DOCSLIB.ORG

Anal Fissures Rarely Occur in Patients with Ulcerative Colitis. Here We Report a 26-Year-Old Man Diagnosed with Ulcerative Colitis Involving Intractable Anal Fissures

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anal Fissures Rarely Occur in Patients with Ulcerative Colitis. Here We Report a 26-Year-Old Man Diagnosed with Ulcerative Colitis Involving Intractable Anal Fissures Showa Univ J Med Sci 13(4), 315 319, December 2001 Case Report Intractable Fissures in a Patient with Ulcerative Colitis Naokuni YASUDA 1), Makoto WATANABE 1), H1rotaka TANAKA 1), Mlkl SHIBUSAWA2) and Mltsuo KUSANO 2) Abstract : Anal fissures rarely occur in patients with ulcerative colitis. Here we report a 26-year-old man diagnosed with ulcerative colitis involving intractable anal fissures. The patient underwent restorative proctocolectomy for ulcerative colitis and sliding skin graft (SSG) for intractable anal fissures. Anal function was monitored by a manometric study. Generally, patients subjected to pouch surgery should retain fairly well-preserved anal sphincter muscle structure and function. A manometric study confirmed that SSG was an effective procedure for the preservation of the sphincter in patients receiving restorative proctocolectomy for ulcerative colitis and intractable fissures. Key words : ulcerative colitis, intractable fissure, manometry Introduction Anal fissures occur more rarely in ulcerative colitis than Crohn's disease. In this report, we present a patient subjected to sliding skin graft (SSG) for intractable anal fissures and restorative proctocolectomy for ulcerative colitis, with the monitoring of anal function by a manometric study. Case Report A 26-year-old Japanese man was admitted to hospital with severe anal bleeding. The patient was diagnosed with ulcerative colitis (proctitis type) in July 1989. In 1993, the subject was prescribed prednisolone, 5-30 mg/day, and salazosulfapyridine, 3000 mg/day (or 5-ASA, 1500 mg/dav) by our medical department. The patient was admitted to our hospital on August 15, 1997 due to bloody diarrhea. At the time of admission, height and weight measurements were 172 cm and 56 kg, respectively. Medical examination revealed that the patient was very weak. Body temperature and pulse rate were 36.8•Ž and 76 bpm, respectively. The blood pressure was 124/80 mmHg. Standard laboratory tests were performed (Table 1). Three days after admission, severe bleeding was observed from the anus due to ulcerative colitis. Despite a consequent increase in prednisolone dosage to 60 mg, anal bleeding persisted. Thirteen days after admission, the patient went into shock due to amemia (hemoglobin count of 7.2 g/dl ), and was therefore given a blood transfusion at 6 units/day. Following transfusion, hemoglobin levels increased to 8.4 g/dl. Fifteen days after admission, the patient was referred to our department. He underwent an emergency operation of total colectomy with ileostomy and mucus fistula (Fig. 1). Two deep anal fissures were observed 1) Department of Surgery, Isesaki Municipal Hospital, 1180 Tsunatori-Town Isesaki, 372-0812, Japan, 2) Second Department of Surgery, Showa University 316 Naokuni YASUDA, et al Table 1. Fig. 1. Macroscopic appearance of resected large intestine. Inflamed mucosa and multiple ulcers are evident. at 0 and 6 o'clock respectively, during surgery (Fig. 2). On the second day after surgery, bleeding was noted from the mucus fistula. After treatment with enema kits containing 1.5 mg betamethasone (Steronema), bleeding ceased. The patient was discharged on the 60th day after surgery. Following improvement of the general condition of the subject, restorative proctectomy and SSG for persistent anal fissure were performed six months later (Fig. 3). Recovery was uneventful, and over the next several weeks, prednisolone dosage was rapidly reduced. The patient was discharged 18 days after the operation. Six months later, an examination was conducted under anesthesia because of persistent discharge from the anus. This revealed that the wound from SSG had not yet healed. After another six months, closure ileostomy was performed, following healing of the wound from the anal fissure. The patient was able to resume normal activities and return to work. Anal Fissures in Ulcerative Colitis 317 Fig. 2. Anal fissures are shown. Fig. 3. SSG ; An elliptical incision is made around the fissure, dissecting the scarred internal sphincter. The rectal mucosa is sutured to the lower margin of the incision. Then, a semicircle incision is made around the suture line