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Digestive Diseases and Sciences Sep 2022Clinical presentation after ingestion of foreign body is a common finding in surgical practice. Perianal sepsis due to a foreign body is, usually, secondary to...
Clinical presentation after ingestion of foreign body is a common finding in surgical practice. Perianal sepsis due to a foreign body is, usually, secondary to introduction via the trans-anal route. The case here reported is extremely rare since an ingested fishbone passed asymptomatically through most of the gastrointestinal tract, with resultant late-onset ischiorectal abscess. Moreover, clinical evidence of the perianal abscess manifested one month after the fishbone had been ingested. The final localization of the fishbone-lying anterior to the sacrum-complicated the preoperative and intraoperative detection of the ingested foreign body.
Topics: Abscess; Animals; Anus Diseases; Fishes; Foreign Bodies; Meals
PubMed: 35857242
DOI: 10.1007/s10620-022-07625-2 -
Surgical Infections Jun 2022Non-surgical intervention has been proposed for the management of perianal abscess (PA) and fistula-in-ano (FIA), with potential benefits in terms of quality of life,...
Non-surgical intervention has been proposed for the management of perianal abscess (PA) and fistula-in-ano (FIA), with potential benefits in terms of quality of life, wound healing, and functional outcome, although this strategy remains rare and controversial. Here, we aimed to compare the intermediate-term outcomes of non-surgical management with those of surgical incision and/or drainage. A study of pediatric patients with first-time PA and/or FIA was conducted retrospectively from January 2010 to December 2020. The patient population was stratified by surgical and non-surgical management. The clinical outcomes, including PA recurrence, FIA formation, and wound healing time, were compared between the surgical and non-surgical management groups. A total of 457 patients managed for first-time PA and/or FIA were eligible for the current study. Of these patients, 169 (50.9%) patients received non-surgical intervention. There were no differences in terms of age, gender distribution, wound healing course, or abscess size between the two groups. Furthermore, no difference was noted between the two groups in terms of PA recurrence and/or FIA development rates and revisits for additional treatment. Although PA/FIA management is still controversial, non-surgical intervention exhibited promising outcomes for most cases of first-time PA/FIA, with fewer hospital admissions and surgical procedures and similar recurrence and fistula formation incidences. Immediate surgical intervention might be avoided because PA/FIA has a chance for spontaneous resolution in children.
Topics: Abscess; Anus Diseases; Child; Humans; Quality of Life; Rectal Fistula; Retrospective Studies; Treatment Outcome
PubMed: 35647894
DOI: 10.1089/sur.2021.351 -
Wounds : a Compendium of Clinical... Aug 2022Perianal abscess is defined as a local collection of pus in the perianal tissues. It is among the most common anorectal problems encountered by surgeons. Further...
INTRODUCTION
Perianal abscess is defined as a local collection of pus in the perianal tissues. It is among the most common anorectal problems encountered by surgeons. Further extension of this infection into the unilateral or bilateral ischiorectal fossa leads to a horseshoe abscess. Morbid obesity is a risk factor for horseshoe perianal abscess with the potential to disrupt the normal healing process.
CASE REPORT
A 35-year-old male with morbid obesity presented to the surgery outpatient clinic in a hospital in Subang, West Java, Indonesia, with continuous severe pain and swelling around the anus of approximately 7 days' duration. Local examination of the anogenital area revealed a horseshoe perianal abscess extending to the ischiorectal fossa, approximately 1 cm from the anal verge and measuring 7.5 cm × 4.5 cm × 10 cm. Physical examination findings included tenderness to palpation; the presence of blood, pus, and necrotic tissue; and fluctuance. Incision and drainage were performed in the operating room under general anesthesia. In lieu of colostomy, the patient chose wound healing by secondary intention. Postoperative open wound care consisted of wet-to-moist gauze dressings during the first 2 postoperative days, followed by hydrocolloid dressing after the pus and blood were adequately drained, and finally, alginate dressing after granulation tissue formed. Aluminum silicate (microporous ceramic) was used as the external (secondary) wound dressing. Time to healing was 8 weeks.
CONCLUSION
Horseshoe abscesses are challenging to manage. Thorough and careful diagnosis, prompt fluid resuscitation to overcome fluid and electrolyte imbalance and to ensure proper antibiotic administration, nutrition intake, and a planned surgical approach as well as individualized postoperative care are necessary to achieve healing.
Topics: Abscess; Adult; Alginates; Aluminum Silicates; Anti-Bacterial Agents; Anus Diseases; Electrolytes; Hospitals, Rural; Humans; Male; Obesity, Morbid; Wound Healing
PubMed: 36108243
DOI: 10.25270/wnds/21100 -
International Journal of Colorectal... Mar 2021Needle aspiration of an acute simple perianal abscess may be an alternative to conventional incision drainage with potential advantages in wound healing, functional... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Needle aspiration of an acute simple perianal abscess may be an alternative to conventional incision drainage with potential advantages in wound healing, functional outcome, and quality of life. The aim and objectives of the study are to compare the outcome of needle aspiration and postoperative antibiotics with that of conventional surgical incision drainage of acute perianal abscess. The primary outcome was abscess recurrence. Secondary outcomes were fistula formation, wound healing, quality of life, and fecal continence.
