Epidemiology and outcomes of anal abscess in patients on chronic dialysis: a 14-year retrospective study

OBJECTIVES: We conducted this retrospective study to elucidate the clinical presentation and outcomes of anal abscess in chronic dialysis patients. METHODS: We performed a chart review of patients who were hospitalized for anal abscess from Jan. 2002 to Dec. 2015. A total of 3,074 episodes of anal abscess were identified. Of these, 43 chronic dialysis patients with first-time anal abscess were enrolled. Patients were divided into a surgical group and a nonsurgical group according to the treatment received during hospitalization. The baseline characteristics, clinical findings, treatments and outcomes were obtained and analyzed. The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence. RESULTS: Of the 43 patients, 27 (62.7%) received surgical treatment, and 16 (37.2%) received antibiotic treatment alone. There was no significant difference in age, sex, body mass index, smoking habits, comorbidities, or dialysis characteristics between the two groups. Perianal abscess was the most common type of anal abscess, and 39.5% of patients experienced fistula formation. Most patients had mixed aerobic and anaerobic flora. Our data demonstrate that there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082). CONCLUSION: In chronic dialysis patients with anal abscess, there was no statistically significant difference in clinical presentation and outcomes between the surgical and nonsurgical groups, although the surgical group had a trend of better in-hospital survival.

Clinical, functional and morphologic evaluation of patients undergoing lateral sphincterotomy for chronic anal fissure treatment. Identification of factors that can interfere with fecal continence / Avaliação clínica, funcional e morfológica de pacientes submetidas à esfincterotomia para tratamento da fissura anal. Identificação dos fatores que podem interferir na continência fecal

Objective: Evaluate clinical, functional and morphologic outcomes of lateral sphincterotomy for chronic anal fissure treatment, and correlate the findings with factors that influence in the anal continence. Method: In a prospective study, female patients treated by lateral sphincterotomy for chronic anal fissure were assessed using Wexner's incontinence score and grouped according to score: group I (score = 0) and group 2 (score ≥1) and evaluated with anal manometry and anorectal 3D ultrasonography. Results: Thirty-six womens were included, 33% had vaginal delivery. Seventeen patients were included in group I and 19 in group II. We found no difference in age, parity and mode of delivery between groups. A significant difference with respect to percentage reduction in resting pressures was noted, when comparing group 1 versus group 2. The anal sphincter muscle length was similar in both groups. However, the length and percentage of transected internal anal sphincter was significantly greater in group II. Conclusion: There was a correlation between fecal incontinence symptoms after sphincterotomy with the percentage of resting pressure reduction, length and percentage of transected internal anal sphincter. .

Objetivo: Avaliar os resultados clínicos, funcionais e morfológicos de pacientes submetidas à esfincterotomia para tratamento de fissura anal, correlacionando os resultados com os fatores que podem interferir com a continência fecal. Método: Foram avaliadas prospectivamente pacientes do sexo feminino submetidas à esfincterotomia lateral interna devido à presença de fissura anal crônica utilizando o escore de incontinência de Wexner e distribuídas em dois grupos. Grupo 1- Escore igual a zero e Grupo 2 - maior ou igual a 1. As pacientes foram submetidas à avaliação funcional e anatômica do canal anal utilizando manometria anorretal e ultrassonografia tridimensional anorretal. Resultados: Das 36 pacientes incluídas, 33% tinham história de parto vaginal. Dezessete pacientes foram incluídas no Grupo 1 e 19 no Grupo 2. Não houve diferença quanto à idade, paridade e tipo de parto entre grupos. Houve diferença significante em relação ao percentual de redução na pressão de repouso quando comparado o grupo 1 com grupo 2. Não houve diferença no comprimento da musculatura esfincteriana entre grupos. No entanto, o comprimento e o percentual de esfíncter anal interno seccionado foram significativamente maiores no grupo 2. Conclusão: Há correlação entre os sintomas de incontinência fecal pós esfincterotomia com o percentual de reducão das pressões de repouso, tamanho e percentual do esfíncter anal interno seccionado. .

