Perianal Abscess Research Articles

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.

FiLaC + SLOFT SAVIOUR FOR COMPLEX ANAL FISTULA

Objective: The aim of the blurb is to quarry into the wide array of treatment options for complex anal stulae in order to rank stula laser tract closure[FiLaC] + submucosal ligation of stula tract[SLOFT] amongst them. Crypt Background: oglandular anal stulae with recurrence and multiple tracts is one of the many complexities in the management of anal stulae. FiLaC + SLOFT is a hybrid surgical Materials and methods: option combining benets of ligation of intersphincteric stulous tract[LIFT] technique and distal laser ablation of stulous tract. Submucosal ligation and dismantling of stulous tract takes care of the cryptoglandular source of origin of anal stulae. Distal closure of the tract is ensured by laser ablation on continuous mode. Since the year 2011, FiLaC and LIFT have been Result: individually tried in the treatment of anal stulae, with success rate ranging from 20-75%. Combining the two is conceptually sound in treating complex anal stulae. Excluding cases of Conclusion: intersphincteric abscess/ sepsis, FiLaC + SLOFT has come-up as an assuring operative blend for treating anal stulae.

S69 Case Report: Enterovesicle Fistulas and Their Presentation in Three Adolescent Males With Crohn's Disease

Case: Background: Enterovesicle fistulas (EVF) in the setting of Crohn’s disease (CD) are uncommon. The aim of this poster is to shed light on the diagnosis and management (medical vs surgical) of EVF in pediatric populations. Methods: This poster compares 3 cases of adolescent males with Crohn's disease, their continued workup, and the difference in disease course in relation to the development of EVF. Results: Case 1: A 12-year-old male with known severe ileocolonic CD diagnosed at age 8, and a history of perianal and intra-abdominal abscesses and perianal fistula experienced recurrent urinary tract infection (UTI) 2 years into his diagnosis. A urine sample revealed stool, and magnetic resonance imaging (MRI) confirmed EVF. Exploratory laparotomy revealed inflamed and structured distal ileum with pre-stenotic dilation of proximal bowel, as well as the EVF. After surgical takedown, ileocectomy, and diverting ileostomy, he was started on infliximab. He has been on infliximab for 28 months with normalization C-reactive protein, normal linear growth curve, and no further episodes of structuring or penetrating CD. Cast 2: After years abdominal pain and growth failure a 16-year-old male (now 17) was diagnosed with Crohn's ileitis. After starting Infliximab, he began complaining of sediment and pneumaturia, which was confirmed on urinalysis (UA). He was taken to surgery for diagnostic laparoscopy where his cecum was found to be adherent to the bladder. Distal loop ileostomy was created. He is currently being treated with infliximab and doing well 1-month post-operatively. Case 3: A 22-year-old male was diagnosed with Crohn’s ileitis at age 13, after presenting with abdominal pain and weight loss. Before beginning medical therapy, he experienced dysuria and pneumaturia with visible stool in his urine sample. EVF was not seen on abdominal Computed Tomography (CT) scan. His EVF was confirmed on exploratory laparotomy, and he underwent EVF take-down, ileocecectomy, and diverting ileostomy, with subsequent successful ileostomy take-down. He was started on thiopurine post-operatively and has remained in remission on therapy for 9 years without no further disease exacerbations. Conclusions: The incidence of EVF among adults with CD ranges from 2% to 5%, although little is known about pediatric patients with EVF. In fact, only 2 case reports in children exist. EVF can be the presenting symptom of CD, or patients with known CD can present with recurrent UTI leading to diagnosis. The distinct symptoms of EVF, dysuria, pneumaturia and fecouria, make it easy to diagnose with UA and confirmatory cross-sectional imaging, although little is known about common sites of connection between the bladder fistula in children and how this affects presentation and management (10). In our 3 cases, patients received surgical intervention followed by aggressive medical management. With the advent and improvement of immunotherapy medications, research in adults has shown that EVF without severe complicating CD can sometimes be treated with medical therapy alone and experience EVF resolution (2,6-9). There is no clear consensus on clinical criteria for medical vs surgical intervention (7,8) so future studies in this area are needed.

