Sinus Tract Research Articles

Local fistula injection of allogeneic human amnion epithelial cells is safe and well tolerated in patients with refractory complex perianal Crohn's disease: a phase I open label study with long-term follow up

Local fistula injection of mesenchymal stromal/stem cells (MSC) is effective for complex perianal Crohn's fistulas but is also expensive and requires specialised facilities for cell revival before administration. Human amnion epithelial cells (hAEC) are non-MSC cells with therapeutic properties. The primary aim of this study was safety of hAEC therapy. Secondary aims included hAEC efficacy, feasibility of the protocol and impact on quality of life. A phase I open label study of ten adults with active complex Crohn's perianal fistulas refractory to conventional treatment, including anti-tumour necrosis factor alpha therapy, was undertaken. A single dose of hAEC was injected into the fistula tract(s) after surgical closure of the internal opening(s). Study outcomes were assessed at week 24 with follow up for at least 52 weeks. Local injection of hAEC was safe, well tolerated and the injection procedure was feasible. Complete response occurred in 4 patients, and a partial response in an additional 4 patients. There was a mean reduction in the Perianal Disease Activity Index of 6.5 points (95% CI-9.0 to-4.0, p=0.0002, paired t-test), modified Van Assche MRI Index of 2.3 points (95% CI-3.9 to-0.6, p=0.012, paired t-test) and a mean improvement of 15.8 points (95% CI 4.9 to 26.8, p=0.010, paired t-test) in quality of life using the Short IBD-Questionnaire in complete responders. Local injection of hAEC therapy for refractory complex perianal fistulising Crohn's disease appears safe, well-tolerated, feasible and demonstrated improvement. Quality of life is improved in those who achieve complete fistula healing. This study was funded by competitive research grant funding from the Gastroenterological Society of Australia Seed Grant2018.

Comparison of Open and Endovascular Aneurysm Repair in Native Arteriovenous Fistulas

Arteriovenous accesses develop aneurysms (FA) during their active use, resulting in pain, erosion, bleeding, and difficulty in cannulation. This study aims to evaluate the outcomes of open and endovascular management of single FA in arteriovenous fistulas (AVF). A retrospective review of all upper extremity primary AVFs over 12years was undertaken at a single center. Patients undergoing elective open and endovascular repair of a single FA were identified. Thirty-day outcomes, cannulation failure, line placement, re-intervention, and functional dialysis (continuous hemodialysis) for 3 consecutive months were examined. Three hundred and seventy nine patients presented with a single FA that met the requirements for intervention: 126 (33%) underwent endovascular repair, and the remainder 253 (67%) underwent open repair. Preoperative fistulogram identified anatomically significant issues in 91% of the cases, and these were treated by balloon angioplasty: 10% within the fistula tract, 44% within the outflow tract, and 47% in the central veins. In open repair, 57% underwent plication, 35% underwent resection and re-anastomosis, and the remainder (8%) underwent interposition grafting. In endovascular repair, successful placement of a stent was achieved in all cases with 1±2 (mean±standard deviation [SD]) covered stents (diameter: 6 -8 mm) placed, achieving successful exclusion of the FA. The combination of early thrombosis and cannulation failures led to the greater need for a tunneled central line in endovascular repair (6.5% vs. 2.4%; endovascular versus open repair; P=0.04). As a result, the mean time for establishing renewed access in the index AVF was significantly higher in endovascular repair (2±3 vs. 2±2weeks, mean±SD; endovascular open repair versus open repair; P=0.001). In follow-up, there were more secondary interventions per year in the endovascular compared to open repair groups (3.1 vs. 1.4 secondary interventions per year; endovascular versus open repair; P=0.04). Median functional dialysis durations were superior in the open repair (48±6%, mean + standard error) compared to the endovascular repair at 5years. (26±7%; P=0.03). Open repair results in a more rapid return to access use, lower need for a tunneled central line, lower secondary re-intervention rates, and superior functional dialysis durations compared to endovascular repair. Open FA repair should be considered for symptomatic single FA repairs before endovascular FA repair.

