Perianal Region Research Articles

Effect of Sacral Erector Spinae Plane Block on Postoperative Analgesia in Perianal Surgeries: A Randomised Controlled Trial

Introduction: Sacral nerves emerge through sacral foramina and traverse below the multifidus muscle. Hence, blocking this myofascial plane can provide postoperative analgesia in the perianal region by blocking the sacral nerves supplying it. Aim: To study the effect of Sacral Erector Spinae Plane Block (SESPB) on postoperative pain and postoperative analgesic requirement in perianal surgeries. Materials and Methods: A randomised controlled trial was done with 60 patients who were randomly allocated into two groups (30 in each group). Group 1 patients received no intervention, whereas Group 2 received bilateral SESPB. The Visual Analogue Scale (VAS), opioid requirement, first analgesic demand, and additional analgesic requirement were compared between the two groups. The qualitative data was analysed by Student’s t-test, whereas the quantitative data was analysed using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Around 18 (60%) of the participants in group 1 were males, whereas group 2 consisted of 15 (50%) males. The mean age in group 1 was 40.7±11.5 years, whereas it was 43.6±12.7 years in group 2. The means of BMI were similar in both groups. The mean VAS score of group 1 was 3.19±0.23, whereas it was 2.37±0.25 in group 2. The first analgesic requirement was significantly delayed, and total tramadol requirement was lower in group 2 compared to group 1. Four patients from group 1 (control group) required inj. diclofenac sodium additionally. Conclusion: Bilateral SESPB provided good postoperative analgesia in patients who underwent perianal surgery. The total analgesic requirement was also found to be lower with this block. Hence, it can be considered a modality for perianal surgeries.

Effective management of acute anal fissure through Ayurveda and yoga

ABSTRACT An anal fissure is a superficial anal skin tear below the dentate line correlated with Parikartikā in Ayurveda. Approximately 40% of patients with acute anal fissures progress to chronic anal fissures. A 37-year-old male presented with complaints of pain in the perianal region, a burning sensation that persisted up to 60­90 min of defecation, irregular bowel habits, hard stool, and intermittent bleeding from rectum for 4 weeks. Visual examination revealed an acute anal fissure at the posterior midline. The patient was treated with Ayurvedic medicines and the practice of Ashwini Mudrā. After 6 weeks of treatment, anal fissures healed completely. Nonsurgical conservative medical management is the initial treatment for acute anal fissures. Sadya Vrana Chikitsā and the practice of Ashwini Mudrā are effective and safe treatments for acute anal fissures. No recurrence has been reported till now. Ayurvedic medicines, Ashwini Mudrā, and dietary restrictions reduce pain, regularize bowel movement, soften stool, enhance blood circulation, and accelerate wound healing in anal fissures. No adverse events were reported during treatment.

Retroperitoneal Abscess as an Extension of Ischiorectal Abscess: A Rare Case Report

Infections of the retroperitoneum can result from primary haematogenous spread of microbes or secondary infections originating from the retroperitoneal area or nearby organs. These abscesses can be caused by a perforated retrocaecal appendix, diverticulitis, perforated duodenal ulcers, iatrogenic gastrointestinal tract perforations, pancreatic cancer, inflammatory bowel diseases, genitourinary extravasation due to obstruction, osteomyelitis, postoperative duodenal ulcer perforations, and infections related to pelvic and puerperal conditions, as well as trauma. However, the occurrence of a retroperitoneal abscess as an extension of an ischiorectal abscess is exceedingly rare. Hereby, the authors present a case report of 27-year-old male who presented with persistent lower right quadrant abdominal pain, high-grade fever, and pus discharge from the perianal region for the last five days. He experienced difficulty passing stools and flatus for three days. Contrast-enhanced Computed Tomography (CECT) revealed a perforated appendix with fluid collection in the preperitoneal space on the right-side. Surgery revealed a significant amount of purulent discharge below the rectus muscle, extending along the right abdomen to the psoas muscle and connecting with the ischiorectal fossa. Retroperitoneal abscesses can originate from the perianal or ischiorectal region through various anatomical spaces.

