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Indian Journal of Gastroenterology :... Sep 2016This pictorial atlas provides a review of perianal fistulas with a brief description of the relevant anatomy, technique of imaging, and examples of various fistula... (Review)
Review
This pictorial atlas provides a review of perianal fistulas with a brief description of the relevant anatomy, technique of imaging, and examples of various fistula types. Magnetic resonance imaging is highly accurate for depiction of both the primary tract and its secondary branches as well as abscesses. It is useful in the accurate preoperative classification of perianal fistulas and allows institution of the correct surgical procedure, thereby reducing the chances of recurrence or complications from occurring.
Topics: Anal Canal; Fecal Incontinence; Humans; Magnetic Resonance Imaging; Postoperative Complications; Rectal Fistula; Recurrence
PubMed: 27638705
DOI: 10.1007/s12664-016-0688-2 -
Journal of Ultrasound Jun 2019Perianal fistulas and abscesses may be cryptogenetic or associated with inflammatory bowel disease (IBD), specifically Crohn's disease. Proper identification and... (Review)
Review
Perianal fistulas and abscesses may be cryptogenetic or associated with inflammatory bowel disease (IBD), specifically Crohn's disease. Proper identification and classification of these lesions are paramount for correct therapeutic management. Current diagnostic modalities include MRI (magnetic resonance imaging), EUS (endoscopic ultrasound), EUA (exam under anaesthesia) and recently, transperineal ultrasound (TPUS). The latter has been proposed as a noninvasive, easily available and cost-effective technique to diagnose, assess and follow up perianal disease particularly in IBD patients. This pictorial review focuses on the role of TPUS in clinical practice, highlighting the features of fistulas and abscesses.
Topics: Abscess; Anal Canal; Fistula; Humans; Rectal Diseases; Rectum; Ultrasonography
PubMed: 31066004
DOI: 10.1007/s40477-019-00381-6 -
Acta Haematologica 2017Perianal abscess may develop during neutropenia periods in patients with acute myeloid leukemia (AML). The standard of care for perianal abscess in AML is unclear.
INTRODUCTION
Perianal abscess may develop during neutropenia periods in patients with acute myeloid leukemia (AML). The standard of care for perianal abscess in AML is unclear.
METHODS
We retrospectively collected patient data in our institute from 2009 to 2012.
RESULTS
Two hundred ninety-two patients with AML were analyzed. In total, 1,051 chemotherapy sessions were administered. Twenty-three patients experienced perianal abscess. Patients with perianal abscess were younger than those without (44 vs. 60 years, p < 0.0001). Perianal abscess developed in various phases of treatment and in the stem cell transplantation period. Twelve recurrences developed in 6 patients. Patients with a prior perianal abscess have a 10-fold risk of developing a subsequent abscess following further chemotherapy. The microbiology profile revealed that most pathogens were derived from the intestinal tracts, which was similar to the findings of previous studies. The 28-day mortality was 14.3% and the direct cause of death was not perianal abscess in any case. Surgical interventions had no impact on recurrence or survival.
CONCLUSION
In patients with AML, perianal abscess results from gastrointestinal tract pathogens. Many patients do not require surgical interventions. The mortality is low but recurrence is common following subsequent chemotherapies. Therefore, awareness of recurrence is important for the timely management of perianal abscess in AML.
Topics: Abscess; Acinetobacter; Adolescent; Adult; Aged; Antineoplastic Agents; Anus Diseases; Enterococcus; Escherichia coli; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Recurrence; Retrospective Studies; Stem Cell Transplantation; Young Adult
PubMed: 28586772
DOI: 10.1159/000475589 -
Journal of Clinical Ultrasound : JCU Jun 2023To describe the incidence and diagnostic performance of ultrasound for perianal abscess or fistula-in-ano in pediatric patients with perianal inflammation.
OBJECTIVES
To describe the incidence and diagnostic performance of ultrasound for perianal abscess or fistula-in-ano in pediatric patients with perianal inflammation.
METHODS
We included 45 patients with perianal inflammation who underwent ultrasonography. To demonstrate the diagnostic performance of ultrasound for fistula-in-ano, a definite diagnosis of perianal abscess, and fistula-in-ano was determined as that proven through magnetic resonance imaging (MRI) or computed tomography (CT). The absence or presence of perianal abscess and fistula-in-ano on ultrasonography was recorded.
RESULTS
Among the 45 patients, on ultrasound, perianal abscess and fistula-in-ano were detected in 22 (48.9%) and 30 (68.2%) patients, respectively. Nine patients had MRI or CT and a definite diagnosis of perianal abscess or fistula-in-ano; accuracy, negative predictive value, and positive predictive value of ultrasound for perianal abscess were 77.8% (7/9; 95% confidence interval [CI]: 40.0%-97.1%), 66.7% (2/3; 95% CI: 9.4%-99.2%), 83.3% (5/6; 95% CI: 35.9%-99.6%), and those of fistula-in-ano were 100% (9/9; 95% CI: 66.4%-100%), 100% (8/8; 95% CI: 63.1%-100%), and 100% (1/1; 95% CI: 2.5%-100%), respectively.
