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Clinics in Colon and Rectal Surgery Jun 2013Crohn disease involves the perineum and rectum in approximately one-third of patients. Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting... (Review)
Review
Crohn disease involves the perineum and rectum in approximately one-third of patients. Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting and severe, requiring a proctectomy in a small, but significant, portion. Fistula-in-ano and perineal sepsis are the most frequent manifestation seen on presentation. Careful diagnosis, including magnetic resonance imaging or endorectal ultrasound with examination under anesthesia and aggressive medical management, usually with a tumor necrosis factor-alpha, is critical to success. Several options for definitive surgical repair are discussed, including fistulotomy, fibrin glue, anal fistula plug, endorectal advancement flap, and ligation of intersphincteric fistula tract procedure. All suffer from decreased efficacy in patients with Crohn disease. In the presence of active proctitis or perineal disease, no surgical therapy other than drainage of abscesses and loose seton placement is recommended, as iatrogenic injury and poor wound healing are common in that scenario.
PubMed: 24436656
DOI: 10.1055/s-0033-1348047 -
Journal of Clinical Medicine Jan 2023Perianal fistulas are defined as pathological connections between the anorectal canal and the perianal skin. Most perianal fistulas are cryptoglandular fistulas, which... (Review)
Review
Perianal fistulas are defined as pathological connections between the anorectal canal and the perianal skin. Most perianal fistulas are cryptoglandular fistulas, which are thought to originate from infected anal glands. The remainder of the fistulas mainly arises as complications of Crohn's disease (CD), trauma, or as a result of malignancies. Fistulas in CD are considered as a consequence of a chronic and transmural inflammatory process in the distal bowel and can, in some cases, even precede the diagnosis of CD. Although both cryptoglandular and CD-associated fistulas might look similar macroscopically, they differ considerably in their complexity, treatment options, and healing rate. Therefore, it is of crucial importance to differentiate between these two types of fistulas. In this review, the differences between CD-associated and cryptoglandular perianal fistulas in epidemiology, pathogenesis, and clinical management are discussed. Finally, a flow chart is provided for physicians to guide them when dealing with patients displaying their first episode of perianal fistulas.
PubMed: 36675403
DOI: 10.3390/jcm12020466 -
American Journal of Medical Genetics.... Dec 2021The acronym VATER/VACTERL refers to the rare nonrandom association of the following component features (CFs): vertebral defects (V), anorectal malformations (ARM) (A),...
The acronym VATER/VACTERL refers to the rare nonrandom association of the following component features (CFs): vertebral defects (V), anorectal malformations (ARM) (A), cardiac anomalies (C), tracheoesophageal fistula with or without esophageal atresia (TE), renal malformations (R), and limb anomalies (L). For the clinical diagnosis, the presence of at least three CFs is required, individuals presenting with only two CFs have been categorized as VATER/VACTERL-like. The majority of VATER/VACTERL individuals displays a renal phenotype. Hitherto, variants in FGF8, FOXF1, HOXD13, LPP, TRAP1, PTEN, and ZIC3 have been associated with the VATER/VACTERL association; however, large-scale re-sequencing could only confirm TRAP1 and ZIC3 as VATER/VACTERL disease genes, both associated with a renal phenotype. In this study, we performed exome sequencing in 21 individuals and their families with a renal VATER/VACTERL or VATER/VACTERL-like phenotype to identify potentially novel genetic causes. Exome analysis identified biallelic and X-chromosomal hemizygous potentially pathogenic variants in six individuals (29%) in B9D1, FREM1, ZNF157, SP8, ACOT9, and TTLL11, respectively. The online tool GeneMatcher revealed another individual with a variant in ZNF157. Our study suggests six biallelic and X-chromosomal hemizygous VATER/VACTERL disease genes implicating all six genes in the expression of human renal malformations.
