Tetanus after anorectal abscess.

As illustrated by this case report, tetanus can occur as a complication of anorectal surgical procedures or abscesses just as it can in other wounds. A synergistic infection of the perineum occurred in a 62-year-old man 8 days after drainage of an anorectal abscess. He was treated with vigorous debridement and antibiotics and was given tetanus prophylaxis. The next day, tetanus developed, presumably from the original abscess. The patient recovered after aggressive therapy, including muscle relaxants and ventilatory support.

Colonoscopic decompression for acute pseudoobstruction of the colon (Ogilvie's syndrome). Report of 22 cases and review of the literature.

This report has described a series of 22 patients who underwent colonoscopic decompression for acute pseudoobstruction of the colon and summarizes those cases previously reported in the literature. Twenty of the 22 patients (91 percent) were successfully treated by decompression initially. Fifteen patients (68 percent) were cured with the initial procedure, and 4 patients (18 percent) experienced recurrence. Overall, in 17 patients (77 percent), the pseudoobstruction resolved completely with colonoscopic decompression. Three patients (14 percent) underwent operation because of cecal dilatation refractory to colonoscopic decompression, and in one patient (4.5 percent), the colonic dilatation resolved spontaneously after a failed colonoscopy. Complications resulted in the death of one patient (4.5 percent). Our data are similar to those in the literature and indicate that colonoscopic decompression is a safe and efficacious first line of treatment for acute pseudoobstruction of the colon.

Fissurectomy with superficial midline sphincterotomy. A viable alternative for the surgical correction of chronic fissure/ulcer-in-ano.

A series of 121 patients with chronic fissure-in-ano who underwent fissurectomy with superficial midline sphincterotomy was studied. The mean follow-up was 8.1 years. Minor problems with anal competence occurred after the operation in 30 patients (25 per cent). Within two months, this problem had resolved in all patients. One patient (0.8 per cent) had a true recurrence. Five patients (4.1 per cent) had recurrent acute anal abrasions as the result of passage of a hard stool. These healed spontaneously. Twelve patients (9.9 per cent) had fragile scars, but this was a significant problem in only five (4.1 per cent). No patient had significant stricture formation, keyhole deformities, or major persistent problems with anal competence. The patients graded their operations with regard to satisfaction: 118 (97.5 per cent) reported satisfactory results and three (2.5 per cent) reported unsatisfactory results. This study shows that fissurectomy with superficial midline sphincterotomy is a viable approach to the surgical management of chronic fissure-in-ano.

Isolated cystic dilatation of the cystic duct.

Presented was an unusual case of congenital cystic dilatation of the extrahepatic biliary tract in which the cystic changes were confined solely to the cystic duct. There was concomitant common bile duct obstruction secondary to inflammation and mass effect from the cyst. Management consisted of cholecystectomy, excision of the cyst, common bile duct exploration, examination of the ampullary region by duodenotomy, and choledochoduodenostomy.

Invasive necrotizing infection secondary to anorectal abscess.

During a six-year period, six patients were treated for invasive necrotizing infection secondary to anorectal abscess. The delay in definitive diagnosis and treatment ranged from three to 14 days. All patients had significant concomitant diseases. The number of operative procedures for each patient ranged from one to nine. Antibiotics, as well as nutritional supplementation by the parenteral or enteral route, were used on all patients. Each patient had three or more complications attributable to this infection. Hospital stay ranged from 30 to 76 days. All patients survived. Factors contributing to the development of this condition are delay in diagnosis, inadequate and inappropriate treatment, and concomitant disease. Factors associated with a satisfactory outcome are examination under general or conduction anesthesia by an experienced examiner, prompt and definitive operation therapy (including drainage and removal ov all necrotic tissue), antibiotics, frequent reexamination under general anesthesia, nutritional support, and close attention to concomitant disease.