Anal fistula

Fibrin glue has been widely used to treat anal fistulae. In a systematic review of 19 studies the reported success rates ranged from 0 to 100%, which may have been due to differences in patient selection (including fistula aetiology and type), treatment protocols, and follow-up duration (8). 

Hammond TM, Grahn MF, Lunniss PJ. Fibrin glue in the management of anal fistulae. Colorectal Dis 2004 6(5) 308-19. 

Tsai SK, Lee TY, Mok MS Gas Embolism Produced by Hydrogen Peroxide Irrigation of an Anal Fistula During Anesthesia. 1985 63 316-317. 

Indians used alcohol as an analgesic, stopped bleeding with hot oils and tars, removed tumors, drained abscesses, repaired anal fistulas, stitched wounds, performed amputations and cesarean sections, and they knew how to splint fractures. Their fumigation of wounds is one... 

Furthermore, the inflammation may be transmural, penetrating to the muscularis or serosal layers of the GI tract (Fig. 16-2). The propensity for transmural involvement may lead to serious complications of CD, such as strictures, listulae, and abscesses.4,12 While rectal inflammation is typically less common in CD than UC, several types of perianal lesions may be observed in patients with CD. These include skin tags, hemorrhoids, fissures, anal ulcers, abscesses, and fistulae.15... 

Mitochondrial disorders are not commonly regarded as causes of malformations. Facial features included round face, high forehead, small nose, and long flat philtrum, reminiscent of the fetal alcohol syndrome. Limb and trunk involvements included short hands, brachydactyly, hypoplasia of the distal and middle phalanges, hypoplastic nails, and the VACTERL [vertebral anomalies, anal atresia, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, renal (kidney) and/or radial anomalies, and preaxial limb anomalies (in front of or above the central axis of the limb)] association [50]. 

Ulcerative colitis can be accompanied by complications that may be local (involving the colon or rectum) or systemic (not directly associated with the colon). With either type the complications may be rmld, serious, or even life threatening. Local complications occur in the majority of ulcerative colitis patients. Relatively minor complications include hemorrhoids, anal fissures, or perirectal abscesses, and are more likely to be present during active colitis. Enteroenteric fistulas are rare. 

Anal gland adenocarcinoma is typically composed of small glands with scant mucin production. It invades the anorectal wall, has no identifiable intraluminal component, and has no association with a fistula. o Anal gland adenocarcinoma is diffusely positive for CK7 and negative for CK20, CDX2, p63, and CK5/6.270,27i... 

IBD is divided into two major subtypes ulcerative colitis and Crohn s disease. Ulcerative colitis is characterized by confluent mucosal inflammation of the colon starting at the anal verge and extending proximally for a variable extent (e.g., proctitis, left-sided cohtis, or pancolitis). Crohn s disease, by contrast, is characterized by transmnral inflammation of any part of the GI tract bnt most commonly the area adjacent to the ileocecal valve. The inflammation in Crohn s disease is not necessarily confluent, frequently leaving skip areas of relatively normal mucosa. The transmural nature of the inflammation may lead to fibrosis and strictures or, alternatively, fistula formation. 

Curr Opin Pediatr 17 690-694 Poznanski A (1969) A simple device for administering barium to infants. Radiology 93 1106 Quan L, Smith WL (1973) The VATER association vertebral defects, anal atresia, T-E fistula with esophageal atresia, radial and renal dysplasia a spectrum of associated defects. J Pediatr 82 104-107... 

Of special interest in this group of youngsters has been the response of severe rectal and perianal disease to total parenteral nutrition. In one boy (R.G.) who failed to respond to several operations, his upper intestinal tract remission has been accompanied by complete healing of multiple perianal fistulae. In the girl (M.P.) who had an ileocolectomy and post operative parenteral nutrition, multiple perianal fistulae have healed. In this patient the effect of resection of intra-abdominal disease must be considered, but the rapidity of the perineal improvement was similar to that noted for R.G. Lastly, I.W. with severe anal granulomata and ulcers sustained marked improvement of the anal involvement after a brief course of parenteral alimentation. 

Levine and Muenke (1991) reported the case of a pregnant lead worker who sustained brief, early, and quite elevated workplace exposure and delivered an infant with virtually aU of the characteristic defects defining the VACTERL association seen with other human cases, where Pb was not explicitly identified as present. VACTERL refers to collective vertebral anomalies, anal artresia, cardiac defect, renal anomalies, and limb anomalies only tracheoesophageal fistula was absent. A striking feature of these birth defects was their similarity to high-dose birth defects found in various test animal species, a urorecto/caudal pattern of malformations. 

---