to slide the skin graft. Manometry A manometric study was carried out using a three-channel catheter (G92-005/485, Synectics Medical, Stocholm, Sweden), a PC Polygraf HR (Medtronic Functional Diagnostics, Skovlunde, Denmark) and a personal computer with Polygram Software 318 Naokuni YASUDA, et al Table 2. (Medtronic Functional Diagnostics). The study was performed in the left lateral decubitus position. Bowel preparation was not necessary before the study. Maximum levels of basal pressure, squeeze pressure and tolerable volume were measured, using a station pull-through technique. Manometric study was performed prior to restorative proctectomy and SSG, six and twelve months after closure ileostomy, respectively. Results are shown in Table 2. Discussion Anal complications may develop in patients with Crohn's disease. Initially, these complications were considered uncommon in patients with ulcerative colitis1). However, a limited number of authors have reported on patients with ulcerative colitis and complicated fissures2). Notably, in Japan, cases of ulcerative colitis patients displaying anal fissures are much rarer. Restorative proctocolectomy with pouch surgery is the gold-standard surgical treatment for ulcerative colitis3-5). In our department, a two-stage procedure comprising proctocolectomy with ileostomy and closure ileostomy, is usually performed. A three-stage procedure was employed in the present case due to the added risk of complications upon high dosage of steroids and an emergent case. At the first stage of the operation, the fissure was not surgically treated. The fissure appeared to be curing naturally because of dysfunction due to ileostoma. Conditions of high resting pressure, such as spasm of the internal anal sphincter, may cause anal fissures6). There are several traditional techniques for treatment, including dilatation or partial division of the internal sphincter7). However, these procedures are complicated by permanent incontinence8,9). Lateral sphincterotomy appears to be the current standard surgical treatment procedure for anal fissures6,10) It is dangerous to perform lateral sphincterotomy on patients receiving restorative proctectomy, due to possible permanent lower resting anal pressure. It is extremely important that the structure and function of the anal sphincter muscle is preserved in patients subjected to restorative proctocolectomy with pouch surgery11,12). Recent reports indicate that chemical sphincterotomy may be effective in these patients13-15). However, a number of studies suggest that severe headaches often develop as a side-effect following Anal Fissures in Ulcerative Colitis 319 chemical sphincterotomy16,17) We employed SSG in our analyses because of a large severe fissure, which persisted despite covering ileostomy. In the present case, the internal sphincter was preserved as much as possible, although it is usually cut substantially during SSG. In the manometric study, maximal tolerable volume was low before restorative proctectomy and SSG due to inflammation of the rectum. After restorative proctectomy and SSG, the maximal levels of basal pressure, squeeze pressure and tolerable volume improved gradually. Moreover bowel movement was stable (5 times per day). No abnormalities in anal sphincter function were presented. In summary, SSG is an extremely effective procedure for the preservation of the sphincter in patients with intractable fissures who receive restorative proctocolectomy for ulcerative colitis. References 1) William DR, Cpller JA, Corman ML, Nugent FW and Vendenheimer MC : Anal complications in Crohn's disease. Dis Colon Rectum 24 : 22-24 (1981) 2) Goodman MJ and Spargerg M : Complication of chronic ulcerative colitis. In : Ulcerative Colitis, Wiley, New York, pp. 46-49 (1978) 3) Parks AG and Nicholls RJ : Proctocolectomy without ileostomy for ulcerative colitis. Br Med J II : 85-88 (1978) 4) Myers JO, Rothenberger DA and Goldberg SM : The evolution of surgical procedures for anal preservation. In : Restorative proctocolectomy,Nicholls RI, Bartolo DCC and Mortencen NJMcC (Eds), Blackwellscientific publications, London, pp. 1-6 (1993) 5) Meagher AP, Farouk R, Dozois RR, Kelly KA and Pemberton JH: J-pouch-anal anastomosis for chronic ulcerative colitis : complications and long-term outcome in 1310 patients. Br J Surg 85: 800-803 (1998) 6) Williams N and Irving MH : Effect of lateral sphicterotomy on internal anal sphincter function. Dis Colon Rectum 38 : 700-704 (1995) 7) Cannel AG : Modern surgical treatment of hemorrhoids and a new rectoplasty. Am