RESUMO
BACKGROUND: Anal fistula commonly appears after incision and drainage of a perianal abscess. Theoretically, a fistula develops as a consequence of the infection process. Antibiotic treatment was suggested to decrease the possibility of fistula development. OBJECTIVE: We hypothesized that antibiotic treatment has no influence on the development of anal fistula after surgical treatment of perianal abscess. DESIGN: A single-blinded randomized prospective study. SETTINGS: Patients with primary cryptogenic abscesses were eligible to participate. PATIENTS: Patients were divided into 2 groups. Patients in group I received amoxicillin 875 mg/clavulanic acid 125 mg during 7 days after surgery, and patients in group II received no antibiotics. The study database included demographics and clinical and laboratory data. MAIN OUTCOME MEASURES: Patients were examined in our outpatient clinic 2 weeks, 4 months, and 1 year after surgery, and a telephone questionnaire was performed 6 months after surgery. The primary outcome was the formation of anal fistula. The secondary outcome was recurrent perianal abscess. RESULTS: Overall, 98 patients completed the study. Groups were not different in inclusion. Anal fistula was diagnosed in 16 patients (16.3%) in group I (treatment group) and 10 patients (10.2%) in group II (control group; p = 0.67). Nine patients (9.2%) developed recurrent perianal abscess, 4 in the treatment group and 5 in the control group ( p = 0.73). LIMITATIONS: A relatively small number of patients were treated in a single medical center. CONCLUSION: Antibiotic therapy has no influence on anal fistula or recurrent perianal abscess formation after incision and drainage of perianal abscess. See Video Abstract . EL TRATAMIENTO CON ANTIBITICOS NO TIENE INFLUENCIA EN LA FORMACIN DE FSTULA ANAL Y EN EL ABSCESO PERIANAL RECURRENTE DESPUS DE LA INCISIN Y DRENAJE DE UN ABSCESO PERIANAL CRIPTOGNICO UN ESTUDIO PROSPECTIVO ALEATORIZADO, SIMPLE CIEGO: ANTECEDENTES:La fístula anal comúnmente aparece después de la incisión y drenaje de un absceso perianal. Teóricamente, la fístula se desarrolla como consecuencia del proceso infeccioso. Se sugirió tratamiento antibiótico para disminuir la posibilidad de desarrollo de fístula.OBJETIVO:Hipotetizamos que el tratamiento con antibióticos no tiene influencia en el desarrollo de fístula anal después del tratamiento quirúrgico del absceso perianal.DISEÑO:Estudio prospectivo, aleatorio, simple ciego.AJUSTE Y PACIENTES:Los pacientes con absceso criptogénico primario fueron elegibles para participar. Los pacientes se dividieron en dos grupos. Los pacientes del Grupo I recibieron amoxicilina 875 mg/ácido clavulánico 125 mg durante los 7 días posteriores a la cirugía y los pacientes del Grupo II no recibieron antibióticos. La base de datos del estudio incluyó datos demográficos, clínicos y de laboratorio.PRINCIPALES MEDIDAS DE RESULTADO:Los pacientes fueron examinados en nuestra clínica ambulatoria 2 semanas, cuatro meses y 1 año después de la cirugía y se realizó un cuestionario telefónico 6 meses después de la cirugía. El resultado primario fue la formación de una fístula anal. El resultado secundario fue el absceso perianal recurrente.RESULTADOS:En total, 98 pacientes completaron el estudio. Los grupos no fueron diferentes en cuanto a la inclusión. Se diagnosticó fístula anal en 16 (16,3%) pacientes del Grupo I (grupo de tratamiento) y 10 (10,2%) pacientes del Grupo II (grupo control) (p = 0,67). Nueve pacientes (9,2%) desarrollaron absceso perianal recurrente, 4 en el grupo de tratamiento y 5 en el grupo control (p = 0,73).LIMITACIONES:Número relativamente pequeño de pacientes tratados en un solo centro médico.CONCLUSIÓN:La terapia con antibióticos no tuvo influencia sobre la fístula anal o la formación de absceso perianal recurrente después de la incisión y drenaje del absceso perianal. (Traducción - Dr. Fidel Ruiz Healy ).