The short history of surgery for anal abscesses and fistulas : everything has been tried... and it’s not over yet!

The short history of surgery for anal abscesses and fistulas : everything has been tried... and it’s not over yet!

Perianal Abscess Cavity Packing Versus No Packing A Randomized Control Trial

Objective: To compare the outcome of perianal abscess cavity packing versus no packing following I&D. The primary objective is to compare postoperative pain. The secondary outcomes were the number of follow-up visits, fistula formation, wound healing time and abscess recurrence. Methods: A randomized clinical trial was conducted at Dr Ruth K. M. Pfau Civil Hospital Karachi from March 2020 to July 2021. Results: 70 participants' data were analyzed, 35 in the packing group (control) and 35 in the no packing group (intervention). The preoperative and postoperative pain scores at 48 hours are stastatistically not significant. The mean postoperative pain score showed a significant difference at two weeks, showing that the group receiving no packing experienced less intense pain. The mean wound healing time was 44.09 days in the packing group and 26.91 days in no packing group (p=0.001). The occurrence of fistula in ano was 2.8% in the packing group and 5.7% in no packing group (p=0.55). Abscess recurrence was 14.2% in the packing group, while 0% in no packing group (p=0.02). Conclusion: This study revealed that the no-packing technique is superior in decreasing postoperative pain and patient satisfaction. Keywords: Perianal Abscess, Randomized trials, No packing, Packing, Anorectal disease

Characteristics and clinical manifestations of monkeypox among people with and without HIV in the United States: a retrospective cohort.

To compare characteristics and clinical manifestations of monkeypox (MPX) between people with and without HIV in the United States. Retrospective cohort study using TriNetX, a federated research network. Patients 18 years and older with MPX were identified based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code B04 and divided into two groups: people with HIV (PWH) and people without HIV. Differences in baseline characteristics, clinical manifestations, and all-cause healthcare utilization were examined between groups. Outcomes were reported before and after propensity score matching. Of 322 cases of MPX included, 29% ( n = 93) were PWH. Baseline characteristics were similar, but PWH were more likely to identify as Black or African American persons (24% vs. 11%, P = 0.0303) or as Hispanic or Latino persons (24% vs. 11%, P = 0.0345) and more likely to report lifestyle factors affecting health status. Rash and rectal pain were more common in PWH (25% vs. 11%, P < 0.01, and 25% vs. 10%, P < 0.001, respectively). In addition, PWH had higher rates of anal or rectal abscesses (11% vs. 0%, P < 0.0001), phimosis (11% vs. 0%, P < 0.0001), and pneumonia (11% vs. 0%, P < 0.0001). More PWH required urgent care visits (53% vs. 29%, P < 0.0001) and hospitalizations (11% vs. 4%, P = 0.0314), but not emergency department visits (42% vs. 58%, P = 0.0085). PWH had higher rates of clinical manifestations and required greater utilization of healthcare resources for any reason compared with those without HIV.

Clinical characteristics and MRI-based phenotypes of perianal abscess formation in children with fistulizing Crohn's Disease.

