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Frontiers in Surgery 2022In 10%-20% of cases it is impossible to make a differential diagnosis between ulcerative colitis and Crohn's colitis. A 50% failure rate of J pouch ilea-anal anastomosis...
BACKGROUND
In 10%-20% of cases it is impossible to make a differential diagnosis between ulcerative colitis and Crohn's colitis. A 50% failure rate of J pouch ilea-anal anastomosis is observed in Crohn's colitis. In 2009, we created the Padua Prognostic Score for Colitis (PPSC) to predict the long-term clinical and functional outcome and quality of life of patients undergoing restorative proctocolectomy with J pouch. The aim of the present study is to establish and validate the accuracy of a prognostic score for chronic inflammatory bowel diseases (IBD).
PATIENT POPULATION AND METHODS
The PPSC was created in 2009 by integrating clinical and histological information of patients undergoing RPC. It included preoperative perianal abscess or fistula, rectal sparing, terminal ileum involvement, skip lesions and histological diagnosis of indeterminate colitis or Crohn's colitis on the operative specimen. The validity of this score was tested in predicting postoperative abscess or fistula, anal canal disease, pouchitis, pouch failure and new diagnosis of Crohn's disease. Correlation analysis, ROC curve analysis and survival analysis were used to validate the PPSC in a different cohort from the previous one.
RESULTS
We retrospectively enrolled in this study 138 consecutive patients undergoing CPR for ulcerative colitis ( = 127) or indeterminate colitis ( = 11) in our institution since 2005 to 2020. In this period, we observed 11 patients with postoperative abscess or fistula, 3 with anal canal disease, 40 with pouchitis, 6 with pouch failure and 6 with new diagnosis of Crohn's disease. In the new validation cohort, the PPSC confirmed to have a good accuracy in predicting the onset of postoperative CD (AUC = 74.5%, = 0.018). Kaplan Meier curves demonstrate how a PPSC over 1 can reliably predicts the long-term onset of, pouchitis ( = 0.002) and anal abscess or fistulae ( = 0.04).
CONCLUSIONS
In this validation study we confirmed the accuracy of the PPSC in predicting postoperative fistulas or abscesses and pouchitis. Therefore, we believe that in clinical practice patients with a PPSC score greater than 1 should be warned of this risk of possible Crohn's disease diagnosis and pouch failure.
PubMed: 35959125
DOI: 10.3389/fsurg.2022.911044 -
Journal of Clinical Medicine Dec 2020In Crohn's disease (CD), intra-abdominal abscess (IA) and intestinal free-wall perforation (IP) have a common mechanism of transmural inflammation; however, their...
In Crohn's disease (CD), intra-abdominal abscess (IA) and intestinal free-wall perforation (IP) have a common mechanism of transmural inflammation; however, their manifestation is different. This study aimed to investigate differences in the clinical features between IA and IP in Korean patients with Crohn's disease. : A retrospective cohort study. Thirty university hospitals and two local hospitals in Korea. Patients who were diagnosed with CD between July 1982 and December 2008 were enrolled. Clinical characteristics of IA and IP. : Among 1286 patients with CD, 147 (11.4%) had IA and 83 (6.5%) had IP. IA patients were younger than those of IP (24.2 ± 8.6 vs. 30.4 ± 11.1 years, = 0.001). Location and behavior were significantly different between IA and IP ( = 0.035 and 0.021). In multivariate analyses, perianal fistula was not associated with increased risk of IA and IP, while intestinal stricture was associated with increased risk of IA (OR: 2.72, < 0.0001) and IP (OR: 2.76, < 0.0001). In subgroup analyses, 55 (36.5%) IA patients were diagnosed at the diagnosis of CD, and 92 (63.5%) during follow-up of CD, while 47 (56.6%) IP patients were diagnosed at the diagnosis of CD, and 36 (43.3%) during follow-up of CD. There are several differences in the clinical features of IA and IP in Korean patients with CD. The development mechanism is considered as identical, but further investigation should be needed for clinical implication.
PubMed: 33396251
DOI: 10.3390/jcm10010116 -
Gut Pathogens Oct 2021Gas-producing perianal abscess raises the possibility of clostridial infection, with Clostridium perfringens being the most common causative agent, which is highly...
BACKGROUND
Gas-producing perianal abscess raises the possibility of clostridial infection, with Clostridium perfringens being the most common causative agent, which is highly lethal if untreated timely. As the treatment of clostridial infections often differs from that of non-clostridial infections, which they may closely resemble, the importance of accurate pathogenic organism identification cannot be overemphasized. The 16S rDNA of bacteria is highly conserved within a species and among species of the same genus but demonstrates substantial variation between different species, thus making it a suitable genomic candidate for bacterial detection and identification.