Surgery as a preferred modality of treatment for the patients of chronic anal fissure with sentinel piles

To find out the preferred modality of treatment by patients having chronic anal fissure with sentinel pile. Prospective, Observational Study. This study was conducted at the Department of Surgery, Baish General Hospital, Kingdom of Saudi Arabia from January 2008 to December 2011. Forty eight patients had chronic anal fissures associated with sentinel piles. They had been explained the multiple modalities of treatment available along with their advantages and disadvantages. Some patients preferred surgery as 1[st] line of treatment while others conservative. Lateral sphincterotomy associated with fissurectomy was the surgical procedure applied, while 0.2% GTN cream as conservative modality. Out of total 48 patients, 39 were treated by surgery [P=0.2]. Thirty two [Group-A] were treated by surgery as 1[st] line of treatment [P=0.2], while 7 [Group-C] as 2[nd] line after failure with 0.2% GTN cream [P>0.05]. Healing rate and patients' satisfaction were excellent. A total of sixteen patients [41.02%] developed different post-operative complications, out of which, one patient [2.56%] had marked bleeding. One [2.56%] had transient flatus incontinence. Eight [20.51%] suffered from severe pain treated by opiate-derivative analgesic. Six [15.38%] had urinary retention. A total of 16 patients [Group-B] were initially treated conservatively with 0.2% GTN cream [P>0.05]. Out of 16, nine [56.25%] were quite satisfied with conservative treatment, while seven [43.75%] had failure and switched to surgery as 2[nd] line of treatment. None of the modality of treatment is without complications. Lateral sphincterotomy associated with fissurectomy is an effective treatment and gives patients a sense of satisfaction to the patient to get rid of sentinel pile

Lateral internal sphincterotomy; outcome and complications

Anal fissure is a common anorectal problem, presenting with pain during and after defecation. It is associated with increased tone of the internal anal sphincter muscle. The relief of this hypertonia is the cornerstone of the treatment of the anal fissure. The surgical relief of this hypertonia is very successful in treating the fissure with minor morbidity of the procedure. A study was conducted in 486 patients,[344-males and 142 females, 25-40 range]. Saad Surgi-med hospital Faisalabad. 1999 to 2007. Lateral internal anal Sphincterotomy for chronic anal fissure. The therapeutic outcome and complications of the procedure were recorded. Out of 486 patients, 344 were males and 142 females. [range 25-40] The site of fissure was in posterior midline 6 O'clock in 350 patients. [m=257,f=93]; Anterior midline. 12 O'clock in 99 patients. [m=76, f:=23]; both anterior and posterior in 41 patients. [m=l 5, f=26] Eleven patients had associated peri-anal abscess and 19 patients had associated Fistula in ano. All the patients were discharged after 24 hrs with regular follow up at 1, 2, 6, 24 wks. 275 patients had significant relief of pain in 48 hrs, 107 became pain free in 1 wk. 37 has had some pain for 2 wks. In 479 patients fissure healed in 3 months, 7 patients has had delayed healing out of which five patients required curettage of the wound under local anaesthesia which healed subsequently in next six wks. 12 patients had minor incontinence which disappeared in 4 wks. In one patient the incontinence persisted for six months then it got settled. Lateral subcutaneous internal Sphincterotomy is a safe and effective treatment of chronic anal fissure

Consumption of red-hot chili pepper increases symptoms in patients with acute anal fissures. A prospective, randomized, placebo-controlled, double blind, crossover trial / Efeito da pimenta vermelha nos sintomas de pacientes com fissuras anais agudas

BACKGROUND: Red-hot chili pepper and other spices have been blamed for causing or exacerbating symptoms of anal pathologies like anal fissure and hemorrhoids. AIM: To determine if consumption of chilies increases symptoms of acute anal fissures. METHODS: Individual patients were randomized to receive capsules containing chili or placebo for one week in addition to analgesics and fiber supplement. Patients were asked to note score for symptoms like pain, anal burning, and pruritus during the study period. After 1 week, cross over treatment was administered to the same group of patients with the same methodology and results were noted at the end of 2 weeks. RESULTS: Fifty subjects were recruited for this study. Forty three of them completed the trial (22 in the chili group and 21 in the placebo group). The daily mean pain score was significantly lower in the placebo group in the study period. Score 2.05 in chili group and 0.97 in placebo group. There was a significant burning sensation experienced by the patients in the chili group (score 1.85 for the chili group vs 0.71 for the placebo group). Patient’s mean recorded improvement score was significantly higher after taking placebo. Eighty one point three percent patients preferred placebo while 13.9 percent preferred chilies. Two patients had no preference. CONCLUSION: Consumption of chili does increase the symptoms of acute anal fissure and reduces patient compliance.

