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Forensic Science, Medicine, and... Mar 2022A case of a sadistically motivated homicide with extraordinary injuries is reported. A 32-year-old woman was naked with signs of severe blunt trauma and oral, vaginal...
A case of a sadistically motivated homicide with extraordinary injuries is reported. A 32-year-old woman was naked with signs of severe blunt trauma and oral, vaginal and anal penetration. At the crime scene, the intestine lay next to the woman without connection to the body. During the trial before the criminal court, the perpetrator admitted fisting and inserting several objects into the vagina, anus and oral cavity. Moreover, after anal and vaginal insertion of the hands, large parts of the intestine were torn and pulled out through the anus and the vagina. The results of the forensic pathological examination and additional investigation are discussed and compared with the pertinent literature. This extraordinary case of a sadistically motivated homicide ended with a final judgment that is extremely rare in German jurisdiction.
Topics: Adult; Anal Canal; Criminals; Female; Homicide; Humans; Lacerations; Rape
PubMed: 34677793
DOI: 10.1007/s12024-021-00433-6 -
International Urogynecology Journal Nov 2020The perineal clinic is a dedicated setting offering assessment for various childbirth-related presentations including obstetric anal sphincter injuries (OASIs), perineal... (Observational Study)
Observational Study
INTRODUCTION AND HYPOTHESIS
The perineal clinic is a dedicated setting offering assessment for various childbirth-related presentations including obstetric anal sphincter injuries (OASIs), perineal wound complications, pelvic floor dysfunction and other conditions such as female genital mutilation(FGM). We describe the clinical presentation and outcomes of women from a tertiary perineal clinic based on data collected over an 11-year period.
METHODS
This is a retrospective observational study. A one-stop outpatient service was offered to all women who sustained OASIs (postnatally and antenatally in a subsequent pregnancy), perineal complications (within 16 weeks postpartum), FGM and/or peripartum symptoms of urinary/anal incontinence or prolapse. Assessment included history with validated questionnaires, examination and anal manometry and endoanal ultrasound when appropriate. Outcomes were compared among different grades of OASIs. Management of each type of presentation was reported with outcomes.
RESULTS
There were 3254 first attendance episodes between 2006 and 2016. The majority (58.1%) were for OASIs, followed by perineal wound complications. Compared to the lower grades, the higher grades of OASI were associated with poorer outcomes in terms of symptoms, investigations and complications. Women with OASIs had unrelated symptoms such as urinary incontinence, perineal pain and wound infections that needed further intervention. A high proportion(42%) of wound complications required further specialist management.
CONCLUSION
We describe a dedicated, one-stop perineal clinic model for antenatal and postnatal women for management of perineal and pelvic floor disorders. This comprehensive and novel data will enable clinicians to better counsel women regarding of outcomes after OASI and focus training to minimize risks of morbidities.
Topics: Anal Canal; Delivery, Obstetric; Fecal Incontinence; Female; Humans; Lacerations; Obstetric Labor Complications; Perineum; Pregnancy
PubMed: 32617635
DOI: 10.1007/s00192-020-04405-2 -
Clinical Anatomy (New York, N.Y.) May 2020Magnetic resonance images of the anal canal show small, circular, low-intensity areas arranged in a row and a high-intensity area surrounding them internally and...
Magnetic resonance images of the anal canal show small, circular, low-intensity areas arranged in a row and a high-intensity area surrounding them internally and externally in the longitudinal muscle layer that cannot be explained by current anatomical findings. The purpose of this study was to elucidate the detailed structure of the longitudinal smooth muscle of the anal canal and to interpret the magnetic resonance image of the longitudinal muscle. Specimens for macroscopic anatomy and histology were obtained from six and seven cadavers, respectively. The histological nature of the longitudinal muscle was examined by staining serial transverse and coronal sections of the lateral wall of the anal canal with Masson's trichrome stain and using immunohistochemistry for smooth and skeletal muscle fibers. Dense and sparse areas of smooth muscle fibers coexisted in the longitudinal muscle layer. The dense areas formed columnar muscle bundles approximately 1.0-1.5 mm in diameter, and they continued from the longitudinal muscle bundles of the rectum. The columnar muscle bundles of the longitudinal anal muscle were internally and externally surrounded by sparsely arranged smooth muscle fibers that ran longitudinally. The coexistence of dense and sparse areas of smooth muscle fibers suggests that the structure of the smooth muscle is optimized for its function. This histological nature is probably reflected in the magnetic resonance image of the longitudinal muscle as the coexistence of low- and high-intensity areas. Clin. Anat. 33:619-626, 2020. © 2019 Wiley Periodicals, Inc.
