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World Journal of Gastroenterology Oct 2014Anal fistulas are a common manifestation of Crohn's disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a... (Review)
Review
Anal fistulas are a common manifestation of Crohn's disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence.
Topics: Anal Canal; Crohn Disease; Digestive System Surgical Procedures; Fecal Incontinence; Gastrointestinal Agents; Humans; Patient Care Team; Predictive Value of Tests; Rectal Fistula; Risk Factors; Treatment Outcome; Wound Healing
PubMed: 25309057
DOI: 10.3748/wjg.v20.i37.13205 -
BMC Medical Imaging Sep 2023Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and... (Review)
Review
BACKGROUND
Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and explored methods for improving the preoperative diagnostic accuracy of fistulas in males with ARMs after colostomy.
METHODS
A retrospective analysis was performed on males with ARMs after colostomy admitted to our hospital from January 2015 to June 2022. All patients underwent magnetic resonance imaging (MRI) and high-pressure colostogram (HPC) before anorectal reconstruction. Patients with no fistula as diagnosed by both modalities underwent a voiding cystourethrogram (VCUG). General information, imaging results and surgical results were recorded.
RESULTS
Sixty-nine males with ARMs after colostomy were included. Age at the time of examination was 52 ~ 213 days, and the median age was 89 days. The Krickenbeck classification according to surgical results included rectovesical fistula (n = 19), rectoprostatic fistula (n = 24), rectobulbar fistula (n = 19) and no fistula (n = 7). There was no significant difference in the diagnostic accuracy between MRI and HPC for different types of ARMs. For determining the location of the fistula, compared to surgery, HPC (76.8%, 53/69) performed significantly better than MRI (60.9%, 42/69) (p = 0.043). Sixteen patients diagnosed as having no fistula by MRI or HPC underwent a VCUG, and in 14 patients, the results were comfirmed. However, there were 2 cases of rectoprostatic fistula that were not correctly diagnosed.
CONCLUSION
High-pressure colostogram has greater accuracy than MRI in the diagnosis of fistula type in males with ARMs after colostomy. For patients diagnosed with no fistula by both methods, VCUG reduces the risk of false-negative exclusion, and rectoprostatic fistula should be considered during the operation.
Topics: Humans; Male; Infant; Anorectal Malformations; Retrospective Studies; Colostomy; Rectal Fistula; Magnetic Resonance Imaging
PubMed: 37749545
DOI: 10.1186/s12880-023-01105-3 -
Journal of Visceral Surgery Apr 2015The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible... (Review)
Review
The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible for the formation of abscesses and/or fistulas. When this presents as an abscess, emergency drainage of the infected cavity is required. At the stage of fistula, treatment has two sometimes conflicting objectives: effective drainage and preservation of continence. These two opposing constraints explain the existence of two therapeutic concepts. On one hand the laying-open of the fistulous tract (fistulotomy) in one or several operative sessions remains the treatment of choice because of its high cure rates. On the other hand surgical closure with tract ligation or obturation with biological components preserves sphincter function but suffers from a higher failure rate.
Topics: Abscess; Anus Diseases; Emergencies; Humans; Ligation; Rectal Fistula; Suction; Surgical Flaps; Treatment Outcome
PubMed: 25261376
DOI: 10.1016/j.jviscsurg.2014.07.008 -
Acta Chirurgica Iugoslavica 2012Perianal fistula is a very unpleasant condition. It is also quite difficult to be solved without recurrence or with complete preservation of sphincter function. This... (Review)
Review
Perianal fistula is a very unpleasant condition. It is also quite difficult to be solved without recurrence or with complete preservation of sphincter function. This paper summarizes the etiology, classification of fistulas along with the long-term surgical experiences in the approach and the treatment of this condition.
Topics: Humans; Rectal Fistula
PubMed: 23373352
DOI: 10.2298/aci1202009n -
Diseases of the Colon and Rectum Feb 2020
Topics: Abscess; Adult; Anus Diseases; Diagnosis, Differential; Drainage; Humans; Male; Physical Examination; Rectal Fistula; Rectum
PubMed: 31914108
DOI: 10.1097/DCR.0000000000001576 -
BMJ (Clinical Research Ed.) Oct 2012
Review
Topics: Anal Canal; Disease Management; Humans; Rectal Fistula
PubMed: 23069597
DOI: 10.1136/bmj.e6705 -
Inflammatory Bowel Diseases May 2020
Topics: Crohn Disease; Humans; Infliximab; Rectal Fistula; Recurrence
PubMed: 31504545
DOI: 10.1093/ibd/izz198 -
The Surgical Clinics of North America Dec 1988Except for unusual diseases, fistula in ano originates from infection in the anal crypts of Morgagni, forming an abscess which, when it opens, results in a tract leading...
Except for unusual diseases, fistula in ano originates from infection in the anal crypts of Morgagni, forming an abscess which, when it opens, results in a tract leading to the skin surface. A tentative diagnosis can often be made by a careful history followed by local examination. A history of para-anal abscess followed by intermittent discharge will almost always be elicited. Alternative causes, including especially Crohn's disease, are also described. Operative technique is described, including various methods for finding the internal opening and obscure branching tracts, as well as a number of pitfalls to be avoided.
Topics: Anal Canal; Humans; Methods; Rectal Fistula
PubMed: 3194823
DOI: 10.1016/s0039-6109(16)44697-9 -
Asian Journal of Surgery Dec 2023
Topics: Male; Humans; Mastectomy, Segmental; Rectum; Rectal Fistula; Prostatectomy; Urinary Bladder Fistula
PubMed: 37775377
DOI: 10.1016/j.asjsur.2023.09.070 -
Journal of Traditional Chinese Medicine... Oct 2023In the study of the mechanism of wound healing after anal fistula surgery, how to scientifically and efficiently promote wound healing is of great significance. At...
In the study of the mechanism of wound healing after anal fistula surgery, how to scientifically and efficiently promote wound healing is of great significance. At present, modern medical treatment of wounds after anal fistula surgery mostly focuses on physical therapy intervention, new wound dressing and packing, and external application of growth factors. However, these therapies have many problems, and there is still no consensus on their clinical use. Traditional Chinese Medicine (TCM) has several methods to promote wound healing, such as oral administration, rubbing, and fumigation, which have a long history and obvious efficacy, but research in this area is relatively scattered and lacks classification and summarizing. Therefore, this paper analyzes and summarizes the existing research on TCM for promotion of wound healing after anal fistula surgery, carries out targeted analyses according to different clinical syndromes and treatment methods, and analyzes the defects in current research and anticipates future research trends in order to provide theoretical support for the advantages of TCM in promoting wound healing after anal fistula surgery.
Topics: Humans; Medicine, Chinese Traditional; Administration, Oral; Wound Healing; Rectal Fistula
PubMed: 37679994
DOI: 10.19852/j.cnki.jtcm.20230630.002