This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal disease...This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.展开更多
This article examines the complex relationship between disease perception,negative emotions,and their impact on postoperative recovery in patients with perianal diseases.These conditions not only cause physical discom...This article examines the complex relationship between disease perception,negative emotions,and their impact on postoperative recovery in patients with perianal diseases.These conditions not only cause physical discomfort,but also carry a significant emotional burden,often exacerbated by social stigma.Psycho-logical factors,including stress,anxiety,and depression,activate neuroendocrine pathways,such as the hypothalamic–pituitary–adrenal axis,disrupting the gut microbiota and leading to dysbiosis.This disruption can delay wound healing,prolong hospital stay,and intensify pain.Drawing on the findings of Hou et al,our article highlights the critical role of illness perception and negative emotions in shaping recovery outcomes.It advocates for a holistic approach that integrates psychological support and gut microbiota modulation,to enhance healing and improve overall patient outcomes.展开更多
[Objectives]To investigate the use of the classical Chinese medicine formula Sihu Powder modified decoction for postoperative fumigation and sitz bath in patients with perianal abscess,aiming to promote wound healing ...[Objectives]To investigate the use of the classical Chinese medicine formula Sihu Powder modified decoction for postoperative fumigation and sitz bath in patients with perianal abscess,aiming to promote wound healing and reduce medical burden.[Methods]An observational cohort study was conducted,selecting 200 patients with perianal abscess who underwent surgery in Shenzhen Guangming District People's Hospital.They were randomly divided into a treatment group and an observation group,with 100 cases in each group.Both groups followed the same surgical and antibiotic treatment principles.Starting from the first postoperative day,the treatment group received fumigation and sitz bath with modified Sihu Powder for decoction twice daily;the observation group used Compound Huangbai Liquid for fumigation and sitz bath twice daily.Indicators including pain score,wound secretion score,wound granulation tissue growth score,multidrug-resistant bacterial infection clearance rate,antibiotic usage days,and wound healing rate were observed in both groups 7,14 and 21 d after operation.[Results]On postoperative day 7,the differences in postoperative pain score,wound secretions,and multidrug-resistant bacterial clearance rate between the treatment group and the observation group were statistically significant.On postoperative day 14,the differences between the two groups were significant in indicators including pain score,wound secretions,wound granulation tissue growth,multidrug-resistant bacterial clearance rate,and wound healing rate.On postoperative day 21,the difference in wound healing rate between the two groups was significant;furthermore,the antibiotic usage days in the treatment group were significantly fewer than those in the observation group.[Conclusions]Modified Sihu Powder for fumigation and washing can effectively alleviate postoperative pain in perianal abscess patients,inhibit the colonization and infection of multidrug-resistant bacteria at the wound site,accelerate wound healing,reduce antibiotic usage intensity and medical burden.It possesses advantages such as being economical,effective,safe,and easy to operate,making it worthy of clinical promotion.展开更多
BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a te...BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a tertiary coloproctology reference center.METHODS Seventy-two patients who underwent surgical intervention for perianal fistula between August 2019 and January 2023 were treated using a modified fistulotomy technique.In this approach,the fistula tract was excised from the external opening up to the external sphincter fibers.The internal orifice was widened,and the septic focus within the inter sphincteric space was curetted.Partial internal sphincterotomy was performed up to the inter sphincteric plane.The anoderm from the internal orifice to the inter sphincteric space was closed with absorbable suture material,and a loose seton was placed at the level of the external sphincter.RESULTS The 72 patients who underwent modified fistulotomy were 77.8%male and 22.2%female,with a mean age of 42.2±11.5 years.The median follow-up period was 19 months.Preoperatively,93.1%of patients had high trans sphincteric fistulas,and 6.9%were females with anterior low trans sphincteric fistulas.In all cases,setons were placed during surgery using vascular tape.A total of 12.5%of patients experienced incontinence,involving gas(6.9%)or soiling(5.6%).There were no reports of solid or liquid incontinences.Complete healing was achieved in 83.3%of the patients,with a recurrence rate of 4.2%and a non-healing rate of 12.5%.CONCLUSION Our preliminary analysis suggests that this modified fistulotomy technique that targets distalization of the internal orifice is a promising alternative management strategy for perianal fistulas.展开更多
Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particu...Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particularly anti-tumor necrosis factor agents,the majority of patients still require surgical intervention.Accurate diagnosis and monitoring are essential to optimise outcomes and guide multidisciplinary management.Although clinical scoring systems such as the perianal disease activity index are widely used,their subjective application limits their reproducibility and reliability,underscoring the need for more objective methods of evaluating perianal fistulising Crohn’s disease activity.Imaging has thus become central to the objective assessment of perianal fistulising Crohn’s disease,with magnetic resonance imaging(MRI)recognised as the gold standard in view of its ability to provide clear,detailed images of the perianal region in a radiation-free manner.Guidelines also endorse the use of imaging modalities such as endoanal ultrasound and transperineal ultrasound as viable alternatives to MRI for the assessment of perianal fistulising Crohn’s disease in centres with appropriate expertise.This article aims to evaluate and compare the diagnostic accuracy and clinical utility of MRI,endoanal ultrasound,and transperineal ultrasound in the assessment of perianal fistulising Crohn’s disease,highlighting their respective strengths,limitations,and roles in clinical practice.展开更多
BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world ...BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development,treatment failure,and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies,reduce treatment burden,and improve outcomes in patients with CPF.AIM To describe the epidemiology,treatments,outcomes,and associated risk/protective factors for complex CPF.METHODS Electronic databases(MEDLINE,EMBASE,EBM Reviews,EconLit)were searched.Two reviewers independently used populations,interventions,comparators,outcomes,study designs,and time criteria to identify relevant studies.Observational studies published in English from January 1,2015 to February 17,2022 with>50 patients were included,even if complex CPF was not defined.Items of interest included complex CPF definitions,epidemiology,treatment patterns,morbidity,mortality,and risk factors associated with complex CPF development,treatment failure,and undergoing multiple surgeries.Data were reported using descriptive statistics.RESULTS Overall,140 studies were included.Complex CPF definitions were heterogeneous and rarely reported(24 studies).Hence,data mostly related to CPF in general.CPF prevalence was variable(range:1.5%-81.0%).Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn’s disease diagnosis(range:3.5%-50.1%).Overall healing and failure rates after treatment were in the range of 10.5%-80.2%and 3.6%-83.0%,respectively.Abscesses were the most frequently reported morbidity(n=18).No CPF-related deaths were reported.No consistent risk or protective factors were identified.CONCLUSION Epidemiology,treatment patterns,and risk factors for CPF vary,likely due to inconsistent CPF and clinical outcome definitions.Standardization would facilitate comparability,which may inform optimal complex CPF treatment strategies.展开更多
Perianal fistulizing Crohn’s disease(PFCD)is a common presentation of CD,which affects the patients’quality of life,including social and sexual function.The management of PFCD remains a critical challenge in inflamm...Perianal fistulizing Crohn’s disease(PFCD)is a common presentation of CD,which affects the patients’quality of life,including social and sexual function.The management of PFCD remains a critical challenge in inflammatory bowel disease,primarily due to limited understanding of the mechanisms involved in its pathogenesis,complicating medical treatment.Increased production of inflammatory cytokines such as tumor necrosis factor and interleukin-13 by infiltrating macrophages and other inflammatory cells stimulate the epithelial-to-mesenchymal transition,resulting in activation of myofibroblasts and elevation of matrix metalloproteinases,leading to fistula formation.Given the potential for malignant transformation,PFCD screening is critical.Cytokine and inflammationtargeted therapies can help control this disease,but recurrence is a common complication.Surgical interventions such as fistulotomy represent viable therapeutic options,with magnetic resonance imaging serving as an important diagnostic tool for delineating fistula tract anatomy.Animal models and clinical trials demonstrate that injection of mesenchymal stem cells(MSCs)into the fistula results in suppression of the inflammatory cells and cytokines and complete resolution of PFCD.Recently,MSC-derived extracellular vesicles were found to stimulate fistula healing,with encouraging results.In this article,we comment on the review article by Pacheco et al,summarizing the various lines of PFCD treatment and highlighting the role of screening for this disease.Importantly,we focus on the various mechanisms involved in the pathogenesis of PFCD,the therapeutic roles of MSCs and related extracellular vesicles,and explore the potential role of autophagy in enhancing the therapeutic efficacy of these cells,which may help in the treatment of this disease.展开更多
BACKGROUND Anal canal adenocarcinoma with secondary perianal Paget’s disease(PPD)is clinically rare and exhibits atypical symptoms,often misdiagnosed as benign conditions such as hemorrhoids or perianal eczema,leadin...BACKGROUND Anal canal adenocarcinoma with secondary perianal Paget’s disease(PPD)is clinically rare and exhibits atypical symptoms,often misdiagnosed as benign conditions such as hemorrhoids or perianal eczema,leading to delayed treatment.Further summarization of diagnostic and therapeutic key points,as well as reasons for misdiagnosis,is necessary to enhance clinical awareness.CASE SUMMARY A retrospective analysis was conducted on a 72-year-old female patient with a 2-year history of perianal moisture,pruritus,and hematochezia,who was repeatedly misdiagnosed with mixed hemorrhoids.The diagnosis of anal canal adenocarcinoma with secondary PPD was confirmed through colonoscopy,perianal skin biopsy,and immunohistochemical staining(CK7,CK20,etc.).The patient underwent 3D laparoscopic-assisted abdominoperineal resection(APR)with extended perianal skin excision,achieving negative margins and primary wound healing.No recurrence or metastasis was observed during the 12-month follow-up.CONCLUSION Secondary PPD has a high misdiagnosis rate.Clinicians should maintain a high index of suspicion for elderly patients with prolonged perianal symptoms(e.g.,pruritus,hematochezia>6 months)and promptly perform colonoscopy and immunohistochemical testing for definitive diagnosis.APR combined with extended perianal resection is an effective treatment,and standardized long-term follow-up is crucial for prognosis.展开更多
BACKGROUND Perianal fistulas pose dual challenges to Crohn's disease(CD)patients.Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of peria...BACKGROUND Perianal fistulas pose dual challenges to Crohn's disease(CD)patients.Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.AIM To determine the accuracy of endoanal ultrasound(EUS)and shear wave elastography(SWE)for evaluating perianal fistulizing CD(PFCD)activity.METHODS This was a retrospective cohort study.A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups:Non-anal fistula group(n=23),low-activity perianal fistulas[n=19,perianal disease activity index(PDAI)≤4],high-activity perianal fistulas(n=25,PDAI>4)based on the PDAI.All patients underwent assessments including EUS+SWE,pelvic magnetic resonance[pelvic magnetic resonance imaging(MRI)],C-reactive protein,fecal calprotectin,CD activity index,PDAI.RESULTS The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%,and there was good consistency in the classification of perianal fistulas(Kappa=0.752,P<0.001).Significant differences were observed in the blood flow Limberg score(χ^(2)=8.903,P<0.05)and shear wave velocity(t=2.467,P<0.05)between group 2 and 3.Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD(Magnifi-CD)score(r=-0.676,P<0.001),a weak negative correlation with the PDAI score(r=-0.386,P<0.05),and a weak correlation between the Limberg score and the PDAI score(r=0.368,P<0.05).CONCLUSION EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients.It may be the ideal tool to assess PFCD activity objectively for management strategies.展开更多
