Perianal Abscess Research Articles

Mirikizumab: A promising breakthrough in Crohn's disease treatment.

Crohn's disease (CD) is a chronic, progressive inflammatory bowel disorder characterized by persistent inflammation and noncontiguous "skip lesions" throughout the gastrointestinal tract. With a prevalence of 100-300 cases per 100,000 individuals, CD is most common in Western Europe and North America. Symptoms include abdominal pain, diarrhea, fever, weight loss, and anemia, with severe cases leading to complications such as perianal abscesses and cutaneous fistulas. Treatment involves pharmaceutical interventions, bowel rest, and sometimes surgery, with biological therapies like ustekinumab and mirikizumab gaining prominence. The VIVID-1 trial assessed mirikizumab in patients with moderately to severely active CD. By Week 12, mirikizumab significantly outperformed placebo in clinical response (45.4% vs. 19.6%, p < 0.000001). By Week 52, it showed higher clinical remission rates (54.1% vs. 19.6%) and demonstrated non-inferiority to ustekinumab in clinical remission (p = 0.51). The SEQUENCE study compared risankizumab to ustekinumab, with risankizumab showing superior reductions in inflammatory markers and higher biologic remission rates at Weeks 8, 24, and 48. Both treatments had similar safety profiles, with common adverse events including COVID-19, anemia, and headache. Mirikizumab, based on the VIVID-1 trial outcomes, is a promising addition to CD therapy. It demonstrated significant clinical responses and remission rates, warranting further research on its long-term efficacy and safety. Updating professional guidelines and addressing affordability will ensure broader access and improved management of CD.

Butyricimonas faecihominis: an atypically resistant bacterium implicated in abscess formation - a case report

BackgroundThis case report presents a unique instance of abscesses with an uncommon pathogen isolated from blood cultures.Case presentationWe present the case of a perianal abscess in a 50-year-old man with a history of cocaine abuse and bilateral hip replacements. The rapid progression led to septic shock and multi-organ failure, requiring intensive care unit admission, surgery including protective transversostomy. Blood cultures showed growth of Butyricimonas spp. with resistance to penicillin and piperacillin-tazobactam. The immediate switch to meropenem led to a significant improvement in the patient’s condition. The patient was discharged after 40 days of hospitalization in good general condition and the reversal of the transversostomy was performed six months later.ConclusionThe identification of Butyricimonas faecihominis, a rarely reported pathogen, emphasizes the challenges of diagnosing and treating unusual infections. This case emphasizes the importance of rapid microbiological diagnosis, interdisciplinary collaboration, and targeted antibiotic therapy in the treatment of abscesses and sepsis.

Extensive Fournier’s Gangrene Due to Delayed Management of Perianal Abscess in Uncontrolled Diabetes: A Case Report

Abstract Fournier’s gangrene is a rapidly spreading gangrene predominantly affecting the genital and perianal region. It has the highest mortality and is more common in immunocompromised and diabetic patients. Poorly controlled diabetes is one of the common risk factors for Fournier’s gangrene. Delayed diagnosis and treatment increase mortality by nearly 100%. In our case, the patient was initially managed for a perianal abscess and later progressed to Fournier’s gangrene. A 48-year-old male diabetic presented with erythematous swelling in the right-side scrotal region for one-week duration. He had a recent perianal abscess and underwent incision and drainage at another hospital He also reported fever with chills and rigors for the past two days. The patient is now in a state of septic shock. He has a history of irregular medication for type 2 diabetes mellitus. Clinical examination confirmed Fournier’s gangrene resulting from a perianal abscess in the context of uncontrolled diabetes. The patient underwent an emergency wound debridement under spinal anesthesia. Extensive wound debridement was performed on the right hemiscrotum. Necrotic tissue was debrided on the right perianal region. The patient was initiated on empirical antibiotics, receiving a calculated dose of cefoperazone with sulbactam and metronidazole. Additionally, the patient underwent sitz baths and received regular wound dressing. Following wound debridement and glycemic control with insulin, the patient showed signs of improvement. Four weeks post-debridement, the patient underwent split-skin grafting for the raw area on the scrotum, while the fistula site was allowed to heal by secondary intention. The cornerstone in managing perianal abscess with Fournier’s gangrene in diabetic patients is extensive wound debridement, antibiotic coverage, and proper management of diabetes. Early diagnosis and prompt surgery of perianal abscess can reduce the risk of developing Fournier’s gangrene in diabetic patients. Post-surgical raw areas can be effectively managed with split-skin grafts.