Topics: Anorectal Malformations; Cytoskeletal Proteins; DNA-Binding Proteins; Esophageal Atresia; Female; Genes, X-Linked; Genetic Association Studies; Genetic Predisposition to Disease; HSP90 Heat-Shock Proteins; Heart Diseases; Hemizygote; Homeodomain Proteins; Humans; Kidney; Male; Receptors, Interleukin; Tracheoesophageal Fistula; Transcription Factors; Exome Sequencing
PubMed: 34338422
DOI: 10.1002/ajmg.a.62447 -
Asia Pacific Journal of Clinical... 2020To evaluate the impacts of fistula status over 12 months on growth and development and anemia in infants with anorectal malformation (ARM) and to analyze the effects of...
BACKGROUND AND OBJECTIVES
To evaluate the impacts of fistula status over 12 months on growth and development and anemia in infants with anorectal malformation (ARM) and to analyze the effects of comorbidities.
METHODS AND STUDY DESIGN
The ARM group included infants who suffered from ARM and underwent three operations including colostomy, anoplasty (group A) and fistula closure (group B). The normal group included infants aged approximately 6 months and 12 months who were classified as groups C and D. A 24-h dietary recall questionnaire was completed by the guardians of all the participants. Data on height, weight, hemoglobin (Hb) level and comorbidities were extracted from electronic medical records. Then, we compared the impacts of the 12-month fistula status on growth and development and anemia among the infants.
RESULTS
In total, 47 patients in the ARM group and 100 infants in the normal group were included. The height-for-age z-score (HAZ) was lower in group A than in group B. Compared with those in group D, weight, height, the HAZ and the weight-forage z-score (WAZ) were lower in group B. The incidence of anemia was higher in the ARM group than in the normal group.
CONCLUSIONS
Patients with ARM are at risk for growth problems and anemia. The long-term impacts of fistula status on infant length presented earlier than those associated with other physical indicators. Compared to infants with urogenital comorbidities, those with congenital heart disease (CHD) seemed to be more prone to growth disorders and anemia.
Topics: Anemia; Anorectal Malformations; Fistula; Growth Disorders; Humans; Incidence; Infant
PubMed: 33377362
DOI: 10.6133/apjcn.202012_29(4).0003 -
Scientific Reports Jan 2021The anorectal malformation with long perineal fistula is a rare anomaly in the spectrum of anorectal malformations. Aim of the study is to describe the series of...
The anorectal malformation with long perineal fistula is a rare anomaly in the spectrum of anorectal malformations. Aim of the study is to describe the series of patients with anorectal malformation with long perineal fistula and compare the outcome with patient with standard perineal fistula. From March 2012 to January 2019, 7 patients who suffered from anorectal malformation with long perineal fistula were retrospectively reviewed. Three were operated on primarily by our department, and 4 cases were re-operated after a perineal anoplasty repair performed elsewhere. Four were operated by laparoscopy assisted anorectoplasty, and 3 cases were repaired by posterior sagittal anorectoplasty. The follow-up outcomes were compared with 71 cases of normal perineal fistula (NPF) in the same period. 7 cases have been followed up for 0.5-4 years (M = 2.57 ± 1.26) after definitive surgery. Their bowel function score was lower than normal perineal fistula (SPF = 12, range: 5-18; NPF = 18.5, range: 18-20). Four cases underwent anorectomanometry. The incidence of rectoanal inhibitory reflex was lower in the special type group. (p = 0.14). Three cases of contrast enema using barium: 2 cases of colorectal dilatation and thickening changes, 1 case showed no obvious abnormalities. Anorectal perineal fistula should be examined by distal colostogram at preoperation. This should be altered in: When suspecting a case of anorectal malformation type long perineal fistula a preoperative contrast enema could give insight of the anatomy befor performing a anoplasty.
