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Asian Journal of Surgery Aug 2023
Topics: Humans; Crohn Disease; Abscess; Anus Diseases; Rectal Fistula; Patients
PubMed: 36990810
DOI: 10.1016/j.asjsur.2023.03.032 -
Alimentary Pharmacology & Therapeutics Oct 2004Fistulizing Crohn's disease can involve the bowel, but is more commonly seen in the perianal region. In acute perianal Crohn's disease, perianal lesions are... (Review)
Review
Fistulizing Crohn's disease can involve the bowel, but is more commonly seen in the perianal region. In acute perianal Crohn's disease, perianal lesions are manifestations of disease activity and are frequently treated concomitantly with bowel lesions. Spontaneous resolution occurs in up to 50% of patients. Fistulae are secondary lesions that may progress to destruction of the sphincter apparatus necessitating proctectomy after years of suffering. The control of sepsis is the first objective. The drainage of abscesses and the placement of setons are essential steps in treatment. Disease severity can be readily assessed by examination under anaesthesia and by magnetic resonance imaging. Endoscopic ultrasonography is sensitive, but is hampered by the necessary introduction of a large instrument into an often narrowed anorectum. Antibiotics, especially metronidazole and ciprofloxacin, are useful short-term therapies to decrease or stop drainage, but relapse is immediate on discontinuation. Immunosuppression with azathioprine (2.5 mg/kg per day) or mercaptopurine (1.5 mg/kg per day) is effective, but slow and often incomplete. The management of perianal fistulizing disease resistant to standard treatment has greatly improved with the introduction of the anti-tumour necrosis factor-alpha antibody, infliximab. The complete arrest of the drainage of fistulae is obtained in 46% of patients 10 weeks after the administration of 5-10 mg/kg of infliximab at weeks 0, 2 and 6 and, on average, lasts for 12 weeks. A treatment algorithm for fistulizing Crohn's disease must therefore involve the early and optimal use of immunosuppression and of infliximab. Medical and surgical co-operation is also critical to achieve the best possible outcome.
Topics: Algorithms; Anti-Bacterial Agents; Anus Diseases; Crohn Disease; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Prognosis; Rectal Fistula
PubMed: 15352905
DOI: 10.1111/j.1365-2036.2004.02060.x -
Pediatric Radiology Oct 2014Perianal complications of Crohn disease are a common occurrence in children and can result in significant morbidity when not accurately characterized prior to surgical... (Review)
Review
Perianal complications of Crohn disease are a common occurrence in children and can result in significant morbidity when not accurately characterized prior to surgical intervention. MRI is an excellent imaging modality for the evaluation of perianal inflammatory bowel disease - allowing characterization and detailed description of perianal fistulas. MRI has many advantages over other imaging modalities for the pediatric patient. Radiologists will benefit from a sophisticated understanding of perianal anatomy, the classification of perianal fistulas, the advantages MRI offers in characterization of perianal fistulas as well as the common and incidental findings that are important in the MRI evaluation of perianal inflammatory bowel disease in children. Perianal fistulas are found at a high rate in pediatric referrals and are more commonly found in male patients.
Topics: Adolescent; Anal Canal; Anus Diseases; Child; Child, Preschool; Crohn Disease; Diagnosis, Differential; Female; Humans; Image Enhancement; Infant; Magnetic Resonance Imaging; Male
PubMed: 25246189
DOI: 10.1007/s00247-014-3085-y -
Indian Pediatrics Aug 1997
Topics: Administration, Topical; Anus Diseases; Condylomata Acuminata; Disease-Free Survival; Humans; Infant; Male; Phytotherapy; Plants, Medicinal; Plants, Toxic; Podophyllum
PubMed: 9492407
DOI: No ID Found -
Southern Medical Journal Dec 1979The colposcope was introduced into colon and rectal surgery for the evaluation of anal and perianal disease. The standard technics of gynecologic colposcopy were used....
The colposcope was introduced into colon and rectal surgery for the evaluation of anal and perianal disease. The standard technics of gynecologic colposcopy were used. The indications included evaluations of pruritus ani, condyloma, mass lesions, unexplained bleeding or pain, and follow-up of patients previously treated for carcinoma of the anus or lower rectum.
