Annals of Coloproctology

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Original Article

Anorectal benign disease

Antibiotic use during the first episode of acute perianal sepsis: a still-open question: Stanislas Blondin, David Lobo, Axel Egal, Saliha Ysmail-Dahlouk, Milad Taouk, Josée Bourguignon, David Blondeel, Isabelle Etienney; Ann Coloproctol. 2025;41(1):40-46. Published online February 3, 2025; DOI: https://doi.org/10.3393/ac.2024.00472.0067

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Purpose
The role of antibiotics in preventing fistula formation following an initial abscess remains a subject of debate. This study compared the incidence of fistula in ano in patients experiencing their first episode of acute perianal sepsis, with and without antibiotic therapy, and evaluated the prevalence of fistula in ano necessitating surgical intervention at 1 year.
Methods
This retrospective cohort study was conducted at a tertiary care hospital with a dedicated proctology department. All patients who presented to the emergency proctology unit with a first episode of acute perianal sepsis were eligible for inclusion.
Results
This study included 276 patients. At 1 year, fistula formation was identified in 65.6% of all patients, 54.0% of those who had received antibiotics, and 75.0% of those who had not (P<0.001). This finding remained significant after weighted propensity analysis (odds ratio, 0.53; 95% confidence interval, 0.31–0.92; P=0.025).
Conclusion
The rate of fistula formation was relatively high in this study. However, it was lower among patients with perianal sepsis who were treated with antibiotics, although a causal relationship could not be established. Prolonged follow-up is needed to clarify the role of antibiotic therapy in preventing or delaying fistula development in patients with acute perianal sepsis.

Citations

Citations to this article as recorded by

Associations between adjuvant antibiotic therapy and fistula formation after incision and drainage of anorectal abscesses: results from a retrospective cohort study
J. Alabbad, S. Almutairi, N. Alsabagha, H. Alhamly, F. Alnaqi
Techniques in Coloproctology.2026;[Epub] CrossRef

Review

Benign proctology,Rare disease & stoma

Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature: Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith; Ann Coloproctol. 2021;37(5):269-274. Published online October 29, 2021; DOI: https://doi.org/10.3393/ac.2021.00332.0047

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Abstract PDF

Actinomycosis is a serious suppurative, bacterial infection caused by the gram-positive anaerobic Actinomyces species. Primary perianal actinomycosis is rare and challenging for the colorectal surgeon. We aimed to present our experience and compare this with available literature. All patients with isolated Actinomyces on microbiology reports, between January 2013 and February 2021, were identified and reviewed. Data collection was retrospective based on electronic patient records. The site of infection and treatment strategy were examined. Perianal cases were evaluated in depth. All publications available in the literature were interrogated. Fifty-nine cases of positive actinomycosis cultures were reviewed. Six cases of colonization were excluded. Actinomyces turicensis was the most common organism isolated. Five cases of perianal actinomycosis were identified requiring prolonged antibiotic and surgical therapy. Twenty-one studies, most case reports, published since 1951 were also reviewed. Diagnosis of perianal actinomycosis may be challenging but should be suspected particularly in recurrent cases. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium. An extended course of antibiotic therapy (months) is required for eradication in certain cases.

Citations

Citations to this article as recorded by

Actinomyces Species As Emerging Pathogens: An Observational Study of Clinical Infections and Microbiological Implications
Abraham A Ayantunde, Joanne Kiang, Nadeem S Raja, Javeed Ahmed, Anjali Sanghera, Saumya Venkatesha, Andrew C Ekwesianya
Cureus.2025;[Epub] CrossRef
Imaging of perineal suppurations: a pictorial essay
Mohamed Amine Haouari, Chloé Gallégo, Vincent de Parades, Charlotte Fite, Caroline Touloupas, Alexandre Delpla, Isabelle Bouley-Coletta, Marc Zins
Abdominal Radiology.2025;[Epub] CrossRef
Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Colonic actinomycosis masquerading a cancer resulting complete bowel obstruction-a case report
Lilamani Rajthala, Santosh Sirpaili, Krishna Mohan Adhikari
International Journal of Surgery Case Reports.2024; 125: 110563. CrossRef
Letter to the Editor: Actinomyces turicensis Causing Fournier Gangrene
Kaiying Wang, Thomas Zheng Jie Teng, Vishal G. Shelat
Surgical Infections.2022; 23(4): 411. CrossRef
Fungal perianal abscess as the initial presentation of disseminated coccidioidomycosis
Christian Olivo-Freites, Oscar E. Gallardo-Huizar, Christopher J. Graber, Kevin Ikuta
IDCases.2022; 30: e01636. CrossRef

Original Articles

Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain: Zahra Abdulla Isa Yusuf Hasan, Bayan Mohamed, Rawaa AlSayegh, Raed AlMarzooq; Ann Coloproctol. 2023;39(1):27-31. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2020.00962.0137

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4 Web of Science
5 Citations

Abstract PDF

Purpose
Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice.
Methods
A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software.
Results
The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas.
Conclusion
The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.