RACIONAL: A pimenta vermelha e outras especiarias têm sido responsabilizadas por agravar a sintomatologia das doenças anais, tais como fissuras e hemorróidas. OBJETIVO: Determinar se o consumo de pimentas vermelhas aumentaria os sintomas em fissuras anais agudas. MÉTODOS: Pacientes foram recrutados e randomizados para receber cápsulas contendo pimenta ou placebos por 1 semana, somadas a analgésicos e suplementos de fibras. Foi solicitado que anotassem um escore de sintomas, tais como dor, queimação anal, prurido durante o período de estudo. Após 1 semana o tratamento foi cruzado e administrado ao mesmo grupo de pacientes com a mesma metodologia e os resultados foram anotados ao final de duas semanas. RESULTADOS: Cinqüenta pacientes foram selecionados e 43 completaram o estudo (22 no grupo pimenta e 23 no grupo placebo). O escore médio diário de dor foi significativamente mais baixo (2,05 no grupo pimenta e 0,97 no grupo placebo). A sensação de queimação foi sentida de modo significativo no grupo pimenta (1,85 para o grupo pimenta vs 0,71 para o grupo placebo). O escore de melhora dos sintomas foi significantemente alto após tomar o placebo. Oitenta e um virgula três porcento dos pacientes preferiram tomar placebo contra 13,9 por cento que preferiram pimenta. Dois pacientes não referiram preferências. CONCLUSÃO: O consumo de pimentas agrava os sintomas de fissuras anais agudas.

Fisura anal, opciones terapéuticas actuales: [revisión] / Anal fissure, actually treatment options: [review]

La fisura anal es una patología frecuente y probablemente la causante de la mayor parte de las proctalgias agudas severas. Esta revisión tiene por objetivo, evaluar los procedimientos actualmente utilizados para el tratamiento de esta enfermedad. En principio se describen algunos aspectos ligados a la etiopatogenia y a la evolución natural con la intención de comprender la utilización de las distintas modalidades terapéuticas. Posteriormente se analizan las características de cada método en particular, como así también sus beneficios, efectos adversos y resultados. Al final del trabajo, se expone el algoritmo de tratamiento seguido por los autores.

The anal fissure is a frequent pathology and probably the cause of most of the severe acute proctalgias. This revision has by objective, to evaluate the procedures at the moment used for the treatment of this disease. In principle some aspects related to etiopatogenia are described and to the natural evolution, with the intention to understand the use of different therapeutic modalities. Later the characteristics of each method in individual are analyzed, like thus also their benefits, adverse effects and results. At the end of the work, the algorithm of treatment followed by the authors is exposed.

Comparative study of lateral internal sphincterotomy with anal dilatation for the treatment of chronic anal fissures

To compare the results of lateral internal sphincterotomy with anal dilatation in chronic anal fissure. Interventional study. It was carried out in surgical department of PNS Shifa hospital Karachi, from October 2003 to September 2004. The first 80 consecutive patients of either sex irrespective of age were included in this study. All these patients were with chronic anal fissure, with failed medical treatment and long history. They were divided into two groups each comprising 40 patients. Group A had lateral internal sphincterotomy [LIS] and Group B had anal dilatation [AD]. All these patients were operated under spinal / general anesthesia in lithotomy position. LIS was associated with remarkably low incidence of postoperative complications. Anal incontinence was seen in 12.5% and recurrence in 2.5% of patients in case of LIS, while the corresponding figures for AD were 50% and 7.5% respectively. LIS being a superior surgical procedure than AD should be the procedure of choice in chronic anal fissures

Perineal fistulae: Diagnostic Aspects

Perineal fistulae can be divided pathologically into congenital fistulae lined by epithelium and acquired ones whose occurrence is closely related to the abscess-fistula sequence and accordingly are usually lined by granulation Acquired fistulae may be further divided according to their mode of into delayed onset fistulae relative to the initialing event and the classical perianal fistulae and its differential diagnoses. Missing the latter lesions for the well acknowledged perianal fistula may have dire consequences on results of therapy in the form of repeated recurrences or the dreaded grades of incontinence. Most of these lesions require the appropriate chemotherapeutic. agents with rather less aggressive surgical maneuvers if compared to the corresponding techniques in classical perianal fistulae. The last two considerations make preoperative identification of these ions of paramount importance

Nitric acidum: su personalidad homeopática / Nitric acidum: its homeopathic personality