Topics: Anus Diseases; Biopsy; Colposcopy; Humans; Rectal Diseases
PubMed: 515767
DOI: No ID Found -
Scandinavian Journal of... 2006Anorectal endosonography (AE), which was introduced 20 years ago, derives from the study of urology. It was first used to evaluate rectal tumours and later also to... (Review)
Review
Anorectal endosonography (AE), which was introduced 20 years ago, derives from the study of urology. It was first used to evaluate rectal tumours and later also to investigate benign disorders of the anal sphincters and pelvic floor. The technique is easy to perform, it has a short learning curve and causes no more discomfort than a routine digital examination. A rotating probe with a 360 degrees radius and a frequency between 5 and 16 MHz is introduced to the rectum and then slowly withdrawn so that the pelvic floor and subsequently the sphincter complex are seen. Recently, it has become possible to reconstruct three-dimensional images. AE has been used for almost every possible disorder in the anal region and has increased our insight into anal pathology. The clinical indications for AE are: 1. Faecal incontinence in patients when surgery is an option. AE can show sphincter defects with excellent precision. There is a perfect correlation with surgical findings. Studies comparing AE with endoanal magnetic resonance imaging (MRI) have shown that both methods are equally good for demonstrating defects in the external anal sphincter; the internal anal sphincter is better visualized with AE. After sphincter repair, the effect is directly related to the decrease in the sphincter defect. 2. Perianal fistulae. AE has been shown to be accurate in staging perianal cryptoglandular fistulae and fistulae in Crohn's disease. When there is an external fistula opening, H2O2 can be introduced with a plastic infusion catheter. The tract then becomes visible as a hyperechoic lesion ("white"). It has been shown that this corresponds well with surgical findings. It is equally sensitive as endoanal MRI. Since recurrent cryptoglandular fistulae are complex in 50% and Crohn's fistula in 75%, it is mandatory to perform AE preoperatively in these patients to avoid missed tracts during surgery and subsequent recurrences. 3. Rectal tumors. In low tubulovillous adenomas or malignant polyps considered removable locally, confirming the local resectability (T0 or T1) is mandatory. Although larger rectal and more advanced tumours can be evaluated with AE, MRI is more sensitive in staging nodal involvement. 4. Anal carcinoma for staging. AE has been shown to stage better than the classical TNM classification for both local extension and prognosis. In conclusion, AE images the internal and external anal sphincter with high accuracy. It is easy to perform and is of particular value in the diagnosis of anal incontinence and perianal fistulae. It is excellent in staging anal carcinoma and can also be used in staging rectal carcinoma, especially very low large malignant polyps.
Topics: Anus Diseases; Endosonography; Humans; Rectal Diseases
PubMed: 16782637
DOI: 10.1080/00365520600664292 -
Inflammatory Bowel Diseases Oct 2009Perianal fistulation is a common complication of Crohn's disease (CD). Fistulating perianal CD appears to represent a distinct phenotype of CD, separate from luminal... (Review)
Review
Perianal fistulation is a common complication of Crohn's disease (CD). Fistulating perianal CD appears to represent a distinct phenotype of CD, separate from luminal fistulating disease, with differing disease behavior and which often requires different therapeutic strategies. The etiology of Crohn's perianal fistulae appears to have genetic, microbiological, and immunological components. Relationships with IBD5, which codes for the organic/cation transporter and IRGM, important in the autophagy pathway, have been identified but further genetic associations remain elusive. The partially efficacious use of antibiotics and fecal diversion imply a microbiological component and, similarly, the partial efficacy of immunosuppressants and anti-tumor necrosis factor alpha (TNFalpha) treatments suggest not only that an immunological process is taking place, but also that microbiota alone cannot account for the pathogenesis. Recent work implicates failures in the tissue injury/repair process with myofibroblasts, matrix metalloproteinases, and an epithelial-to-mesenchymal transition being possible culprits. We examine these areas in a review of the current understanding of the etiology of Crohn's perianal fistulae.
Topics: Anus Diseases; Crohn Disease; Humans; Immunologic Factors
PubMed: 19637358
DOI: 10.1002/ibd.21026 -
Gastroenterology Clinics of North... Dec 2013Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons,... (Review)
Review
Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas.
Topics: Abscess; Animals; Anus Diseases; Drainage; Fibrin Tissue Adhesive; Humans; Magnetic Resonance Imaging; Rectal Fistula; Surgical Flaps; Tissue Adhesives; Tomography, X-Ray Computed; Ultrasonography
PubMed: 24280399
DOI: 10.1016/j.gtc.2013.08.003 -
Gastroenterology Nov 2003
Review
Topics: Anus Diseases; Crohn Disease; Humans; Incidence; Rectal Fistula
PubMed: 14598268
DOI: 10.1016/j.gastro.2003.08.025 -
Der Hautarzt; Zeitschrift Fur... Jun 2015Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory disease characterized by painful nodules, abscesses, fistulas, sinus tracts and scarring, which... (Review)
Review
Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory disease characterized by painful nodules, abscesses, fistulas, sinus tracts and scarring, which may lead to severe functional and psychological impairment. Patients often suffer for many years before the right diagnosis is finally made. HS/AI is still a therapeutic challenge. Conservative therapies play a role in mild stages of the disease; however they do not result in healing. Therapy of choice associated with the lowest recurrence rate is a radical wide excision of involved skin.
Topics: Anus Diseases; Hidradenitis; Hidradenitis Suppurativa; Humans; Recurrence; Risk Factors; Treatment Outcome
PubMed: 25877488
DOI: 10.1007/s00105-015-3616-y