-
Techniques in Coloproctology Nov 2010The most common cause of anal fistula is anal gland sepsis, resulting in formation of anorectal abscess, particularly if the latter allowed bursting spontaneously or has...
The most common cause of anal fistula is anal gland sepsis, resulting in formation of anorectal abscess, particularly if the latter allowed bursting spontaneously or has been inadequately opened at operation. Surgical treatment of the fistula must intent to its healing or simply its drainage or its transformation to a simpler one. Superficial, low transsphincteric and intersphincteric fistulas are treated by the lay-open technique. The use of a loose seton allows time for any sepsis and induration to settle before a decision about further treatment is made. Also, the use of a tight seton in the management of complex fistula may avoid an early muscle division before any tissue scarring happened. The patient with a perianal fistula must have a steady trustful relationship with his surgeon and must be fully informed on the therapeutic plan and reassured for a favourable outcome.
Topics: Female; Humans; Male; Rectal Fistula
PubMed: 20676718
DOI: 10.1007/s10151-010-0607-y -
Colorectal Disease : the Official... Mar 2023
Topics: Humans; Rectal Fistula; Crohn Disease; Treatment Outcome
PubMed: 36350257
DOI: 10.1111/codi.16389 -
Colorectal Disease : the Official... Mar 2023
Topics: Humans; Crohn Disease; Infliximab; Gastrointestinal Agents; Fistula; Rectal Fistula; Treatment Outcome
PubMed: 36427019
DOI: 10.1111/codi.16432 -
World Journal of Gastroenterology Feb 2021Fistula and intraabdominal fistula are common complications of Crohn's disease (CD), but complex rectal fistula with abscess formation is rare. Tumor necrosis factor...
BACKGROUND
Fistula and intraabdominal fistula are common complications of Crohn's disease (CD), but complex rectal fistula with abscess formation is rare. Tumor necrosis factor antagonists combined with percutaneous drainage or surgical intervention is optimal treatment for fistulizing CD with intraabdominal abscess. There is no study show the efficacy of vedolizumab in such complicated condition.
CASE SUMMARY
A 47-year-old man has decompensated liver cirrhosis, child B. He suffered from abdominal pain, bloody diarrhea, fever, and body weight loss. CD with rectoprostatic fistula, rectopresacral fistula, pre-sacral abscess and cyto-megalovirus (CMV) infection were noted. He received antibiotics, anti-viral therapy, transverse colostomy and vedolizumab treatment. Six months later, he had deep remission and complete fistula tracts closure.
CONCLUSION
Early vedolizumab and stool diversion are effective and safe in treating CD with complex rectal fistula with abscess formation.
Topics: Abscess; Antibodies, Monoclonal, Humanized; Child; Crohn Disease; Humans; Male; Middle Aged; Rectal Fistula; Treatment Outcome
PubMed: 33584075
DOI: 10.3748/wjg.v27.i5.442 -
Tijdschrift Voor Diergeneeskunde Feb 1999
Topics: Animals; Cautery; Cryotherapy; Dog Diseases; Dogs; Electrocoagulation; Immunosuppressive Agents; Rectal Fistula
PubMed: 10081810
DOI: No ID Found -
Colorectal Disease : the Official... Oct 2007
Review
Topics: Anal Canal; Colorectal Surgery; Endosonography; HIV Infections; Humans; Ireland; Magnetic Resonance Imaging; Manometry; Proctoscopy; Rectal Fistula; Sepsis; Societies, Medical; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; United Kingdom
PubMed: 17880382
DOI: 10.1111/j.1463-1318.2007.01372.x -
International Journal of Colorectal... Nov 2000This study investigated the effectiveness of magnetic resonance imaging (MRI) with rectal administration of the enteral contrast agent gadolinium diethylene triamine...
This study investigated the effectiveness of magnetic resonance imaging (MRI) with rectal administration of the enteral contrast agent gadolinium diethylene triamine pentaacetic acid (Gd-DTPA) in the diagnosis of recurrent perianal fistulae, assessing the number, anatomical extent, location, and signal intensities of various lesions. Fistulas were examined by MRI before and after rectal administration of Gd-DTPA in 50 patients (excluding fistulas due to inflammatory bowel disease). Surgical findings were compared with both pre- and postcontrast T1-weighted, T2-weighted, and short T1 inversion recovery (STIR) sequences. Of the 68 fistulous tracts detected surgically, precontrast imaging identified 16 by T1-weighted images (hypointense), 27 by T2-weighted images (hyperintense or iso- to weakly hyperintense), and 54 by STIR. Postcontrast imaging identified 29 by T1-weighted images, 58 by T2-weighted, and 54 by STIR. MRI with rectal administration of Gd-DTPA thus facilitates determination of fistula tracts, which are better resolved by precontrast STIR than by either precontrast T1- or T2-weighted images. Postcontrast T2-weighted images were substantially superior to T1-weighted. Both noncontrast STIR and postcontrast T2-weighted sequences were adequate for classifying fistulas in ano, but in complex recurrent anal fistula postcontrast T2-weighted images were more helpful.
Topics: Adult; Contrast Media; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Rectal Fistula; Rectum
PubMed: 11151437
DOI: 10.1007/s003840000251 -
Zhonghua Nan Ke Xue = National Journal... May 2022To explore the risk factors and management principles of rectal injury during laparoscopic radical prostatectomy (LRP).