Se plantean en este trabajo las características predominantes de la personalidad de NIT-AC. integrando los síntomas en una dinámica mental que explica los desbordes y desórdenes de su personalidad. En NIT-AC. se produce un QUIEBRE MORAL DESESPERANZADO que lo conduce a un afán inflexible de REVANCHISMO reivindicatorio como resultante del RENCOR y ODIO universal que desarrolla contra quienes proyecta la responsabilidad de su sufrir. Carece de toda tolerancia y firmeza anímica para sublimar sus FRUSTRACIONES en productos altruistas. La consecuencia radicalizada de esta conflictiva es la AUTOMARGINACION social y la MARGINALIDAD a la que es proclive y que puede hundirlo en conductas delincuenciales, disgregadas y corruptas, sin retorno. Se completa con los SINTOMAS CLAVE de NIT-AC y con un caso clínico ejemplificador

Manejo multidisciplinario del cáncer de ano : asociación radio-quimioterapia / Multi-disciplinary management of the anal cancer : radio-chemotherapy association

Se presentan 21 casos de cáncer anal, todos carcinomas epidermoides, tratados en forma prospectiva con asociación de quimioradioterapia desde abril de 1986 a septiembre de 1994. De ellos 18 son mujeres y 3 hombres, con una edad promedio de 65,7 años y con un rango de 51 a 82 años. Todos se trataron con un esquema de 5 FU, 1000 mg/m2/días 1-5 infusión continua y Myt. C, 10mg/m2/día 1 bolus y radioterapia externa (RT), 3000 cGy/16 fracc. El 71,4 por ciento dan a la anamnesis antecedentes de patología inflamatoria anorrectal previa y constipación. Hubo un 85,7 por ciento de control local completo; un caso de control parcial que requirió de la segunda parte del esquema de quimioterapia (QT) con recidiva local a los 2 años 7 meses en que se pesquisa HIV (+) y se rescata con resección abdóminoperineal (RAP) y 2 casos de no esterilizaciones durante la terapia que van a la RAP sin mayores complicaciones. Se presentaron complicaciones agudas de moderada intensidad en un 60 por ciento de la serie que cedieron rápidamente con manejo médico habitual. Hubo solo 2 casos de diarrea con deshidratación aguda que requirieron hospitalización. Las secuelas definitivas fueron mínimas y en relación con leve o moderado edema local. Ningún paciente, que preservó el aparato esfinteriano, quedó con incontinencia anal. El esquema se cumplió en todos los enfermos que fueron tratados por el mismo equipo médico y evaluados con las mismas pautas. El seguimiento es de 100 por ciento de los casos, con una mediana de 60 meses. Actualmente el 100 por ciento vivos sin evidencia de enfermedad y excelente calidad de vida.

Um estudo transversal sobre fissura e sangramento anal em crianças de 0 - 12 anos de idade com constipaçäo intestinal / A cross-sedtional studies about fissure and anal bleeding in children from 0 - 12 years old with intestinal constipation

O autor estuda a associaçao entre fissura e sangramaneto anal, em uma amostra de 62 crianças de 0 - 12 anos de idade com constipaçao intestinal. Foi encontrado um qui quadrado de 14,55 (p=0.0004), e um odds ratio de 10 com intervalo de confiança de 95 por cento entre 2,42 e 44,56. Existe dependência entre estas duas variáveis.

Fissura anal: analise de 152 casos submetidos a tratamento cirurgico / Anal fissures: analysis of 152 cases submitted to surgical treatment

Foram analisados retrospectivamente 152 casos de fissura anal tratados cirurgicamente nos servicos de Colo-proctologia dos Hospitais de Caridade e Universitario, de Florianopolis, SC, tratados quase que exclusivamente pela tecnica de Gabriel, com esfincterotomia posterior. A patologia incidiu em maior numero no sexo feminino, na 3 e 4 decadas da vida, sendo o tipo cronico da fissura o mais comumente enncontrado. A linha media posterior foi acometida em 74,5 por cento sendo a infeccao cripto-glandular a principal causa (86,5 por cento). O sintoma dominante foi a dor, seguida do sangramento com percentuais de 96,1 por cento e 87,5 por cento, respectivamente. A patologia associada mais frequente foi a doenca hemorroidal. A fissurectomia posterior com esfincterotomia foi a cirurgia realizada em 67,8 por cento e a anestesia geral empregada em 80,2 por cento dos pacientes. A recidiva detectada apresentou um percentual de 3,2 por cento.

