Annals of Coloproctology

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Benign proctology,Rare disease & stoma

Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature: Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith; Ann Coloproctol. 2021;37(5):269-274. Published online October 29, 2021; DOI: https://doi.org/10.3393/ac.2021.00332.0047

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Actinomycosis is a serious suppurative, bacterial infection caused by the gram-positive anaerobic Actinomyces species. Primary perianal actinomycosis is rare and challenging for the colorectal surgeon. We aimed to present our experience and compare this with available literature. All patients with isolated Actinomyces on microbiology reports, between January 2013 and February 2021, were identified and reviewed. Data collection was retrospective based on electronic patient records. The site of infection and treatment strategy were examined. Perianal cases were evaluated in depth. All publications available in the literature were interrogated. Fifty-nine cases of positive actinomycosis cultures were reviewed. Six cases of colonization were excluded. Actinomyces turicensis was the most common organism isolated. Five cases of perianal actinomycosis were identified requiring prolonged antibiotic and surgical therapy. Twenty-one studies, most case reports, published since 1951 were also reviewed. Diagnosis of perianal actinomycosis may be challenging but should be suspected particularly in recurrent cases. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium. An extended course of antibiotic therapy (months) is required for eradication in certain cases.

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Actinomyces Species As Emerging Pathogens: An Observational Study of Clinical Infections and Microbiological Implications
Abraham A Ayantunde, Joanne Kiang, Nadeem S Raja, Javeed Ahmed, Anjali Sanghera, Saumya Venkatesha, Andrew C Ekwesianya
Cureus.2025;[Epub] CrossRef
Imaging of perineal suppurations: a pictorial essay
Mohamed Amine Haouari, Chloé Gallégo, Vincent de Parades, Charlotte Fite, Caroline Touloupas, Alexandre Delpla, Isabelle Bouley-Coletta, Marc Zins
Abdominal Radiology.2025;[Epub] CrossRef
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
Colonic actinomycosis masquerading a cancer resulting complete bowel obstruction-a case report
Lilamani Rajthala, Santosh Sirpaili, Krishna Mohan Adhikari
International Journal of Surgery Case Reports.2024; 125: 110563. CrossRef
Letter to the Editor: Actinomyces turicensis Causing Fournier Gangrene
Kaiying Wang, Thomas Zheng Jie Teng, Vishal G. Shelat
Surgical Infections.2022; 23(4): 411. CrossRef
Fungal perianal abscess as the initial presentation of disseminated coccidioidomycosis
Christian Olivo-Freites, Oscar E. Gallardo-Huizar, Christopher J. Graber, Kevin Ikuta
IDCases.2022; 30: e01636. CrossRef

Original Article

Benign proctology,Surgical technique

Injection of aluminum potassium sulfate and tannic acid in the treatment of fecal incontinence: a single-center observational study: Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki; Ann Coloproctol. 2022;38(6):403-408. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00248.0035

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Graphical Abstract Abstract PDF

Purpose
Perianal injection of bulking agents is an attractive treatment option for patients with mild to moderate fecal incontinence (FI). Various bulking agents have been used for injection therapy, but the optimal injection materials and methods are yet to be standardized. This study aimed to evaluate the effects of injection therapy using aluminum potassium sulfate and tannic acid (ALTA) in the management of FI.
Methods
This study included consecutive patients who underwent ALTA injection therapy for FI at our institution. The procedure was performed with the patient in the jackknife position, under caudal epidural anesthesia. The procedure consisted of a 4-step injection to the 3 main cushions and a multipoint injection to the remaining submucosa of the anal canal.
Results
Seventy-seven patients (mean age, 76 years) were enrolled in the study. The mean Cleveland Clinic incontinence score of 11.9 ± 4.1 at baseline significantly improved to 7.3 ± 5.2 at 3 months following treatment. The mean maximal resting pressure also increased significantly 3 months after the intervention. Postoperative complications were observed in 3 patients (3.9%), and all events were mild. The mean duration of postoperative follow-up was 17.5 months. The cumulative recurrence-free rate at 3 years was 72.4%.
Conclusion
ALTA injection for FI is safe, easy to perform, and provides reasonable mid-term outcomes. Moreover, concomitant anorectal diseases that may be contraindicated by other injectable bulking agents could be treated simultaneously. Therefore, ALTA injection is a promising alternative in the absence of other injectable agents.

