Perianal Abscess Research Articles

Ayurveda management of Recurrent Ischiorectal Abscess with Horseshoe connection - A case report

Anorectal abscesses are one of the potentially debilitating diseases among them perianal abscess and ischiorectal abscess are common. Lateral spread of the ischiorectal abscess through the conjoint tendon leads to a horseshoe abscess. Surgical treatment is incision and drainage. Complications include sepsis, faecal incontinence, and fistula in ano. Kshara sutra is proved effective for fistula in ano, which helps in preventing recurrence. Here we report a case of ischiorectal abscess with horseshoe connection came with swelling and pain over the right perianal region. The condition was diagnosed as guda vidradi (perianal abscess) as per Ayurveda classics, and Bhedana karma is considered as primary treatment. Considering the recurrence and chronicity, kshara sutra ligation was planned after Bhedana karma. The case was completely cured with minimal follow-ups. Post-operative wounds healed with minimal scar formation. Adoption of the treatment has given successful results in the management of ischiorectal abscess with horseshoe connection

Surgical laser therapy for cryptoglandular anal fistula: Protocol of a systematic review and meta-analysis.

Anal fistula is the natural evolution of perianal abscess and one of the most common perianal diseases for adults. For complex fistula, it is still very challenging for anorectal surgeons to manage. With the introduction of laser technique in surgery, it is becoming more and more widely used for the treatment of cryptoglandular anal fistula. During the past decade, numerous studies have reported the clinical effectiveness and postoperative outcomes of different forms of laser treatment for anal fistula. However, as these studies were varied in terms of baseline characteristics, the evidence for the true clinical effectiveness of laser treatment for anal fistula need further critical appraisal. Therefore, the purpose of this study is to evaluate the outcomes of surgical laser therapy for cryptoglandular anal fistula stratified by laser type and Parks' classification through a synthesis of quantitative and qualitative evidence. This study will be carried out with adherence to the Cochrane Handbook. We will search PubMed, Cochrane Library, and Embase until June, 2022 to identify all relevant interventional and observational studies examining the effects of laser therapy on the clinical outcomes for cryptoglandular anal fistula. Data extraction from eligible studies will be performed independently by two unblinded authors using standardized extraction forms. Risk of bias assessment for each study will be conducted using Cochrane tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa scale (NOS) tool for observational studies. The DerSimonian-Laird random-effects model will be used to calculate the pooled estimates. Heterogeneity will be examined by subgroup analysis stratified by laser type and Parks' classification and other study characteristics. Potential publication bias will be assessed by funnel plot symmetrical and Egger's regression tests. The synthesis of quantitative and qualitative evidence of this systemic review will yield updated and comprehensive evidence of laser treatment on specific outcomes, which can provide anorectal surgeons with high level evidence-based recommendations to improve patient care and clinical outcomes. OSF registration number: DOI 10.17605/OSF.IO/36ADW.

Ischiorectal abscess with retro and intraperitoneal dissemination: a case report

Ischiorectal abscess with retro and intraperitoneal dissemination: a case report

Virtual reality distraction, a novel tool for pain alleviation during dressing change following surgical drainage of perianal abscess at Day Treatment Centre.

The pain induced by postoperative dressing changes adversely influence recovery and quality of life. In this study, we try to evaluate the pain alleviation effect of virtual reality (VR) distraction during postoperative dressing changes of patients who received surgical drainage of perianal abscess. This was a prospective, randomized clinical trial. A total of 172 patients with perianal abscess were randomly assigned into control (only analgesics) and VR groups (VR distraction + analgesics). The pain and physiological measurements of all patients were collected before, during, and after the first dressing change following surgery. The difference in pain intensity and physiological parameters measurement between control and VR group was analyzed. The baseline characteristics of VR and control group were comparable (all P > 0.05). There was no significant difference in mean pain scores prior to and after dressing change between groups (both P > 0.05). Mean pain scores of 5, 10, 15, and 20 min measuring points during the first dressing change were significantly lower in the VR group compared with the control group (all P < 0.05). Pulse rates and oxygen saturation were not significantly different between groups. VR can be used as an effective adjuvant pain distraction approach for postoperative dressing change.

Effectiveness and safety of darvadstrocel in patients with complex perianal fistulizing Crohn's disease: a systematic review.

