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International Journal of Colorectal... Dec 2023Anal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the...
PURPOSE
Anal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the development of anal fistulas are sparse. This study aimed to identify the risk factors for anal fistulas after anal abscess surgery.
METHODS
This was a multicentre, retrospective cohort study of patients undergoing acute surgery for anal abscesses in the Capital Region of Denmark between 2018 and 2019. The patients were identified using ICD-10 codes for anal abscesses. Predefined clinicopathological factors and postoperative courses were extracted from patient records.
RESULTS
A total of 475 patients were included. At a median follow-up time of 1108 days (IQR 946-1320 days) following surgery, 164 (33.7%) patients were diagnosed with an anal fistula. Risk factors for developing fistulas were low intersphincteric (OR 2.77, 95CI 1.50-5.06) and ischioanal (OR 2.48, 95CI 1.36-4.47) abscesses, Crohn's disease (OR 5.96, 95CI 2.33-17.2), a history of recurrent anal abscesses (OR 4.14, 95CI 2.47-7.01) or repeat surgery (OR 5.96, 95CI 2.33-17.2), E. coli-positive pus cultures (OR 4.06, 1.56-11.4) or preoperative C-reactive protein (CRP) of more than 100 mg/L (OR 3.21, 95CI 1.57-6.71).
CONCLUSION
Several significant clinical risk factors were associated with fistula development following anal abscess surgery. These findings are clinically relevant and could influence the selection of patients for specialised follow-up, facilitate expedited diagnosis, and potentially prevent unnecessarily long treatment courses.
Topics: Humans; Abscess; Retrospective Studies; Escherichia coli; Anus Diseases; Rectal Fistula; Drainage; Treatment Outcome
PubMed: 38093036
DOI: 10.1007/s00384-023-04576-6 -
JPRAS Open Mar 2024Reconstruction of complex rectovaginal fistula is challenging, and it has a high recurrence rate. Traditional reconstruction included a local flap or a myocutaneous flap...
Reconstruction of complex rectovaginal fistula is challenging, and it has a high recurrence rate. Traditional reconstruction included a local flap or a myocutaneous flap reconstruction, which is either difficult in radiated cases or that the flap is too thick for flap inset and requires multiple times of revision. Here we report successful rectovaginal fistula repair using a pedicled medial circumflex femoral artery perforator flap (MCFAP). A retrospective chart review was done to collect the information of this 63-year-old female patient who had rectovaginal fistula (RVF) resulting from concurrent radiochemotherapy for cervical cancer. She received direct repair of the RVF, but it recurred. We applied a pedicle perforator flap to successfully repair the defect. The fistula was repaired by separating the posterior vaginal wall from the anterior rectal wall. The anterior wall of the rectum was primarily repaired, leaving a defect of 4 × 5 cm in the posterior vaginal wall. A pedicled MCFAP flap was harvested from her right medial thigh and transferred via a subcutaneous tunnel for reconstruction of the posterior vaginal wall defect. The postoperative course was uneventful. Postoperative gastrointestinal series showed no more RVF, and her colostomy was taken down one year after the reconstruction. This first experience suggests that a pedicle perforator flap can be used successfully for reconstruction of a rectovaginal fistula.
PubMed: 38090551
DOI: 10.1016/j.jpra.2023.11.002 -
International Journal of Surgery... Mar 2024
Topics: Humans; Anal Canal; Rectal Fistula; Treatment Outcome
PubMed: 38052018
DOI: 10.1097/JS9.0000000000000981 -
Nigerian Journal of Clinical Practice Nov 2023Fistula-in-ano is caused by idiopathic infection of the cryptoglands located in the anal intersphincteric plane when the resultant cryptoglandular abscess drains...
Fistula-in-ano is caused by idiopathic infection of the cryptoglands located in the anal intersphincteric plane when the resultant cryptoglandular abscess drains internally and externally. It is a common surgical disease that responds well to surgical intervention. In cases of recurrent non-healing fistula-in-ano, an underlying cause should be suspected and searched for. We present a 29-year-old man who had recurrent complex fistula-in-ano caused by broomsticks of an unknown source. Fistulotomy, tactile wound exploration, extraction of the broomsticks, and wound debridement were done. The wound healed well by secondary intention. Few cases of recurrent complex fistula-in-ano had been reported in the literature. However, this is the first time to the best of our knowledge that broomsticks causing non-healing, complex fistula-in-ano that is being reported. We suggest the use of a bending machine instead of mashing broom bunch in the preparation of Ewedu soup which is a delicacy for the Yoruba tribe in Nigeria to eliminate the chances of inadvertent ingestion of broomsticks when eating Ewedu soup.