The perianal disease affects up to one-third of individuals with Crohn's disease(CD),causing disabling symptoms and significant impairment in quality of life,particularly for those with perianal fistulising CD(PFC...The perianal disease affects up to one-third of individuals with Crohn's disease(CD),causing disabling symptoms and significant impairment in quality of life,particularly for those with perianal fistulising CD(PFCD).The collaborative effort between gastroenterologists and surgeons is essential for addressing PFCD to achieve fistula closure and promote luminal healing.Limited fistula healing rates with conventional therapies have prompted the emergence of new biological agents,endoscopic procedures and surgical techniques that show promising results.Among these,mesenchymal stem cells injection is a particularly hopeful therapy.In addition to the burden of fistulas,individuals with perianal CD may face an increased risk of developing anal cancer.This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes.Currently,there is no established formal anal screening programme.In this review,we provide an overview of the current state of the art in managing PFCD,including novel medical,endoscopic and surgical approaches.The discussion also focuses on the relevance of establishing an anal cancer screening programme in CD,intending to propose a risk-based surveillance algorithm.The validation of this surveillance programme would be a significant step forward in improving patient care and outcomes.展开更多
BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various fac...BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various factors,including individual differences among patients,the characteristics of the disease itself,and the psychological state of the patient.Understanding these factors can help healthcare providers develop more personalized and effective post-operative care plans for patients with perianal disease.AIM To investigate the effect of illness perception(IP)and negative emotions on POR outcomes in patients with perianal disease.METHODS A total of 146 patients with perianal disease admitted to the First People's Hospital of Changde City from March to December 2023 were recruited.We employed a general information questionnaire,the Brief Illness Perception Questionnaire(B-IPQ),and the Hospital Anxiety and Depression Scale(HADS).We used the 15-item Quality of Recovery Score(QoR-15)to measure patients’recovery effects.Finally,we conducted Pearson’s correlation analysis to examine the relationship between pre-operative IP and anxiety and depression levels with POR quality.RESULTS Fifty-three(36.3%)had poor knowledge of their disease.Thirty(20.5%)were suspected of having anxiety and 99(67.8%)exhibited symptoms.Forty(27.4%)were suspected of having depression and 102(69.9%)displayed symptoms.The B-IPQ,HADS-A,HADS-D,and QoR-15 scores were 46.82±9.97,12.99±3.60,12.58±3.36,and 96.77±9.85,respectively.There was a negative correlation between pre-operative IP,anxiety,and depression with POR quality.The influence of age and disease course on post-operative rehabilitation effect are both negative.The impact of B-IPQ,HADS-A,and HADS-D on POR was negative.Collectively,these variables accounted for 72.6%of the variance in POR.CONCLUSION The quality of POR in patients with perianal disease is medium and is related to age,disease course,IP,anxiety,and depression.展开更多
Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses w...Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.展开更多
This article discusses the literature review article by Pacheco et al published in July 2024;the authors provided good reviews of perianal Crohn’s disease(CD),and challenges faced by clinicians in the management.CD,c...This article discusses the literature review article by Pacheco et al published in July 2024;the authors provided good reviews of perianal Crohn’s disease(CD),and challenges faced by clinicians in the management.CD,characterized by its chronic and relapsing nature,is an idiopathic condition that can involve any segment of the gastrointestinal tract.Perianal disease impacts up to 40%of patients with CD,with perianal fistulas constituting up to 80%of perianal lesions.Perianal CD can be highly incapacitating and profoundly diminish the overall well-being of patients.The management focuses on controlling the perianal sepsis and treating luminal CD.Biologics are crucial to the treatment approach,and results have been encouraging.The surgery focuses on controlling the sepsis,with more definitive treatments being fistula surgery,fecal diversion,and proctectomy as the last resort.This manuscript briefly describes the burden of CD,the challenges posed by perianal CD,and the role of different treatment modalities from colorectal surgeon’s perspective.展开更多
In this editorial we comment on the article by Pacheco et al published in a recent issue of the World Journal of Gastroenterology.We focus specifically on the burden of illness associated with perianal fistulizing Cr...In this editorial we comment on the article by Pacheco et al published in a recent issue of the World Journal of Gastroenterology.We focus specifically on the burden of illness associated with perianal fistulizing Crohn’s disease(PFCD)and the diagnostic and therapeutic challenges in the management of this condition.Evol-ving evidence has shifted the diagnostic framework for PFCD from anatomical classification systems,to one that is more nuanced and patient-focused to drive ongoing decision making.This editorial aims to reflect on these aspects to help clinicians face the challenge of PFCD in day-to-day clinical practice.展开更多
BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE S...BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess.He developed postoperative incision infection and was referred to the department where the authors work.Initially,perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected.Despite receiving antibiotic therapy and undergoing surgical debridement,deeper necrotic areas formed in the patient’s perianal wounds,accompanied by persistent high fever.Blood and fungal cultures yielded negative results.The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS.CONCLUSION CMML with perianal NSS is a rare condition,often misdiagnosed as perianal abscess or perianal necrotizing fasciitis.Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.展开更多
