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Abdominal Imaging Nov 2007Crohn's disease is a chronic, transmural inflammatory process of the gastrointestinal tract. It often affects the colon with the perianal area. The most common... (Review)
Review
Crohn's disease is a chronic, transmural inflammatory process of the gastrointestinal tract. It often affects the colon with the perianal area. The most common intestinal manifestations include external and/or internal fistulas and abscesses. Assessment of the activity of perianal fistulas in the course of Crohn's disease seems to be an important factor influencing therapeutic approach. Fistula's activity is evaluated by such methods as magnetic resonance imaging, anal ultrasound and examination under anaesthesia. Usefulness of imaging methods in the diagnosis of fistulas still remains to be defined.MRI is used to present a wide spectrum of perianal fistulazing Crohn's disease. Additionally, it is an important instrument revealing location, extent and severity of inflammation. It is also very helpful to detect clinically silent sepsis related to small, local inflammation. The most common method used in MR imaging to assess topography of a fistula's track, is Parks' classification.Clinical indications to MRI may include follow-up studies of a diagnosed disease, classification of fistulas' subtypes in the course of Crohn's disease, determination of the extent of fistulas' tracts and spread of an inflammatory process what can guide surgical procedures.
Topics: Anus Diseases; Contrast Media; Crohn Disease; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Rectal Fistula
PubMed: 17334876
DOI: 10.1007/s00261-007-9188-2 -
The Australian and New Zealand Journal... Jun 1996A case of hereditary presacral teratoma involving father and daughter is described. The use of magnetic resonance imaging in the diagnosis of this condition is... (Review)
Review
A case of hereditary presacral teratoma involving father and daughter is described. The use of magnetic resonance imaging in the diagnosis of this condition is illustrated and a review of the literature of this unusual condition is presented.
Topics: Adult; Anus Diseases; Chronic Disease; Constipation; Constriction, Pathologic; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Sacrococcygeal Region; Soft Tissue Neoplasms; Teratoma
PubMed: 8678865
DOI: 10.1111/j.1445-2197.1996.tb01224.x -
Alimentary Pharmacology & Therapeutics Oct 2015Temporary faecal diversion is sometimes used for management of refractory perianal Crohn's disease (CD) with variable success. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Temporary faecal diversion is sometimes used for management of refractory perianal Crohn's disease (CD) with variable success.
AIMS
To perform a systematic review with meta-analysis to evaluate the effectiveness, long-term outcomes and factors associated with success of temporary faecal diversion for perianal CD.
METHODS
Through a systematic literature review through 15 July 2015, we identified 16 cohort studies (556 patients) reporting outcomes after temporary faecal diversion. We estimated pooled rates [with 95% confidence interval (CI)] of early clinical response, attempted and successful restoration of bowel continuity after temporary faecal diversion (without symptomatic relapse), and rates of re-diversion (in patients with attempted restoration) and proctectomy (with or without colectomy and end-ileostomy). We identified factors associated with successful restoration of bowel continuity.
RESULTS
On meta-analysis, 63.8% (95% CI: 54.1-72.5) of patients had early clinical response after faecal diversion for refractory perianal CD. Restoration of bowel continuity was attempted in 34.5% (95% CI: 27.0-42.8) of patients, and was successful in only 16.6% (95% CI: 11.8-22.9). Of those in whom restoration was attempted, 26.5% (95% CI: 14.1-44.2) required re-diversion because of severe relapse. Overall, 41.6% (95% CI: 32.6-51.2) of patients required proctectomy after failure of temporary faecal diversion. There was no difference in the successful restoration of bowel continuity after temporary faecal diversion in the pre-biological or biological era (13.7% vs. 17.6%, P = 0.60), in part due to selection bias. Absence of rectal involvement was the most consistent factor associated with restoration of bowel continuity.
CONCLUSIONS
Temporary faecal diversion may improve symptoms in approximately two-thirds of patients with refractory perianal Crohn's disease, but bowel restoration is successful in only 17% of patients.
