[Hidradenitis suppurativa]. / Hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa is an inflammatory, chronic and recurrent disease of appocrine glands, located in inguinal, axillar, perineal, perianal areas and scalp. OBJECTIVE: To determine the frequency and therapeutic management. METHODS: A retrospective, transverse, and descriptive study was carried out. All patients with hidradenitis suppurativa, and who were managed by the Coloproctology Unit from the Gastroenterology Service of the General Hospital of Mexico City from January 1995 to December 2004, were included. RESULTS: We reviewed 12,689 files and identified 15 patients (0.12%) with hidradenitis suppurativa; nine fulfilled inclusion criteria. CONCLUSIONS: This is a complex disease with a diagnostic and therapeutic challenge.

Hidradenitis suppurativa / Hidradenitis suppurativa

Introducción: la hidradenitis supurativa es una enfermedad inflamatoria, crónica, recurrente, originada en las glándulas apocrinas; se puede localizar en axila, ingle, periné, región anoperineal y cuero cabelludo. Objetivo: conocer la frecuencia y el manejo terapéutico. Material y métodos: se trató de un estudio retrospectivo, transversal y descriptivo, Se incluyeron los pacientes portadores de hidradenitis supurativa atendidos en la Unidad de Coloproctología del Servicio de Gastroenterología, Hospital General de México, de enero de 1995 a diciembre de 2004. Resultados: se revisaron 12,689 expedientes clínicos y se identificaron 15 pacientes (0.12 %), de los cuales nueve cumplieron los criterios de inclusión. Conclusiones: la hidradenitis supurativa es una enfermedad compleja que constituye un reto diagnóstico y terapéutico.

BACKGROUND: Hidradenitis suppurativa is an inflammatory, chronic and recurrent disease of appocrine glands, located in inguinal, axillar, perineal, perianal areas and scalp. OBJECTIVE: To determine the frequency and therapeutic management. METHODS: A retrospective, transverse, and descriptive study was carried out. All patients with hidradenitis suppurativa, and who were managed by the Coloproctology Unit from the Gastroenterology Service of the General Hospital of Mexico City from January 1995 to December 2004, were included. RESULTS: We reviewed 12,689 files and identified 15 patients (0.12%) with hidradenitis suppurativa; nine fulfilled inclusion criteria. CONCLUSIONS: This is a complex disease with a diagnostic and therapeutic challenge.

[Surgical alternatives in the treatment of anal abscesses]. / Alternativas en el tratamiento quirúrgico de los abscesos anales.

INTRODUCTION: Anal abscess is a pus collection localized in some of the regions around the anus and rectum. We reviewed the experience in the management of abscesses in Coloproctology Unit at the Gastroenterology Service in the General Hospital of Mexico. MATERIAL AND METHODS: This is a retrospective, longitudinal and descriptive study in patients diagnosed as carriers of an anal abscess during the period from January 1998 to December 2002. RESULTS: During this period, 9,233 first consultations took place, 241 fulfilled inclusion criteria: 197 (81.74%) were male and 44 (18.25%) were female. Perianal abscesses affected 156 patients (64.73%), 51 ischiorectal abscesses (21.16%), 17 horseshoe (7.05%), 14 intersphincteric (5.80%) and 3 has supralevator abscesses (1.24%). CONCLUSIONS: There were 96.68% nonspecific anal abscesses. Simple drainage is an initial adequate management. Most patients (73%) were attended in the office. Pain was the most common symptom (99%). Perianal and ischiorectal localizations were the most frequently classified and there was no mortality.

[Non-surgical alternative management of hemorrhoidal disease]. / Manejo alternativo no quirúrgico de la enfermedad hemorroidaria.

