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Cureus Apr 2024Chronic intestinal schistosomiasis (CIS) refers to the long-term effects of infection with Schistosoma parasites in the intestines. This condition typically develops...
Chronic intestinal schistosomiasis (CIS) refers to the long-term effects of infection with Schistosoma parasites in the intestines. This condition typically develops after repeated or prolonged exposure to contaminated freshwater containing Schistosoma eggs. The current study reports a case of an adult male, who complained of abnormal abdominal and anal pain for a month and had a medical history of complex perianal fistulae. The endoscopic investigation revealed different degrees of hyperemia, concentrated in the sigmoid colon and rectum. Lesions were localized in the rectum and sigmoid colon. Yellow granular hyperplasia, whether concentrated or dispersed, single or multiple polyps, along with observations of mucosal congestion, edema, faint vascular striations, erosions, superficial ulcers, and scattered petechial hemorrhages were noted. Also, the segmented areas of the colon had different degrees of inflammation. The microscopic histopathological analysis showed a culprit of surgical scar tissue. The granulomas harbored Schistosome parasites at the submucosal depth. Also, an erosion in the colonic mucosal tissues accompanied by lymphoplasmacytic and micro-abscess infiltrates was seen. A Schistosoma bilharzial ova was observed in the granuloma at the submucosal level. Endoscopic and histopathological investigations are useful tools to differentiate between CIS and Crohn's disease. These tools can distinguish CIS from Crohn's disease. Early detection and treatment are essential to prevent the progression of the disease and minimize long-term complications.
PubMed: 38770490
DOI: 10.7759/cureus.58614 -
Revista Espanola de Enfermedades... May 2024A 70-year-old male was admitted with severe haematochezia and lipothymia. His medical history was relevant for coronary artery disease and radiation proctopathy. During...
A 70-year-old male was admitted with severe haematochezia and lipothymia. His medical history was relevant for coronary artery disease and radiation proctopathy. During hospitalization, was hemodynamically stable with persistent haematochezia. Laboratory examination revealed continuous haemoglobin fall, despite erythrocyte reposition, with administration of 11 units since admission. Colonoscopy showed an 8mm fibrinous lesion with an adherent clot, at 40cm from the anal verge. During exploration, a heavy spurting haemorrhage developed, with haemostasis being achieved with 4 clips, followed by site tattoo. Considering the risk of severe bleeding relapse in a high-risk patient, the patient underwent emergent Hartmann type colectomy. Histopathology report revealed a vascular lesion with arterial and venous vessels, protruding through the submucosa, muscular and subserosa, with a focal mucosal erosion, without neoplastic disease, compatible with an arteriovenous malformation (AVM).
PubMed: 38767028
DOI: 10.17235/reed.2024.10419/2024 -
Surgical Case Reports May 2024The rectal and vaginal walls are typically sutured if severe perineal lacerations with rectal mucosal damage occur during vaginal delivery. In case of anal incontinence...
BACKGROUND
The rectal and vaginal walls are typically sutured if severe perineal lacerations with rectal mucosal damage occur during vaginal delivery. In case of anal incontinence after the repair, re-suturing of the anal sphincter muscle is standard procedure. However, this procedure may not result in sufficient improvement of function.
CASE PRESENTATION
A 41-year-old woman underwent suture repair of the vaginal and rectal walls for fourth-degree perineal laceration at delivery. She was referred to our department after complaining of flatus and fecal incontinence. Her Wexner score was 15 points. Examination revealed decreased anal tonus and weak contractions on the ventral side. We diagnosed anal incontinence due to sphincter dysfunction after repair of a perineal laceration at delivery. We subsequently performed sphincter re-suturing with perineoplasty to restructure the perineal body by suturing the fascia located lateral to the perineal body and running in a ventral-dorsal direction, which filled the space between the anus and vagina and increased anal tonus. One month after surgery, the symptoms of anal incontinence disappeared (the Wexner score lowered to 0 points), and the anorectal manometry values increased compared to the preoperative values. According to recent reports on the anatomy of the female perineal region, bulbospongiosus muscle in women does not move toward the midline to attach to the perineal body, as has been previously believed. Instead, it attaches to the ipsilateral surface of the external anal sphincter. We consider the fascia lateral to the perineal body to be the fascia of the bulbospongiosus muscle.
