Manejo Clínico ­ Quirúrgico de pacientes con Fisura Anal en la Unidad de Coloproctología del HECAM / Clinical-Surgical Management of patients with Anal Fissure in the Unit HECAM Coloproctology

La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.

Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.

Causes and Management of Pruritus Ani.

CASE SUMMARY: A 48-year-old healthy man presented to the office reporting a long-standing history of anal pruritus. He had tried various over-the-counter creams without much success. Besides an anal fissure in the past, which responded to nitroglycerin ointment, his medical history was unremarkable. On physical examination, he was found to have grade I hemorrhoids and mild fecal smearing on perianal skin. Recent colonoscopy and laboratory work ordered by the primary care provider were normal. He was counseled on common inciting agents and local irritants and was advised on hygiene, diet modification, and stool-bulking agents. The colorectal surgeon recommended that the patient keep a journal about his symptoms, foods, and household chemicals used. He was seen twice more over the course of 6 months to pinpoint the cause of his pruritus. A short-course trial of topical steroid, barrier cream, and topical tacrolimus was not helpful. A biopsy of perianal skin was performed and was unrevealing. Eventually, given the persistence of symptoms, it was decided that he would undergo methylene blue injection to address his pruritus (Fig. 1). The procedure consisted of several intradermal and subcutaneous injections of 10 mL of 1% methylene blue combined with 7.5 mL of 0.25% bupivacaine with adrenaline (1/100,000) and 7.5 mL 0.5% lidocaine. After the methylene blue injection, the severity of his symptoms improved, but pruritus still persisted. A methylene blue injection of the same concentration was repeated in 3 months with complete resolution of symptoms.

Perianal psoriasis as the first manifestation of the disease

Introduction: Inverse psoriasis affects the skin of flexural areas, such as the groin, axillae, umbilicus, intergluteal fold, and external genitalia. Clinical Case: We herein report the case of a man who presented with anal pruritus and, upon physical examination, a perianal dermatosis was found, which was characterized by erythematous plaques, with fine scaling. The case was initially managed with zinc oxide, and when no improvement was observed, we decided to take an incisional biopsy, which indicated histological changes suggestive of psoriasiform dermatitis. Discussion: Inverse psoriasis affects 3% to 7% of patients with psoriasis, and it manifests with erythematous plaques without the classic scaling appearance. The skin in these areas is susceptible to maceration, irritation, and ulceration, which alter the classic clinical picture. It may present with typical lesions or, less frequently, in isolation in the anogenital region. In the anogenital presentation only, the diagnosis should be made by biopsy, looking for the classic histopathological features of psoriasis. As for the first-line treatment, low- or medium-potency topical steroids are used for short periods of time; the second-line treatment is with emollients and tar-based products; and the third-line treatment uses an immunomodulator. Conclusion: This presentation is infrequent, and it requires a high index of suspicion for the diagnosis, always supported by biopsies, in search of the classic histopathological features of psoriasis. (AU)

Prevalencia de enterobiasis y factores socioambientales en una zona rural de Ecuador / Prevalence of enterobiasis and socio-environmental factors in a rural area from Ecuador

La gestión de los residuos sanitarios requiere atención especial y todos los equipos sanitarios deben participar en la manipulación de los residuos. Se presta menos atención a la gestión de residuos sanitarios en países en vías de desarrollo y no hay evidencia sobre las prácticas de gestión de residuos sanitarios en algunas instituciones sanitarias. Este estudio se realizó para evaluar las prácticas de gestión de residuos sanitarios y los factores asociados en tres hospitales de Perú. Es un estudio descriptivo, cuantitativo y de corte transversal basado en tres establecimientos de salud. Los datos se recopilaron mediante cuestionarios y listas de verificación de observación. El (66,67%) de los trabajadores conocían sobre el manejo de los desechos biológicos. La mayoría conocía los riesgos asociados con el manejo de los mismos (95,91%). Los participantes tenían el conocimiento de que pueden evitarse las infecciones. Nueve de cada diez de los trabajadores realizaron por lo menos dos capacitaciones en la gestión del manejo de los desechos biológicos. El 95,91% conocía los códigos de colores correctos de los contenedores para diferentes flujos de desechos. En cuanto a las actitudes, 161 (94,15 %) indicó que la gestión de los desechos biológicos era importante y 162 (94,74%) estuvo de acuerdo en que era necesaria una implementación estricta para la gestión adecuada de los mismos en el establecimiento de salud. Elementos clave para mejorar las prácticas de gestión de residuos sanitarios en hospitales: promover prácticas que reduzcan el volumen de residuos generados y aseguren una adecuada segregación de residuos(AU)

Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes. However, less attention is paid to health care waste management in developing countries and there is no evidence on health care waste management practices in some institutions providing health services. This study was conducted to assess healthcare waste management practices and associated factors in three hospitals in Peru. It is a descriptive, quantitative and cross-sectional study based on three health establishments. Data were collected using questionnaire and observational checklists. The (66.67%) of the workers knew about the management of biological waste. The majority knew the risks associated with handling them (95.91%). Participants were aware that infections can be prevented. Nine out of ten of the workers completed at least two trainings in the management of biological waste. 95.91% knew the correct container color codes for different waste streams. Regarding attitudes, 161 (94.15%) indicated that the management of biological waste was important and 162 (94.74%) agreed that strict implementation was necessary for proper management of biological waste in the environment health facility. Key elements to improve healthcare waste management practices in hospitals: promote practices that reduce the volume of waste generated and ensure proper waste segregation(AU)

[Web search data as health data? : Geographic differences, temporal trends, and topics of interest from internet search engine analyses in Germany]. / Websearch-Daten als Gesundheitsdaten? : Geografische Unterschiede, zeitliche Trends und Interessenschwerpunkte von Internetsuchmaschinenanfragen in Deutschland.

BACKGROUND: Limited timely, cost-effective, and regional availability of healthcare data is considered one of the limiting factors for timely analyses in the field of health services research and thus for healthcare delivery to the general population. Thus, Internet search engine analyses are coming into focus in this context. OBJECTIVES: What contribution can data on the volume of Internet searches for various diseases make to the health care of the German population? Where is the potential and where are the limitations? METHODS: A review of the current literature and a selective overview of Internet search engine analyses of dermatological, allergological, and infectious diseases published in the last 4 years in Germany were performed. RESULTS: By analyzing web search data, temporal developments such as seasonality, months with the highest interest, and geographical differences can be mapped at the national, state (Bundesländer), and city level and major points of interest (e.g., skin cancer of the eye or anal itching) regarding a certain health topic can be identified. In addition, some studies were able to show correlations between search volume and external factors (e.g., temperature, care structure) and to registered cases (e.g., skin cancer, Lyme disease). CONCLUSION: Web search data, given the limitations noted, are able to directly provide spatiotemporal mapping regarding the needs of the Internet-using population. They are particularly useful in situations where traditional health data are limited or unavailable.

Adult-onset perianal Langerhans cell histiocytosis presenting as pruritus ani: a case report and review of the literature.

BACKGROUND: Langerhans cells belong to the histiocytic system and give rise to two tumors: Langerhans cell histiocytosis and Langerhans cell sarcoma. Clinical aggressiveness and degree of atypia distinguish the two neoplasms. Langerhans cell histiocytosis can infiltrate a single or multiple organ systems and particularly affects bone, skin, and lymph nodes. Perianal cutaneous Langerhans cell histiocytosis is a rare condition in adults, with 15 cases reported in the literature. CASE: We present the case of a 50-year-old hispanic man who presented with a 9-month history of pruritus ani and a personal history of diabetes insipidus. Punch biopsy confirmed a lesion of Langerhans cells origin but could not exclude Langerhans cell sarcoma because of limited sample size. An additional biopsy was planned as well as a positron emission tomography scan to determine the extent of disease spread. While the patient failed to follow up for repeat biopsy, the positron emission tomography scan was performed and was negative for metastatic disease. A stable perianal lesion of Langerhans cell histiocytosis with benign clinical features in a 50-year-old male despite lack of treatment is extremely rare and has not been described in the literature so far. Here, we review the presentation and workup of patients with Langerhans cell histiocytosis, review the relevant literature, and discuss treatment planning. CONCLUSION: Perianal Langerhans cell histiocytosis is rare, and there should be a high index of suspicion with chronic or new perianal lesions, especially in a patient with a history of diabetes insipidus. It is also important to consider the patient's full clinical course when it is not possible to reach a definitive pathological diagnosis before management.

