Purpose
The aims of this study are to evaluate the clinical characteristics of perianal abscess and fistula-in-ano in children, and to assess our experience in treatment, and to identify factors that ...affected the clinical outcomes.
Methods
A retrospective review of children with perianal abscess and fistula-in-ano was carried out in a tertiary care children’s hospital from January 2005 to December 2010. Demographic information of the patients, localization of the lesions, treatment procedures, microbial organisms in pus, usage of antibiotics, abscess recurrence, development of fistula-in-ano, and duration of symptoms were recorded. Patients with systemic diseases and inflammatory bowel diseases were excluded from the study.
Results
A total of 158 children (146 males, 12 females) treated for perianal abscess and fistula-in-ano with a median age of 7.2 months (ranging 16 days to 18 years) were eligible for the study. Initial examination of the 136 patients revealed perianal abscess and 22 patients with fistula-in-ano. Primary treatment was incision and drainage (I/D) for the fluctuating perianal abscess (73.5%), and local care for the spontaneously (S/D) drained abscess (26.5%) with or without antibiotic therapy. Patients were divided into two groups according to age distribution, 98 of the patients were younger than 12 months, and 60 were older than 12 months of age. There was no significant difference in sex distribution, localization of the lesions, treatment procedures, recurrence of abscess and fistula-in-ano formation between the two age groups (
p
> 0.05). Recurrence rates (27% in I/D and 30.6% in S/D,
p
> 0.05) and development of fistula-in-ano (20% in I/D and 27.8 in S/D,
p
> 0.05) were not significant I/D and S/D groups. Kind of the microorganisms in pus swaps did not effect the fistula-in-ano formation. Usage of antibiotics significantly reduced the development of fistula-in-ano (
p
= 0.001), but did not effect the recurrence of perianal abscess (
p
> 0.05). The mean follow-up period was 10.6 ± 8.6 months. While the 9 of the overall 52 fistula-in-ano (22 initial, 30 after abscess treatment) were resolved spontaneously, 43 of the remaining needed surgical intervention (fistulotomy/fistulectomy).
Conclusions
Although management of perianal abscess is still controversial, simple drainage of the perianal abscess with additional antibiotic therapy reduces the development of fistula-in-ano. Fistula-in-ano within children has a chance of spontaneous resolution thus the immediate surgical intervention should be avoided.
Purpose
One-anastomosis-gastric-bypass (OAGB) has become a common bariatric procedure worldwide. Marginal ulcers (MU) are a significant non-immediate complication of gastric bypass surgeries. There ...seems to be concern among surgeons that MU are more common after OAGB compared with Roux-en-Y gastric bypass (RYGB) due to the constant and extensive exposure of the anastomosis to bile. The aim of this study was to compare the incidence, presentation, and management of MU between the two surgeries.
Materials and Methods
A retrospective study of prospectively collected data was performed to include all consecutive patients between 2010 and 2020, who underwent elective OAGB or RYGB at our institution. Patients diagnosed with symptomatic MU were identified. Factors associated with this complication were assessed and compared between the two surgeries.
Results
Symptomatic MU were identified in 23/372 OAGB patients (6.2%) and 35/491 RYGB patients (7.1%) (
p
= 0.58). Time to ulcer diagnosis was shorter in OAGB patients (12 ± 11 vs. 22 ± 17 months,
p
< 0.01). Epigastric pain was the common symptom (78% OAGB vs. 88.5% RYGB,
p
= 0.7) and approximately 15% of ulcers presented with perforation upon admission (17% vs.11.4%,
p
= 0.7). Re-operation was required in 5/23 OAGB (21.7%) and 6/36 RYGB (17%) patients (
p
= 0.11) while the rest of the patients were managed non-operatively.
Conclusions
The risk of developing a marginal ulcer is similar between patients who underwent OAGB and RYGB. Patients diagnosed with MU following OAGB tend to present earlier; however, the clinical presentation is similar to RYGB patients. The management of this serious complication seems to be associated with acceptable outcomes with comparable operative and non-operative approaches.