Magnetic resonance imaging is the gold standard compared other clinical fin-dings.But shear wave elastography technique combined with endoscopic ultra-sound can evaluate the degree of fibrosis of fistula tissue in Cr...Magnetic resonance imaging is the gold standard compared other clinical fin-dings.But shear wave elastography technique combined with endoscopic ultra-sound can evaluate the degree of fibrosis of fistula tissue in Crohn’s disease patients.This topic is highly relevant to the current discourse,especially for It shows a certain degree of innovation and practicality and is worthy of study and popularization.展开更多
BACKGROUND Orificial tuberculosis is a rare type of tuberculosis,which is easy to be misdiagnosed,and can cause great damage to the perianal skin and mucosa.Early diagnosis can avoid further erosion of the perianal mu...BACKGROUND Orificial tuberculosis is a rare type of tuberculosis,which is easy to be misdiagnosed,and can cause great damage to the perianal skin and mucosa.Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria.CASE SUMMARY Here,we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis,intestinal tuberculosis and orificial tuberculosis.This is an extremely rare case of cutaneous tuberculosis of the anus,which was misdiagnosed for nearly a year.The patient received conventional treatment in other medical institutions,but specific treatment was delayed.Ultimately,proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure.CONCLUSION For skin ulcers that do not heal with repeated conventional treatments,consider ulcers caused by rare bacteria,such as Mycobacterium tuberculosis.展开更多
Background:Anal fistula is a long-term disease characterized by a tubular structure with one end opening in the anorectal canal and the other end opening on the surface of the perineum or perianal skin with chronic pu...Background:Anal fistula is a long-term disease characterized by a tubular structure with one end opening in the anorectal canal and the other end opening on the surface of the perineum or perianal skin with chronic pus drainage.It is linked to Bhagandar in Ayurveda,and in Sushruta Samhita,Acharya has mentioned 5 forms of Bhagandar.The boil in the present case was Shukla,sthira i.e.hard and firm,with Picchila strava and Kandu resembling the features of Parisraavi bhagandar.Aim and objective:The current case was diagnosed as Parisravi bhagandar,which resembles trans-sphincteric or intersphincteric fistula in modern ano.In Ayurveda,the management of Parisraavi Bhagandar,Shastra,kshara,and Agnikarma is advised and the use of Ksharasutra,which contributes to complete cutting and healing of the track without reoccurrence,similarly Modern surgeon depends on surgery i.e radical excision of the track,ligation with Seton,and use of chemical irritants like urethane,silver nitrates,etc.A cutting seton(tight)gently slices the confined muscle to close the fistula with the least interruption to continence.This operation is especially advised when a one-stage fistulotomy poses a considerable risk of incontinence.Material and methods:The method performed here was Core Partial Fistulectomy followed by Ksharasutra application till complete healing of the wound.Discussion and conclusion:This case study provides the successful management of Parisraavi Bhagandara(high anal,trans-sphincteric fistula in ano)in 61-year-old male patient with an integrated surgical&Ayurvedic management approach.展开更多
BACKGROUND About 90%of perianal infection is caused by cryptoglandular infection.Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body...BACKGROUND About 90%of perianal infection is caused by cryptoglandular infection.Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body have been reported.The most common sites of impaction and perforation include the appendix,cecum and the terminal ileum.The rectum is an unusual site of foreign body impaction.This report intends to highlight that ingested foreign body impacted in the rectum is an extremely rare cause of perianal abscess and subsequent fistula in infants.CASE SUMMARY Two cases of perianal abscess and fistula due to ingested jujube pit impacted in the rectum are reported.Both cases are infants with free previous medical history suffered from recurrent perianal infection.The caregivers of the two patients denied ingestion of a foreign body or any history of trauma.Physical examination combined with ultrasound or computed tomography scan established the diagnosis.Both of the patients underwent operation under general anesthesia.In case 1,a jujube pit with sharp ends was discovered embedded within a subcutaneous fistula.The jujube pit was then removed intact along with fistula resection.The wound was successfully laid open to allow healing by secondary intention.In case 2,a jujube pit was found with its sharp end puncturing the rectum,surrounded by pus and necrotic tissue.Subsequent incision and adequate drainage were performed.The whole jujube pit was then removed from the abscess cavity at the same time.Both patients received colonoscopy to rule out inflammatory bowel disease or other potential damages by the ingested jujube pit.The postoperative period was uneventful.At 1.5 year follow-up,no recurrent abscess or fistula were found in either patient.CONCLUSION An impacted foreign body must not be overlooked as an unusual cause of perianal abscess and fistula,especially in young children.展开更多
BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infec...BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infections that originate from these.Furthermore,the complete resection of this cyst is curative.We report our diagnostic and treatment experience with one case of malignant transformation of a perianal tailgut cyst,which was initially misdiagnosed as perianal abscess.CASE SUMMARY A 72-year-old woman visited our institution with complaints of a refractory nonhealing lesion on the right hip,which repeatedly broke and suppurated for more than 70 years,and aggravated in 4 mo.The patient was given a diagnosis of refractory perianal abscess with repeated incision and drainage procedures.Computed tomography of the pelvic cavity revealed a giant perianal cyst.Subsequent biopsy revealed a tumor with moderate-to-severe glandular epithelial dysplasia,and suggested that this was derived from the developmental cysts in the posterior rectal space.After further clarifying the nature and extent of the tumor by magnetic resonance imaging,total cystic resection was performed.Postoperative histopathological examination confirmed the malignancy,dictating the investigators to add postoperative chemotherapy to the treatment regimen.CONCLUSION The malignant transformation of perianal tailgut cysts is very uncommon,and this should be differentiated from perianal abscess.Complete surgical removal is curative,and postoperative pathology may determine the necessity of additional postoperative chemotherapy or radiotherapy,which may be beneficial for preventing local recurrence and metastasis.展开更多
基金Supported by National Research Foundation of Korea,No.NRF-2021S1A5A8062526.