Prurito anal en niños cubanos con dipylidiosis / Anal pruritus in Cuban children with dipylidiasis

Introducción: La dipylidiosis es una zoonosis parasitaria producida por Dipylidium caninum. La infección es más frecuente en niños que en adultos debido al estrecho contacto de los primeros con mascotas (perros y gatos). La dipylidiosis es una enfermedad benigna y autolimitada, generalmente cursa de manera asintomática, aunque en ocasiones pueden aparecer algunos síntomas. Objetivo: Exponer el caso de niños cubanos con prurito anal, forma clínica poco frecuente de presentación de la dipylidiosis. Presentación de casos: Se trata de cuatro niños de La Habana, Cuba, atendidos en la atención primaria y secundaria de salud por presentar prurito anal, acompañado de la expulsión de elementos blanquecinos móviles en las deposiciones. Se les realizó estudios de las heces y técnica de Graham, con resultados negativos. La falta de diagnóstico etiológico de una posible parasitosis, propició la remisión de los casos al Laboratorio Nacional de Referencia de Parasitología del Instituto de Medicina Tropical Pedro Kouri donde se interrogó a las madres y se indicaron exámenes de las heces, que identificaron D. caninum. Conclusión: Ante niños con prurito anal, forma clínica de presentación poco frecuente de la dipylidiosis, es necesario hacer el diagnóstico diferencial de esta taeniosis zoonótica y solicitar el diagnóstico parasitológico para confirmar la parasitosis. Los resultados negativos obtenidos en la atención primaria y secundaria de salud, hacen sospechar el desconocimiento del diagnóstico de esta zoonosis parasitaria en la red nacional de salud, que, además, produjo demora de dicho diagnóstico y su confirmación en el nivel terciario de salud(AU)

Introduction: Dipylidiasis is a parasitic zoonosis produced by Dipylidium caninum. The infection is more frequent in children than in adults due to the close contact of children with pets (dogs and cats). Dipylidiasis is a benign and self-limiting disease, usually occurs asymptomatically, although sometimes some symptoms may appear. Objective: Present the case of Cuban children with anal pruritus, a rare clinical form of presentation for dipylidiasis. Presentation of cases: Four children from Havana, Cuba, treated in primary and secondary health care services after presenting anal pruritus, accompanied by the withdraw of mobile whitish elements in the stools. Stool studies and Graham's technique were performed, with negative results. The lack of etiological diagnosis of a possible parasitosis, led to the referral of the cases to the National Reference Laboratory of Parasitology of Pedro Kouri Institute of Tropical Medicine where the mothers were questioned and stool tests were indicated, which identified D. caninum. Conclusion: In children with anal pruritus, a rare clinical form of presentation of dipylidiasis, it is necessary to make the differential diagnosis of this zoonotic taeniosis and request the parasitological diagnosis to confirm this parasitosis. The negative results obtained in primary and secondary health care services make suspect the ignorance of the diagnosis of this zoonotic taeniosis in the national health network, which, in addition, produced delay in the diagnosis and its confirmation at the tertiary level of health(AU)

Melanoma anal, patología infrecuente, reporte de un caso / Anal melanoma uncommon pathology, case report / Melanoma anal, patologia infreqüente, relato de um caso

El melanoma anal (MA) es un tumor infrecuente, caracterizado por presentar un comportamiento agresivo y mal pronóstico(1). La sintomatología inespecífica con la cual se presenta y su similitud con etiologías benignas anorrectales, dificulta el diagnóstico y puede conducir a un retraso en el mismo(2)(3). Por lo tanto, es necesaria una exploración física minuciosa y un elevado índice de sospecha. Se discute el caso de una paciente que consultó por tumoración anal dolorosa, no pigmentada y rectorragia; a la que se le realiza diagnóstico de melanoma anal.

Anal melanoma (MA) is an infrequent tumor, characterized by aggressive behavior and poor prognosis(1). The nonspecific symptomatology and its similarity with benign anorectal etiologies, makes the diagnosis difficult and leads to a delay in it(2)(3).Therefore, a thorough physical examination and a high index of suspicion are necessary. The case of a patient who consulted for a non-pigmented and painful anal mass with rectal bleeding is discussed; which is diagnosed with anal melanoma.

