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Gastrointestinal Endoscopy Clinics of... Oct 2022Perianal Crohn's disease is associated with decreased quality of life, high morbidity, and high health care use. Treatment goals are to provide infection control, stop... (Review)
Review
Perianal Crohn's disease is associated with decreased quality of life, high morbidity, and high health care use. Treatment goals are to provide infection control, stop fistula drainage, and heal fistula tracts while preserving the anorectal sphincter. Treatment includes a combination of medical and surgical intervention, but new techniques are using interventional endoscopy to act as either a bridge to surgery or to decrease the need for surgical intervention. The decision on which approach to pursue requires knowledge of prior surgery, altered anatomy, prior fistula treatment, and imaging and endoscopic evaluation of fistula complexity, mucosal involvement, and associated stricture or abscess.
Topics: Abscess; Crohn Disease; Endoscopy; Humans; Quality of Life; Rectal Fistula; Treatment Outcome
PubMed: 36202514
DOI: 10.1016/j.giec.2022.04.005 -
International Journal of Colorectal... Mar 2016The aim of this study was to assess the impact of diabetes mellitus, Crohn's disease, HIV/aids, and obesity on the prevalence and readmission rate of perianal abscess.
INTRODUCTION
The aim of this study was to assess the impact of diabetes mellitus, Crohn's disease, HIV/aids, and obesity on the prevalence and readmission rate of perianal abscess.
METHODS
The study cohort was based on the Swedish National Patient Register and included all patients treated for perianal abscess in Sweden 1997-2009. The prevalence and risk for readmission were assessed in association with four comorbidity diagnoses: diabetes mellitus, Crohn's disease, HIV, and/or AIDS and obesity.
RESULTS
A total of 18,877 patients were admitted during the study period including 11,138 men and 4557 women (2.4:1). Crohn's disease, diabetes, and obesity were associated with a significantly higher prevalence of perianal abscess than an age- and gender-matched background population (p < 0.05). In univariate analysis, neither age nor gender had any significant impact on the risk for readmission. In a multivariate Cox proportional hazard analysis, Crohns disease was the only significant risk factor for readmission of perianal abscess.
CONCLUSION
Crohn's disease, diabetes, and obesity increase the risk for perianal abscess. Of these, Crohn's and HIV has an impact on readmission. The pathogenesis and the influence of diabetes and obesity need further research if we are to understand why these diseases increase the risk for perianal abscess but not its recurrence.
Topics: Abscess; Adult; Anal Canal; Comorbidity; Female; HIV Infections; Humans; Male; Patient Admission; Prevalence; Proportional Hazards Models; Recurrence; Sweden
PubMed: 26768004
DOI: 10.1007/s00384-015-2500-7 -
Indian Pediatrics Nov 2020
Topics: Abscess; Anus Diseases; Child, Preschool; Humans; Lacerations; Male; Skin Diseases
PubMed: 33231182
DOI: No ID Found -
Pediatric Surgery International Nov 2023
Topics: Humans; Child; Abscess; Anti-Bacterial Agents; Anus Diseases; Retrospective Studies
PubMed: 37991538
DOI: 10.1007/s00383-023-05601-z -
Pediatric Pathology & Laboratory... 1996This is a retrospective study of 78 children with perianal abscess and/or fistula in ano presenting during a 6 1/2-year period. Sixty-five were males and 13 females....
This is a retrospective study of 78 children with perianal abscess and/or fistula in ano presenting during a 6 1/2-year period. Sixty-five were males and 13 females. Their ages at presentation ranged from 22 days to 18 years (median 1.7 year), and the majority of males were below 2 years of age. The 13 females all presented with perianal abscess, the majority of which grew Staphylococcus aureus (69.2%). On follow-up, none of them developed fistula in ano. Twenty-two of the 65 males (33.8%) presented initially with fistula in ano. The remaining 43 presented with perianal abscess. Four of them were found to have fistula in ano at the time of incision and drainage and on follow-up, and 14 others developed fistula in ano. Of the 40 cases of fistula in ano, all were males; 25 were on the right side and 9 on the left side, 5 had bilateral fistula in ano, and 1 had two fistulas on the left side at 3 and 5 o'clock positions. Gut-derived organisms were isolated from 88.4% of the males with perianal abscess. There appears to be a causal relationship between perianal abscess and fistula in ano.
