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The Journal of Small Animal Practice Jan 1995The literature about the anal sacs of healthy dogs and the pathogenesis, diagnosis and therapy of anal sac impaction and sacculitis are reviewed. Knowledge about the... (Review)
Review
The literature about the anal sacs of healthy dogs and the pathogenesis, diagnosis and therapy of anal sac impaction and sacculitis are reviewed. Knowledge about the physiological role of the anal sacs is still confusing. The colour and consistency of the anal sac contents are variable in healthy dogs and there are no pathognomonic signs of anal sac impaction or sacculitis. The wide variation in macroscopic detail of anal sac secretions may give rise to misinterpretation and thus overdiagnosis of sacculitis. Other diseases such as vaginitis, flea allergy, atopy, proctitis, parasites and perianal fistulae can lead to similar signs and must be eliminated from the differential diagnosis before the anal sacs are incited as the cause of the signs. Further research is necessary on the morphological, physical and biochemical aspects of the anal sacs and their secretions to define more precise criteria for the diagnosis of impaction and sacculitis. It is imperative that controlled therapeutic trials should be performed, and such studies are indispensable for the rational therapy of anal sac disease.
Topics: Anal Sacs; Animals; Anus Diseases; Dog Diseases; Dogs; Inflammation
PubMed: 7815780
DOI: 10.1111/j.1748-5827.1995.tb02756.x -
Digestive Diseases (Basel, Switzerland) 2014Complex perianal disease is associated with poor outcome and requires early effective therapy. Corticosteroids are not effective in perianal fistulising Crohn's disease,... (Review)
Review
Complex perianal disease is associated with poor outcome and requires early effective therapy. Corticosteroids are not effective in perianal fistulising Crohn's disease, and antibiotics, immunosuppressants and anti-TNF therapy are required. It is important to consider combined medical surgical therapy after accurate imaging using an MRI scan of the pelvis. Drainage of any abscess at examination under anaesthesia and seton insertion are important before introduction of immunosuppressants and anti-TNF therapy. Long-term follow up of patients in a single centre reported responders to azathioprine having a reduced risk of perianal surgery (OR = 0.36; 95% CI: 0.27-0.46), but complex perianal fistulising Crohn's disease generally requires combination therapy with anti-TNF and azathioprine. Patients with recent perianal disease without fistulae and aged 40 years or older respond better to azathioprine monotherapy. Response to monotherapy with azathioprine is often slow and incomplete. In the recent GETAID study of early administration of azathioprine versus conventional management in patients at high risk of disabling disease, a higher cumulative proportion of patients in the azathioprine group were free of perianal surgery. In patients not responding to anti-TNF therapy, thalidomide or tacrolimus may be considered. Hyperbaric oxygen may be used as adjunctive therapy where available. The role of adipose-derived stem cell injection requires further long-term studies. In prevention of post-operative recurrence of Crohn's disease, azathioprine or 6-mercaptopurine had a favourable incremental cost-effectiveness ratio compared with no prophylactic therapy up to 1 year. In a Cochrane systematic review, azathioprine/6-mercaptopurine was associated with a significantly reduced risk of clinical recurrence [RR = 0.59, 95% CI: 0.38-0.92, number needed to treat (NNT) = 7] and severe endoscopic recurrence (RR = 0.6, 95% CI: 0.44-0.92, NNT = 4). Individual studies of prevention of post-operative recurrence using azathioprine/6-mercaptopurine have shown only modest benefit. In patients at high risk of relapse after surgical resection, anti-TNF therapy may be beneficial, but more data is required from ongoing studies. Strategies to prevent post-operative recurrence in Crohn's disease are evolving but need further refinement.
Topics: Anus Diseases; Crohn Disease; Humans; Immunosuppressive Agents; Postoperative Period; Recurrence
PubMed: 25531359
DOI: 10.1159/000367835 -
Journal of Pediatric Gastroenterology... May 2017Although perianal complications of Crohn disease (CD) are commonly encountered in clinical practice, the epidemiology of perianal CD among populations of children is... (Observational Study)
Observational Study
BACKGROUND
Although perianal complications of Crohn disease (CD) are commonly encountered in clinical practice, the epidemiology of perianal CD among populations of children is poorly understood. We sought to characterize the prevalence of perianal disease in a large and diverse population of pediatric patients with CD.