Topics: Male; Humans; Adult; Treatment Outcome; Rectal Fistula; Anal Canal; Abscess; Causality
PubMed: 38044785
DOI: 10.4103/njcp.njcp_92_23 -
EBioMedicine Dec 2023Local fistula injection of mesenchymal stromal/stem cells (MSC) is effective for complex perianal Crohn's fistulas but is also expensive and requires specialised...
Local fistula injection of allogeneic human amnion epithelial cells is safe and well tolerated in patients with refractory complex perianal Crohn's disease: a phase I open label study with long-term follow up.
BACKGROUND
Local fistula injection of mesenchymal stromal/stem cells (MSC) is effective for complex perianal Crohn's fistulas but is also expensive and requires specialised facilities for cell revival before administration. Human amnion epithelial cells (hAEC) are non-MSC cells with therapeutic properties. The primary aim of this study was safety of hAEC therapy. Secondary aims included hAEC efficacy, feasibility of the protocol and impact on quality of life.
METHODS
A phase I open label study of ten adults with active complex Crohn's perianal fistulas refractory to conventional treatment, including anti-tumour necrosis factor alpha therapy, was undertaken. A single dose of hAEC was injected into the fistula tract(s) after surgical closure of the internal opening(s). Study outcomes were assessed at week 24 with follow up for at least 52 weeks.
FINDINGS
Local injection of hAEC was safe, well tolerated and the injection procedure was feasible. Complete response occurred in 4 patients, and a partial response in an additional 4 patients. There was a mean reduction in the Perianal Disease Activity Index of 6.5 points (95% CI -9.0 to -4.0, p = 0.0002, paired t-test), modified Van Assche MRI Index of 2.3 points (95% CI -3.9 to -0.6, p = 0.012, paired t-test) and a mean improvement of 15.8 points (95% CI 4.9 to 26.8, p = 0.010, paired t-test) in quality of life using the Short IBD-Questionnaire in complete responders.
INTERPRETATION
Local injection of hAEC therapy for refractory complex perianal fistulising Crohn's disease appears safe, well-tolerated, feasible and demonstrated improvement. Quality of life is improved in those who achieve complete fistula healing.
FUNDING
This study was funded by competitive research grant funding from the Gastroenterological Society of Australia Seed Grant 2018.
Topics: Adult; Humans; Amnion; Crohn Disease; Epithelial Cells; Follow-Up Studies; Hematopoietic Stem Cell Transplantation; Mesenchymal Stem Cell Transplantation; Quality of Life; Rectal Fistula; Treatment Outcome
PubMed: 38042747
DOI: 10.1016/j.ebiom.2023.104879 -
Arquivos de Gastroenterologia 2023Fistulizing perianal Crohn's disease poses a treatment challenge, and researchers postulate that this phenotype in young male patients could have a worst outcome.
BACKGROUND
Fistulizing perianal Crohn's disease poses a treatment challenge, and researchers postulate that this phenotype in young male patients could have a worst outcome.
OBJECTIVE
Thus, the aim of this study was to assess whether sex influences the response to treatment for these patients.
METHODS
This systematic review (PROSPERO CRD42022319629) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. We selected articles published in English, Spanish, Portuguese, and Italian between 2010 and 2020 in the PubMed and Science Direct databases. According to the PICO acronym, prospective studies in patients older than 18 years with the objective of treating fistulizing perianal Crohn's disease were selected. Studies in pediatric populations, retrospective, without treatment objectives, and that included only rectovaginal fistulas or a single sex were excluded. Study quality was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa scale.
RESULTS
Of the 1887 articles found, 33 were included. Most studies used anti-TNF drugs as treatment (n=11). Ten studies had subgroup analyses; of them, the two studies reporting sex differences used infliximab and adalimumab as treatment and showed that women had a longer fistula closure time than men.
CONCLUSION
This systematic review showed that few data corroborate the difference between sexes in the treatment of fistulizing perianal Crohn's disease, possibly having a greater relationship with the phenotype. However, considering the lack of results, further studies with this objective and with standardization of fistulas and response assessment methods are needed.
