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Yetto T, Burns C. Linear IgA bullous dermatosis associated with ulcerative proctitis: treatment challenge. Dermatol Online J 2018; 24:13030/qt46421332. [PMID: 30261573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023] Open
Abstract
Linear IgA bullous dermatosis is a rare bullous disease in children and adults that can be associated with autoimmune conditions, malignancies, infections, or medication exposure. The definitive diagnosis relies on the biopsy. A 58-year-old man presented to our clinic with a pruritic vesicular and bullous eruption. Histology showed the classic findings of a subepidermal blister with neutrophilic infiltrate and linear IgA deposition along the dermal-epidermal junction. Upon further evaluation, he was diagnosed with ulcerative proctitis. His therapy was complicated owing to side effects and lack of response to the standard treatment options. Dapsone, a first-line therapy, caused symptomatic methemoglobinemia whereas niacinamide with doxycycline were not effective. He required intravenous and oral steroids to reach improvement followed by transitioning to methotrexate.
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Struyve M, Meersseman W, Van Moerkercke W. Primary syphilitic proctitis : case report and literature review. Acta Gastroenterol Belg 2018; 81:430-432. [PMID: 30350534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rectal ulcerations are an uncommon presentation of a primary syphilis infection. Anorectal syphilis is difficult to diagnose because of its often asymptomatic or atypical clinical presentation. It is important to consider sexually transmitted diseases (STD) in all patients presenting with rectal symptoms. A history of anal sexual intercourse should be made, especially in men having sex with men (MSM). Moreover, the possibility of a primary syphilis infection of the rectum should be considered. Endoscopic findings might be diverse, whereas a typical chancre can present as an anorectal ulcer associated with regional lymphadenopathy. It is important to consider other causes of anorectal ulcers, like other STD, inflammatory bowel disease (IBD) or even malignant causes. The diagnosis of anorectal syphilis is based on the combination of the clinical presentation, serology tests, endoscopic findings and biopsies. The cornerstone of the treatment is based on an intramuscularly administration of a long-acting preparation of penicillin (benzathine penicillin G).
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Harbord M, Eliakim R, Bettenworth D, Karmiris K, Katsanos K, Kopylov U, Kucharzik T, Molnár T, Raine T, Sebastian S, de Sousa HT, Dignass A, Carbonnel F. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management. J Crohns Colitis 2017; 11:769-784. [PMID: 28513805 DOI: 10.1093/ecco-jcc/jjx009] [Citation(s) in RCA: 777] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Borycka-Kiciak K, Strus M, Pietrzak P, Wawiernia K, Mikołajczyk D, Gałęcka M, Heczko P, Tarnowski W. Clinical and microbiological aspects of the use of Lactobacillus rhamnosus PL1 strains in proctological patients with symptoms of chronic proctitis. POLISH JOURNAL OF SURGERY 2017; 89:16-22. [PMID: 28703111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Recurrent proctitis and the symptoms associated therewith pose significant clinical problem in proctological patients. The objective of this study was to assess the impact of the probiotic Lactobacillus rhamnosus PL1 strain on the clinical presentation and composition of intestinal microbiota in patients with symptoms of proctitis in the course of hemorrhoidal disease and diverticulosis. Material consisted of 24 patients in whom no complete clinical improvement could be obtained after the treatment of the underlying disease. Subject to the assessment was the presence and the intensity of clinical symptoms as well as qualitative and quantitative changes in the composition of bacterial flora detected in the stool before, during and after a 9-week supplementation with the probiotic Lactobacillus rhamnosus PL1 strain. RESULTS In the entire study group, the intensity of pain after 12 weeks was significantly lower (p=0,.011) compared to baseline; the intensity of flatulence and abdominal discomfort was reduced significantly as early as after 3 weeks, with the difference reaching a highly significant level after 12 weeks (pP<0,.0001). No significant difference was observed in the frequency of the reported episodes of diarrhea, constipation, as well as itching and burning in the anal region. As early as after 3 weeks of supplementation with the probiotic L. rhamnosus PL1 strain, significant qualitative and quantitative changes were observed in the composition of intestinal microbiota; the changes differed depending on the underlying disease. An increase in the total counts of the bacteria of Lactobacillus genus, particularly L. rhamnosus PL1 strain was observed regardless of the underlying disease. CONCLUSION Tthe probiotic Lactobacillus rhamnosus PL1 strain appears to be useful in restoring appropriate ratios of bacterial populations in patients presenting with symptoms of proctitis in the course of the treatment of certain diseases of the lower gastrointestinal tract.
