Perineum Research Articles

Monkeypox outbreak 2023 in Chengdu, China: an observational study

Monkeypox is a zoonotic viral disease caused by monkeypox virus infection and formerly this disease had been endemic mainly in Africa. Since May 2022, the disease has rapidly spread across the world and some imported case was confirmed sporadically in China. Under these circumstances, data of confirmed cases were collected consecutively in Chengdu, southwest China to investigate clinical and epidemiological characteristics. In this study, 28 male patients were confirmed to have monkeypox infection, with 26 identifying as MSM (men who have sex with men). Typical lesions included papules, pustular papules, vesicles, scabs and ulcerations. The most common sites of skin lesions were anogenital and perineal areas, three patients developed a widespread exanthem. Seven patients reported a history of sexual transmitted diseases, no one was hospitalized and there were no deaths. Three instances of secondary transmission were identified among close contacts, all of them were sexual partners of our participants. Furthermore, this observation provides insights of the public health for surveillance of this emerging disease and raises awareness among people at risk.

Hidradenitis Suppurativa Treatment During Pregnancy and Lactation: Navigating Challenges.

Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory skin condition primarily affecting skin folds such as the axilla, groins, and the inframammary, perineal, and perianal regions. It is characterized by painful abscesses, sinus tracts, and scarring. Predominantly affecting young adults, particularly females, HS often emerges during reproductive age, and flares are widely reported during pregnancy and postpartum, underscoring the need to consider management strategies tailored to pregnant or lactating individuals. Moreover, the chronic and relapsing nature of HS, along with challenges related to the safety and compliance of medication use during pregnancy and lactation, as well as various comorbidities and psychological distress, significantly complicate its management in pregnant or lactating women. Treatment options, including topical clindamycin, oral clindamycin-rifampicin, adalimumab, metformin, antiseptic washes, and certolizumab pegol, have accumulated evidence supporting their relative safety in pregnant and lactating women. While certolizumab pegol has shown promising safety data among biologics, it requires more efficacy data in HS. Conversely, while newly approved HS medications such as secukinumab and bimekizumab show promise for the general population, further research is necessary to evaluate their safety profiles in pregnant and breastfeeding individuals. The scant research available on HS in pregnant and lactating women, also shown by our systematic literature review, highlights the need for a comprehensive investigation into the safety, efficacy, and suitability of management strategies.

Enhanced patient recovery with early extensive surgical deb-ridement in Fournier's Gangrene: evaluation of perioperative outcomes in a multicentric experience.

Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis primarily affecting the perineal, genital, and perianal regions. This rapidly progressing bacterial infection predominantly affects middleaged and elderly men. This multicenter study aims to describe the management in a wide cohort of Fournier's gangrene cases that presented to three tertiary centers with early extensive surgical debridement. We retrospectively collect data from patients with FG who were referred to the Urology Clinic of the Department of Medicine and Surgery (Perugia), the Urological Andrological Surgery and Minimally Invasive Techniques Unit (Terni) of the University of Perugia, and the Urology Unit of the Surgery Department of the Macerata Civic Hospital between January 2019 and March 2024 for onset of classic signs and symptoms of FG. Extensive surgical debridement was immediately performed under general anesthesia to reach normochromic and vascularized tissue in wide and depth extension, assuring vital and healthy margins. For all patients, intravenous daptomycin plus piperacillin/tazobactam were administered. 28 male patients with FG underwent early surgical debridement. In two cases, orchidectomy and partial penectomy were required during surgical debridement due to extensive necrosis. Colon diversion and urinary diversion were not necessary for any of the patients. 32.1% complications were recorded according to the Clavien Dindo classification; 6 patients died in the perioperative. Excluding death data, the average duration of antibiotic therapy was 22.0±9.1 days, and the average length of stay was 17.6±11.8 days. Fournier's gangrene has high mortality rates. It requires timely surgical debridement and antibiotic therapy to achieve positive outcomes. This study shows that a primary extensive debridement can help reduce the need for further intervention and shorten the hospital stay.

