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The Indian Journal of Surgery Dec 2015Management of benign anorectal conditions like abscesses and haemorrhoids is usually uneventful. However, complicated perianal complications can result and have sparsely...
Management of benign anorectal conditions like abscesses and haemorrhoids is usually uneventful. However, complicated perianal complications can result and have sparsely been reported in literature. Hereby, we report a series of seven patients who presented with rare sequelae like necrotising fasciitis, intraperitoneal or retroperitoneal involvement. All patients responded well to surgical management. Accordingly, complicated perianal sepsis warrants a timely and aggressive surgical intervention.
PubMed: 27011454
DOI: 10.1007/s12262-013-0997-y -
International Journal of Infectious... Mar 2020Extrahepatic hydatid disease has been reported in several locations, including the pelvis, and it often poses a diagnostic challenge. There are very few reported cases...
Extrahepatic hydatid disease has been reported in several locations, including the pelvis, and it often poses a diagnostic challenge. There are very few reported cases of primary perineal ischio-anal fossa hydatid cysts. We present a case of a 46-year-old female who had complained of painless left perianal mass for 8 months. The first clinical and radiological diagnosis was a cystic lesion of the perianal region. However, surgical and pathological examination revealed the diagnosis of hydatid disease of ischio-anal fossa. The patient underwent surgical excision. At 1-year follow-up, the patient was disease-free. Hydatid disease of the perianal area, although rare, must be kept in the differential diagnosis of pathologies of any perianal mass or lump.
Topics: Animals; Diagnosis, Differential; Echinococcosis; Echinococcus; Female; Humans; Middle Aged; Radiography
PubMed: 31981765
DOI: 10.1016/j.ijid.2020.01.015 -
International Journal of General... 2021Fistula relapse occurs in 20-30% of patients with perianal Crohn's disease (PCD) despite optimal medico-surgical management. We aimed in this study to assess the rate of...
BACKGROUND AND AIMS
Fistula relapse occurs in 20-30% of patients with perianal Crohn's disease (PCD) despite optimal medico-surgical management. We aimed in this study to assess the rate of perianal and luminal relapse after surgically induced remission and to determine factors associated with fistula relapse.
METHODS
Consecutive perianal CD patients who achieved clinical remission after surgery for fistulising PCD from January 2013 to January 2019 were included. The cumulative probabilities of relapse-free survival were estimated using the Kaplan-Meier method.
RESULTS
A total of 130 patients were included. Sixty-six of 130 patients received infliximab (IFX) therapy after perianal surgery. After a median follow-up of 62 months (interquartile range [IQR]: 28-117 months), perianal relapse occurred in 30 of 64 (46.9%) nonbiological medication-treated cases and in 14 of 66 (21.1%) cases in the IFX therapy group. The cumulative probabilities of perianal relapse-free survival in patients with nonbiological treatment were 77.1% at 1 year, 54.6% at 3 years, and 30% at 5 years. The rates of survival without perianal fistula relapse in the IFX-treated group were 91.6%, 69.2%, and 59.3% at 1, 3 and 5 years, respectively. In patients treated with IFX after perianal surgery, discontinuation of IFX therapy (odds ratio [OR]=2.43, p=0.036), a penetrating CD phenotype (OR=4.324, =0.019), and a complex perianal fistula (OR=3.392, =0.026) were independently associated with perianal relapse in multivariate analysis.
CONCLUSION
Infliximab therapy reduced the risk of perianal relapse after surgical remission in PCD patients compared with nonbiological treatment. However, approximately 40% of patients using infliximab experienced perianal relapse at 5 years, and patients who discontinued use of IFX or experienced a penetrating phenotype or a complex perianal fistula were associated with increased relapse rate.
PubMed: 34285563
DOI: 10.2147/IJGM.S315505 -
Clinics in Colon and Rectal Surgery Jul 2019Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation... (Review)
Review
Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation of the disease. The perianal area is often under stress in patients with Crohn's disease, because of the diarrhea, and the fecal urgency, frequency, and incontinence caused by proximal disease. Symptomatic perianal disease can therefore be due to the effects of the stress on an otherwise normal anus, or the result of Crohn's disease in the low rectum and/or perianal tissues themselves. This key distinction should drive the investigation and management of anal and perianal symptoms in patients with Crohn's disease. In this review, the evaluation and management of the various manifestations of Crohn's disease in the perineum and perianal tissues will be described.
