatic relief, successful restoration of intestinal continuity remains uncommon and most patients ultimately undergo a total proctocolectomy with end ileostomy.
LIMITATIONS
Limited literature published, all retrospective in nature.
CONCLUSIONS
Despite significant advances in medical and surgical therapy in Crohn's disease over the last decades, there is clearly an unmet need in the management of anorectal strictures in Crohn's disease.
Topics: Anus Diseases; Biological Therapy; Constriction, Pathologic; Crohn Disease; Dilatation; Disease Management; Endoscopy; Female; Humans; Ileostomy; Proctocolectomy, Restorative; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 33149025
DOI: 10.1097/DCR.0000000000001834 -
ANZ Journal of Surgery Oct 2017
Topics: Adolescent; Anus Diseases; Anus Neoplasms; Buschke-Lowenstein Tumor; Humans; Male; Papillomaviridae; Treatment Outcome
PubMed: 28975738
DOI: 10.1111/ans.14152 -
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 -
Gastrointestinal Endoscopy Clinics of... Oct 2022Crohn disease (CD) patients can develop fistula or abscess from persistent active disease or postsurgical complications. Penetrating CD is traditionally treated with... (Review)
Review
Crohn disease (CD) patients can develop fistula or abscess from persistent active disease or postsurgical complications. Penetrating CD is traditionally treated with medication and surgery. The role of medication alone in the treatment of fistula is limited, except perianal fistulas or enterocutaneous fistula. Surgery is the standard treatment in those with hollow-organ to hollow-organ fistula, like ileovesicular fistula. Surgery is invasive with a higher risk of postoperative complications. Endoscopic therapy has evolved as a valid option. Fistulotomy, surgical or endoscopic, should be considered first-line therapy when feasible. Incision and drainage of perianal abscesses with an endoscopic device may be attempted.
Topics: Abscess; Anus Diseases; Crohn Disease; Humans; Intestinal Fistula; Rectal Fistula; Treatment Outcome
PubMed: 36202513
DOI: 10.1016/j.giec.2022.05.006 -
Missouri Medicine 2020Anorectal conditions are one of the most common problems evaluated by primary care physicians. Most patients present with rectal pain, rectal bleeding, or purulent... (Review)
Review
Anorectal conditions are one of the most common problems evaluated by primary care physicians. Most patients present with rectal pain, rectal bleeding, or purulent drainage per rectum. Colorectal conditions have overlapping symptoms. Thorough history and careful anorectal examination can differentiate common anorectal conditions like hemorrhoids, anorectal abscesses, anal fistula, anal fissure, and anal condyloma. Most of these conditions can be diagnosed and treated without imaging.
Topics: Anus Diseases; Colorectal Surgery; Diagnosis, Differential; Fissure in Ano; Hemorrhoids; Humans; Primary Health Care
PubMed: 32308242
DOI: No ID Found -
Journal of Visceral Surgery Apr 2015The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible... (Review)
Review
The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible for the formation of abscesses and/or fistulas. When this presents as an abscess, emergency drainage of the infected cavity is required. At the stage of fistula, treatment has two sometimes conflicting objectives: effective drainage and preservation of continence. These two opposing constraints explain the existence of two therapeutic concepts. On one hand the laying-open of the fistulous tract (fistulotomy) in one or several operative sessions remains the treatment of choice because of its high cure rates. On the other hand surgical closure with tract ligation or obturation with biological components preserves sphincter function but suffers from a higher failure rate.
Topics: Abscess; Anus Diseases; Emergencies; Humans; Ligation; Rectal Fistula; Suction; Surgical Flaps; Treatment Outcome
PubMed: 25261376
DOI: 10.1016/j.jviscsurg.2014.07.008 -
Arquivos de Gastroenterologia May 2019
Topics: Anus Diseases; Humans; Periodicals as Topic; Rectal Diseases
PubMed: 31141058
DOI: 10.1590/S0004-2803.201900000-11 -
Journal of Magnetic Resonance Imaging :... Oct 2019The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal... (Review)
Review
The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal sphincter complex is an integral part of the coordinated effort of defecation. As imaging plays an important role in assessment of pathologic conditions involving the anal region, understanding the normal anatomy of the anal sphincter complex is important for correct image interpretation and accurate diagnosis. This review discusses the anatomy and function of the anal sphincter complex, important technical considerations for MRI, and various inflammatory, infectious, and neoplastic processes, as well as pathologic structural conditions that affect the anal region. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1018-1032.
Topics: Anal Canal; Anus Diseases; Humans; Magnetic Resonance Imaging
PubMed: 31115134
DOI: 10.1002/jmri.26776 -
Diseases of the Colon and Rectum May 2018There has been a surge in clinical trials studying the safety and efficacy of mesenchymal stem cells for the treatment of perianal Crohn's disease. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There has been a surge in clinical trials studying the safety and efficacy of mesenchymal stem cells for the treatment of perianal Crohn's disease.
OBJECTIVE
The purpose of this work was to systematically review the literature to determine safety and efficacy of mesenchymal stem cells for the treatment of refractory perianal Crohn's disease.
DATA SOURCES
Sources included PubMed, Cochrane Library Central Register of Controlled Trials, and Embase.
STUDY SELECTION
Studies that reported safety and/or efficacy of mesenchymal stem cells for the treatment of perianal Crohn's disease were included. Two independent assessors reviewed eligible articles.
INTERVENTION
The study intervention was delivery of mesenchymal stem cells to treat perianal Crohn's disease.
MAIN OUTCOMES MEASURES
Safety and efficacy of mesenchymal stem cells used to treat perianal Crohn's disease were measured.
RESULTS
Eleven studies met the inclusion criteria and were included in the systematic review. Three trials with a comparison arm were included in the meta-analysis. There were no significant increases in adverse events (OR = 1.07 (95% CI, 0.61-1.89); p = 0.81) or serious adverse events (OR = 0.53 (95% CI, 0.28-0.98); p = 0.04) in patients treated with mesenchymal stem cells. Mesenchymal stem cells were associated with improved healing as compared with control subjects at primary end points of 6 to 24 weeks (OR = 3.06 (95% CI, 1.05-8.90); p = 0.04) and 24 to 52 weeks (OR = 2.37 (95% CI, 0.90-6.25); p = 0.08).
LIMITATIONS
The study was limited by its multiple centers and heterogeneity in the study inclusion criteria, mesenchymal stem cell origin, dose and frequency of delivery, use of scaffolding, and definition and time point of fistula healing.
CONCLUSIONS
Although there have been only 3 trials conducted with control arms, existing data demonstrate improved efficacy and no increase in adverse or serious adverse events with mesenchymal stem cells as compared with control subjects for the treatment of perianal Crohn's disease.
Topics: Anus Diseases; Crohn Disease; Humans; Injections; Mesenchymal Stem Cell Transplantation; Practice Guidelines as Topic; Treatment Outcome
PubMed: 29578916
DOI: 10.1097/DCR.0000000000001093 -
Current Problems in Surgery May 2017
Review
Topics: Abscess; Anesthetics, Local; Anus Diseases; Crohn Disease; Dietary Fiber; Female; Fissure in Ano; Guidelines as Topic; Hemorrhoidectomy; Hemorrhoids; Humans; Rectal Fistula; Sphincterotomy, Endoscopic; Vaginal Fistula
PubMed: 28583256
DOI: 10.1067/j.cpsurg.2017.02.003