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David Parés, Herand Abcarian
Benign anorectal conditions produce anal pain, rectal bleeding, or discharge from the perianal region, which are highly prevalent symptoms in the general population. Hemorrhoidal disease, anal fissure, perianal abscess, proctalgia syndromes, and pruritus anii are the most common clinical disorders. Well-trained physicians, irrespective of their specialty, can treat most of these disorders and refer them to a specialist in proctology only when necessary. The aim of this review is to provide a practical guide to the management of benign anorectal disorders in terms of their initial management and the criteria for specialist referral...
February 27, 2018: American Journal of Medicine
Alexandra W Elias, Dorin T Colibaseanu, Kristopher P Croome
Colonic small cell carcinomas (SCCs) are rare, aggressive tumors characterized by early metastasis and poor prognosis. We describe a 39-year-old man with a history of ulcerative colitis and left colon adenocarcinoma resected at an outside institution who presented with hematochezia and proctalgia. Work-up revealed left colon SCC with liver metastases. After his excellent response to neoadjuvant chemotherapy, we performed synchronous proctocolectomy and right hepatectomy. Final pathologic evaluation revealed colonic primary SCC and recurrent adenocarcinoma with metastatic SCC to the liver; lymph nodes were positive for metastatic SCC and adenocarcinoma...
October 2017: Journal of Surgical Case Reports
Michel Bouchoucha, Florence Mary, Cyriaque Bon, Bakhtiar Bejou, Gheorghe Airinei, Robert Benamouzig
OBJECTIVE: Sleep disorders are often associated with functional gastrointestinal disorders (FGIDs). This study aims to evaluate the association of sleep disorders with specific FGIDs and to assess the related importance of psychological disorders. METHODS: We included 1009 consecutive patients with FGIDs (70.9% females). The patients completed a Rome III questionnaire and after a psychological evaluation on anxiety and depression they were classified according to their sleep disorders using a 7-point grading scale: Groups 1-3, drowsiness (severe, moderate, mild); Group 4, no change; Groups 5-7, insomnia (mild, moderate, severe)...
February 2018: Journal of Digestive Diseases
M Del Mar Aguilar, Pedro Moya, M José Alcaide, Alba Fernández, M Amparo Gómez, Jair Santos, Rafael Calpena, Antonio Arroyo
INTRODUCTION: The treatment of chronic anal fissure (FAC) differs depending on the professional. To come to a consensus, the current situation in Spain should be studied. The aim of this study is to evaluate the current situation of the management of FAC in Spanish hospitals. METHODS: Descriptive study, with data from a survey of surgeons of the Spanish Association of Coloproctology. Data was collected according to the doctor's autonomous community, type of hospital and professional category; FAC management data and 3 clinical cases...
January 2018: Cirugía Española
Marios Grigoriou, Aristeidis Ioannidis, Konstantinia Kofina, Christoforos Efthimiadis
Proctalgia fugax is considered as intermittent anal pain of unknown etiology; a variety of treatments have been used, without, however, permanent results. Injection of botulinum A toxin is recently suggested as an alternative option. We present the case of a woman presenting proctalgia fugax that was untreatable through other current forms of treatment. After two administrations of botulinum A toxin, 80 units and 100 units each, the patient remained asymptomatic on 8-month follow-up control. Botulinum A toxin injection can reduce internal anal sphincter pressure, leading to relief of symptoms, and seems a promising option with minimal morbidity in cases on proctalgia fugax that does not respond to other current treatments...
November 2017: Journal of Surgical Case Reports
Thomas Simopoulos, Robert J Yong, Jatinder S Gill
Chronic neuropathic pelvic pain remains a recalcitrant problem in the field of pain management. Case series on application of 10 kHz spinal cord stimulation is presented. High frequency stimulation can improve chronic neuropathic pain states that are known to be mediated at the conus medullaris and offers another avenue for the treatment of these patients.
November 6, 2017: Pain Practice: the Official Journal of World Institute of Pain
Ya-Hong Xue, Shu-Qing Ding, Yi-Jiang Ding, Li-Qun Pan
AIM: To assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP). METHODS: In this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups...
June 7, 2017: World Journal of Gastroenterology: WJG
Fernando de la Portilla, María Luisa Reyes-Díaz, María Victoría Maestre, Rosa María Jiménez-Rodríguez, Ana María García-Cabrera, José M Díaz-Pavón, Jorge Manuel Vázquez-Monchul, Juan Antonio Villanueva
INTRODUCTION: The PICS-AF™ (Curaseal Inc.) device is a new plug made of collagen that has a retention system in the internal orifice. This pilot study was designed to assess both the feasibility and safety of this plug in the treatment of trans-sphincteric anal fístulas. METHODS: A total of 44 patients (34 men), with a mean age of 54.68±7.3, with trans-sphincteric anal fístulas were included in the study; 34 of them were analyzed. All patients were examined according to a strict preoperative protocol and until 6 months after surgery...
April 12, 2017: Cirugía Española
A Gumber, S Ayyar, H Varia, S Pettit
A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement...
March 2017: Annals of the Royal College of Surgeons of England
Adil E Bharucha, Tae Hee Lee
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men...
