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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 -
Asian Journal of Surgery Feb 2024
Topics: Humans; Treatment Outcome; Rectal Fistula; Anal Canal; Fecal Incontinence
PubMed: 37973479
DOI: 10.1016/j.asjsur.2023.11.015 -
World Journal of Clinical Cases Oct 2023Monkeypox (MPX) is a zoonotic infection that is endemic in Western and Central Africa along the Congo River basin. It has a high case fatality rate especially in younger...
BACKGROUND
Monkeypox (MPX) is a zoonotic infection that is endemic in Western and Central Africa along the Congo River basin. It has a high case fatality rate especially in younger age groups. It belongs to the virus family orthopoxvirus like smallpox. It is transmitted from wild animals to humans but human to human transmission has been established. It is often a self-limited infection in endemic regions. Recently, attention has been given to MPX with the spread of infection to Europe and the United States of America (USA). There is currently sporadic infection of MPX in the USA especially amongst men who have sex with men (MSM). It is a serious life-threatening infection in human immunodeficiency virus/acquired immunodeficiency syndrome co-infected individuals especially those who are treatment naïve with severe immunosuppression.
CASE SUMMARY
We report a 38-year old man who presented with rectal pain, and anal, torso, and facial rash. Abdominal computed tomography scan showed a near obstructive rectal mass with peri-anal fistula. MPX was positive. He was started on tecovirimat (TPOXX) and HAART therapy. Additional treatment provided included vaccinia immunoglobulin following his clinical deterioration.
CONCLUSION
This case highlights a rare presentation of MPX with peri-anal fistula and near obstructive rectal mass, and the significance of MPX as a differential diagnosis in proctitis in MSM in addition to other sexually transmitted infection like gonorrhea and chlamydia.
PubMed: 37969438
DOI: 10.12998/wjcc.v11.i30.7418 -
The American Journal of Case Reports Nov 2023BACKGROUND Surgery for locally advanced rectal cancer with frozen pelvis is challenging. Therefore, we designed the "modular pelvic exenteration" surgical strategy to...
BACKGROUND Surgery for locally advanced rectal cancer with frozen pelvis is challenging. Therefore, we designed the "modular pelvic exenteration" surgical strategy to achieve better radical resection. CASE REPORT A 51-year-old man with rectal cancer refused surgery and received chemotherapy and radiotherapy. He was intolerant to chemotherapy and did not respond well to radiotherapy. With cancer progression, he presented at our hospital with emaciation, fatigue, dysuria, bloody urine, bloody stool, and anal pain. Computed tomography and magnetic resonance imaging revealed the rectal tumor involved multiple adjacent organs and caused rectovesical fistula, bilateral hydronephrosis, hydroureterosis, and local pelvic infection. The rectal tumor was fixed in the pelvic cavity, presenting a frozen pelvis pattern. There was no distant metastasis. As the patient could not tolerate chemotherapy, was unsuitable for immune-check point inhibitor because the tumor had microsatellite stability, and did not respond well to radiotherapy, surgical resection seemed the most suitable treatment option. After the patient's anemia and malnutrition improved, our designed modular pelvic exenteration surgery was performed. In this strategy, we divided pelvic organs and tissues into 4 independent modules. After combining the modules planned to be resected, we delineated the pre-resection margin. By this strategy, the tumor was removed en bloc, with a clear resection margin. The patient was discharged 13 days after the operation, without complications. Follow-up for 24 months revealed no signs of tumor recurrence. CONCLUSIONS For locally advanced rectal cancer with frozen pelvis, the modular pelvic exenteration strategy may help to achieve satisfactory surgical effects in selected patients.
Topics: Male; Humans; Middle Aged; Pelvic Exenteration; Margins of Excision; Neoplasm Recurrence, Local; Rectal Neoplasms; Pelvis
PubMed: 37968899
DOI: 10.12659/AJCR.941684 -
World Journal of Clinical Cases Oct 2023Giant condyloma acuminatum (GCA) is an uncommon condition affecting the anogenital area.
BACKGROUND
Giant condyloma acuminatum (GCA) is an uncommon condition affecting the anogenital area.
CASE SUMMARY
Here, we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance of multiple cauliflower-like warts over his penile shaft, pubis region, and groin as well as urine leakage along the distal penile shaft. Physical examination revealed an ulcerative skin perforation with pus discharge under the distal prepuce base, which was initially suspected to be a urethral fistula. However, during surgery, it was discovered that the perforation was caused by a giant condyloma lesion that had obliterated the prepuce opening, with infection and high pressure causing subsequent skin perforation. He underwent circumcision and wide excision with electrocauterization of the warts. He was discharged after the surgery, and the residual lesion was treated with imiquimod and low-dose oral tegafur-uracil.
CONCLUSION
Penile GCA can cause prepuce perforation and can be postoperatively treated with imiquimod and low-dose oral tegafur-uracil.
PubMed: 37946780
DOI: 10.12998/wjcc.v11.i29.7107 -
Case Reports in Pediatrics 2023Anorectal malformations (ARM) without a fistula are a rare congenital condition. Although may seem more simple to repair compared with ARM with fistulas, surgery has...
Anorectal malformations (ARM) without a fistula are a rare congenital condition. Although may seem more simple to repair compared with ARM with fistulas, surgery has proved to be challenging. We report the case of a newborn who presented a well-formed anus and normal genitalia; a blind-ending anal canal was detected after the insertion of a rectal probe, thus allowing the diagnosis of ARM. Anal probing straight after birth avoids the possible complications related to intestinal obstruction due to a missed diagnosis of ARM. Examination of the perineal region is an important step in the evaluation of the newborn and represents the tool for a prompt identification of ARM. Adding anal probing to accurate inspection perineum is a good clinical practice and should always be performed even in presence of a normal-looking perineum.
PubMed: 37942057
DOI: 10.1155/2023/3669723 -
Endoscopy Dec 2023
Topics: Female; Humans; Anastomotic Leak; Rectovaginal Fistula; Colorectal Neoplasms; Rectum; Endoscopy; Anastomosis, Surgical
PubMed: 37940119
DOI: 10.1055/a-2178-4008 -
World Journal of Surgery Dec 2023
Topics: Humans; Prospective Studies; Rectal Fistula; Treatment Outcome; Microbiota
PubMed: 37930384
DOI: 10.1007/s00268-023-07230-y