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Richardson D, Goldmeier D. Lymphogranuloma venereum: an emerging cause of proctitis in men who have sex with men. Int J STD AIDS 2016; 18:11-4; quiz 15. [PMID: 17326855 DOI: 10.1258/095646207779949916] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Before 2003, lymphogranuloma venereum (LGV) was rare in developed nations. Several large clusters of LGV in men who have sex with men have been reported across Europe and in the United States of America (USA) since 2003. LGV is caused by L1, L2 and L3 serovars of Chlamydia trachomatis and is a sexually transmitted infection. LGV causes genital ulcers, infected inguinal lymph nodes (buboes) and proctitis/proctocolitis. Treatment with a three-week course of doxycycline prevents rectal strictures, bowel obstruction, bowel perforation and possibly death. Clinicians seeing men who have sex with men with inguinal lymphadenopathy and bowel symptoms should be aware of this current epidemic.
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Navas-Cuéllar JA, Jiménez-Rodríguez RM, Aparicio-Sánchez D, Díaz-Pavón JM, Padillo-Ruiz J, de-la-Portilla-de-Juan F. Vacuolar internal anal sphincter myophaty as a rare cause of proctalgia fugax and constipation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015; 107:52-53. [PMID: 25603337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Actis GC, Pellicano R, Rosina F. Ulcerative proctitis in out-patient practice: an unexpected clinical challenge. MINERVA GASTROENTERO 2014; 60:201. [PMID: 25176055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Nanaeva BA, Vardanian AV. [Tacrolimus in perianal manifestations of Crohn's disease]. EKSPERIMENTAL'NAIA I KLINICHESKAIA GASTROENTEROLOGIIA = EXPERIMENTAL & CLINICAL GASTROENTEROLOGY 2013:53-57. [PMID: 24294772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Domènech E, Gisbert JP. Letter: real-life management of new onset ulcerative colitis and proctitis. Aliment Pharmacol Ther 2012; 36:685-6; author reply 686. [PMID: 22966799 DOI: 10.1111/apt.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Zuccati G, Tiradritti L, Lorenzoni E, Giomi B, Mastrolorenzo A. Sexually transmitted diseases syndromic approach: proctitis. GIORN ITAL DERMAT V 2012; 147:395-406. [PMID: 23007214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Proctitis is a common problem and is most frequently associated with inflammatory bowel diseases (IBD). However, in the last ten years the incidence of infectious proctitis appears to be rising, especially in men who have sex with men. This may be due to the rise of people participating in receptive anal sex as well as the increase in sexually transmitted infections, such as those from Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus and Treponema pallidum. Recent outbreaks of lymphogranuloma venereum among homosexual men throughout Europe highlight the need to consider sexually transmitted infections in the differential diagnosis of proctitis. Symptoms of infectious proctitis can include rectal blood and mucous discharge, anorectal pain, aphtous ulcers and, sometimes, generalized lymphadenopathy and fever. A careful history and physical examination are crucial in establishing a diagnosis, eventually supported by endoscopy, histology, serology, culture and PCR. Treatment with antibiotics or antivirals is usually initiated, either empirically or after establishing a diagnosis. Coinfections, HIV testing, and treatment of sexual partners should always be considered.
