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Annals of Gastroenterology 2017Patients with Crohn's disease often develop perianal disease, successfully managed in most cases. However, its most aggressive form, complex perianal disease, is... (Review)
Review
Patients with Crohn's disease often develop perianal disease, successfully managed in most cases. However, its most aggressive form, complex perianal disease, is associated with high morbidity and a significant impairment in patients' quality of life. The aim of this review is to provide an updated approach to this condition, reviewing aspects of its epidemiology, diagnosis and therapeutic alternatives. Emerging treatment options are also discussed. A multidisciplinary assessment of these patients with a coordinated medical and surgical approach is crucial.
PubMed: 28042236
DOI: 10.20524/aog.2016.0099 -
Polish Journal of Radiology 2014Magnetic resonance imaging (MRI) depicts infectious foci in the perianal region better than any other imaging modality. MRI allows definition of the fistula, associated... (Review)
Review
Magnetic resonance imaging (MRI) depicts infectious foci in the perianal region better than any other imaging modality. MRI allows definition of the fistula, associated abscess formation and its secondary extensions. Accurate information is necessary for surgical treatment and to obtain a decrease in the incidence of recurrence and complications. Radiologists should be familiar with anatomical and pathological findings of perianal fistulas and classify them using the MRI - based grading system. The purpose of this article was to provide an overview for evaluation of perianal fistulas, examples of various fistula types and their classification.
PubMed: 25550766
DOI: 10.12659/PJR.892098 -
Indian Journal of Dermatology 2017Eccrine syringofibroadenoma (ESFA) is a rare eccrine ductal adnexal tumor. It shows variable presentations as solitary or multiple nodular lesions arranged in different...
Eccrine syringofibroadenoma (ESFA) is a rare eccrine ductal adnexal tumor. It shows variable presentations as solitary or multiple nodular lesions arranged in different patterns. It is most commonly seen in middle-aged to elderly patients, and most common sites include the extremities. Classic histopathological findings show anastomosing cords and strands of uniform cuboidal cells surrounded by fibrovascular stroma. Herein, we report a case of reactive ESFA which developed on the perianal region of a 31-year-old man.
PubMed: 28979031
DOI: 10.4103/ijd.IJD_566_16 -
Frontiers in Nutrition 2023Symptomatic perianal disease is common in patients with Crohn's disease (CD), and perianal fistulas represent the primary form of anal involvement. This type of... (Review)
Review
Symptomatic perianal disease is common in patients with Crohn's disease (CD), and perianal fistulas represent the primary form of anal involvement. This type of involvement is associated with a poor prognosis and a disabling course. The treatment is challenging and involves both surgical and medical approaches. Despite combined therapy, a significant portion of patients may still require proctectomy to control the symptoms. Consequently, investigating factors that may influence the outcome of perianal disease remains a priority area of research in CD. Nutritional deficiencies are well documented among CD patients with luminal forms of involvement and are closely related to poor clinical outcomes, therapy response, and postoperative complications. As a result, leading guidelines recommend regular nutritional assessment and correction of nutritional deficiencies in patients requiring a surgical approach. Despite these recommendations and the high rate of surgeries among CD patients with perianal disease, there is a shortage of studies addressing the real impact of nutritional status on the course and outcomes of perianal disease. This knowledge gap underscores the importance of further research to understand better and improve the management of perianal CD. This narrative review aims to provide an overview of nutritional status assessment and the influence of nutritional status on the outcomes of patients with perianal CD.
PubMed: 37743921
DOI: 10.3389/fnut.2023.1271825 -
American Journal of Translational... 2023This study aimed to comprehensively evaluate perianal fistulas and their related complications using magnetic resonance imaging (MRI).
OBJECTIVE
This study aimed to comprehensively evaluate perianal fistulas and their related complications using magnetic resonance imaging (MRI).
METHODS
We enrolled 115 eligible patients who underwent preoperative perianal MRI. Primary fistulas, internal and external openings, and related complications were evaluated using MRI. All fistulas were classified according to Park's classification, Standard Practice Task Force classification, St. James's grade, and the position of the internal opening.
RESULTS
In total, 169 primary fistulas were detected in 115 patients; 73 (63.5%) patients had a single primary tract and 42 (36.5%) patients had multiple primary tracts, and 198 internal and 129 external openings were identified. Based on Park's classification, 150 (88.7%) primary fistulas were classified into the following types: intersphincteric (82, 54.7%), trans-sphincteric (58, 38.6%), suprasphincteric (8, 5.3%), extrasphincteric (1, 0.7%), and diffuse intersphincteric with trans-sphincteric (1, 0.7%) types. Based on St. James's grade, 149 fistulas were classified into grade 1 (52, 34.9%), grade 2 (30, 20.1%), grade 3 (20, 13.4%), grade 4 (38, 25.5%), and grade 5 (9, 6.1%). We detected 92 (54.4%) simple and 77 (45.6%) complex perianal fistulas and 72 (42.6%) high and 97 (57.4%) low perianal fistulas. Furthermore, we detected 32 secondary tracts in 23 (20.0%) patients and 87 abscesses in 60 (52.2%) patients. Levator ani muscle involvement and extensive soft tissue edema were detected in 12 (10.4%) and 24 (20.9%) patients, respectively.
