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Cureus Jul 2022A tailgut cyst (TGC) is a rare congenital lesion that occurs due to failure of involution of the distal hindgut, leading to the development of a mucus-secreting cyst....
A tailgut cyst (TGC) is a rare congenital lesion that occurs due to failure of involution of the distal hindgut, leading to the development of a mucus-secreting cyst. The clinical presentation is nonspecific, and often the diagnosis can be missed. We present the case of a 20-year-old female with a TGC in the perianal region. Surgical excision of the cyst was performed, followed by an uneventful recovery. The young age of our patient and the anatomical location of the TGC make our case a rare entity, highlighting the need for practicing surgeons to keep TGC as a differential in mind while examining masses in the perianal region.
PubMed: 36060408
DOI: 10.7759/cureus.27512 -
Histopathology Jan 2021Paget's disease of the perianal skin is a rare form of extramammary Paget's disease, and may be a primary intraepithelial adnexal neoplasm or secondary due to spread...
AIMS
Paget's disease of the perianal skin is a rare form of extramammary Paget's disease, and may be a primary intraepithelial adnexal neoplasm or secondary due to spread from an underlying colorectal lesion, nearly always colorectal adenocarcinoma. Secondary perianal Paget's disease associated with non-invasive colorectal adenomas is exceedingly uncommon, with only a few reported cases.
METHODS AND RESULTS
Herein, we present the clinical and pathological features of the largest series of secondary perianal Paget's disease arising in association with colorectal adenomas. There was gender parity and the median age was 72 years (range = 68-76 years). In all cases, perianal Paget's disease was associated with colorectal adenomas, including three (75%) conventional tubular adenomas and one (25%) tubulovillous adenoma with serrated foci. All adenomas had high-grade dysplasia and one had intramucosal adenocarcinoma (lamina propria invasion; Tis), but all lacked submucosal invasion. The intraepithelial Paget's cells showed a colorectal phenotype by immunohistochemistry in all cases. At follow-up, two patients had no evidence of disease at 6 and 87 months, one had residual perianal Paget's disease at 8 months and one developed invasive adenocarcinoma of the perianal tissue at 36 months.
CONCLUSIONS
Similar to its mammary analogue, secondary perianal Paget's disease may arise in association with invasive and/or in-situ colorectal lesions. Although the latter is an uncommon presentation of a recognised rare disease, knowledge of this phenomenon is important to forestall overdiagnosis of invasion and potential overtreatment. The clinical course is variable, such that close follow-up is required.
Topics: Adenocarcinoma; Adenoma; Aged; Anal Canal; Anus Neoplasms; Colorectal Neoplasms; Female; Humans; Immunohistochemistry; Male; Paget Disease, Extramammary
PubMed: 32705713
DOI: 10.1111/his.14218 -
International Journal of Surgery Case... 2017Perianal pseudolymphoma is a rare lymphoproliferative disorder that can mimic cutaneous lymphoma. The condition can present acutely with concerns of perianal sepsis. The...
INTRODUCTION
Perianal pseudolymphoma is a rare lymphoproliferative disorder that can mimic cutaneous lymphoma. The condition can present acutely with concerns of perianal sepsis. The purpose of this case review is to review the current literature on perianal pseudolymphoma and emphasise to the surgical community its presentation, suggested aetiology and management.
CASE PRESENTATION
In this case report, we detail the case of a 28-year-old female who presented with perianal pseudolymphoma. Malignant lymphoproliferative diseases required exclusion. Conservative management of this rare condition was successful.
DISCUSSION
We highlight the differential diagnoses, investigations and treatment options for a rare condition. A review of the literature on the limited published data on perianal pseudolymphoma is briefly discussed.
CONCLUSION
The aim of this case report is to highlight the existence of such a rare condition that can imitate an acute surgical presentation and its successful conservative management.
PubMed: 28881336
DOI: 10.1016/j.ijscr.2017.08.014 -
The Indian Journal of Radiology &... Jan 2021Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating perianal fistulae, due to its ability to show the relationship of perianal fistulae...
Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating perianal fistulae, due to its ability to show the relationship of perianal fistulae with anal sphincters, fistula extensions, secondary ramifications and associated complications. To evaluate the role of diffusion-weighted MRI in the evaluation of perianal fistulae. A hospital-based cross-sectional study. The study group composed of 47 patients of perianal fistula. MRI with diffusion-weighted imaging (DWI) was performed with Philips 0.5 T Ingenia scanner. DWI with different -values ( = 50, = 400, and = 800 smm ) were obtained. The MRI findings were correlated with local clinical examination and or surgical findings. Chi-square test, independent samples -test, and receiver operating characteristic curve analysis. Fifty-nine perianal fistulas in 47 patients were included in the study sample. The visibility of perianal fistula on DWI was less than T2-weighted (T2W) and combined DWI-T2W images. Distinctly visualized (visibility score 2) perianal fistulas were observed in 47 fistulas (79.6%) on DWI, 54 (91.5%) on T2W, and 58 (98.3%) on DWI-T2W images. The mean of apparent diffusion coefficient (ADC) values of active fistula was 0.972 ± 0.127 [SD] 10 mm /s and inactive was 1.232 ± 0.185 [SD] 10 mm /s with a significant difference ( -value < 0.0005). A cut-off mean ADC value of 1.105 × 10 mm /s was used to differentiate active from the inactive fistula with a sensitivity of 87.5% and specificity of 73.3%. Combined DWI-T2W evaluation had a better performance in the detection of fistula than DWI or T2W alone. DWI with mean ADC calculation had a good performance in differentiating active from the inactive fistulas.
PubMed: 34316116
DOI: 10.1055/s-0041-1729673 -
International Journal of Surgery Case... Jun 2022Crohn's disease (CD) is a chronic bowel disease that, due to exacerbated inflammation, can lead to complications such as the development of perianal fistulas. The...
INTRODUCTION AND IMPORTANCE
Crohn's disease (CD) is a chronic bowel disease that, due to exacerbated inflammation, can lead to complications such as the development of perianal fistulas. The development of mucinous adenocarcinoma in perianal fistulas in patients with CD is rare and, consequently, few reports exist in the literature.
CASE PRESENTATION
We report the case of a 71-year-old man diagnosed 22 years ago with CD with perineal involvement, who came with complaints of intense perianal pain, a gluteal mass, and local bleeding. Tomography of his abdomen showed an expansive, heterogeneous, and solid perianal mass on the right, with interspersed necrotic/liquefied areas and possible mucinous content. The patient was referred to the surgery department for an incisional biopsy, which confirmed mucinous adenocarcinoma. The patient underwent extra levator abdominoperineal rectal resection (APR) with partial prostatectomy.
CLINICAL DISCUSSION
Perineal mucinous adenocarcinoma arising in a fistula associated with CD is very rare. Since the symptoms overlap, early diagnosis of malignancy is difficult. Histological analysis is the gold standard for its diagnosis. Surgical resection through APR is well-established and, despite being a complex procedure with potential complications, tends to have good results. However, the locoregional and inguinal lymph node involvement was related to a worse progression in this case.
CONCLUSION
The diagnostic hypothesis of mucinous adenocarcinoma should be suspected in CD patients who present long-term perineal involvement with fistulas. Biopsies and imaging exams should be performed to aid the diagnosis of the condition and thus contribute to the surgical plan.
PubMed: 35653944
DOI: 10.1016/j.ijscr.2022.107211 -
Polski Przeglad Chirurgiczny Feb 2020Perianal abscess and fistula-in-ano are common findings in infants and children. The perianal abscess is usually a manifestation of a fistula-in-ano. Experience of our...
INTRODUCTION
Perianal abscess and fistula-in-ano are common findings in infants and children. The perianal abscess is usually a manifestation of a fistula-in-ano. Experience of our center indicates general lack of knowledge of the origin of the abscess and therefore, it is usually treated by incision and drainage, which leads to repeated recurrences.
AIM
We aimed to present the optimal management of fistula-in-ano and perianal abscess in order to reduce or even eliminate the risk of recurrence.
MATERIAL AND METHODS
The retrospective study included 24 infants with perianal abscess treated at our center between 2013 and 2015. Patients were divided into two groups: group I (50%) was primary treated in our center, while group II had undergone prior surgical interventions in other hospitals. Fistula-in-ano was intraoperatively identified in all patients (100%) and fistulotomy was performed.
RESULTS
No fecal incontinence or recurrence of perianal abscess were observed in any of our patients. In group II, the disorder was associated with severe inflammation, some patients underwent an additional surgical intervention, such as incision and drainage of an extensive buttock's abscess; patients required longer antibiotic therapy and prolonged hospitalization.
CONCLUSION
Minimally invasive approach (sitz baths, antibiotic therapy, puncture or incision and drainage of the abscess) appears tempting due to its simplicity and lack of need for general anesthesia, but it is associated with a high recurrence rate. Fistulotomy and fistulectomy, which are slightly more invasive procedures, significantly reduce the recurrence rate of fistulain- ano and perianal abscess.