文摘This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.
文摘This article examines the complex relationship between disease perception,negative emotions,and their impact on postoperative recovery in patients with perianal diseases.These conditions not only cause physical discomfort,but also carry a significant emotional burden,often exacerbated by social stigma.Psycho-logical factors,including stress,anxiety,and depression,activate neuroendocrine pathways,such as the hypothalamic–pituitary–adrenal axis,disrupting the gut microbiota and leading to dysbiosis.This disruption can delay wound healing,prolong hospital stay,and intensify pain.Drawing on the findings of Hou et al,our article highlights the critical role of illness perception and negative emotions in shaping recovery outcomes.It advocates for a holistic approach that integrates psychological support and gut microbiota modulation,to enhance healing and improve overall patient outcomes.
基金Supported by Shenzhen Guangming District Health System Scientific Research Project(2020R01120).
文摘[Objectives]To investigate the use of the classical Chinese medicine formula Sihu Powder modified decoction for postoperative fumigation and sitz bath in patients with perianal abscess,aiming to promote wound healing and reduce medical burden.[Methods]An observational cohort study was conducted,selecting 200 patients with perianal abscess who underwent surgery in Shenzhen Guangming District People's Hospital.They were randomly divided into a treatment group and an observation group,with 100 cases in each group.Both groups followed the same surgical and antibiotic treatment principles.Starting from the first postoperative day,the treatment group received fumigation and sitz bath with modified Sihu Powder for decoction twice daily;the observation group used Compound Huangbai Liquid for fumigation and sitz bath twice daily.Indicators including pain score,wound secretion score,wound granulation tissue growth score,multidrug-resistant bacterial infection clearance rate,antibiotic usage days,and wound healing rate were observed in both groups 7,14 and 21 d after operation.[Results]On postoperative day 7,the differences in postoperative pain score,wound secretions,and multidrug-resistant bacterial clearance rate between the treatment group and the observation group were statistically significant.On postoperative day 14,the differences between the two groups were significant in indicators including pain score,wound secretions,wound granulation tissue growth,multidrug-resistant bacterial clearance rate,and wound healing rate.On postoperative day 21,the difference in wound healing rate between the two groups was significant;furthermore,the antibiotic usage days in the treatment group were significantly fewer than those in the observation group.[Conclusions]Modified Sihu Powder for fumigation and washing can effectively alleviate postoperative pain in perianal abscess patients,inhibit the colonization and infection of multidrug-resistant bacteria at the wound site,accelerate wound healing,reduce antibiotic usage intensity and medical burden.It possesses advantages such as being economical,effective,safe,and easy to operate,making it worthy of clinical promotion.
文摘BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a tertiary coloproctology reference center.METHODS Seventy-two patients who underwent surgical intervention for perianal fistula between August 2019 and January 2023 were treated using a modified fistulotomy technique.In this approach,the fistula tract was excised from the external opening up to the external sphincter fibers.The internal orifice was widened,and the septic focus within the inter sphincteric space was curetted.Partial internal sphincterotomy was performed up to the inter sphincteric plane.The anoderm from the internal orifice to the inter sphincteric space was closed with absorbable suture material,and a loose seton was placed at the level of the external sphincter.RESULTS The 72 patients who underwent modified fistulotomy were 77.8%male and 22.2%female,with a mean age of 42.2±11.5 years.The median follow-up period was 19 months.Preoperatively,93.1%of patients had high trans sphincteric fistulas,and 6.9%were females with anterior low trans sphincteric fistulas.In all cases,setons were placed during surgery using vascular tape.A total of 12.5%of patients experienced incontinence,involving gas(6.9%)or soiling(5.6%).There were no reports of solid or liquid incontinences.Complete healing was achieved in 83.3%of the patients,with a recurrence rate of 4.2%and a non-healing rate of 12.5%.CONCLUSION Our preliminary analysis suggests that this modified fistulotomy technique that targets distalization of the internal orifice is a promising alternative management strategy for perianal fistulas.
文摘Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particularly anti-tumor necrosis factor agents,the majority of patients still require surgical intervention.Accurate diagnosis and monitoring are essential to optimise outcomes and guide multidisciplinary management.Although clinical scoring systems such as the perianal disease activity index are widely used,their subjective application limits their reproducibility and reliability,underscoring the need for more objective methods of evaluating perianal fistulising Crohn’s disease activity.Imaging has thus become central to the objective assessment of perianal fistulising Crohn’s disease,with magnetic resonance imaging(MRI)recognised as the gold standard in view of its ability to provide clear,detailed images of the perianal region in a radiation-free manner.Guidelines also endorse the use of imaging modalities such as endoanal ultrasound and transperineal ultrasound as viable alternatives to MRI for the assessment of perianal fistulising Crohn’s disease in centres with appropriate expertise.This article aims to evaluate and compare the diagnostic accuracy and clinical utility of MRI,endoanal ultrasound,and transperineal ultrasound in the assessment of perianal fistulising Crohn’s disease,highlighting their respective strengths,limitations,and roles in clinical practice.