Topics: Anal Canal; Anorectal Malformations; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Laparoscopy; Male; Rectal Fistula; Retrospective Studies
PubMed: 33462249
DOI: 10.1038/s41598-021-81056-3 -
European Radiology Dec 2022There are a range of sphincter-preserving procedures available to treat anorectal fistula, some of which can be precluded, or rendered more optimal by specific features... (Review)
Review
There are a range of sphincter-preserving procedures available to treat anorectal fistula, some of which can be precluded, or rendered more optimal by specific features of fistula anatomy. Magnetic resonance imaging (MRI) is the gold standard modality for assessing anorectal fistula. To maximise clinical utility, the MRI report should accurately describe these clinically relevant features. We aimed to develop a minimum dataset for reporting MRI of anorectal fistula, in order to improve the assessment and management of these patients. A longlist of 70 potential items for the minimum dataset was generated through systematic review of the literature. This longlist was presented to radiologists, surgeons and gastroenterologists in an online survey to understand the features that shape current clinical practice. The longlist and survey results were then presented to an expert consensus panel to generate the final minimum dataset through discussion and anonymous voting. The final minimum dataset details the general characteristics, features of the internal and external openings, path of the fistula through the sphincters and any associated extensions and collections that should be described in all MRI reports for anal fistula. Additional surgical and perianal Crohn's disease subsets were developed to indicate the features that aid decision-making for these patients, in addition to a minimum dataset for the clinical request. This study represents a multi-disciplinary approach to developing a minimum dataset for MRI reporting of anal fistula, highlighting the most important features to report that can assist in clinical decision-making. KEY POINTS: • This paper recommends the minimum features that should be included in all MRI reports for the assessment of anal fistula, including Parks classification, number of tracts, features of the internal and external opening, path of the tract through the sphincters, the presence and features of extensions and collections. • Additional features that aid decision-making for surgery or in the presence of Crohn's disease have been identified. • The items that should be included when requesting an MRI are specified.
Topics: Humans; Crohn Disease; Consensus; Rectal Fistula; Magnetic Resonance Imaging; Clinical Decision-Making
PubMed: 35732929
DOI: 10.1007/s00330-022-08931-z -
Advances in Medicine 2017Methylene blue (MB) has been found to have unique analgesic property through temporary disruption of sensory nerve conduction. In anorectal surgery, MB is widely used as... (Review)
Review
BACKGROUND
Methylene blue (MB) has been found to have unique analgesic property through temporary disruption of sensory nerve conduction. In anorectal surgery, MB is widely used as a biologic stain but the analgesic effect has never been studied. Thus, a literature review completed with critical appraisal is required to find out its efficacy.
METHODS
A review has been run to find out its efficacy. Literature search proceeded in database sites, namely, PubMed, EBSCO, Cochrane, Wiley, and ProQuest using the following keywords: "anorectal" OR "hemorrhoid" OR "anal fistula" OR "anal fissure" OR "anal abscess" OR "anal pruritus" AND "methylene blue" AND "analgesic"; then the critical appraisal and its implication were discussed.
RESULT
There were 491 articles in full text found, and four studies met the inclusion criteria. Two studies were focused on the evaluation of VAS in hemorrhoid surgery whereas the rest were focused on the evaluation of symptom score in anal pruritus.
CONCLUSIONS
A study with level of evidence 2 on VAS showed the efficacy. The rest showed insufficient evidence due to variations of anorectal surgery and the methods and techniques of MB application. A further prospective clinical study is required.
PubMed: 28894786
DOI: 10.1155/2017/3968278 -
International Journal of Pediatrics &... Dec 2017Rectovaginal fistula is a rare type of anorectal malformation; the incidence being less than 1%. We describe five cases of rectovaginal fistula managed at our...
BACKGROUND
Rectovaginal fistula is a rare type of anorectal malformation; the incidence being less than 1%. We describe five cases of rectovaginal fistula managed at our institution.
MATERIALS AND METHODS
Case records of five female neonates with rectovaginal fistula managed at our institute between 2010 and 2016 were reviewed and analysed with respect to age at presentation, clinical presentations, physical findings, investigations, management and outcome.
