RESUMO
En este reporte presentamos tres pacientes en quienes ocurrieron condiciones inflamatorias perianales tardías, luego de la administración de sustancias modeladoras no identificadas en los glúteos. El diagnóstico inicial y supuesto no fue correcto, ya que no se investigó durante la evaluación preliminar el antecedente de la administración de elementos modeladores. Recomendamos que los pacientes con patologías inflamatorias del ano, sobre todo aquellos cuyo curso es extraño, se les pregunte acerca de la administración de agentes modeladores en los glúteos. Esta práctica puede contribuir a la eficacia del diagnóstico de manifestaciones perianales caracterizadas por flogosis, que se presentan de forma inusual. (AU)
In this report we present three patients in which late perianal inflammatory conditions occurred after administration of unidentified modeling agents to the buttocks. The initial diagnosis was not correct because of the administration of modeling agents was not investigated during the initial eval-uation. We recommend inquiring patients with inflammatory pathologies of the anus, especially those whose course is unusual, about the adminis-tration of modeling agents to the buttocks. This approach can contribute to the efficiency of the diagnosis of perianal complaints characterized by inflammation, but rare in its appearance. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças do Ânus/cirurgia , Doenças do Ânus/etiologia , Biopolímeros/efeitos adversos , Nádegas/cirurgia , Doenças do Ânus/diagnóstico , Técnicas Cosméticas , Migração de Corpo Estranho , Implantação de Prótese/efeitos adversosRESUMO
Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.
Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Doenças do Ânus/terapia , Condiloma Acuminado/terapia , Antivirais/uso terapêutico , Doenças do Ânus/cirurgia , Doenças do Ânus/tratamento farmacológico , Papillomaviridae , Condiloma Acuminado/cirurgia , Condiloma Acuminado/tratamento farmacológico , Demografia , Estudos Retrospectivos , Infecções por Papillomavirus/terapia , Estimativa de Kaplan-Meier , Aminoquinolinas/uso terapêuticoAssuntos
Doenças do Ânus/cirurgia , Desbridamento , Drenagem , Gangrena de Fournier/cirurgia , Radiografia Intervencionista , Antibacterianos/uso terapêutico , Doenças do Ânus/diagnóstico por imagem , Doenças do Ânus/microbiologia , Doenças do Ânus/patologia , Terapia Combinada , Gangrena de Fournier/diagnóstico por imagem , Gangrena de Fournier/microbiologia , Gangrena de Fournier/patologia , Humanos , Masculino , Resultado do Tratamento , Adulto JovemRESUMO
AIM: The aim of the study was to evaluate urgent care practice with regard to anorectal abscesses (AA) in a tertiary-level referral hospital. MATERIALS AND METHODS: this was retrospective and unicentric study. Patients who underwent surgery for AA between 2016 and 2017 were included in the study. Demographic variables were analyzed as well as the treatment performed, the need for hospitalization, use of antibiotics, and referral to the coloproctology outpatient department (COD). The recurrence risk factors were also evaluated. RESULTS: A total of 220 evaluations under anesthesia were performed, corresponding to 190 patients, 129 males (mean age 46 ± 14.9 years). The most frequent treatment in the emergency department (ED) was simple drainage (75.8%). Antibiotic therapy was prescribed in 62.9% of the cases. A total of 41.1% of the patients were referred to a specialized COD. The only risk factor associated with recurrence was the presence of an associated anal fistula. CONCLUSIONS: Anorectal abscesses are very frequent in the ED. There is great clinical variability regarding the taking of cultures, prescription of antibiotics, and referral criteria to a specialized coloproctology outpatient department, without clear impact of any of them on the recurrence of the abscess.
OBJETIVO: Evaluar el manejo de los abscesos perianales por parte del servicio de cirugía de urgencias. MÉTODO: Estudio unicéntrico retrospectivo. Se incluyeron pacientes que requirieron manejo quirúrgico de abscesos perianales de 2016 a 2017. Se analizaron variables demográficas, tratamientos realizados, necesidad de ingreso hospitalario, uso de antibióticos y necesidad de derivación a la consulta externa de coloproctología. Así mismo, se evaluaron los factores relacionados con la recurrencia del absceso. RESULTADOS: Durante el periodo de estudio se realizaron 220 exploraciones, correspondientes a 190 pacientes (129 hombres) con una edad media de 46 ± 14.9 años. El tratamiento quirúrgico más frecuentemente realizado fue el drenaje simple (75.8%). Se prescribieron antibióticos en el 62.9% de los casos. El 41.1% de los pacientes fueron remitidos a consulta externa de coloproctología. El único factor de riesgo asociado a la recurrencia fue la presencia de una fístula perianal asociada. CONCLUSIONES: Los abscesos perianales son frecuentes en los servicios de urgencias. Hay una gran variabilidad clínica en su manejo, sobre todo en lo relativo a la realización de cultivos, la prescripción de antibióticos y la derivación a unidades de coloproctología especializadas, sin que ninguna de estas medidas tenga un claro impacto en la recurrencia.