The aim of this study was to explore potential correlation of the MR imaging features and clinical characteristics with formation of perianal abscess in children with Crohn's perianal fistulas (CPF). From 2010 to 2020, pediatric patients with CPF diagnosis on their first pelvic MRI were identified retrospectively. All patients were divided into two groups based on the presence or absence of perianal abscess. Baseline clinical and MRI characteristics were recorded for each patient. All the statistical calculations were performed using R (version 3.6.3). A total of 60 patients [F:M 17:43, median age 14 years (IQR 10-15), ranging 3-18 years] were included in this study. Forty-four abscesses were identified in 36/60 children (mean volume 3 ± 8.6 ml, median 0.3 ml). In 24/60 patients with perianal disease, no abscess was detected on the MRI. Ten patients (28%) showed perianal abscess on pelvic MRI at the initial diagnosis. The rate of active disease on colonoscopy (visible ulcerations/aphthous ulcers) was similar in both groups (95% vs. 94%). With regards to disease location, the majority of patients (40/60, 66.6%) in both groups had ileocolonic CD. All patients without abscess had a single perianal fistula (n = 24; 3 simple and 21 complex fistulae), however, patients with perianal abscess tended to have >1 fistulous tracts (n = 50 fistulas; all complex, 27 single, 10 double and 1 triple). Intersphincteric fistula was the most common fistula type in both groups (79% and 66%, p = 0.1). The total length of fistula (3.8 ± 1.7 vs. 2.8 ± 0.8 cm, p = 0.006) and presence of multiple external openings (n = 25 vs. 7, p = 0.019) were significantly higher in patients with abscesses, and fistula length >3.3 cm showed 80% specificity and 83% PPV for the presence of perianal abscess. Fistulas were symptomatic (pain, bleeding or drainage) at similar rates in both groups (68% and 70%, p = 0.1). Pediatric patients with CPF who develop perianal abscess have a distinct imaging phenotype defined by longer fistula length (>3.3 cm), multiple skin openings and multiple fistulous tracts (≥2) on MRI. Patients who have these features but does not have an abscess on imaging may merit more aggressive treatment (and close monitoring) to prevent the development of an abscess.

Abdominopelvic CT Imaging Findings in the Emergency Department in Patients With HIV Positive Status: Single Institute Experience

ObjectiveTo assess emergency department (ED) abdominopelvic computed tomography (CT) imaging utilization and findings in patients with known human immunodeficiency virus (HIV) positive status. Materials and MethodsA retrospective chart review of imaging, clinical, and laboratory data was performed for HIV positive patients who demonstrated HIV-related findings on abdominopelvic CT imaging performed within the ED. ResultsOne hundred and eighty-eight patients with 522 CT scans of the abdomen and/or pelvis were reviewed. 47 patients with HIV presenting to the ED on 82 separate occasions were included in this study (mean age 43.3 years). Patients presented to the ED with infectious/inflammatory disease (n = 54) or history of HIV-related malignancy or new/worsening HIV-related malignancy (n = 28). The most common findings on abdominopelvic CT were anorectal pathology including anorectal abscess or proctitis (n = 22), followed by colitis (n = 19). Findings of HIV-associated malignancy were less common, including anal/rectal cancer (n = 7), Kaposi's sarcoma (n = 4), and lymphoma (n = 2). At the time of ED visit, 25.6% (n = 21) of patients had acquired immunodeficiency syndrome (AIDS). Higher WBC counts were found in the infectious/inflammatory group (P = 0.021) and patients without AIDS (P = 0.0159), while lower WBC counts were associated with new or worsening malignancy (P = 0.007) and AIDS (P = 0.0000). Patients with AIDS were more likely to be deceased at the time of our study. ConclusionsThe majority of ED visits within our population were attributed to infectious/inflammatory etiologies. CT findings demonstrated predominantly infectious/inflammatory processes, with anorectal pathology being the most common. Findings of malignancy on CT were less common, while opportunistic infections and AIDS-defining malignancies were uncommon.