Auricular point acupressure for managing postoperative pain and reducing anxiety in patients with perianal abscesses

ObjectiveThe objective of this study is to assess the efficacy of auricular point acupressure in relieving postoperative pain and reducing anxiety among patients with perianal abscesses. MethodsWe included 61 patients with perianal abscesses who were admitted to the Nantong First People's Hospital between July 2019 and June 2020 and were scheduled to undergo one-stage radical surgery. We divided them into the treatment group (n = 31), where patients were administered preoperative auricular acupressure targeting the bilateral Shenmen, subcortical, and other points. They were instructed to apply pressure five to six times per day, each time for about 3–5 min. Patients in the control group (n = 30) received routine preoperative preparation. The treatment duration for both groups was one week. We compared the two groups using the pain visual analog scale (VAS) scores, the use of additional postoperative analgesics, and scores on the Hamilton anxiety and depression scales pre- and post-surgery at 6 h, 24 h, 48 h, 72 h, and 1 week after surgery, as well as at the time of the first bowel movement. ResultsPatients in the treatment group reported lower VAS scores than those of the control group at 48 h, 72 h, 1 week, and at the first defecation post-surgery, and the differences were statistically significant (all P < 0.05). Additional postoperative analgesics were used in seven patients in the treatment group (22.58 %) and in 10 patients in the control group (33.33 %). The difference between the two groups was not statistically significant (χ2 = 0.88, P = 0.35). Postoperative scores for the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) in the treatment group were significantly lower than those in the control group (P < 0.05). ConclusionThe results of this study demonstrated that auricular point acupressure was effective in alleviating postoperative pain in patients with perianal abscesses and simultaneously reduced their postoperative psychological stress reactions. This dual effect provided both pain relief and a reduction of anxiety with fewer adverse reactions, making it a safe and effective treatment option.

Effectiveness of methylene blue as a local anesthetic and analgesic in perianal operations: A prospective double-blind randomized control trial

BackgroundPerianal operations often result in significant postoperative pain, which negatively affects patient comfort and recovery. The search for effective pain relief options has led to the investigation of methylene blue, a biological stain with potential analgesic properties. AimsThis study aimed to evaluate the analgesic and anaesthetic effects of a mixture of methylene blue and lidocaine compared to plain lidocaine in the management of postoperative pain after perianal operations. MethodsA prospective, double-blinded, randomized controlled trial was conducted at a single center between 2015 and 2023. A total of 727 adult patients undergoing perianal surgical operations were randomly assigned to two groups: the experimental group received a solution of methylene blue and lidocaine, while the control group received plain lidocaine. Pain levels were assessed using the Visual Analog Scale (VAS), and follow-up visits and phone calls were conducted. The analysis included 727 participants who underwent operations for perianal abscess, fistula, fissure, and haemorrhoid. The participants were divided into the experimental group (N=329) and the control group (N=398). The data were analyzed using SPSS version 28, applying descriptive and inferential statistical methods. ResultsThe study included a total of 727 patients, with a mean age of 47 years (ranging from 18 to 90 years). Among the patients, 56.5% were males and 43.5% were females. The two groups showed significant differences in terms of postoperative analgesic use and pain-free days (p<0.001). Specifically, the methylene blue group had lower Visual Analog Scale (VAS) scores compared to the control group (p<0.05, p<0.001), respectively. No significant differences in immediate complications were observed between the two groups. ConclusionMethylene blue is an effective intervention for reducing postoperative pain after perianal operations, potentially decreasing the need for additional pain medication. The findings of this study suggest that methylene blue has a promising role in pain management without an increase in complications.

