Annals of Coloproctology

Original Articles

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; Received July 31, 2024 Accepted October 4, 2024 Published online February 3, 2025; DOI: https://doi.org/10.3393/ac.2024.00472.0067 [Epub ahead of print]

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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.

Benign bowel disease

Implications of bacteriological study in complicated and uncomplicated acute appendicitis: Sorin Cimpean, Alberto Gonzalez Barranquero, Ion Surdeanu, Benjamin Cadiere, Guy-Bernard Cadiere; Received February 28, 2022 Accepted July 7, 2022 Published online November 10, 2022; DOI: https://doi.org/10.3393/ac.2022.00157.0022 [Epub ahead of print]

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Purpose
Bacteriological sample in the presence of intra-abdominal free fluid is necessary to adapt the antibiotherapy and to prevent the development of resistance. The aim was to evaluate the differences between uncomplicated acute appendicitis (UAA) and complicated acute appendicitis (CAA) in terms of bacterial culture results and antibiotic resistance, and to evaluate the factors linked with CAA.
Methods
We performed a single-center, retrospective observational study of all consecutive patients who presented with appendicular peritonitis and underwent emergent surgery in a tertiary referral hospital in Brussels, Belgium, between January 2013 and December 2020. The medical history, parameters at admission, bacterial culture, antibiotic resistance, and postoperative outcomes of 268 patients were analyzed. UAA was considered catarrhal or phlegmonous inflammation of the appendix. CAA was considered gangrenous or perforated appendicitis.
Results
Positive microbiological cultures were significantly higher in the CAA group (68.2% vs. 53.4%). The most frequently isolated bacteria in UAA and CAA cultures were Escherichia coli (37.9% and 48.6%, respectively). Most observed resistances were against ampicillin (28.9% and 21.7%) and amoxicillin/clavulanic acid (16.4% and 10.5%) in UAA and CAA, respectively. A higher Charlson Comorbidity Index, an elevated white blood cell count, an open procedure, and the need for drainage were linked to CAA. Culture results, group of bacterial isolation, and most common isolated bacteria were not related to CAA.
Conclusion
CAA presented a higher rate of positive cultures with increased identification of gram-negative bacteria. Bacterial culture from the peritoneal liquid does not reveal relevant differences in terms of antibiotic resistance.

Citations

Citations to this article as recorded by

Causative microbes and antibiotic susceptibility of acute appendicitis in adults and children
Chia-Hsiang Yu, Chia-Ning Chang, Chih-Chien Wang
Pediatrics & Neonatology.2024; 65(2): 159. CrossRef
Optimizing Antibiotic Management for Adult Patients Presenting with Acute Perforated Appendicitis: A Quality Improvement Study
Carlos Gallego-Navarro, Jason Beckermann, Maria E. Linnaus, Hayden J. Swartz, Shelby Stewart, Justin M. York, Ryan R. Gassner, Christopher A. Kasal, Annaliese G. Seidel, Corey J. Wachter, Kirstin J. Kooda, Jennifer R. Rich, Mark D. Sawyer
Surgical Infections.2024;[Epub] CrossRef
The role of intraoperative swab during appendectomy in patients with uncomplicated and complicated appendicitis
Bruno Leonardo Bancke Laverde, Matthias Maak, Melanie Langheinrich, Stephan Kersting, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann, Maximilian Brunner
International Journal of Colorectal Disease.2023;[Epub] CrossRef

The importance of topical metronidazole in the treatment of acute anal fissure: a double-blind study controlled for prospective randomization: Tuba Mert; Ann Coloproctol. 2023;39(2):131-138. Published online January 18, 2022; DOI: https://doi.org/10.3393/ac.2021.00675.0096

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6 Web of Science
7 Citations

Graphical Abstract Abstract PDF

Purpose
Acute anal fissure, a disease characterized by severe pain in the anorectal area, reduces quality of life and becomes chronic absent appropriate treatment. More recently, anaerobic infections have been noted as contributive to etiopathogenesis. This study investigates topical metronidazole’s effect in the treatment of acute anal fissure.
Methods
Our prospective randomized controlled double-blind study included 2 groups of 100 patients older than 18 years from our General Surgery Clinic with anal fissure complaints for less than 8 weeks. Topical diltiazem treatment was started in group 1, and topical diltiazem and metronidazole treatment in group 2. Pain levels were evaluated by the visual analogue scale (VAS) score, and recovery status was evaluated by physical examination findings ab initio and at the 1st, 4th, and 6th weeks. VAS score levels, demographic, clinical, and recovery status were then compared.
Results
There was no difference between the groups as to age, sex, pain on defecation, bleeding, constipation, and duration of pain, bleeding and constipation (P>0.05). From week 1, fissure epithelialization and healing rates were higher in group 2 (P<0.001); group 2 VAS score levels were lower than in group 1 (P<0.001) and achieved by group 1 only in week 4 (P=0.073).
Conclusion
Adding topical metronidazole to treatment reduces the duration and severity of pain, shortens healing time, and increases the healing rate.