Topics: Anus Diseases; Colectomy; Crohn Disease; Feces; Humans; Ileostomy; Proctocolectomy, Restorative; Recurrence
PubMed: 26264359
DOI: 10.1111/apt.13356 -
Obstetrics and Gynecology Dec 2001Patients with a wide variety of anorectal lesions present to family physicians. Most can be successfully managed in the office setting. A high index of suspicion for... (Review)
Review
Patients with a wide variety of anorectal lesions present to family physicians. Most can be successfully managed in the office setting. A high index of suspicion for cancer should be maintained and all patients should be questioned about relevant family history or other indications for cancer screening. Patients with condylomata acuminata must be examined for human papillomavirus infection elsewhere after treatment of the presenting lesions. Their sexual partners should also be counseled and screened. Both surgical and nonsurgical treatments are available for the pain of anal fissure. Infection in the anorectal area may present as different types of abscesses, cryptitis, fistulae or perineal sepsis. Fistulae may result from localized infection or indicate inflammatory bowel disease. Protrusion of tissue through the anus may be due to hemorrhoids, mucosal prolapse, polyps or other lesions.
Topics: Anus Diseases; Colorectal Neoplasms; Female; Gynecology; Humans; Mass Screening; Women's Health
PubMed: 11755566
DOI: 10.1016/s0029-7844(01)01687-8 -
Journal of the Royal Society of Medicine Jun 1982Symptomatic anal disease (excluding skin tags) was observed in 49 out of 151 successive patients treated for Crohn's disease. Two main types of anal disease were...
Symptomatic anal disease (excluding skin tags) was observed in 49 out of 151 successive patients treated for Crohn's disease. Two main types of anal disease were encountered: anal ulceration (23 patients) and anal abscesses and fistulae (26 patients). The ulcer group rarely required local surgical treatment. In the fistula group, a low tract was demonstrated and laid open in 20 patients. The healing times after operation in these patients were compared with those of 18 patients with non-Crohn's fistula-in-ano treated by the same method. No significant difference between the two groups could be demonstrated. Surgical treatment of low fistula-in-ano may be undertaken in patients with Crohn's disease, provided the bowel disease is under adequate control.
Topics: Abscess; Anus Diseases; Crohn Disease; Humans; Rectal Fistula; Ulcer; Wound Healing
PubMed: 7086789
DOI: 10.1177/014107688207500609 -
Diseases of the Colon and Rectum 1981Anal fissures, fistulas, and abscesses occurred as complications in 22 per cent of our population of 1,098 patients with Crohn's disease. Crohn's colitis was much more...
Anal fissures, fistulas, and abscesses occurred as complications in 22 per cent of our population of 1,098 patients with Crohn's disease. Crohn's colitis was much more frequently associated with an anal lesion than Crohn's disease of the small bowel (52 per cent vs. 14 per cent). When an anal lesion is the manifesting sign, Crohn's disease will soon develop elsewhere in the intestine. Since these lesions frequently herald the onset of intestinal Crohn's disease, the physician must always be aware of the possibility of inflammatory bowel disease when dealing with suspicious anal lesions.
Topics: Abscess; Anus Diseases; Crohn Disease; Female; Fissure in Ano; Humans; Male; Rectal Fistula
PubMed: 7472097
DOI: 10.1007/BF02603444 -
Therapeutische Umschau. Revue... Jul 2013Perinatal skin disease present a frequent problem in clinical practise. Their treatment confronts different medical specialties. For the sake of modesty, it often takes... (Review)
Review
Perinatal skin disease present a frequent problem in clinical practise. Their treatment confronts different medical specialties. For the sake of modesty, it often takes a long time until patients seek medical attention. Common complaints entail a variety of differential diagnoses including infectious , primary inflammatory, allergic and neoplastic skin disease, systemic diseases, drug side-effects and diseases of the ano-rectum. A systematic approach to diagnosis and treatment, with emphasis on interdisciplinary collaboration is therefore essential to achieve rapid and sustained healing.