High-resolution direct magnetic resonance imaging fistulography with hydrogen peroxide for diagnosing anorectal fistula: A preliminary retrospective study.

Fistula-in-ano is an abnormal tunnel formation linking the anal canal with the perineum and perianal skin. Multiple imagining methods are available to evaluate it, among which magnetic resonance imaging (MRI) is the most advanced noninvasive preoperative method. However, it is limited in its visualization function. To investigate the use of intraluminal MRI for perianal fistulas via a novel direct MRI fistulography method. We mixed 3% hydrogen peroxide (HP) with gadolinium for HPMRI fistulography, retrospectively analyzing 60 cases of complex/recurrent fistula-in-ano using physical examination, trans-perineal ultrasonography (TPUS), low-spatial-resolution MRI, and high-resolution direct HPMRI fistulography. We assessed detection rates of fistula tracks, internal openings, their relationship with anal sphincters, and perianal abscesses using statistical analyses, including interobserver agreement (Kappa statistic), and compared results with intraoperative findings. Surgical confirmation in 60 cases showed that high-resolution direct HPMRI fistulography provided superior detection rates for internal openings (153) and fistula tracks (162) compared to physical exams, TPUS, and low-spatial-resolution MRI (Z > 5.7, P < 0.05). The effectiveness of physical examination and TPUS was also inferior to that of our method for detecting perianal abscesses (54) (Z = 6.773, 3.694, P < 0.05), whereas that of low-spatial-resolution MRI was not significantly different (Z = 1.851, P = 0.06). High-resolution direct HPMRI fistulography also achieved the highest interobserver agreement (Kappa: 0.89, 0.85, and 0.80), while low-spatial-resolution MRI showed moderate agreement (Kappa: 0.78, 0.74, and 0.69). TPUS and physical examination had lower agreement (Kappa range: 0.33-0.63). High-resolution direct HPMRI fistulography enhances the visualization of recurrent and complex fistula-in-ano, including branched fistulas, allowing for precise planning and improved surgical outcomes.

Neuro-reproductive toxicity and carcinogenicity of 1-bromopropane - studies for evidence-based preventive medicine (EBPM).

Bromopropane was introduced commercially as an alternative to ozone-depleting and global warming solvents. The identification of 1-bromopropane neurotoxicity in animal experiments was followed by reports of human cases of 1-bromopropane toxicity. In humans, the most common clinical features of 1-bromopropane neurotoxicity are decreased sensation, weakness in extremities, and walking difficulties. Moreover, decreased cognition, abnormal findings on brain magnetic resonance imaging, urinary incontinence, and numbness in the perineal area have also been described in workers exposed to 1-bromoporopane. Murine histological studies showed that exposure to 1-bromopropane reduced the density of brain noradrenergic axons. Furthermore, proteome studies demonstrated 1-bromopropane-induced changes in the expression of proteins in the hippocampus of rats, similar to the changes seen in mice exposed to acrylamide, suggesting a common mechanism of electrophile-induced neurotoxicity. In addition to its neurotoxicity, 1-bromopropane also induces male reproductive toxicity in rats, though the targeted areas in the reproductive system differ from those affected by 2-bromopropane. However, exposure to high levels of 1-bromopropane was reported to induce spermatogenic cell degeneration, similar to that caused by 2-bromopropane, suggesting common mechanism(s) underlying 1- and 2-bromopropane-induced male reproductive toxicity. Plural approaches, including human, animal and mechanistic studies, are useful for identification of 1-bromopropane neurotoxicity. The International Agency for Research on Cancer (IARC) summarized that 1-bromopropane as well as 2-bromopropane share several key characteristics of carcinogens. Plural approaches can establish evidence-based preventive medicine (EBPM) by modification of the conventional evidence-based medicine (EBM), which has been developed for therapeutic medicine and represented by the EBM pyramid.