Hydatid hepatopleural fistula causing biliothorax: minimally invasive approach with ERCP stent placement and chest tube drainage: a case report

Introduction and importance: Biliothorax and hydatid bilio-bronchial fistula (HBBF) are rare complications of hydatid cysts of the liver with high perioperative mortality. Case presentation and clinical discussion: The authors here report the case of a patient with a right massive pleural effusion with evidence of HBBF in imaging studies, who underwent surgical resection of a hydatid cyst of the liver 8 years ago. The patient was managed with intercostal chest tube drainage for biliothorax and endoscopic sphincterotomy with biliary stent placement for the re-establishment of internal biliary drainage, which ultimately allowed the fistulous tract to heal without any major surgical intervention. Conclusion: This article focuses on the successful management of the HBBF at our institution. Our findings emphasize the significance of early diagnosis and the criticality of implementing aggressive and early interventions to minimize complications and fatalities. By examining this specific case and reviewing existing literature, the authors have determined that endoscopic treatment appears to be a viable, secure, and efficacious option for addressing postoperative HBBF.

1300. Comparison of the Clinical Characteristics and Outcomes of Anaerobic Prosthetic Joint Infections (PJI) and Aerobic PJIs : A Retrospective Review

Abstract Background PJI is an uncommon but serious complication of joint arthroplasties that can result in significant morbidity and cost. There is a paucity of studies in the literature on PJIs caused by anaerobic organisms either as the sole pathogen or part of a polymicrobial infection. The purpose of this study was to compare the clinical presentation and outcomes of PJI caused by anaerobes as opposed to aerobes. Methods This was a retrospective review of 306 patients who met Musculoskeletal Infection Society (MSIS) criteria for PJI from 2014 to 2020 at the University of Iowa Hospitals and Clinics (UIHC). 38 patients with anaerobic PJI were compared to 268 patients with aerobic PJI. Statistical analyses were performed using Pearson’s Chi square, Fisher exact test, t-test, and binary logistic regression. Results PJI with anaerobes represented 12.4% of all PJI cases in our institution, which is higher than the 3-6% reported in literature. Patients with anaerobic PJI had longer duration of symptoms (19.4 weeks vs 10.9 weeks, p = 0.012), were more likely to have a sinus tract on exam (23.7% vs 5.9%, p < 0.001), less fever on presentation ( 13.2% vs 30.2%, p = 0.029), more radiographic abnormalities (50.0% vs 31.1%, p< 0.001), lower erythrocyte sedimentation rate (49.0mm/hr vs 67.7 mm/hr, p = 0.003), lower C-reactive protein (6.6 mg/dL vs 12.1mg/dL, p = 0.004), and more likely to be polymicrobial (42.1%vs 8.0%, p < 0.001) compared to aerobic PJI. There was a higher proportion of anaerobes in shoulder PJIs compared to other joints (39.5% vs 5.5%, p< 0.001). Two-stage exchange was the most common surgical treatment in patients with anaerobic PJI (39.4%) whereas debridement and implant retention was the most common (44.5%) surgical treatment done in patients with aerobic PJI. No significant differences were seen between the two groups in terms of recurrences. Independent factors associated with anaerobic infection were shoulder prosthetic joint (AOR 10.5, CI 3.4 - 32.8) and presence of sinus tract (AOR 10.1, CI 3.1 - 32.6). Conclusion Anaerobic cultures should be performed in patients with PJI, and they should especially be considered on the differential in patients with shoulder PJI, longstanding symptoms, sinus tract on examination and abnormalities noted on radiographs. Disclosures All Authors: No reported disclosures

Identification of the role of pyroptosis-related genes in chronic rhinosinusitis based on WGCNA

BackgroundChronic rhinosinusitis (CRS) is a complex chronic inflammatory disease of the nose, paranasal sinus, and upper respiratory tract. Its treatment methods mainly include antibiotic treatment and surgical treatment. However, the molecular mechanism of its inflammation is still unclear. Pyroptosis is a programmed cell death. As an important natural immune response, pyroptosis plays an essential role in fighting infection. MethodsIn this paper, a weighted co-expression network (WGCNA) was used to screen gene modules significantly related to CRS. Then it intersects with the genes related to scorching death (PRGs). We evaluated the immune landscape of CRS by the expression of intersecting genes. In addition, in the enrichment analysis of intersection genes and PPI network analysis, we verified the pathways closely related to CRS and hub genes. Finally, the interaction network between the hub gene, miRNA, and TF was constructed. In this paper, qRT-qPCR technology was also used to detect the hub gene related to CRS. ResultsHub genes (CASP3, IL18, NAIP, NLRC4, and TP53) found in this paper are directly or indirectly related to CRS, and these genes were proved to be of diagnostic significance to CRS by ROC curve and qRT-qPCR vertification. In the infiltration abundance of CRS and its control group, the infiltration abundance of Plasma cells, T cells follicular helper, Macrophages M2, Dendritic cells activated, and Neutrophils cells in the two groups were significantly different. We also constructed the interaction network between the hub genes and miRNAs and the interaction network between hub genes and TFs. Most of these miRNAs and TFs were also related to CRS. ConclusionsWith the help of the WGCNA and PPI analysis, our results provide a better understanding of the role of biomarkers CASP3, IL18, NAIP, NLRC4, and TP53 in the development of CRS and provide a research basis for the mining of biomarkers related to the diagnosis and treatment of CRS.

