-
Journal of Medical Imaging and... Oct 2019Magnetic resonance imaging provides detailed visualisation, identification and extent assessment of many anal disorders. While many studies are performed in the... (Review)
Review
Magnetic resonance imaging provides detailed visualisation, identification and extent assessment of many anal disorders. While many studies are performed in the evaluation of malignant processes such as anorectal carcinoma, the primary focus of this pictorial review is benign lesions, which involve the anal canal and perianal spaces. This pictorial review will illustrate the MRI appearances of a variety of benign conditions, which predominantly affect the anal canal, including abscess, fistulae, lipomas, developmental cysts and inflammatory conditions. MRI aids in the identification and characterisation of these abnormalities, of coexisting complications and differentiation from other perineal abnormalities. This pictorial review highlights the spectrum of non-malignant processes involving the perianal region.
Topics: Anus Diseases; Contrast Media; Humans; Magnetic Resonance Imaging
PubMed: 31368659
DOI: 10.1111/1754-9485.12934 -
Der Internist Oct 2017In 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... (Review)
Review
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.
Topics: Abscess; Anal Canal; Anus Diseases; Condylomata Acuminata; Fissure in Ano; Hemorrhoids; Humans; Internal Medicine; Venous Thrombosis
PubMed: 28884323
DOI: 10.1007/s00108-017-0318-9 -
Gastrointestinal Endoscopy Clinics of... Oct 2022Perianal Crohn's disease is associated with decreased quality of life, high morbidity, and high health care use. Treatment goals are to provide infection control, stop... (Review)
Review
Perianal Crohn's disease is associated with decreased quality of life, high morbidity, and high health care use. Treatment goals are to provide infection control, stop fistula drainage, and heal fistula tracts while preserving the anorectal sphincter. Treatment includes a combination of medical and surgical intervention, but new techniques are using interventional endoscopy to act as either a bridge to surgery or to decrease the need for surgical intervention. The decision on which approach to pursue requires knowledge of prior surgery, altered anatomy, prior fistula treatment, and imaging and endoscopic evaluation of fistula complexity, mucosal involvement, and associated stricture or abscess.
Topics: Abscess; Crohn Disease; Endoscopy; Humans; Quality of Life; Rectal Fistula; Treatment Outcome
PubMed: 36202514
DOI: 10.1016/j.giec.2022.04.005 -
European Journal of Pediatric Surgery :... Oct 2020The incidence of Crohn's disease is increasing worldwide. The clinical course of childhood onset Crohn's disease is particularly aggressive with characteristic disease... (Review)
Review
The incidence of Crohn's disease is increasing worldwide. The clinical course of childhood onset Crohn's disease is particularly aggressive with characteristic disease localization in the ileocecal region and colon, often associated with perianal disease. Severe complications of perianal disease include recurrent perianal sepsis, chronic fistulae, fecal incontinence, and rectal strictures that impair quality of life and may require fecal diversion. Care of patients with perianal Crohn's disease requires a multidisciplinary approach with systematic clinical evaluation, endoscopic assessment, and imaging studies followed by combined medical and surgical management. In this review, we provide an update of the epidemiology, pathophysiology, diagnostics, and management of perianal Crohn's disease in children and adolescents.
Topics: Abscess; Adolescent; Anus Diseases; Child; Crohn Disease; Humans; Rectal Fistula
PubMed: 32942329
DOI: 10.1055/s-0040-1716724 -
Clinics in Colon and Rectal Surgery Mar 2018Anorectal complaints are not uncommon in pediatric care, but the etiology and management can differ significantly from adults. Age is an important factor when... (Review)
Review
Anorectal complaints are not uncommon in pediatric care, but the etiology and management can differ significantly from adults. Age is an important factor when considering etiology and management, distinguishing between infants, children, and adolescents. For all ages, malignancy is rarely a consideration, but a thorough examination of infants and children typically requires deep sedation or general anesthesia. Very little primary literature or evidence exists to guide care; so there are many opportunities for careful study to enhance our understanding beyond personal experience and historical practice patterns.