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Zur E. Gastrointestinal mucositis: focus on the treatment of the effects of chemotherapy and radiotherapy on the rectum. INTERNATIONAL JOURNAL OF PHARMACEUTICAL COMPOUNDING 2012; 16:117-124. [PMID: 23050323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In an article published in the January/February 2012 issue of the International Journal of Pharmaceutical Compounding, damage to the oral mucosa, commonly referred to as oral mucositis, as a result of chemotherapy, radiotherapy, or a combination of both therapies was discussed. his article continues that discussion but in respect to the injury that these rapies cause to the gastrointestinal tract. Like oral mucositis, gastrointestinal mucositis is a significant problem in oncology, as it causes very serious pathologies along the alimentary tract, damaging the quality of life of the oncologic patient, and sometimes the damages are life-threatening. The most vulnerable organs of the gastrointestinal tract to radiation and chemotherapy toxicities are the small intestine, colon, and rectum. This article concentrates on the chronic rectum and anus toxicities of radiotherapy and escribes two compounding preparations to treat chronic radiation induced proctitis with rectal bleeding. As in oral mucositis, although substantial scientific progress has been made in learning more about this pathology, current treatments to manage gastrointestinal mucositis is inadequate.
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Vuong T, Waschke K, Niazi T, Richard C, Parent J, Liberman S, Mayrand S, Loungnarath R, Stein B, Devic S. The Value of Botox-A in Acute Radiation Proctitis: Results From a Phase I/II Study Using a Three-Dimensional Scoring System. Int J Radiat Oncol Biol Phys 2011; 80:1505-11. [PMID: 20656418 DOI: 10.1016/j.ijrobp.2010.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 03/30/2010] [Accepted: 04/02/2010] [Indexed: 11/20/2022]
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Zakharash MP, Kucher ND, Krivoruk MI, Iaremchuk IA. [Application of antiseptic decasan in purulent infections of pararectal region]. KLINICHNA KHIRURHIIA 2011:18-20. [PMID: 21698929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The results of studying of antiseptic preparation Decasan for the treatment of patients, suffering purulent infections of pararectal region, are adduced. Efficacy of Decasan was analyzed in 102 patients. The results of investigation obtained are trusting hig antiseptic efficacy of preparation, witnessing possibility of its application as a preparation of choice for the treatment of patients, suffering purulent infections of pararectal region.
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Molnár T, Farkas K, Nagy F, Wittmann T. Sexually transmitted infection as a cause of proctitis: asking about sexual orientation is more useful in the diagnosis than endoscopy or histology. JOURNAL OF GASTROINTESTINAL AND LIVER DISEASES : JGLD 2010; 19:464. [PMID: 21188347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Heyman MB, Kierkus J, Spénard J, Shbaklo H, Giguere M. Efficacy and safety of mesalamine suppositories for treatment of ulcerative proctitis in children and adolescents. Inflamm Bowel Dis 2010; 16:1931-9. [PMID: 20848454 PMCID: PMC3252049 DOI: 10.1002/ibd.21256] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment of ulcerative proctitis has not been well studied in pediatric populations. We conducted an open-label trial to evaluate the clinical efficacy of a mesalamine suppository (500 mg) to treat pediatric patients with mild to moderate ulcerative proctitis. METHODS Pediatric patients (5-17 years of age) with ulcerative proctitis were enrolled for baseline evaluations, including a flexible sigmoidoscopic (or colonoscopic) assessment with biopsies performed at study entry. Eligible patients were started on mesalamine suppositories (500 mg) at bedtime. Two follow-up visits were scheduled after 3 and 6 weeks of treatment. The dose could be increased to 500 mg twice daily at the week 3 follow-up visit if deemed appropriate by the investigator based on the Disease Activity Index (DAI) assessment. The primary outcome measure was a DAI derived from a composite score of stool frequency, urgency of defecation, rectal bleeding, and general well-being. RESULTS Forty-nine patients were included in the intent-to-treat analysis. The mean DAI value decreased from 5.5 at baseline to 1.6 and 1.5 at weeks 3 and 6, respectively (P < 0.0001). Only 4 patients had their dose increased to 500 mg twice daily at week 3. Forty-one patients experienced at least one adverse event, most of which were deemed mild and unrelated to study therapy. The most common treatment-emergent adverse events were gastrointestinal (n = 30, 61.2%). CONCLUSIONS This study showed that a daily bedtime dose of a 500 mg mesalamine suppository is safe and efficacious in children with ulcerative proctitis.