Распространенные гельминтозы в практике педиатра

Enterobiasis and ascariasis are the most prevalent helminthic diseases encountered in pediatric practice within the Russian Federation. Both diseases are caused by roundworms, namely pinworms and ascarids, respectively. Pinworm parasites in the intestines of a child. Female pin-worms emerge from the anus and deposit eggs in the perianal folds, which is accompanied by severe pruritus, the primary symptom of this disease. Reinfection may result from scratching the perianal region and subsequent ingestion of eggs. The treatment of enterobiasis commences with the implementation of a patient hygiene regimen to prevent reinfection. Pharmacological treatment entails the administration of albendazole, mebendazole, and pyrantel. Ascaridosis is a geohelminth disease. In the absence of adherence to established hygiene protocols, ascarid eggs may gain access to the body from the external environment. Ascarid larvae from the intestines may gain access to the lungs via the bloodstream, resulting in the development of respiratory symptoms. Adult worms reside in the intestines and cause abdominal discomfort. Albendazole is an efficacious and safe medication for the treatment of ascaridosis in children. It is of the utmost importance to diagnose helminth infections at an early stage and to implement preventative measures. The most effective method of prevention is adherence to personal hygiene practices. These factors are of the utmost importance in further reducing the incidence of helminth infections. KEYWORDS: enterobiasis, pinworms, ascaridosis, ascarids, symptoms, diagnostics, treatment, prevention, albendazole. FOR CITATION: Belmer S.V. Common helminthiases in pediatric practice. Russian Journal of Woman and Child Health. 2024;7(3):281–285 (in Russ.). DOI: 10.32364/2618-8430-2024-7-3-13.

Complex Anterior Supralevator Anal Fistula With Prostatic Abscess Treated With Ksharasutra: A Case Report

Anorectal diseases are a major health threat in the field of health sciences. Fistula‐in‐ano is one of the treatable complex benign lesions of the rectum and anal canal. Complex high anal fistulas can reoccur even after surgical treatment. Establishing a cure for cryptoglandular fistula‐in‐ano is problematic, as a significant percentage of these diseases persist or recur if the internal opening of the anal fistula is left untreated. Here, we report a case of complex left anterolateral supralevator anal fistula with communication to the prostate gland that forms a prostatic abscess, as it is very rare. After following Ksharasutra (Ayurvedic medicated seton) treatment with regular wound care, significant regression in the condition was observed. A follow‐up scan showed no evidence of fistula‐in‐ano. A 50‐year‐old businessman presented with complaints of discomfort deep inside the rectum and perineum associated with pain at the base of the scrotum and pus discharge from the perianal region for 1 year. He was diagnosed to have a complex left anterolateral supralevator anal fistula with communication to the prostate substance after a thorough clinical examination and transrectal ultrasonography. After undergoing Ksharasutra treatment for 4 months, pus discharge completely stopped, and sonofistulogram report showed no evidence of fistula‐in‐ano. Images of the sonofistulogram report were documented before and after the treatment. This article highlights the unique feature of Ksharasutra therapy where the fistula extending to the prostate was treated with no loss of function of the anal sphincter.

The Novel Use of Bipolar Radiofrequency Microneedling in the Treatment of Lichen Sclerosus.

