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Arch Pediatr 2022 Apr 3;29(3):171-176. Epub 2022 Mar 3.

Third Department of Pediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Benign anorectal disease refers to a diverse group of frequent anorectal complaints that cause considerable discomfort, disability, and often constitute a significant problem for the child and his or her family. Hemorrhoids, fissures, rectal prolapse, and perianal abscess and fistulas are the most common anorectal disorders in pediatric population and their appearance may be age-specific. Although they generally follow a benign course, a careful examination must be performed in order to exclude other serious and complicated underlying pathology. Read More

Gastroenterol Clin North Am 2022 03 8;51(1):123-144. Epub 2022 Jan 8.

Division of Gastroenterology & Hepatology, Alix School of Medicine, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA. Electronic address:

Painful and bothersome anorectal syndromes can be a diagnostic and therapeutic challenge for clinicians because structural and functional abnormalities may often coexist and require a multidisciplinary approach to management. Although it is often difficult to attribute all of a patient's anorectal symptoms to a singular disorder with definitive intervention and cure, improving quality of life, treating coexistent conditions such as functional constipation and/or defecation disorders, addressing psychological comorbidities if present, and confirming there is no evidence of inflammatory or malignant conditions are top priorities. Read More

Updates Surg 2022 Feb 27;74(1):179-183. Epub 2021 Nov 27.

General Surgery, Hospital Val Vibrata, Sant'omero, 64027, L'Aquila, TE, Italy.

We report the results of the surgical treatment of anal fissures complicated by abscess or fistula and formulate hypotheses about their nature. Among patients operated between 2012 and 2020 for anal fissure resistant to medical therapy, those affected by septic complications were selected for our inquiry. Surgical treatment consisted in the drainage of the sepsis, fissurectomy, posterior sphincterotomy and anoplasty. Read More

Ther Umsch 2021 ;78(9):547-558

Klinik für Gastroenterologie/Hepatologie, Kantonsspital St. Gallen.

Symptoms, diagnostic and therapy of perianal disease in patients with inflammatory bowel diseases Inflammatory bowel diseases (IBD) frequently affect the perianal region. Due to the great functional importance of the anorectum, this frequently results in a significant burden of disease for the patient. For assessment of perianal IBD symptoms, the clinical history is of great importance. Read More

Front Surg 2021 9;8:730261. Epub 2021 Sep 9.

Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.

General or regional anesthesia is predominantly used for anorectal surgery, however in the recent years more attention was drawn in the use of local anesthesia for anorectal surgery. In this study we present the technique and results of the use of local perianal anesthetic infiltration for minor anorectal operations. In this cohort study patients undergoing surgery for hemorrhoids, anal fissures and low anal fistulas were included. Read More

Dtsch Med Wochenschr 2020 12 30;145(24):1742-1747. Epub 2020 Nov 30.

End- und Dickdarmzentrum Mannheim.

During the last years there was quite a lot of new developments in the international literature. Mostly these were technical methods and instruments. The results were from acceptable improvements to disappointing outcomes. Read More

Int J Gynaecol Obstet 2021 May 12;153(2):340-343. Epub 2020 Dec 12.

Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA.

Objective: To compare the demographics and self-reported medical comorbidities of patients with vulvar lichen sclerosus (VLS) with those of women with other vulvar conditions.

Methods: Intake questionnaires for patients presenting to the University of Michigan Center for Vulvar Diseases between 1996 and 2019 were entered into a de-identified database (n = 1983). Responses to questions about thyroid disease, urinary symptoms and signs, gastrointestinal conditions, and pain conditions were collected. Read More

Mil Med 2020 09;185(9-10):e1794-e1802

Division of General Surgery, Department of Surgery, Uniformed Services University of the Health Sciences (USUHS)/Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889.

Introduction: Anorectal diseases, among the most common surgical conditions, are underrepresented in medical training. The Fundamentals of Anorectal Technical Skills course was developed to provide cost-effective formal training in diagnosis of common anorectal conditions and in commonly performed anorectal procedures using the theories of deliberative practice and perceptual and adaptive learning.

Materials And Methods: First- through third-year general surgery and internal medicine residents and third- and fourth-year medical students participated in a course consisting of didactic instruction and hands on skills stations. Read More

Am Fam Physician 2020 01;101(1):24-33

University of Virginia School of Medicine, Charlottesville, VA, USA.

Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal incontinence. Although these are benign conditions, symptoms can be similar to those of cancer, so malignancy should be considered in the differential diagnosis. History and examination, including anoscopy, are usually sufficient for diagnosing these conditions, although additional testing is needed in some situations. Read More

Ann Gastroenterol 2020 Jan-Feb;33(1):9-18. Epub 2019 Nov 29.

Department of General Surgery, Division of Gastrointestinal and General Surgery Portland, Oregon Health and Science University, OR, USA.

Hemorrhoids, anal fissures, and fistulas are common benign anorectal diseases that have a significant impact on patients' lives. They are primarily encountered by primary care providers, including internists, gastroenterologists, pediatricians, gynecologists, and emergency care providers. Most complex anorectal disease cases are referred to colorectal surgeons. Read More

Endosc Int Open 2019 Nov 11;7(11):E1549-E1562. Epub 2019 Nov 11.

Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

 Anal examination and video anoscopy (VA) are rarely performed during colonoscopies. The aim of this study is to demonstrate that anal examination and VA provide important information in all routine colonoscopies.  A cross-sectional study was conducted on 12,151 patients screened by VA which were performed during routine outpatient colonoscopy between 2006 and 2018. Read More

Khirurgiia (Mosk) 2019 (8. Vyp. 2):32-39

Rostov State Medical University, Health Ministry of the Russian Federation, Rostov-on-Don, Russian Federation.

Aim: To objectify the criteria for choosing the method of treatment of anal fissures, to determine the indications for surgery and sphincterotomy.

Material And Methods: The results of treatment of 206 patients with chronic and acute anal fissures between the ages of 17 to 75 years are analyzed. The posterior anal fissure was detected in 175 (84. Read More

J Surg Res 2019 11 25;243:249-254. Epub 2019 Jun 25.

Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. Electronic address:

Background: Benign anal diseases, including hemorrhoids, fissures, abscesses, fistulas, and anal condylomata, affect 10%-15% of our population. Most patients seen by nonsurgical providers experience delayed treatment. We examined at our institution whether an educational session on anorectal diseases would benefit trainees from medical and surgical specialties. Read More

S Afr Med J 2019 Jan 31;109(2):122-126. Epub 2019 Jan 31.

Department of Surgery, Worcester Hospital and Ukwanda Centre for Rural Health, Stellenbosch University, Cape Town, South Africa.

Background: There are limited published data describing surgical admissions at a regional hospital level in the South African (SA) context.

Objectives: To retrospectively review data from an electronic discharge summary  database at a regional SA hospital from 2012 to 2016 to describe the burden of surgical disease by analysing characteristics of the patients admitted.

Methods: All discharge summary records for the 4-year period were reviewed after extraction from a database created for the surgery department. Read More

J Crohns Colitis 2019 Apr;13(5):572-577

Department of Colorectal Surgery, Beaujon Hospital, University Denis Diderot [Paris VII], Clichy, France.

Background And Aims: Faecal diversion [FD] can be proposed in patients with refractory anoperineal Crohn's disease [APCD]. This study aimed to assess long-term results of this strategy, following the advent of the anti-tumour necrosis factor [TNF] era.

Methods: All patients who underwent FD for refractory APCD between 2005 and 2017 were included, excluding patients with a history of ileal pouch-anal anastomosis. Read More

Int J Surg Pathol 2019 Jun 21;27(4):423-426. Epub 2018 Sep 21.

1 University of Miami, FL, USA.

Background: Epithelioid hemangioendothelioma (EHE) is an uncommon malignant endothelial neoplasm that most commonly arises in soft tissue, bone, lung, and liver. Crohn's disease (CD) is an inflammatory bowel disease of unknown etiology that is frequently associated with complications including strictures, fistulas/fissures, and neoplasms.

Case Description: A 43-year-old woman with a 6-year history of severe CD presented with anal pain and bleeding. Read More

Clin Colon Rectal Surg 2018 Mar 25;31(2):117-120. Epub 2018 Feb 25.

Departments of Surgery and Child Health, University of Arizona College of Medicine, Phoenix, AZ.

Anorectal complaints are not uncommon in pediatric care, but the etiology and management can differ significantly from adults. Age is an important factor when considering etiology and management, distinguishing between infants, children, and adolescents. For all ages, malignancy is rarely a consideration, but a thorough examination of infants and children typically requires deep sedation or general anesthesia. Read More

Internist (Berl) 2017 Oct;58(10):1053-1064

Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.

In proctology patients can often be helped with very little effort. With knowledge of the most common disease symptoms the treating physician can in many cases correctly recognize the cause of the complaints and initiate the appropriate therapy or arrange referral to a proctological institution. This article aims to briefly and succinctly present the most common diseases in proctology (e. Read More

J Pediatr Gastroenterol Nutr 2017 09;65(3):293-298

*Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Hospital, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel †Department of Radiology, Sheba Medical Center, Tel-Hashomer, Israel ‡Department of Diagnostic Imaging, Hospital for Sick Children §Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada ||Pediatric Radiology Unit, Shaare Zedek Medical Center, Jerusalem, Israel ¶Department of Radiology, Hospital Regional Universitario Carlos Haya, Malaga, Spain #Electroradiology Department, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Cracow, Poland **Department of Radiology, University of Munich, Munich, Germany ††Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA ‡‡Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH §§Department of Radiology, Connecticut Children's Medical Center, Hartford, CT ||||Department of Radiology, Schneider Children's Hospital, Petah Tikva, Israel ¶¶Diagnostic Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel ##Division of Gastroenterology, Hospital for Sick Children, Toronto, Ontario, Canada ***Institute of Gastroenterology, Nutrition and Liver Disease, Shaare Zedek Medical Center, Jerusalem, Israel.

Objectives: Data on the outcomes of children with perianal Crohn disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults.