P1070 Comaparison of Effectiveness and Perisitence Anti-TNF drugs on Perianal Fistulizing Crohn’s Disease: A Single Tertiary IBD Referral Center Experience

Abstract Background Perianal Crohn’s disease (CD) is a debilitating and often challenging manifestation of Crohn’s disease that involves the formation of fistulas, abscesses, and other inflammatory lesions around the anus and perineal area. It is associated with significant morbidity, including pain, recurrent infections, and impairment of daily activities. Treatment of perianal CD is complex, requiring a multidisciplinary approach to control disease activity, promote healing, and preserve anal function. Anti-TNF (tumor necrosis factor) biologic agents, such as infliximab and adalimumab, have become a mainstay in the management of perianal Crohn’s disease. However, there is still a debate which anti-TNF agents acts better than other in this subset of patients. Here in this study, we aimed to evaluate the compare the efficacy and persistence of two Anti-TNF agents in perianal Crohn’s disease. Methods This was a single center, retrospective cohort analysis of patients with Crohn’s disease either received adalimumab or infliximab as a first line biologic treatment. A total of 396 patients were included to this analysis. Demographic information such as gender, age, Montreal classification, smoking and prior medications were noted from patients electronic medical records. Weighted Kaplan-Meier and Cox models were used to assess the outcomes. Results Out of 446 Crohn’s disease patients, 128 patients had perianal Crohn’s disease. Gender, smoking, extraintestinal manifestations presence and family history were not different between patients with and without perianal disease. However, in perianal disease group there was more concomitant immunomodulator use than in patients with no perianal involvement (61.5% vs 49.4%, p&amp;lt;0.05). Anti-TNF drug persistence was significantly higher in patients without perianal involvement when compared to patients with with perianal involvement (Figure 1). There was no significant difference in drug persistence rates in perianal Crohn’s disease between infliximab and adalimumab treatment (Figure 2). The concomitant use of immunomodulator drugs did not make any impact. Conclusion In Crohn’s disease patients, anti-TNF medication persistence rates was observed to be significantly lower in those with perianal involvement. However, which anti-TNF agent was chosen as first line biologic did not change medication persistence rates. Concomitant thiopurine use did not make any impact on the results.

P0277 Skin tag excision in Crohn’s disease: first, do no harm?

Abstract Background Traditionally, perianal skin tag excision has been contraindicated in patients with Crohn’s disease (CD) owing to risk of non-healing wounds. However, little data exists on this topic. We aimed to review our institutional experience with outcomes after perianal skin tag excision in patients with CD. We hypothesized that perianal skin tag excision in CD would be associated with non-healing wounds. Methods We retrospectively reviewed adults with CD who underwent skin tag excision with or without limited excisional hemorrhoidectomy at our center between 2012 and 2024. Demographics, CD characteristics, medications, operative data, pathology, and postoperative outcomes were reviewed. Results Forty-five patients with CD underwent excision of skin tags (28, 62%) and/or limited excisional hemorrhoidectomy (20, 44%). Demographics, CD characteristics, and medications are detailed in Table 1. Short -term complications occurred in 2 (4.4%); 1 fistula and 1 wound dehiscence. Pathology results were available for 42 (93%) patients; the majority were benign (33, 78.5%) but a small subset (2, 5%) had anal intraepithelial neoplasms (Table 2). Long-term complications occurred in 11 (24.4%) patients (Table 2), of which 9 (81.8%) were managed [conservatively or with non-operative therapy. Complications included perianal fistula (4, 8.8%), anal stenosis (4, 8.8%), nonhealing wounds (2, 4.4%) and anal fissure (1, 2.2%). Of these patients, seven (63.6%) later had complete wound healing. Almost half of these patients had penetrating disease with perianal involvement (5, 45.5%). At most recent follow-up, 41 (91.1%) patients had complete wound healing, and only one (2%) patient required proctectomy. Four patients (9%) had persistent non-healing wounds; 2 with history of perianal fistulae requiring surgery (one requiring diversion), 1 with fistula 4 years after skin tag excision, and 1 later diagnosed with perianal hidradenitis suppurativa. Three (75%) of these patients had prior surgery for perianal disease (one each: fissure, abscess, and stricture), and all were on biologic therapy (infliximab, 3; adalimumab, 1). Conclusion Perianal skin tag excision in carefully selected CD patients resulted in wound healing in the majority (91%) of patients and can be considered for lifestyle limiting symptoms. Pathology was typically benign but occasionally revealed actionable results, including neoplasia, and should encourage routine pathologic evaluation of specimens. The risk of long-term complications was low, but higher in the CD population compared to average, and the sequelae were mostly managed with non-operative therapy. Our data suggests that previous surgery for perianal Crohn’s may be a risk factor for non-healing wounds after perianal skin tag excision.

