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Clinics in Colon and Rectal Surgery Mar 2016Pruritus ani is a common condition with many different potential causes. Because of this, it can be difficult to treat. It is important to identify and eliminate any... (Review)
Review
Pruritus ani is a common condition with many different potential causes. Because of this, it can be difficult to treat. It is important to identify and eliminate any inciting factors, which are often unintentional consequences of the patient's attempts to alleviate symptoms. If no reversible cause is found, simple measures with diet modification and perianal hygiene are tried before using topical medications or procedures.
PubMed: 26929750
DOI: 10.1055/s-0035-1570391 -
Clinics in Colon and Rectal Surgery Sep 2019This article provides an overview of the principles in the evaluation and management of perianal Crohn's disease (CD). Manifestation-specific treatment is addressed... (Review)
Review
This article provides an overview of the principles in the evaluation and management of perianal Crohn's disease (CD). Manifestation-specific treatment is addressed including abscess, fistula, skin tags, hemorrhoids, fissure, ulcers, strictures, ano-, and rectovaginal fistulas as well CD-associated hidradenitis suppurativa.
PubMed: 31507348
DOI: 10.1055/s-0039-1687834 -
Clinics in Colon and Rectal Surgery Sep 2019Anal cancer is a heterogeneous and rare disease process that accounts for ∼1.5% of all gastrointestinal tract malignancies. The perianal skin plays host to a variety... (Review)
Review
Anal cancer is a heterogeneous and rare disease process that accounts for ∼1.5% of all gastrointestinal tract malignancies. The perianal skin plays host to a variety of different premalignant and malignant lesions, all with variable histology, treatment options, and prognosis. Anal cancers in general are notorious for having a delayed or missed diagnosis leading to treatment delays and may have an impact on survival. This delay is in part due to the nonspecific symptomatology and also improper physical examination of the sensitive and anatomically complex perianal region and anal canal. This article examines the various types of perianal cancers and their precursor lesions and will explore treatment options as well as outcomes and prognosis.
PubMed: 31507349
DOI: 10.1055/s-0039-1687835 -
The British Journal of Surgery Sep 2022Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim of this randomized clinical trial (RCT) was to assess if non-packing is less painful and if it is associated with adverse outcomes.
METHODS
The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial was a multicentre, RCT (two-group parallel design) of adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess. Participants were randomized 1:1 (via an online system) to receive continued postoperative wound packing or non-packing. Blinded data were collected via symptom diaries, telephone, and clinics over 6 months. The objective was to determine whether non-packing of perianal abscess cavities is less painful than packing, without an increase in perianal fistula or abscess recurrence. The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale).
RESULTS
Between February 2018 and March 2020, 433 participants (mean age 42 years) were randomized across 50 sites. Two hundred and thirteen participants allocated to packing reported higher pain scores than 220 allocated to non-packing (38.2 versus 28.2, mean difference 9.9; P < 0.0001). The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group (OR 0.69, 95 per cent c.i. 0.39 to 1.22; P = 0.20). The proportion of patients with abscess recurrence was also low: 13/223 (6 per cent) in the non-packing group and 7/213 (3 per cent) in the packing group (OR 1.85, 95 per cent c.i. 0.72 to 4.73; P = 0.20).
CONCLUSION
Avoiding abscess cavity packing is less painful without a negative morbidity risk.
REGISTRATION NUMBER
ISRCTN93273484 (https://www.isrctn.com/ISRCTN93273484).
REGISTRATION NUMBER
NCT03315169 (http://clinicaltrials.gov).
Topics: Abscess; Adult; Anus Diseases; Bandages; Drainage; Humans; Pain; Rectal Fistula; Treatment Outcome
PubMed: 35929816
DOI: 10.1093/bjs/znac225 -
Clinics in Colon and Rectal Surgery Sep 2019Parasitic infections of the gastrointestinal tract are a cause of morbidity to millions of individuals worldwide. These parasites are endemic in underdeveloped countries... (Review)
Review
Parasitic infections of the gastrointestinal tract are a cause of morbidity to millions of individuals worldwide. These parasites are endemic in underdeveloped countries with poor sanitation allowing for spread through contaminated water supplies. While much is known about these parasites, the cutaneous manifestations caused by infection are infrequently reported in the literature. The deposition of the parasites into the perianal region often leads to significant skin irritation. Cutaneous findings vary from a mild pruritus ani to a macular rash to even severe perianal ulceration. This article discusses the perianal cutaneous findings caused by the parasitic illnesses, amebiasis, schistosomiasis, , strongyloidiasis, and cutaneous larva migrans, as well as their respective management.
PubMed: 31507346
DOI: 10.1055/s-0039-1687832 -
Journal of the Korean Society of... May 2023Perianal fistula is a common inflammatory condition in the general population and affects the area around the anal canal. Although most cases are benign, they cause... (Review)
Review
Perianal fistula is a common inflammatory condition in the general population and affects the area around the anal canal. Although most cases are benign, they cause serious morbidity and require surgical treatment due to a high risk of recurrence. MR imaging is a gold standard technique for the evaluation of perianal fistulas and provides accurate information on the anatomy of the anal canal, its relationship to the anal sphincter complex, accurate identification of secondary tracts or abscesses, and reporting associated complications. MR imaging can help monitor treatment effects and determine treatment methods. Crohn's disease-related fistulas often require medical rather than surgical treatment. The radiologist is required to know the anatomy and MR imaging findings of the perianal fistula to present an accurate diagnosis to the clinician.
PubMed: 37325009
DOI: 10.3348/jksr.2023.0018 -
Frontiers in Surgery 2022
PubMed: 35836609
DOI: 10.3389/fsurg.2022.952874 -
Ugeskrift For Laeger Feb 2023A 34-year-old man, homosexual, came to the clinic of venerology due to severe perianal pain. When examinated, small, eroded vesicles were found perianally. This was...
A 34-year-old man, homosexual, came to the clinic of venerology due to severe perianal pain. When examinated, small, eroded vesicles were found perianally. This was interpreted as a primary herpes infection. At the follow-up visit, several vesicular and papular elements were now present on the body. The patient tested positive for mpox. This case confirms that mpox is a relevant differential diagnose in venerology in Denmark.
Topics: Male; Humans; Adult; Diagnosis, Differential; Mpox (monkeypox); Herpes Zoster; Dermatitis
PubMed: 36762374
DOI: No ID Found