Effect of Colostomy on Treatment Outcome in Fournier Gangrene: A Prospective Comparative Study

Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients’ groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn’t statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.

EFFECT OF GHONTAPHALADI VARTHI IN THE MANAGEMENT OF PERIANAL SINUS - A CASE REPORT

Nadi Vrana is a term used to describe the sinus. Sinus is a blind track lined by granulation tissue from an epithelial surface.it can be treated mainly by Ksharasutra therapy and by other methods which include varti, Lepana etc. In Susrutha Samhitha Chikitsasthana first chapter Dwivarineeya chikitsa; it is mentioned that the Vrana Varthi 1can be used in Nadi Vrana where the wound is having minute opening, deep and going into the Mamsadhatu (muscles). In the present case study, a 44-year-old male patient visited the OPD with Grade 1 inter sphincteric sinus in the perianal region and the patient was selected for application of the Ghontaphaladi Varthi. Daily application of Ghontaphaladi Varthi has shown significant changes in the healing of the track and a decrease in the severity of the associated symptoms like pain and discharge. Keywords: Nadi Vrana, Ghontaphaladi Varthi, Sinus

MICROBIOLOGICAL PROFILE, ANTIBIOTIC SENSITIVITY AND PROGNOSIS OF PATIENTS WITH FOURNIER’S GANGRENE: A PROSPECTIVE, HOSPITAL BASED STUDY FROM NORTH INDIA

Background: Fournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotic therapy for FG. Materials and Methods: Data from patients who underwent surgery for FG was retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated. Outcome was also assessed in terms of mortality. Results: Fifty patients with a median age of 58.5 (40-83) years were included. The perianal region and scrotum (88%) were the most commonly affected. Diabetes mellitus (DM) was the most common comorbidity (92%). The median time to onset of symptoms was 7 (2-15) days, and the median duration of hospital stay was 22 (4-65) days. Ventilator requirement was required in 15 (30%) patients. The median UFGSI score was 9.5 (3-15). The overall mortality rate was 26%. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0-10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (68%). Acinetobacter baumannii and Klebsiella pneumonia were signicantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of > 9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate. Conclusion: Causative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modied. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.

Giant condiloma of Bushke-Levenstein of anal canal and perianal skin. Clinical case

The article is devoted to a rare disease of the perianal region — Buschke-Levenshtein tumor. A clinical case and a literature review on the etiology, pathogenesis and experience of treating such tumors are presented. Evidence based sources show that currently there is no generally accepted tactics of managing patients with this pathology. In this regard, each case of treatment of such patients is of not only scientific but also practical interest. In this case, the tactics of staged treatment with the use of high-temperature dissectors and immunocorrection was chosen, which made it possible to achieve a good clinical result without the formation of extensive and long-term non-healing wound defects in the perianal region.

Perianal Infections in Patients With Hematologic Malignancy: The Risk of Fournier’s Gangrene Leading to Mortality and Irreversible Organ Damage

Introduction. The efficacy of surgical intervention for perianal infection in patients with hematologic malignancy is not well-established. Objective. This article presents a case series of perianal infection progressing to Fournier’s gangrene (FG) in patients with hematologic malignancy to guide physicians, because to the author’s knowledge, there were no randomized or prospective studies presenting the management strategies reported herein. It was hypothesized that surgery might reduce mortality and morbidity in patients with inflammation spreading beyond the perianal region, in patients with abscess formation, and in those who show no improvement with medical therapy. Materials and Methods. The data of 4 adults with hematologic malignancy who developed perianal infection progressing to FG between January 2010 and December 2018 were reviewed retrospectively. Patients younger than 18 years and patients without hematologic malignancies or FG were excluded. The primary outcome was mortality. The secondary outcome was irreversible organ damage. Results. Four male patients with a mean age of 36.75 years ± 13.1 standard deviation (range, 23–52 years) reported fever and dull anal pain during treatment for hematologic malignancy. A broad-spectrum antibiotic regimen was administered as initial empiric therapy at onset of fever and was de-escalated based on the culture results and clinical response. However, FG arose in all cases approximately 8.75 days ± 6.94 (range, 3–17 days) after onset of anal pain. All patients underwent surgical debridement, and diverting ostomy was performed in 3 cases. One patient died of overwhelming sepsis (25%), and 1 patient required orchiectomy (25%). Conclusions. Clinical suspicion of FG may be effective in reducing mortality in patients with hematologic malignancy, especially in cases with fever accompanied by anal pain. Surgical intervention may improve the prognosis for patients with inflammation spreading beyond the perianal region, patients with abscess formation, those who show no improvement in medical therapy, and those who develop FG. Diverting ostomy may improve survival in patients with FG.