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Abscesso , Antibacterianos , Drenagem , Fístula Retal , Recidiva , Humanos , Fístula Retal/etiologia , Fístula Retal/cirurgia , Fístula Retal/tratamento farmacológico , Masculino , Feminino , Drenagem/métodos , Método Simples-Cego , Adulto , Pessoa de Meia-Idade , Abscesso/cirurgia , Abscesso/etiologia , Estudos Prospectivos , Antibacterianos/uso terapêutico , Doenças do Ânus/cirurgia , Doenças do Ânus/microbiologia , Resultado do Tratamento , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Complicações Pós-Operatórias/epidemiologiaRESUMO
Benign anorectal diseases such as hemorrhoidal disease, anal fissure, anal pruritus, perianal abscess, and fistula are the most common ones. The aim of this study was to assess sexual function in patients after surgery for benign anorectal diseases. Sixty-one male patients with perianal fistulas, operated on at Department of General Surgery, Faculty of Medicine, completed a self-administered questionnaire including the International Index of Erectile Function (IIEF) score. The median IIEF score of the postoperative patients was significantly higher (24, range [10-25]) than that of preoperative patients (22, range [5-25]), p < .0001. Sexual function is significantly influenced by surgery for benign anorectal diseases.
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Doenças do Ânus , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Doenças do Ânus/cirurgia , Adulto Jovem , Idoso , Doenças Retais/cirurgia , Fístula Retal/cirurgia , Disfunção Erétil/etiologia , Disfunção Erétil/cirurgiaRESUMO
The efficacy of surgical intervention for perianal infection in patients with hematologic malignancies is not well established. Therefore, our study aimed to investigate the clinical efficacy and complications of surgical treatment of perianal infection in patients with hematologic malignancies. This retrospective study included patients with hematological malignancies who were diagnosed with perianal infections and treated at the China Aerospace Science & Industry Corporation 731 Hospital between 2018 and 2022. Patient characteristics, hematological data, surgical intervention, and complications, including recurrence and mortality, were analyzed. This study included 156 patients with leukemia aged 2 months to 71 years who were treated surgically for perianal infection, comprising 94 males and 62 females. Perianal infection included 36 cases of abscesses, 91 anal fistulas, and 29 anal fissures accompanied by infection. A total of 36 patients developed severe complications postoperatively, including 4 patients who died, 6 patients with severe incision bleeding, 18 patients with severe pain, 6 patients with sepsis, 12 patients who needed reoperation, 15 patients with hospitalization for more than 2 weeks, and 3 patients with anal stenosis; none of the patients developed anal incontinence. Additionally, risk factors for postoperative complications of perianal infection in patients with hematologic malignancies include leukopenia, agranulocytosis, thrombocytopenia, depth of abscess and not undergone an MRI. Surgical intervention may improve the prognosis of patients with perianal abscess formation, particularly in patients who show no improvement with medical therapy and those who develop perianal sepsis. Granulocytopenia and thrombocytopenia should be improved before surgery, which can significantly reduce postoperative complications. Although these findings are from a case series without a comparator, they may be of value to physicians because to the best of our knowledge, no randomized or prospective studies have been conducted on the management of perianal infections in patients with hematological malignancies.