Citations

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Effective non-surgical treatment of hemorrhoids with sclerosing foam and novel injection device
Juan Cabrera Garrido, Gonzalo López González
Gastroenterology & Endoscopy.2024; 2(4): 176. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Akane Ito, Kenji Watanabe, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2024; 8(4): 331. CrossRef
Simple Anal Reinforcement with Anal Encirclement Using an Artificial Ligament in Patients with fecal Incontinence: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki
Journal of the Anus, Rectum and Colon.2022; 6(3): 174. CrossRef

Case Reports

Benign proctology

Anal Gland/Duct Cyst: A Case Report: Guh Jung Seo, Ju Heon Seo, Kyung Jin Cho, Hyung-Suk Cho; Ann Coloproctol. 2020;36(3):204-206. Published online January 20, 2020; DOI: https://doi.org/10.3393/ac.2018.09.06.1

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1 Citations

Abstract PDF

Anal gland/duct cyst (AGC) is rare and observed in only 0.05% of patients undergoing anal surgery. AGC is thought to be a retention cyst in the anal gland and arises when an obstruction of the anal duct causes fluid collection in the anal gland. We report a case of AGC in a 66-year-old woman without anal symptoms. Found by colonoscopy, the AGC was excised transanally. The histopathology of the specimen confirmed AGC. Colonoscopists should include AGC in the differential diagnosis of anal canal mass and rule out of malignancy. Excision is recommended for definitive diagnosis and treatment.

Citations

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Cystic lesions of the retrorectal space
Ian S Brown, Anna Sokolova, Christophe Rosty, Rondell P Graham
Histopathology.2023; 82(2): 232. CrossRef

Black Anal Canal: Acute Necrosis: Sandra Barbeiro, Catarina Martins, Cláudia Gonçalves, Paulo Alves, Inês Gil, Manuela Canhoto, Filipe Silva, Isabel Cotrim, Cristina Amado, Liliana Eliseu, Helena Vasconcelos; Ann Coloproctol. 2016;32(4):156-158. Published online August 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.4.156

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Abstract PDF: Acute ischemia of the rectum or anal canal resulting in necrosis is extremely uncommon because both the rectum and the anal canal have excellent blood supplies. We present a case with spontaneous necrosis of the anal canal without rectal involvement. Surgical debridement was accomplished, and the recovery was uneventful. The patient was elderly, with probable atherosclerotic arterial disease, and presented with hypotension. Due to the lack of other precipitating factors, the hypoperfusion hypothesis seems to be the most suitable in this case. To the best of our knowledge, no similar cases have been reported in the literature on this subject.

Late Presentation of Anal Canal Duplication in Adults: A Series of Four Rare Cases: Rezvan Mirzaei, Bahar Mahjubi, Mina Alvandipoor, Mohammad Yasin Karami; Ann Coloproctol. 2015;31(1):34-36. Published online February 28, 2015; DOI: https://doi.org/10.3393/ac.2015.31.1.34

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10 Web of Science
11 Citations

Abstract PDF

Anal canal duplication (ACD) is a very rare condition, especially in adults. Four cases in adults are reported. In three cases, the orifice of duplication was located behind the native anus, and in one case, it was located anteriorly. In all cases, no communication between the anal canal and the tract of duplication was noted. Complete removals of the duplications were done through a perineal approach. Histology showed fibro-muscular tissue lined with a squamous epithelium. The postoperative courses were uneventful.