Perianal Tuberculosis in an Immunocompetent Patient: Exploring the Uncommon Manifestation

AbstractAs it is an infrequent etiology, the diagnosis of perianal tuberculosis is challenging, especially in the absence of a pulmonary focus. TB should be considered in the differential diagnosis of perianal ulcers, fistulas, abscesses, mainly in non-healing and recurrent anal lesions. Treatment with anti-TB agents can provide complete recovery. Furthermore, these lesions are often diagnosed later after complete histopathological and mycobacterial results, where the benefit of avoiding morbid multiple surgeries by effective anti-TB treatment is lost.We reported a rare case of an immuno-competent patient with perianal TB, which was the first manifestation of the disease. A fit-and-well man in his 20s presented a large perianal abscess. Unexpectedly, his chest X-ray showed a rounded hyper-transparency in the left lung. The abscess was drained. Posterior investigation with culture analysis from pus swabs and sputum revealed the presence of Mycobacterium tuberculosis complex infection. After completing the 6 months of oral administration of anti-TB drugs, the patient was asymptomatic.By highlighting this unusual manifestation, we aim to improve clinicians' awareness of perianal TB, facilitating early recognition and appropriate management.

Vaccine-associated paralytic poliomyelitis in oral polio vaccine recipients: disproportionality analysis using VAERS and systematic review

ABSTRACT Background Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event of oral poliovirus vaccines (OPV), particularly affecting immunodeficient individuals. Research design and methods This study aimed to (1) Assess the association between OPV and VAPP using Vaccine Adverse Event Reporting System (VAERS) database (2) Outline patient characteristics and risk factors associated with the occurrence of VAPP in OPV recipients through a systematic review of case reports and case series. A disproportionality analysis was conducted using the data from VAERS, encompassing adverse events reported from 1990 till February 2023. Additionally, we conducted a systematic review of case reports and case series using PubMed, Scopus, and Embase databases. Results The VAERS data revealed 130 VAPP reports among 1,739,903 OPV linked adverse events, with year 2010 reporting the strongest association. The systematic review of 37 studies highlighted VAPP occurrence within 2 months to 4 years post-vaccination, typically with acute flaccid paralysis. Immunodeficiency and perianal abscess emerged as major risk factors. Out of the 37 included studies, 27 showed consistent causal association of VAPP with OPV using WHO-AEFI causality assessment tool. Conclusion The study emphasized the seriousness of VAPP and highlights its association with OPV, identifying immunodeficiency as a prominent contributor to VAPP manifestation.

Importance of high-frequency and low-frequency three-dimensional endoanal ultrasound scan in diagnosing perianal fistula and abscess

Importance of high-frequency and low-frequency three-dimensional endoanal ultrasound scan in diagnosing perianal fistula and abscess

Predictive Factors and Timing of Developing Anal Fistula after Drainage of Cryptoglandular Anorectal Abscess: A Retrospective Cohort Study

Background: Cryptoglandular infection is one of the main causes of common anorectal infections that presents in conjunction with abscess following anal fistula after drainage. Objective: To evaluate the rate and predictive factors of fistula formation following anorectal abscess drainage, and the timing of fistula diagnosis. Materials and Methods: The present study was a retrospective study of 232 patients with cryptoglandular anorectal abscess that underwent drainage in the operating room under anesthesia between 2010 and 2019. The predictive factors of fistula development were analyzed using Cox’s proportional hazard. Results: Seventy out of 232 patients (30%) developed anorectal fistula after drainage of anorectal abscess. Median follow-up time was 35.5 months, and 25.02% (95% CI 19.89 to 31.19) of patients developed fistula within 12 months after the surgery. Independent factors in developing anal fistula after drainage were female gender (HR 2.17, 95% CI 1.15 to 4.14, p=0.017), alcohol consumption (HR 2.24 95% CI 1.20 to 4.22, p=0.012), and driver (HR 2.80, 95% CI 1.08 to 7.25, p=0.034). The protective factors are gauze packing (HR 0.43, 95% CI 0.23 to 0.82, p=0.009) and identifiable organism from pus culture (HR 0.59, 95% CI 0.36 to 0.99, p=0.046). Conclusion: After drainage of a cryptoglandular anorectal abscess, there is a need to raise the awareness concerning anorectal fistula in female patient, alcohol drinkers, and those who work as drivers. Bacterial cultures should be taken, and gauze drain should be positioned. The potential fistula formation should be monitored in the first year after the operation with an option of extending to a second year.