UNLABELLED: Clinical manifestations of hemorrhoidal disease depend on its location (internal or external) and the presence or not of complications. PURPOSE: To describe the results of the three most common alternatives for non-surgical procedures treating internal hemorrhoids: rubber band ligation, esclerotherapy and infrared photocoagulation. MATERIALS AND METHODS: A retrospective, longitudinal and descriptive study from January 1998 to December 2002 was carried out, including variables like age, gender, clinical manifestations and date of initiation, type of non-surgical alternative treatment, complications, management and stage of the illness. RESULTS: In 9,103 charts reviewed this study included 2,701 patients with hemorrhoidal disease, with an annual incidence of 540.20 patients; 1,388 (51.39%) were male and 1,313 (48.62%) were female; ages between 17 and 78 years, 44.10 as a mean age. Rubber band ligation was used in 516 patients (67.45%), esclerotherapy in 177 (23.13%) and infrared photocoagulation in 72 cases (9.41%). CONCLUSIONS: Rubber band ligation is mainly indicated for internal hemorrhoids II degree, the esclerotherapy is indicated in the suppression of acute hemorrhage, but in the long term, this method has the poorest results. Infrared photocoagulation has its best results in internal hemorrhoids I degree because it causes less pain and complications and patients accept it better.

[Surgical management of anal fistula]. / Manejo quirúrgico de la fístula anal.

UNLABELLED: Anal fistula has been known since the beginning of medical history and is defined as a duct of fibrous infected walls that runs from anal crypt to skin or rectal lumen. Internal orifice is called primary or internal, while cutaneous orifice is referred to as secondary or external. Several techniques have been developed for surgical management of anal fistula, including fistulotomy, fistulectomy with or without sphincter repair, placement of sedal cutting or seton drainage, endorectal advancement flap, and fibrin glue, among others. GENERAL OBJECTIVE: Our aim was to demonstrate the experience in management of anal fistula at the Coloproctology Unit, Gastroenterology Service, of the Mexico City General Hospital. MATERIALS AND METHODS: We conducted a retrospective, longitudinal, and descriptive study in patients with anal fistula. All patients had complete clinical and proctologic studies and pre-operative laboratory analysis. RESULTS: A total of 8,816 files were reviewed from January 1997 to December 2001; 642 (7.28%) patients were carriers of a fistula, but only 595 satisfied inclusion criteria; 500 (84.03%) were male and 95 (15.97%), female, with annual incidence of 119. Average global age was 34 years (37 years in males and 28 years in females). Age range was 17 to 80 years; most frequent decades were 31 to 40 years in 197 patients (33.11%) and 41 to 50 years in 140 patients (23.53%). Anal fistula was intersphincteric in 351 (59%) and transsphincteric in 149 (25.04%). Fistulectomy was carried out in 422 patients (70.92%), fistulotomy in 108 (18.15%), seton division in 22 (3.69%), sedal in 10 (1.68%), seton drainage in two (0.33%), endorectal advancement flap in five (0.84%), fistulectomy with sphincter repair in 14 (2.35%) patients, and in 12 (2.0%) patients it was impossible to know what type of treatment had been carried out. DISCUSSION: The fundamental aims to accomplish in treatment of anal fistula include curing, preserving anal continence, minimizing healing defects, and offering to the patient a quick recovery.

[Hemorrhoidal desarterialization guided by Doppler. A surgical alternative in hemorrhoidal disease management]. / Desarterialización hemorroidaria guiada por Doppler. Una alternativa quirúrgica en el manejo de la enfermedad hemorroidaria.

BACKGROUND: Hemorrhoidal disease is a common condition that includes 30% of patients seen for the first time at the Colon and Rectal Unit of the Gastroenterology Service, Hospital General in Mexico City. This study shows experience with hemorrhoidal desarterialization guided by Doppler in patients with internal hemorrhoidal disease stages II or III in the Coloproctology Units of the Hospital General in Mexico City and at the North Medical Unit in Monterrey, Nuevo Leon, Mexico. MATERIALS AND METHODS: A prospective, longitudinal, and descriptive study was performed in 56 patients with diagnosis of internal hemorrhoids stages II or III, not complicated, and treated by hemorrhoidal artery ligation guided by Doppler between July 1, 2002 and April 31, 2003. RESULTS: 49 patients were included, 32 male (66%) and 17 female (34%), aged between 21 and 75 years with mean age of 43.5 years; 40 patients had internal hemorrhoids stage II (82%) and nine, stage III (18%). With a follow-up of 4 months or longer, all patients were symptomless: bleeding and hemorrhoidal prolapse disappeared. CONCLUSIONS: Doppler-Guided hemorrhoidal desarterialization is indicated in patients with internal hemorrhoids stages II or III; it is a simple technique that requires a short learning curve, minimal anesthetic and surgical materials, and pain after the procedure is mild and short-lived in the majority of patients.