Current update on the role of endoanal ultrasound: a primer for radiologists

Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and physiology of the anorectal region and has been used in pre-and post-operative settings of anorectal pathologies. EAUS is not only useful in the evaluation of benign pathologies but also in loco-regional staging of anal and rectal tumors. EAUS has several advantages over MRI, including reduced cost, better patient tolerance, and improved scope of application in patients with contraindications to MRI. Despite its benefits, EAUS is not widely performed in many centers across the globe. This article aims to educate radiologists, trainees, and surgeons about the indications, contraindications, patient preparation, imaging technique, and findings of EAUS. We will also highlight the technical difficulties, diagnostic challenges, and procedural complications encountered during EAUS, along with a comparative analysis of EAUS with other imaging approaches.

Anorectal pathology in the HIV population: a guide for radiologists

Patients with human immunodeficiency virus (HIV) can present with a wide range of different acute and chronic pathologies. Anorectal conditions are particularly common in this unique patient population, including pathologies, such as proctitis, anorectal abscess, anorectal fistula, and anal squamous cell carcinoma. The radiologist plays a critical role in the assessment of these common forms of anorectal disease, as these conditions can present with various findings on imaging assessment. Pelvic CT, MRI, and FDG-PET/CT are among the most common modalities used for assessment of anorectal disease in the HIV patient population. Knowledge of the fundamental clinical and imaging findings associated with these pathologies in HIV patients is critical for radiologists.

Reviewing perianal abscess management and recurrence: lessons from a trainee perspective

Background

Perianal abscesses are a common surgical emergency. Due to their perceived ease, drainage is often delegated to junior trainees with varying levels of experience. The purpose of this study is to evaluate the current trend in perianal abscesses management at our institution, and identify factors that predict subsequent fistula formation or abscess recurrence.

Methods

All acute patients admitted to a major teaching hospital who required surgical drainage of a perianal abscess were analysed over a two‐year period from January 2019 to December 2020. Patient demographics, clinical and laboratory findings were retrospectively reviewed. Proceduralist experience, operative management strategy and recurrence rates (fistula or abscess) were analysed.

Results

The mean age of patients was 43 years old, and 73% were male. Trainees performed 96% of the procedures. Re‐presentation with a fistula or abscess recurrence requiring further surgery was 31%. Comorbidities of IBD, diabetes, or malignancy were present in one‐third of patients and significantly increased the risk of recurrence (P = 0.01). Searching for a fistula tract was performed in 41% of cases but did not reduce recurrence (P = 0.9). Seton insertion occurred in 10%, and fistulotomy in 2%.

Conclusion

Perianal abscess drainage at our institution is almost exclusively performed by trainees, the majority of which occurs after‐hours. Patients who present with a fever, inflammatory bowel disease, diabetes mellitus or malignancy are at an increased risk of recurrent abscess or a subsequent fistula after drainage, and input from an experienced surgeon may be of value when considering seton insertion or fistulotomy.

Perianal abscess management is primarily done by trainees of varying experience. This retrospective review evaluates current trends at our institution and identify factors that predict abscess recurrence.

Utilization of “Perineal Wound Image Application” In Perineal Wound Digital Image Screening

BACKGROUND: A variety of serious conditions can affect the perineum, from infections that clear up on their own to conditions that are dangerous or add to the patient’s discomfort. Data at the level of each zone are an important factor for determining the area of wound healing. Injury investigations should include the identification of the injury, the calculation of the area of the injury which is generally important in determining treatment. AIM: This study aims to present the findings of determining the characteristics of the perineal wound category and determining the area of the wound using MATLAB programming. MATERIALS AND METHODS: The trial data in this study used 10 digital images with the development of 1000 trials and resulted in an accuracy rate of 86%. Digital image application is designed with 11 categories of perineal wounds that include assessment of wound color and characteristics. RESULTS: The use of the application was carried out by 21 midwife health workers with the results of 81% of applications making it easier for officers to classify wounds, and 85.7% stated that the application could be a guide in making decisions about perineal wound care. Determination of wound categories and perineal wound area in this program proves the ease for health workers in planning appropriate care and treatment. This makes it very easy for users to do programming so that users are not too bothered by programming logic and focus more on the logic of solving problems on a hand. CONCLUSION: The development of innovative perineal wound screening applications will provide convenience in practicality and efficiency of use in the future.

Posterior Detachment of the Anorectum Following Blunt Trauma to the Perineum

To the best of our knowledge, there have been few reports in the literature about perineal injury without an associated pelvic fracture. In this report, we are going to discuss the mechanism, management, and outcome of two cases of perineal injury associated with car accidents.

The two cases, one male and one female, presented with sustained isolated soft tissue injuries to the perineum. Both cases revealed a separated anorectum from the coccyx and sacrum without detectable damage to the lumen or surrounding sphincter. Pelvis fracture was not present in either case nor did the urinary bladder or urethra show signs of injury. A defunctioning (temporary) colostomy medical innervation was done to both and the perineal wound was left to heal. At last, both patients were satisfied with the final outcome.

Impalement injury of the perineum with an iron rod with a minimal injury: A near miss: A case report

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Perineal impalement injuries are often fatal.

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We report a perineal impalement injury by an iron rod piercing the perineum with minimal external and internal injuries.

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Urgent laparotomy to manage all the potential injuries along with effective resuscitation and prehospital care are critical.

Introduction and importance

Penetrating perineal injury in children is uncommon. However, the injury is serious and life-threatening with significant morbidity and mortality.

Case presentation

We report an unusual case of a 13-year-old boy with an accidental perineal impalement injury by an iron rod, which pierced through the perineum and exited through the left loin, however with minimal external and internal injuries.

Clinical discussion

Multiple vital organs in the pelvic space are vulnerable to damage in perineal impalement injury. Vital organ injury, amount of blood loss, and effectiveness of the resuscitation determine the outcome of an impalement injury. Urgent laparotomy forms the cornerstone in management as all the potential injuries can be identified and managed immediately.

Conclusion

Effective resuscitation and accurate assessment of the associated injuries along with proper pre-hospital care with a multidisciplinary approach is crucial for the survival and optimum outcome of the victim.