CONCLUSIONS
In a case of postpartum anal incontinence due to sphincter dysfunction after repair of severe perineal laceration, perineoplasty with re-suturing an anal sphincter muscle resulted in improvement in anal sphincter function. Compared to conventional simple suture repair of the rectal wall only, this surgical technique may improve sphincter function to a greater degree.
PubMed: 38724859
DOI: 10.1186/s40792-024-01917-7 -
International Journal of Surgery Case... Apr 2024Buschke-Löwenstein tumor (BLT) is a rare perianal lesion caused by low-risk mucosal HPV 6 or 11 but less frequently associated with high-risk HPV types. It is a large,...
INTRODUCTION AND IMPORTANCE
Buschke-Löwenstein tumor (BLT) is a rare perianal lesion caused by low-risk mucosal HPV 6 or 11 but less frequently associated with high-risk HPV types. It is a large, exophytic, verrucous lesion of the anogenital region. BLT presents as a benign tumor but exhibits malignant clinical behavior and has a high rate of local recurrence and malignant transformation. The optimal treatment approach for BLT is still debated due to the lack of consensus. Various therapeutic modalities have been proposed, including topical agents, surgical excision, immunotherapy, chemo-radiotherapy, and electrocoagulation.
CASE PRESENTATION
This case report presents a heterosexual, immunocompetent patient with anal pain, pruritus, and spontaneous bleeding. The physical examination revealed an exophytic, pedunculated verrucous lesion, which appeared to be a typical fibroepithelial lesion.
CLINICAL DISCUSSION
The patient underwent wide excision, followed by a re-excision due to a surgical margin issue. The tumor exhibited malignant transformation into a well-differentiated SCC. However, due to the tumor's stage, size, location, histological type, and the extended time interval between the two surgeries, postoperative radiotherapy was not performed. Follow-up examinations over 12 months revealed no evidence of recurrence in either the patient's clinical evaluation or pelvic MRI.
CONCLUSIONS
Although comprehensive research is lacking, wide local excision is considered the preferred first-line treatment for early-stage cases without evidence of local invasion. Furthermore, HPV immunization can prevent the development of Buschke-Löwenstein tumor, and early administration of the HPV vaccine is recommended to avoid acquiring HPV infection.
PubMed: 38704971
DOI: 10.1016/j.ijscr.2024.109715 -
Journal of the Anus, Rectum and Colon 2024Lateral internal sphincterotomy is a conventional surgical intervention for chronic anal fissures, yet the potential for postoperative anal incontinence underscores the...
OBJECTIVES
Lateral internal sphincterotomy is a conventional surgical intervention for chronic anal fissures, yet the potential for postoperative anal incontinence underscores the need for an alternative approach. This study aimed to evaluate the outcomes of patients with chronic fissures who underwent a combination of fissurectomy, vertical non-full thickness midline sphincterotomy (VNMS), and mucosal advancement flap (MAF), as a means of mitigating the risk of incontinence.
METHODS
This retrospective analysis included forty-six consecutive patients with chronic anal fissures, unresponsive to topical diltiazem, who underwent fissurectomy combined with VNMS and MAF between April 2018 and May 2023. Primary outcome measures encompassed fissure healing rates. Continence was assessed using the Fecal Incontinence Severity Index (FISI), and manometric assessments were conducted before the procedure and three months postoperatively.
RESULTS
With a median follow-up of 27 months, there were no postoperative complications, and the overall fissure healing rate reached 96% (44/46). At three months post-procedure, FISI scores were reduced to 0, with no instances of fecal soiling. Anal resting pressure exhibited a significant reduction at 3 months [pre-op: 133 (95% CI, 128-150) vs. 3 mo: 109 (95% CI, 100-117) cmHO; = 0.01]. Similarly, maximum anal squeeze pressure showed a significant decrease three months post-surgery [pre-op: 317 cmHO (95% CI, 294-380) vs. 3 mo: 291 cmHO (95% CI, 276-359), = 0.03].
CONCLUSIONS
The combination of fissurectomy, VNMS, and MAF proved to be an effective approach for chronic anal fissures, yielding favorable medium-term outcomes without postoperative anal incontinence.
PubMed: 38689786
DOI: 10.23922/jarc.2023-072 -
International Journal of Infectious... Jul 2024We report a long-term remission in candidiasis in a 57-year-old Finnish female with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) suffering...