Topics: Child; Humans; Male; Female; Crohn Disease; Retrospective Studies; Prospective Studies; Tumor Necrosis Factor Inhibitors; Rectal Fistula; Treatment Outcome; Infliximab
PubMed: 38018554
DOI: 10.1590/S0004-2803.230402023-28 -
Asian Journal of Surgery Feb 2024
Topics: Humans; Rectal Fistula; Anal Canal; Upper Extremity; Treatment Outcome
PubMed: 38008618
DOI: 10.1016/j.asjsur.2023.10.119 -
Medicine Nov 2023Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula...
Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016-2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.
Topics: Child; Humans; Infant; Anorectal Malformations; Retrospective Studies; Rectum; Laparoscopy; Rectal Fistula; Postoperative Complications; Urethral Diseases; Diverticulum; Anal Canal; Treatment Outcome
PubMed: 37986398
DOI: 10.1097/MD.0000000000035825 -
Medicine Nov 2023Perianal abscess is a common disease of the anus and intestine. Surgery is an important treatment option for perianal abscess. However, some patients have a long healing...
RATIONALE
Perianal abscess is a common disease of the anus and intestine. Surgery is an important treatment option for perianal abscess. However, some patients have a long healing time, poor healing effect after surgery, or even pseudo-healing. Platelet-rich plasma (PRP) is rich in platelets that can release a large number of factors when activated and promote wound healing. Moreover, there are few reports on the use of PRP for wounds that are difficult to heal after perianal abscess surgery.
PATIENT CONCERNS
The patient had reported a complaint of perianal swelling and discomfort associated with anal pain, which was considered a perianal abscess. Ceftriaxone, fumigation, and sitz bath were administered after mixed hemorrhoid and perianal abscess surgeries were performed; however, the wound remained unhealed for more than 3 months, and there was a fistula under the skin.
DIAGNOSIS
Perianal color ultrasonography revealed perianal abscess.
INTERVENTIONS
Autologous PRP treatment was performed 5 times for each patient.
OUTCOMES
The postoperative wound healed within 15 days after 5 times PRP treatments.
LESSONS
PRP is a novel treatment option for pseudo-healing.
Topics: Humans; Abscess; Rectal Fistula; Anus Diseases; Skin; Platelet-Rich Plasma; Skin Diseases; Treatment Outcome
PubMed: 37986293
DOI: 10.1097/MD.0000000000035996 -
Surgical Case Reports Nov 2023A colovesical fistula (CVF) is commonly treated by resection of the intestine containing the fistula or creation of a defunctioning stoma. We herein report a case of...
BACKGROUND
A colovesical fistula (CVF) is commonly treated by resection of the intestine containing the fistula or creation of a defunctioning stoma. We herein report a case of successful fistula closure and avoidance of colostomy after placement of a covered colonic self-expanding metallic stent (SEMS) as a palliative treatment for a malignant CVF.
CASE PRESENTATION
A 75-year-old man undergoing infusional 5-fluorouracil and irinotecan chemotherapy plus bevacizumab for recurrent peritoneal dissemination of rectal cancer was admitted to our hospital because of fecaluria with a high-grade fever. Blood tests showed a moderate inflammatory reaction (white blood cell count, 9200/mm; C-reactive protein, 11.03 mg/dL; procalcitonin, 1.33 ng/mL). Urinary sediment examination showed severe bacteriuria. Abdominal contrast-enhanced computed tomography showed intravesical gas, thickening of the posterior wall of the bladder, and irregular thickening of the sigmoid colon wall contiguous with the posterior bladder wall. Magnetic resonance imaging (MRI) clearly showed a fistula between the bladder and sigmoid colon. Colonoscopy revealed a circumferential malignant stricture 15 cm from the anal verge, and a fistula to the bladder was identified by water-soluble contrast medium. We diagnosed a complicated urinary tract infection (UTI) associated with a CVF due to peritoneal dissemination and started empirical treatment with sulbactam/ampicillin. Given the absence of active inflammatory findings around the fistula on MRI and the patient's physical frailty, we decided to place a covered SEMS to close the fistula. Under fluoroscopic and endoscopic guidance, a covered colonic SEMS of 80-mm length and 20-mm diameter was successfully deployed, and the fistula was sealed immediately after placement. Urine culture on day 3 after stenting was negative for bacteria, and a contrast study on day 5 showed no fistula. The patient was discharged home on day 6 with no complications. The UTI did not recur for 4 months after discharge.
CONCLUSIONS
A covered colonic SEMS was useful for sealing a malignant CVF in a patient unfit for surgery, and MRI was valuable to determine the status of the fistula. A covered colonic SEMS could be an alternative to surgical treatment for CVFs in patients who require palliative care.
PubMed: 37985577
DOI: 10.1186/s40792-023-01784-8