CONCLUSIONS
Perianal abscess and fistula-in-ano were detected by ultrasound in half of the patients with perianal inflammation. Accordingly, ultrasound has an acceptable diagnostic performance for perianal abscess and fistula-in-ano.
Topics: Humans; Child; Abscess; Incidence; Anus Diseases; Rectal Fistula; Ultrasonography
PubMed: 36870044
DOI: 10.1002/jcu.23446 -
Biomedicines Oct 2020Inflammatory bowel diseases (IBD) are gastrointestinal tract pathologies of unknown etiology; they have an alternating trend, with active and silent phases. IBD are... (Review)
Review
Inflammatory bowel diseases (IBD) are gastrointestinal tract pathologies of unknown etiology; they have an alternating trend, with active and silent phases. IBD are classified in two main forms: ulcerative colitis (UC) and Crohn's disease (CD). Both have chronic and recurrent course, gastrointestinal symptoms, and extraintestinal manifestations. The altered immune response role seems to be important both in UC and CD. In the majority of cases, CD begins with abdominal pain, diarrhea, decrease in appetite, and weight loss; there can be also perianal fistulas, rhagades, and perianal recurrent abscesses. In addition, retarded growth and delayed puberty can precede the development of the disease or can even be predominant at onset. Growth retardation is found in 40% of IBD patients, but the underlying mechanism of this and other extra-intestinal manifestations are partially known: the main hypotheses are represented by malnutrition and inflammatory response during the active phase of the disease. The increased level of pro-inflammatory cytokines can influence growth, but also the onset of puberty and its progression. In addition, it could be essential to clarify the role and the possible effects of all the currently used treatments concerning growth failure and delayed puberty.
PubMed: 33138015
DOI: 10.3390/biomedicines8110458 -
Frontiers in Surgery 2022Anal canal duplication (ACD) is a very rare duplication of the gastrointestinal tract and is described as a secondary anal orifice along the posterior side of the normal... (Review)
Review
BACKGROUND
Anal canal duplication (ACD) is a very rare duplication of the gastrointestinal tract and is described as a secondary anal orifice along the posterior side of the normal anal canal. Early surgical removal is advisable, also in asymptomatic patients, because of the risk of inflammatory complications, such as recurrent crissum abscess, and malignant changes.
CASE PRESENTATION
A previously healthy 2-year-old boy was evaluated in the emergency department with fever. He complained of anal pain in the absence of incentive. Physical examination and ultrasound confirmed a diagnosis of perianal abscess. He was treated with incision and drainage of the abscess and intravenous antibiotics. Two months after his discharge from the hospital, he developed fever and had intervals discharge pus and pain in the same locations. Colorectal endoscopy revealed that there was no fistula opening at the rectal wall. Intraoperative fistulography showed a fistulous tract that was connected to a subcutaneous cavity. Excision of the fistulous tract and wide drainage of the deep postanal space were performed. The patient was referred to our hospital for further evaluation 6 months later. Physical examination showed a secondary anus that had not been noticed before. MRI showed an anal fistula between 1 and 3 o'clock, and preoperative fistulography revealed a 3-cm-long tubular structure without any connection with the rectum. The diagnosis of ACD was made by intraoperative examination with a metal catheter and the postoperative pathological analysis. The duplicated anal canal was resected completely via a perianal approach without any rectal injury. Histology showed a squamous epithelium in the distal end with some smooth-muscle fibers. After a follow-up of 8 months, the patient has been doing well.
CONCLUSION
Recurrent crissum abscess should raise clinical attention to alimentary tract congenital malformations such as ACD. Prompt recognition of these unique presentations of ACD is needed, and complete excision through a perineal approach or posterior sagittal approach is recommended.
PubMed: 35647015
DOI: 10.3389/fsurg.2022.908390 -
Journal of Clinical Imaging Science 2021Perianal fistulae are commonly complicated by abscesses and ramifications, which have well-recognized imaging morphology. Less commonly, atypical findings of solid...
Perianal fistulae are commonly complicated by abscesses and ramifications, which have well-recognized imaging morphology. Less commonly, atypical findings of solid enhancing mass-like lesions with no fluid component are associated with chronic and recurrent fistulae, the etiology of which includes inflammatory masses as well as locally aggressive malignancy. The latter predicts poorer prognosis and warrants extensive surgical resection. The reading radiologist must identify the unusual appearance, be aware of the possible etiologies, and if appropriate recommend prompt tissue sampling to exclude malignancy. This is pertinent as it determines surgical management, which is crucial in achieving a potential curative outcome.