P0781 Perianal lesions present at paediatric Crohn’s disease diagnosis require early treatment with tumour necrosis factor antagonist to reduce high risk of perianal fistulising complications: a post-hoc analysis of a prospective, multicentre study

Abstract Background Paediatric patients with Crohn’s disease (CD) have differing risks for developing perianal fistulising complications (PFC), which develop in nearly 1 in 3 children with CD.1 Perianal lesions, such as skin tags and/or fissures, at CD diagnosis may augment the risk of PFC development, whereas tumour necrosis factor antagonist (anti-TNF) treatment may reduce the PFC risk.2, 3 We sought to determine the magnitude of PFC risk attributable to perianal lesions, and to evaluate the optimal timing of anti-TNF therapy to prevent PFC in a prospective multicentre cohort of children with CD. Methods Data from paediatric patients (&amp;lt;21 yr) with newly diagnosed CD were prospectively collected by 7 centres, with supplemental record review. To evaluate new PFC, we excluded those with PFC within 14 days of CD diagnosis. We defined the timing of anti-TNF after diagnosis but prior to PFC. The primary outcome was PFC development evaluated with Cox proportional hazard models. Bivariate comparisons were made with t-test, chi-square, or Spearman rank sum for age at diagnosis, gender, race, disease phenotype location, and perianal lesions. Results Of 546 patients without PFC within 2 weeks of diagnosis (median age 13.1 yr, interquartile range [IQR] 10.9-15.4, 40% female, 85% White),128 (18%) had perianal lesions at diagnosis. In total, 60 patients (11%) had perianal lesions, and 125 (23%) developed PFCs. There were no differences in perianal lesions by age at diagnosis (p=0.34), gender (p= 0.58), race (p=0.15), or phenotype (p=0.16). Median time from CD diagnosis to anti-TNF therapy in those with perianal lesions was 22 days (IQR 13-48), and 60 days (IQR 18-270) for those without perianal lesions (p&amp;lt;0.001). Perianal lesions at diagnosis were associated with &amp;gt;2-fold increased risk of PFC (hazard ratio 2.39, 95% confidence interval 1.51-3.77). Compared to early anti-TNF and no perianal lesions (reference), those with perianal lesions at diagnosis and anti-TNF delay and had the highest risk of PFC development at nearly every timepoint (Figure 1). Earlier anti-TNF use in those with perianal lesions reduced the risk to near baseline rate of PFC in those without perianal lesions. Conclusion Children with CD who have perianal skin tags and/or fissures are at greatly increased risk of developing PFC. Early anti-TNF, ideally starting within 30 days of diagnosis, should be considered to prevent development of PFCs in children with perianal lesions. Delays in anti-TNF treatment in children with perianal lesions can be associated with up to 12-fold greater risk of PFC development by 1 year.

Fournier's Gangrene leads to lower Quality of Life and Self-esteem.