Lichen sclerosus (LS) is a chronic, distressing, inflammatory process that has a huge impact on quality of life in women. Uncontrolled vulvar LS can lead to chronic symptoms of itching and pain and can lead to anatomic changes, scarring, and elevated risk of cancer. First-line therapy with corticosteroids is often not successful in controlling symptoms, especially over the long term. This is the first study to review the effects of bipolar radiofrequency (RF) with microneedling to treat the vaginal and vulvar symptoms of LS. This retrospective study was initiated due to the recognition of improvement in vulvar skin condition and resolution of lichen sclerosus symptoms in patients who had already failed traditional treatment and underwent radio frequency with microneedling procedures of the vulva, perineum, and perianal regions. Patients were treated with three treatments of bipolar RF and bipolar RF with microneedling four to eight weeks apart. Patient questionnaires were used to assess improvement in the symptoms of LS including itching, tearing of tissue, changes in the appearance and color of tissue, and dryness of skin and mucosa. The data from the questionnaires showed a significant reduction or complete resolution in these symptoms, with 86% of the patients reporting either significant or complete resolution. In the case of itching, which is typically one of the most severe symptoms of LS, 91% of patients reported significant or complete resolution. 87% of patients reported symptom resolution lasting at least six months, with 39% of the patients having results lasting 12 months or more before recurrence. Recurrences can be retreated on an as-needed basis or with annual maintenance therapy consisting typically of just one treatment. Radiofrequency with microneedling treatments for persistent LS showed significant improvement in LS symptoms. As LS is a chronic recurring condition, the treatment protocol resulted in high patient satisfaction for these women who had not experienced these results in terms of amount of symptom resolution or duration of symptom resolution with prior treatments using topical steroid cream or other modalities.

Retrospective Study of Fournier Gangrene and it’s Co-relation with FGSI Scores in its Management at a Tertiary Hospital in Mauritius

Background: Fournier’s gangrene is an acute rapidly progressive necrotizing fasciitis of infectious etiology. It usually affects scrotum, penis, perineum, perianal region and anterior abdominal wall occasionally. It is a poly-microbial infection resulting in thrombotic occlusion of small subcutaneous blood vessels leading to cutaneous gangrene. In spite of low prevalence at present FG carries considerable morbidity and mortality. It affects all age groups and both sexes. It is more prone in individuals with Diabetes Mellitus, chronic alcoholism, urogenital, anorectal diseases and immune-compromised persons. The diagnosis of FG is mostly clinical but radiological imaging was also needed to assess the extent of the disease. The management comprises of mainly aggressive surgical debridement under broad spectrum antibiotics coverage and ICU support. Material and Methods: It is a retrospective study comprising 30 number of FG cases clinically diagnosed and admitted in Dr Bruno Cheong Hospital, Flacq, Mauritius from 2019-2023. The data collected from hospital records comprising of routine and emergency cases. The preexisting co-morbidities, socio-economic status and outcome of management as per FGSI scores were assessed and recorded. Statistical Analysis: Standard statistical method, like SPSS was adopted for the analysis. Results: In the present study FGSI scores were co-related with the clinical picture and biochemical parameters of 30 no. of cases to assess severity of the disease. Moreover, FG being a serious and complicated disease, it was managed by a team comprising of surgeons and ICU team. Conclusion: FGSI scoring system is an excellent tool to assess the severity of the disease, in terms of mortality risk and outcome of management.

Single Case study on Horse Shoe Fistula with Partial Fistulectomy followed by Kshara Sutra Procedure

Bhagandara is enumerated under Astamahagada[1] and it is a Chedana Sadya Vyadi, clinically which can be correlated to Fistula-In-Ano. It is a communicating track lined by unhealthy granulation tissue; opens internally in the anal canal or rectum and perianal region. Commonly this disease develops after spontaneous bursting or inappropriate surgical drainage of an abscess. It then remains open with pus discharge.[2] The incidence of a Fistula-in-Ano developing from an anal abscess ranges from 26% to 38%, the prevalence rate of Fistula-in-Ano is 8.6 cases per 100,000 population worldwide, in men the prevalence rate is 12.3 cases per 100,000 population and in women it is 5.6 cases per 100,000 population.[3] Depending upon the extent and nature of Fistulous tracks, Acharya Sushruta has described different type of incision in the management of Bhagandara. Here in this article a small attempt has been made to throw light on Sushrutokta Chedana Karma in Bhagandara.

Bowen's disease with compact orthokeratosis at perianal region: a case report

Bowen's Disease (BD) is an in situ squamous cell carcinoma (SCC) of epidermis, potentially malignant, which mainly affects sun-exposed areas. Nevertheless, the disease had an increased incidence in non-photo exposed areas, such as the anogenital region, correlating ambiental exposures, highlighting the Human Papillomavirus (HPV) infection as an important risk factor. BD has a positive prognosis according to its slow progress and prolonged time taken for full expression. In the anogenital region, presented in this case, the risk of invasive carcinoma is less than 6%. This case reports an unusual presentation of BD, describing a lesion with compact orthokeratosis in the anogenital region. The condition was diagnosed in a prevention routine of primary care attention, emphasizing the importance of premature diagnosis and satisfactory treatment, not just at BDs, but in a variety of conditions.