Topics: Abscess; Child; Female; Fissure in Ano; Follow-Up Studies; Humans; Male; Recurrence; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 32312918
DOI: 10.5604/01.3001.0013.8158 -
BMC Gastroenterology Oct 2021The significance of different ages of perianal disease (PD) onset in patients with perianal Crohn's disease (PCD) remains unknown. We aimed to investigate the impact of... (Observational Study)
Observational Study
Perianal disease onset age is associated with distinct disease features and need for intestinal resection in perianal Crohn's disease: a ten-year hospital-based observational study in China.
BACKGROUND AND AIMS
The significance of different ages of perianal disease (PD) onset in patients with perianal Crohn's disease (PCD) remains unknown. We aimed to investigate the impact of paediatric-onset PD (POP) and adult-onset PD (AOP) on the Crohn's disease (CD) course in a Chinese cohort.
METHODS
The medical records of diagnosed PCD patients from 2008 to 2018 were reviewed retrospectively. The cumulative incidence and predictors of intestinal resection were calculated using the Kaplan-Meier and logistic regression analysis.
RESULTS
Complex perianal fistulas (71.7% vs 50.0%, p = 0.011) and infliximab (IFX) treatment (33.3% vs 22.0%, p = 0.044) were more common among the POP patients (age < 18 years old, n = 84). A younger PD onset age (15.1 ± 2.9 vs 30.2 ± 10.5 years, p < 0.001) and shorter PCD diagnostic delay (12 vs 24 months, p = 0.033) was found in the POP cohort. AOP patients (age ≥ 18 years old, n = 209) had a higher rate of current smoking (12.9% vs 4.8%, p = 0.040), stricturing behaviour (42.1% vs 27.4%, p = 0.024) and intestinal resection (21.1% vs 4.8%, p = 0.001). The cumulative probability of intestinal resection in AOP patients was higher than that in POP patients (p = 0.007). In multivariable analysis, AOP (OR: 4.939, 95% CI 1.538-15.855, p = 0.007), stricturing behaviour (OR: 1.810, 95% CI 1.008-3.251, p = 0.047) and rectal inflammation (OR: 3.166, 95% CI 1.119-8.959, p = 0.030) were predictive factors for CD-related intestinal resection in all PCD patients. AOP patients with complex perianal fistula (OR: 2.257, 95% CI 1.041-4.891, p = 0.039) and POP patients with rectal inflammation (OR: 3.166, 95% CI 1.119-8.959, p = 0.030) were more likely to suffer intestinal resection. The IFX administration significantly decreased the rate of intestinal resection in AOP patients (r = - 0.900, p = 0.037).
CONCLUSIONS
The AOP patients have more complicated luminal disease and higher rate of intestinal resection than COP patients. The perianal diseases onset-age can provide clinical treatment guidance for individual management of CD patients.
Topics: Adolescent; Adult; Age of Onset; Child; China; Crohn Disease; Delayed Diagnosis; Hospitals; Humans; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 34649523
DOI: 10.1186/s12876-021-01961-9 -
Frontiers in Surgery 2022The role of surgery in managing perianal abscesses in the pediatric population is debatable, and data on recurrence risk is rare. This study aimed to evaluate the...
PURPOSE
The role of surgery in managing perianal abscesses in the pediatric population is debatable, and data on recurrence risk is rare. This study aimed to evaluate the efficiency of surgery for a perianal abscess in children and identify parameters that predict recurrence.
METHODS
We performed a retrospective review of all children younger than age 14 requiring surgery for a perianal abscess from 2000 to 2018.
RESULTS
Out of 103 enrolled patients, 27 (26%) had recurrent perianal disease. Recurrences appeared after a median of 5 months (range: 1-18 months), in 12 cases as perianal abscess and 15 cases as fistula . Anal fistula probing was performed in 33% of all patients, of which 16 (15%) underwent fistulotomy. In univariate analysis, older age ( = 0.034), fistula probing ( = 0.006) and fistulotomy ( = 0.009) was associated with treatment success. History of perianal abscess, multilocal occurrence, and the presence of enteric flora in wound swabs was associated with treatment failure ( = 0.002, OR = 0.032). In multivariate analysis, anal fistula probing was independently associated with treatment success ( = 0.019, OR = 22.08), while the history of perianal abscess was associated with treatment failure ( = 0.002, OR = 0.032).