We report a long-term remission in candidiasis in a 57-year-old Finnish female with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) suffering from recurrent oral, esophageal, gastric, vaginal, and anal candidiasis since childhood. Candidiasis treatment with antifungal medicines fluconazole, itraconazole, posaconazole, voriconazole, caspofungin, nystatin, or amphotericin-B during 2008-2021 had variable effects and intermittent development of antifungal resistance and hospital periods. The patient started using fermented lingonberry juice (FLJ) as a mouth rinse daily in April 2021. No symptoms or mucosal signs of candidiasis in any part of the digestive system or vaginal area have been noticed during this exceptionally long-term 2 ½ year remission in candidiasis without antifungal medications.
Topics: Humans; Female; Middle Aged; Polyendocrinopathies, Autoimmune; Antifungal Agents; Mouthwashes; Candidiasis; Remission Induction; Treatment Outcome; Fruit and Vegetable Juices
PubMed: 38649005
DOI: 10.1016/j.ijid.2024.107066 -
Journal of Hematology Apr 2024Anorectal infections in neutropenic leukemia patients are a significant and potentially life-threatening complication. The pathogenesis of this condition is not entirely... (Review)
Review
Anorectal infections in neutropenic leukemia patients are a significant and potentially life-threatening complication. The pathogenesis of this condition is not entirely understood and believed to be multifactorial, including mucosal injury as a result of cytotoxic drugs, profound neutropenia and impaired host defense. Establishing an early diagnosis is key and often made clinically on the basis of signs and symptoms, but also from imaging studies demonstrating perianal inflammation or fluid collection. The management of anorectal infections in neutropenic leukemia patients is not straightforward, as there are no well-conducted studies on this entity. This review seeks to provide a framework into the pathophysiology and clinical presentation of anorectal infections in neutropenic leukemia patients, propose a diagnostic approach and to discuss controversies in the management of this condition.
PubMed: 38644983
DOI: 10.14740/jh1251 -
Heliyon Apr 2024Grade IV circular hemorrhoids are difficult to treat. We aim to describe the modified whitehead hemorrhoidectomy procedure and to assess the effectiveness and safety of...
BACKGROUND
Grade IV circular hemorrhoids are difficult to treat. We aim to describe the modified whitehead hemorrhoidectomy procedure and to assess the effectiveness and safety of this procedure for grade IV circular hemorrhoid patients.
METHODS
Patients with grade Ⅳ circular hemorrhoids who underwent modified Whitehead hemorrhoidectomy and partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids were retrospectively reviewed. Clinical data were extracted from the database at our institution, and long-term postoperative complications were assessed through repeated outpatient examinations and telephonic communication.
RESULTS
A total of 205 patients were included in this study. The mean operative time was 59.2 ± 13.8 min. The average hospital stay was 4.6 ± 1.0 days. For postoperative complications, 66 (32.2%) patients had urinary retention, 10 (4.9%) patients had a sense of incomplete rectal emptying, 5 (2.4%) patients had anal incontinence, and 6 (2.9%) patients had wound infection. For long-term postoperative complications, 3 (1.5%) patients experienced mild to moderate anal stricture, 2 (1%) patients experienced mucosal ectropion, they all had smooth recoveries, and none of them needed secondary surgery. None of these patients had a hemorrhoid recurrence. A total of 205 patients who received modified Whitehead hemorrhoidectomy and 161 who received partial hemorrhoidectomy were included. There were no residual hemorrhoids in patients who received modified Whitehead hemorrhoidectomy, and none had hemorrhoid recurrence. Fifty-eight patients who received partial hemorrhoidectomy had hemorrhoidal residues, and 19 patients experienced hemorrhoid recurrence. After modified Whitehead hemorrhoidectomy, 3 patients developed anal stenosis, and 2 had mucosal ectropion. Four patients developed anal stricture after partial hemorrhoidectomy, and none had mucosal ectropion. They all had smooth recoveries, and none of them needed a secondary surgery. For the mean duration of surgery, postoperative bleeding, postoperative pain, wound infection, sense of incomplete rectal emptying, anal incontinence, and urinary retention, no statistically significant differences were found between the two groups.