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Abscesso , Neoplasias Hematológicas , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Idoso , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/cirurgia , Abscesso/cirurgia , Abscesso/etiologia , Adolescente , Criança , Adulto Jovem , Doenças do Ânus/cirurgia , Pré-Escolar , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Lactente , Fístula Retal/cirurgia , Fístula Retal/etiologia , Resultado do Tratamento , Fissura Anal/cirurgiaRESUMO
BACKGROUND The incidence of human immunodeficiency virus (HIV) infection is on the rise, and perianal region diseases in HIV-infected patients have become increasingly prevalent. This study aimed to analyze the surgical treatment outcomes of HIV-infected patients presenting with perianal concerns. MATERIAL AND METHODS We included 311 HIV-positive patients admitted to the Infectious Diseases Clinic of Samsun Training and Research Hospital between January 2014 and December 2022. From this group, we selected those who sought care at the general surgery outpatient clinic for perianal and anal concerns, retrospectively reviewing their medical records. RESULTS Out of 311 patients, 54 (17.3%) were referred to the general surgery outpatient clinic with anal and/or perianal region complaints. Of these cases, 38 (70.3%) had a single disease, while 16 (29.6%) had combined diseases. There were 20 males (95%) and 1 female (5%). Among these 54 patients, 33 (61.1%) received medical treatment from the outpatient clinic, while 21 (38.9%) underwent surgical intervention. The diagnoses included 22 hemorrhoidal diseases, 24 anal condylomas, 15 anal fissures, 11 anal abscesses, and 4 anal fistulas. We evaluated the postoperative results and recurrence status of these patients. CONCLUSIONS Perianal diseases in HIV-positive patients can be categorized as isolated or combined. The management of patients with postoperative follow-up compliance problems and combined diseases with low CD4 counts may pose treatment challenges.
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Doenças do Ânus , Infecções por HIV , Masculino , Humanos , Feminino , Estudos Retrospectivos , Pacientes Ambulatoriais , Turquia/epidemiologia , Doenças do Ânus/complicações , Doenças do Ânus/cirurgia , Doenças do Ânus/epidemiologia , Infecções por HIV/complicações , Complicações Pós-OperatóriasRESUMO
En este reporte presentamos tres pacientes en quienes ocurrieron condiciones inflamatorias perianales tardías, luego de la administración de sustancias modeladoras no identificadas en los glúteos. El diagnóstico inicial y supuesto no fue correcto, ya que no se investigó durante la evaluación preliminar el antecedente de la administración de elementos modeladores. Recomendamos que los pacientes con patologías inflamatorias del ano, sobre todo aquellos cuyo curso es extraño, se les pregunte acerca de la administración de agentes modeladores en los glúteos. Esta práctica puede contribuir a la eficacia del diagnóstico de manifestaciones perianales caracterizadas por flogosis, que se presentan de forma inusual. (AU)
In this report we present three patients in which late perianal inflammatory conditions occurred after administration of unidentified modeling agents to the buttocks. The initial diagnosis was not correct because of the administration of modeling agents was not investigated during the initial eval-uation. We recommend inquiring patients with inflammatory pathologies of the anus, especially those whose course is unusual, about the adminis-tration of modeling agents to the buttocks. This approach can contribute to the efficiency of the diagnosis of perianal complaints characterized by inflammation, but rare in its appearance. (AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças do Ânus/cirurgia , Doenças do Ânus/etiologia , Biopolímeros/efeitos adversos , Nádegas/cirurgia , Doenças do Ânus/diagnóstico , Técnicas Cosméticas , Migração de Corpo Estranho , Implantação de Prótese/efeitos adversosRESUMO
BACKGROUND: Anorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26-37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula. METHOD: The aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months). DISCUSSION: This clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess. TRIAL REGISTRATION: EudraCT Number: 2021-003376-14. Registered on November 26, 2021.
