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Gan To Kagaku Ryoho 2019 Jan;46(1):88-90

Dept. of Surgery, Yao Tokushukai General Hospital.

An 81-year old man with a perirectal abscess was referred in May 2017 by another hospital. We observed swelling in the anal region at the 4 o'clock position and performed incisional drainage. Although this alleviated the pain and inflammation in the anal region, the irritation recurred in early June. Read More

Ultrasound Int Open 2019 Jan 5;5(1):E34-E51. Epub 2019 Feb 5.

Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway.

This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). Read More

Bull Emerg Trauma 2019 Jan;7(1):72-75

Kirikkale University School of Medicine, Department of General Surgery, Kirikkale, Turkey.

Adv Surg 2018 Sep 19;52(1):179-204. Epub 2018 Jun 19.

Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Suite D-333, Springfield, IL 62781-0001, USA. Electronic address:

Front Pediatr 2018 16;6:143. Epub 2018 May 16.

Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States.

Perianal abscess and fistula-in-ano are well-described in the pediatric population. They are most common in infants less than 1 year of age and often resolve with oral antibiotics; occasionally they require drainage or fistulotomy. The etiology is commonly associated with cryptoglandular obstruction and subsequent infection, however alternative diagnoses should be considered in cases of recurrent abscesses and fistulae that are refractory to standard treatments. Read More

Rev Esp Enferm Dig 2018 Jun;110(6):410

Radiodiagnóstico, Hospital General Universitario, Ciudad Real.

Lymphogranuloma venereum (LGV) is a condition caused by invasive serovars of Chlamydia trachomatis. The classical inguinal presentation that is characterized by the development of transient genital ulcer(s) and inguinal or femoral lymphadenopathy has decreased in our environment. At present, infection by this bacterium has emerged as an important cause of proctitis and proctocolitis in men who have sex with other men. Read More

Case Rep Med 2018 25;2018:6068258. Epub 2018 Feb 25.

Department of Internal Medicine, Section of Infectious Diseases, Virginia Tech Carilion-School of Medicine and Research Institute, Roanoke, VA, USA.

has a wide variety of presentations. A rare occurrence is gastrointestinal tuberculosis. It may occur anywhere along the alimentary canal but usually occurs in the ileocecum with rare involvement of the appendix. Read More

Ugeskr Laeger 2018 01;180(2)

The causative organism of melioidosis is Burkholderia pseudomallei, a Gram-negative bacterium endemic to Southeast Asia and Northern Australia. The clinical presentation varies, ranging from asymptomatic cases to rapidly progressive septicaemia and shock. Abscesses may be found in any internal organ. Read More

Clin Nephrol Case Stud 2017 6;5:38-41. Epub 2017 Jul 6.

Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA, and.

Background: Calciphylaxis in a nondialysis patient is a rare condition and is characterized by calcific deposition in tissue. We present a case of calciphylaxis in a nondialysis patient who was diagnosed by clinical presentation and skin biopsy and was treated with sodium thiosulfate with improvement of skin lesions.

Case: A 43-year-old female with type 2 diabetes and atrial fibrillation taking oral anticoagulation medication presented with reddish drainage from the right buttock. Read More

Am Surg 2017 Jul;83(7):699-703

A minimally invasive (MI) approach using small incisions and vessel loops for drainage of simple perianal abscesses has been described in the pediatric population with decreased postoperative pain and comparable results to the traditional incision and drainage (I&D). The hypothesis was MI I&D will yield similar outcomes in adults. Patients who underwent I&D of perianal abscesses at an urban hospital from January 2008 to December 2015 were identified by Current Procedural Terminology code. Read More

Surg Endosc 2018 Feb 19;32(2):660-666. Epub 2017 Jul 19.

Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-Gun Jeonnam, 58128, Republic of Korea.

Background: Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralow anterior resection (ULAR).

Methods: We retrospectively reviewed a database of patients with rectal cancer who underwent surgery between January 2007 and June 2015, and included patients with an anastomosis within 4 cm from the anal verge. Read More

Arab J Gastroenterol 2017 Jun 16;18(2):122-125. Epub 2017 Jun 16.

Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.

Clin Endosc 2017 May 11;50(3):297-300. Epub 2017 Apr 11.

Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. Read More

Endoscopy 2017 May 14;49(5):484-490. Epub 2017 Feb 14.

Endoscopy Unit, Paoli Calmette Institute, Marseille, France.

 Endoscopic ultrasound (EUS)-guided pelvic abscess drainage has been reported but long-term data remain limited. This two-center study evaluated long-term outcome of EUS-guided pelvic abscess drainage.  Between May 2003 and December 2015, 37 consecutive patients were treated for perirectal or perisigmoid abscesses via EUS-guided drainage using plastic or lumen-apposing metal stent (LAMS). Read More

Clin Nephrol 2016 Nov 14. Epub 2016 Nov 14.

Ahead of Print article withdrawn by publisher.

Background: Calciphylaxis in a nondialysis patient is a rare condition and is characterized by calcific deposition in tissue. We present a case of calciphylaxis in a nondialysis patient who was diagnosed by clinical presentation and skin biopsy and was treated with sodium thiosulfate with improvement of skin lesions. Read More

Pain Ther 2016 Dec 5;5(2):237-248. Epub 2016 Nov 5.

The Medicines Company, Parsippany, NJ, USA.

Fentanyl iontophoretic transdermal system (ITS) [IONSYS, The Medicines Company, Parsippany, NJ, USA] is a needle-free, patient-controlled, postoperative opioid pain management treatment. It is indicated for the short-term management of acute postoperative pain in adults requiring opioid analgesia in the hospital. The safety and effectiveness of fentanyl ITS for acute postoperative pain management has been demonstrated in a range of surgery and patient types studied in seven phase 3 trials (three placebo-controlled trials and four active-comparator trials). Read More

Am J Gastroenterol 2016 Oct;111(10):1381

Montefiore Medical Center, Bronx, New York, USA.

J Med Case Rep 2016 Aug 2;10:214. Epub 2016 Aug 2.

Department of Rheumatology, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, JHAAC Room 1B.13, Baltimore, MD, 21224, USA.

Background: We report a case in which the extraintestinal manifestations of inflammatory bowel disease preceded development of gastrointestinal symptoms by nearly 9 months in the context of an unusual autoantibody panel, mimicking granulomatosis with polyangiitis. This case highlights the intricacies and overlap of autoimmune diseases, and illustrates an interesting clinical phenotype: cytoplasmic anti-neutrophil cytoplasmic antibody positive inflammatory bowel disease with predominantly extraintestinal manifestations. Perinuclear anti-neutrophil cytoplasmic antibody positivity has been frequently reported in association with inflammatory bowel disease, but cytoplasmic anti-neutrophil cytoplasmic antibody positivity is uncommon. Read More

Ther Apher Dial 2016 Apr 23;20(2):206-8. Epub 2016 Feb 23.

Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.

J Pak Med Assoc 2016 Jan;66(1):97-100

Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi.

Chronic granulomatous disease is a rare inherited disorder characterised by inability of phagocytes to generate reactive oxygen species needed for intracellular killing of phagocytosed microorganisms. We report the case of an 8-month-old male child with recurrent chest infections and perianal abscess that had no response to conventional antibiotic treatment. His two elder brothers died due to similar complaints at the ages of 4 and 5 months. Read More

Turk J Pediatr 2015 Mar-Apr;57(2):189-91

Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey.

Chronic granulomatous disease (CGD) is an autosomal recessive or X-linked disorder caused by NADPH oxidase deficiency leading to an impaired ability of reactive superoxide anion and metabolite formation and recurring severe bacterial and fungal infections, with a high mortality rate. Diarrhea, colitis, ileus, perirectal abscess formation and anal fissures are reported gastrointestinal findings in these patients. We report a case of intractable colitis associated with CGD in a young girl. Read More

Intest Res 2015 Jan 29;13(1):85-9. Epub 2015 Jan 29.

Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Klebsiella pneumoniae (K. pneumoniae) can at times cause invasive infections, especially in patients with diabetes mellitus and a history of alcohol abuse. A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks. Read More

J Trauma Acute Care Surg 2015 Jan;78(1):120-5

From the Johns Hopkins University School of Medicine (B.C.P.), Baltimore, Maryland; and Department of Surgery, University of California, Davis Medical Center (J.M.G., D.H. W.), Sacramento, Maryland.