Efficacy of surgical treatment of perianal infection in patients with hematological malignancy.

The efficacy of surgical intervention for perianal infection in patients with hematologic malignancies is not well established. Therefore, our study aimed to investigate the clinical efficacy and complications of surgical treatment of perianal infection in patients with hematologic malignancies. This retrospective study included patients with hematological malignancies who were diagnosed with perianal infections and treated at the China Aerospace Science & Industry Corporation 731 Hospital between 2018 and 2022. Patient characteristics, hematological data, surgical intervention, and complications, including recurrence and mortality, were analyzed. This study included 156 patients with leukemia aged 2 months to 71 years who were treated surgically for perianal infection, comprising 94 males and 62 females. Perianal infection included 36 cases of abscesses, 91 anal fistulas, and 29 anal fissures accompanied by infection. A total of 36 patients developed severe complications postoperatively, including 4 patients who died, 6 patients with severe incision bleeding, 18 patients with severe pain, 6 patients with sepsis, 12 patients who needed reoperation, 15 patients with hospitalization for more than 2 weeks, and 3 patients with anal stenosis; none of the patients developed anal incontinence. Additionally, risk factors for postoperative complications of perianal infection in patients with hematologic malignancies include leukopenia, agranulocytosis, thrombocytopenia, depth of abscess and not undergone an MRI. Surgical intervention may improve the prognosis of patients with perianal abscess formation, particularly in patients who show no improvement with medical therapy and those who develop perianal sepsis. Granulocytopenia and thrombocytopenia should be improved before surgery, which can significantly reduce postoperative complications. Although these findings are from a case series without a comparator, they may be of value to physicians because to the best of our knowledge, no randomized or prospective studies have been conducted on the management of perianal infections in patients with hematological malignancies.

Antibiotic Treatment Has No Influence on Anal Fistula Formation and Recurrent Perianal Abscess After Incision and Drainage of Cryptogenic Perianal Abscess: A Randomized Single-Blinded Prospective Study.