O melanoma anal (MA) é um tumor infrequente, caracterizado por apresentar um comportamento agressivo e ter um mauprognóstico(1). A sintomatologia inespecífica da sua apresentação e a sua similaridade com etiologias benignas anorretais dificultam o diagnóstico e pode levar a um atraso do mesmo(2)(3). Por tanto é necessário uma exploração física minuciosa e um indice de suspeita elevado. Discute-se o um caso de uma paciente que consultou por uma tumoração anal, dolorosa, não pigmentada e retorragia, a qual se realizou o diagnostico de melanoma anal.

Melanoma del canal anal: a propósito de un caso / Melanoma of the anal canal: a propos of a case

RESUMEN Los melanomas mucosos son tumores poco frecuentes y de mal pronóstico. Presentan un comportamiento agresivo, y pueden tener varias localizaciones en el aparato digestivo. Este tipo de tumores es más frecuente en la región anorectal. Se presentó un caso de una paciente femenina de 59 años, con un cuadro de varios meses de evolución; caracterizado por ardor, prurito anal y sensación de masa que prolapsaba a través del ano. Se constató al examen físico masa tumoral aspecto polipoideo. Se realizó polipectomía donde la biopsia arrojó como resultados el aspecto histológico de un melanoma mucoso de canal anal.

ABSTRACT Mucous melanomas are few frequent and have a bad prognosis. They present an aggressive behavior and might have several locations in the digestive system. This kind of tumors is more frequent at the anus-rectal region. The authors presented the case of a female patient, aged 59 years, with clinical conditions of several months of evolution, characterized by burning, anal pruritus and the sensation of a mass prolapsing through the anus. A tumor mass of polypoid aspect was found at physical examination. Polypectomy was carried out and the biopsy showed the histologic aspect of a mucous melanoma of the anal canal.

Long-term follow-up of intradermal injection of methylene blue for intractable, idiopathic pruritus ani.

BACKGROUND: While various medical treatments such as topical steroid ointment, antihistamine agent, and sedatives have been used for treating idiopathic intractable pruritus ani, they are not long-term solutions, due to the high recurrence rate. The aim of this study was to determine the effect of methylene-blue intradermal-injection therapy for treating patients with idiopathic intractable pruritus ani. Symptom improvement and recurrence rates were determined with a long-term follow-up. METHODS: A retrospective study was conducted from January 2011 to October 2013 on consecutive patients with intractable pruritus ani treated with methylene-blue intradermal injection. The therapy included 5 ml of 1% methylene blue and 15 ml of 1% lidocaine. Follow-up included a physical exam and satisfaction-score survey (1 = much worse, 2 = worse, 3 = no improvement, 4 = much better, 5 = gone completely) before treatment, 6 weeks after treatment, and 3 years after treatment to check patient status and recurrence rate. RESULTS: Of 103 treated patients, 96 were able to attend the 6-week follow-up visit. There were 58 (60.4%) males and 38 (39.6%) females with a mean age of 48.34 ± 10.21 years. Their mean satisfaction score at 6 weeks was 4.23 ± 0.86. Of the total of 96 patients, 9 (9.4%) patients scored 3 or less in their satisfactions score at 6 weeks. 62 (64.6%) patients were evaluated 3-year post-treatment. The satisfaction score at 3 years after treatment was 4.74 ± 0.57. Besides the 9 patients who initially failed treatment, 4 of the remaining 53 patients scored 3 or less in their satisfaction score surveys. Thus, the recurrence rate at 3 years was 7.5% (4/53). CONCLUSIONS: Methylene-blue intradermal injection can result in a high symptom improvement rate with low recurrence rate for patients with idiopathic pruritus ani.

Itch in Special Skin Locations Management.

Itch management can be particularly complicated in some small areas like the scalp or the anogenital region for many reasons: the frequently poor diagnosis of the causes of itch in these areas, the dense innervation of these areas, and the symbolic value of these areas for the human psyche. The diagnosis of itchy scalp is easier than that of anogenital pruritus. Clinical examination and a careful inventory of all diseases of the patient and of the local environment are necessary. Localized treatments are frequently used at both sites, whereas specific pharmaceutical formulations are necessary for the pilose or the mucous environment. Nonetheless, systemic treatments or psychological interventions can be very useful.

[Differential diagnosis of anal eczema]. / Differenzialdiagnose des Analekzems.