J Surg 75 : 320-324 (1948) 8) Khubchandani IT and Reed JF : Sequelae of internal sphincterotomy for chronic anal fissure in ano. Br J Surg 76:431-434 (1989) 9) Corman ML Anal fissure. In : Colon & Rectal Surgery 3rd ed J. B. Lippincott Co Philadelphia, pp. 116-132 (1993) 10) Notras MJ : The treatment of anal fissure by lateral subcutaneous internal sphincterotomy- a technique and results. Br J Surg 58: 96-100 (1971) 11) Takesue Y, Yokohama T, Kodama Y, Murakami Y, Imamura Y and Matsuura Y : Influence of ileal pouch capacity and anal sphincter function on the clinical outcome after ileal pouch-anal anastomosis. Surg Today 27 : 392-397 (1997) 12) Lewis WG, Miller AS, Williamson MER, Sagar PM, Holdsworth PJ, Axon ATR and Johnston D : The perfect pelvic pouch-what makes the difference?.Gut 37 : 552-556 (1995) 13) Gorfine
Load more

Recommended publications
  • Crohn's Disease of the Anal Region
    Gut: first published as 10.1136/gut.6.6.515 on 1 December 1965. Downloaded from Gut, 1965, 6, 515 Crohn's disease of the anal region B. K. GRAY, H. E. LOCKHART-MUMMERY, AND B. C. MORSON From the Research Department, St. Mark's Hospital, London EDITORIAL SYNOPSIS This paper records for the first time the clinico-pathological picture of Crohn's disease affecting the anal canal. It has long been recognized that anal lesions may precede intestinal Crohn's disease, often by some years, but the specific characteristics of the lesion have not hitherto been described. The differential diagnosis is discussed in detail. In a previous report from this hospital (Morson and types of anal lesion when the patients were first seen Lockhart-Mummery, 1959) the clinical features and were as follows: pathology of the anal lesions of Crohn's disease were described. In that paper reference was made to Anal fistula, single or multiple .............. 13 several patients with anal fissures or fistulae, biopsy Anal fissures ........... ......... 3 of which showed a sarcoid reaction, but in whom Anal fissure and fistula .................... 3 there was no clinical or radiological evidence of Total 19 intra-abdominal Crohn's disease. The opinion was expressed that some of these patients might later The types of fistula included both low level and prove to have intestinal pathology. This present complex high level varieties. The majority had the contribution is a follow-up of these cases as well as clinical features described previously (Morson and of others seen subsequently. Lockhart-Mummery, 1959; Lockhart-Mummery Involvement of the anus in Crohn's disease has and Morson, 1964) which suggest Crohn's disease, http://gut.bmj.com/ been seen at this hospital in three different ways: that is, the lesions had an indolent appearance with 1 Patients who presented with symptoms of irregular undermined edges and absence of indura- intestinal Crohn's disease who, at the same time, ation.
    [Show full text]
  • Pneumoperitoneum Due to a Transmural Anal Fissure by Glen Huang, Hussam Bitar
    A CASE REPORT A CASE REPORT Pneumoperitoneum Due to a Transmural Anal Fissure by Glen Huang, Hussam Bitar Pneumoperitoneum is usually due to a perforated viscus and requires surgical intervention, however, a minority of cases can be managed nonsurgically. Nonsurgical pneumoperitoneum has a wide variety of causes, but a transmural anal fissure being the cause has yet to be documented. In this case we describe a case of pneumoperitoneum due to a transmural fissure caused by extreme diarrhea. INTRODUCTION nal fissures are common and typically result (Figure 1). This air appeared to be contiguous with a from mucosal tear. In traumatic cases, the tear transmural anal tear that was noted as well (Figure 2). may be transmural. These tears typically occur Complete blood count (CBC) demonstrated an elevated A 3 posteriorly to the midline and patients often present white blood cell count of 16.9 x 10 cells/µL (local with anal pain or rectal bleeding.1 Pneumoperitoneum control 3.8-10.79 x 103 cells/µL) with 87% neutrophils is a collection of air in the peritoneal cavity, typically (local control 40-79%). The rest of the CBC was within occurring from a ruptured hollow viscus. However, normal limits. cases of pneumoperitoneum without evidence of The patient was then admitted and given a full perforation can rarely occur.2 Here, we discuss a case of liquid diet to allow for bowel rest. He was also placed pneumoperitoneum secondary to an acute anal fissure. on intravenous antibiotics for the possibility of perianal cellulitis given his increased white blood cell count.