CONCLUSION
Our study identified probing for fistula as a predictor of therapy success, while the history of perianal abscess was identified as a predictor of treatment failure. Therefore, in all children with perianal abscess, fistula probing and if present, fistulotomy should be performed.
PubMed: 36589625
DOI: 10.3389/fsurg.2022.1065466 -
BMC Surgery May 2020The choice of surgery for perianal sepsis is currently controversial. Some people advocate one-time radical surgery for perianal sepsis, while others advocate incision...
BACKGROUND
The choice of surgery for perianal sepsis is currently controversial. Some people advocate one-time radical surgery for perianal sepsis, while others advocate incision and drainage. The objective of this study is to observe the formation probability of secondary anal fistula after incision and drainage in patients with perianal sepsis and determine factors that contribute to secondary anal fistula after incision and drainage.
METHODS
A retrospective descriptive analysis was conducted in 288 patients with perianal sepsis who were treated with anorectal surgery in the Suzhou Hospital of Traditional Chinese Medicine from January 2016 to June 2018. The patients were followed by telephone, physical examination, and pelvic MRI examination for at least 1 year after surgery.
RESULTS
Three patients were not followed, 98 patients did not receive surgical treatment or one-time radical surgery for perianal sepsis, and 187 patients were ultimately identified for the study. Anal fistula was present in 105 patients, and the rate of formation of secondary anal fistula was 56.15%. There was no statistically significant difference in the fistula formation rate between different types of sepsis (P>0.05). And, in patients with secondary anal fistula, there was no significant correlation between the location of sepsis and the type of secondary anal fistula (P>0.05).
CONCLUSIONS
The incidence of secondary anal fistula after incision and drainage of perianal sepsis is 56.15%, which is lower than the incidence found in previous study. Young is a risk factor for secondary anal fistula after incision and drainage of perianal sepsis. There is no significant correlation between the location of sepsis and the type of secondary anal fistula. Simple incision and drainage is a suitable choice for patients with acute perianal sepsis.
Topics: Adolescent; Adult; Aged; Child; Drainage; Female; Humans; Incidence; Male; Middle Aged; Rectal Fistula; Retrospective Studies; Risk Factors; Sepsis; Young Adult
PubMed: 32375721
DOI: 10.1186/s12893-020-00762-3 -
BMJ Open Aug 2023Perianal infection is a serious complication in patients undergoing chemotherapy for haematological malignancies. Therefore, we aimed to develop a predictive model to... (Randomized Controlled Trial)
Randomized Controlled Trial Observational Study
Construction and validation of a risk prediction model for perianal infection in patients with haematological malignancies during chemotherapy: a prospective study in a tertiary hospital in China.
OBJECTIVES
Perianal infection is a serious complication in patients undergoing chemotherapy for haematological malignancies. Therefore, we aimed to develop a predictive model to help medical staff promptly screen patients at a high risk of perianal infection during chemotherapy.
DESIGN
This was a single-centre prospective observational study.
SETTING
This study was conducted in a tertiary teaching hospital in Chengdu, China.
PARTICIPANTS
The study sample comprised 850 patients with haematological malignancies who underwent chemotherapy at the department of haematology or our hospital between January 2021 and June 2022.
INTERVENTIONS
The included patients were randomly divided into training and validation groups in a 7:3 ratio. Based on the discharge diagnosis, patients with perianal infection were selected as the case group and the other patients were selected as the control group.
OUTCOME MEASURE
The main outcome measure was the occurrence of perianal infections.
RESULTS
A predictive model for perianal infections was established. A history of perianal infection, haemorrhoids, constipation and duration of diarrhoea were independent risk factors. The area under the curve of the The area under the receiver operating characteristic (ROC) curve for the training and validation groups were 0.784 (95% CI 0.727 to 0.841) and 0.789 (95% CI 0.818 to 0.885), respectively. Additionally, the model had good calibration in both the training and validation groups with a non-significant Hosmer-Lemeshow test (p=0.999 and 0.482, respectively).
CONCLUSIONS
The risk prediction model, including a history of perianal infection, history of haemorrhoids, constipation and duration of diarrhoea ≥3 days of perianal infection in patients with haematological malignancies during chemotherapy, has good prediction reliability and can be helpful in guiding clinical medical staff in screening and early intervention of high-risk groups.
Topics: Humans; Tertiary Care Centers; Prospective Studies; Hemorrhoids; Reproducibility of Results; China; Hematologic Neoplasms; Communicable Diseases; Constipation; Diarrhea; Hospitals, Teaching
PubMed: 37597870
DOI: 10.1136/bmjopen-2023-074196