Managing complex perianal fistulizing Crohn's disease (CD) remains challenging, despite current medical and surgical treatment approaches. Darvadstrocel, a therapy utilizing adipose-derived stem cells, shows promise in promoting tissue regeneration and healing, offering a novel and effective treatment for fistula management. A systematic literature search was conducted on PubMed and Scopus to identify studies involving patients with complex perianal fistulizing CD treated with darvadstrocel. In total, 2 randomized controlled trials (RCT), 5 observational studies with retrospective data collection and 2 observational studies with prospective design were included in the final review. Data from the European ADMIRE-CD RCT demonstrated that darvadstrocel is superior to placebo in terms of clinical and imaging improvement over both the short and long term. These findings align with the prospective studies analyzed in this systematic review. The rate of treatment-emergent adverse events in the ADMIRE-CD trial's RCTs was similar in both the darvadstrocel and control groups, with perianal abscess being the most common adverse event up to 52 weeks after drug administration. Retrospective studies indicated no side-effects beyond 52 weeks. Darvadstrocel appears to be a new, potentially effective and safe treatment option for the management of complex perianal fistulas. However, more randomized clinical trials are needed to evaluate the efficacy and safety profile of the drug.

Effect of Huayu Qufu Shengji Decoction on Postoperative Pain and Wound Healing Time in Patients with Perianal Abscess

This study aimed to investigate the impact of postoperative pain and wound healing time in patients who underwent perianal abscess surgery. A total of 106 patients who underwent perianal abscess surgery from July 2019 to May 2021 were enrolled as study subjects and randomly divided into a control group and a treatment group with 53 patients in each group. The control group received potassium permanganate sitz bath after surgery, while the treatment group received smoked Huayu Qufu Shengji decoction after surgery. The levels of postoperative pain (measured by visual analog scale score), wound healing, inflammatory factors and treatment response rate were compared between the two groups. Before treatment, the visual analog scale scores were similar in both groups (p>0.05). However, after treatment, the visual analog scale scores in both groups decreased significantly and the visual analog scale score in the treatment group was lower than that in the control group (p<0.05). Moreover, the treatment group had a shorter wound shedding time, a quicker emergence of new epithelium and a smaller wound healing time compared to the control group (p<0.05). Before treatment, the levels of inflammatory factors such as tumor necrosis factor alpha, interleukin-6 and interleukin-1 beta were similar in both groups (p>0.05). However, after treatment, the level of each inflammatory factor was lower in the treatment group than in the control group (p<0.05). The treatment group showed a significantly higher treatment response rate than the control group (p<0.05). The application of smoked Huayu Qufu Shengji decoction and sitz bath in patients who underwent perianal abscess surgery can relieve pain, promote faster wound healing and improve the inflammation state, resulting in a significant overall effect. Therefore, this treatment can be preferred as a first-line therapy.

Transmural or mucosal healing in Crohn´s disease. Which is the goal to be pursued?

In their original report of regional ileitis, Crohn, Ginzburg and Oppenheimer already described that inflammation involved not only the ileal mucosa: "the submucosal and, to a much lesser extent, the muscular layers of the bowel are the seat of marked inflammatory hyperplastic and exudative changes", they wrote 1. Ninety years later it is well established that the inflammatory process that characterizes Crohn´s disease (CD) involves all the layers of the intestinal wall; this fact is directly related with the development of progressive digestive tract damage related to disabling complications such as strictures, fistulae, perforation, and perianal or abdominal abscesses.

Perianal abscess leading to subcutaneous emphysema and septic shock with multi-organ failure: A case report

Perianal abscess leading to subcutaneous emphysema and septic shock with multi-organ failure: A case report

A case series of Extra-peritoneal spread of perianal abscess: a rare complication of perianal abscess - Experience from a tertiary care centre in India.

Extra-peritoneal spread of perianal abscess is a rare form of anorectal disease responsible for significant morbidity. We present a case series of 10 patients who presented with abdominal pain as a common symptom. 9 of 10 were not diagnosed at presentation to index centre. A proper examination of the perianal region as well as abdomen can help us suspect this condition clinically and can be confirmed with cross sectional imaging. Draining seton with adequate drainage of both perianal and extra-peritoneal component is the key treatment.

A study of the diagnostic efficacy of diffusion-weighted magnetic resonance imaging in the diagnosis of perianal fistula and its complications.