Background: Trauma and emergency surgery continues to evolve as a surgical niche. The simple fact that The Journal of Trauma is now entitled The Journal of Trauma and Acute Care Surgery captures this reality. We sought to characterize the niche that trauma and emergency surgeons have occupied during the maturation of the acute care surgery model. Read More

J Trauma Acute Care Surg 2014 Nov;77(5):705-708

From the Departments of Surgery-Trauma/Critical Care (M.L.C.) and Preventive Medicine (M.L.C.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery (S.A.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Surgery (P.M.), University of Cincinnati, Cincinnati, Ohio; Department of Surgery (S.R.), Cooper Medical School of Rowan University, Camden, New Jersey; Department of Surgery (S.Sa.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (K.S.), Yale School of Medicine, New Haven, Connecticut; Department of Surgery (GTT), Scripps Memorial Hospital La Jolla, La Jolla, California; Baylor Institute for Health Care Research and Improvement (S.Sh.), Dallas, Texas.

Background: Emergent general surgical diseases encompass a broad spectrum of anatomy and pathophysiology, creating challenges for outcomes assessment, research, and surgical training. The goal of this study was to measure anatomic disease severity for eight emergent general surgical diseases using the uniform grading system of the American Association for the Surgery of Trauma (AAST).

Methods: The Committee on Patient Assessment and Outcomes of AAST applied the previously developed uniform grading system to eight emergent general surgical diseases using a consensus of experts. Read More

BMC Infect Dis 2014 Aug 27;14:466. Epub 2014 Aug 27.

Intensive Care Unit, CHU Dupuytren, Limoges, France.

Background: Prostatic abscesses are an uncommon disease usually caused by enterobacteria. They mostly occur in immunodeficient patients. It is thus extremely rare to have a Staphylococcal prostatic abscess in a young immunocompetent patient. Read More

Surg Endosc 2015 May 26;29(5):1045-50. Epub 2014 Aug 26.

Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University, Rome, Italy,

Background: ELRR by TEM is a valid alternative to TME in selected patients with early low rectal cancer, with similar long-term oncological results and better Quality of Life. The authors' policy is to close the residual defect, with possibly a higher risk of dehiscence from tension on the suture line. Aim is to evaluate if a modified technique may reduce the risk of dehiscence. Read More

Indian J Gastroenterol 2014 Sep 13;33(5):410-3. Epub 2014 Jul 13.

Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India,

Background: Endoscopic ultrasound (EUS)-guided drainage is an effective treatment for many abscesses in the abdomen. We review our experience with EUS-guided drainage of pelvic abscesses.

Methods: Thirty consecutive patients who underwent EUS-guided pelvic abscess drainage were evaluated after excluding three patients with distance to transducer >2 cm or organized abscess. Read More

J Dermatol 2014 Jun;41(6):547-50

Department of Dermatology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan.

Fournier's gangrene (FG) is an infrequent but highly lethal infection. Here we report a 74-year-old man who presented with genital swelling and severe malaise. Based on the physical and imaging examination results, the diagnosis of FG was confirmed. Read More

Case Rep Emerg Med 2014 13;2014:817124. Epub 2014 Feb 13.

Center for Policy and Emergency Medicine Research, Oregon Health and Science University, 3181 SW Sam Jackson Boulevard, Portland, OR 97239, USA.

A 12-year-old boy was brought to an urgent care center for fever, back pain, and abnormal gait. In addition to back pain, the patient was found to be persistently febrile but also had decreased perianal sensation and bowel incontinence. He was therefore referred to the emergency department where his back pain improved without medication but he was still febrile with bowel incontinence and persistently decreased perianal sensation. Read More

Med Clin North Am 2014 May 21;98(3):609-23. Epub 2014 Mar 21.

Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA. Electronic address:

Anal problems are pervasive, embarrassing and vexing to patients. Primary care providers should be well versed in addressing these concerns, which uncommonly require referral for specialty care. Additionally, anal symptoms and findings may herald previously undiagnosed underlying illness. Read More

Ann Surg Oncol 2014 May 20;21(5):1616-23. Epub 2014 Feb 20.