EPIDERMAL INCLUSION CYST OF THE PERIANAL REGION: REPORT OF A RARE CASE

Epidermal cysts are congenital lesions that originate from embryonal tissue remnants. It requires histopathology for its diagnosis. In this case, we report a young male with no comorbidities presenting with perianal swelling. He was evaluated and taken up for surgery. Post operative period was uneventful and he was discharged on 2nd post operative day. He is doing well at 4 months of follow up.

Coexistence of human immuno deficiency virus, diabetes mellitus, epididymal cysts, and Fournier's gangrene: A case report

Fournier's gangrene (FG) is a form of necrotizing fasciitis that is localized in the external genital organs and perianal region and causes skin and subcutaneous tissue gangrene. The clinical picture may vary depending on the patient's comorbidities and the extent of infection; Many predisposing conditions such as immunodeficiency, diabetes, alcoholism encourage the spread of the infection. In this case report, we highlighted the importance of emergency debridement in patients with multiple comorbidities by presenting the Fournier's Gangrene case in a 57-year-old immunosuppressive male patient with cystic lesions in the epididymis, with a history of hypertension, coronary artery disease, diabetes, HIV (human immunodeficiency virus) and a history of bipolar disorder. The patient, who was operated on for debridement by the urology, was given 1x500mg daptomycin, 3x1g meropenem, 3x450mg clindamycin IV treatment. The patient was discharged with full recovery after 17 days of hospitalization. Clinical suspicion in Fournier's gangrene cases, early surgical debridement, and extended-spectrum anti biotherapy are important. with rapid diagnosis and treatment in patients with improvement can also be seen in patients with comorbidities.

Homeopathic treatment of perianal fistula in a dog - Case Report / Tratamento homeopático da fístula perianal num cão - Relato de caso

Perineal fistulas are frequently diagnosed in dogs in clinical practice. They are characterized by an inflammatory lesion in the perianal region or adjacent tissues, causing pain and discomfort to patients. In many cases, fistulas can be ulcerated. In general, corticosteroids and immunosuppressants are the treatment of choice for perianal fistulas. However, they cause various side effects. Surgical intervention is also an option, but sequelae may occur, such as fecal incontinence, the most frequent of them. From this perspective, it is evident that conventional treatments do not provide the complete restoration of the patients' health. On the other hand, homeopathic treatments are gaining space in the veterinary clinical routine with successful results for various diseases that affect animals. This study aimed to report the case of a German Spitz male dog diagnosed with perianal fistula exclusively treated by homeopathy. The prescription of medicines was based on the law of similars, and the medicines Arnica montana, Belladonna, Hamamellis virginiana, and Nitric acidum were chosen. The therapeutic protocol established restored the affected tissues' function with a complete resolution of the disease in 15 days. No complications were recorded.

Mixed Adenoneuroendocrine Carcinoma of the Perianal Region

Introduction: Mixed adenoneuroendocrine carcinoma (MANEC) is a tumor of the gastrointestinal tract that contains both exocrine and endocrine components, with each component representing a minimum of 30% of the total tumor mass.

Management of of complex fistula-in-ano by a IFTAK technique - case report

Ksharsutra is a Medicated seton which is made by coating the Barbour thread with 21 coatings of Kshara i.e. an herbal alkaline powder, turmeric and latex of Euphorbia nerrifolia. Ksharsutra application is a minimal invasive well established procedure in management of fistula-in-ano. Research on Ksharsutra started since 1968 and it is being used till date with high success rate. In this case report the patient was asymptomatic before 15 years but then a boil developed at perianal region which spontaneously bursted and pus discharge was seen from the boil. Patient was diagnosed with Grade 5 St. James’s university hospital classification of perianal fistulae. This was a case of high anal horse shoe fistula. In this case Fistulectomy or Fistulotomy would cause incontinence. So in this case the Ksharsutra was used but with a modification of classical technique called as IFTAK (Interception of fistulous track with application of Ksharsutra) technique. In which a window was created at 6o’ clock and intersphincteric tract was identified and in that tract Ksharsutra was placed. This technique cures such types of complex Fistula in ano with minimal tissue damage and duration of healing is also reduced.