Anal fistula commonly appears after incision and drainage of a perianal abscess. Theoretically, a fistula develops as a consequence of the infection process. Antibiotic treatment was suggested to decrease the possibility of fistula development. We hypothesized that antibiotic treatment has no influence on the development of anal fistula after surgical treatment of perianal abscess. A single-blinded randomized prospective study. Patients with primary cryptogenic abscesses were eligible to participate. Patients were divided into 2 groups. Patients in group I received amoxicillin 875 mg/clavulanic acid 125 mg during 7 days after surgery, and patients in group II received no antibiotics. The study database included demographics and clinical and laboratory data. Patients were examined in our outpatient clinic 2 weeks, 4 months, and 1 year after surgery, and a telephone questionnaire was performed 6 months after surgery. The primary outcome was the formation of anal fistula. The secondary outcome was recurrent perianal abscess. Overall, 98 patients completed the study. Groups were not different in inclusion. Anal fistula was diagnosed in 16 patients (16.3%) in group I (treatment group) and 10 patients (10.2%) in group II (control group; p = 0.67). Nine patients (9.2%) developed recurrent perianal abscess, 4 in the treatment group and 5 in the control group ( p = 0.73). A relatively small number of patients were treated in a single medical center. Antibiotic therapy has no influence on anal fistula or recurrent perianal abscess formation after incision and drainage of perianal abscess. See Video Abstract . ANTECEDENTES:La fístula anal comúnmente aparece después de la incisión y drenaje de un absceso perianal. Teóricamente, la fístula se desarrolla como consecuencia del proceso infeccioso. Se sugirió tratamiento antibiótico para disminuir la posibilidad de desarrollo de fístula.OBJETIVO:Hipotetizamos que el tratamiento con antibióticos no tiene influencia en el desarrollo de fístula anal después del tratamiento quirúrgico del absceso perianal.DISEÑO:Estudio prospectivo, aleatorio, simple ciego.AJUSTE Y PACIENTES:Los pacientes con absceso criptogénico primario fueron elegibles para participar. Los pacientes se dividieron en dos grupos. Los pacientes del Grupo I recibieron amoxicilina 875 mg/ácido clavulánico 125 mg durante los 7 días posteriores a la cirugía y los pacientes del Grupo II no recibieron antibióticos. La base de datos del estudio incluyó datos demográficos, clínicos y de laboratorio.PRINCIPALES MEDIDAS DE RESULTADO:Los pacientes fueron examinados en nuestra clínica ambulatoria 2 semanas, cuatro meses y 1 año después de la cirugía y se realizó un cuestionario telefónico 6 meses después de la cirugía. El resultado primario fue la formación de una fístula anal. El resultado secundario fue el absceso perianal recurrente.RESULTADOS:En total, 98 pacientes completaron el estudio. Los grupos no fueron diferentes en cuanto a la inclusión. Se diagnosticó fístula anal en 16 (16,3%) pacientes del Grupo I (grupo de tratamiento) y 10 (10,2%) pacientes del Grupo II (grupo control) (p = 0,67). Nueve pacientes (9,2%) desarrollaron absceso perianal recurrente, 4 en el grupo de tratamiento y 5 en el grupo control (p = 0,73).LIMITACIONES:Número relativamente pequeño de pacientes tratados en un solo centro médico.CONCLUSIÓN:La terapia con antibióticos no tuvo influencia sobre la fístula anal o la formación de absceso perianal recurrente después de la incisión y drenaje del absceso perianal. (Traducción - Dr. Fidel Ruiz Healy ).

Salvage surgery for pouch-related complication after ileal pouch–anal anastomosis: a report of two cases

BackgroundPouch-related complications (PRCs), such as pelvic abscesses and perianal complex fistulas, can occur after ileal pouch–anal anastomosis (IPAA) in ulcerative colitis (UC). They are often difficult to treat and require salvage surgery. We report two cases of PRC associated with fistulas.Case presentationFirst case: A 38-year-old man was diagnosed with UC at age 26 years. Four months after the diagnosis of UC, the patient underwent hand-assisted laparoscopic restorative proctocolectomy, IPAA, and ileostomy for acute fulminant UC. Two years after the closure of the ileostomy, the patient developed a perianal abscess and underwent ileostomy reconstruction. He was referred to our department at 35 years of age, because his symptoms did not improve despite repeated seton drainage of a complicated perineal fistula. We diagnosed PRC with a pelvic abscess and complicated pouch fistula and performed salvage surgery. This diagnosis was revised to Crohn’s disease. Second case: A 50-year-old man was diagnosed with UC at age 18 years and was administered high doses of steroids; however, his symptoms did not improve. He underwent restorative proctocolectomy, IPAA, and ileostomy at another hospital. The ileostomy was closed, and his condition stabilized thereafter. At 35 years of age, perianal pain developed, and he was diagnosed with a complicated pouch–perineal fistula. A fistula was observed near the staple line of the ileal end closure on the head side of the pouch. Reconstruction of the ileostomy and seton drainage were performed; however, his symptoms did not improve, and he was referred to our hospital. We diagnosed PRC with a pelvic abscess and a complicated pouch fistula and performed salvage surgery. The resected specimen showed strictures in two locations: at the oral site of the afferent limb (at the pouch) and at the IPAA. Both patients returned to society and are currently outpatients.ConclusionsWe encountered two cases of PRC after IPAA that did not improve with seton drainage or ileostomy. Pouch resection was performed after considering the patient’s quality of life and reintegration into society.