CONCLUSIONS
Compared with partial hemorrhoidectomy, modified whitehead hemorrhoidectomy is an effective and safe surgical procedure and does not significantly increase the risk of anal stenosis and mucosal ectropion for grade IV circular hemorrhoid patients. Prospective randomized controlled trials are needed to verify our results.
PubMed: 38596109
DOI: 10.1016/j.heliyon.2024.e28465 -
Vaccines Feb 2024Human papillomavirus (HPV) encompasses a diverse array of viruses, comprising approximately 200 serotypes that affect humans. While the majority of HPV strains are... (Review)
Review
Human papillomavirus (HPV) encompasses a diverse array of viruses, comprising approximately 200 serotypes that affect humans. While the majority of HPV strains are associated with benign skin or mucous membrane growths, a subset is implicated in severe health conditions, such as cervical, anal, vulvar, and vaginal cancers. Despite the established effectiveness of HPV vaccines in preventing cervical and anal carcinomas in particular, their therapeutic potential in addressing cutaneous diseases linked to diverse HPV strains remains an intriguing area of investigation. This narrative review critically examines the existing literature to assess the viability of HPV immunization as a therapeutic intervention for prevalent cutaneous conditions. These include genital and extragenital cutaneous warts, epidermodysplasia verruciformis, and keratinocyte carcinomas. The findings suggest a promising dual role for HPV vaccines in preventing and treating dermatologic conditions while emphasizing future research directions, including the immunization perspective against β-HPVs. Moreover, the presence of conflicting study outcomes underscores the imperative for larger-scale, randomized trials with well-matched control groups to validate the efficacy of HPV immunization in the dermatologic context. This review contributes valuable insights into the evolving landscape of HPV-vaccine applications in the field of dermatology.
PubMed: 38543862
DOI: 10.3390/vaccines12030228 -
BMC Infectious Diseases Mar 2024Cases of mpox have been reported worldwide since May 2022. Limited knowledge exists regarding the long-term course of this disease. To assess sequelae in terms of... (Observational Study)
Observational Study
BACKGROUND
Cases of mpox have been reported worldwide since May 2022. Limited knowledge exists regarding the long-term course of this disease. To assess sequelae in terms of scarring and quality of life (QoL) in mpox patients 4-6 months after initial infection.
METHODS
Prospective observational study on clinical characteristics and symptoms of patients with polymerase chain reaction (PCR)-confirmed mpox, including both outpatients and inpatients. Follow-up visits were conducted at 4-6 months, assessing the Patient and Observer Scar Assessment Scale (POSAS), the Dermatology Life Quality Index (DLQI) and sexual impairment, using a numeric rating scale (NRS) from 0 to 10.
RESULTS
Forty-three patients, age range 19-64 years, 41 men (all identifying as MSM) and 2 women, were included. Upon diagnosis, skin or mucosal lesions were present in 93.0% of cases, with 73.3% reporting pain (median intensity: 8, Q1-Q3: 6-10). Anal involvement resulted in a significantly higher frequency of pain than genital lesions (RR: 3.60, 95%-CI: 1.48-8.74). Inpatient treatment due to pain, superinfection, abscess or other indications was required in 20 patients (46.5%). After 4-6 months, most patients did not have significant limitations, scars or pain. However, compared to patients without such complications, patients with superinfection or abscess during the acute phase had significantly more extensive scar formation (median PSAS: 24.0 vs. 11.0, p = 0.039) and experienced a significantly greater impairment of their QoL (median DLQI: 2.0 vs. 0.0, p = 0.036) and sexuality (median NRS: 5.0 vs. 0.0, p = 0.017).
CONCLUSION
We observed a wide range of clinical mpox manifestations, with some patients experiencing significant pain and requiring hospitalization. After 4-6 months, most patients recovered without significant sequelae, but those with abscesses or superinfections during the initial infection experienced a significant reduction in QoL and sexuality. Adequate treatment, including antiseptic and antibiotic therapy during the acute phase, may help prevent such complications, and hence, improve long-term outcomes.
Topics: Male; Humans; Female; Young Adult; Adult; Middle Aged; Abscess; Superinfection; Cohort Studies; Quality of Life; Cicatrix; Follow-Up Studies; Homosexuality, Male; Mpox (monkeypox); Sexual and Gender Minorities; Pain
PubMed: 38491447
DOI: 10.1186/s12879-024-09191-6