Transrectal ultrasonography of perianal fistulas: a single center experience from a surgeon's point of view.

AIM: Two-dimensional transrectal ultrasonography can nowadays be safely used for preoperatively evaluation of perianal fistulas. The aim of this study is to demonstrate its efficacy by comparing the results of this imaging technique with the surgical findings, as well as recurrence rates. PATIENTS AND METHODS: A 4-year retrospective study with a mean follow-up of 4.7 years was performed, including patients treated surgically for a perianal fistula at the surgical department of a tertiary secondary hospital. All these patients underwent preoperatively a transrectal ultrasound with H2O2 for surgery planning, while 12 of them had also a MRI-scan. RESULTS: The sample was consisted of 53 patients with a mean age of 32.4 years and a 0.3 female/male ratio. During the mean 4.7 years follow up 2 patients (3,8%) had a recurrence, while in none of these cases an anal-sphincter muscle trauma was noted. The operative findings were in all cases consisted with the transrectal ultrasonography Results. The MRI-scan failed to demonstrate the presence of a fistula in 3 out of the 12 patients (25%). CONCLUSIONS: Our data support that the use of ultrasound with H2O2 preoperatively, for a safe surgery planning, leads to an accurate surgical procedure and fewer recurrence rates.

Malakoplakia of the large intestine: an incidental extremely rare finding.

Malakoplakia is a rare inflammatory disease, most commonly found in the urinary tract. It appears be related to a functional deficiency of macrophages, resulting in an inability to destroy digested bacteria and it is associated with various conditions that cause immunodeficiency. A rare case of malakoplakia of the colon in a healthy 68-year old male is presented. The patient underwent emergency surgery with colon resection and an end stoma with closure of the distal bowel (Hartmann's procedure), due to incarcerated ventral hernia and sigmoid-colon rupture. He underwent reversal of the Hartmann's procedure four months after the initial operation. The histological examination from the anastomotic rings revealed Michaelis-Gutmann bodies that are pathognomonic of malakoplakia. He received per os ciprofloxacin, bethanecol and ascorbic acid for 12 months. Follow-up endoscopy did not exhibit any signs of the disease. A case of a healthy patient presenting with malakoplakia without any underlying disease that causes immunodeficiency is extremely rare. Treatment of malakoplakia involves the eradication of microorganisms. Cholinergic agonists, such as bethanechol and ascorbic acid, as well as antimicrobial treatment with trimpethoprim/sulphamethoxazol and rifampicin are most commonly being used. Long-term antimicrobial treatment has been reported (6 months to 3 years).

Epidural abscess imitating recurrent pilonidal sinus: a case report.

Pilonidal sinus or pilonidal cyst is a common benign disease, affecting mostly young working men. We present the first case of an epidural abscess imitating pilonidal sinus. A 33-year old male, suffering from previously undiagnosed and untreated diabetes mellitus (DM), presented to our emergency department (ER), one month after open surgical treatment of pilonidal sinus, due to weakness and fever. After re-operation of the pilonidal cyst and due to post-operative pus production and continuation of fever a computer tomogr aphy (CT )scan was performed revealing an epidural abscess extending from the thoracic vertebrae 12 (T-12) to the sacrococcygeal area. At that point he underwent new surgery for drainage of the epidural abscess. The patient received intravenous antimicrobial treatment and was discharged on the 23rd postoperative day without signs or symptoms of infection. At follow up for a whole year no signs of recurrence have been observed.