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Chattopadhyay G, Ray D, Chakravartty S, Mandal S. Formalin instillation for uncontrolled radiation induced haemorrhagic proctitis. TROPICAL GASTROENTEROLOGY : OFFICIAL JOURNAL OF THE DIGESTIVE DISEASES FOUNDATION 2010; 31:291-294. [PMID: 21568145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Radiation induced haemorrhagic proctitis is a well recognized complication of pelvic radiotherapy and its treatment is quite challenging. AIM To evaluate the efficacy of local instillation of 4% formalin in the management of uncontrolled radiation induced haemorrhagic proctitis. METHODS This prospective study included twenty-three patients who underwent formalin instillation. We documented the control of the symptoms, assessed the outcome of the treatment, presence of complications & long term results. RESULTS All patients were followed for a median of 13 months. In 15 patients, the bleeding stopped after a single treatment and in 6 after a second session. Only two patients required formalin instillation for the third time. During the follow-up period all patients were reviewed systemically with reference to the pretreatment complaints. No recurrent rectal bleeding occurred, bowel frequency was decreased and no further blood transfusion was required. CONCLUSION Local instillation of 4% formalin is an effective treatment for uncontrolled radiation induced haemorrhagic proctitis.
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Bernal-Sprekelsen JC, de las Marinas MD, Salvador A, Landete FJ, Morera FJ. Recurrent pericarditis in a patient with ulcerative proctitis due to mesalazine suppositories. Int J Colorectal Dis 2010; 25:1143-4. [PMID: 20237787 DOI: 10.1007/s00384-010-0921-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2010] [Indexed: 02/04/2023]
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Kanaev SV, Baranov SB. [Ten-year experience with use of Tantum Rosa drug for prevention and therapy of radiation-related rectitis and vaginitis in uterine and vaginal cancer]. VOPROSY ONKOLOGII 2010; 56:715-718. [PMID: 21395131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Sharma B, Kumar R, Singh KK, Chauhan V. Intrarectal application of formalin for chronic radiation proctitis: a simple, cheap and effective treatment. TROPICAL GASTROENTEROLOGY : OFFICIAL JOURNAL OF THE DIGESTIVE DISEASES FOUNDATION 2010; 31:37-40. [PMID: 20860224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Chronic radiation proctitis is known to be a difficult to treat condition. Argon Plasma Coagulation (APC) though being effective requires prolonged sessions and has limited availability. Formalin, by virtue of its chemical cauterizing effects, has been found to be effective in patients with bleeding radiation cystitis and hemorrhagic proctitis. Our goal was to study the effectiveness of 4% formalin instillation in resistant patients of chronic hemorrhagic radiation proctitis. METHODS 13 patients with chronic radiation proctitis were treated with instillation of 50 mi 4% formalin into the rectum (3 minutes for 3 times). The total mucosal contact time was approximately 10 minutes. Their clinical response, tolerance to treatment and complications were assessed. Patients who did not have complete response were given another session(s) a week later. RESULTS The mean (SD) age of patients was 48.62 +/- 11.66 years. Twelve patients (92%) were female who received radiotherapy for carcinoma cervix and 1(08%) was male with carcinoma prostate. The overall clinical response rate was 100%; eight patients (61.5%) had complete cessation of bleeding while 5 patients (38.5%) had significant cessation of bleeding. Eight patients needed only one session, four needed 2 sessions and one patient needed 3 sessions for the clinical response. Serious complications were not observed. No recurrence of symptoms was seen during follow-up. CONCLUSION The treatment of hemorrhagic radiation proctitis with local formalin instillation is effective, well tolerated, inexpensive, technically simple and safe procedure.