Successful Use of Granulocyte Transfusion Therapy As a Bridge to Hematopoietic Stem Cell Transplant in a Child with Aplastic Anemia and Refractory Perirectal Abscess

Background: Idiopathic aplastic anemia (IAA) is a rare, life-threatening acquired form of bone marrow failure characterized by multilineage cytopenias and hypocellular bone marrow. Profound neutropenia associated with very severe aplastic anemia (vsAA) is an important risk factor for development of life-threatening fungal and bacterial infections. Perirectal cellulitis and perianal abscess are one such infection and are associated with high rates of morbidity. The ability to eradicate infections in IAA is limited by the lack of imminent neutrophil recovery prior to treatment with either immune suppressive therapy (IST) or hematopoietic stem cell transplant (HSCT). We describe the successful use of granulocyte transfusion to treat antibiotic refractory proctitis with perianal abscess in a profoundly neutropenic child with vsAA. Case: A 7yoF presented with fever and pancytopenia in the setting of Human Metapneumovirus and Parainfluenza. Bone marrow biopsy showed hypocellularity (60-70%) with granulocytic and megakaryocytic hypoplasia, favoring viral suppression. Ultimately, she progressed to transfusion dependence. Repeat bone marrow aspirate and biopsy ultimately revealed bone marrow aplasia, DEB chromosomes, telomere lengths, and PNH clones were negative, confirming the diagnosis of vsAA. She was subsequently admitted for febrile neutropenia (F&N) and was found to have mild respiratory COVID-19, but began to complain of rectal pain that was initially attributed to her history of constipation. She defervesced on IV antibiotics (abx) and was discharged home with negative cultures. Within a week she represented with hematochezia and F&N and was found to have proctitis with perianal fistula on MRI (figure 1); GI PCR panel was + Enteroaggregative E. coli, no resistant organisms were identified. She clinically improved and discharged on IV piperacillin-tazobactam (pip-tazo). Despite 2 weeks of IV abx, she developed new fever and imaging confirmed persistent proctitis with peri-rectal abscess. As she had limited response to abx alone we trialed a short course of granulocytes with improvement in anorectal inflammation by CT. She was discharged with a plan to continue IV pip-tazo until achieving radiographic cure; however, interval imaging after an additional 2 weeks of abx showed rebound of her proctitis and she was again admitted with F&N and rising inflammatory markers. Her failure to eradicate her peri-rectal infection despite prolonged antibiotics (>4weeks), along with her previous response to a short course of granulocyte transfusion prompted us to prescribe a prolonged 10-day course of granulocytes with continued antibiosis. Her post-granulocyte CT showed resolution of her perirectal abscess and proctitis (figure 2). With resolution of her infection, she was able to proceed to HSCT which she completed without recurrence of her anorectal infection. Discussion: Conventional granulocyte transfusions are considered when patients have severe neutropenia (<500/uL), bacterial or fungal infection refractory to antimicrobials, and reasonable expectation of neutrophil recovery, but evidence for efficacy is limited. In our case, there was no expectation of imminent bone marrow recovery and our patient's infection limited her ability to proceed to IST or HSCT for treatment of her vsAA. Thus, in conjunction with infectious disease and transfusion medicine, and given her known response to granulocytes, we successfully re-attempted a prolonged, but limited, 10-day course of granulocyte transfusions and were able to eradicate a case of antibiotic-refractory proctitis with peri-anal fistula. We suggest an expanded application for the use of granulocytes in profoundly neutropenic patients without imminent recovery for severe, anti-microbial refractory infection. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effect of Agnikarma in Perianal Subcutaneous Fistula- A Case Report