基金Supported by Takeda Pharmaceuticals USA,Inc.Medical writing support was provided by Luke Humphreys,PhD,of Oxford PharmaGenesis,Oxford,UK and was funded by Takeda Development Center Americas,Inc.
文摘BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development,treatment failure,and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies,reduce treatment burden,and improve outcomes in patients with CPF.AIM To describe the epidemiology,treatments,outcomes,and associated risk/protective factors for complex CPF.METHODS Electronic databases(MEDLINE,EMBASE,EBM Reviews,EconLit)were searched.Two reviewers independently used populations,interventions,comparators,outcomes,study designs,and time criteria to identify relevant studies.Observational studies published in English from January 1,2015 to February 17,2022 with>50 patients were included,even if complex CPF was not defined.Items of interest included complex CPF definitions,epidemiology,treatment patterns,morbidity,mortality,and risk factors associated with complex CPF development,treatment failure,and undergoing multiple surgeries.Data were reported using descriptive statistics.RESULTS Overall,140 studies were included.Complex CPF definitions were heterogeneous and rarely reported(24 studies).Hence,data mostly related to CPF in general.CPF prevalence was variable(range:1.5%-81.0%).Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn’s disease diagnosis(range:3.5%-50.1%).Overall healing and failure rates after treatment were in the range of 10.5%-80.2%and 3.6%-83.0%,respectively.Abscesses were the most frequently reported morbidity(n=18).No CPF-related deaths were reported.No consistent risk or protective factors were identified.CONCLUSION Epidemiology,treatment patterns,and risk factors for CPF vary,likely due to inconsistent CPF and clinical outcome definitions.Standardization would facilitate comparability,which may inform optimal complex CPF treatment strategies.
文摘Perianal fistulizing Crohn’s disease(PFCD)is a common presentation of CD,which affects the patients’quality of life,including social and sexual function.The management of PFCD remains a critical challenge in inflammatory bowel disease,primarily due to limited understanding of the mechanisms involved in its pathogenesis,complicating medical treatment.Increased production of inflammatory cytokines such as tumor necrosis factor and interleukin-13 by infiltrating macrophages and other inflammatory cells stimulate the epithelial-to-mesenchymal transition,resulting in activation of myofibroblasts and elevation of matrix metalloproteinases,leading to fistula formation.Given the potential for malignant transformation,PFCD screening is critical.Cytokine and inflammationtargeted therapies can help control this disease,but recurrence is a common complication.Surgical interventions such as fistulotomy represent viable therapeutic options,with magnetic resonance imaging serving as an important diagnostic tool for delineating fistula tract anatomy.Animal models and clinical trials demonstrate that injection of mesenchymal stem cells(MSCs)into the fistula results in suppression of the inflammatory cells and cytokines and complete resolution of PFCD.Recently,MSC-derived extracellular vesicles were found to stimulate fistula healing,with encouraging results.In this article,we comment on the review article by Pacheco et al,summarizing the various lines of PFCD treatment and highlighting the role of screening for this disease.Importantly,we focus on the various mechanisms involved in the pathogenesis of PFCD,the therapeutic roles of MSCs and related extracellular vesicles,and explore the potential role of autophagy in enhancing the therapeutic efficacy of these cells,which may help in the treatment of this disease.
基金Supported by Guangdong Provincial Medical Research Fund General Program,No.B2025209。
文摘BACKGROUND Anal canal adenocarcinoma with secondary perianal Paget’s disease(PPD)is clinically rare and exhibits atypical symptoms,often misdiagnosed as benign conditions such as hemorrhoids or perianal eczema,leading to delayed treatment.Further summarization of diagnostic and therapeutic key points,as well as reasons for misdiagnosis,is necessary to enhance clinical awareness.CASE SUMMARY A retrospective analysis was conducted on a 72-year-old female patient with a 2-year history of perianal moisture,pruritus,and hematochezia,who was repeatedly misdiagnosed with mixed hemorrhoids.The diagnosis of anal canal adenocarcinoma with secondary PPD was confirmed through colonoscopy,perianal skin biopsy,and immunohistochemical staining(CK7,CK20,etc.).The patient underwent 3D laparoscopic-assisted abdominoperineal resection(APR)with extended perianal skin excision,achieving negative margins and primary wound healing.No recurrence or metastasis was observed during the 12-month follow-up.CONCLUSION Secondary PPD has a high misdiagnosis rate.Clinicians should maintain a high index of suspicion for elderly patients with prolonged perianal symptoms(e.g.,pruritus,hematochezia>6 months)and promptly perform colonoscopy and immunohistochemical testing for definitive diagnosis.APR combined with extended perianal resection is an effective treatment,and standardized long-term follow-up is crucial for prognosis.
基金the Major Project of Department of Education of Anhui Province of China,No.2023AH040396.
