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Acquired anorectal disorders: Prolapse, fistula, and hemorrhoids
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Anal fistula is a communication between the perianal skin and the anal canal following perianal abscess. Fistulas are “low” in infants/children and usually pass straight between the skin sinus and the anal canal at the level of the dentate line. Presentation is of a perianal abscess treated either surgically or, more often, incompletely by antibiotics alone, resulting in a chronically discharging perianal sinus. “Flare-ups” of recurrent painful swelling and redness may occur.
Transsphincteric Fistula-in-Ano with External Opening 3 cm from Anal Verge
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
After the clinical examination and imaging, the surgeon should obtain a reasonable assessment of the type and course of the anal fistula. If the surgeon is still unsure, then it is advisable to seek the help of an experienced colleague. The type of surgery undertaken will depend on the type and extent of the fistula as well as the surgeon’s experience. The two most important complications that need to be discussed with the patient prior to surgery include the risk of incontinence (flatus and feces) and that of recurrence[2].
Perianal Abscess
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Up to 50% off individuals with an anal abscess develop an anal fistula which often requires surgery. Other fistulas develop secondary to trauma (i.e., rectal foreign bodies), Crohn's disease, anal fissures, carcinoma, radiation therapy, actinomycoses, tuberculosis and lymphogranuloma venereum secondary to chlamydial infection.
Cytomegalovirus enteritis with intractable diarrhea in infants from a tertiary care center in China
Published in Scandinavian Journal of Gastroenterology, 2020
Yuhuan Wang, Zhiheng Huang, Ziqing Ye, Cuifang Zheng, Zhinong Jiang, Ying Huang
In a report of two patients with CMV enterocolitis and 21 immunocompetent young children with CMV colitis that were reviewed in the literature, the majority of patients were male (73%, 16/22, with one patient with unknown gender information) [3]. In our study, 80.0% (8/10) percent of patients were male, which is potentially suggestive of subtle differences among host immune defenses (X-linked or otherwise) against CMV [3]. In previous reviews, the colon is most commonly affected in CMV colitis, and the rectum is rarely involved [27]. However, in our study, rectal ulcerations were detected in six patients (60%), and one of them also had perianal abscess and anal fistula. Thus, rectum involvement may not be rare, and more cases are needed to assess its phenotype. Typical endoscopic findings of various ulcer types, including punched-out ulcers, irregular ulcers, longitudinal ulcers, and a cobblestone-like appearance, were reviewed in the literature [28,29]. Our study obtained similar results, except for the lack of observation of cobblestone-like appearance.
Fistulectomy and primary sphincteroplasty (FIPS) to prevent keyhole deformity in simple anal fistula: a single-center retrospective cohort study
Published in Acta Chirurgica Belgica, 2021
Nicolas De Hous, Thomas Van den Broeck, Charles de Gheldere
A simple anal fistula was defined as either an intersphincteric or a low transsphincteric fistula crossing <30% of the external anal sphincter [2]. The location of the treated fistula tract was defined according to the location of the external and internal opening in relation to the anus in lithotomy position. Patients with acute perianal sepsis were first treated by incision and drainage with seton placement and had definitive surgery only after acute sepsis had resolved. Data collected consisted of patient age at surgery, sex, smoking, fistula type (according to the Parks classification), fistula etiology (cryptoglandular or retrofissural), fistula location (anterior, lateral, posterior), operative time and previous fistula surgery (number and type).
Jump Technique versus Seton Method for Anal Fistula Repair: A Randomized Controlled Trial
Published in Journal of Investigative Surgery, 2022
Jalaluddin Khoshnevis, Roberto Cuomo, Farzaneh Karami, Terifeh Dashti, Alireza Kalantar Motamedi, Mohammadreza Kalantar Motamedi, Eznollah Azargashb, Negaar Aryan, Payam Sadeghi
The ultimate goal in the treatment of anal fistula is to eliminate the primary or any associated secondary openings and tracts with continence remaining intact [6, 7]. Fistulotomy is the “gold standard” approach for the treatment of anal fistula. For simple fistulae, the recurrence rate subsequent to fistulotomy is generally between 2–9% with a change in continence in 0–17% of patients [8, 9]. Fistulotomy wounds could last for prolonged healing periods, therefore causing significant discomfort, distress and contour defects around the anus in patients [10].