Fistula-in-ano is a debilitating disease affecting anorectal region. It is an abnormal tract lined with fibrous tissue and unhealthy granulation tissue. It usually begins from a perianal abscess caused by cryptoglandular infection. The abscess burst spontaneously and forms fistula-in-ano. It may also seen in association with other diseases like Crohn’s disease, lymphogranuloma venereum, actinomycosis, malignancy and TB. It is distressing to the patient and the surgeon due to its recurrent nature and the complications like postoperative incontinence. The disease can be classified as low anal and high anal fistulae on the basis of its internal opening. Perianal subcutaneous fistula is included under low anal fistula. Generally, the modern treatment measures for fistula-in-ano include fistulectomy, fistulotomy, advancement flaps, fistula clip closure, LIFT technique, VAAFT procedure, anal fistula plug repair, fibrin glue and seton technique. The prime aim of the treatment is to eradicate the tract and drain the site of infection while preserving anal continence. In Ayurveda, Fistula-in-ano can be correlated with Bhagandara on the basis of signs and symptoms. Since it is difficult to treat, Acharya Susruta considered it as one among Ashtamahagada. He described the treatment as Shastra Karma, Kshara Karma, Agni Karma. In the present case study, a 35-year old male patient visited the OPD with perianal subcutaneous fistula was selected for Agnikarma after fistulotomy to reduce the treatment period and to improve the quality of living. Daily dressing was done with Jathyadi ghrta and the patient was cured within 21 days of intervention. The follow up was done for next 3 months and no complications were noted.

Incidental Succinate Dehydrogenase (SDH) Deficient Renal Cell Carcinoma and Paraganglioma in a 24-Year-Old

Abstract Introduction/Objective Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) is rare neoplasm (&amp;lt;0.2% of all RCCs) caused by SDH-subunit gene mutation, usually SDHB. Patients carrying such mutations are also predisposed to other SDH-deficient neoplasms such as paraganglioma, gastrointestinal stromal tumor, and pituitary adenoma. Here, we report a case of incidental SDH-deficient RCC and paraganglioma. Methods/Case Report A 24-year-old male without past medical or family history presented to ED for perianal abscess. Imaging showed 8-cm heterogeneous left renal mass (figure-A) and 3.3-cm mass below aortic bifurcation, highly concerning for RCC with metastasis. Biopsy of kidney mass showed nested and trabecular epithelial neoplasm with weakly eosinophilic and occasionally vacuolated cytoplasm (figure-B). Nuclei were round with smooth contour and inconspicuous nucleoli. Tumor was immunopositive for PAX8, e-cadherin, P504S, and CD10, while negative for CK7, CD117, and Melan-A. SDHB immunostain was negative in tumor with intact staining in intervening endothelium. Findings were consistent with SDH-deficient RCC. Biopsy of pelvic mass showed low-grade neoplasm that was immunopositive for synaptophysin, chromogranin, and GATA3, with S100-positive sustentacular cells, consistent with paraganglioma. Patient underwent radical nephrectomy which revealed 7.5-cm, well-circumscribed, tan-red, predominantly solid mass with few cysts. Histologically, tumor had thin fibrous capsule and morphologically similar to biopsy. Tumor was limited to kidney without necrosis, sarcomatoid/rhabdoid differentiation, or vascular invasion. Results (if a Case Study enter NA) NA. Conclusion SDH-deficient RCC is rare low-grade entity with risk of metastasis and development of other neoplasms, which requires continued follow-up and potential genetic testing for patient and family members. Therefore, including SDH-deficient RCC in differential diagnosis of eosinophilic renal neoplasms is essential.

Knowledge of perianal Crohn's disease among nurses in an Italian tertiary centre

Background: Patients with Crohn's disease can develop anal and perianal lesions, such as fistulas, ulcers, skin tags, perianal abscesses and strictures. Perianal Crohn's disease (PCD) is a condition that has a major impact on patients' quality of life. The multidisciplinary team includes a nurse who manages the patient according to evidence-based medicine. Clinical practice and post-registration training are the way forward for nurses to acquire the skills needed to deliver quality care. Aims: This study explored the assessment of nurses' knowledge of PCD. A cross-sectional survey was used to look at the nurses' knowledge. Methods: The questionnaire was administered over 2 months, between September and October 2019. The questionnaire was anonymous, validated by a panel of experts in the field and consisted of 30 questions to assess knowledge and two questions to assess the need for training. It was directed to 120 clinical nurses in the departments of medicine and abdominal surgery. Results: There were 120 nurses enrolled, and 64.2% of nurses had cared for patients with PCD at least once. The survey showed a fairly low level of knowledge of the diagnostic and therapeutic care pathways for patients affected by PCD. On the other hand, a high need for training and in-depth study of the subject emerged. Conclusion: The nurse, an integral part of the multidisciplinary team, plays an important role in the education of these patients. Nurses' present level of knowledge can certainly be improved thanks to their willingness to undertake training courses or to use information tools.