RESULTS
The age at presentation varied from 1 day to 2 years of age. Three of them presented in the neonatal period, one presented at 1 month of age and one at two years of age with sigmoid loop colostomy done elsewhere. All had absent anal opening; two neonates passed small amounts of stools through vagina, but little in amounts. The one-month old patient had history of passing stools through vaginal orifice, but had presented to us with obstruction. All patients underwent high sigmoid loop colostomy followed by definitive procedure at a later date - Posterior Sagittal Anorectoplasty. One patient is awaiting definitive repair.
CONCLUSION
Rectovaginal fistula is a rare anorectal malformation and needs thorough investigation and appropriate management for good outcome.
PubMed: 30805518
DOI: 10.1016/j.ijpam.2017.08.003 -
Medicine Jan 2021Anal fistula is characterized with perianal cellulitis, anorectal pain, smelly or bloody drainage of pus, and difficulty in controlling bowel movements. Ligation of...
BACKGROUND
Anal fistula is characterized with perianal cellulitis, anorectal pain, smelly or bloody drainage of pus, and difficulty in controlling bowel movements. Ligation of intersphincteric fistula tract (LIFT) technique is a recently developed approach against anal fistula, and it could alleviate the pain of the patient, with little postoperative trauma, which can greatly shorten the wound healing time and hospitalization stay. We conduct the meta-analysis and systematic review to systematically evaluate the clinical efficacy and safety of LIFT in the treatment of anal fistula.
METHODS
Randomized controlled trials of LIFT against anal fistula will be searched in several Chinese and English databases. Two reviewers will independently conduct the literature extraction and risk of bias assessment. Statistical analysis will be conducted in RevMan 5.3.
RESULTS AND CONCLUSIONS
The study will help to systematically evaluate the clinical efficacy and safety of LIFT in the treatment of anal fistula.
OSF REGISTRATION NUMBER
DOI 10.17605/OSF.IO/T4FUH.
Topics: Anal Canal; Humans; Length of Stay; Ligation; Meta-Analysis as Topic; Randomized Controlled Trials as Topic; Rectal Fistula; Research Design; Systematic Reviews as Topic; Treatment Outcome; Wound Healing
PubMed: 33530171
DOI: 10.1097/MD.0000000000023700 -
The Journal of International Medical... Jan 2021Horseshoe anal fistula is a common anorectal disease, and there is no standard procedure for its treatment. In this study, we performed a modified surgical procedure for...
OBJECTIVE
Horseshoe anal fistula is a common anorectal disease, and there is no standard procedure for its treatment. In this study, we performed a modified surgical procedure for the treatment of horseshoe anal fistula and investigated its efficacy and adverse effects.
METHODS
We retrospectively analyzed the outcomes of video-assisted anal fistula treatment combined with an anal fistula plug (VAAFT-Plug) in 26 patients with a horseshoe anal fistula. The follow-up period ranged from 6 to 18 months. Preoperative and postoperative data were collected to analyze the cure rate, anal sphincter function, and incidence of complications.
RESULTS
The surgeries were successfully performed in all patients, 23 of whom were cured (effective cure rate of 88.46%). Three patients developed recurrence and were cured after traditional surgery. No patients developed severe complications or postoperative anal incontinence. The VAAFT-Plug protocol was performed with a small incision in the fistula that subsequently promoted fistula healing and preserved sphincter function.
CONCLUSION
Although randomized controlled trials will be needed to fully validate these findings, our results suggest that VAAFT-Plug represents a promising treatment strategy for horseshoe anal fistulas. This technique preserves normal anal function and achieves satisfactory outcomes in most patients.
Topics: Anal Canal; Fecal Incontinence; Humans; Rectal Fistula; Retrospective Studies; Treatment Outcome; Video-Assisted Surgery
PubMed: 33435765
DOI: 10.1177/0300060520980525