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Diseases of the Colon and Rectum Aug 2016
Topics: Female; Humans; Male; Rectal Fistula
PubMed: 27384087
DOI: 10.1097/DCR.0000000000000629 -
Techniques in Coloproctology Oct 2022
Topics: Humans; Rectal Fistula
PubMed: 35947242
DOI: 10.1007/s10151-022-02674-1 -
Seminars in Ultrasound, CT, and MR Aug 2016Perianal fistulas and other inflammatory diseases of the anus and perianal soft tissues are a cause of substantial morbidity, and are a major part of the practice of any... (Review)
Review
Perianal fistulas and other inflammatory diseases of the anus and perianal soft tissues are a cause of substantial morbidity, and are a major part of the practice of any colorectal surgeon. Magnetic resonance imaging (MRI) has a key role in the assessment of patients for the extent of fistulizing Crohn disease, complications related to fistulas, and to assist in confirming the diagnosis or proposing an alternative. Technique is critical and in particular, the selection of sequences for diagnosis and characterization of abnormalities with the main choices being between standard anatomical sequences (T1 or T2), assessing for edema (FS T2 or STIR), assessing abnormal contrast enhancement (FS T1), and assessing for abnormal diffusion or a combination of these. Guidance on MRI sequence selection, classification of fistulas, the current guidance on the role of MRI in assessing patients, and advice on how to provide useful structured reports, as well as how to detect complications of perianal sepsis are included.
Topics: Contrast Media; Humans; Magnetic Resonance Imaging; Rectal Fistula
PubMed: 27342895
DOI: 10.1053/j.sult.2016.04.004 -
Annals of Surgical Oncology Jun 2023Fistula-associated anal adenocarcinoma (FAAC) is a rare consequence in patients with long-standing perianal fistulas. A paucity of data are available for this patient...
BACKGROUND
Fistula-associated anal adenocarcinoma (FAAC) is a rare consequence in patients with long-standing perianal fistulas. A paucity of data are available for this patient collective, making clinical characterization and management of this disease difficult.
OBJECTIVE
This study aimed to describe a single-center experience with FAAC patients, their clinical course, and histopathological and molecular pathological characterization.
METHODS
All patients receiving surgery for an anal fistula in 1999-2019 at a tertiary university referral hospital were included in this retrospective analysis. Patients with FAAC were eligible for histopathological analysis, including immunohistochemistry and molecular profiling.
RESULTS
This study included 1004 patients receiving surgical treatment for an anal fistula, of whom 242 had an underlying inflammatory bowel disease (IBD). Ten patients were diagnosed with a fistula-associated anal carcinoma (1.0%), and six of these patients had an FAAC (0.6%). The mean overall survival of FAAC patients was 24 ± 3 months. FAAC immunohistochemistry revealed positive staining for CK20, CDX2 and MUC2, while stainings for CK5/6 and CK7 were negative. All FAAC specimens revealed microsatellite stability. Molecular profiling detected mutations in 35 genes, with the most frequent mutations being TP53, NOTCH1, NOTCH3, ATM, PIK3R1 and SMAD4.
CONCLUSION
FAAC is rare but associated with poor clinical outcome. Tissue acquisition is crucial for early diagnosis and therapy and should be performed in long-standing, non-healing, IBD-associated fistulas in particular. The immunophenotype of FAAC seems more similar to the rectal-type mucosa than the anal glands.
Topics: Humans; Retrospective Studies; Adenocarcinoma; Anal Canal; Rectal Fistula; Anus Neoplasms; Inflammatory Bowel Diseases; Treatment Outcome
PubMed: 36757514
DOI: 10.1245/s10434-023-13115-0 -
Canadian Journal of Surgery. Journal... Sep 1977It is now possible to define with precision the pathogenesis of anal fistulous abscesses. Common as well as rarer types of fistulas can be classified according to the...
It is now possible to define with precision the pathogenesis of anal fistulous abscesses. Common as well as rarer types of fistulas can be classified according to the anatomy of the anal canal. Identification and proper treatment of these conditions need a thorough systematic approach; knowledge of their symptomatology, anatomy and pathology is of paramount importance, and successful treatment is based on accepted surgical principles. A detailed description of the management of these fistulas is presented. Factors explaining recurrences are also mentioned.
Topics: Abscess; Humans; Rectal Diseases; Rectal Fistula; Rectum
PubMed: 890615
DOI: No ID Found -
Journal of the National Medical... Nov 1988The etiology of anorectal abscess and fistula-in-ano is discussed. The anatomy, which is vital to the understanding and treatment of the above, is reviewed, with two of... (Review)
Review
The etiology of anorectal abscess and fistula-in-ano is discussed. The anatomy, which is vital to the understanding and treatment of the above, is reviewed, with two of the more common classifications of fistula-in-ano presented. The different methods of treating each are discussed, and some of the common complications of the procedure are listed. A true understanding of the disease process and anatomy is needed before treatment of fistulous abscesses is begun, but, with it, successful outcomes will occur in most cases.
Topics: Abscess; Anus Diseases; Female; Humans; Male; Rectal Diseases; Rectal Fistula
PubMed: 3074175
DOI: No ID Found -
Nature Reviews. Gastroenterology &... Jun 2022
Topics: Crohn Disease; Humans; Infliximab; Rectal Fistula; Treatment Outcome
PubMed: 35505240
DOI: 10.1038/s41575-022-00623-9 -
Der Chirurg; Zeitschrift Fur Alle... Dec 2012CRYPTOGLANDULAR ANAL FISTULA: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is... (Review)
Review
CRYPTOGLANDULAR ANAL FISTULA: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is determined by the anatomy of the anal sphincter and perianal fistulas will not heal on their own. The therapy of a fistula is oriented between a more aggressive approach (operation) and a conservative treatment with fibrin glue or a plug. Definitive healing and the development of incontinence are the most important key points. ANAL FISSURES: Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation.
Topics: Abscess; Combined Modality Therapy; Fissure in Ano; Humans; Long-Term Care; Rectal Fistula
PubMed: 23179514
DOI: 10.1007/s00104-012-2297-7 -
The Surgical Clinics of North America Jun 2024Anal suppurative processes are commonly encountered in surgical practice. While the initial therapeutic intervention is philosophically straightforward (incision and... (Review)
Review
Anal suppurative processes are commonly encountered in surgical practice. While the initial therapeutic intervention is philosophically straightforward (incision and drainage), drainage of the appropriate space and treatment of the subsequent fistula in ano require a thorough understanding of perianal anatomy and nuanced decision making. Balancing the risk of fecal incontinence with simple fistulotomy versus the higher risk of fistula recurrence with all sphincter-sparing fistula treatments can be a challenge for surgeons and patients alike.
Topics: Humans; Rectal Fistula; Anal Canal; Drainage; Evidence-Based Medicine
PubMed: 38677815
DOI: 10.1016/j.suc.2023.11.002 -
Clinical Radiology Feb 1998
Review
Topics: Anal Canal; Endosonography; Humans; Magnetic Resonance Imaging; Rectal Fistula; Tomography, X-Ray Computed
PubMed: 9502083
DOI: 10.1016/s0009-9260(98)80053-6