Antibiotic Treatment foLlowing surgical drAinage of perianal abScess (ATLAS): protocol for a multicentre, double-blind, placebo-controlled, randomised trial

IntroductionPerianal fistula is a burdening disease with an annual incidence of 6–12/100 000 in Western countries. More than 90% of crypto-glandular fistulas originate from perianal abscess. Despite adequate drainage, up...

A CASE OF ANAPHYLAXIS TO FOSAPREPITANT

<h3>Introduction</h3> Fosaprepitant is a small molecule, intravenously administered antiemetic drug that is a selective NK-1 receptor antagonist. Systemic hypersensitivity reactions to fosaprepitant are rare. <h3>Case Description</h3> A 42-year-old male with Shwachman-Diamond syndrome presents with newly diagnosed myelodysplastic syndrome. He was initiated on chemotherapy with azacitidine and venetoclax. He developed neutropenic fever from a perianal abscess and fistula. Chemotherapy was paused, and cefepime/metronidazole was started. When chemotherapy was restarted, he was pretreated with fosaprepitant 150mg for refractory nausea. Fosaprepitant was administered over 7 minutes. Symptoms of shortness of breath and epigastric pain began during the infusion. Hypoxia developed 17 minutes after the infusion with O2 84% and a new 4L oxygen requirement. Notable signs included wheezing, periorbital/perioral edema, tachypnea, and tachycardia. He received 0.3mg IM epinephrine, nebulized epinephrine, 50mg IV Benadryl, and 125mg IV methylprednisolone. He required intubation for worsening upper lip/tongue edema and recrudescence of wheezing as well as an epinephrine IV infusion for hypotension. A tryptase level was drawn 3 hours after symptom onset and was elevated to 13.2 mcg/L (baseline 6.7 mcg/L). <h3>Discussion</h3> Fosaprepitant is an unusual cause of systemic hypersensitivity reactions with <1% incidence reported in the literature. Our patient represents an unexpected case of anaphylaxis on first exposure to fosaprepitant with the likely mechanism being non-IgE mediated mast cell activation. Chemotherapy and antibiotics were reintroduced without complication. Increased awareness of hypersensitivity reactions to fosaprepitant is critical given the growing use of this antiemetic drug for cases of refractory nausea.

Expert consensus on clinical application of Fufang Jingjie for Fumigation and Washing

Fufang Jingjie for Fumigation and Washing is one of the commonly used and effective drugs for external fumigation and washing of traditional Chinese medicine, it has the functions of dispelling wind, drying and dampness, alleviating edema, and reducing swelling, relieving pain and relieving itching. It is widely used for the treatment of external hemorrhoids, mixed hemorrhoids, internal hemorrhoids prolapse and incarceration, anal fissures, perianal abscess, anal fistula acute attack, perianal eczema and other diseases. It has a significant effect on the uncomfortable symptoms caused by various anal diseases, such as swelling, pain, wet itching, falling and swelling, and many secretions, as well as various postoperative complications. Fufang Jingjie for Fumigation and Washing has been used in clinic for many years, it has a lot of research evidence and experience in clinical application. In order to further improve the clinicians' knowledge of Fufang Jingjie for Fumigation and Washing and guide clinical medication more reasonably, this consensus invites front-line clinical experts from anorectal department to compile, referring to the relevant clinical literature and guide, combining with the clinical treatment experience of experts, the function, usage, dosage, adverse reactions and points for attention were discussed of Fufang Jingjie for Fumigation and Washing. This consensus was formed to provide reference for the clinical application of Fufang Jingjie for Fumigation and Washing.