    [Show full text]
  • How to Optimize Surgical Treatment of Chronic Anal Fissure Combined
    Sys Rev Pharm 2020;11(11):171-176 A multHifaceotedwreviewtjournaOl in tphe ftielidmof phiarzmaecy Surgical Treatment of Chronic Anal Fissure Combined With Rectocele In Women BV.eFl.gKоruоlidkNоvastikоyn,aNl .RVe. sОelaeryсnhiUk,nAiv.Pe.rsKirtyiv, сRhuisksоiav,a3,0M80.S1.5A,lBeneligсhоerоvda,, PYоabroedsyh SAt..L,.85 ABSTRACT Anal fissure is a common condition in women of all ages. The most common Keywords: anal fissure, rectocele, surgical treatment, wound healing causes are childbirth and constipation. Anal fissure is often diagnosed in women with rectocele. Unsatisfactory results of surgical treatment of chronic anal fissures Correspondence: in patients with rectocele enforce to continue the investigations for the optimal V.F. Kulikоvsky solution of this problem. Belgоrоd Natiоnal Researсh University, Russia,308015, Belgоrоd, Pоbedy St., 85 The aim of research was to improve the results of surgical treatment of chronic anal fissures in patients with rectocele. Materials and Methods. In 2015-2019, on the basis of the Surgery Department of Belgоrоd Natiоnal Researсh University and Coloproctology Department of Belgorod St. Joasaph's Hospital, we conducted a comparative assessment of the results of surgical treatment of 74 patients with recocele and chronic anal fissure, who underwent isolated surgery of anal fissure excision (1st group, n=35) and anal fissure excision, combined with posterior colporrhaphy in the 2nd group (n=39). According to indications for spasm of the internal anal sphincter, in patients of both groups internal lateral sphincterotomy was performed. Results. Local pain syndrome in the anus area in the first day after the operation in all patients was intensive. Starting from the 2nd day, the pain in the area of the vaginal wound of the patients of the 2nd group almost did not bother them.
    [Show full text]
  • What Is an Anal Fissure?
    What is an Anal Fissure? This is a fairly common condition (number one cause of anal pain and bleeding -- more common than hemorrhoids) in which the lining of the anal canal becomes torn. This generally produces pain or burning, especially with passage of a bowel movement. Bleeding may also occur. A fissure usually occurs with constipation or after forceful passage of a large, hard bowel movement. However, fissures also may occur without straining, since the tissue lining the anal canal is very delicate. How is a fissure diagnosed? When a fissure is present, a digital rectal exam is usually painful. The fissure can be usually be visualized by an external inspection of the anus, or an anoscope can be used to determine the extent of the tear. How is a fissure treated? • Warm tub or sitz baths several times a day in plain warm water for about 10 minutes. • Stool softeners or fiber to provide a regular soft, formed bowel movement. • Creams and/or suppositories (Preparation-H or Anusol or product with lidocaine added). • May add Nitroglycerin to anus to relieve spasm and pain thus allow healing. Most fissures will heal within several weeks, but surgery may be necessary if symptoms persist. Surgical treatment usually consists of cutting a portion of the muscle in the anal canal (sphincterotomy). This procedure reduces the tension produced by the fissure and allows it to heal. Of course, the best treatment is prevention, and ingestion of a high fiber diet to promote bowel regularity is of utmost importance. What do you do After. .? (Anal discomfort and how to deal with it) By: W.
    [Show full text]
  • Anal Fissure Emily Steinhagen, M.D
    RESIDENT’S CORNER Anal Fissure Emily Steinhagen, M.D. Division of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio CASE SUMMARY: A 30-year-old otherwise healthy decreases blood flow to the area and prevents healing once a woman presents with 1 week of pain, “like passing fissure has formed. The association between fissures and hy- glass,” with defecation and bright red blood with bowel pertonic sphincters has been demonstrated manometrically, movements. She typically has hard stools. as has the association between hypertonic sphincter and de- creased blood flow to the anoderm. CLINICAL QUESTIONS PRESENTATION • What are the presenting signs and symptoms of anal The most frequent symptom for fissure patients is sharp fissure? pain. Patients may describe having a bowel movement like • What are the medical and surgical treatment passing glass or razor blades. The pain is worst with, and options? immediately after, bowel movements. In more chronic cases, constant pain may be reported as muscular hyper- trophy occurs and sphincter spasm begins to contribute to the pain process. Patients often report bright red blood BACKGROUND either streaking the stool or when wiping. Anal fissures are longitudinal tears in the anal canal, distal On physical examination, patients with an acute fis- to the dentate line. They are typically seen in younger to sure will likely have a normal perineum. It may be possi- middle-aged adults. The incidence is difficult to estimate, ble to palpate a hypertonic sphincter with some degree of because a large proportion are self-limited and are never tenderness. Those with a more chronic fissure may have a formally diagnosed, a common issue with estimating the small skin tag or sentinel pile in the posterior or anterior frequency of benign anorectal diagnoses.
    [Show full text]
  • Chronic Anal Fissure
    Journal of Antibiotics Research Volume 1 | Issue 1 ISSN: 2574-5980 Research Article Open Access Chronic Anal Fissure - A Multi Centric Study Abro AH*, Agha AH, Laghari AR, Bhurgari A, Ali S and Ali SA Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan Peoples Medical University Nawabshah and Hamdard University Karachi *Corresponding author: Abro AH, Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, E-mail: [email protected], [email protected] Citation: Abro AH, Agha AH, Laghari AR, Bhurgari A, Ali S, et al. (2015) Chronic Anal Fissure – A Multi Centric Study. J Antibiot Res 1(1): 104. doi: 10.15744/2574-5980.1.104 Received Date: June 26, 2015 Accepted Date: September 21, 2015 Published Date: September 24, 2015 Abstract Back Ground: Chronic anal fissure is a commonest anal condition of world population and our country is not an exception. Conservative management is initially recommended with creams and oral analgesics. When conservative measures fail despite of recommended length of therapy, surgical option is offered to the affecters. Lateral sphincterotomy is a surgical option recommended and accepted worldwide. The pre amble of the study was to assess lateral sphincterotomy in terms of safety and final outcome for the surgical management of chronic anal fissure. Patients and Methods: 120 diagnosed cases of chronic anal fissure admitted during 1st June 2013 to 31st May 2014 in the Department of surgery Liaquat university hospital Jamshoro and Peaple’s medical university Nawabshah Sindh Pakistan were included in study. Patients with anal fissure with other peri-anal conditions, recurrent anal fissure, hepatitis positive, and children’s were excluded from the study.
    [Show full text]
  • Chapter 5 – Gastrointestinal System
    CHAPTER 5 – GASTROINTESTINAL SYSTEM First Nations and Inuit Health Branch (FNIHB) Clinical Practice Guidelines for Nurses in Primary Care. The content of this chapter was revised October 2011. Table of Contents ASSESSMENT OF THE GASTROINTESTINAL SYSTEM ......................................5–1 EXAMINATION OF THE ABDOMEN ........................................................................5–2 COMMON PROBLEMS OF THE GASTROINTESTINAL SYSTEM .........................5–4 Anal Fissure .......................................................................................................5–4 Constipation .......................................................................................................5–5 Dehydration (Hypovolemia) ...............................................................................5–8 Diarrhea ...........................................................................................................5–11 Diverticular Disease .........................................................................................5–15 Diverticulitis ......................................................................................................5–15 Diverticulosis ....................................................................................................5–16 Dyspepsia ........................................................................................................5–17 Gallbladder Disease .........................................................................................5–18 Biliary Colic ......................................................................................................5–21
    [Show full text]
  • Chronic Anal Fissures RICHARD L
    Clinical Evidence Handbook A Publication of BMJ Publishing Group Chronic Anal Fissures RICHARD L. NELSON, Northern General Hospital, Sheffield, United Kingdom This is one in a series of Chronic anal fissures typically occur in the • Open partial lateral internal anal chapters excerpted from midline, with visible sphincter fibers at the sphincterotomy may be equivalent to closed the Clinical Evidence Handbook, published by fissure base, anal papillae, sentinel piles, and partial internal anal sphincterotomy in fis- the BMJ Publishing Group, indurated margins. sure healing. London, U.K. The medical • Anal fissures are a common cause • Longer internal anal sphincter division information contained of anal pain during and for one to two (to the dentate line, as opposed to the fissure herein is the most accurate available at the date of hours after defecation. The cause is not fully apex only) may be more effective at reducing publication. More updated understood, but low intake of dietary fiber anal fissure. and comprehensive infor- may be a risk factor. The risk of minor flatus or fecal inconti- mation on this topic may Chronic fissures typically have a cycli- nence is greater with internal anal sphinc- be available in future print • editions of the Clinical Evi- cal history of intermittent healing and recur- terotomy than with botulinum toxin. dence Handbook, as well rence, but about 35% will eventually heal, at Topical nitroglycerin increases the risk as online at http://www. least temporarily, without intervention. of headache compared with internal anal clinicalevidence.bmj.com (subscription required). • Atypical features, such as multiple, sphincterotomy. large, or irregular fissures, or those not Postsurgical fecal incontinence may be This series is coordinated in the midline, may indicate underlying confused with postsurgical leakage (a short- by Kenny Lin, MD, MPH, Associate Deputy Editor malignancy, sexually transmitted infections, term adverse effect).
    [Show full text]
  • Ankylosing Spondylitis and Inflammatory Bowel Disease*
    Ann Rheum Dis: first published as 10.1136/ard.37.1.30 on 1 February 1978. Downloaded from Annals of the Rheumatic Diseases, 1978, 37, 30-32 Ankylosing spondylitis and inflammatory bowel disease* I. Prevalence of inflammatory bowel disease in patients suffering from ankylosing spondylitis S. G. M. MEUWISSEN, BETTY J. DEKKER-SAEYS, D. AGENANT, AND G. N. J. TYTGAT From the Division ofGastroenterology, Department ofMedicine, University ofAmsterdam, and the Amsterdam Centre for Rheumatic Diseases, The Netherlands SUMMARY To establish the prevalence of inflammatory bowel disease in ankylosing spondylitis (AS), 79 AS patients underwent detailed medical screening, including sigmoidoscopic and roentgeno- logical examination. 48 had gastrointestinal symptoms and the others did not. In 3 patients a diagnosis of Crohn's disease was made which was previously established. In all other patients inflammatory bowel disease could be excluded. The prevalence of inflammatory bowel disease in this series of patients with AS therefore was 3.8 %. copyright. An association between ankylosing spondylitis (AS) gastrointestinal screening, all patients were carefully and inflammatory bowel disease (IBD) seems to be interviewed, special attention being paid to com- firmly established (Romanus, 1953; Steinberg and plaints such as heartburn, dysphagia, fat intolerance, Story, 1957; Wilkinson and Bywaters, 1958; abdominal pain, frequency and other characteristics McBride et al., 1963; Jayson and Bouchier, 1968; of bowel motions, loss of blood or mucus, previous Jayson et al., 1970). However, it is not clear to what abdominal surgery and family history of IBD. At extent patient selection contributed to the wide clinical examination the abdomen was examined variation in the reports of prevalence of AS in for inflammatory masses, fistulae, or any otherhttp://ard.bmj.com/ patients with ulcerative colitis and Crohn's disease.
    [Show full text]
  • Anal Fissure Epidemiology and Related Diseases in Children
    DOI: 10.14744/scie.2018.84803 Original Article South. Clin. Ist. Euras. 2018;29(4):295-300 Anal Fissure Epidemiology and Related Diseases in Children Mustafa Yaşar Özdamar,1 Erkan Hirik2 ABSTRACT Objective: After an anal fissure (AF), patients frequently avoid defecation, even if they have 1Department of Pediatric Surgery, diarrhea, due to severe anal pain. This is particularly evident in constipated patients, however Erzincan Binali Yıldırım University the type of functional disease that causes AF is not limited to constipation or persistent Faculty of Medicine, Erzincan,Turkey diarrhea. The aim of this study was to examine the prevalence and the clinical importance 2Department of Urology, Erzincan Binali Yıldırım University Faculty of of diseases associated with AF in childhood age groups among young patients with different Medicine, Erzincan, Turkey clinical pictures. Submitted: 23.08.2018 Methods: The data related to age, sex, and the accompanying disease of AF patients were Accepted: 12.10.2018 collected from a hospital database. Of 7406 patients, 728 were identified and categorized Correspondence: in 6 distinct disease groups associated with AF: constipation; constipation with anal incon- Mustafa Yaşar Özdamar, tinence, urinary incontinence, or anal incontinence and urinary incontinence; infantile colic Erzincan Binali Yıldırım Üniversitesi Tıp Fakültesi, (IC); and diaper dermatitis (DD). The symptoms of the AF-related diseases were recorded Çocuk Cerrahisi Anabilim Dalı, and it was assessed whether AF-related symptoms were reduced after AF treatment. 24100 Erzincan, Turkey E-mail: Results: Of the 728 AF-associated patients of all groups, it was observed that 1 week [email protected] after AF therapy, 529 (72%) experienced a regression in both current disease and AF-re- lated symptoms (p<0.05; r=0.26).
    [Show full text]
  • Anal Fissures David B
    CLINICAL PRACTICE GUIDELINES Clinical Practice Guideline for the Management of Anal Fissures David B. Stewart, Sr., M.D. • Wolfgang Gaertner, M.D. • Sean Glasgow, M.D. John Migaly, M.D. • Daniel Feingold, M.D. • Scott R. Steele, M.D. Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Surgeons anal fissures is anal pain, which is often provoked by def- is dedicated to ensuring high-quality patient care ecation and may last for several hours following defecation. Tby advancing the science, prevention, and manage- Anorectal bleeding may also be associated with fissures, ment of disorders and diseases of the colon, rectum, and and, when this symptom is present, it can contribute to a anus. The Clinical Practice Guidelines Committee is com- misdiagnosis of symptomatic hemorrhoids. In up to 90% of posed of society members who are chosen because they cases, the anal fissure is located within the posterior midline have demonstrated expertise in the specialty of colon and of the anal canal. Fissures are located in the anterior midline rectal surgery. This committee was created to lead interna- in as many as 25% of female patients and in as many as 8% tional efforts in defining quality care for conditions related of male subjects. In 3% of patients, fissures can be located to the colon, rectum, and anus. This is accompanied by at posterior and anterior positions simultaneously. Fissures developing clinical practice guidelines based on the best located at lateral locations within the anal canal, and multi- available evidence.
    [Show full text]
  • Lower Gastrointestinal Disorders: Disorders of the Intestines
    IFFGD International Foundation for PO Box 170864 Milwaukee, WI 53217 Functional Gastrointestinal Disorders www.iffgd.org (179) © Copyright 2003-2009 by the International Foundation for Functional Gastrointestinal Disorders Reviewed and Updated by Author, 2009 Difficult to Interpret Intestinal Complaints By: W. Grant Thompson, M.D., F.R.C.P.C., F.A.C.G., Professor Emeritus, Faculty of Medicine, University of Ottawa, Ontario, Canada A medical history provides essential information for the pass normal or even loose stools and not have constipation. diagnosis of intestinal complaints. Doctors must interpret However, if the stools are also hard and difficult to pass, the symptoms described by their patients if they are to then the transit of material through the gut is likely slowed, focus their examination and choose the right tests. and constipation is present. Reference to the Bristol Stool Disorders of gastrointestinal function such as the irritable Form Scale (Table 1) may help the reader understand the bowel syndrome or functional constipation, diarrhea, or relation of stool form to transit time. Such details are bloating are characterized by no structural abnormality. In important if inappropriate treatment is to be avoided. these cases, diagnosis depends entirely upon the history, and diagnostic tests, if needed at all, are done to rule out Table1 Bristol Stool Form Scale inflammations, tumors and other anatomic gut disease. Type 1 Accurate diagnosis depends upon how accurately the Separate hard lumps like nuts (difficult to pass) individual describes his or her symptoms, and how skillfully the doctor interprets them. Type 2 Sausage shaped but lumpy The following are some examples of complaints due to intestinal disease or dysfunction that convey imprecise Like a sausage but with cracks on meanings.
    [Show full text]