Annals of Coloproctology

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Anorectal benign disease

Antibiotic use during the first episode of acute perianal sepsis: a still-open question: Stanislas Blondin, David Lobo, Axel Egal, Saliha Ysmail-Dahlouk, Milad Taouk, Josée Bourguignon, David Blondeel, Isabelle Etienney; Ann Coloproctol. 2025;41(1):40-46. Published online February 3, 2025; DOI: https://doi.org/10.3393/ac.2024.00472.0067

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Abstract PDF: Purpose
The role of antibiotics in preventing fistula formation following an initial abscess remains a subject of debate. This study compared the incidence of fistula in ano in patients experiencing their first episode of acute perianal sepsis, with and without antibiotic therapy, and evaluated the prevalence of fistula in ano necessitating surgical intervention at 1 year.
Methods
This retrospective cohort study was conducted at a tertiary care hospital with a dedicated proctology department. All patients who presented to the emergency proctology unit with a first episode of acute perianal sepsis were eligible for inclusion.
Results
This study included 276 patients. At 1 year, fistula formation was identified in 65.6% of all patients, 54.0% of those who had received antibiotics, and 75.0% of those who had not (P<0.001). This finding remained significant after weighted propensity analysis (odds ratio, 0.53; 95% confidence interval, 0.31–0.92; P=0.025).
Conclusion
The rate of fistula formation was relatively high in this study. However, it was lower among patients with perianal sepsis who were treated with antibiotics, although a causal relationship could not be established. Prolonged follow-up is needed to clarify the role of antibiotic therapy in preventing or delaying fistula development in patients with acute perianal sepsis.

Diagnosis and Management of a Cryptoglandular Actinomycotic Fistula-in-Ano: An Update on 7 New Cases and a Review of the Literature: Axel Egal, Isabelle Etienney, Heym Beate, Jean Francois Fléjou, Charles André Cuenod, Patrick Atienza, Pierre Bauer; Ann Coloproctol. 2018;34(3):152-156. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.07.23

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Abstract PDF

Purpose
Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001.
Methods
This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris.
Results
From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study. The main symptom was an acute painful ischioanal abscess. One patient exhibited macroscopic small yellow granules (“sulfur granules”), another “watery pus” and a third subcutaneous gluteal septic metastasis. All patients were overweight (body mass index ≥ 25 kg/m²). Histological study of surgically excised tissue established the diagnosis. All the patients were managed with a combination of classical surgical treatment and prolonged antibiotic therapy. No recurrence was observed during follow-up, the median follow-up being 3 years.
Conclusion
Actinomycosis should be suspected particularly when sulfur granules are present in the pus, patients have undergone multiple surgeries or suppuration has an unusual aspect. Careful histological examination and appropriate cultures of pus are needed to achieve complete eradication of this rare, but easily curable, disease.

Citations

Citations to this article as recorded by

Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Development of a new patient-reported outcome measure for complex cryptoglandular fistulas (20-Item complex cryptoglandular fistula questionnaire™): a qualitative study
Jeffrey D. McCurdy, Patrick Crooks, Chad Gwaltney, Robert Krupnick, Kathy-Ann Cadogan, Chitra Karki
Journal of Patient-Reported Outcomes.2024;[Epub] CrossRef
Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature
Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith
Annals of Coloproctology.2021; 37(5): 269. CrossRef

The Use of a Staged Drainage Seton for the Treatment of Anal Fistulae or Fistulous Abscesses: Cheong Ho Lim, Hyeon Keun Shin, Wook Ho Kang, Chan Ho Park, Sa Min Hong, Seung Kyu Jeong, June Young Kim, Hyung Kyu Yang; J Korean Soc Coloproctol. 2012;28(6):309-314. Published online December 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.6.309

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29 Citations

Abstract PDF

Purpose

The aim of this retrospective study was to evaluate the rate of recurrence and incontinence after the treatment of fistulae or fistulous abscesses by using the staged drainage seton method.

Methods

According to the condition, a drainage seton alone or a drainage seton combined with internal opening (IO) closure and relocation of the seton was used. After a period of time, the seton was changed with 3-0 nylon; then, after another period of time, the authors terminated the treatment by removing the 3-0 nylon. Telephone interviews were used for follow-up. The following were evaluated: the relationship between the type of fistula and recurrence; the relationship between the type of fistula and the period of treatment; the relationship between the recurrence and presence of abscess; the relationship between IO closure and recurrence; the relationship between the period of seton change and recurrence; reported continence for flatus, liquid stool, and solid stool.