Abstract Background/Purpose Pilonidal disease is a common and frustrating problem among adolescents due to its high recurrence rate. The rhomboid excision and Limberg flap techniques promise ...successful results, but the lower part of the incision left on the intergluteal sulcus is prone to recurrences. Consequently, we have developed a new modification to this technique and have designed a descriptive prospective study to evaluate its efficiency. Methods We conducted this prospective study between March 2011 and March 2012. All of the patients who were operated on for sacrococcygeal pilonidal disease were included in this study. The surgical procedure primarily consisted of symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap in order to keep the inferior corner of the suture line apart from the intergluteal sulcus. Results A total of 15 adolescents (8 boys and 7 girls) were included in the study group. Of the patients, 47% were normal, 13% were overweight, and 40% were obese. Five patients were operated on under general anesthesia, and 10 were operated on under spinal anesthesia. The length of the flap margins ranged from 2.5 to 7 cm (median = 4 cm). The median duration of hospitalization was 5 days, and the median duration of suction drainage was 4 days. The median postoperative follow-up period was 4 months (ranging from 1 to 12 months), and we did not encounter any wound infection or recurrent disease during this period. Only one patient had wound hematoma as a result of drain breakdown and was treated with wound care without any additional complications. Conclusion Although the number of patients in this study was small and the follow-up period was short, we obtained satisfactory results without any recurrence by performing a symmetrically rotated rhomboid excision and lateralized Limberg flap procedure.
A rare case of imperforate hymen associated with bicornuate uterus in an infant is presented as a cause of bilateral hydroureteronephrosis and pelvic mass in infancy. The importance of postoperative ...radiologic evaluation for diagnosis of accompanying uterine abnormalities is introduced. A 8-month-old girl with restlessness and intermittent fever was brought to the daily outpatient clinic by her parents. Ultrasound exam showed bilateral grade 4 hydroureteronephrosis and a large cystic pelvic mass. Magnetic resonance scan of the pelvis revealed marked hematocolpos. A cruciate incision was made over the hymen under general anesthesia. During a 6-month followup gradual resolution of bilateral hydroureteronephrosis was documented. Although the details of the uterine anomaly were obscured in preoperative imaging, postoperative US and MR demonstrated bicornuate uterus. Postoperative pelvic radiologic examination is highly recommended to verify the resolution of hematocolpos and to screen for any concomitant anomalies that can have long-term clinical significance.
Purpose
Autonomic nervous system dysfunction exists in autoimmune diseases. Symptoms of autoimmune gastritis are not specific, and some patients may present symptoms suggestive of delayed gastric ...emptying. This study aims to investigate whether any autonomic dysfunction exists in autoimmune gastritis patients, and if so, to clarify the relationship between the autonomic nervous dysfunction, delayed gastric emptying, and gastrointestinal symptoms.
Methods
75 patients (50 women, mean age 56.73 ± 11.77) diagnosed with autoimmune gastritis were investigated by means of autonomic nervous system and gastric emptying tests. All patients underwent a standardized scintigraphic gastric emptying study and five tests evaluating autonomic nervous system. Patients with autonomic nervous system dysfunction were then analyzed and compared by means of existence of delayed gastric emptying and gastrointestinal symptoms.
Results
62 patients had autonomic nervous system dysfunction (14 mild, 40 moderate, and 8 severe autonomic dysfunction). The mean total score of autonomic tests was 3.85 ± 2.35. Total autonomic score of patients (
n
= 60) with delayed gastric emptying was significantly higher than patients (
n
= 15) with normal gastric emptying (4.68 ± 1.7 vs. 1.53 ± 0.58,
p
< 0.001). Mean gastroparesis cardinal symptom index was significantly higher in patients (
n
= 60) with delayed gastric emptying half-time compared to patients (
n
= 15) with normal gastric emptying half-time (1.89 ± 1.16 vs 0.4 ± 0.3,
p
< 0.001).
Conclusions
Most of patients with autoimmune gastritis also have autonomic nerve dysfunction. There is a close relationship between autonomic nervous system dysfunction and delayed gastric emptying. Gastroparesis cardinal symptom index has a high sensitivity and specificity in predicting both autonomic nerve function and delay in gastric emptying.
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