Mediastinal Mass, Cancer, or Infection, Atypical Paraesophageal Actinomycosis Infection, Clinical and Surgical Approach.

Actinomyces israelii (AI) is a Gram-positive, rod-shaped bacterium that lives commensally on and within humans as a typical colonizer within the gastrointestinal tract, including the mouth. As an opportunistic pathogen, infection often results from tissue injury or breach of the mucosal barrier (ie, during various dental or GI procedures, aspiration, or specific pathologies such as diverticulitis). Symptoms generally present slowly as a non-tender, indurated mass that evolves into multiple abscesses, fistulae, or draining sinus tracts without regard for anatomical barriers, including fascial planes or lymphatic drainage. However, it may also present as an acute suppurative infection with pain and rapid progression to abscess formation.

Endoscopic closure of refractory external pancreatic fistula by injecting metal coil in the fistula tract

Endoscopic closure of refractory external pancreatic fistula by injecting metal coil in the fistula tract

Treatment of Teeth with Root Resorptions: A Case Report and Systematic Review

Aim. This article presents an evaluation of different multidisciplinary treatment approaches to managing teeth with external and internal root resorptions.
 Methods. This study presents a clinical case of a 35-year-old female patient referred to Akdeniz University for dental issues. A comprehensive review of the literature was conducted, encompassing 21 articles sourced from PubMed and Web of Science over the past decade, including case reports and case series.
 Results. Case Report. A clinical case of a 35-year-old female patient seeking treatment for dental aesthetic concerns was reported and discussed. Intraoral examination revealed discoloration of maxillary anterior teeth and a sinus tract in the apical region of tooth #11. The resorption area was sealed with mineral trioxide aggregate. Afterward, the coronal part of the root was filled using the warm-vertical compaction method. During the final visit, non-vital bleaching was applied to teeth #11 and #21. After all these procedures, aesthetic coronal restorations were completed. Systematic Review. In the context of this clinical case, a literature review was conducted, encompassing an assessment of a total of 25 cases of external and internal resorptions. Among these cases, a combination of surgical and endodontic treatments was applied in 12 cases, while non-surgical endodontic treatment was performed in 13 cases.
 Conclusions. In the present case report, a patient who had both external and internal root resorptions was treated with mineral trioxide aggregate and flap operation, with no subsequent complications during the follow-up sessions. Among the 21 reports included in our review, 24 out of 25 treated teeth demonstrated successful outcomes, while only one tooth necessitated extraction.

Septic suturitis: A suspected cause of periapical infection in a young horse

SummaryThis case report describes septic suturitis as a likely cause of periapical dental disease in a 3‐year‐old Thoroughbred colt. The horse was presented for a unilateral sinusitis initially managed by a frontal osteotomy and sinus lavage and subsequently developed a septic suturitis. Subsequently, a computed tomography (CT) examination identified a periapical infection of cheek tooth 109 with associated sinusitis of the rostral sinus compartments and an extensive suturitis, with the most severe changes located at the right nasomaxillary suture line. There was an associated local fistulous tract rostral to the mesial periapical region of cheek tooth 107 but unassociated with typical periapical or endodontic dental disease changes on CT. The sinusitis did not respond to oral extraction of cheek tooth 109 and sinus lavage. A repeat head CT 2 weeks later, now revealed buccal alveolar bone loss surrounding cheek tooth 107 with obvious periodontal and endodontic dental disease changes. Oral extraction of cheek tooth 107 was performed and local curettage of the fistulous tract was conducted. We conclude that septic suturitis can become extensive and slow to resolve and its rostral extension can cause periapical infection of the closely associated rostral cheek teeth in young horses.