Assuntos
Doenças do Ânus , Fístula Retal , Dermatopatias , Adulto , Humanos , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/prevenção & controle , Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Doenças do Ânus/complicações , Doenças do Ânus/prevenção & controle , Doenças do Ânus/cirurgia , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Fístula Retal/prevenção & controle , Drenagem/efeitos adversos , Drenagem/métodos , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como AssuntoRESUMO
INTRODUCTION: Pediatric patients with perianal Crohn's Disease (CD) suffer recalcitrant fistulas, abscesses, and strictures. Fecal diversion is a palliative last resort, but the expected clinical course and long-term management of the ostomy for this population is unclear. We sought to identify factors predictive of ostomy takedown and establish management recommendations for fistulizing and stenosing disease. METHODS: We reviewed our institutional registry for patients aged 1-18 years with CD who received perianal surgery from 2011 to 2021. We analyzed medical therapy, examinations under anesthesia (EUA), fistula and stenosis response, and rates of fecal diversion and reversal. RESULTS: There were 109 patients with fistulizing CD and 21 with stenosing CD. There were 8 diverted for fistula and 4 due to stricture [8/109 (7 %) vs 4/21 (19 %), p = 0.213]. Three patients with fistulizing disease had their ostomy reversed at an average of 1.46 years. Each demonstrated consistent CD control and with no additional perianal flares. The remainder have been diverted 3.15 ± 4.57 years with 2.1 ± 2.8 EUAs. Only one patient with stricture was durably reversed, but they still require serial anal dilation. Two were reversed but required re-diversion due to stricture progression. CONCLUSION: Reversal rates after fecal diversion for pediatric perianal CD remain disappointingly low and diversion does not obviate the possibility of future EUAs. While reversal was successful for medically responsive patients with fistulizing disease, those with stenosing disease remained dependent on anal dilations and were more likely to fail reversal. Fecal diversion does nothing to reverse an established stricture and such patients will likely need to decide between indefinite dilations or permanent ostomy. LEVEL OF EVIDENCE: IV. TYPE OF STUDY: Retrospective review.
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Doença de Crohn , Estomia , Humanos , Doença de Crohn/complicações , Doença de Crohn/cirurgia , Criança , Adolescente , Masculino , Feminino , Pré-Escolar , Estudos Retrospectivos , Lactente , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Doenças do Ânus/cirurgia , Doenças do Ânus/etiologiaRESUMO
BACKGROUND: Acute surgical units (ASU) are increasingly being adopted and in our system are staffed by colorectal and non-colorectal general surgeons. This study aims to evaluate whether surgeon specialization was associated with improved outcomes in perianal abscess. METHODS: Patients with perianal abscess admitted to the ASU between 2016 and 2020 were identified from a prospective database and their medical records reviewed. Patients with IBD, treatment for fistula-in-ano within the preceding year, or perianal sepsis of non-cryptoglandular origin were excluded. Patients admitted under an ASU colorectal (CR) consultant were compared with those under a non-CR general surgeon in a retrospective cohort study. Primary outcome was perianal abscess recurrence. For those without initial fistula, hazard of recurrent abscess or fistula was analysed. Multivariable Cox PH regression analysis was performed. RESULTS: Four-hundred and eight patients were included (150 CR, 258 non-CR). The CR group more frequently had a fistula identified at index operation (34.0% versus 10.9%, P < 0.0001). However, Cox multivariable analysis found no difference in hazard of recurrent abscess between groups (HR 1.12, 95% CI 0.65-1.95, P = 0.681)). Abscess recurred in 18.7% CR and 15.5% non-CR. Subsequent fistula developed in 14.7% in both groups. For patients without initial fistula, there was no difference between groups in hazard of recurrent abscess or fistula (HR 1.18, 95% CI 0.69-2.01, P = 0.539). CONCLUSION: Surgeon specialization was not associated with improved outcomes for ASU patients with perianal abscess, albeit with potential selection bias. CR surgeons were more proactive identifying fistulas; this raises the possibility that drainage alone may be adequate treatment.