CASE PRESENTATION
Here, we report the case of a 53-year-old patient who was admitted to the hospital for a gas-producing perianal abscess. The patient was managed with ceftizoxime and ornidazole and then received debridement and drainage at the lesion on the second day after admission. The bacterial cultures of the patient isolates from the debridement showed a coinfection of Escherichia coli and Enterococcus faecium. Although perianal redness and swelling subsided obviously after the surgery, the patient was febrile to 38.3℃ with his left upper thigh red and swollen, aggravated with tenderness and crepitus. Considering insufficient debridement and the risk of incorrect identification of pathogens, a second debridement and drainage were performed 4 days after the primary operation, and 16S rDNA sequencing of the isolates implicated Clostridium perfringens infection. Given the discrepancies in diagnostic results and the treatment outcomes, Enterococcus faecium was identified as sample contamination, and a diagnosis of coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess was confirmed. The patient was then successfully treated with meropenem and vancomycin and was discharged at 27 days of admission.
CONCLUSIONS
This case represents the first report of coinfection of both clostridial and non-clostridial organisms in gas-producing perianal abscess and the first case reporting the use of 16S rDNA sequencing in the diagnosis of perianal abscess. Timely pathogen identification is critical for treating gas-producing perianal abscess and an antibiotic regimen covering both aerobic and anaerobic organisms is recommended before true pathogens are identified.
PubMed: 34645489
DOI: 10.1186/s13099-021-00457-x -
Alternative Therapies in Health and... Nov 2023Investigating the therapeutic effect of the non-cutting traction seton technique on perianal abscess.
OBJECTIVE
Investigating the therapeutic effect of the non-cutting traction seton technique on perianal abscess.
METHODS
The clinical data of 70 patients with perianal abscesses diagnosed and treated by the Department of Anorectal Surgery of University Affiliated Hospital from January 2020 to December 2021 were collected, and conducted a retrospective study on them, of which 40 cases were treated with non-cut traction seton in the study group, and other 30 cases were treated with perianal abscess incision and drainage in the control group. The perioperative indexes (operation time, intraoperative bleeding volume, time of postoperative dressing change, time of postoperative granulation tissue formation, postoperative defecation-control ability, postoperative pain score, postoperative wound cleanliness) and follow-up indexes (wound healing time, incontinence Wexner score, recurrence rate, patient satisfaction) were compared between these two groups.
RESULTS
The operation time of the study group was more than that of the control group, and the difference was not statistically significant (P > .05). The intraoperative bleeding volume, time of postoperative dressing change, time of postoperative granulation tissue formation, the scores on postoperative defecation-control ability, the scores on postoperative wound cleanliness, postoperative complication rate, postoperative pain score, time of wound healing, incontinence Wexner score, and recurrence rate all from the study group were better than those in the control group. The patient satisfaction from the study group was higher than that in the control group, and the above differences were statistically significant (P < .05).
CONCLUSION
Non-cutting traction suture technique has obvious advantages in the treatment of perianal abscess, shortening wound healing time and granulation tissue formation time, reducing intraoperative blood loss and postoperative complication rate, etc. It provides a reference for clinical treatment of perianal abscess.
PubMed: 37944981
DOI: No ID Found -
BMJ Open Nov 2022Perianal fistula is a burdening disease with an annual incidence of 6-12/100 000 in Western countries. More than 90% of crypto-glandular fistulas originate from perianal...
INTRODUCTION
Perianal fistula is a burdening disease with an annual incidence of 6-12/100 000 in Western countries. More than 90% of crypto-glandular fistulas originate from perianal abscess. Despite adequate drainage, up to 83% recur or result in an anal fistula, the majority developing within 12 months. There is some evidence that gut-derived bacteria play a role in the development of perianal fistula. Up till now, it is not common practice to routinely administer prophylactic antibiotics to prevent anal fistula development. There is a need for a study to establish whether adding antibiotic treatment to surgical drainage of perianal abscess results in a reduction in perianal fistulas.
METHODS AND ANALYSIS
This multicentre, double-blind, randomised, placebo-controlled trial investigates whether addition of antibiotics (ciprofloxacin and metronidazole) to surgical drainage of a perianal abscess is beneficial compared with surgical drainage alone. The primary outcome is the development of a perianal fistula within 1 year. Secondary outcomes include quality of life, treatment costs, need for repeated drainage, patient-reported outcomes and other clinical outcomes. Participants are recruited in one academic and seven peripheral Dutch clinics. To demonstrate a reduction of perianal fistula from 30% to 15% when treated with adjuvant antibiotics with a two-sided alpha of 0.05, a power of 80% and taking a 10% loss to follow-up percentage into account, the total sample size will be 298 participants. Data will be analysed according to the intention-to-treat principle.