Analysis of the achievement of primary and secondary goals and influencing factors in single-rooted immature permanent teeth after regenerative endodontic procedures: a retrospective study

ObjectiveThis study explored the achievement of primary and secondary goals and factors influencing their achievement in regenerative endodontic procedures (REPs) for immature permanent teeth.MethodsDental records of all patients who received REPs for immature permanent teeth at the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology between January 2012 and January 2023 were retrieved. The evaluation of the primary goal was based on medical and radiographic records. The achievement of the primary goal was defined as the absence of clinical signs and symptoms, such as pain, swelling, or sinus tract and the absence of periapical radiolucency, as assessed on postoperative periapical radiographs. The achievement of secondary goal represented increased root wall thickness and/or increased root length, that is, continued root development. Periapical radiographs before and after treatment were used to evaluate the achievement of the secondary goal. The secondary goal was required to be achieved alongside the achievement of primary goal.ResultsA total of 436 teeth (136 anterior and 300 posterior teeth) were included in this study, 96.1% of which demonstrated achievement of the primary goal. Signs of failure (17 teeth) included crown fracture and uncontrolled and recurrent periapical lesions. In addition, 77.8% of teeth demonstrated achievement of the secondary goal, and more than half of the teeth exhibited a complete root development. Evaluation factors included patients’ age, sex, tooth type, etiology, preoperative periapical lesion, duration of clinical signs and symptoms, follow-up period, and stage of root development. The achievement of the primary and secondary goals were significantly related to age and tooth type (p < 0.05).ConclusionsChildren with a younger initial visit age are more likely to achieve primary and secondary goals. Additionally, posterior teeth had an advantage over anterior teeth in achieving primary and secondary goals.

Management of Pilonidal Sinus Disease with Homoeopathy: An Evidence- Based Case Report

Abstract: Pilonidal disease is an infection that occurs beneath the skin in the gluteal cleft just above the anus. It affects 7% of the population. In conventional mode of treatment there are several surgical or non-surgical treatments available but with high recurrence rate and post-surgical complications. Owing to the limited therapeutic efficacy of conventional treatment for PSD, an alternative approach is warranted. In this case, A 25years male patient attended OPD with pricking pain and oozing of foul-smelling discharge from three orifices above anus at sacral region since last 1 year. He had occasional reddish rash in sinus tract region. Based on his clinical symptoms and physical examination we diagnosed the case as Pilonoidal Sinus Disease. After thorough case taking, evaluation and analysis of the case the patient was prescribed Graphites and a marked improvement was noticed. Complain resolved within 1 and a half month and the patient was followed-up for one year with no recurrence. As this is a type of disease condition, where patient suffer due to pain and discomfort affecting his daily life leading, outcome-related to impact on daily living (ORIDL) Scale was used to evaluate the improvement. The MONARCH was used to assess the possible causal attribution.

Endoscopic vacuum therapy for nonhealing cavity with fistulous tract after peroral endoscopic myotomy for Zenker’s diverticulum

Video 1Endoscopic vacuum therapy for nonhealing cavity with fistulous tract after peroral endoscopic myotomy for Zenker diverticulum.

Periapical Cyst Forming Cutaneous Sinus Tract: Unusual Presentation-Case Report.

A cutaneous sinus tract due to periapical cyst being very rare may easily be misdiagnosed, leading to incorrect treatment. Identifying the etiology is difficult, but it is the key to effective therapy. The case presented here is a cutaneous sinus tract in the nasolabial region of odontogenic origin. After surgery and extraction of the tooth, the sinus tract healed remarkably (Belmehdi et al. in Contemp Clin Dent 9:314-318, 2018; Latifa et al. in Clin Case Rep 10:e05333, 2022).

Direct hydrogen peroxide MRI fistulography versus indirect (intravenous) MRI fistulography in patients with perianal fistula