To determine the diagnostic efficacy of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis of perianal fistula and its complications. This is a retrospective study based on the data of 47 patients with a clinical diagnosis of perianal fistula, who had an MRI study performed on a 1.5-T GE Signa MR scanner. DWI sequences were done using 3 different b-values. Other routine MR sequences were included. The MR images were studied to compare the diagnostic efficacy of the DW MRI sequence and other sequences in diagnosing perianal fistula and its complications. Apparent diffusion coefficient (ADC) values of abscesses and inflammatory soft tissue lesions were measured using ADC maps. The standard reference to obtain diagnostic efficacy was post-surgical data. Seventy-nine perianal fistulas were diagnosed in 47 patients who had undergone an MRI study. The sensitivity and specificity of different MR sequences in diagnosing perianal fistulas are T2 FSFSE: 92% sensitivity; DWI: 96% sensitivity; combined T2+DWI: 100% sensitivity; and post-gadolinium T1 FS has 100% sensitivity in diagnosing perianal fistulas. The mean apparent diffusion coefficient for the abscess in our study was 0.990 ± 0.05 × 10-3, and the mean apparent diffusion coefficient for an inflammatory soft tissue lesion was 1.440 ± 0.05 × 10-3. The optimal ADC cut-off for the abscess was 1.098 × 10-3 mm2/s showing 100% sensitivity and 93.8% specificity. DW imaging is a reliable sequence to diagnose perianal fistula and its complications. Measurement of ADC values is reliable in diagnosing perianal abscess collection. DWI sequence helps patients with renal impairment in whom IV gadolinium is contraindicated.

A Review of Surgical Approach taken by AcharyaSushrutain theManagement ofShataponakaBhagandaraw.s.r to MultipleTractFistulaIn Ano

Fistula in Ano is a track lined by granulation tissue, which connects perianal skin superficially to anal canal, anorectum or rectum deeply. It usually occurs in a pre-existing anorectal abscess which burst spontaneously. Acharaya Sushruta included Bhagandara in Ashtamaharoga and discussed it in detail based on its prevalence and difficulty in treatment. Shatponaka Bhagandara is one of the five varieties of Bhagandara that Acharya Sushruta has mentioned. In an effort to reduce recurrence rates and increase success rate over the past many years, numerous authors have proposed innovative procedures. However, Fistula-in-Ano is still a challenging surgical condition. In order to manage this difficult condition and create new trends in our understanding of Fistula-in-Ano, it is necessary to rediscover the old wisdom of Acharya Sushruta. The objective of this study is to review and interpret the surgical approach taken by Acharya Sushruta in the management of Shatponaka Bhagandara in light of contemporary surgical literatures, which may hold the key for successful management of this disease.

Unique challenges in management alcoholic hepatitis with large left sided ischiorectoal abscess- A case report

Alcoholic hepatitis is a condition with high mortality and morbidity. It is routine to have infectious complications with alcoholic hepatitis. However, ischiorectal abscess with its unique management challenges has not been described in the literature. We describe here a case of ischiorectal abscess with alcoholic hepatitis, and how the post-operative course is much more complicated due to underlying alcoholic hepatitis.

Chinese expert consensus on standardized treatment for presacral cysts.

Presacral cysts are cystic or cyst-solid lesions between the sacrum and rectum, almost involving adjacent pelvic floorstructures including sacrococcygeal fascia, rectum, and anal sphincter. Presacral cysts are usually benign, currently believed to arise from aberrant embryogenesis. Presacral cysts are clinically rare and the true incidence is unknown. Surgical resection remains the major treatment for presacral cysts. Unless the cysts are completely resected, recurrence is unavoidable. Recurrent cysts or hard-to-heal sinuses in the sacrococcyx cause patients extreme pain. However, the current knowledge of presacral cysts is insufficient. They are occasionally confused with other diseases such as ovarian cysts and perianal abscesses. Moreover, lack of the correct surgical concept and skills leads to palliative treatment for complex presacral cysts and serious complications such as impairing the function of the anal sphincter or important blood vessels and nerves. The consensus summarizes the opinions and experiences of multidisciplinary experts in presacral cysts and aims to provide clinicians with a more defined concept of the treatment, standardize the surgical approach, and improve the efficacy of presacral cysts.