TRPS1 expression in primary and secondary extramammary Paget diseases: An immunohistochemical analysis of 93 cases

Extramammary Paget disease (EMPD) predominantly manifests de novo as primary EMPD, with less than 30 % of cases associated with underlying internal malignancy (secondary EMPD). Differentiating primary from secondary EMPDs based solely on histopathology poses challenges, often necessitating supplementary screening, such as endoscopy or imaging studies, to definitively exclude underlying carcinomas like colonic adenocarcinoma. Recently, TRPS1 immunohistochemistry, initially identified as a sensitive and specific marker for carcinomas and mesenchymal tumors of mammary origin, has been proposed for EMPD. In this study, we conducted a systematic assessment of TRPS1 expression across 93 EMPD cases, comprising 82 primary EMPDs and 11 secondary EMPDs. Our aim was to assess the potential utility of TRPS1 as a marker to differentiate between primary and secondary EMPDs. Our findings revealed that 88 % (72/82) of primary EMPDs displayed TRPS1 expression, while secondary EMPDs consistently lacked TRPS1 expression (100 %; 11/11). Within the primary EMPD group, consistent TRPS1 immunoreactivity was observed in lesions originating outside the perianal region, such as the groin/inguinal area, axilla, and trunk. Interestingly, a majority (91 %; 10/11) of primary EMPDs originating in the perianal region exhibited an absence of TRPS1 expression. Upon excluding cases of perianal primary EMPDs, the sensitivity and specificity of TRPS1 for primary EMPDs reached 100 %. Our findings suggest that TRPS1 expression holds notable sensitivity and specificity for primary EMPDs, particularly when arising from non-perianal cutaneous sites. Hence, in suitable clinical contexts, TRPS1 immunohistochemistry may emerge as a promising and valuable tool for distinguishing primary and secondary EMPDs.

Microstructural characterization of the skin in the African straw-coloured fruit bat, Eidolon helvum (Pteropodidae).

The African straw-coloured fruit Bat, Eidolon helvum, is a Yinpterochiroptera bat that is of public health and ecological importance. This study investigated the light microscopic morphology, morphometry and histochemistry of the skin and its glands across the cheek, withers, croup, ventral abdomen, perianal region, wing membrane, intercrural membrane and foot pad of the species. Sweat glands were absent and hypodermis was observed only in the withers, croup and ventral abdomen. The croup had the highest density of hair follicles while the perianal region had the highest density of sebaceous gland acini. The thicknesses of the dermis and epidermis were significantly high in the withers and foot pad respectively. Hair follicles and sebaceous glands were absent in the wing membrane. The sebaceous glands had melanin pigmentation at the periphery and stained positive to Alcian Blue-periodic acid Schiff at the withers and ventral abdomen. Epidermal and dermal thicknesses reported in this study were generally higher than those of Yangochiroptera bats and the presence of sebaceous glands and hair follicles in the wing membrane were variable in different bat species. This study has provided baseline information on the light microscopic morphology and morphometry of the skin and its glands across the various body regions in the African straw-coloured fruit bat. This information would be helpful in the understanding, handling, skin disease treatment and management of the bat in captivity for biomedical research purposes.