Assuntos
Abscesso , Doenças do Ânus , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Abscesso/cirurgia , Adulto , Doenças do Ânus/cirurgia , Recidiva , Resultado do Tratamento , Fístula Retal/cirurgia , Cirurgiões , Doença Aguda , Especialização , IdosoRESUMO
PURPOSE: Anal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the development of anal fistulas are sparse. This study aimed to identify the risk factors for anal fistulas after anal abscess surgery. METHODS: This was a multicentre, retrospective cohort study of patients undergoing acute surgery for anal abscesses in the Capital Region of Denmark between 2018 and 2019. The patients were identified using ICD-10 codes for anal abscesses. Predefined clinicopathological factors and postoperative courses were extracted from patient records. RESULTS: A total of 475 patients were included. At a median follow-up time of 1108 days (IQR 946-1320 days) following surgery, 164 (33.7%) patients were diagnosed with an anal fistula. Risk factors for developing fistulas were low intersphincteric (OR 2.77, 95CI 1.50-5.06) and ischioanal (OR 2.48, 95CI 1.36-4.47) abscesses, Crohn's disease (OR 5.96, 95CI 2.33-17.2), a history of recurrent anal abscesses (OR 4.14, 95CI 2.47-7.01) or repeat surgery (OR 5.96, 95CI 2.33-17.2), E. coli-positive pus cultures (OR 4.06, 1.56-11.4) or preoperative C-reactive protein (CRP) of more than 100 mg/L (OR 3.21, 95CI 1.57-6.71). CONCLUSION: Several significant clinical risk factors were associated with fistula development following anal abscess surgery. These findings are clinically relevant and could influence the selection of patients for specialised follow-up, facilitate expedited diagnosis, and potentially prevent unnecessarily long treatment courses.
Assuntos
Doenças do Ânus , Fístula Retal , Humanos , Abscesso/complicações , Abscesso/diagnóstico , Estudos Retrospectivos , Escherichia coli , Doenças do Ânus/complicações , Doenças do Ânus/cirurgia , Fístula Retal/complicações , Fístula Retal/cirurgia , Drenagem/efeitos adversos , Resultado do TratamentoRESUMO
RATIONALE: Perianal abscess is a common disease of the anus and intestine. Surgery is an important treatment option for perianal abscess. However, some patients have a long healing time, poor healing effect after surgery, or even pseudo-healing. Platelet-rich plasma (PRP) is rich in platelets that can release a large number of factors when activated and promote wound healing. Moreover, there are few reports on the use of PRP for wounds that are difficult to heal after perianal abscess surgery. PATIENT CONCERNS: The patient had reported a complaint of perianal swelling and discomfort associated with anal pain, which was considered a perianal abscess. Ceftriaxone, fumigation, and sitz bath were administered after mixed hemorrhoid and perianal abscess surgeries were performed; however, the wound remained unhealed for more than 3 months, and there was a fistula under the skin. DIAGNOSIS: Perianal color ultrasonography revealed perianal abscess. INTERVENTIONS: Autologous PRP treatment was performed 5 times for each patient. OUTCOMES: The postoperative wound healed within 15 days after 5 times PRP treatments. LESSONS: PRP is a novel treatment option for pseudo-healing.
Assuntos
Doenças do Ânus , Plasma Rico em Plaquetas , Fístula Retal , Dermatopatias , Humanos , Abscesso/cirurgia , Abscesso/complicações , Fístula Retal/etiologia , Fístula Retal/cirurgia , Doenças do Ânus/cirurgia , Pele , Dermatopatias/complicações , Resultado do TratamentoRESUMO
OBJECTIVE: To study the influence of clinical characteristics and diagnosis and treatment methods of perianal abscess on postoperative recurrence or formation of anal fistula to provide a basis for selecting appropriate surgical and inspection methods for clinical treatment of perianal abscess in the future. METHODS: The clinical data of 394 patients with perianal abscesses were collected, the influencing factors were investigated, and univariate analysis and multivariate logistic regression analysis were performed to further determine the risk factors affecting the prognosis of perianal abscess. RESULTS: The results showed that the rate of preoperative blood routine results in the uncured group was higher (51.16%) than in the cured group (35.61%); the rate of high abscess space in the uncured group (23.26%) was higher than in the cured group (9.11%); the proportion of patients in the uncured group who underwent magnetic resonance imaging (MRI) before surgery (27.90%) was lower than in the cured group (45.30%); the proportion of patients in the uncured group who underwent simple drainage (51.16%) was higher than in the cured group (28.49%). The two groups had significant differences in perineal MRI examination, surgical method, preoperative blood routine, and abscess space (p = 0.030, p = 0.002, p = 0.047 and p = 0.010, respectively). Based on the results of univariate analysis and multivariate logistic regression analysis, the extent of the abscess cavity (OR = 2.544, 95%CI = 1.087-5.954, p = 0.031) and the surgical method (OR = 2.180, 95%CI = 1.091-4.357, p = 0.027) were independent influencing factors for postoperative recurrence of perianal abscess or anal fistula. CONCLUSION: Preoperative assessment of the abscess range and precise intraoperative methods to resolve the infection of the abscess glands in the internal mouth can effectively improve the cure rate.