Results

The recurrence rate of fistulae or suppuration was 6.5%, but for cases of horseshoe extension, the recurrence rate was 57.1%. The rate of recurrence was related to the type of fistula (P = 0.001). Incontinence developed in 3.8% of the cases. No statistically significant relationship was found between the rate of recurrence and the presence of an abscess or between the closure of the IO and the period of seton change or removal.

Conclusion

In the treatment of anal fistulae or fistulous abscesses, the use of a staged drainage seton can reduce the rate of recurrence and incontinence.

Citations

Citations to this article as recorded by

Efficacy and safety of video-assisted anal fistula treatment in anorectal fistula: a meta-analysis
Chunqiang WANG, Tianye HUANG, Xuebing WANG
Minerva Gastroenterology.2024;[Epub] CrossRef
Loose seton in the treatment of transsphincteric anal fistulas complicated by additional fistula tracks (randomized trial)
A. G. Khitaryan, A. Z. Alibekov, A. A. Golovina, S. A. Adizov, X. S. Oplimakh
Koloproktologia.2024; 23(4): 94. CrossRef
A Large Study on Lifestyle Factors Increasing Probability of Fistula and Factors Responsible for Recurrent Fistula
Hitender Suri, Deepika Suri, Kamalpreet Bansal, Sauvik Suri, Virendera Ghodke
International Journal of Medical and Oral Research.2022; 7(1): 4. CrossRef
Fistula in Ano: Evolution of Treatment and Present Scenario
Nisar A. Chowdri
Indian Journal of Colo-Rectal Surgery.2022; 5(3): 37. CrossRef
Ambulatory seton placement followed by fistulotomy: efficacy and safety for perianal fistula treatment
Verónica Gamelas, Guilherme Simões, Sara Santos, Rafaela Loureiro, Isabel Seves, João Costa Simões, Maria João Bettencourt
European Journal of Gastroenterology & Hepatology.2021; 33(7): 956. CrossRef
Influence of the cotton and silastic seton on the distance of the anal sphincter cables after fistulotomy in rats
Ana Laura Sanches Lima, Beatriz Schorro Gianini, Bruna Miranda Santana, Carlos Henrique Marques dos Santos, Doroty Mesquita Dourado, Juliano Seger Falcão, Lucas Bannwart, Sara Jéssica Falcão Câmara
Journal of Coloproctology.2020; 40(01): 056. CrossRef
How to deal with complex anal fistula in an immunosuppressed patient
Marie S. De Robles, Robert D. R. Winn
ANZ Journal of Surgery.2020; 90(9): 1764. CrossRef
Relocation and silastic tension only (RASTO) procedure for very long anal fistula tracts: Initial case series with results of a new surgical technique
John Alfred Carr
International Journal of Surgery Open.2020; 26: 1. CrossRef
Comparison of the Efficacy of the Various Treatment Modalities in the Management of Perianal Crohn’s Fistula: A Review
Shah Huzaifa Feroz, Asma Ahmed, Abilash Muralidharan, Pragatheeshwar Thirunavukarasu
Cureus.2020;[Epub] CrossRef
Nigam′s Modified Roeder′s Knot in Cutting Seton in High Fistula-in-ano Prevents Rethreading and Reapplication of Seton
VK Nigam, Siddharth Nigam
World Journal of Colorectal Surgery.2020; 9(4): 64. CrossRef
Loose Seton Technique as a Conventional Procedure for the Treatment of Anal Fistula and Long-Term Results
Hasan Calis
Acta Medica Alanya.2019; 3(1): 67. CrossRef
Ligature method for the treatment of anal fistula: a modern view on the old approach (literature review)
A. I. Musin, E. V. Antipova, A. A. Ulyanov, D. E. Kuznetsov
Grekov's Bulletin of Surgery.2019; 178(2): 79. CrossRef
Drainage Seton Versus External Anal Sphincter–Sparing Seton After Rerouting of the Fistula Tract in the Treatment of Complex Anal Fistula: A Randomized Controlled Trial
Waleed Omar, Abdallah Alqasaby, Mahmoud Abdelnaby, Mohamed Youssef, Mostafa Shalaby, Mohamed Anwar Abdel-Razik, Sameh Hany Emile
Diseases of the Colon & Rectum.2019; 62(8): 980. CrossRef
