In recent years,with the change of rhythm and eating habits of the public,the number of patients with anorectal diseases has gradually increased,and postoperative urinary retention has also become more common.Urinary ...In recent years,with the change of rhythm and eating habits of the public,the number of patients with anorectal diseases has gradually increased,and postoperative urinary retention has also become more common.Urinary retention refers to the symptoms of anorectal diseases and is caused by improper urination and incompletion of urination due to surgical and pain causes that result in bladder and urine filling and are accompanied by lower abdominal distention and pain.In traditional Chinese medicine,acupuncture is simple and effective as a treatment.In this article,we focus on five meridians that pass through the lower abdomen Ren meridian,kidney meridian,spleen meridian,stomach meridian,and liver meridian,namely the"five meridians,"and study the mechanism of action so as to provide new therapeutic ideas for clinical acupuncture treatment of postoperative urinary retention of anorectal diseases.展开更多
Due to the special perianal location,anorectal diseases are prone to form chronic refractory wounds after surgery,with Qi(气)deficiency and blood stasis as the main cause.As a classical theory in TCM medicine,"si...Due to the special perianal location,anorectal diseases are prone to form chronic refractory wounds after surgery,with Qi(气)deficiency and blood stasis as the main cause.As a classical theory in TCM medicine,"simmering pus and forming flesh"attaches great importance to harmonizing Qi and blood in the wound healing period,which gradually achieves significant efficacy in clinical application after anorectal disease surgery.Literatures in recent years on"simmering pus and forming flesh"method being applied to postoperative wound healing in all kinds of anorectal diseases(such as anal fistula,perianal abscess,anal fissure,mixed hemorrhoid,etc.)were reviewed,and advantages and characteristics of its clinical efficacy in anorectal diseases were summarized,so as to provide reference for postoperative wound healing and repair treatment in anorectal diseases.展开更多
Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders.Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting,but pati...Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders.Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting,but patients tend not to seek medical attention due to embarrassment or fear of cancer.As a result,patients frequently present with advanced disease after experiencing significant decreases in quality of life.A number of patients with anorectal complaints are referred to gastroenterologists.However,gastroenterologists' knowledge and experience in approaching these conditions may not be sufficient.This article can serve as a guide to gastroenterologists to recognize,evaluate,and manage medically or non-surgically common benign anorectal disorders,and to identify when surgical referrals are most prudent.A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic.Topics reviewed include hemorrhoids,anal fissures,anorectal fistulas and abscesses,and pruritus ani.展开更多
Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of in...Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.展开更多
Background:Patients with Crohn’s disease(CD)are believed to have more aggressive anorectal abscess and fistula disease.We assessed the types of procedures performed and perioperative complications associated with the...Background:Patients with Crohn’s disease(CD)are believed to have more aggressive anorectal abscess and fistula disease.We assessed the types of procedures performed and perioperative complications associated with the surgical management of anorectal abscess and fistula disease in patients with and without CD.Methods:The American College of Surgeons National Surgical Quality Improvement Program database(ACS-NSQIP,2005-2010)was used to calculate 30-day outcomes using regression modeling,accounting for demographics,comorbidities and surgical procedures.ICD-9 codes for anorectal abscess or fistula were used for initial selection.Patients were then stratified,based on the presence or absence of underlying CD.Local procedures included incision and drainage of abscesses,fistulotomy and seton placement.Cutaneous fistulas were considered simple,while all others were classified as complex(-vaginal,-urethral and-vesical).Results:A total of 7,218 patients(mean age 45 years;64%male)met inclusion criteria,with underlying CD in 345(4.8%).CD patients were more likely to have a seton placed(9.9 vs 8.2%,P<0.001)and be on steroids(15.4 vs 4.3%,P<0.001).Thirty-seven percent of CD patients underwent local procedures,while 46%had a proctectomy and8%underwent diversion.Fistulotomy was more common in those without underlying CD(16 vs 11%,P<0.001).The overall complication