Dermatologic disorders often show involvement of the (peri)anal skin. However, diagnosis of (peri)anal dermatoses is often difficult even for experienced dermatologists due to delayed clinical presentation or prior treatment with over-the-counter medications. The distinct anatomical conditions of the (peri)anal region results in atypical clinical presentation of common dermatoses. Typical symptoms include pruritus, burning, bleeding and pain. Careful history of symptoms, stool, hygiene, sexual practice as well as thorough inspection of the entire body and proctological examination are crucial to make the correct diagnosis. In case of atypical presentation or uncertainty a biopsy needs to be obtained to ensure correct diagnosis and treatment.

[Pseudo-condylomatous neurodermatitis of the anal margin]. / Forme pseudo-condylomateuse d'une nevrodermite de la marge anale.

Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better compared to arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnostic. We studied 30 cases of CVT diagnosed in the department of neurology of the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%) , consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behcet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes was observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated.

Common anorectal conditions: evaluation and treatment.

Anorectal conditions are frequently encountered clinical entities but are often misunderstood and misdiagnosed. Although the most common anorectal disorders are not considered life threatening, they can negatively impact patients' activities of daily living and quality of life. Comprehensive anorectal examination, including the use of anoscopy, has become a "lost art," and graduate medical education programs should utilize more formal training in this area. This review discusses the comprehensive anorectal exam and the diagnosis and management of three common anorectal disorders: hemorrhoids, anal fissure, and pruritus ani.

Management and outcome of perianal Paget's disease: a 6-decade institutional experience.

BACKGROUND: Perianal Paget's disease (intraepithelial adenocarcinoma) is rare and sometimes difficult to diagnose because symptoms are nonspecific. It is often noninvasive but frequently recurs locally. Invasive disease can metastasize to distant sites. OBJECTIVE: The purpose of this work was to review the diagnosis, management, and outcomes of patients with perianal Paget's disease. DESIGN: Institutional databases were queried for all of the cases of perianal Paget's disease at Memorial Sloan-Kettering Cancer Center between 1950 and 2011. Clinicopathologic factors were investigated for association with recurrence and survival. SETTINGS: The study was conducted at a tertiary care center. PATIENTS: Sixty-five patients with perianal Paget's disease were included in the study (35 women [54%]; median age at diagnosis, 66 years [range, 60-72 years]; and 41 with invasive disease/24 with noninvasive disease). A total of 56% with invasive disease were men. MAIN OUTCOME MEASURES: Measures included median follow-up, disease status, local and distant recurrence, sites of recurrence, disease-specific survival, overall survival, and treatment modality. RESULTS: A total of 95% with invasive disease and 87% with noninvasive disease were symptomatic at presentation. The most common symptoms were pruritus and perianal bleeding. The duration of symptoms was longer in patients with invasive (12.0 months; range, 4.0-18.0 months) versus noninvasive (3.5 months; range, 1.0-10.0 months) disease. Synchronous malignancies unrelated to the primary disease were noted in 5 patients with invasive disease and 3 with noninvasive disease. Noninvasive disease was treated with a wide local excision and invasive disease with a wide local excision (n = 32, 78%) or abdominoperineal resection (n = 9, 22%). Forty-one patients (27 invasive and 14 noninvasive) required multiple operations for tumor clearance. In those with invasive disease, the median time to recurrence was 5 years, and the median tumor-specific survival rate was 10 years. LIMITATIONS: This was a retrospective study, limited by selection bias. CONCLUSIONS: Perianal Paget's disease is associated with nonspecific symptoms, frequently delaying diagnosis. Wide local excision is the treatment of choice if negative margins can be obtained. Abdominoperineal resection should be considered for invasive disease. Local recurrence is common; follow-up includes periodic proctoscopy and digital examination. Invasive disease can metastasize to distant sites; follow-up should include the examination of inguinal lymph nodes and the imaging of liver and lungs.

Pruritus ani: diagnosis and treatment.

Pruritus ani is a common condition with multiple causes. Primary causes are thought to be fecal soiling or food irritants. Secondary causes include malignancy, infections including sexually transmitted diseases, benign anorectal diseases, systemic diseases, and inflammatory conditions. A broad differential diagnosis must be considered. A reassessment of the diagnosis is required if symptoms or findings are not responsive to therapy. The pathophysiology of itching, an overview of primary and secondary causes, and various treatment options are reviewed.