Fournier's gangrene (FG) is a life-threatening necrotizing infection of the perineal, genital, or perianal regions, often requiring extensive surgical intervention and prolonged recovery. Despite advances in acute management, the long-term impact of FG on patients' self-esteem and quality of life remains underexplored. This retrospective study included 48 patients treated for FG at seven urological centres in Austria between 2017 to 2022. Several in-house data were collected and patients were contacted after a mean of 4.5yrs to complete a questionnaire including the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), Short-Form (SF12) quality of life questionnaire, and the Rosenberg self-esteem scale (RSE). The study recruited 48 patients with a median age of 64 years; 58.7% required intensive care unit (ICU) stays due to infection (median duration. 6 days). The in-house mortality rate was 8.3%. Survivors (n=44) had a median hospitalization of 16 days. They were contacted by mail, 18 completed the questionnaire. There was a high prevalence of urinary symptoms and erectile dysfunction, wound pain, and impaired quality of life. Severe erectile dysfunction (IIEF-5 score ≤7) was reported by 46.2%, and 38.9% reported Visual Analog Scale (VAS) pain score ≥4. Impaired self-esteem (mean RSE score: 12.4) correlated with functional impairments, including urinary symptoms (IPSS ≥20 in 55.6%), erectile dysfunction, and wound-related pain. Physical and mental health were strongly associated with decreased self-esteem, with hypertension (61.1%) and alcohol abuse (16.7%) negatively impacting outcomes. FG negatively impacts patients' self-esteem and quality of life, particularly in the presence of pre-existing risk factors. The findings highlight the importance of integrated rehabilitation approaches to mitigate long-term psychological and functional impairments.

Investigating the Impacts of Perianal Skin Cancer on Patient Quality of Life

Perianal skin cancer, while rare, can have severe consequences on patient quality of life. This study sought to address this question by examining patient lived experience, social impact, psychological symptoms, and perceived informational needs following a diagnosis of perianal skin cancer. Mixed methods enabled contextualization, exploration, and illumination of pertinent patient issues. Results indicated that stigma, communication, psychological and physical effects, and concern for survival may impact patient care. Psychometric data support these findings. Patient informational needs suggest a reduction in the perceived frequency of all needs and a strong preference for digital over face-to-face information provision. As a truly patient-centered study, this paper provides an important starting point for the consideration of psychosocial support for perianal skin cancer patients. The outcomes are disseminated across clinical policy, offering highlighted points of consideration. Perianal skin cancers are rare. They are rare enough that, in general, the evidence base lacks the larger studies and data that could enable more consistent practice worldwide. This is the first patient-centered investigation of the impacts of perianal skin cancer on quality of life and patient well-being, and it is the first patient study to cascade into policy amendment within the United Kingdom, notably within the clinical unit. This study provides concrete, specific outcomes related to patient experience and clinical need, and suggests both the generic nature of the support available to assist these patients and the lack of productive practice that could be molded and strengthened from it.

Perianal Skin Tags as a Diagnosis Clue to Crohn's Disease

Perianal Skin Tags as a Diagnosis Clue to Crohn's Disease

Assessing Mortality Risk in Fournier's Gangrene: A Study Using the Simplified Prognostic Scoring System

Background: Fournier’s gangrene (FG) is an uncommon yet serious type of necrotising fasciitis that impacts the perineal, genital, and perianal areas. The simplified prognostic scoring system for Fournier’s gangrene emphasizes essential clinical indicators, including age, body mass index (BMI), comorbidity status, and presentation timing, to develop a practical tool that facilitates rapid decision-making. Objective: To study the Risk factors for mortality using Simplified Prognostic Scoring System in patients with Fournier's gangrene. Method: A prospective study utilised a non-probability consecutive sampling technique. This investigation took place within the urology department of the Sindh Institute of Urology and Transplantation from January 2018 to June 2022. All patients admitted with the working diagnosis of Fournier’s gangrene through emergency services, from January 2018 to June 2022. Demographic information (age, gender, co-morbidities), vital signs, presentation (mode of onset), and primary body areas affected were noted. All these patients will receive conservative management, which encompasses broad-spectrum antibiotics, nutritional management, and nursing care. Additionally, each will receive debridement, and their wounds will be evaluated on a daily basis. Result: A total of 130 patients were discharged without any reported deaths from early presentations. In contrast, 183 patients were discharged, with 9 deaths noted from delayed presentations. Additionally, 2 individuals were discharged, while 17 patients succumbed during treatment due to late presentations with septic shock. Conclusion: The simplified prognostic scoring system is a valuable tool for risk stratification in patients with Fournier’s gangrene and should be routinely used in clinical practice to improve patient outcomes.

