ABSTRACT
AIM: The aim of the study was to evaluate urgent care practice with regard to anorectal abscesses (AA) in a tertiary-level referral hospital. MATERIALS AND METHODS: this was retrospective and unicentric study. Patients who underwent surgery for AA between 2016 and 2017 were included in the study. Demographic variables were analyzed as well as the treatment performed, the need for hospitalization, use of antibiotics, and referral to the coloproctology outpatient department (COD). The recurrence risk factors were also evaluated. RESULTS: A total of 220 evaluations under anesthesia were performed, corresponding to 190 patients, 129 males (mean age 46 ± 14.9 years). The most frequent treatment in the emergency department (ED) was simple drainage (75.8%). Antibiotic therapy was prescribed in 62.9% of the cases. A total of 41.1% of the patients were referred to a specialized COD. The only risk factor associated with recurrence was the presence of an associated anal fistula. CONCLUSIONS: Anorectal abscesses are very frequent in the ED. There is great clinical variability regarding the taking of cultures, prescription of antibiotics, and referral criteria to a specialized coloproctology outpatient department, without clear impact of any of them on the recurrence of the abscess.
OBJETIVO: Evaluar el manejo de los abscesos perianales por parte del servicio de cirugía de urgencias. MÉTODO: Estudio unicéntrico retrospectivo. Se incluyeron pacientes que requirieron manejo quirúrgico de abscesos perianales de 2016 a 2017. Se analizaron variables demográficas, tratamientos realizados, necesidad de ingreso hospitalario, uso de antibióticos y necesidad de derivación a la consulta externa de coloproctología. Así mismo, se evaluaron los factores relacionados con la recurrencia del absceso. RESULTADOS: Durante el periodo de estudio se realizaron 220 exploraciones, correspondientes a 190 pacientes (129 hombres) con una edad media de 46 ± 14.9 años. El tratamiento quirúrgico más frecuentemente realizado fue el drenaje simple (75.8%). Se prescribieron antibióticos en el 62.9% de los casos. El 41.1% de los pacientes fueron remitidos a consulta externa de coloproctología. El único factor de riesgo asociado a la recurrencia fue la presencia de una fístula perianal asociada. CONCLUSIONES: Los abscesos perianales son frecuentes en los servicios de urgencias. Hay una gran variabilidad clínica en su manejo, sobre todo en lo relativo a la realización de cultivos, la prescripción de antibióticos y la derivación a unidades de coloproctología especializadas, sin que ninguna de estas medidas tenga un claro impacto en la recurrencia.
Subject(s)
Anus Diseases , Rectal Fistula , Abscess/drug therapy , Abscess/surgery , Ambulatory Care , Anus Diseases/drug therapy , Anus Diseases/surgery , Drainage , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
INTRODUCTION: There are limited data on the aetiology and management of perianal abscesses (PAs). The aim of this retrospective study was to define the characteristics of children with PAs; describe our experience with PA from the perspective of paediatric infectious medicine and determine the factors that influence clinical outcomes. METHODS: We performed a retrospective review of cases of PA in children with no underlying disease managed in a tertiary referral hospital between January 2005 and July 2015. We collected data on demographic characteristics, symptoms, abscess size and location, abscess recurrences, laboratory and microbiological findings, treatment modalities, diagnosis of systemic illness at the end of the diagnostic workup and clinical outcomes. RESULTS: We included a total of 47 patients in the study, with a predominance of male patients (93.6 vs 6.4%, P<.001). The median age was 7.7 months (IQR 1.8-13.7 months), and 40 children (85.1%) were younger than 2 years of age. Four PAs drained spontaneously and 7 healed without need of drainage (23.4%). Drainage by simple incision was applied to 36 patients (76.5%) and six PAs required fistulotomy (12.7%). Recurrent abscesses were found in 25 patients (53.1%). Three patients with recurrent PA were diagnosed with inflammatory bowel disease at the end of the diagnostic evaluation. CONCLUSIONS: Based on the findings of our study, measurement of white blood cell counts and serum levels of acute phase reactants may be useful in the initial evaluation of children with PA. In light of the high relapse rates observed in surgically managed patients, it seems reasonable to use a conservative approach in patients aged less than 2 years.