Topics: Aged; Aged, 80 and over; Anal Canal; Cadaver; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Smooth
PubMed: 31573098
DOI: 10.1002/ca.23467 -
Clinical Gastroenterology and... Oct 2015The anal sphincters and puborectalis are imaged routinely with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at...
BACKGROUND & AIMS
The anal sphincters and puborectalis are imaged routinely with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at rest. By using a MRI torso coil, we identified a patulous anal canal in some patients with anorectal disorders. We aimed to evaluate the relationship between anal sphincter and puborectalis injury, a patulous anal canal, and anal pressures.
METHODS
We performed a retrospective analysis of data from 119 patients who underwent MRI and manometry analysis of anal anatomy and pressures, respectively, from February 2011 through March 2013 at the Mayo Clinic. Anal pressures were determined by high-resolution manometry, anal sphincter and puborectalis injury was determined by endoanal MRI, and anal canal integrity was determined by torso MRI. Associations between manometric and anatomic parameters were evaluated with univariate and multivariate analyses.
RESULTS
Fecal incontinence (55 patients; 46%) and constipation (36 patients; 30%) were the main indications for testing; 49 patients (41%) had a patulous anal canal, which was associated with injury to more than 1 muscle (all P ≤ .001), and internal sphincter (P < .01), but not puborectalis (P = .09) or external sphincter (P = .06), injury. Internal (P < .01) and external sphincter injury (P = .02) and a patulous canal (P < .001), but not puborectalis injury, predicted anal resting pressure. A patulous anal canal was the only significant predictor (P < .01) of the anal squeeze pressure increment.
CONCLUSIONS
Patients with anorectal disorders commonly have a patulous anal canal, which is associated with more severe anal injury and independently predicted anal resting pressure and squeeze pressure increment. It therefore is important to identify a patulous anal canal because it appears to be a marker of not only anal sphincter injury but disturbances beyond sphincter injury, such as damage to the anal cushions or anal denervation.
Topics: Adult; Aged; Anal Canal; Anus Diseases; Female; Humans; Hydrostatic Pressure; Magnetic Resonance Imaging; Male; Manometry; Middle Aged; Perineum; Retrospective Studies
PubMed: 25869638
DOI: 10.1016/j.cgh.2015.03.033 -
BMJ (Clinical Research Ed.) Sep 1993
Topics: Anal Canal; Fecal Incontinence; Female; Humans; Obstetric Labor Complications; Pregnancy
PubMed: 8401042
DOI: 10.1136/bmj.307.6905.636 -
Annals of Medicine Dec 2022To explore the therapeutic effects of biofeedback in the treatment of faecal incontinence (FI) after surgery for anorectal malformation (ARM).
OBJECTIVE
To explore the therapeutic effects of biofeedback in the treatment of faecal incontinence (FI) after surgery for anorectal malformation (ARM).
METHODS
Clinical data were collected from paediatric patients for postoperative biofeedback due to FI caused by ARM between May 2017 and November 2021. The data included the duration of symptoms, the integrity of the anal sphincter, anorectal manometry parameters, and FI scores. These patients were divided into the low ARM group (group A) and the high ARM group (group B).
RESULTS
A total of 45 paediatric patients were enrolled in the study. There were 28 cases in group A and 17 cases in group B. The differences in age, gender, and body weight were not statistically significant between the two groups ( > 0.05). The differences in the clinical indicators were also not statistically significant between the two groups at the time of the initial evaluation. The duration of symptoms was 2.21 ± 0.71 years and 4.14 ± 1.89 years in groups A and B. There were 16 cases with an intact anal sphincter in group A and only two cases with an intact anal sphincter in group B. This difference was statistically significant between the two groups ( < .05). The anal resting pressure, initial sensitivity threshold, defaecation sensitivity threshold, defaecation urge threshold, and FI scores were significantly improved in both groups post-treatment compared to pre-treatment ( < .001). Strong impulses improved significantly in group A, while strong impulses did not improve significantly in group B. The multivariate logistic regression analysis with these variables further showed that symptom duration and anal sphincter integrity were the main factors influencing the therapeutic effects of biofeedback.
CONCLUSION
Biofeedback plays a positive role in the treatment of FI in paediatric patients following surgery for ARM. Symptom duration and anal sphincter integrity were found to be the main factors influencing the therapeutic effect of biofeedback.