METHODS
We conducted retrospective analyses from a prospective observational cohort, the ImproveCareNow Network (May 2006-October 2014), a multicenter pediatric inflammatory bowel disease quality improvement collaborative. Clinicians prospectively documented physical examination and phenotype classification at outpatient visits. Perianal examination findings and concomitant phenotype change were used to corroborate time of new-onset perianal disease. Results were stratified by age, sex, and race and compared across groups with logistic regression. Cumulative incidence was estimated using Kaplan-Meier analyses and compared between groups with Cox proportional hazard regression models.
RESULTS
The registry included 7076 patients with CD (41% girls). Missing/conflicting entries resulted in 397 (6%) patient exclusions. Among the remaining 6679 cases, 1399 (21%) developed perianal disease. Perianal disease was more common among boys (22%) than girls (20%; P = 0.013) and developed sooner after diagnosis among those with later rather than early onset disease (P < 0.001). Perianal disease was also more common among blacks (26%) compared with whites (20%; P = 0.017). Asians with later onset CD developed perianal disease earlier in their disease course (P = 0.01). There was no association between disease location or nutritional status at diagnosis and later development of perianal disease.
CONCLUSIONS
In this large multicenter collaborative, we found that perianal disease is more common among children with CD than previously recognized. Differences in the development of perianal disease were found across racial and other subgroups. Treatment strategies are needed to prevent perianal disease development.
Topics: Adolescent; Anus Diseases; Child; Crohn Disease; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Phenotype; Prevalence; Proportional Hazards Models; Registries; Retrospective Studies; Risk Factors; United Kingdom; United States
PubMed: 27801750
DOI: 10.1097/MPG.0000000000001447 -
Pediatric Annals Feb 2016Pediatric inflammatory bowel disease is a chronic gastrointestinal disease consisting of Crohn's disease (CD) and ulcerative colitis (UC). Both disease processes can... (Review)
Review
Pediatric inflammatory bowel disease is a chronic gastrointestinal disease consisting of Crohn's disease (CD) and ulcerative colitis (UC). Both disease processes can share similar clinical symptoms including abdominal pain, diarrhea, hematochezia, and weight loss; CD can also be complicated by penetrating and fistulizing disease. Perianal skin tags, perianal abscesses, recto-cutaneous fistulae, and rectal stenosis are among the phenotypic characteristics of perianal CD. Current treatment strategies are focused on the surgical drainage of abscesses and the closure of fistulous tracts as well as controlling intestinal inflammation with the use of immunomodulators (6-mercaptopurine and methotrexate) and biologics (infliximab and adalimumab). Current guidelines by the American Gastroenterology Association and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommend a combination of surgical intervention and medical management for the treatment of perianal CD.
Topics: Abscess; Adolescent; Anus Diseases; Child; Crohn Disease; Humans; Male; Rectal Fistula; Recurrence
PubMed: 26878185
DOI: 10.3928/00904481-20160113-02 -
The American Journal of Gastroenterology Apr 2010
Topics: Adult; Algorithms; Anus Diseases; Chronic Disease; Constipation; Diagnosis, Differential; Fecal Incontinence; Female; Humans; Middle Aged; Pain; Rectal Diseases; Syndrome
PubMed: 20372131
DOI: 10.1038/ajg.2010.70 -
Rozhledy V Chirurgii : Mesicnik... Apr 2014Periproctal inflammations related to the anus are characterized by the rapid spread of the infection to the surrounding tissue, which is determined by the anatomical... (Review)
Review
Periproctal inflammations related to the anus are characterized by the rapid spread of the infection to the surrounding tissue, which is determined by the anatomical characteristics and infectious agents. Inflammation, which starts as a phlegmon, quickly forms boundaries and an abscess develops in most cases. Up to 80-90% of anorectal abscesses develop according to the crypto-glandular theory on the basis of infection of the anal glands, spilling into the Morgagni crypts in the anal canal. Up to two-thirds of such abscesses are associated with the emergence of anorectal fistulas. Anorectal abscesses can be divided into marginal and subcutaneous perianal abscesses, submucosal, intersphincteric, ischiorectal and supralevator abscesses. Their diagnosis is based on thorough physical examination, sometimes also with the help of imaging methods such as computed tomography, magnetic resonance imaging and endoanal ultrasound. What is decisive for the successful treatment of anorectal abscessess is their early and adequate surgical drainage. Adjuvant antibiotic therapy is necessary only when the overall signs of sepsis are present and for patients with a comorbidity such as diabetes, valvular heart disease, or immunodeficiency.