Topics: Abscess; Adolescent; Anal Canal; Child; Child, Preschool; Female; Fissure in Ano; Humans; Infant; Infant, Newborn; Male; Rectal Fistula
PubMed: 9025874
DOI: No ID Found -
Der Chirurg; Zeitschrift Fur Alle... Jul 2019
Topics: Abscess; Anus Diseases; Diagnosis, Differential; Humans; Intestines
PubMed: 31073656
DOI: 10.1007/s00104-019-0971-8 -
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 -
Cirugia Espanola Nov 2008
Topics: Abscess; Anus Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged
PubMed: 19080914
DOI: 10.1016/s0009-739x(08)75921-9 -
Pediatric Surgery International Oct 2023
Topics: Humans; Abscess; Anus Diseases; Rectal Fistula
PubMed: 37801089
DOI: 10.1007/s00383-023-05563-2 -
Pediatrics International : Official... Oct 2019Combination therapy with two different traditional medicine formulations called hainosankyuto and juzentaihoto (TJ-122 and TJ-48; Tsumura & Co, Tokyo, Japan) may be...
BACKGROUND
Combination therapy with two different traditional medicine formulations called hainosankyuto and juzentaihoto (TJ-122 and TJ-48; Tsumura & Co, Tokyo, Japan) may be effective for perianal abscess (PA), but their effectiveness has not been established. The present study investigated the effectiveness of combination therapy with TJ-122 and TJ-48 as the most effective conservative treatment for PA.
METHODS
We identified 69 patients with PA under 2 years of age and divided them into four groups according to the formulations used: group 1, TJ-122 (n = 17); group 2, TJ-48 (n = 14); group 3, TJ-122 and TJ-48 (n = 19); and group 4, no traditional medicines (n = 19). Treatment was continued for 3-6 months after resolution of the PA in groups 1 and 2, and for 1 year in group 3. Age at presentation, duration of purulent discharge (PD), frequency of surgical intervention (incision and drainage [ID]; fistulotomy/fistulectomy), and recurrence rates were statistically analyzed.
RESULTS
Mean age (months) was 8.6 ± 9.2, 6.9 ± 7.3, 5.2 ± 4.7, and 3.8 ± 3.1 in groups 1, 2, 3, and 4, respectively (P = n.s.). Mean PD (weeks) was 2.5 ± 2.2, 7.1 ± 10.8, 2.0 ± 0.0, and 2.7 ± 1.0, respectively. Duration of PD was significantly longer in group 2 than in groups 1 and 3 (P < 0.05). Mean number of ID procedures was 1.0 ± 0.2, 2.3 ± 0.5, 0, and 1.6 ± 0.2, respectively. Group 1 had significantly less ID than group 2 (P < 0.01). Recurrence rates were 6%, 36%, 0%, and 32%, respectively. Groups 1 and 3 had significantly less recurrence than group 2 (P < 0.05), and group 3 had significantly less recurrence than group 4 (P < 0.01).
CONCLUSIONS
Combination therapy with TJ-122 and TJ-48 decreased recurrence and surgical intervention to zero in this study, demonstrating high effectiveness for treating PA in children.
Topics: Abscess; Anus Diseases; Drug Administration Schedule; Drug Therapy, Combination; Drugs, Chinese Herbal; Female; Follow-Up Studies; Humans; Immunologic Factors; Infant; Infant, Newborn; Male; Medicine, Chinese Traditional; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 31394015
DOI: 10.1111/ped.13988