Assuntos
Doenças do Ânus , Fístula Retal , Humanos , Abscesso/cirurgia , Abscesso/diagnóstico , Abscesso/etiologia , Doenças do Ânus/cirurgia , Doenças do Ânus/diagnóstico , Doenças do Ânus/etiologia , Drenagem/métodos , Prognóstico , Fístula Retal/cirurgia , Fístula Retal/diagnósticoRESUMO
Intersphincteric resection (ISR) is the ultimate sphincter-preserving surgical technique for low rectal cancer. To promote the standardized implementation of ISR, this review discusses the important issues regarding the clinical application of ISR with reference to the latest Chinese expert consensus on ISR. In terms of ISR-related pelvic anatomy of the rectum/anal canal, hiatal ligament is not identical with the anococcygeal ligament. At the level where the rectourethralis muscle continuously extends to the posteroinferior area of the membranous urethra from the rectum, the neurovascular bundle is identified between the posterior edge of rectourethralis muscle and the anterior edge of the longitudinal muscle of the rectum. This knowledge is crucial to detect the anterior dissection plane during ISR at the levator hiatus level. The indication criteria for ISR included: (1) stage I early low rectal cancer; (2) stage II-III low rectal cancer undergoing neoadjuvant treatment, and supra-anal tumors and juxta-anal tumors of stage ycT3NxM0, or intra-anal tumors of stage ycT2NxM0. However, signet ring cell carcinoma, mucinous adenocarcinoma and undifferentiated carcinoma should be contraindicated to ISR. For locally advanced low rectal cancer (especially anteriorly located tumor), neoadjuvant treatment should be carried out in a standardized manner. However, it should be recognized that neoadjuvant chemoradiotherapy was a risk factor for poor anal function after ISR. For surgical approaches for ISR, including transanal, transabdominal, and transanal transabdominal approaches, the choice should be based on oncological safety and functional consequences. While ensuring the negative margin, maximal preservation of rectal walls and anal canal contributs to better postoperative anorectal function. Careful attention must be paid to complications regarding ISR, with special focus on the anastomotic complications. The incidence of low anterior resection syndrome (LARS) was higher than 40%. However, this issue is often neglected by clinicians. Thus, management and rehabilitation strategies for LARS with longer follow-ups were required.
Assuntos
Doenças do Ânus , Neoplasias do Ânus , Carcinoma de Células em Anel de Sinete , Laparoscopia , Neoplasias Retais , Humanos , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Complicações Pós-Operatórias , Laparoscopia/métodos , Canal Anal/cirurgia , Canal Anal/patologia , Neoplasias do Ânus/patologia , Doenças do Ânus/cirurgia , Síndrome de Ressecção Anterior Baixa , Carcinoma de Células em Anel de Sinete/patologia , Resultado do TratamentoRESUMO
Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.