PubMed: 34513211
DOI: 10.25259/JCIS_54_2021 -
Intestinal Research Jan 2015Klebsiella pneumoniae (K. pneumoniae) can at times cause invasive infections, especially in patients with diabetes mellitus and a history of alcohol abuse. A 61-year-old...
Klebsiella pneumoniae (K. pneumoniae) can at times cause invasive infections, especially in patients with diabetes mellitus and a history of alcohol abuse. A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks. After admission, he underwent sigmoidoscopy, which revealed multiple ulcerations with yellowish exudate in the rectum and sigmoid colon. The patient was treated with ciprofloxacin and metronidazole. After one week, follow up sigmoidoscopy was performed owing to sustained fever and diarrhea. The lesions were aggravated and seemed webbed in appearance because of damage to the rectal mucosa. Abdominal computed tomography and rectal magnetic resonance imaging were performed, and showed a perianal and perirectal abscess. The patient underwent laparoscopic sigmoid colostomy and perirectal abscess incision and drainage. Extended-spectrum beta-lactamase-producing K. pneumoniae was identified in pus culture. The antibiotics were switched to ertapenem. He improved after surgery and was discharged. K. pneumoniae can cause rapid invasive infection in patients with diabetes and a history of alcohol abuse. We report the first rare case of proctitis and perianal abscess caused by invasive K. pneumoniae infection.
PubMed: 25691848
DOI: 10.5217/ir.2015.13.1.85 -
Gastrointestinal Endoscopy Jun 2017Fistula and abscess represent penetrating disease phenotypes of Crohn's disease (CD) and can develop in patients with or without prior history of CD-related surgery.... (Review)
Review
Fistula and abscess represent penetrating disease phenotypes of Crohn's disease (CD) and can develop in patients with or without prior history of CD-related surgery. While CD fistula and abscess have been traditionally treated with medical and surgical therapy, the role of endoscopic therapy in this particular phenotype of CD is expanding recently, thanks to advanced endoscopic techniques and a better understanding of pathogenesis and natural history of the disease and principle of treatment. The success of endoscopic treatment for inflammatory bowel disease depends on comprehension and appreciation of principles, then techniques, followed by instrument and device. Attempts should be made to temporarily or permanently close the feeding side (or the primary) orifice at the gut, by various forms of clipping. Endoscopic fistulotomy is feasible, particularly for perianal fistula and surgery-associated distal bowel fistula. Perianal abscess can be treated with endoscopic incision and drainage and even seton placement. Endoscopic treatment for fistula and abscess as well as for stricture has become an important part of the multidisciplinary approach to complex CD.
Topics: Abdominal Abscess; Crohn Disease; Drainage; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Fistula; Male; Rectal Fistula; Rectovaginal Fistula
PubMed: 28153572
DOI: 10.1016/j.gie.2017.01.025 -
Techniques in Coloproctology Apr 2022Magnetic resonance imaging (MRI) is used as a standard for assessment of complex perianal fistulas. Apart from textual description of the case, 3D reconstructed models...
BACKGROUND
Magnetic resonance imaging (MRI) is used as a standard for assessment of complex perianal fistulas. Apart from textual description of the case, 3D reconstructed models from MRI further aid in understanding the entire anatomy of the fistula tract and its relation to the pelvic floor. This information is crucial as it helps surgeons to understand the extent and complexity of the disease before surgical treatment. However, 3D model generation from MRI is a time-consuming step for a radiologist as it requires tedious manual delineations to be performed on every slice of the images. The aim of this study was to develop a method that could enable radiologists to present enhanced information to surgeons for treatment of complex perianal fistulas while simultaneously reducing the manual efforts and time required to generate the information.
METHODS
A method was proposed to depict relevant anatomies of complex perianal fistula as parametric models in three-dimensional (3D) space. A plugin inside 3D Slicer software was developed for the generation of the parametric models from MRI. The levator ani muscle, internal sphincter, and external sphincter are represented as tubular structures, whereas fistula tracks and abscess are presented as splines.
RESULTS
Parametric models were generated to depict three cases of complex perianal fistulas and similarity measures were computed for ten cases. Visual comparison of the parametric models was made with the 3D models generated by the standard approach. The parametric models took less time to create and were able to visually present enriched information as compared to the 3D models generated by the standard approach.
CONCLUSIONS
The proposed method, using parametric models, shows potential for faster generation and better visualization of the 3D information required for the treatment of complex perianal fistula cases.
Topics: Cutaneous Fistula; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Pelvic Floor; Rectal Fistula
PubMed: 35094202
DOI: 10.1007/s10151-022-02573-5