PubMed: 31275071
DOI: 10.1055/s-0039-1683907 -
Journal of Clinical Medicine Oct 2023Perianal fistulizing Crohn's Disease (pCD) affects about 25% of patients with Crohn's Disease (CD). It remains a difficult entity to manage with a therapeutic ceiling of... (Review)
Review
Perianal fistulizing Crohn's Disease (pCD) affects about 25% of patients with Crohn's Disease (CD). It remains a difficult entity to manage with a therapeutic ceiling of treatment success despite improving medical and surgical management. The refractory nature of the disease calls for an imminent need to better understand its immunopathogenesis and classification to better streamline our treatment options. In this article, we overview the current state of pCD management and discuss where the future of its management may lie.
PubMed: 37835022
DOI: 10.3390/jcm12196379 -
Clinics in Colon and Rectal Surgery Jan 2022Perianal fistulizing Crohn's disease represents a severe phenotype associated with significant morbidity. Patients with perianal fistulizing disease are more likely to... (Review)
Review
Perianal fistulizing Crohn's disease represents a severe phenotype associated with significant morbidity. Patients with perianal fistulizing disease are more likely to have a severe disease course and have significant reductions in quality of life. Moreover, these patients are at risk for the development of distal rectal and anal cancers. Given the complexity and severity of this patient group, the management of perianal Crohn's disease must be undertaken by a multidisciplinary team. The gastroenterologist and colorectal surgeon play a critical role in the diagnosis and management of perianal fistulizing disease. An examination under anesthesia provides critical information and is an essential part of the work-up of complex perianal fistulas. The radiologist also plays a central role in characterizing anatomy and assessing response to treatment. Several imaging modalities are available for these patients with magnetic resonance imaging as the imaging modality of choice. Perianal disease developing after ileal pouch-anal anastomosis represents a particularly challenging form of fistulizing disease and requires a multidisciplinary clinical and radiologic approach to differentiate surgical complications from recurrent Crohn's disease.
PubMed: 35069030
DOI: 10.1055/s-0041-1740038 -
Indian Journal of Dermatology 2017Eccrine syringofibroadenoma (ESFA) is a rare eccrine ductal adnexal tumor. It shows variable presentations as solitary or multiple nodular lesions arranged in different...
Eccrine syringofibroadenoma (ESFA) is a rare eccrine ductal adnexal tumor. It shows variable presentations as solitary or multiple nodular lesions arranged in different patterns. It is most commonly seen in middle-aged to elderly patients, and most common sites include the extremities. Classic histopathological findings show anastomosing cords and strands of uniform cuboidal cells surrounded by fibrovascular stroma. Herein, we report a case of reactive ESFA which developed on the perianal region of a 31-year-old man.
PubMed: 28979031
DOI: 10.4103/ijd.IJD_566_16 -
Polish Journal of Radiology 2014Magnetic resonance imaging (MRI) depicts infectious foci in the perianal region better than any other imaging modality. MRI allows definition of the fistula, associated... (Review)
Review
Magnetic resonance imaging (MRI) depicts infectious foci in the perianal region better than any other imaging modality. MRI allows definition of the fistula, associated abscess formation and its secondary extensions. Accurate information is necessary for surgical treatment and to obtain a decrease in the incidence of recurrence and complications. Radiologists should be familiar with anatomical and pathological findings of perianal fistulas and classify them using the MRI - based grading system. The purpose of this article was to provide an overview for evaluation of perianal fistulas, examples of various fistula types and their classification.
PubMed: 25550766
DOI: 10.12659/PJR.892098 -
Journal of Ultrasound Mar 2015Crohn's disease is a chronic inflammatory disease which may involve any segment of the gastrointestinal tract, most frequently the terminal ileum, the large intestine,... (Review)
Review
Crohn's disease is a chronic inflammatory disease which may involve any segment of the gastrointestinal tract, most frequently the terminal ileum, the large intestine, and the perianal region. The symptoms of perianal Crohn's disease include skin disorders, hemorrhoids, anal ulcers, anorectal stenosis, perianal abscesses and fistulas, rectovaginal fistulas and carcinoma of the perianal region. The perianal manifestations of Crohn's disease cause great discomfort to the patient and are among the most difficult aspects to treat. Management of perianal disease requires a combination of different imaging modalities and a close cooperation between gastroenterologists and dedicated surgeons.
PubMed: 25767636
DOI: 10.1007/s40477-013-0042-9 -
Cancers Mar 2021Perianal fistulizing Crohn's disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn's disease are also at risk of... (Review)
Review
Perianal fistulizing Crohn's disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn's disease are also at risk of perianal fistula-related squamous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn's disease and there is a paucity of data regarding its incidence, diagnosis and management. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn's disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula-related carcinoma in CD (Chron's disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diagnosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long-standing disease in the perineum are present. Future studies are needed to understand the role of HPV vaccination in preventing fistula-related cancer.
PubMed: 33809997
DOI: 10.3390/cancers13061445