Citations

Citations to this article as recorded by

Efficacy of local metronidazole with glyceryl trinitrate versus topical glyceryl trinitrate alone in the treatment of acute anal fissure: a randomized clinical trial
Hesham M. Elgendy, Ahmed AbdelMawla, Ahmed F. Hussein
The Egyptian Journal of Surgery.2024; 43(1): 304. CrossRef
Belgian consensus guideline on the management of anal fissures
P Roelandt, G Bislenghi, G Coremans, D De Looze, M.A. Denis, H De Schepper, P Dewint, J Geldof, I Gijsen, N Komen, H Ruymbeke, J Stijns, M Surmont, D Van de Putte, S Van den Broeck, B Van Geluwe, J Wyndaele
Acta Gastro Enterologica Belgica.2024; 87(2): 304. CrossRef
Avances terapéuticos en el abordaje de las fisuras anales: explorando la sinergia entre Farmacología y Nanotecnología
Carlos Ostwaldo Pazmiño-Chiluiza, María Luisa González Rodríguez
Ars Pharmaceutica (Internet).2024; 65(4): 409. CrossRef
Local plus oral antibiotics and strict avoidance of constipation is effective and helps prevents surgery in most cases of anal fissure
Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya
Annals of Coloproctology.2023; 39(2): 188. CrossRef
COMPARATIVE STUDY ON THE EFFICACY OF TOPICAL METRONIDAZOLE, TOPICAL NITROGLYCERINE, AND TOPICAL DILTIAZEM IN THE MANAGEMENT OF CHRONIC ANAL FISSURE
PURSHOTAM DASS GUPTA, FAHAD TAUHEED, ANURAG SARASWAT, Karthik P
Asian Journal of Pharmaceutical and Clinical Research.2023; : 141. CrossRef
The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Francesca Iacobellis, Luigi Brusciano, Luigi Monaco, Domenico Izzo, Alfredo Giordano, Michele Pinto, Corrado Fantini, Marcello Gasparrini, Michele Schiano Di Visconte, Francesca Milazzo, Giovanni Ferrer
BMC Surgery.2023;[Epub] CrossRef
Comparative Efficacy of Topical Metronidazole and Glyceryl Trinitrate Versus Topical Glyceryl Trinitrate Alone in the Treatment of Acute Anal Fissure: A Randomized Clinical Trial
M Hasaan Shahid, Sidra Javed, Saryia Javed, Anwar Zeb Khan, Adeel Kaiser, Reda H Mithany
Cureus.2022;[Epub] CrossRef

Management of Colonic Diverticulitis Tailored to Location and Severity: Comparison of the Right and the Left Colon: Byeoung Hoon Chung, Gi Won Ha, Min Ro Lee, Jong Hun Kim; Ann Coloproctol. 2016;32(6):228-233. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.228

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Abstract PDF

Purpose

This study assessed optimal management of colonic diverticulitis as functions of disease location and severity and factors associated with complicated diverticulitis.

Methods

This retrospective review analyzed 202 patients diagnosed between 2007 and 2014 at Chonbuk National University Hospital, South Korea, with colonic diverticulitis by using abdominopelvic computed tomography. Diverticulitis location was determined, and disease severity was categorized using the modified Hinchey classification.

Results

Patients included 108 males (53.5%) and 94 females (46.5%); of these, 167 patients (82.7%) were diagnosed with right-sided and 35 (17.3%) with left-sided colonic diverticulitis. Of the 167 patients with right-sided colonic diverticulitis, 12 (7.2%) had complicated and 155 (92.8%) had uncomplicated diverticulitis; of these, 157 patients (94.0%) were successfully managed conservatively. Of the 35 patients with left-sided colonic diverticulitis, 23 (65.7%) had complicated and 12 (34.3%) had uncomplicated diverticulitis; of these, 23 patients (65.7%) were managed surgically. Among patients with right-sided diverticulitis, those with complicated disease were significantly older (54.3 ± 12.7 years vs. 42.5 ± 13.4 years, P = 0.004) and more likely to be smokers (66.7% vs. 32.9%, P = 0.027) than those with uncomplicated disease. However, among patients with left-sided diverticulitis, those with complicated disease had significantly lower body mass index (BMI; 21.9 ± 4.7 kg/m² vs. 25.8 ± 4.3 kg/m², P = 0.021) than those with uncomplicated disease.