MANAGEMENT OF GUDA VIDRADI LEADING TO PARISRAVI BHAGANDARA (FISTULA-IN-ANO) BY BHEDANA KARMA FOLLOWED BY KSHARA SUTRA: A CASE STUDY

Guda vidradhi (Anal abscess) is described by Acharya Sushruta under Antar vidradhi. Vidradhi remains as a localized painful condition, with all the features of Vrana shotha (inflammation) with severe pain, tendency of early suppuration. Guda vidradhi is co-related with anal abscess on the basis of symptom. A perianal abscess is an infection in a mucous- secreting gland in the anal canal around anus. Fistula-in-Ano is an epithelial-lined tract connecting the anal canal to perianal skin. Parisravi Bhagandara is a type of bhagandara told by Acharya Sushruta caused by predominance of kapha dosa. Parisravi Bhagandara is treated by Chitraka based kshara sutra, which is cost effective and requires less hospitalization. Ayurveda as well as modern science described same line of treatment in the presence of pus. Acharya Sushruta mentioned that Bhedana Karma at the most prominent part for evacuation of dosha. Kshara sutra procedure was carried out on 40 years old female patient suffering from Guda Vidradi leading to Parisravi Bhagandara. After the complete cut through of fistulous track and wound healing, there were no complaints of pus discharge or pain. Bhedana Karma followed by Chitraka based Kshara Sutra in management of Guda Vidradi leading to Parisravi Bhagandara has significant results when compared with contemporary sciences. Kshara sutra can be carried out in OPD’s, with less complications, minimal scar after healing and cost effective when compared with contemporary sciences.

Etiology, clinical manifestations and prevention of perianal infection in patients with hematological malignancies

Introduction. Perianal infection (PI) in patients with hematological malignancies is characterized by a wide spectrum of pathogens and a variety of clinical manifestations and mechanisms of development of the infectious process.Aim: to study the pathogenetic mechanisms of PI development in patients with hematological malignancies and to develop prevention tactics.Materials and methods. The prospective study included 132 patients with hematological malignancies who had episodes of PI. The infectious process in the pararectal fi ber was registered based on the data of clinical examination or magnetic resonance imaging. Sources of infection and microbiologic results were studied.Results: Two main mechanisms of PI development were revealed, the frequency of which was statistically significantly different depending on the presence of neutropenia (p &lt; 0.0001, odds ratio (OR) = 24.42 (confidence interval (CI) 95% [9.82–60.74]). In PI episodes that developed against the background of neutropenia, the predominant mechanism of infection was the penetration of microorganisms through broken tissue barriers (75 %): anal fissures were the entry gate of infection in 62.9 % of episodes; perianal ulcers and skin erosions — in 12.1 %. The alternative route of infection (cryptogladular mechanism) was registered in the majority of patients without neutropenia (66.7 %) and was represented by the involvement of crypts of the anal canal (28.6 %) or the presence of pararectal fistulas (38.1 %). Clinical manifestations of PI were associated with leukocyte count (p &lt; 0.0001) and mechanism of infection (p &lt; 0.0001). The median leukocyte count in patients with abscesses (2.12×109 /L) was statistically significantly higher than in infiltrates (0.57×109 /L) and necrosis (0.74×109 /L). The main source of infection in infiltrates was anal fissures (70.4 %), while in abscesses the main sources of infection were crypts of the anal canal (39 %) and pararectal fistulas (36 %). The main causative agents of PI were Gram-negative bacteria (Escherichia coli (43 %), Klebsiella spp. (15 %), Pseudomonas aeruginosa (4.4 %)), and Enterococci (12.5 %). P. aeruginosa was isolated more often in necrosis (22 %) than in other clinical forms of PI (3–5 %) (p = 0.0033), while the frequency of detection of other bacteria was independent of the clinical manifestations of PI. PI was a microbiologically proven source of sepsis in 9.5 % of PI episodes. The probability of PI-associated bloodstream infections was highest at 5 days and was significantly higher in patients with neutropenia (10 % vs 2 %) (p = 0.0044).Conclusion: Different mechanisms of pararectal cell infection should be taken into account when forming a strategy for the prevention of PI.