文摘BACKGROUND Perianal fistulas pose dual challenges to Crohn's disease(CD)patients.Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.AIM To determine the accuracy of endoanal ultrasound(EUS)and shear wave elastography(SWE)for evaluating perianal fistulizing CD(PFCD)activity.METHODS This was a retrospective cohort study.A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups:Non-anal fistula group(n=23),low-activity perianal fistulas[n=19,perianal disease activity index(PDAI)≤4],high-activity perianal fistulas(n=25,PDAI>4)based on the PDAI.All patients underwent assessments including EUS+SWE,pelvic magnetic resonance[pelvic magnetic resonance imaging(MRI)],C-reactive protein,fecal calprotectin,CD activity index,PDAI.RESULTS The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%,and there was good consistency in the classification of perianal fistulas(Kappa=0.752,P<0.001).Significant differences were observed in the blood flow Limberg score(χ^(2)=8.903,P<0.05)and shear wave velocity(t=2.467,P<0.05)between group 2 and 3.Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD(Magnifi-CD)score(r=-0.676,P<0.001),a weak negative correlation with the PDAI score(r=-0.386,P<0.05),and a weak correlation between the Limberg score and the PDAI score(r=0.368,P<0.05).CONCLUSION EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients.It may be the ideal tool to assess PFCD activity objectively for management strategies.
文摘The perianal disease affects up to one-third of individuals with Crohn's disease(CD),causing disabling symptoms and significant impairment in quality of life,particularly for those with perianal fistulising CD(PFCD).The collaborative effort between gastroenterologists and surgeons is essential for addressing PFCD to achieve fistula closure and promote luminal healing.Limited fistula healing rates with conventional therapies have prompted the emergence of new biological agents,endoscopic procedures and surgical techniques that show promising results.Among these,mesenchymal stem cells injection is a particularly hopeful therapy.In addition to the burden of fistulas,individuals with perianal CD may face an increased risk of developing anal cancer.This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes.Currently,there is no established formal anal screening programme.In this review,we provide an overview of the current state of the art in managing PFCD,including novel medical,endoscopic and surgical approaches.The discussion also focuses on the relevance of establishing an anal cancer screening programme in CD,intending to propose a risk-based surveillance algorithm.The validation of this surveillance programme would be a significant step forward in improving patient care and outcomes.
文摘BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various factors,including individual differences among patients,the characteristics of the disease itself,and the psychological state of the patient.Understanding these factors can help healthcare providers develop more personalized and effective post-operative care plans for patients with perianal disease.AIM To investigate the effect of illness perception(IP)and negative emotions on POR outcomes in patients with perianal disease.METHODS A total of 146 patients with perianal disease admitted to the First People's Hospital of Changde City from March to December 2023 were recruited.We employed a general information questionnaire,the Brief Illness Perception Questionnaire(B-IPQ),and the Hospital Anxiety and Depression Scale(HADS).We used the 15-item Quality of Recovery Score(QoR-15)to measure patients’recovery effects.Finally,we conducted Pearson’s correlation analysis to examine the relationship between pre-operative IP and anxiety and depression levels with POR quality.RESULTS Fifty-three(36.3%)had poor knowledge of their disease.Thirty(20.5%)were suspected of having anxiety and 99(67.8%)exhibited symptoms.Forty(27.4%)were suspected of having depression and 102(69.9%)displayed symptoms.The B-IPQ,HADS-A,HADS-D,and QoR-15 scores were 46.82±9.97,12.99±3.60,12.58±3.36,and 96.77±9.85,respectively.There was a negative correlation between pre-operative IP,anxiety,and depression with POR quality.The influence of age and disease course on post-operative rehabilitation effect are both negative.The impact of B-IPQ,HADS-A,and HADS-D on POR was negative.Collectively,these variables accounted for 72.6%of the variance in POR.CONCLUSION The quality of POR in patients with perianal disease is medium and is related to age,disease course,IP,anxiety,and depression.
文摘Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.
文摘This article discusses the literature review article by Pacheco et al published in July 2024;the authors provided good reviews of perianal Crohn’s disease(CD),and challenges faced by clinicians in the management.CD,characterized by its chronic and relapsing nature,is an idiopathic condition that can involve any segment of the gastrointestinal tract.Perianal disease impacts up to 40%of patients with CD,with perianal fistulas constituting up to 80%of perianal lesions.Perianal CD can be highly incapacitating and profoundly diminish the overall well-being of patients.The management focuses on controlling the perianal sepsis and treating luminal CD.Biologics are crucial to the treatment approach,and results have been encouraging.The surgery focuses on controlling the sepsis,with more definitive treatments being fistula surgery,fecal diversion,and proctectomy as the last resort.This manuscript briefly describes the burden of CD,the challenges posed by perianal CD,and the role of different treatment modalities from colorectal surgeon’s perspective.
文摘In this editorial we comment on the article by Pacheco et al published in a recent issue of the World Journal of Gastroenterology.We focus specifically on the burden of illness associated with perianal fistulizing Crohn’s disease(PFCD)and the diagnostic and therapeutic challenges in the management of this condition.Evol-ving evidence has shifted the diagnostic framework for PFCD from anatomical classification systems,to one that is more nuanced and patient-focused to drive ongoing decision making.This editorial aims to reflect on these aspects to help clinicians face the challenge of PFCD in day-to-day clinical practice.
基金Supported by the National Key Research and Development Program of China,No.2021YFC2009100Included in the information database of“Pelvic Diaphragm Health Archives”,No.2021YFC2009103.