Topics: Anus Diseases; Humans; Skin Diseases
PubMed: 23926638
DOI: 10.1024/0040-5930/a000428 -
Diseases of the Colon and Rectum Dec 1990During the past two decades, an explosive growth in both the prevalence and types of sexually transmitted diseases has occurred. Up to 55 percent of homosexual men with... (Review)
Review
During the past two decades, an explosive growth in both the prevalence and types of sexually transmitted diseases has occurred. Up to 55 percent of homosexual men with anorectal complaints have gonorrhea; 80 percent of the patients with syphilis are homosexuals. Chlamydia is found in 15 percent of asymptomatic homosexual men, and up to one third of homosexuals have active anorectal herpes simplex virus. In addition, a host of parasites, bacterial, viral, and protozoan are all rampant in the homosexual population. Furthermore, the global epidemic of AIDS has produced a plethora of colorectal manifestations. Acute cytomegalovirus ileocolitis is the most common indication for emergency abdominal surgery in the homosexual AIDS population. Along with cryptosporidia and isospora, the patient may present to the colorectal surgeon with bloody diarrhea and weight loss before the diagnosis of human immunodeficiency virus (HIV) disease. Other patients may present with colorectal Kaposi's sarcoma or anorectal lymphoma, and consequently will be found to have seropositivity for HIV. However, in addition to these protean manifestations, one third of patients with AIDS consult the colorectal surgeon with either condylomata acuminata, anorectal sepsis, or proctitis before the diagnosis of HIV disease. Although aggressive anorectal surgery is associated with reasonable surgical results in some asymptomatic HIV positive patients, the same procedures in AIDS (symptomatic HIV positive) patients will often be met with disastrous results. It is incumbent upon the surgeon, therefore, to recognize the manifestations of HIV disease and diagnose these conditions accordingly.
Topics: Acquired Immunodeficiency Syndrome; Anus Diseases; Colonic Diseases; Female; Humans; Male; Rectal Diseases; Sexually Transmitted Diseases
PubMed: 2242700
DOI: 10.1007/BF02139224 -
Der Hautarzt; Zeitschrift Fur... Jun 2015Patients with anal complaints require a high level of sensitivity of the involved healthcare professionals. A large variety of different pathological changes lead to... (Review)
Review
Patients with anal complaints require a high level of sensitivity of the involved healthcare professionals. A large variety of different pathological changes lead to very similar clinical symptoms. A carefully guided history interview is able to target in many cases the underlying condition. Treatment should not be performed before definite exclusion of any malignant disease. However, patients most of all blame hemorrhoids for any anal physical discomfort and visit the physician with high expectations in treatment of their supposed disease. The following summary ranks anal diseases by frequency considering their clinical appearance and delimitation and provides an overview of symptoms associated with hemorrhoids.
Topics: Anus Diseases; Anus Neoplasms; Cooperative Behavior; Diagnosis, Differential; Fibroma; Fissure in Ano; Hemorrhoids; Humans; Interdisciplinary Communication; Rectal Fistula
PubMed: 25862524
DOI: 10.1007/s00105-015-3617-x -
African Health Sciences Dec 2005Tuberculosis is one of the causes of granulomatous disease within the anorectal region. The clinical features, which include symptoms and signs of anal pain or... (Review)
Review
BACKGROUND
Tuberculosis is one of the causes of granulomatous disease within the anorectal region. The clinical features, which include symptoms and signs of anal pain or discharge, multiple or recurrent fistula in ano and inguinal lymphadinopathy, are not characteristically distinct from other anal lesions. It is also difficult to distinguish it from other granulomatous diseases involving the same area.
MATERIALS AND METHODS
A Medline database was used to perform a literature search for articles relating to the term 'anal', 'tuberculosis' and 'Koch's'.
CONCLUSION
Analysis of the available literature shows that Koch's lesion in and around the anus is not uncommon. The presentation is varied in nature and tuberculosis should be suspected in lesions not responding to the conventional approaches. The treatment is two-fold: surgical for the suppuration and medical for the tuberculosis.
Topics: Anus Diseases; Diagnosis, Differential; Humans; Suppuration; Tuberculosis
PubMed: 16615850
DOI: 10.5555/afhs.2005.5.4.345