METHODS
This is a three-center randomized controlled trial, including adults with acute perianal abscess. The needle aspiration group received clindamycin for one week postoperatively. All included patients were scheduled for a follow-up at 2, 12, and 52 weeks postoperatively including physical examination, quality of life assessment (SF 36 questionnaire), and fecal continence (Wexner score).
RESULTS
A total of 98 patients were included. The recurrence rate was 41% in needle aspiration and 15% in incision drainage, with HR of 3.033 (p = 0.014). Fistula formation was 15% without significant difference between the groups. There was no significant difference in wound healing, quality of life, or fecal incontinence scores.
CONCLUSION
Needle aspiration with postoperative antibiotics cannot be recommended as an alternative for surgical incision in the treatment of acute perianal abscess.
TRIAL REGISTRATION NUMBER
ClinicalTrials.org with identification number NCT02585141, initial release on 15 October 2015.
Topics: Abscess; Adult; Anus Diseases; Drainage; Humans; Neoplasm Recurrence, Local; Quality of Life; Rectal Fistula; Recurrence; Surgical Wound; Treatment Outcome
PubMed: 33447866
DOI: 10.1007/s00384-021-03845-6 -
Emergency Radiology Jun 2015Computed tomography (CT) is an effective, readily available diagnostic imaging tool for evaluation of the emergency room (ER) patients with the clinical suspicion of... (Review)
Review
Computed tomography (CT) is an effective, readily available diagnostic imaging tool for evaluation of the emergency room (ER) patients with the clinical suspicion of perianal abscess and/or infected fistulous tract (anorectal sepsis). These patients usually present with perineal pain, fever, and leukocytosis. The diagnosis can be easy if the fistulous tract or abscess is visible on inspection of the perianal skin. If the tract or abscess is deep, then the clinical diagnosis can be difficult. Also, the presence of complex tracts or supralevator extension of the infection cannot be judged by external examination alone. Magnetic resonance imaging (MRI) is the best imaging test to accurately detect fistulous tracts, especially when they are complex (Omally et al. in AJR 199:W43-W53, 2012). However, in the acute setting in the ER, this imaging modality is not always immediately available. Endorectal ultrasound has also been used to identify perianal abscesses, but this modality requires hands-on expertise and can have difficulty localizing the offending fistulous tract. It may also require the use of a rectal probe, which the patient may not be able to tolerate. Contrast-enhanced CT is a very useful tool to diagnose anorectal sepsis; however, this has not received much attention in the recent literature (Yousem et al. in Radiology 167(2):331-334, 1988) aside from a paper describing CT imaging following fistulography (Liang et al. in Clin Imaging 37(6):1069-1076, 2013). An infected fistula is indicated by a fluid-/air-filled soft tissue tract surrounded by inflammation. A well-defined round to oval-shaped fluid/air collection is indicative of an abscess. The purpose of this article is to demonstrate the usefulness of contrast-enhanced CT in the diagnosis of acute anorectal sepsis in the ER setting. We will discuss the CT appearance of infected fistulous tracts and abscesses and how CT imaging can guide the ER physician in the clinical management of these patients.
Topics: Abscess; Acute Disease; Contrast Media; Diagnosis, Differential; Emergency Service, Hospital; Humans; Rectal Fistula; Tomography, X-Ray Computed
PubMed: 25421387
DOI: 10.1007/s10140-014-1284-3 -
Advances in Surgery Sep 2018
Review
Topics: Abscess; Biopsy, Needle; Conservative Treatment; Fecal Incontinence; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Immunohistochemistry; Male; Proctectomy; Prognosis; Rectal Diseases; Rectal Fistula; Treatment Outcome
PubMed: 30098612
DOI: 10.1016/j.yasu.2018.04.004 -
Zeitschrift Fur Gastroenterologie Jun 2008Perianal and perineal ultrasound is an effective but rarely applied diagnostic modality. Transmural inflammation, fistula and abscesses in patients with inflammatory... (Review)
Review
Perianal and perineal ultrasound is an effective but rarely applied diagnostic modality. Transmural inflammation, fistula and abscesses in patients with inflammatory bowel disease can be delineated and perirectal tumours can be staged. The method is complementary to endorectal ultrasound. Also oblique transsphincteric fistula can be displayed in detail.