rate after local treatment was 4.9%,with no difference between patients with and without CD(7.7 vs 4.9%,P=0.144).This was not affected by fistula type-simple(7.9 vs 3.9%,P=0.194)vs complex(33 vs 7.1%,P=0.21)—or when stratified by wound(3.8 vs 2.4%;P=0.26)or systemic complications(3.8 vs 2.5%;P=0.53).Yet,complications following emergency procedures were higher in patients with CD(21.4 vs 5.9%,P=0.047).Factors significantly associated with increased complications were Crohn’s disease(OR=8.2),lack of functional independence(OR=2.0),pre-operative weight loss(OR=2.6)and pre-operative acute renal failure(OR=5.6).Steroids were also associated with a 1.7-fold increase in complications,independent from CD.Conclusions:While most patients with anorectal abscess/fistula are treated with local procedures,proctectomy and diversion use is fairly common in those with underlying CD.Although complication rates following elective local procedures for anorectal abscess/fistula are similar in patients with and without CD,they are higher in patients on steroids and in CD patients undergoing emergent procedures.展开更多
BACKGROUND There are no studies on incidental anal ^18F-fluorodeoxyglucose(^18FDG)uptake.AIM To assess the rate and aetiologies of incidental anal ^18FDG uptake and to evaluate the correlation between ^18FDG positron-...BACKGROUND There are no studies on incidental anal ^18F-fluorodeoxyglucose(^18FDG)uptake.AIM To assess the rate and aetiologies of incidental anal ^18FDG uptake and to evaluate the correlation between ^18FDG positron-emission tomography/computed tomography(PET/CT)parameters and the diagnosis of an anorectal disease.METHODS The data from patients with incidental anal ^18FDG uptake were retrospectively analysed.Patients who underwent anorectal examinations were identified and compared to those who did not undergo examinations.Patients who were offered treatment were then identified and compared to those who did not receive treatment.RESULTS Among the 43020^18FDG PET/CT scans performed,197^18FDG PET/CT scans of 146 patients(0.45%)reported incidental anal uptake.Among the 134 patients included,48(35.8%)patients underwent anorectal examinations,and anorectal diseases were diagnosed in 33(69.0%)of these patients and treated in ^18/48(37.5%)patients.Among the examined patients,those with a pathology requiring treatment had significantly smaller metabolic volumes(MV)30 and MV41 values and higher maximal and mean standardized uptake value measurements than those who did not require treatment.CONCLUSION Incidental anal ^18FDG uptake is rare,but a reliable anorectal diagnosis is commonly obtained when an anorectal examination is performed.The diagnosis of an anorectal disease induces treatment in more than one-third of the patients.These data should encourage practitioners to explore incidental anal ^18FDG uptake systematically.展开更多
文摘In recent years,with the change of rhythm and eating habits of the public,the number of patients with anorectal diseases has gradually increased,and postoperative urinary retention has also become more common.Urinary retention refers to the symptoms of anorectal diseases and is caused by improper urination and incompletion of urination due to surgical and pain causes that result in bladder and urine filling and are accompanied by lower abdominal distention and pain.In traditional Chinese medicine,acupuncture is simple and effective as a treatment.In this article,we focus on five meridians that pass through the lower abdomen Ren meridian,kidney meridian,spleen meridian,stomach meridian,and liver meridian,namely the"five meridians,"and study the mechanism of action so as to provide new therapeutic ideas for clinical acupuncture treatment of postoperative urinary retention of anorectal diseases.
基金Scientific Research Projects of China Medical Association of Minorities (2019KYXM-Z1119-80)General Projects in Natural Sciences of Science and Technology Department of Shaanxi Province (2020JM-588)Research and Development Projects in Science and Technology of Xianyang (2018K02-97)
文摘Due to the special perianal location,anorectal diseases are prone to form chronic refractory wounds after surgery,with Qi(气)deficiency and blood stasis as the main cause.As a classical theory in TCM medicine,"simmering pus and forming flesh"attaches great importance to harmonizing Qi and blood in the wound healing period,which gradually achieves significant efficacy in clinical application after anorectal disease surgery.Literatures in recent years on"simmering pus and forming flesh"method being applied to postoperative wound healing in all kinds of anorectal diseases(such as anal fistula,perianal abscess,anal fissure,mixed hemorrhoid,etc.)were reviewed,and advantages and characteristics of its clinical efficacy in anorectal diseases were summarized,so as to provide reference for postoperative wound healing and repair treatment in anorectal diseases.