Topics: Anal Canal; Anorectal Malformations; Biofeedback, Psychology; Child; Fecal Incontinence; Humans
PubMed: 36039487
DOI: 10.1080/07853890.2022.2114607 -
American Family Physician Apr 2002External hemorrhoids represent distended vascular tissue in the anal canal distal to the dentate line. Persons with thrombosed external hemorrhoids usually present with... (Review)
Review
External hemorrhoids represent distended vascular tissue in the anal canal distal to the dentate line. Persons with thrombosed external hemorrhoids usually present with pain on standing, sitting or defecating. Acutely tender, thrombosed external hemorrhoids can be surgically removed if encountered within the first 72 hours after onset. Hemorrhoidectomy is performed through an elliptic incision over the site of thrombosis with removal of the entire diseased hemorrhoidal plexus in one piece. Caution must be exercised to avoid cutting into the muscle sphincter below the hemorrhoidal vessels. Infection after suture closure is rare secondary to the rich vascular network in the anal area. Stool softeners must be prescribed postoperatively to help prevent tearing at the suture line. Training and experience in general and skin surgery are necessary before the physician attempts this procedure unsupervised.
Topics: Anal Canal; Education, Medical; Hemorrhoids; Humans; Thrombosis
PubMed: 11989640
DOI: No ID Found -
World Journal of Gastroenterology Feb 2009Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for...
Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis (RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis; these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery. Each technique has advantages and disadvantages in long-term functional outcomes, operative and postoperative complications, and risk of neoplasia. Therefore, we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation.
Topics: Adenocarcinoma; Anal Canal; Anastomosis, Surgical; Colitis, Ulcerative; Colonic Pouches; Humans; Inflammation; Postoperative Complications; Proctocolectomy, Restorative; Rectal Neoplasms; Sepsis; Sutures; Treatment Outcome
PubMed: 19230038
DOI: 10.3748/wjg.15.769 -
Journal of Visceral Surgery Dec 2017
Review
Topics: Anal Canal; Electric Stimulation Therapy; Fecal Incontinence; Female; Follow-Up Studies; Gracilis Muscle; Humans; Implantable Neurostimulators; Male; Postoperative Care; Quality of Life; Plastic Surgery Procedures; Treatment Outcome
PubMed: 29169776
DOI: 10.1016/j.jviscsurg.2017.10.014 -
Ultrasound in Obstetrics & Gynecology :... Mar 2020The anal sphincter is commonly evaluated with endoanal ultrasound. Recently, translabial ultrasound imaging has been proposed for sphincter imaging, with moderate to...
OBJECTIVE
The anal sphincter is commonly evaluated with endoanal ultrasound. Recently, translabial ultrasound imaging has been proposed for sphincter imaging, with moderate to good correlation between the methods. An endosonographic defect is defined as one with a radial extension of > 30° in at least two-thirds of the length of the anal sphincter. This is equivalent to defining significant anal sphincter trauma on translabial tomographic ultrasound imaging (TUI) as a defect in at least four of six slices, a definition which has been validated. This study was designed to validate a residual defect angle of > 30° for the definition of significant anal sphincter trauma on translabial ultrasound.
METHODS
This was a retrospective study involving 399 women attending a tertiary urogynecology unit in 2014. All underwent a standardized interview, including determination of St Mark's fecal incontinence score (SMIS), clinical examination and 3D/4D translabial ultrasound examination with the woman at rest and on pelvic floor muscle contraction (PFMC). External (EAS) and internal (IAS) anal sphincter defect angles were measured in individual TUI slices and associations with anal incontinence symptoms, bother score and SMIS were analyzed.
RESULTS
There were weak but significant correlations of anal incontinence symptoms, bother score and SMIS with EAS and IAS defect angle, measured on images acquired with the woman at rest and on PFMC. The predictive value of single-slice defect angle on TUI was low, and areas under the receiver-operating-characteristics curves were too low to determine a distinct cut-off value for defect angle.
CONCLUSIONS
Anal sphincter residual defects on single translabial TUI slices are weakly associated with measures of anal incontinence. Single-slice defect angle is too poor a predictor to allow validation of the 30° defect angle cut-off used in endoanal ultrasound. Larger studies in populations with a higher prevalence of anal incontinence are needed before we can disregard anal sphincter defects smaller than 30° on translabial ultrasound. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Endosonography; Fecal Incontinence; Female; Humans; Middle Aged; Predictive Value of Tests; Reference Values; Retrospective Studies; Tomography; Vulva; Young Adult
PubMed: 31271480
DOI: 10.1002/uog.20390