Does microbiology of perianal abscesses affect the length of hospital stay?

BackgroundPerianal abscess is a common disease among adults, necessitating surgical drainage. We aimed to assess the role of microbiology and other factors in prolonged hospitalization of patients with perianal abscesses. MethodsThis retrospective study included all patients aged 18 or older who underwent surgical incision and drainage for perianal abscess in a single medical center between 2016 and 2020. Data regarding demographics, bacteriological cultures, and length of hospital stay were collected via electronic patient charts. A prolonged hospital stay was defined as a LOS longer than 3 days. ResultsA total of 791 patients were included, of which 77.5% were male, with a mean age of 43.2. Overall, 46.1% of patients had positive cultures, of which 69.9% were polymicrobial. The most common pathogen found in obtained cultures was Escherichia coli (69.9%), followed by streptococcus species (36.7%) and Bacteroides (26.0%). Females had a significantly longer hospital stay (p = 0.03). Prolonged hospital stay was associated with older age (p < 0.0001), female gender (p = 0.04), and positive cultures for Enterococcus (p = 0.02). ConclusionsThis study identified clinical and microbiological risk factors for prolonged hospitalization in patients with perianal abscesses. Further studies are needed to evaluate the association between specific pathogens and rates of complications.

Sexual Function After Surgical Treatment for Benign Anorectal Disorders.

Benign anorectal diseases such as hemorrhoidal disease, anal fissure, anal pruritus, perianal abscess, and fistula are the most common ones. The aim of this study was to assess sexual function in patients after surgery for benign anorectal diseases. Sixty-one male patients with perianal fistulas, operated on at Department of General Surgery, Faculty of Medicine, completed a self-administered questionnaire including the International Index of Erectile Function (IIEF) score. The median IIEF score of the postoperative patients was significantly higher (24, range [10-25]) than that of preoperative patients (22, range [5-25]), p < .0001. Sexual function is significantly influenced by surgery for benign anorectal diseases.

"Emergency Room Incision and Drainage of Perirectal Abscess is Equivalent to Incision and Drainage in the Operating Room".

Current guidelines for management of anorectal abscesses make no recommendations for operative vs bedside incision and drainage (I&D). The purpose of this study was to determine if management in the operating room is necessary to adequately drain anorectal abscesses and prevent short-term complications for patients presenting to the emergency department (ED). Patients with perirectal abscesses were identified and divided into two groups based on intervention type: "bedside" or "operative." Demographic, laboratory, and encounter data were obtained from the medical record. Study outcomes included 30-day complications (return to the ED, reintervention, and readmission). Data were analyzed with univariate and multivariate analyses using SPSS (version 28). A total of 113 patients with anorectal abscesses were identified. Sixty-six (58%) underwent bedside I&D and 47 (42%) operative I&D. The overall complication rate was 10%. A total of 9 patients (6 bedside and 3 operative) returned to the ED. Six of these patients required reintervention (5 bedside and 1 operative), and 1 was readmitted. Two patients from the bedside group required a second I&D during their index admission. Pre-procedure SIRS (P = .02) was found to be associated with 30-day complications. Provider specialty and training level were not associated with 30-day complications. In this study, for patients presenting to the ED, bedside drainage was found to be an adequate management strategy to achieve complete drainage without a significant increase in the rate of complications when compared to operative drainage.