文摘BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess.He developed postoperative incision infection and was referred to the department where the authors work.Initially,perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected.Despite receiving antibiotic therapy and undergoing surgical debridement,deeper necrotic areas formed in the patient’s perianal wounds,accompanied by persistent high fever.Blood and fungal cultures yielded negative results.The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS.CONCLUSION CMML with perianal NSS is a rare condition,often misdiagnosed as perianal abscess or perianal necrotizing fasciitis.Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.
文摘Magnetic resonance imaging is the gold standard compared other clinical fin-dings.But shear wave elastography technique combined with endoscopic ultra-sound can evaluate the degree of fibrosis of fistula tissue in Crohn’s disease patients.This topic is highly relevant to the current discourse,especially for It shows a certain degree of innovation and practicality and is worthy of study and popularization.
文摘BACKGROUND Orificial tuberculosis is a rare type of tuberculosis,which is easy to be misdiagnosed,and can cause great damage to the perianal skin and mucosa.Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria.CASE SUMMARY Here,we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis,intestinal tuberculosis and orificial tuberculosis.This is an extremely rare case of cutaneous tuberculosis of the anus,which was misdiagnosed for nearly a year.The patient received conventional treatment in other medical institutions,but specific treatment was delayed.Ultimately,proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure.CONCLUSION For skin ulcers that do not heal with repeated conventional treatments,consider ulcers caused by rare bacteria,such as Mycobacterium tuberculosis.
文摘Background:Anal fistula is a long-term disease characterized by a tubular structure with one end opening in the anorectal canal and the other end opening on the surface of the perineum or perianal skin with chronic pus drainage.It is linked to Bhagandar in Ayurveda,and in Sushruta Samhita,Acharya has mentioned 5 forms of Bhagandar.The boil in the present case was Shukla,sthira i.e.hard and firm,with Picchila strava and Kandu resembling the features of Parisraavi bhagandar.Aim and objective:The current case was diagnosed as Parisravi bhagandar,which resembles trans-sphincteric or intersphincteric fistula in modern ano.In Ayurveda,the management of Parisraavi Bhagandar,Shastra,kshara,and Agnikarma is advised and the use of Ksharasutra,which contributes to complete cutting and healing of the track without reoccurrence,similarly Modern surgeon depends on surgery i.e radical excision of the track,ligation with Seton,and use of chemical irritants like urethane,silver nitrates,etc.A cutting seton(tight)gently slices the confined muscle to close the fistula with the least interruption to continence.This operation is especially advised when a one-stage fistulotomy poses a considerable risk of incontinence.Material and methods:The method performed here was Core Partial Fistulectomy followed by Ksharasutra application till complete healing of the wound.Discussion and conclusion:This case study provides the successful management of Parisraavi Bhagandara(high anal,trans-sphincteric fistula in ano)in 61-year-old male patient with an integrated surgical&Ayurvedic management approach.
文摘BACKGROUND About 90%of perianal infection is caused by cryptoglandular infection.Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body have been reported.The most common sites of impaction and perforation include the appendix,cecum and the terminal ileum.The rectum is an unusual site of foreign body impaction.This report intends to highlight that ingested foreign body impacted in the rectum is an extremely rare cause of perianal abscess and subsequent fistula in infants.CASE SUMMARY Two cases of perianal abscess and fistula due to ingested jujube pit impacted in the rectum are reported.Both cases are infants with free previous medical history suffered from recurrent perianal infection.The caregivers of the two patients denied ingestion of a foreign body or any history of trauma.Physical examination combined with ultrasound or computed tomography scan established the diagnosis.Both of the patients underwent operation under general anesthesia.In case 1,a jujube pit with sharp ends was discovered embedded within a subcutaneous fistula.The jujube pit was then removed intact along with fistula resection.The wound was successfully laid open to allow healing by secondary intention.In case 2,a jujube pit was found with its sharp end puncturing the rectum,surrounded by pus and necrotic tissue.Subsequent incision and adequate drainage were performed.The whole jujube pit was then removed from the abscess cavity at the same time.Both patients received colonoscopy to rule out inflammatory bowel disease or other potential damages by the ingested jujube pit.The postoperative period was uneventful.At 1.5 year follow-up,no recurrent abscess or fistula were found in either patient.CONCLUSION An impacted foreign body must not be overlooked as an unusual cause of perianal abscess and fistula,especially in young children.
文摘BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infections that originate from these.Furthermore,the complete resection of this cyst is curative.We report our diagnostic and treatment experience with one case of malignant transformation of a perianal tailgut cyst,which was initially misdiagnosed as perianal abscess.CASE SUMMARY A 72-year-old woman visited our institution with complaints of a refractory nonhealing lesion on the right hip,which repeatedly broke and suppurated for more than 70 years,and aggravated in 4 mo.The patient was given a diagnosis of refractory perianal abscess with repeated incision and drainage procedures.Computed tomography of the pelvic cavity revealed a giant perianal cyst.Subsequent biopsy revealed a tumor with moderate-to-severe glandular epithelial dysplasia,and suggested that this was derived from the developmental cysts in the posterior rectal space.After further clarifying the nature and extent of the tumor by magnetic resonance imaging,total cystic resection was performed.Postoperative histopathological examination confirmed the malignancy,dictating the investigators to add postoperative chemotherapy to the treatment regimen.CONCLUSION The malignant transformation of perianal tailgut cysts is very uncommon,and this should be differentiated from perianal abscess.Complete surgical removal is curative,and postoperative pathology may determine the necessity of additional postoperative chemotherapy or radiotherapy,which may be beneficial for preventing local recurrence and metastasis.