BackgroundPerianal fistula is a rather common disease; its symptoms range from mild to severe, impairing anal continence; accurate preoperative evaluation avoids recurrence following surgical procedures.Aim of workOur study examined the diagnostic accuracy of magnetic resonance imaging with direct percutaneous instillation of hydrogen peroxide mixed with gadolinium (direct fistulography) in comparison to intravenous gadolinium contrast-enhanced study (indirect fistulography).MethodsThis prospective study was conducted on patients referred to Airforce hospital radiology department and were diagnosed with perianal fistula, Direct and indirect MR fistulography were performed using a 1.5T MRI scanner. The type of fistulae, internal openings, secondary branches, and abscesses were compared to surgical findings.ResultsOur study included 35 male patients. Both direct and indirect methods detected primary tracts with 97.1% sensitivity and accuracy rates of 91.9% and 89.2%, respectively. The direct method was superior in detecting secondary branches and internal openings with accuracy rates of 97.37% and 93.3%, respectively, compared to 86.8% and 86.6% for the indirect method, while the indirect method was superior in detecting abscess collections with 100% accuracy rate compared to 89.2% accuracy rate for the direct method. None of the patients reported fever or bleeding after the procedure.ConclusionsBoth direct and indirect fistulography showed comparable abilities in detecting primary fistulous tracts. However, the direct fistulography was superior in detecting internal openings and secondary tracts particularly in chronic cases, whereas indirect Fistulography was superior in detecting abscess collections. Incorporating both methods into our routine could thus improve the efficacy of surgical procedures.

Wide Local Excision of Complex or Infected Pilonidal Sinus Followed by Negative Pressure Wound Therapy: Does It Enhance Wound Healing?

Background Pilonidal sinus disease (PSD) is a chronic skin condition caused by hair retention that affects the sacrococcygeal cleft. The purpose of this study is to compare the efficacy of negative pressure wound therapy (NPWT) to routine daily dressings (DDs) in wound healing after complex or infected pilonidal sinus tract excision. Materials and methods The study included 81 individuals who had extensive local excisions for pilonidal sinuses that were complex or infected. Randomly selected participants were given either NPWT or the usual dressing. Between the two groups, the length of hospitalization, the amount of time needed to resume daily activities, and the amount of time needed for full wound closure were compared. Results Forty-two patients received NPWT, while 39 patients received DDs as usual. There was no discernible difference between the two groups in terms of operating time or hospital stay. However, patients who underwent NPWT experienced a quicker final wound closure (59.24 ± 10.21 days compared to routine DD with a mean time of 75.31 ± 14.68 days, P = 0.001) and returned to normal activities earlier (17.36 versus 21.75 days in NPWT and routine DD, respectively). Conclusion Compared to patients who received standard DDs, those who were postoperatively managed with NPWT showed faster wound healing and return to normal activities. Whenever feasible, this strategy may be employed to improve patient recovery.

Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report.

We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks.

Small Intestinal Adenocarcinoma Involving a Submucosal Ectopic Lymph Node: A Case Report.

An 83-year-old male with a 55-year history of Crohn's disease, ileocecectomy 40 years prior, and naturopathic treatment for 25 years, presented with nausea, vomiting, and abdominal pain. Computed tomography of abdomen and pelvis demonstrated partial small intestinal obstruction and a 4.4-cm solid left renal mass. After 3 months of recurrent intestinal obstruction and development of a pericolonic abscess, resection of the ileocolonic anastomosis, abscess, and partial nephrectomy were performed. Histopathology demonstrated chronic active enteritis with fistula tract formation, consistent with Crohn's disease, and moderately differentiated small intestinal adenocarcinoma extending from mucosa into subserosa. A submucosal intestinal lymph node-like structure containing adenocarcinoma demonstrated endothelial venules, open marginal and intermediate sinuses, multiple polarized germinal centers, and partial capsule, consistent with an ectopic lymph node, also called a tertiary lymphoid organ. Twenty mesenteric lymph nodes were negative for carcinoma. The renal mass was a papillary renal cell carcinoma, Stage I. Intestinal tertiary lymphoid organs form in chronic immune activation and have variable structures ranging from simple B and T cell clusters to organized groups with high endothelial venules and lymphatic vessels. Encapsulation of tertiary lymphoid organs is rare, with some sources claiming this entity is never encapsulated. To our knowledge, this is the first report of small intestinal adenocarcinoma involving a submucosal encapsulated tertiary lymphoid organ, the prognostic significance of which is uncertain. We suggest increased awareness of intestinal tertiary lymphoid organs as an entity and further studies to delineate the effect their involvement by adenocarcinoma imparts on survival.

The Biomineralization Conundrum of Calcified Extraradicular Deposits on the Apical Root Surface of Teeth: A Case Report

Background: Calcified extraradicular deposits on the apical root surface of teeth (CEDARST) are rarely seen in the dental field, compared with dental calculus deposits, which are very frequent. However, the exact biomineralization process of this entity has remained unclear until now. Objective: To report a case of an exuberant calcified extraradicular deposit on the apical root surface of an anterior tooth with apical periodontitis and propose for the first time some potential mechanisms involved in this pathological mineralization, and thereby suggest directions for future research. Case Presentation: In brief, a root-canal-treated canine displaying a radiographic periapical radiolucency was treated, and the sinus tract persisted despite root canal retreatment in which high endodontic standards were maintained. Endodontic surgery was performed, and the curettage of the pathologic tissue revealed an exuberant calculus-like material attached to the outer root surface, around the exit of the apical foramen. Two-year follow-up radiography revealed complete bone healing, and the patient´s tooth was asymptomatic and functional. Conclusion: The development of CEDARST seems to depend on a fine synergic control exerted by specific microorganisms (mainly bacteria) on this pathological mineralization, as well as on the local chemical microenvironment of the apical lesion of the affected tooth. Microbial implications and inhibitors of mineralization seem to play a dominant role in CEDARST biomineralization.

Behçet's disease with intestinal involvement: a case report and review of the literature

BackgroundBehçet’s disease (BD) is a chronic systemic disease characterized by vasculitis as the basic pathological change. BD is rare, and gastrointestinal involvement occurs in 3% to 25% of affected patients. This article describes a rare case of intestinal BD along with a literature review of intestinal involvement in BD.Case presentationA 50-year-old Han woman from China presented with a > 6-month history of distending pain in the right upper abdomen. Because of mechanical obstruction secondary to stricture formation from an ileocecal ulcer, she underwent radical right colon resection, and postoperative pathologic examination indicated an ileocecal ulcer. The patient was readmitted to the hospital 6 months postoperatively for recurrence of the same symptoms. Colonoscopy indicated obvious narrowing of the anastomosis with an oval-shaped deep ulcer that could not be passed by the endoscope. Pathologic examination showed acute and chronic inflammation of the anastomotic mucosa and granulation tissue. In addition, gastroscopy showed a 3.0- × 4.0-cm giant ulcer at the junction of the descending bulb along with a sinus tract. Moreover, total gastrointestinal computed tomography angiography showed significant thickening of the intestinal wall near the transverse colon, forming a sinus tract at the junction of the antrum and duodenum with a length of about 1.3 cm and width of about 0.2 cm. Further inquiry regarding the patient’s medical history revealed that she had developed repeated oral ulcers 3 years previously and repeated eye inflammation 5 years previously. Specimens of the right half of the colon removed 6 months previously were sent to Run Run Shaw Hospital Affiliated to Zhejiang University for consultation. The pathologic examination revealed vasculitis in the submucosa and subserosa, and the patient was finally diagnosed with BD. She began treatment with adalimumab, and repeat gastroenteroscopy revealed that the intestinal ulcer had significantly improved.ConclusionsAn oval-shaped deep intestinal ulcer is a characteristic lesion in patients with BD and may involve the intestinal muscle layer. This case emphasizes that BD is a vasculitis affecting multiple organs and can present with a single, deep, clean-edged intestinal ulcer that penetrates the bowel wall to form a sinus tract. Therefore, careful examination and differential diagnosis should be carried out to prevent a poor prognosis. Adalimumab is effective for patients with intestinal BD.

Early Clinical Mapping of Submandibular Gland Fistula: A Case Report and Systematic Review.

Introduction Submandibular gland fistula (SGF) is a rare subset of salivary gland fistulas. It is seldom tough to diagnose them prior to surgical exploration, and it is often clinically confused with close differentials. An early diagnosis based on pertinent clinical features and focused radiological findings can be pivotal in optimal management and help prevent recurrence and avoid unnecessary investigations/interventions. Objective To review articles that discuss SGF and provide vital etiological, clinical, and imaging features of this rare entity that can aid in early clinical diagnosis. Data Synthesis An extensive review involving PubMed and Google Scholar and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Conclusion Submandibular gland fistula is a rare entity. It can be confused with close differentials, including branchial fistulas, if not thoroughly examined. Discharge from fistulae along with submandibular pain/tenderness and/or swelling are important diagnostic clues. A history of trauma, nodule at the site of discharge, prior submandibular disease/calculi, or discharge aggravated with food further increases a clinical suspicion. Optimal radiological investigation looking for calculi/foreign body and delineating the fistula tract is vital to affirm a diagnosis. Gland with fistula excision is a commonly advocated treatment of choice with no reports of recurrence, although conservative management and gland preserving surgery have also reported a favorable prognosis.