RESUMO
PURPOSE: Management of perianal Crohn's disease is still controversial, and reports on large series are very few in the literature. The aim of this multicenter study was to investigate the outcome of both medical and surgical treatment in 225 patients. METHODS: Patients cared for at different institutions were followed up for a median of six years. Most of them had either anal fistula or an abscess (86 percent and 43 percent, respectively), but fissures were also present in 26 percent of the cases. Diarrhea and anal pain were the most common symptoms. Anal lesions preceded the onset of intestinal symptoms in 19 percent of cases. RESULTS: Medical treatment was curative only in 21 of 123 patients. Overall, medical and surgical treatment either cured or improved 62 percent of the cases. Fifty percent had an intestinal resection. Abscess drainage and fistulotomy were the most common anal surgeries. Rectovaginal fistulas (n = 30) required intestinal surgery in 36 percent and anal surgery in 20 percent of the cases, 50 percent with good results. Of 166 patients who had anal surgery, 97 (58 percent) had a positive outcome. Recurrence of anal disease requiring further surgery occurred in 24.5 percent of the cases. CONCLUSIONS: Limited surgeries seem to achieve satisfactory results in more than one-half of the patients affected by perianal Crohn's lesions, whereas medical treatment alone is curative in a small portion of them.
Assuntos
Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/cirurgia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácidos Aminossalicílicos/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Doenças do Ânus/classificação , Criança , Colostomia/métodos , Doença de Crohn/diagnóstico , Feminino , Seguimentos , Humanos , Ileostomia/métodos , Masculino , Mesalamina , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Reoperação , Sulfassalazina/uso terapêutico , Resultado do TratamentoRESUMO
The presence of candida and other fungi was investigated in 300 patients referred with anal problems of diverse aetiology. Candida was present in 13% and played a pathogenic role in about 50% of all positive cultures. It is concluded that cultural tests for fungal pathogens should always be performed in cases of anal itching or burning combined with other anal skin problems.
Assuntos
Candidíase/etiologia , Doenças Retais/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Ânus/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Fístula Retal/cirurgia , Canal Anal/cirurgia , Humanos , Métodos , Fístula Retal/classificaçãoRESUMO
The cryonecrosis process of haemorrhoids and cryonecrosis of living organic tissues follow the same laws. On the basis of these observations and of personal experience, the cryohaemorrhoidectomy technique is described and its most important practical aspects underlined.