Topics: Abscess; Anal Canal; Anus Diseases; Anus Neoplasms; Diagnosis, Differential; Fecal Incontinence; Humans; Perineum; Rectal Diseases; Rectal Fistula; Rectal Neoplasms; Rectum; Ultrasonography
PubMed: 18537090
DOI: 10.1055/s-2008-1027518 -
Computational Intelligence and... 2022The purpose of this study was to evaluate the intervention effect of evidence-based nursing (EBN) on vacuum sealing drainage (VSD) recovery of patients with high...
Intervention Effect of Evidence-Based Nursing on Postoperative Recovery of Vacuum Sealing Drainage in Patients with High Perianal Abscess with Magnetic Resonance Imaging Sequence Images.
The purpose of this study was to evaluate the intervention effect of evidence-based nursing (EBN) on vacuum sealing drainage (VSD) recovery of patients with high perianal abscess after vacuum sealing drainage based on magnetic resonance imaging (MRI) sequence images. 60 patients with high perianal abscess were selected, and 30 patients before VSD were selected as the control group. Routine nursing was implemented in the control group, 30 patients after VSD were observed, and EBN was implemented in the observation group. The detection rates of various types of perianal abscess with different sequence combinations were studied, and the effects of EBN on pain and anal function scores of perianal abscess patients were analyzed. Anal function and defecation were assessed, and postoperative complications were calculated. Different combinations of MRI sequences can reach higher detection rates of intersphincter abscess and ischial anal abscess. The observation group had better pain relief and anal function recovery. The complication rate of the observation group was 16.67%, which was significantly lower than that of the control group ( < 0.05). It was confirmed that different MRI sequence combinations had higher detection rates for intersphincter abscess and ischial fossa abscess. EBN can promote the recovery of anal function and reduce complications in patients with perianal abscess.
Topics: Abscess; Evidence-Based Nursing; Humans; Magnetic Resonance Imaging; Negative-Pressure Wound Therapy; Pain
PubMed: 35785101
DOI: 10.1155/2022/1405134 -
The Turkish Journal of Pediatrics 2019Zhu Y, Xu F. The pathogens and curative effects analysis of perianal abscess of infants under 3 months. Turk J Pediatr 2019; 61: 40-43. In order to guide clinical...
Zhu Y, Xu F. The pathogens and curative effects analysis of perianal abscess of infants under 3 months. Turk J Pediatr 2019; 61: 40-43. In order to guide clinical treatment for perianal abscess of young infants, the characteristics of pathogens and curative effects analysis were conducted. Bacterial culture results, antibiotics susceptibility tests and curative effects of abscess incision were retrospectively analyzed in 66 cases of perianal abscess of infants under 3 months. There were 48 cases of Klebsiella pneumoniae, 7 cases of Staphylococcus, 6 cases of Escherichia coli, 5 cases of Proteus in the pathogen culture results. Klebsiella pneumoniae, the predominant pathogen, was susceptible to most antibiotics, especially to imipenem, cefoperazonesulbactam and amikacin with low drug resistance rates. However, high drug resistance rates were found to ampicillin and nitrofurantion. After abscess incision, the complication rate of anal fistula was 6.6% in infants under 3 months and 60.3% in the adult group. There was significant difference P<0.01. In conclusion, Klebsiella pneumoniae was the most common pathogen in perianal abscess of infants under 3 months and was commonly resistant to ampicillin and nitrofurantion. Since perianal abscess of infants under 3 months is a self-limited disorder, simple surgical intervention and synchronous sensitive antibiotic administration are suggested as the optimal management.
Topics: Abscess; Adult; Anti-Bacterial Agents; Anus Diseases; Combined Modality Therapy; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Retrospective Studies; Staphylococcal Infections; Treatment Outcome
PubMed: 31559720
DOI: 10.24953/turkjped.2019.01.007 -
Techniques in Coloproctology Dec 2008Most anal abscesses are caused by anal fistula and invasion of the surrounding tissues by a mixed colonic flora. The treatment comprises excision of the abscess and. if...
Most anal abscesses are caused by anal fistula and invasion of the surrounding tissues by a mixed colonic flora. The treatment comprises excision of the abscess and. if appropriate, fistulectomy. Primary anorectal actinomycosis and perianal actinomycosis are very rare and are caused by Actinomyces, which is a ubiquitous microaerophilic bacterium. Here we report a case of perianal actinomycosis. The patient had a short history of painless perineal induration without fever or leucocytosis with normal routine blood tests. After excision sulphur granules drained from the cavity and the pathological investigations were indicative of perianal actinomycosis. Appropriate surgery and antibiotic treatment healed the perianal infection. After elimination of other diagnoses, e.g. Crohn's disease, tuberculosis and malignant growths, this rare case of perianal actinomycosis should be kept in mind in the differential diagnosis of a painless perianal mass.
Topics: Abscess; Actinomycosis; Anus Diseases; Combined Modality Therapy; Diagnosis, Differential; Humans; Male; Middle Aged; Perineum
PubMed: 19018464
DOI: 10.1007/s10151-008-0446-2