OBJECTIVE
To explore the risk factors and management principles of rectal injury during laparoscopic radical prostatectomy (LRP).
METHODS
We retrospectively analyzed the clinical data on 7 cases of LRP complicated with rectal injury and treated in Huzhou Central Hospital from January 2010 to June 2021. Four of the 7 PCa patients were found with complete rectal rupture during LRP, of whom 2 were treated by laparoscopic rectal repair (LRR) and the other 2 by LRR + colostomy during surgery. Another case of rectal muscle injury also underwent LRR. Two cases of delayed rectal rupture were observed postoperatively and treated by colostomy + transrectal repair in the second-stage operation.
RESULTS
The rectal injuries were found in the apex of the prostate in all the 7 cases, pathologically staged as pT2b��pT3b and with Gleason scores of 7��10. Postoperative follow-up lasted 2 to 18 months, during which the 5 cases of intraoperative rectal repair recovered well without complications, and of the 2 cases of postoperative rectal repair, 1 made a good recovery and the other 1 developed rectourethral fistula.
CONCLUSION
Rectal injury during radical prostatectomy tends to occur in the apex of the prostate and can be effectively managed by laparoscopic repair. Meanwhile, attention should be paid to the postoperative complication of rectourethral fistula.
Topics: Male; Humans; Prostate; Retrospective Studies; Prostatectomy; Rectal Fistula; Laparoscopy; Prostatic Neoplasms
PubMed: 37477482
DOI: No ID Found -
Canadian Journal of Surgery. Journal... Dec 1991Fistulas-in-ano may be classified as simple or complex, or according to their anatomy--intersphincteric, transsphincteric suprasphincteric or extrasphincteric. Most of... (Review)
Review
Fistulas-in-ano may be classified as simple or complex, or according to their anatomy--intersphincteric, transsphincteric suprasphincteric or extrasphincteric. Most of them are treated surgically. Simple fistulas may be treated by fistulotomy, but complex or high fistulas require careful evaluation and often require alternative surgical procedures. In all instances, the objective should be to eradicate the fistula without compromising continence. Perianal disease may be present in 10% to 80% of patients with Crohn's disease. In these patients treatment must be individualized. Important considerations are the presence or absence of rectal disease, the complexity of the fistula and the strength of the anal sphincter muscle. Treatment options include fistulotomy, simple drainage or unroofing of abscesses and fistulas, use of medical agents, bowel rest, construction of a loop ileostomy and, ultimately, proctectomy.
Topics: Anal Canal; Crohn Disease; Humans; Rectal Fistula
PubMed: 1747837
DOI: No ID Found -
Cellular and Molecular Gastroenterology... 2023Perianal fistula represents one of the most disabling manifestations of Crohn's disease (CD) due to complete destruction of the affected mucosa, which is replaced by...
BACKGROUND AND AIMS
Perianal fistula represents one of the most disabling manifestations of Crohn's disease (CD) due to complete destruction of the affected mucosa, which is replaced by granulation tissue and associated with changes in tissue organization. To date, the molecular mechanisms underlying perianal fistula formation are not well defined. Here, we dissected the tissue changes in the fistula area and addressed whether a dysregulation of extracellular matrix (ECM) homeostasis can support fistula formation.
METHODS
Surgical specimens from perianal fistula tissue and the surrounding region of fistulizing CD were analyzed histologically and by RNA sequencing. Genes significantly modulated were validated by real-time polymerase chain reaction, Western blot, and immunofluorescence assays. The effect of the protein product of TNF-stimulated gene-6 (TSG-6) on cell morphology, phenotype, and ECM organization was investigated with endogenous lentivirus-induced overexpression of TSG-6 in Caco-2 cells and with exogenous addition of recombinant human TSG-6 protein to primary fibroblasts from region surrounding fistula. Proliferative and migratory assays were performed.
RESULTS
A markedly different organization of ECM was found across fistula and surrounding fistula regions with an increased expression of integrins and matrix metalloproteinases and hyaluronan (HA) staining in the fistula, associated with increased newly synthesized collagen fibers and mechanosensitive proteins. Among dysregulated genes associated with ECM, TNFAI6 (gene encoding for TSG-6) was as significantly upregulated in the fistula compared with area surrounding fistula, where it promoted the pathological formation of complexes between heavy chains from inter-alpha-inhibitor and HA responsible for the formation of a crosslinked ECM. There was a positive correlation between TNFAI6 expression and expression of mechanosensitive genes in fistula tissue. The overexpression of TSG-6 in Caco-2 cells promoted migration, epithelial-mesenchymal transition, transcription factor SNAI1, and HA synthase (HAs) levels, while in fibroblasts, isolated from the area surrounding the fistula, it promoted an activated phenotype. Moreover, the enrichment of an HA scaffold with recombinant human TSG-6 protein promoted collagen release and increase of SNAI1, ITGA4, ITGA42B, and PTK2B genes, the latter being involved in the transduction of responses to mechanical stimuli.
CONCLUSIONS
By mediating changes in the ECM organization, TSG-6 triggers the epithelial-mesenchymal transition transcription factor SNAI1 through the activation of mechanosensitive proteins. These data point to regulators of ECM as new potential targets for the treatment of CD perianal fistula.
Topics: Humans; Crohn Disease; Caco-2 Cells; Epithelial-Mesenchymal Transition; Rectal Fistula; Transcription Factors; Extracellular Matrix
PubMed: 36521659
DOI: 10.1016/j.jcmgh.2022.12.006