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Cureus Mar 2024Hirschsprung disease is an uncommon medical condition caused by the lack of migration of ganglion cells to the rectum during embryonic development, affecting the...
Hirschsprung disease is an uncommon medical condition caused by the lack of migration of ganglion cells to the rectum during embryonic development, affecting the peristaltic movements of the intestine. It is a chronic medical condition responsible for chronic constipation and intestinal obstruction. We present the case of a 10-year-old female with a history of Hirschsprung disease and colectomy admitted to a pediatric hospital for the management of multiple colonic ulcers and severe anemia who subsequently developed a rectovaginal fistula. This patient's admission was complicated by perianal and vaginal excoriations, a paralytic ileus, and fecal incontinence. This case report is unique due to the development of a rare pediatric complication of Hirschsprung disease.
PubMed: 38690493
DOI: 10.7759/cureus.57316 -
World Journal of Gastrointestinal... Apr 2024Chronic myelomonocytic leukemia (CMML) complicated with Sweet syndrome (SS) is a rare hematological neoplasm. However, cases of concomitant development of perianal...
BACKGROUND
Chronic myelomonocytic leukemia (CMML) complicated with Sweet syndrome (SS) is a rare hematological neoplasm. However, cases of concomitant development of perianal necrotizing SS (NSS) have not been reported.
CASE SUMMARY
We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess. He developed postoperative incision infection and was referred to the department where the authors work. Initially, perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected. Despite receiving antibiotic therapy and undergoing surgical debridement, deeper necrotic areas formed in the patient's perianal wounds, accompanied by persistent high fever. Blood and fungal cultures yielded negative results. The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS.
CONCLUSION
CMML with perianal NSS is a rare condition, often misdiagnosed as perianal abscess or perianal necrotizing fasciitis. Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.
PubMed: 38690058
DOI: 10.4240/wjgs.v16.i4.1176 -
Gastroenterology & Hepatology Apr 2024
PubMed: 38682121
DOI: No ID Found -
Gastroenterology & Hepatology Apr 2024
PubMed: 38682120
DOI: No ID Found -
Iranian Journal of Microbiology Feb 2024Extra-intestinal salmonellosis is associated with higher case fatality and is underestimated in the developing countries like India. Here we present a case series of...
BACKGROUND AND OBJECTIVES
Extra-intestinal salmonellosis is associated with higher case fatality and is underestimated in the developing countries like India. Here we present a case series of bacteriologically proven extra-intestinal salmonellosis managed at our institute over the past two years.
MATERIALS AND METHODS
Retrospective analysis of bacteriologically proven extra-intestinal salmonellosis over two years between January 2020 to December 2021 was carried out. Medical records were reviewed for site of infection, evidence of any underlying or predisposing illnesses and antimicrobial susceptibility report.
RESULTS
Eight patients were diagnosed with extra-intestinal salmonellosis. Male to female ratio was 3:1. Mean age was 44 years. Four were typhoidal and four were nontyphoidal Salmonellae. The extra-intestinal sites involved were purulent aspirates from scrotum, caecum, perianal region, intraperitoneal collection, synovium, and urine. Predisposing factors include chronic myeloid leukemia, HIV and gastric malignancy. All deep seated abscess required surgical intervention. All typhoidal (n=4) were sensitive to cotrimoxazole, ampicillin, ceftriaxone. Among nontyphoidal , one was resistant to cotrimoxazole; two were resistant to ampicillin, ceftriaxone and three resistant to ciprofloxacin.
CONCLUSION
The diagnosis of extra-intestinal salmonellosis requires a high degree of clinical suspicion and should be included in the differential diagnosis in patients with deep-seated abscesses.
PubMed: 38682064
DOI: 10.18502/ijm.v16i1.14885 -
Journal of Surgical Case Reports Apr 2024This case illustrates the surgical management of a perianal mass, initially misdiagnosed as condyloma acuminatum in a male patient in his late 50s, later identified as...
This case illustrates the surgical management of a perianal mass, initially misdiagnosed as condyloma acuminatum in a male patient in his late 50s, later identified as invasive squamous cell carcinoma following excision. Despite extensive preoperative evaluation, the lesion's malignancy was confirmed through histopathology. The significant, fungating mass required a multidisciplinary approach, culminating in a pT3 staging and additional wide excision with inferior gluteal artery perforator flap reconstruction. This case underscores the critical importance of surgical diligence and adaptability, highlighting the role of comprehensive surgery in both diagnosis and treatment of complex perianal malignancies, and reaffirms the value of a multidisciplinary team in achieving favourable outcomes.
PubMed: 38681478
DOI: 10.1093/jscr/rjae266 -
Cureus Mar 2024Internal anal sphincter achalasia (IASA) is a rare anorectal disorder that presents as chronic refractory constipation in pediatrics. With a poor response to...