Fisura anal crónica / Chronic anal fissure

La fisura anal crónica es una enfermedad desagradable y dolorosa. El espasmo del esfinter interno es de importancia etiológica. El autor analiza una serie de 578 casos de fisura anal y revisa la bibliografía, concluyendo que es esencial establecer el diagnóstico de fisura anal idiopática, descartando patologías asociadas, en particular el absceso posterior. Ciento once pacientes fueron tratados con la operación de Sarner y ciento cuarenta y dos con esfinterotomía lateral interna con la técnica de Notaras. La principal complicación de los dos primeros grupos fueron los trastornos de la continencia 23.4 por ciento y 8.1 por ciento respectivamente. Con la esfinteretomía lateral interna la incontinencia a los gases se redujo al 0.7 por ciento. Por ello proponemos, como tratamiento electivo, la esfinteretomía lateral interna subcutánea en razón de su alto porcentaje de curaciones (100 por ciento), con desaparición inmediata del dolor siendo el tiempo promedio de curación de dos semanas. La esfinterotomía lateral interna es el procedimiento de elección en el tratamiento de la fisura anal crónica.

Manifestaciones perianales de la histoplasmosis generalizada / Perianal manifestations of the generalized hystoplasmosis

Se presenta un paciente portador de histoplasmosis generalizada que cursa la forma clínica sistémica rápida ampliamente diseminada. En el cuadro clínico prima la afectación del sistema nervioso central acompañado de hepatoesplenomegalia, linfadenopatía generalizada y lesiones tegumentarias expresadas como úlceras múltiples en cavidad oral, pie y región perianal. Se describen las caraterísticas de estas lesiones periorificiales y se evalúa su frecuencia.

Tratamiento quirurgico de la fisura anal / Surgical treatment of the anal fissure

Se revisaron 33 pacientes por fisura anal entre marzo, 1986 y junio 1988. Fueron tratados con esfinterotomia interna lateral subcutanea 28 pacientes (85%) y con dilatacion forzada o procedimiento de Lord, 5. La fisura se localizo en 27 pacientes (82%) pacientes en la linea media anterior y en los 3 (9%) restantes se localizo lateralmente. En ningun caso se demostro asociacion con enfermedad inflamatoria intestinal. En 10 casos (30%) se encontro el complejo de hemorroide centinela y papila anal hipertrofica; en uno de ellos la histologia de la hemorroide centinela resecada revelo un carcinoma escamocelular in situ. Se presento recidiva en un paciente al que se le practico dilatacion anal forzada. En ninguno de los pacientes sometidos a esfinterotomia interna recidivo la enfermedad. En 4 (12%) pacientes se presentaron complicaciones infecciosas y en 1 (3%) granuloma anal; todos los casos se resolvieron facilmente con drenaje y curetaje del espacio interesfinteriano. El seguimiento de los pacientes se realizo hasta los 6 meses postoperatorio. No se presento ningun caso de incontinencia fecal, filtracion de materia fecal o retardo en la cicatrizacion. Se concluye que la esfinterotomia interna lateral subcutanea es un procedimiento eficaz y sencillo para el tratamiento de la fisura anal cronica. En los casos del presente estudio si hubo complicaciones infecciosas con una frecuencia mucho mayor que la informada en otras series. Esto ha obligado a los autores a depurar la tecnica quirurgica, especialmente si la fisura se acompana de patologia asociada

Fisura anal / Anal fissure

En el servicio de proctologia del Hospital Militar Central se atendieron 102 pacientes con fisuras anales, en un periodo comprendido entre el 1 de enero de 1984 y el 31 de diciembre de 1986; se observa que 89 pacientes recibieron tratamiento medico; de ellos, 6 no presentaron mejoria de los sintomas si de la fisura, por lo cual fueron llevados a cirugia con otros 23 pacientes cuya indicacion quirurgica era una fisura anal cronica. El procedimiento que se efectuo mas frecuentemente fue la hemorroidectomia, fisurectomia con esfinterotomia posterior, en 8 casos. Las complicaciones postoperatorias observadas en esta experiencia, fueron: dolor continuo en 8 pacientes, estrechez anal en 2, incontinencia para gases y liquidos en 2, constipacion en 2, y retencion urinaria en 1. El procedimiento con mayor aceptacion actual en la literatura, por ser el que tiene menor indice de complicaciones, es la esfinterotomia lateral izquierda, el cual solo se efectuo, en esta serie , en 2 pacientes, que no presentaron complicaciones postoperatorias. Los dos grupos no se pueden comparar por el escaso numero del segundo. Es de anotar que se efectuo hemorroidectomia y fisurectomia en dos pacientes y esfinterotomia anterior en otros 2; tampoco observamos complicaciones ni recurrencias de la lesion en estos 4 ultimos pacientes.