ABSTRACT
OBJECTIVE: The artificial anal sphincter has been suggested as an alternative in the treatment of severe anal incontinence when conventional surgical methods are not possible or have failed. Experience in this procedure is still limited and the results have not yet been sufficiently established. The aim of this study is to evaluate the efficacy of the ACTICON (American Medical Systems, Minneapolis, MN) on patients operated upon in our Unit. PATIENTS AND METHOD: In this prospective study an ACTICON sphincter was implanted in 10 patients (8 women) with an average age of 56 years and with an average period of severe anal incontinence of 151 months. The origin of incontinence was obstetric injury (n: 4), neuropathy (n: 3) and sphincteral injury from previous anal surgery (n: 3). The degree of continence was measured using the Fecal Incontinence Scoring System (FISS) and the pre- and postoperative anal manometric parameters at 6-month intervals. The average follow-up time for the efficacy of the implanted system was 29 months. RESULTS: A total of 6 patients [60%] displayed complications in the immediate postoperative period: subaponeurotic reimplantation of the connecting tubes was necessary after infection of the abdominal wound (n:1); superficial dehiscence of the perianal wound (n: 2), infection of the perianal wound (n: 1) and perianal haematoma (n: 2) that were resolved by conservative treatment. For 3 patients [30%] the system was explanted, definitively in one and in 2 of them reimplanted successfully. At the end of the follow-up period, 9 patients [90%] still have an activated artificial sphincter. The score on the Fecal Incontinence System decreased significantly after the system was activated (P < 0.0001) and the pressure with the cuff closed was significantly higher than pre-operative anal pressure (P < 0.0001). All the patients are now continent for solid stool, 56% have occasional involuntary losses of gases and 33% occasionally have involuntary losses of gases and liquid stool. Only 2 patients [22%] have complete continence. CONCLUSIONS: Our findings indicate that the ACTICON artificial anal sphincter is well tolerated and can be an effective alternative in the treatment of severe anal incontinence. Although complete continence is only achieved in a low percentage of cases, for the rest of the patients the ACTICON neosphincter reduces the symptoms considerably.
Subject(s)
Anal Canal/surgery , Fecal Incontinence/surgery , Prostheses and Implants , Prosthesis Implantation , Aged , Device Removal , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications , Prospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
Non-traumatic or spontaneous gas gangrene by Clostridium septicum is a rare infection in humans, characterised by extensive destruction of muscle tissue, a mortality rate of 100% if left untreated (1), and often associated with haematological or colorectal diseases. An associated malignancy was found in 80% of patients with Clostridium septicum infection: 34% had a colorectal carcinoma and 40% had a haematological malignancy (2); the infection usually lies in an often-ulcerated intestinal lesion (3). We report here a case of spontaneous gas gangrene by Clostridium septicum in the right thigh due to perforation of a diverticulum in the sigmoid colon.
Subject(s)
Clostridium Infections/complications , Diverticulum, Colon/etiology , Intestinal Perforation/etiology , Aged , Clostridium Infections/pathology , Female , Gangrene , Humans , ThighABSTRACT
La gangrena gaseosa espontánea o no traumática causada por Clostridium septicum es una rara infección en humanos, caracterizada por una extensa destrucción del tejido muscular, mortalidad del 100 por ciento sin tratamiento (1) y con frecuencia asociada a enfermedades hematológicas o colorrectales. Se encuentra asociación con enfermedades malignas en el 80 por ciento de los pacientes con infección por Clostridium septicum: 34 por ciento con carcinoma colorrectal y el 40 por ciento con neoplasia hematológica (2), y generalmente la infección tiene su origen en una lesión intestinal con frecuencia ulcerada (3).Remitimos un caso de gangrena gaseosa espontánea por Clos tridium septicum en muslo derecho secundario a perforación de un divertículo de colon sigmoide (AU)