Assuntos
Doenças do Ânus , Fístula Retal , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Assistência Ambulatorial , Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/cirurgia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCCIÓN: Se presenta nuestra experiencia en cirugía ambulatoria en patología proctológica. MATERIALES Y MÉTODO: La serie corresponde al análisis de 1.399 pacientes tratados entre agosto de 2003 y diciembre de 2017 en forma prospectiva, RESULTADOS: Fueron intervenidos por fístula anorrectal (20%), enfermedad hemorroidaria (19%), enfermedad pilonidal sacro coccígea (EPSC) (15%), fisura anal (13%), biopsia rectal quirúrgica o resección local endoanal (12%), condilomas (10%) y otras (10%). La morbilidad inmediata es de un caso, por un hematoma luego de una cirugía por EPSC que requirió hemostasia y cierre primario. La tasa de hospitalización inmediata fue de 0,3% y corresponde a 5 casos de retención aguda de orina. La hospitalización tardía fue de un 1,6% y corresponde a 22 pacientes, hospitalizados por sangrado tardío (9), dolor intratable (9) y fiebre (4). Todos fueron tratados en forma conservadora con resolución entre los 2 y 5 días. No se registra morbilidad mayor en esta serie. CONCLUSIONES: La cirugía ambulatoria en patología proctológica es factible y segura.
INTRODUCTION: We present our prospective experience in ambulatory anorectal surgery between August 2003 and December 2017. MATERIALS AND METHOD: The series corresponds to the analysis of 1399 patients treated between August 2003 and December 2017 prospectively. RESULTS: The etiology of the surgerys were anal fistula (20%), hemorrhoidal disease (19%), sacrococcygeal pilonidal disease (15%), anal fissure (13%), rectal surgical biopsy or local resection (12%), condylomata (10%) and others (10%). The immediate morbidity was seen one case, a hematoma after an EPSC surgery that required hemostasis and primary closure. The immediate hospitalization rate was 0.3% and corresponds to 5 cases of acute urinary retention. The late hospitalization was 1.6% and corresponds to 22 patients, due to late bleeding (9), severe pain (9) and fever (4). All were treated conservatively with resolution between 2 and 5 days. No major morbidity is recorded in this series. CONCLUSION: We concluded that outpatient surgery in proctologic pathology is feasible and safe.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Doenças Retais/cirurgia , Cirurgia Colorretal/métodos , Procedimentos Cirúrgicos Ambulatórios/métodos , Doenças do Ânus/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Cirurgia Colorretal/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , HospitalizaçãoRESUMO
OBJECTIVES: We conducted this retrospective study to elucidate the clinical presentation and outcomes of anal abscess in chronic dialysis patients. METHODS: We performed a chart review of patients who were hospitalized for anal abscess from Jan. 2002 to Dec. 2015. A total of 3,074 episodes of anal abscess were identified. Of these, 43 chronic dialysis patients with first-time anal abscess were enrolled. Patients were divided into a surgical group and a nonsurgical group according to the treatment received during hospitalization. The baseline characteristics, clinical findings, treatments and outcomes were obtained and analyzed. The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence. RESULTS: Of the 43 patients, 27 (62.7%) received surgical treatment, and 16 (37.2%) received antibiotic treatment alone. There was no significant difference in age, sex, body mass index, smoking habits, comorbidities, or dialysis characteristics between the two groups. Perianal abscess was the most common type of anal abscess, and 39.5% of patients experienced fistula formation. Most patients had mixed aerobic and anaerobic flora. Our data demonstrate that there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082). CONCLUSION: In chronic dialysis patients with anal abscess, there was no statistically significant difference in clinical presentation and outcomes between the surgical and nonsurgical groups, although the surgical group had a trend of better in-hospital survival.