Correlation between Duration of Diarrhea and Severity of Diaper Dermatitis in Children Aged 0 – 24 Months

Introduction: Diaper dermatitis is a skin disease that commonly occurs in babies, especially whose diapers are always wet and rarely changed. It is a condition in which inflammation occurs in diaper areas, such as the perianal region, buttocks, genitals, inner thighs, and waistline. This study aims to analyze the correlation between duration of diarrhea and severity of diaper dermatitis in children aged 0 – 24 months. Methods: The design of this study was analytic observational using a cross sectional study. Data was collected through an interview with parents using structured questionnaire. Spearman correlation was used to analyze the correlation between duration of diarrhea and severity of diaper dermatitis. This study included 58 babies with diarrhea and diaper dermatitis. This study included 58 infants with a history of diarrhea. Results: The results showed that 37 babies (63.8%) had very mild diaper dermatitis, 18 babies (31.0%) had mild diaper dermatitis, and 3 babies (5.2%) had mild to moderate diaper dermatitis. There was a correlation between duration of diarrhea and severity of diaper dermatitis in children aged 0 – 24 months (p=0.0001). Conclusion: It was concluded that the longer the duration of diarrhea, more severe is the diaper dermatitis.

Characterization of male sexual assault in the state of São Paulo, Brazil: an epidemiological study from 2014 to 2017.

Sexual violence is a pervasive global issue that affects individuals of all genders. However, the experiences of male survivors have often been marginalized and inadequately represented. Male rape, which encompasses several forms of sexual violence against men, remains a sensitive and under-discussed topic in academic literature and public discourse. This study presents a descriptive cross-sectional analysis based on data collected from the Legal Medicine Institute (IML-São Paulo, Brazil) between 2014 and 2017. The analysis includes 7386 reports of sexological examinations performed on male victims of alleged rape. The analysis reveals that a significant majority of rape reports involved victims under the age of 12 or 14, which is considered vulnerable rape by the Brazilian legislation. Regarding the examination of reported cases of abuse against men, it was observed that only the minority of these cases exhibited visible injuries consistent with rape or tested positive for the presence of spermatozoa in the perianal region. Since the absence of visible injuries or spermatozoa does not negate the possibility of rape, this work highlights the challenges in obtaining conclusive evidence, necessitating a comprehensive approach to investigate and prosecute these crimes, creating a more inclusive and supportive environment for all survivors of rape, irrespective of their gender.

Characteristics of condyloma acuminata patients with HIV/AIDS at Prof. Dr. Sulianti Saroso infectious diseases hospital during 2019-2023

Introduction: Condyloma acuminata (CA) or genital warts is a sexually transmitted infection caused by the Human Papillomavirus (HPV). Individuals with CA are more susceptible to HIV compared to those without the condition. CA increases the risk of HIV occurrence and vice versa. This study examines characteristics of CA patients with HIV/AIDS visiting the Dermatology and Venereology Clinic of Prof. Dr. Sulianti Saroso Infectious Diseases Hospital during 2019-2023. Method: The research methodology employed in this study is a retrospective descriptive approach with a cross-sectional design. The sampling technique utilized was the total sampling method. Result: Among 22 recorded cases, 11 fulfilled the study criteria. Most patients were aged 19-44 years (86.7%), male (81.8%), with a history of homosexual relations (54.5%), and exhibited lesions primarily in the perianal region (54.5%). All patients received antiretroviral therapy (ART) (100%), and CD4 count results predominantly ranged from 101-200/mm3 (63.6%). Trichloroacetic acid (TCA) therapy was the most prevalent treatment modality (81.8%). Conclusion: The highest prevalence was noted within the age range of 19-44 years, with a majority of male patients. Unmarried status was most common among the patients. Homosexual history emerged as the predominant pattern of sexual intercourse. The perianal region was the most frequent location. The average CD4 count ranges from 101 to 200/mm3. The predominant treatment method utilized was the application of trichloroacetic acid (TCA).

Hidradenitis Suppurativa in Children and Adolescents: An Update on Pharmacologic Treatment Options.

Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin condition that manifests as painful, deep-seated, inflamed nodules and abscesses in the axillary, groin, perianal, perineal, and inframammary regions. The associated pain, malodour, and disfigurement contribute to its profound negative impact on psychosocial spheres and overall quality of life in affected individuals. Although the symptoms of HS classically begin in the second or third decade of life, HS affects children and adolescents as well. Despite this, there are limited pediatric data on treatment, which are largely based on expert opinion, extrapolation of efficacy data in adults with HS, and safety information from medication use in other pediatric diseases. On this basis, there exist several pharmacological modalities in the treatment of children and adolescents with HS including topical therapies, systemic therapies, and biologics. The goals of this review article are to: (1) review the efficacy of different pharmacological treatment modalities in children and adolescents with HS, and (2) review the safety and monitoring considerations of the different treatment options in children and adolescents with HS.