What every PA needs to know about anorectal pain
Yasmine Hubbard, Denise Rizzolo
JAAPA.2019; 32(1): 1. CrossRef
Draining Setons as Definitive Management of Fistula-in-Ano
Oluwatomilayo O. Daodu, Julia O’Keefe, John A. Heine
Diseases of the Colon & Rectum.2018; 61(4): 499. CrossRef
Gender-based analysis of the characteristics and outcomes of surgery for anal fistula: analysis of more than 560 cases
Sameh Hany Emile, Hesham Elgendy, Ahmad Sakr, Mohamed Youssef, Waleed Thabet, Waleed Omar, Wael Khafagy, Mohamed Farid
Journal of Coloproctology.2018; 38(03): 199. CrossRef
The treatment of anal fistula: secondACPGBIPosition Statement – 2018
G. Williams, A. Williams, P. Tozer, R. Phillips, A. Ahmad, D. Jayne, C. Maxwell‐Armstrong
Colorectal Disease.2018; 20(S3): 5. CrossRef
Seton drainage in sphincter-sparing treatment of rectal fistulas
A. I. Musin, I. V. Kostarev
Khirurgiya. Zhurnal im. N.I. Pirogova.2018; (8): 65. CrossRef
High ligation of the anal fistula tract by lateral approach: A prospective cohort study on a modification of the ligation of the intersphincteric fistula tract (LIFT) technique
Wook Ho Kang, Hyung Kyu Yang, Han Jeong Chang, Yong Taek Ko, Byung Eun Yoo, Cheong Ho Lim, Jae Kwan Hwang, Young Chan Lee, Hyeon Keun Shin, Hae Jung Son
International Journal of Surgery.2018; 60: 9. CrossRef
Anal Fistula Laser Closure: the length of fistula is the Achilles’ heel
A. Lauretta, N. Falco, E. Stocco, R. Bellomo, A. Infantino
Techniques in Coloproctology.2018; 22(12): 933. CrossRef
Video-Assisted Anal Fistula Treatment (VAAFT) for Complex Anal Fistula: A Preliminary Evaluation in China
Hui-hong Jiang, Hai-long Liu, Zhen Li, Yi-hua Xiao, A-jian Li, Yi Chang, Yong Zhang, Liang Lv, Mou-bin Lin
Medical Science Monitor.2017; 23: 2065. CrossRef
Predictive factors for recurrence of high transsphincteric anal fistula after placement of seton
Sameh Hany Emile, Hossam Elfeki, Waleed Thabet, Ahmed Sakr, Alaa Magdy, Tito M Abd El-Hamed, Waleed Omar, Wael Khafagy
Journal of Surgical Research.2017; 213: 261. CrossRef
Retrospective analysis of patients submitted to surgical treatment of perianal fistula in Santa Marcelina Hospital, São Paulo
Isaac José Felippe Corrêa Neto, Janaína Wercka, Diego Palmeira Rangel, Eduardo Augusto Lopes, Hugo Henriques Watté, Rogério Freitas Lino Souza, Alexander Sá Rolim, Laercio Robles
Journal of Coloproctology.2017; 37(03): 193. CrossRef
Evaluation of the cutting seton as a method of treatment for perianal fistula
Salah M. Raslan, Mohammed Aladwani, Nasser Alsanea
Annals of Saudi Medicine.2016; 36(3): 210. CrossRef
Adapting fistula surgery to fistula tract and patient condition: towards a tailored treatment
I. Pascual Miguelañez, M. Alvarez Gallego, I. Rubio Perez, T. Funes Dueñas, J. A. Gazo Martinez
European Surgery.2016; 48(1): 4. CrossRef
Evaluation of the inflammatory response induced by different materials in the treatment of perianal fistulas: experimental study in rats
Mariana Ocampos Galvão, Carlos Henrique Marques dos Santos, Gustavo Ribeiro Falcão
Journal of Coloproctology.2016; 36(01): 016. CrossRef
Pulling Seton: Combination of mechanisms
Ahmad Izadpanah, Mohammad Rezazadehkermani, Seyed Mohammad Hosseiniasl, Afrouz Farghadin, Leila Ghahramani, Alimohammad Bananzadeh, Reza Roshanravan, Ahad Izadpanah
Advanced Biomedical Research.2016;[Epub] CrossRef
The role of loose seton in the management of anal fistula: a multicenter study of 200 patients
M. E. Kelly, H. M. Heneghan, F. D. McDermott, G. J. Nason, C. Freeman, S. T. Martin, D. C. Winter
Techniques in Coloproctology.2014; 18(10): 915. CrossRef
Management of Fistula-in-Ano—The Current Evidence
Parvez Sheikh, Atef Baakza
Indian Journal of Surgery.2014; 76(6): 482. CrossRef