Assuntos
Abscesso/epidemiologia , Doenças do Ânus/epidemiologia , Falência Renal Crônica/epidemiologia , Abscesso/complicações , Abscesso/cirurgia , Idoso , Doenças do Ânus/complicações , Doenças do Ânus/cirurgia , China/epidemiologia , Feminino , Fissura Anal/complicações , Fissura Anal/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/complicações , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recidiva , Diálise Renal , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVES: We conducted this retrospective study to elucidate the clinical presentation and outcomes of anal abscess in chronic dialysis patients. METHODS: We performed a chart review of patients who were hospitalized for anal abscess from Jan. 2002 to Dec. 2015. A total of 3,074 episodes of anal abscess were identified. Of these, 43 chronic dialysis patients with first-time anal abscess were enrolled. Patients were divided into a surgical group and a nonsurgical group according to the treatment received during hospitalization. The baseline characteristics, clinical findings, treatments and outcomes were obtained and analyzed. The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence. RESULTS: Of the 43 patients, 27 (62.7%) received surgical treatment, and 16 (37.2%) received antibiotic treatment alone. There was no significant difference in age, sex, body mass index, smoking habits, comorbidities, or dialysis characteristics between the two groups. Perianal abscess was the most common type of anal abscess, and 39.5% of patients experienced fistula formation. Most patients had mixed aerobic and anaerobic flora. Our data demonstrate that there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082). CONCLUSION: In chronic dialysis patients with anal abscess, there was no statistically significant difference in clinical presentation and outcomes between the surgical and nonsurgical groups, although the surgical group had a trend of better in-hospital survival.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doenças do Ânus/epidemiologia , Abscesso/epidemiologia , Falência Renal Crônica/epidemiologia , Doenças do Ânus/cirurgia , Doenças do Ânus/complicações , Recidiva , China/epidemiologia , Taxa de Sobrevida , Estudos Retrospectivos , Diálise Renal , Resultado do Tratamento , Abscesso/cirurgia , Abscesso/complicações , Fissura Anal/cirurgia , Fissura Anal/complicações , Hospitalização/estatística & dados numéricos , Falência Renal Crônica/complicações , Tempo de Internação/estatística & dados numéricosAssuntos
Humanos , Doenças do Ânus/cirurgia , Doenças do Ânus/epidemiologia , Doenças Retais/cirurgia , Doenças Retais/epidemiologia , Doença de Crohn/terapia , Doença de Crohn/epidemiologia , Períneo/patologia , Estomia , Doença de Crohn/diagnóstico , Fístula Retal/cirurgia , Fístula Retal/terapia , Fístula Retovaginal/cirurgia , Resultado do Tratamento , Terapia Combinada , Abscesso/diagnóstico , Abscesso/terapiaRESUMO
Introducción: La realización en régimen de cirugía mayor ambulatoria (CMA) de procedimientos proctológicos complejos es aún infrecuente en nuestro medio. El objetivo del presente trabajo es presentar los resultados iniciales de un programa de cirugía proctológica en régimen de CMA que incluye procedimientos complejos tales como esfinteroplastias o colgajos de avance rectal. Material y métodos: Se realizó un estudio descriptivo retrospectivo en el que se incluyeron 186 pacientes intervenidos de patología proctológica en un programa de CMA. El programa se basó en la unión de una Unidad de Coloproctología con amplia experiencia en cirugía proctológica y una Unidad de CMA ya establecida en el centro. Se analizaron los resultados tanto de ingreso como de reintervención en el postoperatorio inmediato y precoz. Resultados: Entre enero de 2014 y diciembre de 2015 se realizaron un total de 197 intervenciones, destacando 105 (53,3%) cirugías de fístula anal, 33 (16,8%) hemorroidectomías y 11 (5,6%) esfinteroplastias. De los pacientes intervenidos por fístula perianal, en 25 (23,8%) se realizó un colgajo de avance rectal. Una paciente (0,5%) requirió ingreso tras la cirugía por haberse realizado un proceso más complejo del inicialmente programado, todos los demás pacientes pudieron ser dados de alta sin complicaciones. Tres pacientes (1,5%) reingresaron en el postoperatorio precoz y fueron reoperados debido a una hemorragia poshemorroidectomía, un absceso perianal y dolor anal. Conclusiones: La implementación de un programa de patología proctológica en régimen de CMA que incluya procedimientos complejos como el colgajo de avance endorrectal o la esfinteroplastia es factible, con una baja tasa de ingresos en hospitalización y reingresos posteriores.
Introduction: Complex procedures for anorectal disorders are uncommonly performed as Ambulatory Surgery (AS). The aim of this study was to describe the early results of an AS program that included complex procedures such as advancement rectal flaps for fistula repair. Material and methods: A retrospective descriptive study was performed with 186 patients who were submitted to AS because of benign anorectal disorders. The AS program for anorectal disorders started when a Colorectal Surgery Unit with broad experience in anorectal surgery joined an AS Unit that was already working in the hospital. Hospital admissions and need of early reoperation were analyzed. Results: One hundred and ninety seven procedures were performed between January 2014 and December 2015. One hundred and five (53.3%) fistula repair surgeries were performed, as well as 33 (16.8%) hemorrhoidectomies and 11 (5.6%) anal sphincter repairs. Among the patients who were operated because of an anorectal fistulae, 25 (23.8%) were submitted to advancement rectal flap. One patient (0.5%) could not be discharged after the surgery because the procedure performed was more complex than previously expected. All other patients were discharged. Three patients (1.5%) were addmited during early postoperative course, all of them had to undergo revisional surgery because of hemorrhage, pain and anorectal abscess respectively. Conclusions: Anorectal procedures, including complex procedures such as advancement rectal flap and sphincter repair, can be performed as AS with a low percentage of patients addmited before or after discharge.