Basal Cell Carcinoma of the Vulva

"The basal cell carcinoma (BCC), a malignant tumor representing 75% of all skin cancers other than melanoma [1], is rare on non-exposed skin such as the perianal and genital regions [2]. We describe a woman with BCC of the vulva treated by partial hemivulvectomy. All excision margins were disease-free. The patient recovered without complications. Approximately 200 cases of BCC on perianal and genital skin have been reported in the literature [3,4]. Although the etiology of vulvar BCC is unknown, early diagnosis is important. As BCC on these sites can sometimes appear innocuous, biopsy of all suspicious lesions is recommended [5,6].

A solitary soft-rubbery nodule in the perianal region of a newborn: a clinicopathological challenge.

A solitary soft-rubbery nodule in the perianal region of a newborn: a clinicopathological challenge.

Giant condyloma, buschke-löwenstein tumor in the penis, presentation of a case and review of the literature

Background: Buschke-Löwenstein tumor is a presentation of condyloma acuminata; caused by human papillomavirus infection presenting as an exophytic, polypoid, cauliflower-like lesion; characterized by slow growth, local infiltration, contiguous tissue destruction; with a tendency to recurrence and produce fistulas or abscesses around the affected area. The most frequent location is the vulva, scrotum, penis, perineum and perianal region; Transmitted by sexual contact and more common in men, it is controversial whether it should be considered premalignant or a verrucous carcinoma; It does not present cellular atypia and a third can become malignant; recurrences are frequent. The risk factors are HPV, continuous irritation and poor hygiene of the genital area, phimosis, immunosuppression, smoking and drug addiction. Objective: review literature and case description. Case presentation: 45-year-old male with condylomatous lesion on the genitals of 4 months' duration, on the foreskin and ligament of the glans penis, and other minor lesions on the shaft of the penis; morbid obesity, uncontrolled type 2 diabetes mellitus. He is scheduled for circumcision and removal of the satellite lesions. Conclusion: Giant Buschke-Löwenstein condyloma is considered a low-grade squamous cell carcinoma, locally invasive, with aggressive behavior; Surgical treatment is the option.

Management of Cutaneous Squamous Cell Carcinoma (Clear Cell Variant) in Bovine - A Case Report

Tumors of the bovine gastrointestinal tract are rare, possibly because of the low age of the sample population (Bertone, 1990). Neoplasia in cattle carries a poor prognosis because of early adenocarcinoma metastasis and the high fatality of lymphosarcoma. Squamous cell carcinoma is the second most rude type of skin cancer, with basal cell carcinoma being the most common (Rinker et al., 2001). Squamous cell carcinoma has been documented in bovine (Musser et al., 1993). Clear-cell squamous cell carcinoma is a rare variant of squamous cell carcinoma, first described by Kuo (1980) as a skin tumor. The exact etiology is unclear, but ultraviolet radiation has been suggested as a possible cause in humans (Lawal et al., 2013). This report documents a case of cutaneous squamous cell carcinoma (clear cell variant) in perianal region of a cow and its successful surgical management.

Management of Fournier's gangrene: a practical guide for clinicians.

Fournier's gangrene is a localised form of necrotising fasciitis affecting the external genitalia, perineal and perianal regions. Although rare, it is associated with high rates of morbidity and mortality, so clinician awareness is essential for prompt treatment. Risk factors include diabetes mellitus, hypertension, chronic alcoholism and immunosuppression. Perineal pain in patients with sepsis should be treated with a high level of suspicion and early surgical referral is required as prompt debridement can improve outcomes. Repeated surgical intervention and antimicrobial therapy are often needed and recovery can take a long time, with a long-term impact on quality of life. This article discusses the natural history of Fournier's gangrene, aetiology, risk factors, investigations and treatments with an algorithm to support clinical practice.