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Caselli M G, Pinedo M G, Zúñiga D A, Alvarez L M. [Active and refractory ulcerative proctitis: an update]. Rev Med Chil 2010; 138:109-116. [PMID: 20361160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Ulcerative colitis (UC) is a chronic inflammatory disease of unknown etiology that affects a variable length of the colon, starting from the rectum. When the disease is confined to the rectum is called ulcerative proctitis (UP). Several studies have unsuccessfully attempted to determine the factors that determine the extent of involvement. The goals of therapy in UP are to induce and maintain remission of symptoms and disease. Topical treatment with 5-aminosalicylates (5-ASA) is the treatment of choice to induce remission. In the maintenance phase, long-term follow up studies suggest that treatment with 5-ASA is better than placebo, to maintain the disease inactive. For those patients that do not respond to treatment with topical 5-ASA or have a moderate to severe disease, there are additional therapies such as oral 5-ASA, topical or systemic corticosteroids, immunomodulators, biological therapies (Infliximab) and cyclosporine. Surgery is seldom needed.
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Garrido A, Giráldez A, Pareja F, Márquez JL. [Topical formalin treatment of radiation-induced hemorrhagic proctitis]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2009; 101:735-736. [PMID: 19899945 DOI: 10.4321/s1130-01082009001000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Kiszka-Kanowitz M, Jensen JS. [Picture of the month: lymphogranuloma venereum]. Ugeskr Laeger 2009; 171:622. [PMID: 19284913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Militsa NN, Toporov ID, Kozlov VB, Davydov VI, Grebennikov DS, Postolenko ND. [The treatment of an acute paraproctitis]. KLINICHNA KHIRURHIIA 2008:37-39. [PMID: 19405402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The results of surgical treatment of an acute paraproctitis in 708 patients, in 9 (1.27%) of whom gangrenous -- putrificated form of paraproctitis was diagnosed, are adduced. In 187 (42.6%) patients the abscess disclosure with intraintestinal purulent fistula, going into intestinal lumen, excision was performed, together with cryptectomy -- in 182 (41.4%), the ligature method was applied in 18 (4.1%) with subsequent fistula excision and its internal orifice plasty using mucosal-submucosal flap. For extrasphincteric or transsphincteric purulent tunnel the abscess was opened and drained, its internal orifice sutured, using 'distant" removable suture. It internal orifice was not revealed there was accomplished procedure of disclosure and draining of purulent cavity, the wound sanation with insufflation of ozone-oxygen mixture. In anaerobic paraproctitis the procedure consisted of disclosure and draining of purulent cavities with necrectomy was performed. To all the patients antibacterial therapy was conducted. In 20 (4.5%) patients an acute paraproctitis recurrence had occurred, in 9 (2%) -- pararectal fistula, and in 5 (1.1%) -- the anal sphincter stage I insufficiency.
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Greisser J, Niederer-Loher A, Kernland Lang K. [Perianal erythema in a child--group A streptococci?!]. PRAXIS 2008; 97:143-145. [PMID: 18549015 DOI: 10.1024/1661-8157.97.3.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Perianal streptococcal dermatitis is a common disease. The typical clinical picture includes perianal erythema, pruritus, painful defaecation and bloody stools. The diagnosis is made by a swab taken from the affected skin with bacterial culture. Therapy consists of penicillin for 10 days. Screening for affected persons in contact with the patient is indicated because perianal streptococcal dermatitis is known to be highly contagious. Relapse is common and therefore follow-up visits are recommended. In case of relapse, a first or second generation cephalosporin may be considered.
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