ETHICS AND DISSEMINATION
The study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers (nr. 2021_010). Written consent is obtained from each participant prior to randomisation into the study. The results of this trial will be submitted for publication in international peer-reviewed journals, presented at conferences and spread to coloproctological associations.
TRIAL REGISTRATION NUMBERS
2020-004449-35; NCT05385887.
Topics: Humans; Abscess; Quality of Life; Anus Diseases; Rectal Fistula; Drainage; Anti-Bacterial Agents; Skin Diseases; Treatment Outcome; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 36351727
DOI: 10.1136/bmjopen-2022-067970 -
Microbiology Spectrum Apr 2024The microbiota of perianal abscesses is scarcely investigated. Identifying causative bacteria is essential to develop antibiotic therapy. However, culture-based methods...
The microbiota of perianal abscesses is scarcely investigated. Identifying causative bacteria is essential to develop antibiotic therapy. However, culture-based methods and molecular diagnostics through 16S PCR technology are often hampered by the polymicrobial nature of perianal abscesses. We sought to characterize the microbiota composition of perianal abscesses via metagenomic next-generation sequencing (mNGS). Fourteen patients suffering from perianal abscesses between March 2023 and August 2023 underwent retrospective assessment. Information from medical records was used, including clinical information, laboratory data, and culture and mNGS results. Forty bacterial taxa were identified from perianal abscesses through mNGS, with (71.4%), (57.1%), and (50.0%) representing the most prevalent species. mNGS identified an increased number of bacterial taxa, with an average of 6.1 compared to a traditional culture-based method which only detected an average of 1.1 in culture-positive perianal abscess patients, predominantly (75.0%), revealing the polymicrobial nature of perianal abscesses. Our study demonstrates that a more diverse bacterial profile is detected by mNGS in perianal abscesses, and that is the most prevalent microorganism, potentially serving as a potential biomarker for perianal abscess.IMPORTANCEAccurately, identifying the bacteria causing perianal abscesses is crucial for effective antibiotic therapy. However, traditional culture-based methods and 16S PCR technology often struggle with the polymicrobial nature of these abscesses. This study employed metagenomic next-generation sequencing (mNGS) to comprehensively analyze the microbiota composition. Results revealed 40 bacterial taxa, with (71.4%), (57.1%), and (50.0%) being the most prevalent species. Compared to the culture-based approach, mNGS detected a significantly higher number of bacterial taxa (average 6.1 vs 1.1), highlighting the complex nature of perianal abscesses. Notably, emerged as a potential biomarker for these abscesses. This research emphasizes the importance of mNGS in understanding perianal abscesses and suggests its potential for improving diagnostic accuracy and guiding targeted antibiotic therapy in the future.
Topics: Adult; Humans; Abscess; Escherichia coli; Retrospective Studies; Microbiota; High-Throughput Nucleotide Sequencing; Anti-Bacterial Agents; Bacteroides fragilis; Metagenomics; Skin Diseases; Biomarkers
PubMed: 38385739
DOI: 10.1128/spectrum.03474-23 -
Revista Espanola de Enfermedades... Jul 2023We present the case of a 40-year-old immunocompetent man with complaints of perianal abscess, diarrhea, and weight loss for 3 months. He denied respiratory symptoms....
We present the case of a 40-year-old immunocompetent man with complaints of perianal abscess, diarrhea, and weight loss for 3 months. He denied respiratory symptoms. Colonoscopy revealed ulcers and histopathology showed non-necrotizing granulomas and excluded acid-fast bacilli. Initially, the clinical and histological findings favored the diagnosis of Crohn's disease, however, further investigation by performing chest radiography in the context of a pre-immunomodulatory checklist, revealed pulmonary cavitations confirmed on computed tomography scan. Further mycobacteriological studies suggested the diagnosis of active pulmonary tuberculosis. Demonstration of the presence of Mycobacterium tuberculosis in the colon was possible by RT-PCR. Complete resolution of intestinal and perianal symptoms was achieved 2 weeks after treatment with anti-bacillary agents.
Topics: Male; Humans; Adult; Tuberculosis, Gastrointestinal; Crohn Disease; Colonoscopy; Colon; Granuloma
PubMed: 35748478
DOI: 10.17235/reed.2022.8988/2022 -
Journal of Indian Association of... 2021Hirschsprung's disease (HD) has been traditionally treated from infancy onward and different techniques have been used including Swenson, Soave, and Duhamel procedures....
BACKGROUND
Hirschsprung's disease (HD) has been traditionally treated from infancy onward and different techniques have been used including Swenson, Soave, and Duhamel procedures. The purpose of this study was to evaluate the transanal Swenson's procedure for classical rectosigmoid HD in neonates.