Methods: Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. Read More

Abdom Radiol (NY) 2017 02;42(2):403-422

Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63110, USA.

Anorectal disorders are a common cause of presentation to the emergency department (ED). While the most frequently encountered anorectal conditions, such as hemorrhoids and anal fissures, are relatively benign and do not require imaging for diagnosis or management, there are multiple potentially life threatening anorectal conditions for which imaging is an important component of evaluation, diagnosis, and management. Although computed tomography (CT) is the most commonly used imaging modality for evaluation of anorectal pathology in the ED, magnetic resonance imaging (MRI) has an increasingly important role in the detection, characterization and management of specific anorectal conditions. Read More

Cir Esp 2016 Dec 20;94(10):588-594. Epub 2016 Oct 20.

Clinic for Anesthesiology and Intensive Care, Military Medical Academy, Belgrado, Serbia.

Introduction: This prospective, observational study evaluated transanal dearterialization (THD) efficacy and safety in grade 2-4 hemorrhoids (HD).

Methods: THD was performed under sedation-locoregional anesthesia in 402 outpatients. Patients had follow-up evaluation 3 days, 2 weeks, 1, 6 and 12 months postoperatively. Read More

Perm J 2016 10;20(4):15-222. Epub 2016 Oct 10.

Board-Certified General Surgeon with a special interest in anal health care at the Los Angeles Medical Center in CA.

Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. Read More

Ter Arkh 2016;88(7):72-77

National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russian Federation.

Aim: to identify poor prognostic factors for perianal infection (PI) in patients with hemoblastosis and to define an effective tactic for preventive and therapeutic measures.

Subjects And Methods: The prospective study enrolled 72 patients (37 men and 35 women; mean age, 47 years) with hemoblastosis that was complicated by the development of one of the following forms of PI: abscess, infiltrate, multiple ulcers. Different clinical and laboratory characteristics of the patients were examined to identify risk factors for PI. Read More

Prz Gastroenterol 2015 10;10(2):83-8. Epub 2015 Mar 10.

Chair and Department of Gastroenterology, Human Nutrition, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.

Anal fistulas occurring in Crohn's disease (CD) comprise a risk factor of severe course of inflammation. They are frequently intractable due to various factors such as penetration of the anal canal or rectal wall, impaired wound healing, and immunosuppression, among others. Anal fistulas typical to CD develop from fissures or ulcers of the anal canal or rectum. Read More

Clin Ter 2015 ;166(5):194-9

Dipartimenti di Medicina Interna e Specialità Mediche, "Sapienza" Università di Roma, Italia.

Background And Aims: Our experience in colon-proctology showed the need to update the post-surgical complications score we published (1), adding others that may have an impact on outcome of treatment. The aim of this study was to assess the efficacy of a score obtained from the analysis of the quality of life and severity of complications after proctologic surgery.

Materials And Methods: Between January and December 2013, we studied 150 patients undergoing several ano-rectal surgeries for the presence of hemorrhoids of grade III and IV (63 patients), anal fissures (42 patients), anal fistulas (19 patients), rectocele (15 patients) and mucosal prolapse of the rectum (11 patients). Read More

Minerva Gastroenterol Dietol 2015 Dec 7;61(4):223-33. Epub 2015 Oct 7.

General Surgery Unit, University Hospital Tor Vergata, Rome, Italy -

Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Read More

Ter Arkh 2015 ;87(6):83-87

State Coloproctology Research Center, Ministry of Health of Russia, Moscow, Russia.

Aim: To determine the efficacy of 0.1% tacrolimus ointment in patients with perianal Crohn's disease (CD).

Subjects And Methods: This prospective randomized trial enrolled 20 patients with perianal CD as anal fissures and rectal fistulas. Read More

J Manag Care Spec Pharm 2015 Jul;21(7):559-66

HealthCore, Inc., 123 Justison Ave., Ste. 200, Wilmington, DE 19801.

Background: In recent years, there have been a number of pharmacological innovations for Crohn's disease (CD), a difficult-to-treat condition, including new treatment philosophies (e.g., top-down therapy) and new therapeutic options in terms of the agent and the route of administration. Read More

Chirurg 2015 Aug;86(8):734-40

Kompetenzzentrum für Koloproktologie, End- und Dickdarm-Zentrum Essen, Rüttenscheiderstr. 66, 45130, Essen, Deutschland,

Background: Fistula-in-ano and anal fissures are common proctological diseases. In most cases of anal fissures conservative treatment provides good clinical results, whereas for fistula-in-ano operative treatment is the only option.

Objective: The most important and for the patient most stressful long-term complication is postoperative incontinence, especially as the deliberate severance of the anal sphincter musculature is part of the treatment for many patients. Read More

Ugeskr Laeger 2015 Feb;177(9):V11140623

Center for Perioperativ Optimering, -Kirurgisk Afdeling, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev.

Anal fistulas and fissures are frequent disorders. Affected patients may have significant psychosocial and sexual dysfunction. A few studies have investigated patients with anal fissures and fistulas with regard to sexual dysfunction. Read More