Division of Surgical Oncology, UC Davis Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento, CA, USA,

Background: Despite effective local therapy with surgery and radiotherapy (RT), ~50 % of patients with high-grade soft tissue sarcoma (STS) will relapse and die of disease. Since experimental data suggest a significant synergistic effect when antiangiogenic targeted therapies such as sorafenib are combined with RT, we chose to evaluate preoperative combined modality sorafenib and conformal RT in a phase I/II trial among patients with extremity STS amenable to treatment with curative intent.

Methods: For the phase I trial, eight patients with intermediate- or high-grade STS >5 cm in maximal dimension or low-grade STS >8 cm in maximal dimension received concomitant sorafenib (dose escalation cohort 1:200 twice daily, cohort 2:200/400 daily) and preoperative RT (50 Gy in 25 fractions). Read More

Neurol Sci 2014 Apr 25;35(4):631-2. Epub 2014 Jan 25.

Operative Unit of Neurophysiopathology, CTO, Rome, Italy.

Tech Coloproctol 2014 Feb 17;18(2):165-71. Epub 2013 May 17.

Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria,

Background: Successful anal fistula care in complex cases can be assisted by specialized imaging which accurately defines the site of the internal fistula opening and the fistula type. There are currently limited data concerning the clinical indications for and accuracy of transperineal ultrasound (TP-US) in acute perianal sepsis. The aims of this study were to compare the anatomical interpretation of TP-US images with magnetic resonance imaging (MRI) and surgical findings in an unselected patient cohort presenting with acute perianal sepsis. Read More

J Pediatr Surg 2013 Feb;48(2):e33-6

Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA.

Tailgut cysts are uncommon lesions that usually occur within the presacral space. The relative rarity and nonspecific complaints associated with these lesions often lead to misdiagnosis or unnecessary procedures before the correct diagnosis is made. We describe a case of a 16-year-old female who presented with pelvic pain. Read More

J Surg Case Rep 2013 Jun 26;2013(6). Epub 2013 Jun 26.

Department of Surgery, Berkshire Medical Center/University of Massachusetts Medical School, Pittsfield, MA, USA.

Supralevator abscesses are the rarest manifestation of anorectal suppurative disease. We report a supralevator abscess in a 60-year-old male whose earliest presentation included poorly localized abdominal and pelvic pain, tenesmus, urinary retention and weight loss, initially treated as diverticular disease based upon imaging and presentation. Progressive symptoms led to the discovery of a pelvic abscess with subsequent percutaneous drainage, later followed by emergent laparotomy, where a single perforated diverticulum was revealed to be the source fistulization. Read More

Case Rep Infect Dis 2012 29;2012:913785. Epub 2012 Sep 29.

School of Medicine, University of Pittsburgh, S532 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, USA.

Perirectal abscess is a common colorectal condition that may be present with or without a fistula. In most cases where a fistula coexists the organisms cultured are gut-derived organisms whereas skin-derived organisms are more common in patients without fistula formation. Candida albicans, despite being an microorganism often found in the gastrointestinal tract, has not previously been reported as an isolate from a perirectal abscess culture. Read More

Surg Infect (Larchmt) 2012 Oct 5;13(5):332-5. Epub 2012 Oct 5.

Department of General Surgery, North Middlesex University Hospital National Health Service Trust, Sterling Way, London, United Kingdom.

Background: Perirectal abscess is encountered commonly in surgical practice, and simple incision and drainage usually is sufficient. However, life-threatening sepsis may occur. In such instances, the high morbidity and mortality rates from the severe systemic inflammatory response syndrome (SIRS) associated with rapidly evolving necrotizing and gas-forming soft tissue infections are of major concern. Read More

J Adv Pract Oncol 2012 May;3(3):161-9

The University of Texas MD Anderson Cancer Center, Houston, Texas.

Case Study Ms. S.G. Read More

Therap Adv Gastroenterol 2012 Mar;5(2):95-102

Digestive Disease Service, Pontevedra Hospital Complex, C/Mourente s/n Pontevedra 36001, Spain.

Objectives: The objective of this study was to evaluate the role and benefits of endoscopic ultrasonography (EUS) in the management of postoperative intra-abdominal fluid collections after attempted curative surgery for abdominal cancer.

