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The American Journal of the Medical... Apr 2016Anorectal abscess and fistula-in-ano is a rare disease with an exemplary prognosis. Most patients are diagnosed with cryptoglandular disease but unusual infections raise... (Review)
Review
BACKGROUND
Anorectal abscess and fistula-in-ano is a rare disease with an exemplary prognosis. Most patients are diagnosed with cryptoglandular disease but unusual infections raise difficult antimicrobial management challenges.
METHODS
All primary references identified in PubMed, EMBASE, the ISI Web of Knowledge database and the Cochrane Library, published between 1960 and 2015, using the keywords "anorectal abscess," "fistula-in-ano," "perianal abscess," or "perianal fistula" or all, were uploaded into a database. The databases were also interrogated using keywords specific for each infection type studied.
RESULTS
In all, 52 relevant primary medical publications were identified. There were also 4 relevant organizational standards guideline publications, 1 relevant review and 4 historical publications about the diagnosis and outcomes of anorectal abscess and fistula-in-ano with data derived primarily from prospective and retrospective trials as well as institutional case series to provide an evidence level opinion. The use of antimicrobial therapy in combination with surgical incision and drainage in the treatment of cryptoglandular disease has failed to improved healing times or reduce recurrences or both. Based on limited data, routine antimicrobial therapy may benefit patients with significant comorbid conditions, extensive cellulitis and systemic symptoms. For patients with unusual infecting pathogens (eg, Mycobacterium tuberculosis, Actinomyces species and Chlamydia species) outcomes are favorable with selected antimicrobial therapy agents of various durations.
CONCLUSION
Surgical incision and drainage is the main treatment for anorectal abscess and fistula-in-ano, but a select group of patients with unusual infections benefit from tailored prolonged antimicrobial therapy with the overall recurrence rate remaining low.
Topics: Abscess; Anus Diseases; Clinical Trials as Topic; Communicable Diseases; Humans; Prospective Studies; Rectal Fistula; Retrospective Studies
PubMed: 27079352
DOI: 10.1016/j.amjms.2015.11.012 -
Diseases of the Colon and Rectum Feb 2009This study was designed to review the clinical and pathologic findings, treatment, and outcomes of patients who have a cancer that complicates perianal Crohn's disease.
PURPOSE
This study was designed to review the clinical and pathologic findings, treatment, and outcomes of patients who have a cancer that complicates perianal Crohn's disease.
METHODS
Charts of patients who had documented perianal Crohn's disease and a pathologic diagnosis of anal carcinoma were reviewed.
RESULTS
There were 14 patients (6 men; mean age, 49 years) who had evidence of perianal Crohn's disease (mean, 6.9 (range, 1-20) years) before their cancer diagnosis. The diagnosis often was delayed despite increasing pain, multiple biopsies, and imaging studies. Ten patients had preoperative diagnoses of cancer; however, none of the eight magnetic resonance imaging studies were diagnostic. There were 11 adenocarcinomas (8 mucinous or colloid subtypes) and 3 squamous-cell carcinomas. Treatment included abdominoperineal resections plus chemotherapy in 12, and radiation and a defunctioning stoma in 1 patient. Of the 12 who had an abdominoperineal resection, 3 had posterior vaginectomies and rectus flap reconstructions. At last follow-up (mean, 41 (median, 22) months), five patients were alive without disease, five were alive with disease, and four had died.
CONCLUSIONS
Physicians should have a high level of suspicion of cancer in patients with longstanding perianal Crohn's disease who have a change in symptoms. In this series, patients who were diagnosed preoperatively and treated with multimodality therapy had better outcomes.
Topics: Adenocarcinoma; Adult; Aged; Anal Canal; Anus Diseases; Anus Neoplasms; Carcinoma, Squamous Cell; Crohn Disease; Female; Humans; Male; Middle Aged
PubMed: 19279414
DOI: 10.1007/DCR.0b013e318197d0ad -
Nature Reviews. Gastroenterology &... Jun 2024The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized,... (Review)
Review
The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.
Topics: Humans; Rectal Diseases; Colonic Diseases; Sexual Behavior; Anus Diseases; Pleasure; Sexual Dysfunction, Physiological
PubMed: 38763974
DOI: 10.1038/s41575-024-00932-1 -
The Surgical Clinics of North America Dec 2002Although there are a large variety of anal diagnoses associated with the HIV population, anal condyloma and anal ulcerations make up the vast majority. A large... (Review)
Review
Although there are a large variety of anal diagnoses associated with the HIV population, anal condyloma and anal ulcerations make up the vast majority. A large percentage of individuals having multiple concurrent pathologies should also be noted. Thus, this article concentrates on anal condyloma, anal ulceration and HIV, making note of other significant issues.
Topics: Anus Diseases; Condylomata Acuminata; Digestive System Surgical Procedures; Fissure in Ano; HIV Infections; Humans
PubMed: 12516848
DOI: 10.1016/s0039-6109(02)00085-3 -
Digestive and Liver Disease : Official... Oct 2007Perianal manifestations are common in patients with Crohn's disease and include skin tags and haemorrhoids, fissures, ulcers, abscesses, fistulas, stenosis or cancer.... (Review)
Review
Perianal manifestations are common in patients with Crohn's disease and include skin tags and haemorrhoids, fissures, ulcers, abscesses, fistulas, stenosis or cancer. Primary lesions include Crohn's fissures and cavitating perianal ulcers. Secondary lesions include deep abscesses, fistulas and strictures. A good classification and anatomical description of these conditions is crucial before embarking on any kind of (medical or surgical) therapy, as this greatly influences management. This review analyses and discusses current classifications of any perianal form of Crohn's disease.