Citations

Citations to this article as recorded by

Risk factors for perianal abscess recurrence after incision and drainage: a review of the literature
Kheira Gabsi
International Surgery Journal.2025; 12(2): 255. CrossRef
A Review of the Anatomy of Anal Glands Relevant to Cryptoglandular Fistulas; Are We on the Right Track?
James Church
ANZ Journal of Surgery.2025; 95(11): 2355. CrossRef
Anal Cryptoglandular Suppuration
Oladapo Akinmoladun, Quinton M. Hatch
Surgical Clinics of North America.2024; 104(3): 491. CrossRef
Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence
Shan-Zhong Chen, Kui-Jun Sun, Yi-Fan Gu, Hong-Yuan Zhao, Dong Wang, Yun-Fang Shi, Ren-Jie Shi
World Journal of Gastrointestinal Surgery.2024; 16(11): 3425. CrossRef
Research Progress on Diagnosis and Surgical Treatment of Perianal Deep Space Abscess
永罡秦
Advances in Clinical Medicine.2023; 13(01): 180. CrossRef

Benign GI diease,Benign proctology,Surgical technique

Pilonidal Sinus Management; Bascom Flap Versus Pilonidal Pits Excision: A Single-Center Experience: Ashraf Imam, Harbi Khalayleh, Guy Pines, Deeb Khoury, Eli Mavor, Arie Pelta; Ann Coloproctol. 2021;37(2):109-114. Published online November 6, 2020; DOI: https://doi.org/10.3393/ac.2019.11.19.2

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7 Citations

Abstract PDF

Purpose
This study aimed to evaluate the outcomes of the Bascom cleft lift (flap) and the pilonidal pits excision (Gips procedure).
Methods
The records of all the patients who underwent pilonidal sinus excision between November 2013 and August 2017 were reviewed. Inclusion criteria included either pilonidal pits excision or the Bascom cleft lift procedure. All procedures were performed by a single surgeon. Perioperative complications and recurrence rates were reviewed.
Results
Fifty-three patients met the inclusion criteria. Male/female ratio was 36/17, with a mean age of 23.4 ± 7 years. In this study, 21 patients underwent the Bascom cleft lift (skin flap) procedure and 32 underwent the Gips-style operation. The mean follow-up was 3.5 months. Twenty-eight patients (52.8%) underwent prior drainage of pilonidal abscess. Eleven patients had a previous wide local excision with recurrent disease. A higher rate of recurrence was observed among patients who underwent pits picking following failure of a previous wide local excision (80% vs. 0%, P = 0.02). Minor wound dehiscence developed in 8 patients; all of which were in the Bascom flap group (40% vs. 0%, P < 0.005). All of these wounds healed completely between 3 and 6 weeks.
Conclusion
The Gips procedure is the recommended treatment for simple pilonidal disease. For recurrent pilonidal disease, the Bascom cleft lift (flap) procedure is an excellent option since it demonstrates a short wound healing time and a good success rate. This calls into question the continued use of the wide excision technique used by most surgeons in this country and abroad.