Diagnosis and treatment of perianal Crohn disease: NASPGHAN clinical report and consensus statement.

Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract that includes both Crohn disease (CD) and ulcerative colitis. Abdominal pain, rectal bleeding, diarrhea, and weight loss characterize both CD and ulcerative colitis. The incidence of IBD in the United States is 70 to 150 cases per 100,000 individuals and, as with other autoimmune diseases, is on the rise. CD can affect any part of the gastrointestinal tract from the mouth to the anus and frequently will include perianal disease. The first description connecting regional enteritis with perianal disease was by Bissell et al in 1934, and since that time perianal disease has become a recognized entity and an important consideration in the diagnosis and treatment of CD. Perianal Crohn disease (PCD) is defined as inflammation at or near the anus, including tags, fissures, fistulae, abscesses, or stenosis. The symptoms of PCD include pain, itching, bleeding, purulent discharge, and incontinence of stool. In this report, we review and discuss the etiology, diagnosis, evaluation, and treatment of PCD.

Prurito anal idiopático: revisión bibliográfica y presentación de protocolo de tratamiento / Idiopathic pruritus ani: literature review and presentation of treatment protocol

Introducción: El prurito anal es un síntoma de difícil tratamiento en ausencia de factores predisponentes. Cuando no se logra identificar una causa evidente es habitualmente llamado "prurito anal esencial, primario o idiopático" y en los casos de adjudicarse el síntoma a otra patología se lo refiere como prurito anal secundario. El prurito anal esencial es una patología que representa un desafío para el médico tratante debido al poco consenso sobre el tratamiento de la misma. Objetivo: Realizar una revisión bibliográfica sobre prurito anal primario o idiopático. Presentar un algoritmo de diagnóstico y de tratamiento de pacientes que consultan por esta patología. Efectuar una evaluación inicial de los resultados obtenidos a corto plazo. Lugar de aplicación: Centro Privado de Cirugía y Coloproctología de la Ciudad de Buenos Aires. Diseño: Estudio retrospectivo, descriptivo, observacional y longitudinal. Pacientes y métodos: Se presentan 24 pacientes con diagnóstico de prurito anal esencial que fueron sometidos a tratamiento escalonado del mismo. Resultados: Se obtuvo respuesta favorable completa (ausencia del síntoma prurito por un período mayor a 15 días y con ausencia de lesiones por rascado) en 22 de los 24 pacientes (91,66%), en 2 pacientes (8,33%) se obtuvo respuesta casi completa (mejoría que se traduce en prurito leve sin lesiones cutáneas). No hubo recurrencias ni empeoramiento de los síntomas en ningún paciente. Conclusiones: La mayoría de los casos de prurito anal se deben a una causa coloproctológica o dermatológica, siendo menos frecuentes los casos en los que no se observa una causa responsable. Esta situación tiene relativa frecuencia y representa un desafío tanto para el médico tratante como para el paciente.

Introduction: Pruritus ani is a symptom of difficult treatment in the absence of predisposing factors. When not able to identify an obvious cause is usually called "essential, primary or idiopathic pruritus ani" and in case of winning the symptom to another condition is referred secondary anal itching. The idiopathic anal pruritus is a condition that poses a challenge to the treating physician due to little consensus on the treatment of it. Objetive: To review the literature on primary or idiopathic pruritus ani. To present an algorithm for diagnosis and treatment of patients who consult for this condition. Make an initial assessment of the results obtained in the short term follow-up. Application site: Private Center of Surgery and Coloproctology of the city of Buenos Aires. Design: Retrospective, descriptive, observational and longitudinal study. Patients and Methods: We present 24 patients with idiopathic anal pruritus underwent treatment in stages. Results: Favorable response was obtainded (absence of pruritlls for a period exceeding 15 days and with no scratching injuries) in 22 of 24 patients (91,66%), in 2 patients (8,33%) was obtained almost response almost complete (resulting in improvement mild itching without skin lesions). There was no recurrence or worsening of symptoms in any patient. Conclusions: Most cases of anal pruritus due to one cause dermatological or proctology, being less frequent cases in which there is observed a cause responsible. This situation is relatively common and poses a challengue for both physician and patient.