PATIENT AND METHODS
This was a prospective study in which neonates diagnosed with HD were recruited from January 2017 to December 2018. Cases with a transition zone proximal to the midsigmoid were excluded. All patients underwent a transanal Swenson's procedure in the neonatal period using a unified protocol. Intraoperative course and postoperative outcomes such as leak, pelvic abscess, soiling, perianal excoriation, stricture, enterocolitis, and constipation were evaluated and all patients were followed for at least 6 months.
RESULTS
Twenty-three patients (17 males and 6 females) underwent transanal Swenson's procedure. The mean age was 22 ± 5.7 days. Follow-up ranged from 6 to 30 months. No anastomotic leak, retraction, or prolapse was reported. Mild perianal excoriations occurred early in 9 (39%) cases and all responded to medical treatment and disappeared before 2 months postoperatively. Stricture occurred in 2 (8%) patients, enterocolitis in 3 (13%), and constipation in 3 (13%).
CONCLUSION
Transanal Swenson's procedure is feasible and can be performed safely in neonates with rectosigmoid HD with good short-term outcomes. Proper patient selection and standard protocol following fine procedural hall-marks and details are keys for optimal results and patient satisfaction.
PubMed: 33953507
DOI: 10.4103/jiaps.JIAPS_187_19 -
Asian Journal of Surgery Aug 2019Perianal sepsis and fistula is a troublesome disease in the field of colorectal surgery in term of recurrence and fecal incontinence. The aim of our study is to evaluate... (Review)
Review
Perianal sepsis and fistula is a troublesome disease in the field of colorectal surgery in term of recurrence and fecal incontinence. The aim of our study is to evaluate the role of 'one stage complex anal fistula excision with reconstruction of anal sphincter without stool diversion' regarding fecal incontinence and recurrence. This was prospective cohort study on 175 patients of complex high peri-anal fistulae, the patients were subjected to fistulectomy and reconstruction (primary suture repair) of anal sphincter without stool diversion, the patients were followed up 1 year postoperatively after complete healing of the wound regarding their continence to stool and gases using Wexner score and recurrence of the fistula which is examined clinically and radio-logically using MRI. Among the 175 patients only four had developed fecal incontinence with varying degrees in which 2 patients developed gas incontinence and 2 patients developed soiling, after 3 months 8 patients had recurrence and after 6-9 months 6 patients developed recurrence . Also at the end of follow up period upon performing the confirmatory MRI, 2 patients showed hidden fistulous tracts ending into a high abscess cavity. This ends up into total of 16 recurrent cases. Five patients experienced delayed wound healing. In conclusion, Compared to other treatment modalities for complex anal fistula found in literature, it had been found that one stage surgery (fistulectomy with primary sphincter repair) has good results regarding healing of the fistula with low risk of incontinence, low recurrence rate and good wound healing.
Topics: Adolescent; Anal Canal; Cohort Studies; Digestive System Surgical Procedures; Feasibility Studies; Fecal Incontinence; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Plastic Surgery Procedures; Rectal Fistula; Recurrence; Time Factors; Treatment Outcome; Wound Healing; Young Adult
PubMed: 30738718
DOI: 10.1016/j.asjsur.2018.12.005 -
Journal of Clinical Medicine Sep 2023Cyclic neutropenia is a rare hematological condition characterized by periodic fluctuations in neutrophil counts, with a 21-day periodicity. Clinical presentation varies... (Review)
Review
Cyclic neutropenia is a rare hematological condition characterized by periodic fluctuations in neutrophil counts, with a 21-day periodicity. Clinical presentation varies from mild to severe forms of the disease, with the onset of recurrent fever, painful oral ulcers, recurrent bacterial infections, peritonitis, and septic shock. The availability of granulocyte colony-stimulating factor (G-CSF) has revolutionized the management and natural history of this disease, regulating the proliferation, differentiation, and maturation of the progenitor cells, and reducing the duration of neutropenia. Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a group of chronic pathologies that affect the gastrointestinal tract. The onset of both diseases may be at a young age (even during childhood or adolescence), and clinical manifestations may lead to misdiagnosis, due to similar characteristics such as recurrent infections, oral ulcers, perianal abscesses, and infertility. Moreover, the two pathologies are rarely associated, with different management and therapeutic options. Here, we describe two case reports of patients who underwent surgery because of diagnosis of complicated CD. After surgery, due to persistent neutropenia, the hematologist consultant confirmed suspicions of cyclic neutropenia, and G-CSF therapy was started with benefits, underlining the crucial importance of proper differential diagnosis.
PubMed: 37834967
DOI: 10.3390/jcm12196323