Subject(s)
Abscess , Anus Diseases , Abscess/diagnosis , Abscess/therapy , Anus Diseases/diagnosis , Anus Diseases/therapy , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
Crohn's disease is an inflammatory bowel disease that affects the intestinal bowel in a transmural way presenting with fistulizing phenotypes with abnormal communication between two epithelial surfaces. In perianal Crohn's disease, there are fistulizing tracts between the anal canal and perianal skin that can complicate with abscess formation. Symptoms include pain, perianal discharge and fluctuating lesions, requiring combined clinical and surgical management. The disease is difficult to treat and is associated with significant reduction in quality of life, requiring a multidisciplinary approach for the management of these patients. The following review describes clinical concepts of perianal Crohn's disease, with emphasis on diagnosis and treatment.
La enfermedad de Crohn es una enfermedad inflamatoria del tubo digestivo con compromiso transmural de la pared que puede manifestarse con fenotipos fistulizantes mediante el desarrollo de comunicaciones anormales entre dos superficies epiteliales. En el caso de la enfermedad de Crohn perianal se establecen trayectos fistulosos entre el epitelio del canal anal y la piel alrededor del ano, que pueden complicarse con la formación de abscesos. Clínicamente se presenta con descarga perianal, dolor y masa fluctuante requiriendo un manejo conjunto médico-quirúrgico para el tratamiento de las complicaciones, el control de las fístulas y el compromiso luminal asociado. Es necesario un enfoque multidisciplinario dado que es una enfermedad de difícil manejo que afecta la calidad de vida de los pacientes. En la siguiente revisión se exponen conceptos acerca de la enfermedad de Crohn fistulizante perianal y sus complicaciones, con énfasis en el diagnóstico y tratamiento.
Subject(s)
Humans , Crohn Disease/complications , Rectal Fistula/diagnosis , Rectal Fistula/etiology , Rectal Fistula/therapy , Magnetic Resonance Imaging , Inflammatory Bowel Diseases/complications , Rectal Fistula/classification , AbscessABSTRACT
El General San Martín estuvo postrado en cama desde fines de mayo hasta principios de julio de 1819. El viajero inglés Samuel Haigh que lo visitó dejó constancia del fuerte compromiso de su estado general. En su correspondencia San Martín refiere que padecía por ese entonces una "fistola producida por unas almorranas agangrenadas". Dado que las hemorroides no se complican con fístula, suponemos que el cuadro proctológico agudo habría sido producido por un absceso perianal. Apoyamos esta especulación en: 1) el gran compromiso del estado general que atribuimos a la sepsis, y 2) la referencia a la fístula, que interpretamos como la evacuación espontánea del absceso.
General San Martin was confined in bed, from the end of May to the beginning of July of 1819, tired and exhausted. The English traveller Samuel Haigh, who visit him, wrote about San Martins seriously affected general condition. In his mail, San Martín told he was suffering from "fistula produced by gangrenous hemorrhoids". We know that hemorrhoids dont complicate with fistula, and suppose that his proctologic acute illness could be related to a perianal abscess. Our speculation is supported by: 1) San Martins poor general condition, which we believe secondary to sepsis, and 2) the idea he had about a fistula, which we think was a spontaneous evacuation of an perianal abscess.
Subject(s)
Rectal Diseases , Rectal Fistula , Hemorrhoids/complications , Famous Persons , Argentina , Thrombosis/etiologyABSTRACT
El General San Martín estuvo postrado en cama desde fines de mayo hasta principios de julio de 1819. El viajero inglés Samuel Haigh que lo visitó dejó constancia del fuerte compromiso de su estado general. En su correspondencia San Martín refiere que padecía por ese entonces una "fistola producida por unas almorranas agangrenadas". Dado que las hemorroides no se complican con fístula, suponemos que el cuadro proctológico agudo habría sido producido por un absceso perianal. Apoyamos esta especulación en: 1) el gran compromiso del estado general que atribuimos a la sepsis, y 2) la referencia a la fístula, que interpretamos como la evacuación espontánea del absceso.(AU)
General San Martin was confined in bed, from the end of May to the beginning of July of 1819, tired and exhausted. The English traveller Samuel Haigh, who visit him, wrote about San Martins seriously affected general condition. In his mail, San Martín told he was suffering from "fistula produced by gangrenous hemorrhoids". We know that hemorrhoids dont complicate with fistula, and suppose that his proctologic acute illness could be related to a perianal abscess. Our speculation is supported by: 1) San Martins poor general condition, which we believe secondary to sepsis, and 2) the idea he had about a fistula, which we think was a spontaneous evacuation of an perianal abscess.(AU)
