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Anorectal Conditions Requiring Urgent or Emergency Intervention
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The majority of anorectal abscess are thought to be secondary to obstruction of the anal glands. Normal physiological drainage of these glands is interrupted and contents may track retrograde through a variety of anatomical pathways, forming an abscess, which is then defined based on its location relative to the anal sphincters.1 When an abscess forms in the deep post-anal space and extends across the midline either anterior or posterior to both ischioanal fossae, it is termed a horseshoe abscess. In rare cases the abscess can even extend circumferentially below the anorectal ring. The tissue destruction of the affected areas in a horseshoe abscess can potentially leave the anus without support, leading to a ‘floating’ or free-standing anus.1–3
Anorectal Abscess
Published in Laurence R. Sands, Dana R. Sands, Ambulatory Colorectal Surgery, 2008
Orit Kaidar-Person, Benjamin Person
The treatment of an anorectal abscess is prompt incision and drainage. Most patients can be treated in an outpatient setting; in selected cases, in-hospital drainage is recommended (Table 3). Antibiotic coverage should be given when indicated (2,35). Abscess drainage can be performed relatively easily; however, damage to involved or adjacent anatomical structures can cause lifelong morbidity. Moreover, approaching an anorectal abscess without examining the possibility of a potential fistula may be harmful. It is hypothesized that various types of anorectal abscesses have different incidences of fistula (Table 4) (22); this should be taken into account, and efforts should be made to identify the fistulous tract and internal opening, either during the primary drainage procedure or during follow-up.
LIFT: a feasible option for primary and recurrent fistulas
Published in Acta Chirurgica Belgica, 2021
Sander Van Hoof, Els Van Dessel, Peter Cools
A total of 25 patients were included. Eighteen patients were male, and seven were female. Eighteen patients initially presented with an anorectal abscess without a primary fistula tract at the time of admittance. The mean time of developing a fistula tract after undergoing incision and drainage of the abscess was 102 days (range 22–536). All fistulas were initially examined during a EUA and were classified and categorized depending on several characteristics. All fistula tracts were primary transsphincteric. Nine had an anterior tract, while 16 were posterior fistulas (according to Goodsall’s rule). 11 fistulas were defined as complex with 8 in the male and 3 in the female group. These fistulas were further investigated using MRI imaging before proceeding with the LIFT procedure. Six patients presented with IBD related fistulas. After EUA and identification of the fistula, all patients were treated with a loose seton for 63 days on average (range 30–206) before proceeding with the LIFT procedure. Median follow-up was 11 months (range 1–36) with IBD patients being specific outliers because of frequent gastroenterological follow-up.
Effectiveness of infliximab treatment of complex idiopathic anal fistulas
Published in Scandinavian Journal of Gastroenterology, 2021
Anders Dige, Andreas Nordholm-Carstensen, Kikke Hagen, Helene Tarri Hougaard, Klaus Krogh, Jørgen Agnholt, Bodil Ginnerup Pedersen, Lilli Lundby
It must be emphasized that we cannot exclude the possibility that the included patients may have underlying CD in spite of having normal ileocolonoscopy and faecal calprotectin levels and in some patients also normal capsule endoscopy or MRI of the small bowel at the time of examination. It is estimated that anal fistulas are the only disease manifestation in 5% of CD patients [5]. It has been reported that 2.9% of patients without known CD who present with an anorectal abscess will subsequently be diagnosed with CD within a median time of 14 months [1]. None of the included patients were diagnosed with CD during follow-up.