Successful Reconstruction of a Defect Secondary to an Intersphincteric Abscess with Fournier’s Gangrene Using a Perforator-based Island Flap: A Case Report

Fournier’s gangrene, a soft tissue infection which is aggressive and sometimes lethal, often passes through deep fascial planes of the penis, scrotum, perineum, and lower abdomen; however, it rarely extends upward into the high intermuscular plane. We managed a rare case of Fournier’s gangrene with a high intersphincteric abscess from a perianal infection that resulted in a large defect in the anus and inferior aspect of the scrotum. A perforator-based island flap for the post-debridement defect was performed successfully. The perforator was selected near the defect along the lateral sacral border; the border of the flap design was adjacent to the defect, thus providing a sufficient angle of rotation near the pedicle with minimal dissection. Remnant undissected tissues around the pedicle prevented postoperative vascular complications. Additionally, the distal part of the flap design was elongated to the gluteal sulcus to be harvested as a very thin flap. This study suggests a perforator-based island flap as a secure and convenient option for covering a large defect involving the perianal region and inferior aspect of the scrotum.

A rare case of acute presentation of a chronic massive extraperitoneal abscess: a case report

Extra-peritoneal abscesses are uncommon entities encountered during general surgical practice. They occur in a plane present between the peritoneum and the deep fascia anteriorly, posteriorly or in the pelvis. These abscesses commonly occur as a result of supra-levator and pre-peritoneal extension of an ischiorectal abscess. Treatment includes antibiotics and drainage. Here we have described a case of an abscess in the anterior extra-peritoneal plane extending from perirectal and pararectal space, drained surgically through a midline incision.

Disease- and Medication-Specific Differences of the Microbial Spectrum in Perianal Fistulizing Crohn’s Disease—Relevant Aspects for Antibiotic Therapy

Perianal fistulizing Crohn's Disease (CD) with abscess formation represents an aggressive phenotype in Inflammatory Bowel Disease (IBD) with increased morbidity. Treatment is multidisciplinary and includes antibiotics, but knowledge about the microbial spectrum is rare often resulting in inadequate antimicrobial therapy. In this single center retrospective study, all patients who were operated due to perianal abscess formation were retrospectively analyzed and the microbial spectrum evaluated. Patients were divided into a CD and non-CD group with further subgroup analysis. 138 patients were finally included in the analysis with 62 patients suffering from CD. Relevant differences were detected for the microbial spectrum with anaerobic bacteria being significantly more often isolated from non-CD patients. In a subgroup-analysis of CD patients only, medical therapy had a relevant effect on the microbial spectrum since Streptococcus groups and Enterobacterales were significantly more often isolated in patients treated with steroids compared to those being treated by antibodies. In conclusion, the microbial spectrum of patients suffering from CD varies significantly from non-CD patients and immunosuppressive medication has a relevant effect on isolated pathogens. Based on that, adaption of antibiotic treatment might be discussed in the future.

ПЕРИАНАЛЬНЫЙ АБСЦЕСС, ВЫЗВАННЫЙ ИНОРОДНЫМ ТЕЛОМ

Acute anorectal abscess caused by a foreign bodies is a great rarity. In literature only isolated cases were described. We observed such a case when found a fish bone in an abscess cavity. Diagnostics of such cases is difficult due to to absence of high-technological methods of examination in routine circumstances. Patients are often discharged with the diagnosis acute paraproctitis excluding peculiarirites of pathogenesis of this disease.&#x0D; Analysis of literature shows that foreign bodies should be attributed to etiological factors of anorectal abscesses, or – at least – to significant risk factors of their occurence.

The Role of CT in Diagnosing Perianal Abscesses and Prolonged Wait Time in the Emergency Department

The Role of CT in Diagnosing Perianal Abscesses and Prolonged Wait Time in the Emergency Department