PubMed: 29487494
DOI: 10.1055/s-0037-1609026 -
Frontiers in Surgery 2022
PubMed: 35836609
DOI: 10.3389/fsurg.2022.952874 -
Annals of Gastroenterology 2017Patients with Crohn's disease often develop perianal disease, successfully managed in most cases. However, its most aggressive form, complex perianal disease, is... (Review)
Review
Patients with Crohn's disease often develop perianal disease, successfully managed in most cases. However, its most aggressive form, complex perianal disease, is associated with high morbidity and a significant impairment in patients' quality of life. The aim of this review is to provide an updated approach to this condition, reviewing aspects of its epidemiology, diagnosis and therapeutic alternatives. Emerging treatment options are also discussed. A multidisciplinary assessment of these patients with a coordinated medical and surgical approach is crucial.
PubMed: 28042236
DOI: 10.20524/aog.2016.0099 -
Cureus Apr 2024Perianal abscess is a clinical infective and/or inflammatory collection in the perianal region, one entity of a large group of anal and perianal disorders. Perianal...
BACKGROUND
Perianal abscess is a clinical infective and/or inflammatory collection in the perianal region, one entity of a large group of anal and perianal disorders. Perianal abscesses are often seen as a complication of grade 2 and grade 4 perianal fistulas from St. James's University Hospital classification. Several imaging modalities have been tried in the past for adequate assessment of perianal abscess with contrast-enhanced magnetic resonance imaging (CE-MRI) providing the most accurate results. Diffusion-weighted imaging (DWI) is an emerging sequence that can provide comparable results to CE-MRI in diagnosing and characterizing perianal abscess. The main objective of this study is to assess the role of DWI in adequate identification and assessment of perianal abscess and compare the final results with contrast-enhanced images.
METHODS
Twenty patients with complicated perianal fistula with clinically suspected perianal abscess were evaluated with DWI and CE-MRI. This study was a comparative cross-sectional study conducted in the Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India. Chi-square test was done to find the association between categorical variables. Kappa test was used to find the agreement between two different tests. Receiver operating characteristics (ROC) analysis was done to estimate the area under the curve in predicting the outcome. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were used to measure the validity of the tests.
RESULTS
DWI is a very sensitive MRI sequence and is equivalent to CE-MRI to detect the location and analyzing the loco-regional extent of abscess in complicated perianal fistula cases. DWI is also very sensitive and superior to T2 short tau inversion recovery (STIR) in differentiating perianal abscess from perianal inflammation without abscess.
CONCLUSION
DWI can be used as an alternative to post-contrast fat-suppressed MRI in precisely defining the location and extent of anal and perianal abscesses and disease activity in complicated fistula cases.
PubMed: 38800169
DOI: 10.7759/cureus.59035 -
Diseases of the Colon and Rectum Feb 2020
Topics: Abscess; Adult; Anus Diseases; Diagnosis, Differential; Drainage; Humans; Male; Physical Examination; Rectal Fistula; Rectum
PubMed: 31914108
DOI: 10.1097/DCR.0000000000001576 -
Current Opinion in Gastroenterology Jul 2021Multiple new medications with novel mechanisms of action are now available to treat Crohn's disease (CD). However, they have varying effectiveness in the management of... (Review)
Review
PURPOSE OF REVIEW
Multiple new medications with novel mechanisms of action are now available to treat Crohn's disease (CD). However, they have varying effectiveness in the management of perianal CD. Identifying the most appropriate therapy and optimizing it is essential to maximize effectiveness of therapy. Additionally, the management of perianal CD requires imaging of the perianal area to identify the fistula anatomy and local complications such as abscesses that require surgical drainage. Initial surgical assessment is key to drain abscesses and allow fistula healing with medical therapy.
RECENT FINDINGS
Although anti-tumor necrosis factor (TNFs) remain the most effective medications to treat perianal CD, real-world data suggests that ustekinumab may be a 2nd-line option in patients nonresponsive to an anti-TNF or having contraindications. Mesenchymal stem cells are an emerging therapeutic approach that is currently in Phase 3 trials in the United States and poised to play a major role in the treatment algorithm.
SUMMARY
The management of perianal CD requires a multidisciplinary approach with a combination of initial imaging and surgical assessment to adequately control local sepsis, optimization of biological therapy with adjunct antibiotics or immunomodulators, and close clinical follow-up with imaging to evaluate response to therapy and guide further surgical management options.
Topics: Crohn Disease; Humans; Rectal Fistula; Treatment Outcome; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alpha
PubMed: 33899777
DOI: 10.1097/MOG.0000000000000751