CONCLUSION
MRI is a valuable and comprehensive tool that can not only be used to determine the general condition of perianal fistulas but also to classify them and identify related complications.
PubMed: 37303685
DOI: No ID Found -
World Journal of Clinical Pediatrics Oct 2018Perianal infectious dermatitis (PID) represents a superficial inflammation of the perianal skin, which is of bacterial origin (classically, ). This narrative review aims... (Review)
Review
Perianal infectious dermatitis (PID) represents a superficial inflammation of the perianal skin, which is of bacterial origin (classically, ). This narrative review aims to critically review and summarize the available scientific literature regarding pediatric PID, being the first of its kind, to the best of the author's knowledge. It also reports the first cases of Romanian children with PID. Multiple databases were subjected to systematic literature search (from 1966 to April 30, 2018) to identify studies and case reports of children with PID. As such, this review provides updated information about essential aspects of PID (epidemiology, etiology, pathogenesis, as well as clinical features, required investigations and therapeutic options) and of diagnostic pitfalls. Although a well-defined entity, PID remains largely underdiagnosed. PID may mimic other common conditions with skin manifestations (like candidiasis, pinworms, eczema, irritant dermatitis, anal fissure, hemorrhoids, Crohn's disease, psoriasis, seborrheic dermatitis, zinc deficiency dermatosis and even sexual abuse), with consequent unnecessary, sometimes expensive and invasive investigations and futile therapies, which cause patients and families discomfort and distress. Since PID has an unremitting course, early recognition is imperative, as it allows for prompt and efficacious antibiotic therapy. However, PID represents a stubborn condition and, even if properly treated, its recurrence rate remains high. Further well-designed prospective randomized controlled trials, with adequate follow-up, are required in order to formulate the optimum personalized antibiotic therapy (oral alone or in association with topical medication), able to prevent recurrences. Awareness of this condition by healthcare professionals should improve patient outcomes.
PubMed: 30627524
DOI: 10.5409/wjcp.v7.i4.89 -
World Journal of Gastroenterology Sep 2017Perianal fistulas can occur to up to one-third of patients with Crohn's disease (CD) leading to significant disabling disease and morbidity. Fistulising perianal CD...
Perianal fistulas can occur to up to one-third of patients with Crohn's disease (CD) leading to significant disabling disease and morbidity. Fistulising perianal CD treatment often necessitates a combined pharmacological and surgical approach. Anti-tumor necrosis factor (anti-TNF) therapy, particularly infliximab, has been shown to be very effective for both perianal and internal fistulising CD. Nevertheless, current data suggest that sustained remission and long-term complete fistula healing can be achieved in only 30% to 50% of patients. Moreover, these percentages refer mostly to clinical rather than deep remission, defined as endoscopic and radiologic remission, which is quickly emerging as the preferred goal of therapy. Unfortunately, the therapeutic options for perianal fistulising CD are still limited. As such, it would be of great value to be able to predict, and more importantly, prevent treatment failure in these patients by early and continued optimization of anti-TNF therapy. Similar to ulcerative colitis and luminal CD, recent data demonstrate that higher infliximab concentrations are associated with better clinical outcomes in patients with perianal fistulising CD. This suggests that therapeutic drug monitoring and a treat-to-trough therapeutic approach may emerge as the new standard of care for optimizing anti-TNF therapy in patients with perianal fistulising CD.
Topics: Adalimumab; Colonoscopy; Crohn Disease; Dose-Response Relationship, Drug; Drug Monitoring; Gastrointestinal Agents; Humans; Infliximab; Magnetic Resonance Imaging; Radiography; Rectal Fistula; Standard of Care; Treatment Failure; Treatment Outcome; Tumor Necrosis Factor-alpha
PubMed: 28974885
DOI: 10.3748/wjg.v23.i34.6197 -
British Journal of Hospital Medicine... Nov 2023A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should... (Review)
Review
A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound healing and abscess recurrence? The literature search identified 159 papers on Ovid, Embase and Medline and 48 on PubMed. These were independently screened, and three articles were included in this review as these offered the best information to answer the question. One was a systematic review without meta-analysis, one was a randomised controlled trial and one was a multicentre observational study. Review of these articles led the authors to conclude that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain and confers no protection against recurrence of abscesses or formation of fistulae.
Topics: Adult; Humans; Abscess; Drainage; Multicenter Studies as Topic; Observational Studies as Topic; Pain; Postoperative Period; Randomized Controlled Trials as Topic; Skin Diseases
PubMed: 38019208
DOI: 10.12968/hmed.2023.0308 -
Annals of Coloproctology Feb 2021Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal... (Review)
Review
Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.
PubMed: 33730796
DOI: 10.3393/ac.2021.02.08 -
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