Topics: Abscess; Anal Canal; Anti-Bacterial Agents; Anus Diseases; Drainage; Humans; Rectal Fistula; Tomography, X-Ray Computed
PubMed: 24881481
DOI: No ID Found -
The Netherlands Journal of Medicine Aug 1994Perianal disease in Crohn's disease is a difficult matter to deal with. The indication for therapy is not always clear in this disease with a relatively mild natural... (Review)
Review
Perianal disease in Crohn's disease is a difficult matter to deal with. The indication for therapy is not always clear in this disease with a relatively mild natural course. More confusion is caused by the fact that not all disease in the perianal region in a patient with Crohn's has to be Crohn-related. The usual ailments such as haemorrhoids may occur in a patient with Crohn's disease. The treatment has to be as for every patient. Primary mucosal and submucosal Crohn's disease in the anal canal has to be treated like uncomplicated Crohn's disease in the rest of the gastrointestinal tract with appropriate medication. The option for therapy in complicated abdominal Crohn's disease, most often resection, is not available in perianal disease without giving up faecal continence. One has to make a compromise, wishing to treat the disease as radically as possible, while preserving faecal continence as much as possible. The basis for treatment for complicated Crohn's disease is medical treatment for the primary disease. The choice in surgical options depends on the type of complication. A different strategy is needed for each type of complication. The therapy is different for perianal abscesses, rectovaginal fistulas, stenosis, high perianal fistulas and low perianal fistulas. It is proposed to treat abscesses by early incision and drainage, rectovaginal fistulas by a mucosal advancement anoplasty, high perianal fistulas by a seton procedure, low perianal fistulas by fistulotomy, and stenosis by mild dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Anus Diseases; Crohn Disease; Humans; Incidence; Netherlands
PubMed: 7936009
DOI: No ID Found -
Digestive and Liver Disease : Official... Oct 2007The surgical management of perianal Crohn's disease is complex with a wide range of operations being described. The initial emergency treatment is to drain any source of... (Review)
Review
The surgical management of perianal Crohn's disease is complex with a wide range of operations being described. The initial emergency treatment is to drain any source of underlying sepsis. A loose seton drainage or a defunctioning stoma can then be used as a 'bridge' to definitive treatment allowing both adequate assessment of the condition and preventing further sepsis. The likelihood of success of any surgical repair must be weighed against the risk of faecal incontinence. Improved results of a local surgical repair are seen with optimal surgical and medical management of perianal Crohn's disease.
Topics: Anus Diseases; Crohn Disease; Digestive System Surgical Procedures; Humans; Treatment Outcome
PubMed: 17723322
DOI: 10.1016/j.dld.2007.07.157 -
Canadian Journal of Gastroenterology =... Sep 2000Perianal inflammation is a disabling manifestation of Crohn's disease. The primary lesions found in perianal Crohn's disease evolve in parallel with the disease... (Review)
Review
Perianal inflammation is a disabling manifestation of Crohn's disease. The primary lesions found in perianal Crohn's disease evolve in parallel with the disease elsewhere in the bowel. Although the spontaneous resolution of anal lesions is observed in up to half of patients, the penetrating nature of the disease may lead to secondary lesions including complex fistulae. In some patients, this, in turn, results in the gradual destruction of the sphincter apparatus and anal incontinence. These patients, after years of suffering, often require proctectomy. Control of activity, overall, is the first step in the management of perianal Crohn's disease. Sepsis should be controlled by the drainage of abscesses and by long term use of setons. Although antibiotics and standard immunosuppression often improve perianal fistulae, their action is usually slow and incomplete. Management of perianal Crohn's disease has changed thoroughly in the past two years since the introduction of monoclonal antibodies to tumour necrosis factor (infliximab). Complete arrest of the drainage of fistulae was obtained in 46% of patients after the administration of 5 to 10 mg/kg of infliximab at weeks 0, 2 and 6, with a median duration of effect of 12 weeks. In these patients, long term management of their bowel disease will likely require the repeated use of infliximab. Studies to evaluate this are underway.
Topics: Antibodies, Monoclonal; Anus Diseases; Crohn Disease; Drainage; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Infliximab; Prognosis; Rectal Fistula
PubMed: 11023554
DOI: 10.1155/2000/985045 -
Mayo Clinic Proceedings Oct 2016Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this... (Review)
Review
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis.
Topics: Algorithms; Anal Canal; Anus Diseases; Cystitis, Interstitial; Female; Humans; Male; Muscular Diseases; Pain; Pelvic Pain; Prostatitis
PubMed: 27712641
DOI: 10.1016/j.mayocp.2016.08.011