Internal anal sphincter achalasia (IASA) is a rare anorectal disorder that presents as chronic refractory constipation in pediatrics. With a poor response to conventional constipation-based therapy, it is often misdiagnosed as other conditions, such as ultra-short-segment Hirschsprung disease. This case report describes a rare case of IASA in an adolescent female, emphasizing the importance of ruling out other differentials, including Hirschsprung disease, via rectal biopsy and thus allowing for earlier targeted therapy to improve lifestyle conditions. A 20-year-old female with a history of IASA presents for semiannual botulism toxin injections. Despite initial relief, her constipation symptoms gradually returned after four to five months. She has had a history of ineffective conventional constipation treatments since childhood, which prompted a further workup. Biopsy results during her teenage years confirmed the presence of ganglionic cells, differentiating IASA from Hirschsprung disease. The management plan involved biannual perianal Botox injections, offering relief for approximately six months. IASA's physiological basis involves altered innervation, the absence of nitrergic nerves, and defective neuromuscular junctions in the internal anal sphincter. Diagnosis requires anorectal manometry and a rectal suction biopsy. Treatment options include botulism, toxin injections, and posterior internal anal sphincter myectomy. Botulism injections offer temporary relief, while myectomy provides long-term improvement.
PubMed: 38681397
DOI: 10.7759/cureus.57135 -
Frontiers in Medicine 2024To analyze the clinical characteristics and correlation of Fournier's gangrene induced by sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors, providing...
OBJECTIVE
To analyze the clinical characteristics and correlation of Fournier's gangrene induced by sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors, providing references for safe clinical drug use.
METHODS
The CNKI, WanFang, and PubMed databases were searched, and relevant documents were collected and statistically analyzed. The basic information of patients, drug use information, adverse reactions and outcomes were extracted and analyzed.
RESULTS
A total of 12 patients (8 males and 4 females) were included, with an average age of 55.6 years (ranging from 34 to 72 years). SGLT-2 inhibitors associated with Fournier's gangrene include empagliflozin (5 cases), dapagliflozin (5 cases), and canagliflozin (2 cases). Among them, 10 cases reported the time of first medication, ranging from 1 month to 6 years for the occurrence of adverse reactions. The most common concomitant drug was metformin (7 cases). Adverse reactions mainly manifested as redness, swelling and pain in the buttocks, perineum, perianal, scrotum and other positions, accompanied by an increased white blood cell count. Following surgery and antibiotic treatment, all patients showed improved.
CONCLUSION
Fournier's gangrene induced by SGLT-2 inhibitors is rare. If patients using SGLT-2 inhibitors are suspected of having Fournier's gangrene, it is recommended to discontinue the drugs immediately and initiate active treatment to ensure clinical safety.
PubMed: 38681048
DOI: 10.3389/fmed.2024.1301105 -
Frontiers in Oncology 2024[This corrects the article DOI: 10.3389/fonc.2024.1373607.].
Corrigendum: Misleading clinical and imaging features in atypical aggressive angiomyxoma of the female vulvovaginal or perianal region: report of three cases and review of the literature.
[This corrects the article DOI: 10.3389/fonc.2024.1373607.].
PubMed: 38680852
DOI: 10.3389/fonc.2024.1406876 -
Journal of Clinical Medicine Apr 2024We aimed to identify the incidence and risk factors of perianal pathology during pregnancy and the postpartum period.
OBJECTIVE
We aimed to identify the incidence and risk factors of perianal pathology during pregnancy and the postpartum period.
METHODS
A prospective cohort study was conducted in three institutions in Lithuania. A total of 190 patients were examined and interviewed three times (<12, 18-20 weeks of gestation, and during the first 2 months after delivery). They completed a questionnaire including demographic, obstetric, coloproctological, and birth data.
RESULTS
A total of 73 (34.59%) women developed hemorrhoidal disease after delivery, and 120 (56.87%) developed perianal pathology. Multivariate analysis identified a neonatal birth weight ≥3380 g (OR 4.22; 95% CI 1.83-9.71, < 0.001) and consumption of eggs (OR 3.10; 95% CI 1.13-8.53, = 0.028) or cereals (OR 2.87; 95% CI 1.32-6.25, = 0.008) several times per week as significant risk factors for hemorrhoidal disease. Neonatal birth weight ≥3380 g (OR 3.95; 95% CI 1.47-10.59, = 0.006), maternal BMI ≥ 21.48 (OR 3.58; 95% CI 1.51-8.47, = 0.004), the duration of the second labor period ≥38 min (OR 2.81; 95% CI 1.09-7.23, = 0.032), and consumption of flour products several times per week (OR 2.77; 95% CI 1.10-6.98, = 0.030) were associated with a higher risk of perianal pathology. Daily consumption of fruits and vegetables (OR 0.35; 95% CI 0.15-0.81, = 0.014) and less frequent consumption of eggs were protective factors (OR 0.18; 95% CI 0.06-0.56, = 0.003).
CONCLUSIONS
Perianal diseases, especially hemorrhoidal disease, are common during pregnancy and the postpartum period. A neonatal birth weight ≥ 3380 g, a maternal BMI of ≥21.48, duration of the second labor period of ≥38 min, and consumption of flour products and cereals several times a week are risk factors for developing these diseases.
PubMed: 38673644
DOI: 10.3390/jcm13082371