Introduction - Primary anal actinomycosis of cryptoglandular origin, mainly due to Actinomyces israelii, a specific and rare cause of anal suppurative disease, needs to be recognized because it can be cured using spec...Introduction - Primary anal actinomycosis of cryptoglandular origin, mainly due to Actinomyces israelii, a specific and rare cause of anal suppurative disease, needs to be recognized because it can be cured using specific treatments. Method - Data were reviewed from 6 patients with actinomycotic anal Abscesses of obvious cryptoglandular origin observed in a single proctology unit between 1983 and 2000. Therapeutic management included conventional surgical treatment of anal sepsis followed by a specific oral antibiotic therapy maintained until the surgicalwound had completely healed. Results -All but one of the patients were men (median age, 53 years). All Abscesses, except one, were indolent. No patient presented macroscopic “ sulphur granules” in the pus, but one presented “ watery pus” . The diagnosis was established by histological study of the surgically excised tissue or by anaerobic culture of the pus. In the oneHIV-positive patient, an uncommon organismwas isolated: Actinomyces meyeri. Two cases of recurrence were observed without evidence of Actinomyces infection. Conclusion -Actinomycosis should be suspected particularly in indolent anal suppuration. The Absence of macroscopic “ sulphur granules” does not mean this diagnosis can be ruled out. Careful histological examination of the excised tissue and appropriate anaerobic cultures of pus should be carried out to achieve complete eradication of this rare, but easily curable disease.展开更多
The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vu...The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vulvar abscess. A 40-day-old girl presented symptoms after her parents noted the presence of stool at the vestibulum. On the physical examination, anus was in normal location and size, and had normal sphincter tone. A vestibuler opening was seen in the midline just below of the hymen. A fistulous communication was found between the vestibuler opening and the anus, just above the dentate line. There was a vulvar abscess which had a left lateral vulvar drainage opening 15 mm left lateral to the perineum. After the management of local inflammation and abscess, the patient was operated for primary repair of the fistula. A protective colostomy wasn′t performed prior the operation. A profuse diarrhea started after 5 hours of postoperation. After the diarrhea, a recurrent fistula was occurred on the second postoperative day. A divided sigmoid colostomy was performed. 2 months later, and anterior sagital anorectoplasty was reconstructed and colostomy was closed 1 month later. Various surgical techniques with or without protective colostomy have been described for double termination repair. But there is no consensus regarding surgical management of double termination.展开更多
Objective:The aim of this study was to evaluate the safety and efficacy of three-cavity clearance(TCC)used for the treatment of perianal abscess.Methods:A case–control study of patients with perianal abscess was cond...Objective:The aim of this study was to evaluate the safety and efficacy of three-cavity clearance(TCC)used for the treatment of perianal abscess.Methods:A case–control study of patients with perianal abscess was conducted at the Second and Third Affiliated Hospitals of Nanjing University of Chinese Medicine from June 2013 to March 2016.Clinical data from 46 patients who had TCC were analysed.At the same time,46 patients had simple incision and drainage and 46 patients had abscess drainage and cutting seton(radical abscess incision);the data from these patients were also analysed.The length of hospital stay,time of wound healing,fistula rate and anal incontinence were assessed.Results:The rate of fistula formation in the TCC group was 13.0%—significantly lower than that in the group with simple incision and drainage(39.1%,p<0.01)and similar to the group with radical abscess incision(8.7%,p>0.05).Two patients(4.3%)in the group with radical abscess incision had anal incontinence,flatus and soiling;their Wexner scores were 6 and 3,respectively.There was no anal incontinence in the TCC group or the simple incision and drainage group.There were no statistical differences in the time of wound healing and length of hospital stay among the three groups(both p>0.05).Conclusion:TCC is a safe and effective sphincter-preserving procedure for perianal abscess formation and can decrease the fistula rate after perianal abscess drainage.It appears to be a valuable method that can be used in clinical practice;however,further studies are needed to verify this finding.展开更多
文摘Introduction - Primary anal actinomycosis of cryptoglandular origin, mainly due to Actinomyces israelii, a specific and rare cause of anal suppurative disease, needs to be recognized because it can be cured using specific treatments. Method - Data were reviewed from 6 patients with actinomycotic anal Abscesses of obvious cryptoglandular origin observed in a single proctology unit between 1983 and 2000. Therapeutic management included conventional surgical treatment of anal sepsis followed by a specific oral antibiotic therapy maintained until the surgicalwound had completely healed. Results -All but one of the patients were men (median age, 53 years). All Abscesses, except one, were indolent. No patient presented macroscopic “ sulphur granules” in the pus, but one presented “ watery pus” . The diagnosis was established by histological study of the surgically excised tissue or by anaerobic culture of the pus. In the oneHIV-positive patient, an uncommon organismwas isolated: Actinomyces meyeri. Two cases of recurrence were observed without evidence of Actinomyces infection. Conclusion -Actinomycosis should be suspected particularly in indolent anal suppuration. The Absence of macroscopic “ sulphur granules” does not mean this diagnosis can be ruled out. Careful histological examination of the excised tissue and appropriate anaerobic cultures of pus should be carried out to achieve complete eradication of this rare, but easily curable disease.
文摘The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vulvar abscess. A 40-day-old girl presented symptoms after her parents noted the presence of stool at the vestibulum. On the physical examination, anus was in normal location and size, and had normal sphincter tone. A vestibuler opening was seen in the midline just below of the hymen. A fistulous communication was found between the vestibuler opening and the anus, just above the dentate line. There was a vulvar abscess which had a left lateral vulvar drainage opening 15 mm left lateral to the perineum. After the management of local inflammation and abscess, the patient was operated for primary repair of the fistula. A protective colostomy wasn′t performed prior the operation. A profuse diarrhea started after 5 hours of postoperation. After the diarrhea, a recurrent fistula was occurred on the second postoperative day. A divided sigmoid colostomy was performed. 2 months later, and anterior sagital anorectoplasty was reconstructed and colostomy was closed 1 month later. Various surgical techniques with or without protective colostomy have been described for double termination repair. But there is no consensus regarding surgical management of double termination.
基金supported by the National Nature Science Foundation of China(No.30572447,No.30973837 and No.81273944)the Jiangsu Nature Science Foundation(No.BK20151081).
文摘Objective:The aim of this study was to evaluate the safety and efficacy of three-cavity clearance(TCC)used for the treatment of perianal abscess.Methods:A case–control study of patients with perianal abscess was conducted at the Second and Third Affiliated Hospitals of Nanjing University of Chinese Medicine from June 2013 to March 2016.Clinical data from 46 patients who had TCC were analysed.At the same time,46 patients had simple incision and drainage and 46 patients had abscess drainage and cutting seton(radical abscess incision);the data from these patients were also analysed.The length of hospital stay,time of wound healing,fistula rate and anal incontinence were assessed.Results:The rate of fistula formation in the TCC group was 13.0%—significantly lower than that in the group with simple incision and drainage(39.1%,p<0.01)and similar to the group with radical abscess incision(8.7%,p>0.05).Two patients(4.3%)in the group with radical abscess incision had anal incontinence,flatus and soiling;their Wexner scores were 6 and 3,respectively.There was no anal incontinence in the TCC group or the simple incision and drainage group.There were no statistical differences in the time of wound healing and length of hospital stay among the three groups(both p>0.05).Conclusion:TCC is a safe and effective sphincter-preserving procedure for perianal abscess formation and can decrease the fistula rate after perianal abscess drainage.It appears to be a valuable method that can be used in clinical practice;however,further studies are needed to verify this finding.