文摘Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders.Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting,but patients tend not to seek medical attention due to embarrassment or fear of cancer.As a result,patients frequently present with advanced disease after experiencing significant decreases in quality of life.A number of patients with anorectal complaints are referred to gastroenterologists.However,gastroenterologists' knowledge and experience in approaching these conditions may not be sufficient.This article can serve as a guide to gastroenterologists to recognize,evaluate,and manage medically or non-surgically common benign anorectal disorders,and to identify when surgical referrals are most prudent.A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic.Topics reviewed include hemorrhoids,anal fissures,anorectal fistulas and abscesses,and pruritus ani.
文摘Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.
文摘Background:Patients with Crohn’s disease(CD)are believed to have more aggressive anorectal abscess and fistula disease.We assessed the types of procedures performed and perioperative complications associated with the surgical management of anorectal abscess and fistula disease in patients with and without CD.Methods:The American College of Surgeons National Surgical Quality Improvement Program database(ACS-NSQIP,2005-2010)was used to calculate 30-day outcomes using regression modeling,accounting for demographics,comorbidities and surgical procedures.ICD-9 codes for anorectal abscess or fistula were used for initial selection.Patients were then stratified,based on the presence or absence of underlying CD.Local procedures included incision and drainage of abscesses,fistulotomy and seton placement.Cutaneous fistulas were considered simple,while all others were classified as complex(-vaginal,-urethral and-vesical).Results:A total of 7,218 patients(mean age 45 years;64%male)met inclusion criteria,with underlying CD in 345(4.8%).CD patients were more likely to have a seton placed(9.9 vs 8.2%,P<0.001)and be on steroids(15.4 vs 4.3%,P<0.001).Thirty-seven percent of CD patients underwent local procedures,while 46%had a proctectomy and8%underwent diversion.Fistulotomy was more common in those without underlying CD(16 vs 11%,P<0.001).The overall complication rate after local treatment was 4.9%,with no difference between patients with and without CD(7.7 vs 4.9%,P=0.144).This was not affected by fistula type-simple(7.9 vs 3.9%,P=0.194)vs complex(33 vs 7.1%,P=0.21)—or when stratified by wound(3.8 vs 2.4%;P=0.26)or systemic complications(3.8 vs 2.5%;P=0.53).Yet,complications following emergency procedures were higher in patients with CD(21.4 vs 5.9%,P=0.047).Factors significantly associated with increased complications were Crohn’s disease(OR=8.2),lack of functional independence(OR=2.0),pre-operative weight loss(OR=2.6)and pre-operative acute renal failure(OR=5.6).Steroids were also associated with a 1.7-fold increase in complications,independent from CD.Conclusions:While most patients with anorectal abscess/fistula are treated with local procedures,proctectomy and diversion use is fairly common in those with underlying CD.Although complication rates following elective local procedures for anorectal abscess/fistula are similar in patients with and without CD,they are higher in patients on steroids and in CD patients undergoing emergent procedures.
文摘BACKGROUND There are no studies on incidental anal ^18F-fluorodeoxyglucose(^18FDG)uptake.AIM To assess the rate and aetiologies of incidental anal ^18FDG uptake and to evaluate the correlation between ^18FDG positron-emission tomography/computed tomography(PET/CT)parameters and the diagnosis of an anorectal disease.METHODS The data from patients with incidental anal ^18FDG uptake were retrospectively analysed.Patients who underwent anorectal examinations were identified and compared to those who did not undergo examinations.Patients who were offered treatment were then identified and compared to those who did not receive treatment.RESULTS Among the 43020^18FDG PET/CT scans performed,197^18FDG PET/CT scans of 146 patients(0.45%)reported incidental anal uptake.Among the 134 patients included,48(35.8%)patients underwent anorectal examinations,and anorectal diseases were diagnosed in 33(69.0%)of these patients and treated in ^18/48(37.5%)patients.Among the examined patients,those with a pathology requiring treatment had significantly smaller metabolic volumes(MV)30 and MV41 values and higher maximal and mean standardized uptake value measurements than those who did not require treatment.CONCLUSION Incidental anal ^18FDG uptake is rare,but a reliable anorectal diagnosis is commonly obtained when an anorectal examination is performed.The diagnosis of an anorectal disease induces treatment in more than one-third of the patients.These data should encourage practitioners to explore incidental anal ^18FDG uptake systematically.