Perineal schwannoma (case report and review)

Schwannoma (also known as neurilemmoma) is a type of benign tumor that originates from the myelin sheath around of peripheral nerves. It is composed of schwann cells, which are specialized cells that help to insulate nerve fibers. Schwannomas are relatively rare, accounting for only 5% of all benign tumors in the perineal region. They are usually asymptomatic and are only detected when they come into contact with other organs or structures, causing symptoms such as compression. Preoperative diagnosis of schwannoma is challenging, as it is often difficult to distinguish it from other types of tumors in the same area. The final diagnosis can only be confirmed by intraoperative histology.The method of choice for benign neurilemmomas is complete removal, as they continue growth after resection. Removing part of the tumor may be an option in cases where removing the neoplasm en bloc could damage adjacent structures, such as anal sphincter, levators, rectum, vagina and urethra.Clinical case: twenty-five years old female, had complaints of a tumor in the left buttock area and discomfort in a sitting position for 3 years. Pelvic MRI with intravenous contrast revealed a tumor 6.0 × 5.1 × 9.0 cm in the left ischial region. Surgical removal of the tumor was performed.

Assessing the risk factors for surgical site infections after anal reconstruction surgery in patients with anorectal malformations: a retrospective analysis.

This study aimed to identify surgical site infection (SSI) risk factors after anal reconstruction surgery in patients with anorectal malformations (ARMs). This retrospective analysis from January 2013 to December 2022, including all pediatric surgical facilities in Hokkaido, Japan, examined consecutive patients with ARMs, excluding cloacal cases, regarding perioperative and SSI factors during their initial anal reconstruction surgeries. This study involved 157 cases of major clinical groups and 7 cases of rare/regional variants, among whom 4% developed SSIs. SSIs occurrence varied by type and was primarily observed from the neo-anus to the perineal region. Organ/space SSIs occurred in rectourethral fistula (prostatic/bulbar) and perineal (cutaneous) fistula type. Surgical procedures were abdominal sacroperineal rectoplasty, posterior sagittal anorectoplasty, laparoscopic-assisted anorectal pull-through, cutback anoplasty, and Pott's anoplasty, varied based on the ARM type and facility. In perineal (cutaneous) fistula, vestibular fistula, and anal stenosis cases, a significant association was observed between perianal muscle division and SSIs in patients aged > 4months (p = 0.04). No significant SSI factors were found in other ARM types. The choice of procedure as an interventional perioperative factor is suggested to be associated with SSIs. These findings may contribute to making informed decisions regarding surgical procedures in such cases.

Parental intentions to vaccinate their daughters for HPV. A cross-sectional nationwide study in Greece using the COM-B model

Human papillomavirus (HPV) infection is a common sexually transmitted disease in men and women worldwide. It accounts for the appearance of benign papillomatous or precancerous lesions, which sometimes can be evolved into cancer, especially in the anogenital area. For prevention, a vaccine is available worldwide including Greece, for girls and boys aged 9-18 years. The responsibility for the vaccination usually lies with parents/guardians. This study aimed to measure parental intention to vaccinate their daughters against HPV and identify the determinants that affect it. From September 2021 to March 2022, a cross-sectional nationwide study was carried out among a representative sample of students, and through them their parents/guardians, using multistage stratified sampling. 46 schools in the territory participated, with a representative sample of 3,203 parents/guardians of female students aged 11-18 years, who completed an anonymous questionnaire created based on the Capability, Opportunity, Motivation - Behavior (COM-B) and Theoretical Domain Framework (TDF) models. 905 parents out of the 1358 who hadn’t vaccinated their daughters (66.6%) mentioned that they intended to do so or complete vaccination. Knowledge about the vaccine (p &lt; .001), fear of possible side effects (p &lt; .001), relief that serious diseases could be avoided (p &lt;.001), expert influence (p &lt; .001), and reminders through email (p = .048) were the significant determinates of parents' intention to vaccinate their daughters. The interconnected COM-B and TDF models are suitable frameworks for targeted interventions to foster HPV vaccination.