Treatment of the fistula tract with laser ablation in high anal fistula

&lt;b&gt;Aim and introduction:&lt;/b&gt; Considering the recurrence and fecal incontinence rates in high anal fistulas, surgical treatment of anal fistulas is a challenging process, although many treatments have been defined today. The aim of our study is to evaluate the long-term results of laser ablation of the fistula tract in high anal fistulas.&lt;br /&gt; &lt;b&gt;Material and methods: &lt;/b&gt;The files of patients who underwent laser ablation of the fistula tract due to high anal fistula between June 2020 and January 2022 were evaluated retrospectively. Moreover, their postoperative complications, preoperative and postoperative Cleveland fecal incontinence scores (CCFFSI score), postoperative first day and first-week visual analog scale (VAS) scores, follow-up times, and recurrence rates were analyzed.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 26 patients were included in the study. The mean follow-up period was 39.88±14.34 weeks, and the postoperative first and 7th day VAS scores were 4.61±1.41 and 0.8±1.02, respectively. Preoperative and postoperative CCFI scores were calculated as 1.8±1.41, 1.65±1.32, respectively. Recurrence was observed in 7 patients postoperatively. Postoperative anal abscess developed in 1 patient.&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;Although laser ablation of the fistula tract can be safely performed as a technique that does not affect incontinence, recurrence rates should also be considered. Furthermore, more extensive randomized prospective studies on this technique should be performed.&lt;b&gt; &lt;/b&gt;

Malignant transformation of perianal tailgut cyst: A case report

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. 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. 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.

Leukopenia is an independent risk factor for early postoperative complications following incision and drainage of anorectal abscess.

Few data are available regarding the management of anorectal abscess in patients with leukopenia. The aim of this study was to investigate the impact of leukopenia among patients undergoing incision and drainage for anorectal abscess. A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients from 2015 to 2020. Perianal fistulas and supralevator abscesses were excluded. Patients were grouped based on white blood cell (WBC) count: WBC < 4.5 cells/μl, WBC=4.5-11.0 cells/μl and WBC > 11.0 cells/μl. The 30-day overall complications and outcomes were compared using regression models, accounting for demographics and comorbidities. Ten thousand two hundred and forty (70.3% male) patients were identified. Univariate analysis showed that, compared with patients with leukocytosis (WBC > 11.0 cells/μl) and normal WBC count (WBC=4.5-11.0 cells/μl), patients with leukopenia (WBC <4.5 cells/μl) had higher rates of overall (p < 0.001), pulmonary (p < 0.001) and haematological complications (p < 0.001). They also had higher rates of readmission (p < 0.001), reoperation (p=0.005), discharge to a care facility (p=0.003), increased length of hospital stay (p=0.004) and death (p < 0.001). Multivariable analysis identified leukopenia as an independent risk factor for overall complications [odds ratio (OR) 2.31, 95% CI 1.65-3.24; p < 0.001], pulmonary complications (OR 5.65, 95% CI 1.88-16.97; p=0.002), haematological complications (OR 4.30, 95% CI 2.94-6.28; p < 0.001), unplanned readmission (OR 2.20, 95% CI 1.43-3.40; p < 0.001), reoperation (OR 1.80, 95% CI 1.10-2.93; p=0.019) and death (OR 2.77, 95% CI 1.02-7.52; p=0.046). Discharge to a care facility and length of stay were not significant on multivariable analysis. Leukopenia is associated with increased risk for pulmonary and haematological complications, readmissions, reoperations, discharge to a care facility and death after incision and drainage for anorectal abscess.

Clinical nursing visual health education pathway for patients with perianal abscess†

Abstract Objective: To investigate the effect of a clinical nursing pathway and visual health education on patients with perianal abscesses was the objective of this study. Methods: Eighty patients with perianal abscesses undergoing in-patient surgical treatment (blinded for review) between December 2019 and November 2020 were divided randomly and evenly into a control group and an experimental group. The control group received routine nursing care, and the experimental group received visual health education nursing care. Digital pain scores, patient satisfaction scores, nursing quality scores, and scores measuring knowledge of perianal abscess disease for the two groups before and after nursing care were compared and analyzed. Results: The experimental group had visual analog scale (VAS) scores significantly lower than those of the control group (P &lt; 0.05). For total nursing satisfaction, the experimental group demonstrated a higher satisfaction rate (P &lt; 0.05). Clinical nursing quality scores were significantly higher in the experimental group than those in the control group (P &lt; 0.05). The perianal abscess disease-related knowledge scores after intervention were significantly higher in the experimental group than those in the control group (P &lt; 0.01). Conclusions: Visual health education nursing can help patients better understand and deal with perianal abscess disease.