Topics: Anus Diseases; Crohn Disease; Diagnosis, Differential; Humans; Prognosis; Risk Factors
PubMed: 17720634
DOI: 10.1016/j.dld.2007.07.153 -
Minerva Chirurgica Feb 2018Condylomata acuminata are the most common sexually transmitted disease worldwide. They are not usually a serious problem, but it causes emotional distress to patient and... (Review)
Review
INTRODUCTION
Condylomata acuminata are the most common sexually transmitted disease worldwide. They are not usually a serious problem, but it causes emotional distress to patient and physician alike because of its marked tendency to recurrence. The presence of anogenital warts mandates treatment, also for potential degeneration of the lesions.
EVIDENCE ACQUISITION
A review of the literature has been performed to analyze proposed treatments for anogenital warts.
EVIDENCE SYNTHESIS
Many treatments have been employed. They include cytotoxic agents, immunomodulation and physical ablation. The choice of the appropriate treatment varies depending on the number, size, and location of warts. Complications of various treatments are rare but include permanent depigmentation, itching, pain, scarring, bleeding, anal stenosis or incontinence and sepsis. The therapy of these lesions can sometimes be very painful and expensive, and therapy should not be worse than the disease.
CONCLUSIONS
No specific antiviral treatment is currently available, and no consensus has been reached on the appropriate treatment for anogenital warts. No data are available to indicate whether treatment eliminates infectivity, the primary aim of treatment being to remove the lesions. There is a paucity of published randomized trials. Despite the introduction of antiviral treatments such as interferon, immunomodulating agents or imiquimod, surgical destruction or removal remains the treatment of choice.
Topics: Aminoquinolines; Antiviral Agents; Anus Diseases; Condylomata Acuminata; Cryotherapy; Cytotoxins; Electrosurgery; Female; Humans; Imiquimod; Immunologic Factors; Interferons; Laser Therapy; Male; Papillomaviridae; Papillomavirus Infections; Photochemotherapy; Podophyllotoxin
PubMed: 29154519
DOI: 10.23736/S0026-4733.17.07554-X -
Emergency Medicine Clinics of North... May 2016Patients commonly present to the emergency department with anorectal complaints. Most of these complaints are benign and can be managed conservatively; however, there... (Review)
Review
Patients commonly present to the emergency department with anorectal complaints. Most of these complaints are benign and can be managed conservatively; however, there are a few anorectal emergencies that clinicians must be aware of in order to prevent further complications. The history and physical examination are especially important so that critical disorders can be recognized and specific treatment plans can be determined. It is important to maintain a broad differential diagnosis of anorectal disease and to distinguish benign from serious processes.
Topics: Anus Diseases; Emergency Service, Hospital; Humans; Rectal Diseases
PubMed: 27133243
DOI: 10.1016/j.emc.2015.12.013 -
Seminars in Pediatric Surgery Apr 2024Perianal complications are common and morbid in children with Crohn's disease. In this review, we describe the epidemiology, the presentation and diagnosis, evaluation... (Review)
Review
Perianal complications are common and morbid in children with Crohn's disease. In this review, we describe the epidemiology, the presentation and diagnosis, evaluation and management. We focus on updates such as the increasing frequency of biologic medications and MRI for evaluation. We also highlight controversies on the timing and approaches to surgical techniques. Finally, perianal disease requires the coordination of multidisciplinary care with nursing, radiology, gastroenterology, and surgery to optimize outcomes - both medical and patient-centered.
Topics: Humans; Crohn Disease; Child; Anus Diseases
PubMed: 38603820
DOI: 10.1016/j.sempedsurg.2024.151402 -
Techniques in Coloproctology Dec 2018The French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn's disease. Treatment... (Review)
Review
The French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn's disease. Treatment strategies for acute abscesses, active fistulas (active denovo and still active under treatment), fistulas in remission, and rectovaginal fistulas are suggested. Recommendations have been graded following the international recommendations, and when absent, professional agreement has been established. For each situation, practical algorithms have been drawn.
Topics: Abscess; Algorithms; Anal Canal; Anus Diseases; Colorectal Surgery; Consensus; Crohn Disease; Disease Management; Female; France; Humans; Male; Perineum; Practice Guidelines as Topic; Rectal Fistula; Societies, Medical
PubMed: 30604249
DOI: 10.1007/s10151-018-1906-y -
Inflammatory Bowel Diseases Mar 2010Patients with Crohn's disease are prone to the development of pyogenic complications. These complications are most commonly in the form of perianal or intraabdominal... (Review)
Review
Patients with Crohn's disease are prone to the development of pyogenic complications. These complications are most commonly in the form of perianal or intraabdominal abscesses and/or fistulas. Complications in these 2 distinct areas are managed differently; however, they are similar in the fact that initial treatment relies on medical or minimally invasive management to achieve a nonacute condition prior to definitive surgical procedure. This article reviews the current surgical management of obtaining pyogenic control in both anorectal and intraabdominal Crohn's disease.
Topics: Abdominal Abscess; Anus Diseases; Crohn Disease; Humans; Rectal Fistula
PubMed: 20049952
DOI: 10.1002/ibd.20984