October 2016: Mayo Clinic Proceedings
Julián Panés, Damián García-Olmo, Gert Van Assche, Jean Frederic Colombel, Walter Reinisch, Daniel C Baumgart, Axel Dignass, Maria Nachury, Marc Ferrante, Lili Kazemi-Shirazi, Jean C Grimaud, Fernando de la Portilla, Eran Goldin, Marie Paule Richard, Anne Leselbaum, Silvio Danese
BACKGROUND: Complex perianal fistulas in Crohn's disease are challenging to treat. Allogeneic, expanded, adipose-derived stem cells (Cx601) are a promising new therapeutic approach. We aimed to assess the safety and efficacy of Cx601 for treatment-refractory complex perianal fistulas in patients with Crohn's disease. METHODS: We did this randomised, double-blind, parallel-group, placebo-controlled study at 49 hospitals in seven European countries and Israel from July 6, 2012, to July 27, 2015...
September 24, 2016: Lancet
Adel Elmoghrabi, Mohamed Mohamed, Kristoffer Wong, Michael McCann
We report a case of a 70-year-old woman who presented with progressively increasing intensity of lower abdominal, pelvic and rectal pain of 3-day duration. She had similar symptoms intermittently over the preceding 2 years. CT of the abdomen and pelvis revealed the presence of a 3.8×0.4 cm linear foreign body in the colorectal region. History obtained from relatives recalled inadvertent ingestion of a chicken bone 2 years prior to presentation. Trials of foreign body retrieval, both manually and via rigid and flexible sigmoidoscopy, however, were unsuccessful due to the presence of obstruction by a circumferential rectal stricture...
June 20, 2016: BMJ Case Reports
Satish Sc Rao, Adil E Bharucha, Giuseppe Chiarioni, Richelle Felt-Bersma, Charles Knowles, Allison Malcolm, Arnold Wald
This report defines criteria and reviews the epidemiology, pathophysiology, and management of common anorectal disorders: fecal incontinence (FI), functional anorectal pain and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases...
March 25, 2016: Gastroenterology
S Montrone, A Gonnelli, M Cantarella, A Sainato
AIM: Generally speaking, the negative side of radiation treatment of the pelvic district is the toxicity that may compromise the patient's quality of life and lead to temporary suspension of treatment with possible negative effects on its effectiveness. In neoadjuvant radiochemotherapy for locally advanced rectal cancer (LARC), the toxicity that is most frequently observed is proctitis, usually treated with topical corticosteroids or mesalazine. Hyaluronic acid's function is to restore the regular trophism and elasticity of the connective tissues leading to faster repair of the damage, and this could represent a viable option for the control of actinic proctitis...
December 2015: Minerva Gastroenterologica e Dietologica
Siddharth Singh, Andrea M Stroud, Stefan D Holubar, William J Sandborn, Darrell S Pardi
BACKGROUND: Pouchitis occurs in approximately 50% of patients following ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis. OBJECTIVES: The primary objective was to determine the efficacy and safety of medical therapies (including antibiotics, probiotics, and other agents) for prevention or treatment of acute or chronic pouchitis. SEARCH METHODS: We searched MEDLINE, EMBASE and the Cochrane Library from inception to October 2014...
2015: Cochrane Database of Systematic Reviews
A Ahmad, D Henderson, H Sharma
We report a case of intractable proctalgia on a background of lower back and bilateral leg pain secondary to spinal canal stenosis and spondylolisthesis. A complete resolution was observed following spinal surgery. This case highlights consideration of a spinal aetiology when intractable proctalgia is associated with back and leg pain.
August 2016: British Journal of Neurosurgery
Kyle Staller
Physiologic assessment of the anorectum and pelvic floor by anorectal manometry and balloon expulsion testing provides important insights into the pathologic processes underlying defecatory disorders and guides treatment, specifically the use of biofeedback for the treatment of dyssynergic defecation and the identification of possible structural abnormalities of the pelvic floor. While symptoms and digital rectal examination may suggest pelvic floor dysfunction to the clinician, only pelvic floor testing provides definitive diagnoses of these often treatable abnormalities...
December 2015: Current Treatment Options in Gastroenterology
Dennis Raahave
The present studies explored whether faecal retention in the colon is a causative factor in functional bowel disease, appendicitis, and haemorrhoids. Faecal retention was characterized by colon transit time (CTT) after radio-opaque marker ingestion and estimation of faecal loading on abdominal radiographs at 48 h and 96 h. Specific hypotheses were tested in patients (n = 251 plus 281) and in healthy random controls (n = 44). A questionnaire was completed for each patient, covering abdominal and anorectal symptoms and without a priori grouping...
March 2015: Danish Medical Journal
José Aurelio Navas-Cuéllar, Rosa María Jiménez-Rodríguez, Daniel Aparicio-Sánchez, José Manuel Díaz-Pavón, Javier Padillo-Ruiz, Fernando de-la-Portilla-de-Juan
No abstract text is available yet for this article.
January 2015: Revista Española de Enfermedades Digestivas
Mehdi Moghaddasi, Mahboubeh Aghaii, Mansoureh Mamarabadi
Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5...
December 2014: Journal of Neurological Surgery Reports
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