Multiple Immune Dysregulation Conditions with a Single Underlying Root Cause of NRAS Gene-Positivity: A Case Report

Hematological malignancies in particular are recognized to be linked to immunological dysregulated disorders such hematolytic anemia, immunodeficiency, and autoimmune illnesses. We describe a rare case that had multiple immune dysregulation symptoms and was subsequently found to be positive for the NRAS gene. A male, 29, complained of pleuritic chest pain. On the ECG, he showed broad PR depression and elevated PR in aVR, along with elevated troponin. He received colchicine and NSAIDs as treatment with a good response and resolution of his symptoms. After four weeks, he developed a fever which thought to be secondary to perianal abscess, and a surgical incision and drainage along with broad spectrum antibiotics was used to treat a perianal abscess. Despite receiving extensive medical and surgical care, his fever persisted. His blood film started to show circulating blast cells. Following an immediate bone marrow aspiration and biopsy, there were no notable abnormalities seen, and a 1% blast was present, which was assumed to be the result of stress or infection. Later, a weak positive +1 Coombs (DAT) test is developed and caused active hemolytic anemia required blood transfusion. Along with the anemia, a wrist expanding wound was discovered in the previous IV cannula site. Clinically wound appears as a pyoderma gangrenosum. Histopathology showed purulent dermal inflammation including many neutrophils and macrophages. This feature of micro abscess formation was consisting with the diagnosis of pyoderma gangrenosum. An intravenous steroid (1 mg/kg) was administered in response to a positive Coombs test and pyoderma gangrenosum. The patient's condition greatly improved overall. His wound began to heal as his white blood cell count dropped. After being given oral steroids with a titration-down plan, the patient was sent home. A whole genome sequence was performed on him because he had peri myocarditis, pyoderma gangrenosum, and hematolytic anemia. The results show that he is NRAS gene positive. He was attentively observed clinically with regular out-patient follow-ups as this gene is strongly associated with hematological cancers. He developed symptomatic normocytic anemia a few months later, and a bone marrow aspiration and biopsy were performed to confirm the presence of Myelodysplastic syndromes (MDS). He was transferred to another facility and underwent chemotherapy and bone marrow transplant. In otherwise healthy individuals, the idea of offering a single explanation—Occam's razor—must be considered and investigated. Finding the underlying reason could improve patient care, enable precision therapy, and alter the course of events.

Diffusion-Weighted MRI in Perianal Abscess: Role and Comparison With Contrast-Enhanced MRI.

Perianal abscess is a clinical infective and/or inflammatory collection in the perianal region, one entity of a large group of anal and perianal disorders. Perianal abscesses are often seen as a complication of grade 2 and grade 4 perianal fistulas from St. James's University Hospital classification. Several imagingmodalities have been tried in the past for adequate assessment of perianal abscess with contrast-enhanced magnetic resonance imaging (CE-MRI) providing the most accurate results. Diffusion-weighted imaging (DWI) is an emerging sequence that can provide comparable results to CE-MRI in diagnosing and characterizing perianal abscess. The main objective of this study is to assess the role of DWI in adequate identification and assessment of perianal abscess and compare the final results with contrast-enhanced images. Twenty patients with complicated perianal fistula with clinically suspected perianal abscess were evaluated with DWI and CE-MRI. This study was a comparative cross-sectional study conducted in the Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India. Chi-square test was done to find the association between categorical variables. Kappa test was used to find the agreement between two different tests. Receiver operating characteristics (ROC) analysis was done to estimate the area under the curve in predicting the outcome. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were used to measure the validity of the tests. DWI is a very sensitive MRI sequence and is equivalent to CE-MRI to detect the location and analyzingthe loco-regional extent of abscess in complicated perianal fistula cases. DWI is also very sensitive and superior to T2 short tau inversion recovery (STIR) in differentiating perianalabscess from perianal inflammation without abscess. DWI can be used as an alternative to post-contrast fat-suppressed MRI in precisely defining the location and extent of anal and perianal abscesses and disease activity in complicated fistula cases.

Genomic testing identifies monogenic causes in patients with very early-onset inflammatory bowel disease: a multicenter survey in an Iranian cohort.