Overlooked monkeypox cases among men having sex with men during the 2022 outbreak – a retrospective study

ObjectivesThe aim of this study was to characterize overlooked cases of patients with monkeypox infection in the 2022 outbreak. MethodsClinical characteristics of 26 patients who were misdiagnosed with other diseases were described. ResultsOf the 26 patients who were misdiagnosed, six (23%) were given a diagnosis of bacterial tonsillitis, six (23%) were diagnosed with primary syphilis, five (19.2%) with oral or genital herpes, and four (15.3%) with bacterial proctitis or anal abscess. The average time interval between missed and right diagnosis was 4.4 days. There was no difference in the missed cases between the early and the later month of the outbreak. ConclusionMonkeypox might still be commonly overlooked, especially in patients presenting with fever and sore throat or solitary ulcer as sole manifestations.

Risk factors for therapy failure after surgery for perianal abscess in children.

The role of surgery in managing perianal abscesses in the pediatric population is debatable, and data on recurrence risk is rare. This study aimed to evaluate the efficiency of surgery for a perianal abscess in children and identify parameters that predict recurrence. We performed a retrospective review of all children younger than age 14 requiring surgery for a perianal abscess from 2000 to 2018. Out of 103 enrolled patients, 27 (26%) had recurrent perianal disease. Recurrences appeared after a median of 5 months (range: 1-18 months), in 12cases as perianal abscess and 15 cases as fistula in ano. Anal fistula probing was performed in 33% of all patients, of which 16 (15%) underwent fistulotomy. In univariate analysis, older age (p = 0.034), fistula probing (p = 0.006) and fistulotomy (p = 0.009) was associated with treatment success. History of perianal abscess, multilocal occurrence, and the presence of enteric flora in wound swabs was associated with treatment failure (p = 0.002, OR = 0.032). In multivariate analysis, anal fistula probing was independently associated with treatment success (p = 0.019, OR = 22.08), while the history of perianal abscess was associated with treatment failure (p = 0.002, OR = 0.032). Our study identified probing for fistula as a predictor of therapy success, while the history of perianal abscess was identified as a predictor of treatment failure. Therefore, in all children with perianal abscess, fistula probing and if present, fistulotomy should be performed.

Potential mechanisms of Lian-Zhi-Fan solution for TNBS-induced ulcerative colitis in rats via a metabolomics approach.

Lian-Zhi-Fan (LZF) decoction is a hospital-prescribed traditional Chinese medicine botanical drug prepared by the fermentation of decocted Coptidis Rhizome (Huanglian), Gardeniae Fructus (Zhizi), and alum (Baifan). It has been used clinically in China for the treatment of anal fistula, perianal abscess, ulcerative colitis (UC), and other anorectal diseases for hundreds of years. However, due to the complexity of traditional Chinese medicine, the potential mechanisms of LZF in the treatment of UC have remained unknown. This study primarily investigated the remarkable pharmacological effects of LZF on TNBS-induced UC rats. To explore the complex targets and regulatory mechanisms of metabolic networks under LZF intervention, a metabolomics approach mediated by HPLC/Q-TOF-MS analysis was used to screen the different metabolites and their metabolic pathways in the serum in order to characterize the possible anti-UC mechanisms of LZF. After rectal administration of LZF for seven consecutive days, significant amelioration effects on body weight loss, DAI score, and colon inflammation were found in UC rats. Based on this, further metabolomics identified 14 potential biomarkers in the treatment of UC with LZF, of which five possessed diagnostic significance: L-alanine, taurocholic acid, niacinamide, cholic acid, and L-valine. These metabolites are mainly involved in 12 metabolic pathways, including nicotate and nicotinamide metabolism, glycospholipid metabolism, arginine and proline metabolism, primary bile acid biosynthesis, and pantothenate and CoA biosynthesis. These metabolic pathways suggest that LZF ameliorates UC by regulating amino acid metabolism, fat metabolism, and energy production. This study provides a useful approach for exploring the potential mechanisms of herbal prescription in UC treatment mediated by metabolomics.