Challenges in Management of Fournier’s Gangrene after the Perianal Abscess- A Case Report and Review of Literature

BACKGROUND: Fournier’s Gangrene (FG) is a rare and potentially fatal form of necrotizing fasciitis that affects the perineal, perianal, or genital regions. The condition often originates from an infection in the anorectal or genitourinary area and is exacerbated by comorbidities, such as diabetes mellitus, chronic alcoholism, and immunosuppression. The rapid progression and high mortality associated with FG necessitate immediate diagnosis and prompt surgical intervention. CASE PRESENTATION: We present a case of a 52-year-old male with poorly controlled diabetes mellitus who developed FG following the drainage of a perianal abscess. Despite early surgical intervention, the infection progressed, leading to extensive necrosis of the perineum, scrotum, and lower abdominal wall. The patient required multiple debridement, broad-spectrum antibiotics, and intensive care management. Over a prolonged hospital stay, the patient recovered with significant wound care, including skin grafting, in large defect. This case illustrates the complexity of managing FG, mainly arising from a perianal abscess. The presence of diabetes mellitus complicates the clinical course and increases the risk of severe outcomes. A comprehensive multidisciplinary approach involving surgical, medical, and supportive care teams is essential for successful management. A review of the current literature highlights the critical importance of early and aggressive treatment to improve patient outcomes in FG cases. CONCLUSION: FG following a perianal abscess presents significant management challenges, especially in patients with underlying comorbidities. This case emphasizes the necessity of early diagnosis, prompt surgical intervention, and a multidisciplinary approach to care. Despite the severity of the condition, timely and comprehensive management can lead to favorable outcomes.

Vulvar Lactating Adenoma: A Rare Representation of Mammary-Like Anogenital Glands.

Mammary-like anogenital glands are considered a normal constituent of the anogenital area. These glands can have epithelial components with eccrine or apocrine features. They often undergo transformation into mammary-like lesions, including lactational changes that occur during pregnancy and the breastfeeding period. When they form mass lesions they are referred to as lactating adenomas. Their appearance can clinically be mistaken for other more common benign and malignant entities in the vulva. We describe a vulvar lesion in a 26-year-old woman. The lesion was excised and determined by histologic examination to be a benign lactating adenoma. Subsequent immunohistochemistry was performed. The epithelial cells were positive for GATA3 and estrogen receptor while negative for PAX8, supporting mammary-like differentiation. The myoepithelial markers p63 and calponin were positive at the periphery of the ducts, supporting the benign nature of this lesion.

"Fournier": the eponym of a disastrous gangrene. Clinical case experience.

Fournier's gangrene is a relatively rare infectious necrotizing fasciitis that affects the superficial and deep tissues of the perineal, genital and perianal regions. Expressly known to be highly morbid, this condition can carry a staggering spectrum of mortality in the absence of a diligent multidisciplinary management plan. The disastrous and critical scale of the entity deserves particular attention to improve the results. We report the tragic case of a patient with a medical history of diabetes admitted with the diagnosis of Fournier's gangrene. Examination revealed multi-organ failure and laboratory findings marked leukocytosis, lactic acidosis and elevated inflammatory markers. Despite intensive medical treatment and emergency extensive surgical debridement, the patient died. The particularity of this documented report highlights the need for increased vigilance in the field of professional medical practice, emphasizing the interest in further awareness-raising to bridge the gap between the public and this disease, which could help optimize patient prognosis.