Citations

Citations to this article as recorded by

Anal canal duplication with heterotopic gastric mucosa and anal stenosis: first case report and literature review
Chen Liu, Chuanzhen Xu, Xiaoliang Xu, Yan Zhang, Lei Geng, Yanhui Mei, Hong Ji, Tingliang Fu, Guojian Ding
Frontiers in Pediatrics.2024;[Epub] CrossRef
Cystic lesions of the retrorectal space
Ian S Brown, Anna Sokolova, Christophe Rosty, Rondell P Graham
Histopathology.2023; 82(2): 232. CrossRef
Anal Canal Duplication in a 25-Year-Old Female Patient
Mauricio Gutierrez-Alvarez, Jorge Leal, Kevin Fuentes, Fernando Sotelo, Irving Fuentes, Daniel Camacho
Cureus.2023;[Epub] CrossRef
Anal Canal Duplication Mimicking Recurrent Abscess: A Case Report and Review of the Literature
Dandan Li, Shuaibin Liu, Jiexiong Feng, Jixin Yang
Frontiers in Surgery.2022;[Epub] CrossRef
Early Diagnosis of Anal Canal Duplication: The Importance of a Physical Examination
Ioannis Karamatzanis, Panagiota Kosmidou, Stavros Harmanis, Ioannis Karamatzanis, Giorgos Harmanis
Cureus.2022;[Epub] CrossRef
Case Report: Anal canal duplication associated with anorectal stenosis—A rare presentation
Zhen Zheng, Dong Xiao, Junxiang Wang, Haozhong Xu, Jianxiong Mao, Xiuliang Wang
Frontiers in Pediatrics.2022;[Epub] CrossRef
Anal Canal Duplication in an Adult Female—Case Report and Pathology Guiding
Tudor Mateescu, Cristi Tarta, Paul Stanciu, Alis Dema, Fulger Lazar
Medicina.2021; 57(11): 1205. CrossRef
Anal duplication: is surgery indicated? A report of three cases and review of the literature
A. C. Trecartin, A. Peña, M. Lovell, J. Bruny, C. Mueller, M. Urquidi, Andrea Bischoff
Pediatric Surgery International.2019; 35(9): 971. CrossRef
Anal Canal Duplication Associated with Presacral Cyst in an Adult
Takayuki Toyonaga, Hiromitsu Matsuda, Ryuichi Mibu, Yohei Tominaga, Keiji Hirata, Masafumi Takeyoshi, Masazumi Tsuneyoshi
Journal of the Anus, Rectum and Colon.2018; 2(1): 31. CrossRef
Anal canal duplication presenting with abscess formation
Shohei Honda, Masashi Minato, Hisayuki Miyagi, Hiromi Okada, Akinobu Taketomi
Pediatrics International.2017; 59(4): 500. CrossRef
Anal canal duplication and triplication: a rare entity with different presentations
P. Palazon, V. Julia, L. Saura, I. de Haro, M. Bejarano, C. Rovira, X. Tarrado
Pediatric Surgery International.2017; 33(5): 609. CrossRef

Operative Treatment with a Laparotomy for Anorectal Problems Arising from a Self-Inserted Foreign Body: Seung-Bum Ryoo, Heung-Kwon Oh, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Kyu Joo Park; J Korean Soc Coloproctol. 2012;28(1):56-60. Published online February 29, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.1.56

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Abstract PDF

An anorectal foreign body can cause serious complications such as incontinence, rectal perforation, peritonitis, or pelvic abscess, so it should be managed immediately. We experienced two cases of operative treatment for a self-inserted anorectal foreign body. In one, the foreign body could not be removed as it was completely impacted in the anal canal. We failed to remove it through the anus. A laparotomy and removal of the foreign body was performed by using an incision on the rectum. Primary colsure and a sigmoid loop colostomy were done. A colostomy take-down was done after three months. The other was a rectal perforation from anal masturbation with a plastic device. We performed primary repair of the perforated rectosigmoid colon, and we didea sigmoid loop colostom. A colostomy take-down was done three months later. Immediate and proper treatment for a self-inserted anorectal foreign body is important to prevent severe complications, and we report successful surgical treatments for problems caused by anorectal foreign bodies.

Citations

Citations to this article as recorded by

Rectal foreign bodies. Diagnostic program and emergency care
M. A. Egorkin, E. E. Bolkvadze, V. K. Obukhov, I. N. Gorbunov, M. Ya. Evloeev
Koloproktologia.2024; 23(4): 124. CrossRef
Treatment of rectal foreign bodies
D. A. Khubezov, S. N. Trushin, K. V. Puchkov, D. K. Puchkov, A. Yu. Ogorel’tsev
Khirurgiya. Zhurnal im. N.I. Pirogova.2016; (9): 57. CrossRef
Rectal perforation caused by a sharp pig backbone in a middle-aged patient with mild depression
Hyeong Ju Sun, Jeonghun Lee, Dong Min Kim, Myeong-Su Chu, Kyoung Sun Park, Dong Jin Choi
Yeungnam University Journal of Medicine.2015; 32(1): 31. CrossRef

Large Cell Neuroendocrine Carcinoma of Anal Canal: Report of a Case.: Yun, Min Young , Choi, Sun Keun , Choi, Suk Jin , Hur, Yun Suk , Lee, Kun Young , Kim, Sei Joong , Cho, Young Up , Ahn, Seung Ick , Hong, Kee Chun , Shin, Suk Hwan , Kim, Kyung Rae , Woo, Ze Hong; J Korean Soc Coloproctol. 2007;23(2):132-135.; DOI: https://doi.org/10.3393/jksc.2007.23.2.132

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Abstract PDF: A neuroendocrine carcinoma of the anal canal is a very rare entity; however, this type of tumor is known for its aggressive progression and poor prognosis. We describe the case of a 58-year-old female with a neuroendocrine carcinoma arising in the anal canal. The tumor was found in the anal canal with multiple liver metastases. The patient died due to massive liver metastases 11months after diagnosis and operation. For its rarity and clinical significance, we report the case with a review of the literature.

