-
Clinics in Colon and Rectal Surgery Sep 2019This article provides an overview of the principles in the evaluation and management of perianal Crohn's disease (CD). Manifestation-specific treatment is addressed... (Review)
Review
This article provides an overview of the principles in the evaluation and management of perianal Crohn's disease (CD). Manifestation-specific treatment is addressed including abscess, fistula, skin tags, hemorrhoids, fissure, ulcers, strictures, ano-, and rectovaginal fistulas as well CD-associated hidradenitis suppurativa.
PubMed: 31507348
DOI: 10.1055/s-0039-1687834 -
Diseases of the Colon and Rectum Aug 2020A 22-year-old man presents to your office with a perianal abscess and occasional mild crampy abdominal pain. You take him to the operating room for an examination under...
A 22-year-old man presents to your office with a perianal abscess and occasional mild crampy abdominal pain. You take him to the operating room for an examination under anesthesia (EUA) with incision and drainage of the abscess and note a transphincteric fistula tract through which you place a seton and 2 large skin tags. The anal canal and rectum are without ulceration, but there are mild proctitis and nonprolapsing internal hemorrhoids. Because of a concern for Crohn's disease (CD), he undergoes magnetic resonance enterography and colonoscopy. The magnetic resonance enterography shows inflammation in 20 cm of the distal terminal ileum, and colonoscopy reveals approximately 10 ulcers <5 mm in the terminal ileum without significant narrowing. He is seen in consultation for the initiation of a monoclonal antibody and returns to see you in the office after his first 3 infusions. He is feeling well, has significantly decreased drainage from the perianal fistula, but would really like his seton and skin tags removed while you are there.
Topics: Abscess; Anal Canal; Antibodies, Monoclonal; Colonoscopy; Crohn Disease; Drainage; Humans; Ileum; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Rectal Fistula; Treatment Outcome; Ulcer; Young Adult
PubMed: 32692067
DOI: 10.1097/DCR.0000000000001748 -
JAAPA : Official Journal of the... Nov 2016Benign anal disease encompasses common problems including hemorrhoids, anal fissures, pruritus ani, perianal abscesses, and fistulae. Although many people will suffer... (Review)
Review
Benign anal disease encompasses common problems including hemorrhoids, anal fissures, pruritus ani, perianal abscesses, and fistulae. Although many people will suffer from at least one of these conditions in their lives, healthcare practitioners diagnose and treat them accurately about 50% to 83% of the time. This article reviews common anal problems and the importance of a thorough history and physical examination to proper patient management.
Topics: Anal Canal; Anus Diseases; Fissure in Ano; Hemorrhoids; Humans; Pruritus Ani
PubMed: 27749400
DOI: 10.1097/01.JAA.0000502857.05728.98 -
The British Journal of Dermatology Jan 2024Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic disabling and debilitating inflammatory disease with a high unmet medical need. The prevalence of...
Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic disabling and debilitating inflammatory disease with a high unmet medical need. The prevalence of HS reported in most studies is 1-2%, although it is likely to be under-reported and estimates vary globally owing to variance in data collection methods, ethnicity, geographical location and under-diagnosis. HS is characterized by persistent, painful cutaneous nodules, abscesses and draining tunnels commonly affecting the axillary, anogenital, inguinal and perianal/gluteal areas. Over time, chronic uncontrolled inflammation results in irreversible tissue destruction and scarring. Although the pathophysiology of HS has not been fully elucidated, the tumour necrosis factor (TNF)-α and interleukin (IL)-17 pathways have an important role, involving multiple cytokines. Currently, treatment options include topical medications; systemic therapies, including repeated and/or rotational courses of systemic antibiotics, retinoids and hormonal therapies; and various surgical procedures. The anti-TNF-α antibody adalimumab is currently the only biologic approved by both the US Food and Drug Administration and the European Medicines Agency for HS; however, its efficacy varies, with a clinical response reported in approximately 50% of patients in phase III trials. HS is a rapidly evolving field of discovery, with a diverse range of agents with distinct mechanisms of action currently being explored in clinical trials. Several other promising therapeutic targets have recently emerged, and agents targeting the IL-17 and Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathways are the most advanced in ongoing or completed phase III clinical trials. Alongside limited therapeutic options, significant challenges remain in terms of diagnosis and disease management, with a need for better treatment outcomes. Other unmet needs include significant diagnostic delays, thus missing the therapeutic 'window of opportunity'; the lack of standardized outcome measures in clinical trials; and the lack of established, well-defined disease phenotypes and biomarkers.
Topics: Humans; Hidradenitis Suppurativa; Tumor Necrosis Factor Inhibitors; Adalimumab; Tumor Necrosis Factor-alpha; Abscess
PubMed: 37715694
DOI: 10.1093/bjd/ljad345 -
Journal of the Korean Society of... May 2023Perianal fistula is a common inflammatory condition in the general population and affects the area around the anal canal. Although most cases are benign, they cause... (Review)
Review
Perianal fistula is a common inflammatory condition in the general population and affects the area around the anal canal. Although most cases are benign, they cause serious morbidity and require surgical treatment due to a high risk of recurrence. MR imaging is a gold standard technique for the evaluation of perianal fistulas and provides accurate information on the anatomy of the anal canal, its relationship to the anal sphincter complex, accurate identification of secondary tracts or abscesses, and reporting associated complications. MR imaging can help monitor treatment effects and determine treatment methods. Crohn's disease-related fistulas often require medical rather than surgical treatment. The radiologist is required to know the anatomy and MR imaging findings of the perianal fistula to present an accurate diagnosis to the clinician.
PubMed: 37325009
DOI: 10.3348/jksr.2023.0018 -
Clinical and Experimental Pediatrics Jul 2020
PubMed: 32252144
DOI: 10.3345/cep.2020.00150 -
Diseases of the Colon and Rectum Apr 2024
Topics: Humans; Abscess; Anus Diseases; Drainage; Skin Diseases; Rectal Fistula; Treatment Outcome
PubMed: 38150305
DOI: 10.1097/DCR.0000000000002949 -
Advances in Surgery Sep 2018
Review
Topics: Abscess; Biopsy, Needle; Conservative Treatment; Fecal Incontinence; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Immunohistochemistry; Male; Proctectomy; Prognosis; Rectal Diseases; Rectal Fistula; Treatment Outcome
PubMed: 30098612
DOI: 10.1016/j.yasu.2018.04.004 -
Internal Medicine (Tokyo, Japan) Feb 2022Listeria monocytogenes can cause gastrointestinal infections in healthy children and adults, but they tend to be mild and self-limiting. It can, however, cause serious...
Listeria monocytogenes can cause gastrointestinal infections in healthy children and adults, but they tend to be mild and self-limiting. It can, however, cause serious potentially lethal infections, such as meningitis and bacteremia, to those with underlying conditions. A woman in her 60s with liver cirrhosis developed abdominal pain and a fever, and she turned out to have a perianal abscess caused by L. monocytogenes. Perianal abscess is a rare complication of L. monocytogenes, but a recent epidemiological study revealed that the presence of cirrhosis might also be a risk factor for the development of invasive disease.
Topics: Abscess; Adult; Bacteremia; Child; Female; Fever; Humans; Listeria monocytogenes; Listeriosis; Meningitis, Listeria
PubMed: 34393168
DOI: 10.2169/internalmedicine.7755-21