Anal Diseases among Patients with Leukemia.: Kang, Won Kyung , Jeon, Hyo Sin , Kim, Hyung Jin , Lee, In Kyu , Jeon, Hae Myung , Lee, Myung Ah , Chang, Suk Kyun , Oh, Seong Taek; J Korean Soc Coloproctol. 2006;22(2):86-90.

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Abstract PDF: PURPOSE
Anal diseases are a common complication among patients with leukemia, and the perianal abscess may prove to be the most fatal among anal diseases. We report here the prevalence, the treatment methods, and the prognosis for anal diseases among patients with leukemia.
METHODS
Among the 310 patients who were diagnosed with and treated for leukemia between October 1999 and September 2000, we investigated the medical records of 53 patients with complications due to anal diseases.
RESULTS
Among the 310 patients with leukemia, 53 (17.1%) reported anal diseases. There were 30 patients with hemorrhoids, 15 patients with a perianal abscess, 3 patients with an anal fistula, 3 patients with a fissure and 2 patients with hemorrhoids and fistulas. Anal pain was the most common complaint. Conservative treatment improved the symptoms in 42 patients (79.2%) while surgery was necessary in the remaining 11 patients (20.8%). A hemorrhoidectomy was undertaken in 4 patients, a drainage procedure in 4 paients, and a fistulotomy in 3 patients. Throughout the study period, 6 patients died (11.3%), 3 of them with perianal abscesses. Among the 15 patients with a perianal abscess, 13 showed fever (87%), and 9 patients underwent drainage (4 surgical drainages and 5 natural drainages). E. coli was the most commonly cultured organism.
CONCLUSIONS
The incidence of anal diseases in patients with leukemia was high. Nonsurgical methods were sufficient for hemorrhoids and fistulas. For a perianal abscess, drainage should be undertaken when abscess formation is evident. When abscess formation is not evident, medical treatment is the primary modality, and surgery should be considered only when medical treatment fails to improve or worsens the patient's condition, but the prognosis is poor.

Proper Selection of Antibiotic According to the Bacterial Culture of Anorectal.: Kang, Hae Sung , Shim, Kang Sup , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 1997;13(2):247-254.

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Abstract PDF: The aim of this study was to determine the guideline of usage of antibiotics for anonectal suppurative disease. This study was conducted in consecutive 96 patients, who were taken surgical treatments for the anorectal abscess at the department of general surgery of Ewha Womans University Hospital, from January 1990 to December 1994. All subjects were classified in terms of age, gender, duration, history, associated disease, classification, location, and isolation of organism. The incidence of the anorectal abscess was highest in the 3rd and 4th decade of age and male in terms of gender. 80.3% of all patients were admitted within 10 days after onset. The most common past history of anorectal disease was the anorectal abscess(15 cases, 15.6%) and the associated systemic disease was tuberculosis(9 cases, 9.4%). The main type of anoreclal abscess was the perianal abscess(87.5%) and the most frequent location was posterior area(39.6%). In the pus culture and isolation test, 90.6% of all patients had colony formation and the most frequently cultured organism was E.coli(55 cases,57.3%), followed by Klebsiella species(15 cases,15.6%) and anaerobic Bacteroid species(14 cases,14.6%). In antibiotic sensitivity test, the 3rd generation of aminoglycoside was sensitive in 89 cases and resistant in 3 cases, and the 3rd generation of cephalosporin was sensitive in 87 cases and resistant in 5 cases. These results suggest that the 3rd generation of aminoglycoside or the 3rd generation of cephalosporin could be selected to treat the anorectal suppurative disease.

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