Significance and Impact of the Intersphincteric Plane Sepsis in the Management of the Perianal Sepsis: Ultrasound Study

Background The intersphincteric plane (ISP) is a potential space between the external and the internal anal sphincters. About 90% of the perianal sepsis is caused by an obstruction of the ducts of anal glands with subsequent secondary bacterial infection. The imaging modalities used to diagnose perianal sepsis are the ultrasound via endoanal and transperineal routes and magnetic resonance imaging. Objective The study aimed to identify the various patterns of the ISP sepsis and their incidence among our study group and to clarify the significance of ISP in the pathogenesis of anorectal abscesses and various types of perianal fistula tracts, to optimize the surgical management. Methods Retrospective descriptive study in which 57 patients with an ISP sepsis were evaluated with full medical history, clinical exam, and ultrasound; the final diagnosis was based on combining the results of ultrasound, digital rectal examination under anesthesia, and the operative results. Results The current study showed many patterns of the ISP sepsis and estimated the incidence of each pattern among our study group; such patterns could be fistula tracts, sinus tracts, abscesses, intersphincteric abscess with supralevator extension, sinus with abscess formation, fistula with abscess formation, distension of the ISP with free pus, and other complex patterns like horse abscess, abscess with transsphincteric sinus, and ISP fistula/sinus with transsphincteric branches. Conclusion Understanding the role of the ISP in the pathogenesis of anorectal abscesses and perianal fistula tracts can help in reaching the optimum way of management.

Dangers of delayed diagnosis of perianal abscess and undrained perianal sepsis in Fournier’s gangrene: a case series

Fournier’s gangrene (FG) is a rapidly progressing infective necrotising fasciitis of the perianal, perineal and genital region. It is characterised by its aggressive nature and high mortality rates of between 15% and 50%. While it has been commonly found to primarily develop from urological sources, there have been increasing reports of the role of colorectal sources as the underlying aetiology of FG. Presented is a case series of four FG presentations at a single institution during a 12-month period as a result of underlying untreated perianal disease highlighting its dangers in progressing to a deadly infection, advocating for early and aggressive surgical debridement, and the role of adjunct scoring systems, such as Laboratory Risk Indicator for Necrotising Fasciitis, in guiding clinical diagnosis.

Perianal Crohn's Disease in Children and Adolescents

The incidence of Crohn's disease is increasing worldwide. The clinical course of childhood onset Crohn's disease is particularly aggressive with characteristic disease localization in the ileocecal region and colon, often associated with perianal disease. Severe complications of perianal disease include recurrent perianal sepsis, chronic fistulae, fecal incontinence, and rectal strictures that impair quality of life and may require fecal diversion. Care of patients with perianal Crohn's disease requires a multidisciplinary approach with systematic clinical evaluation, endoscopic assessment, and imaging studies followed by combined medical and surgical management. In this review, we provide an update of the epidemiology, pathophysiology, diagnostics, and management of perianal Crohn's disease in children and adolescents.

Study of intestinal stoma: our experience at Rajarajeswari Medical College and Hospital

Background: Stoma is an artificial opening of intestinal or urinary tract to the abdominal wall. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it.Methods: This is a retrospective descriptive observational study carried out in a surgical unit of Rajarajeswari Medical College and Hospital, Bangalore from August 2015 to August 2016. Data was collected by previous record files including age, gender, history of presenting illness, indication, type of stoma, type of surgery, appropriate operative findings and follow up of the cases. The results were collected, analysed and compared with other studies.Results: A total of 25 patients were evaluated age ranged between 20-70 years. Out of 25 patients 17 were admitted in emergency while 8 in out-patient department. The most common type of stoma made was loop ileostomy (44%) followed by end ileostomy (28%), end colostomy (16%) and loop colostomy (12%). Main indication for a stoma formation was enteric perforation (56%) followed by carcinoma colon and rectum (32%), perianal sepsis (21%), Koch’s abdomen (11%), penetrating injuries (11%). Of the various complications encountered with intestinal stoma, peristomal skin Excoriation (16%) was the most common complication observed followed by other complications as mentioned in study.Conclusions: In spite of enormous exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone.