Prenatal Diagnosis of Anal Atresia – A Case Report

Anal atresia can be divided into high type and low type depending on the relationship between the distal rectal pouch and the puborectalis muscle. Prenatal diagnosis of anal atresia is very challenging. Indirect findings include dilated distal bowel segments and calcified intraluminal meconium in 2nd & 3rd trimester. Direct findings include no PAMC (perianal muscular complex) and no target sign (hypoechoic anal sphincter and echogenic anal mucosa). PAMC is intact in low atresia, no PAMC can only be applied to high atresia. A visible echogenic anal mucosa excludes all cases of high atresia and most cases of low atresia, with the exception of the mildest cases with only a thin membrane covering the anal opening.     

Rare case of granular cell tumor of perianal region: a case report and literature review

Granular cell tumors (GCTs) are rare submucosal neoplasms, with tumors in the oral mucosa accounting for about a third of all cases. In contrast, GCT is a rare anal neoplasm, with fewer than 30 cases of perianal GCT reported in the literature. We report the case of a 36-year-old woman with a perianal lump with no obvious local lesion as the main clinical complaint. The tumor was completely resected and histologically confirmed as a GCT. The patient remained under continuous follow-up. GCT is difficult for surgeons and pathologists to diagnose, and biopsy and immunohistochemical analysis are prerequisites for an accurate diagnosis. An integrated understanding of GCT in terms of its differential diagnosis will contribute to better identification and more appropriate treatment of this disease.     

Perianal and perineal keratoacanthoma: Two cases demonstrating histologic similarity to subungual keratoacanthoma

Perianal keratoacanthomas are rare, with 10 cases reported to date. Perineal keratoacanthoma has not previously been described. In this report, we describe two cases of keratoacanthoma, one perianal and one perineal. Both lesions show prominent dyskeratotic keratinocytes, with striking and curious histologic resemblance to subungual keratoacanthoma.     

中药祛毒汤预防化疗病人肛周感染的效果

[目的]探讨中药祛毒汤坐浴对化疗病人肛周感染发生率的影响.[方法]我科收治的化疗病人分为实验组和对照组.实验组用中药祛毒汤坐浴预防肛周感染,对照组选用1:5000高锰酸钾坐浴预防肛周感染.[结果]实验组与对照组治疗效果差异无统计学意义(P＞0.05).[结论]中药祛毒汤和1:5 000高锰酸钾坐浴均可预防化疗病人肛周感染,但前者毒副反应小,取材方便,价格低廉,病人易于接受.     

Fistula-associated anal carcinoma in Crohn’s disease

Introduction: Fistula-associated anal carcinoma in patients with Crohn’s disease (CD) is a rare condition. More recently, this entity has been increasingly reported likely due to increased recognition, and the incidence may be greater than once appreciated. There remains a paucity of data regarding the incidence, diagnosis, treatment, and outcome of fistula-associated anal carcinoma.

Area covered: This review evaluates the clinical features, pathology, treatment, and prognosis of fistula-associated anal carcinoma in patients with CD. A strategy for surveillance of this carcinoma is proposed by the authors based on the evidence obtained from this review.

Expert commentary: Clinicians caring for patients with CD and perianal involvement need to be aware of the rare yet extremely important association of long-standing perianal disease and fistula-associated carcinoma. Only through awareness, a high level of suspicion will be diagnosed in a timely manner. This involves a thorough history, a proper, and complete anorectal examination, along with early imaging and examination under anesthesia. Through this approach, it is hoped that early diagnose can be achieved in at-risk patients and change the significant morbidity and mortality associated with this diagnosis.     

Perianal Bowen's disease

Thirty-three patients with perianal Bowen's disease were treated at the Cleveland Clinic Foundation from 1954 to 1986. Twenty-one patients were women and 12 were men, ranging in age from 30 to 69 years (mean, 48 years). Twenty patients (61 percent) presented with symptomatic perianal disease, while 13 patients (39 percent) were noted as having perianal Bowen's disease upon pathologic examination of routine hemorrhoidectomy specimens. Ten of the patients (30 percent) had prior histories of unrelated cancer. Twenty-seven patients were managed by wide local excision, three patients by simple excision, three patients by fulguration, and one patient by an abdominoperineal resection. During a follow-up period averaging 3.7 years (range, 0.3 to 10 years), one patient developed a new invasive skin cancer while a second patient experienced a recurrence of perianal Bowen's disease. The characteristic gross appearance of this lesion and its failure to respond to conventional therapy should prompt the performance of a hiopsy, which readily establishes the diagnosis. This experience confirms that wide local excision is adequate therapy for perianal Bowen's disease and that close clinical follow-up is necessary to identify disease recurrence or the development of a malignancy. Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Washington, D.C., April 5 to 10, 1987. The opinions experessed are those of the authors and do not reflect the opinions of the United States Air Force or the Department of Defense.     

改良LIFT术和常规 LIFT术治疗单纯性经括约肌型肛瘘的比较分析

目的：比较改良LIFT术(经括约肌间瘘管结扎术)和常规LIFT术治疗单纯性经括约肌型肛瘘的临床疗效。方法2013年1月至2014年12月,86例单纯性经括约肌型肛瘘患者,随机分成A组和B组,分别接受改良LIFT 术(A组)与常规LIFT术（B组）42例和44例。通过比较两组病例的手术时间、术后疼痛VAS评分、伤口愈合时间、住院时间及治愈率评估两种手术方法的临床疗效。所有随访患者于术后第3个月均测定肛门直肠压力和进行盆底肌电图检查以评估肛门功能。结果所有患者均获得随访3～26个月,平均（8.73±7.15）月。两组患者的手术时间、术后24 h VAS疼痛评分和住院时间比较,差异均无统计学意义（P＞0.05）。两组患者的伤口愈合时间比较,差异无统计学意义（P＞0.05）。但A组治愈率为88.10%,明显高于B组治愈率63.63%,差异有统计学意义（P＜0.05）。两组患者术前和术后3个月的肛门直肠压力无明显变化,差异无统计学意义（P＜0.05）;两组患者术前和术后3个月的内、外括约肌和耻骨直肠肌MUP 平均时限比较,差异均无统计学意义（P＞0.05）。结论改良LIFT术较常规LIFT术明显提高治愈率,是治疗单纯性经括约肌型肛瘘的有效术式。     

中药坐浴及美皮康银离子辅料换药对肛周脓肿术后康复的影响

目的:观察中药坐浴及美皮康银离子辅料换药对肛周脓肿术后康复的影响。方法:将肛周脓肿术后患者76例随机分为治疗组40例和对照组36例。治疗组采用中药煎剂坐浴后美皮康银离子辅料伤口换药,对照组用1∶5 000高锰酸钾溶液坐浴后用呋喃西林纱条换药。比较2组疗效及术后第1、3、7天换药时疼痛情况和伤口渗液情况,住院时间。结果:治疗组治愈率为87.5%,对照组为63.9%,治疗组疗效优于对照组(P0.05);治疗组平均住院时间为(7.50±1.01)天,较对照组(8.44±1.12)天短(P0.05);治疗组术后第1、3天换药时伤口疼痛评分及渗液量均较对照组轻(P0.05),术后第7天2组换药时伤口疼痛评分、渗液量比较无差异(P0.05);换药过程中时间因素是缓解伤口换药疼痛及渗液量的独立影响因素(P0.05),去除时间因素后两种方法比较差异有统计学意义(P0.05)。结论:肛周脓肿术后采用中药坐浴及美皮康银离子辅料换药能提高临床疗效,更好地缓解恢复过程中伤口疼痛和伤口渗液等症状、缩短住院时间。