Conclusion

Conservative management may be effective in patients with right-sided diverticulitis and patients with uncomplicated left-sided colonic diverticulitis. Surgical management may be required for patients with complicated left-sided diverticulitis. Factors associated with complicated diverticulitis include older age, smoking and lower BMI.

Citations

Citations to this article as recorded by

Right‐sided acute diverticulitis in a North African country: Presentation and management in one surgical center
Laila Jedidi, Aymen Mabrouk, Hela Ghali, Anis Ben Dhaou, Senda Ben Lahouel, Sami Daldoul, Houyem Said Latiri, Mounir Ben Moussa
World Journal of Surgery.2024; 48(6): 1509. CrossRef
Current diagnosis and management of acute colonic diverticulitis: What you need to know
Lisa M. Kodadek, Kimberly A. Davis
Journal of Trauma and Acute Care Surgery.2024; 97(1): 1. CrossRef
Comparison of surgical management and outcomes of acute right colic and sigmoid diverticulitis: a French national retrospective cohort study
E. Karam, C. Sabbagh, L. Beyer-Bergeot, P. Zerbib, V. Bridoux, G. Manceau, Y. Panis, E. Buscail, A. Venara, I. Khaoudy, M. Gaillard, M. Viennet, A. Thobie, B. Menahem, C. Eveno, C. Bonnel, J.-Y. Mabrut, B. Badic, C. Godet, Y. Eid, E. Duchalais, Z. Lakkis,
Techniques in Coloproctology.2024;[Epub] CrossRef
Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines
Federico Coccolini, Massimo Sartelli, Robert Sawyer, Kemal Rasa, Bruno Viaggi, Fikri Abu-Zidan, Kjetil Soreide, Timothy Hardcastle, Deepak Gupta, Cino Bendinelli, Marco Ceresoli, Vishal G. Shelat, Richard ten Broek, Gian Luca Baiocchi, Ernest E. Moore, Ib
World Journal of Emergency Surgery.2023;[Epub] CrossRef
Diagnosis and management of acute colonic diverticulitis: results of a survey among Korean gastroenterologists
Jae Gon Lee, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Shin Hee Lee, Myung-Won You, Seong-Eun Kim
The Korean Journal of Internal Medicine.2023; 38(5): 672. CrossRef
Right-sided diverticulitis in a Western population
Adi Rov, Anat Ben-Ari, Eyal Barlev, David Pelcman, Sergio Susmalian, Haim Paran
International Journal of Colorectal Disease.2022; 37(6): 1251. CrossRef
Emergency surgery comparison of right versus left acute colonic diverticulitis: A 10-year outcome analysis
JS Tsang, Chi Chung Foo, Jeremy Yip, Hok Kwok Choi, Wai Lun Law, Oswens Siu Hung Lo
The Surgeon.2021; 19(3): 150. CrossRef
Elective surgical management of diverticulitis
Jordan M. Rook, Jill Q. Dworsky, Thomas Curran, Sudeep Banerjee, Mary R. Kwaan
Current Problems in Surgery.2021; 58(5): 100876. CrossRef
Special Situations in the Management of Diverticular Disease
Elizabeth H. Wood, Michael M. Sigman, Dana M. Hayden
Clinics in Colon and Rectal Surgery.2021; 34(02): 121. CrossRef
Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis
Kil-yong Lee, Jaeim Lee, Youn Young Park, Seong Taek Oh
BMC Gastroenterology.2021;[Epub] CrossRef
WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections
Massimo Sartelli, Federico Coccolini, Yoram Kluger, Ervis Agastra, Fikri M. Abu-Zidan, Ashraf El Sayed Abbas, Luca Ansaloni, Abdulrashid Kayode Adesunkanmi, Boyko Atanasov, Goran Augustin, Miklosh Bala, Oussama Baraket, Suman Baral, Walter L. Biffl, Marja
World Journal of Emergency Surgery.2021;[Epub] CrossRef
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Angelo Gabriele Epifani, Diletta Cassini, Roberto Cirocchi, Caterina Accardo, Francesca Di Candido, Massimiliano Ardu, Gianandrea Baldazzi
World Journal of Gastrointestinal Surgery.2021; 13(12): 1721. CrossRef
Difference in Clinical Features between Right- and Left-Sided Acute Colonic Diverticulitis
Kil-yong Lee, Jaeim Lee, Youn Young Park, Younglim Kim, Seong Taek Oh
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Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?
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What is the Difference Between Right- and Left-Sided Colonic Diverticulitis?
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