Patients with very early-onset inflammatory bowel disease (VEO-IBD) may present because of underlying monogenic inborn errors of immunity (IEI). Strong differences have been observed in the causes of monogenic IBD among ethnic populations. This multicenter study was carried out on 16 Iranian patients with VEO-IBD. We reviewed clinical and basic immunologic evaluation including flow cytometry and immunoglobulin levels. All patients underwent clinical whole exome sequencing (WES). Sixteen patients (8 females and 8 males) with a median age of 43.5 months were enrolled. The median age at the onset of symptoms was 4 months. Most patients (12, 75%) had consanguineous parents. Chronic non-bloody diarrhea (13, 81.3%) and perianal diseases including perianal abscess (6, 37.5%), anal fissure (6, 37.5%), or anal fistula (2, 12.5%) were the most common manifestations. WES identified a spectrum of genetic variants in 13 patients (81.3%): IL10RB (6, 37.5%), MVK (3, 18.8%), and CASP8, SLC35C1, G6PC3, and IKBKB in 1 patient, respectively. In 3 patients (18.7%), no variant was identified. Flow cytometry identified a spectrum of abnormalities that helped to assess the evidence of genetic diagnosis. At the end of the survey, 3 (18.8%) patients were deceased. This high rate of monogenic defects with a broad spectrum of genes reiterates the importance of investigating IEI in patients with infantile-onset IBD.

Aerobic Microbiological Spectrum and Antibiotic Resistance in Children Operated for Anorectal Abscesses.

(1) Background: Anorectal abscesses are a relatively rare pathology in childhood. Most often, male children under 1 year of age are affected. The importance of microbiological examination for the diagnosis and treatment of such patients remains debatable among surgeons, resulting in scarce data being available in the literature. We aimed to identify the aerobic microbiological spectrum and antibiotic resistance of isolates in children undergoing operation to treat anorectal abscesses. (2) Methods: We performed a case series of 102 children diagnosed and operated for anorectal abscesses over a period of 10 years (2010-2019). Purulent wound exudate was used for microbiological evaluation, which was subsequently cultured on 5% sheep-blood agar and eosin-methylene blue agar. For microbiological identification, conventional biochemical tests and semi-automated (API 20, bioMerieux, Marcy-l'Étoile, France) tests were used, as well as automated systems (Vitek-2 Compact, bioMerieux, France). Antimicrobial susceptibility testing was performed by the disk diffusion method of Bauer-Kirby and by determining the minimal inhibitory concentrations for glycopeptides. The results were interpreted according to the EUCAST standard for the corresponding year. (3) Results: Microbiological testing in children operated for anorectal abscesses mainly identified the gut commensals that normally reside in the rectal mucosa. Monocultures were found in just over half of the cases. Escherichia coli, Klebsiella pneumoniae complex, and Proteus mirabilis were the most frequently isolated. In addition, Staphylococcus aureus was found in 7% of patients. In Gram-negative bacteria, antibiotic resistance was most often observed in penicillins, cephalosporins, sulfonamides, and fluoroquinolones. (4) Conclusions: The increasing rates of antimicrobial resistance impose the need for the local monitoring of circulating commensal bacteria associated with anorectal abscesses in children to guide antibiotic therapy when indicated.

LAPORAN KASUS INFEKSI/INFLAMASI TRAKTUS GASTROINTESTINAL BAWAH ABSES PERIANAL DENGAN FISTULA

Perianal abscess with perianal fistula is an infectious-inflammatory disease of the perianal region. This disorder has quite high morbidity and recurrence rates and is treated with surgery. Complete preoperative findings, including anatomy, the connection between the fistula and surrounding structures, and secondary fistulas and abscesses, can be obtained through radiological examination. In this case report, a painful lump that was actively producing pus was found in the perianal area, a perianal ultrasound (USG) and Magnetic Resonance Imaging (MRI) examination was carried out and the diagnosis made was a perianal abscess with fistula. Fistulectomy and abscess drainage were performed.