A Case Report of Surgical Treatment of Anal Condyloma Acuminata in HIV-Infected Patient.: Hyun, Seok Woo , Jung, Hun , Park, Jong Kyung , Oh, Seung Taek , Chang, Suk Kyun; J Korean Soc Coloproctol. 2002;18(5):349-352.

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Abstract PDF: Acquired immunodeficiency syndrome (AIDS) was reported for the first time in the U.S, 1981 and eversince, the number of patients have increased substantially. Similar situation is encountered in Korea, with concordant increase in number of HIV-infected patients requiring surgical management, a high proportion being anal condyloma acuminata, which needs proper evaluation and management due to its malignant potential. Since, we have had a recent case with surgical intervention, we review the pathogenesis and treatment modality of the disease in this paper.

Original Articles

Epidermoid Carcinoma of the Anal Canal: Treatment Outcome and Prognostic Factor.: Kang, Sung Bum , Youk, Oui Gon , Heo, Seung Chul , Jung, Seung Yong , Choi, Hyo Sung , Park, Kyu Joo , Choe, Kuk Jin , Park, Jae Gahb; J Korean Soc Coloproctol. 2002;18(1):42-52.

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Abstract PDF: PURPOSE
During recent two decades, therapeutic strategy for epidermoid carcinoma of anal canal has been changed on basis of the knowledge of the natural course and biologic features. The current study evaluated the treatment outcome and prognostic factors in epidermoid carcinoma of the anal canal.
METHODS
Fifty-seven cases with epidermoid carcinoma of anal canal were treated curatively in Seoul National University College of Medicine from 1976 to 1997. The sex ratio was 1.5 to 1 with male predominance, with a median age of 57.0 years. The histology consisted of 59.6% (34 cases) in squamous cell carcinoma and 40.4% (23 cases) in cloacogenic carcinoma. According to UICC/AJCC staging system, there were 24.6% in stage I, 28.1% in stage II, 31.6% in stage IIIa and 15.8% in stage IIIb. Operation- based treatment was performed in 96.6% of 29 cases during period I (1976~1988) and in 60.7% of 28 cases during period II (1989~1997). Forty-five cases were treated on the basis of operation: 13 cases, operation only; 20, operation plus radiation; 12, operation plus chemoradiotherapy. And 12 cases were managed by combined radiation and chemotherapy.
RESULTS
On median follow-up of 52.0 months (range, 1~160 months), there were 19.3% in local recurrence and 8.8% in systemic recurrence. Recurrence rates were not significantly related to therapeutic strategy (P=0.37). The overall 5-year survival rate was 74.9%. The 5-year survival rates according to therapeutic strategy were 73.3% in the operation-based treatment and 80.0% in the combined radiation and chemotherapy. Survival rates were not significantly related to therapeutic strategy (P=0.48). Three cases, whose sizes were 1 cm, 2 cm and 2.5 cm without lymph node metastasis, were excised locally and are still alive without recurrence. In the multivariate analysis, the metastatic status of lymph nodes had the only independent significant influence on survival.
CONCLUSIONS
Combined radiation and chemotherapy in epidermoid carcinoma of anal canal is the preferred treatment for sphincter-preservation, and local excision in early lesion have good outcome without morbidity associated with chemotherapy or radiation therapy. In this study, lymph node status was the only prognostic variable.

Association of Human Papillomavirus with Human Colorectal Cancer.: Min, Byung Wook , Hong, Jeong Hoon , Lee, Kyung Bum , Moon, Hong Young; J Korean Soc Coloproctol. 2001;17(6):332-336.

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Abstract PDF: PURPOSE
The aim of this study is to confirm the association of human papillomavirus with colorectal cancer.
METHODS
We studied 44 patients who were received operation for colorectal cancer from 1, Jan. 1997 to 31, Dec. at Korea University Guro Hospital. We used paraffin- embedded tissue sections of colorectal adenocarcinomas and human cervical cell lines as a positive control. We also studied 10 cases of anal canal squamous cell carcinomas. The extracted DNA were analyzed by polymerase chain reaction and enzyme restriction method.
RESULTS
Human papillomavirus DNA was not detected in all specimen of colorectal adenocarcinomas. But in 3 of 10 (30%) of anal canal squamous carcinomas, human papillomavirus DNA was detected. We identified this human papillomvirus DNA as type 16 by enzyme restriction technique.
CONCLUSIONS
Human papillomavirus usually associated with malignant transformation are present in anal canal squamous cell carcinomas. This study also showed same result. But this association was absent from adenocarcinoma of the colon and rectum.

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