Methods: The authors retrospectively analysed the Endobase from 1 July 2007 to 30 January 2011 for patients with a postoperative intra-abdominal fluid collection who had undergone EUS-guided drainage and the placement of a stent. The data analysed included the demographics, type of surgery and clinical indications of each patient as well as their clinical and radiological findings. Read More

Am J Emerg Med 2012 Oct 24;30(8):1569-73. Epub 2011 Oct 24.

Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA.

Objective: The objective was to compare bedside ultrasound (US) to clinical examination for the detection of abscess.

Methods: This is a 24-month prospective, observational emergency department (ED) study. Adults with suspected nondraining abscess with planned incision and drainage (I&D) are included in the study. Read More

Ultrasound Med Biol 2011 May 25;37(5):723-8. Epub 2011 Mar 25.

Department of Gastric Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.

The aim of this study was to demonstrate and evaluate the ultrasound-guided drainage of deep pelvic abscesses in which transabdominal percutaneous access could not be performed because of overlying structures. A retrospective analysis of 32 consecutive patients with 33 deep pelvic abscesses was performed. The underlying causes of the abscesses included postsurgical fluid collection or surgical complications in 18 of the 32 patients, and 11 of these patients underwent recent rectal cancer surgery. Read More

Rozhl Chir 2010 Dec;89(12):770-3

I. Chirurgická klinika LF UP a FN Olomouc.

Aim: Evaluate our more than seven year experience with transanal endoscopic microsurgical technique (TEM).

Materials And Methods: The authors prospectively evaluated a set of 393 patients who were operated using the TEM method.

Results: Out of 393 patients, 371 (94%) were indicated for the procedure for rectal tumor; 82 of these tumors were malignant. Read More

Am Surg 2011 Feb;77(2):166-8

Department of General Surgery, Trauma Service, Washington Hospital Center, Washington, DC, USA.

Most patients with anorectal abscess are diagnosed clinically based on pain, erythema, warmth, and fluctuance. Some patients, however, present with subtle or atypical signs. CT is easily accessible and is commonly used for diagnosis and delineation of anorectal abscess. Read More

J Pediatr Surg 2011 Jan;46(1):200-3

Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-2696, USA.

Purpose: This study aim was to review outcomes of pediatric patients after restorative proctocolectomy with or without a protective ileostomy in the treatment of ulcerative colitis and polyposis syndromes.

Methods: All patients who underwent rectal mucosectomy with ileal pouch reservoir and hand-sewn ileal pouch anal anastomosis (IPAA) during 19-year period were reviewed retrospectively.

Results: Eighty-three patients with ulcerative colitis and 7 patients with polyposis syndromes (ages 2. Read More

Radiol Oncol 2010 Dec 14;44(4):220-7. Epub 2010 Oct 14.

Institute of Radiology, Clinical Centre of University of Sarajevo, Sarajevo, Bosnia and Herzegovina.

Background: Fistula is considered to be any abnormal passage which connects two epithelial surfaces. Parks' fistulae classification demonstrates the biggest practical significance and divides fistulae into: intersphincteric, transsphincteric, suprasphincteric and extrasphincteric. Etiology of perianal fistulae is most commonly linked with the inflammation of anal glands in Crohn's disease, tuberculosis, pelvic infections, pelvic malignant tumours, and with the radiotherapy. Read More

Digestion 2011 14;83(1-2):18-23. Epub 2010 Sep 14.

Department of Internal Medicine I, University of Regensburg, Regensburg, Germany.

Background/aims: Some suggest MRI to be superior to ultrasound in Crohn's disease. We analyzed how often MR enterography (MRE) following a routine ultrasound leads to a change in therapeutic decision.

Material And Methods: We retrospectively evaluated 47 patients with Crohn's disease undergoing routine ultrasound examination. Read More

Am J Emerg Med 2011 Mar;29(3):356.e1-3

Emergency Medicine, Georgetown University Hospital, Washington, DC 20007, USA.

A patient with acute hip pain out of proportion to physical findings and inability to weight bear despite negative plain films warrants further in-depth evaluation. Correctly diagnosing the cause of hip pain, a common emergency department (ED) complaint, may be a challenge in the geriatric population (Perron A, Miller M, Brady W. Orthopedic pitfalls in the ED: radiographically occult hip fracture. Read More

Am J Med 2010 Sep;123(9):e13-4