Assuntos
Adenocarcinoma , Doenças do Ânus , Anormalidades do Sistema Digestório , Masculino , Humanos , Idoso , Canal Anal/cirurgia , Colo/cirurgia , Colectomia , Doenças do Ânus/cirurgia , Adenocarcinoma/cirurgia , Anormalidades do Sistema Digestório/cirurgiaAssuntos
Doenças do Ânus , Fístula , Hemorroidas , Humanos , Hemorroidas/cirurgia , Doenças do Ânus/cirurgiaRESUMO
Anorectal manifestations of monkeypox are increasingly being recognized as a potentially serious complication. We present the case of an HIV-positive, tecovirimat-treated male presenting with monkeypox virus-associated severe proctitis with associated perianal pathology. Despite the use of antiviral agents and intravenous vaccinia immune globulin, the monkeypox-associated perianal lesions evolved into abscesses, requiring incision and drainage. This report highlights a multidisciplinary approach involving surgery for anorectal complications of monkeypox virus-associated proctitis and perianal lesions. Surgery may offer immediate relief and reduce the potential long-term morbidity associated with severe monkeypox virus-associated rectal and perianal manifestations refractory to available medical countermeasures.
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Doenças do Ânus , Mpox , Proctite , Doenças Retais , Humanos , Masculino , Doenças Retais/cirurgia , Doenças Retais/complicações , Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/cirurgia , Reto/cirurgia , Proctite/tratamento farmacológico , Proctite/cirurgia , Proctite/complicaçõesRESUMO
BACKGROUND Anal stenosis due to anoderm scarring is usually caused by surgical trauma and decreases the patient's quality of life significantly. Even though mild anal stenosis can be treated non-surgically, surgical reconstruction is unavoidable for moderate to severe cases of anal stenosis, especially stenosis that causes severe anal pain and the inability to defecate. In this study, we report the diamond flap method in the treatment of anal stenosis. CASE REPORT A 57-year-old female patient reported difficulty and discomfort in defecation caused by anal stenosis 2 years after a hemorrhoidectomy surgery. On physical examination, a forceful dilatation was needed using the index finger; the size of the anal canal was precisely 6 mm, as measured by a hegar dilator. Laboratory tests results were normal. The patient underwent an anal repair and diamond flap procedure in which the scar tissue at 6 and 9 o'clock was excised and a diamond graft was incised carefully, with attention given to the vascular supply. Finally, the graft was sutured to the anal canal. After 2 days, the patient was discharged without any adverse event. Ten days after surgery, the diamond flap was in good condition and without any complications. The patient was then scheduled for further follow-up at the Digestive Surgery Division. CONCLUSIONS Anal stenosis due to overzealous hemorrhoidectomy is a complication that is preventable when the procedure is performed by an experienced surgeon. The diamond flap was the option used for anal stenosis treatment and had few complications.
Assuntos
Doenças do Ânus , Hemorroidectomia , Feminino , Humanos , Pessoa de Meia-Idade , Canal Anal/cirurgia , Canal Anal/patologia , Hemorroidectomia/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Qualidade de Vida , Retalhos Cirúrgicos , Doenças do Ânus/etiologia , Doenças do Ânus/cirurgia , Cicatriz/complicações , Resultado do TratamentoRESUMO
Surgery is the most important treatment for perianal abscesses. However, the gut microbiota of patients with perianal abscess and the effects of perianal abscess on the gut microbiota after surgery are unknown. In this study, significant changes in interleukin 6 and tumor necrosis factor-α in the blood of healthy subjects, patients with perianal abscesses, and patients after perianal abscess surgery were identified. 16S rRNA gene sequencing technology was used to detect the changes in the gut microbiota among 30 healthy individuals and 30 patients with perianal abscess before and after surgery. Venn diagrams and alpha diversity analyses indicated differences in the abundance and uniformity of gut microbiota between the healthy individuals and patients with perianal abscesses before and after surgery. Beta diversity analysis indicated that the grouping effects among the control, abscess, and surgery groups were good. The classification and compositional analysis showed significant differences in the gut microbiota between healthy individuals and patients with perianal abscesses before and after surgery. LEfSe analysis, random forest analysis, and ROC curve analysis showed that Klebsiella (AUC = 0.7467) and Bilophila (AUC = 0.72) could be potential biomarkers for the diagnosis of perianal abscess. The functional prediction results showed that the differential microbiota is significantly enriched in the pathways related to nutrition and drug metabolism. This study may have important implications for the clinical management and prognostic assessment of patients with perianal abscesses.