Citations

Citations to this article as recorded by

Efficiency of the new modified inverted Y cleft lift advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease with low-lying tracts near the anus
Walid G. Elshazly, Ahmed Radwan, Mohmed A. Elhalim, Ahmed Moaz
The Egyptian Journal of Surgery.2024; 43(2): 548. CrossRef
ЭФФЕКТИВНОСТЬ КОЛЛАГЕНОВОЙ ГУБКИ ПРОПИТАННОЙ ДОКСИЦИКЛИНОМ ПРИ ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ПИЛОНИДАЛЬНОГО СИНУСА
G.A. Kosayeva
Azerbaijan Medical Journal.2024; (2): 16. CrossRef
Pilonidal diseases in children
Yu. Yu. Koinov, Yu. V. Chikinev, P. V. Trushin, A. I. Shevela, V. V. Sytkov, A. I. Khavkin
Experimental and Clinical Gastroenterology.2024; (10): 206. CrossRef
The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease
Yaoyao Song, Yu Zang, Zequn Chen, Jianjun Li, Minhui Zhu, Hongjuan Zhu, Wanli Chu, Gang Liu, Chuan'an Shen
International Wound Journal.2023; 20(6): 2241. CrossRef
Minimally invasive surgery for pilonidal disease: Outcomes of the Gips technique—A systematic review and meta-analysis
Marta Amorim, José Estevão-Costa, Cristina Santos, Sara Fernandes, Ana Catarina Fragoso
Surgery.2023; 174(3): 480. CrossRef
Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review
Peiliang Wu, Yingyi Zhang, Yewei Zhang, Shuang Wang, Zhe Fan
International Journal of Surgery.2023; 109(8): 2388. CrossRef
Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques
Sara Fernandes, Carolina Soares‐Aquino, Inês Teixeira, Joana Mafalda Monteiro, Miguel Campos
ANZ Journal of Surgery.2022; 92(12): 3288. CrossRef

Case Reports

Benign proctology,Rare disease & stoma

Extraperitoneal Spread of Anorectal Abscess: A Case Report and Literature Review: Papadopoulos S. Konstantinos, Dimopoulos Andreas, Kordeni Kleoniki, Filis Dimitrios; Ann Coloproctol. 2021;37(Suppl 1):S11-S14. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2020.01.20

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152 Download
5 Web of Science
7 Citations

Abstract PDF

Supralevator abscess is a rare form of anorectal disease responsible for very rare but morbid manifestations, one of which is superior spread through fascial planes. We present a rare case of a spreading anorectal abscess in a patient who presented with only diffuse abdominal pain, and we review similar cases in the literature according to anatomical considerations, presentation, diagnostic procedures, and treatment options. We identified 7 previously reported cases of spreading anorectal abscesses. Most abscesses had a horseshoe morphology, and all patients presented or developed abdominal pain. All patients had perianal swelling and pain. Five out of 7 patients were previously mistreated. Only 2 abscesses spread through both the pre- and retroperitoneal planes. Abdominal pain is a dominant feature of extraperitoneal inflammation originating from anorectal abscesses. The absence of perianal signs is rare, and proper inspection of the patient along with the medical history can lead to quicker diagnosis and decisive treatment.

Citations

Citations to this article as recorded by

Fused Ischiorectal Phlegmon with Pre- and Retroperitoneal Extension: Case Report and Narrative Literature Review
Laurențiu Augustus Barbu, Liviu Vasile, Liliana Cercelaru, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Stefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Tiberiu Stefăniță Țenea Cojan, Nicolae-Dragoș Mărgăritescu
Journal of Clinical Medicine.2025; 14(14): 4959. CrossRef
A case of supralevator abscesses involving the prostate and rectum: Formation of a deep and concealed fistula
Feng Chen, Xudan Weng, Yan Li, Jianquan Zhong
Asian Journal of Surgery.2025;[Epub] CrossRef
Ischiorectal abscess with retroperitoneal extension: masquerading as an appendicular abscess
Kalyani Dnyaneshwar Aher, Minakshi Gadhire, Naman Jain, Prafulla Salunkhe
International Surgery Journal.2025; 12(10): 1886. CrossRef
Innovative dual-access surgical strategy for advanced pelvic Fournier’s gangrene: a retrospective study assessing combined suprapubic and transsacral debridement
Zhi-Min Liu, Guo-Zhong Xiao, Jie Huang, Xin Jin, Neng-Sheng Lai, Xing-Yang Wan, Hong-Cheng Lin
BMC Gastroenterology.2025;[Epub] CrossRef
Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report
Hsiang Teng, Po-Hsien Wu
Medicina.2024; 60(2): 293. CrossRef
A Clinical-Anatomical-Radiological Study of Extraperitoneal Spaces: A Case Series
Giridhar Ashwath, Eshwar Kathiresan Manasijan, Logeshbalaji Seelampatti Palanisamy, Anthony P Rozario, Nachiket Shankar
Cureus.2024;[Epub] CrossRef
Complex Tunneling Perirectal Abscess: Intra-abdominal and Extraperitoneal Extension of a Persistent Perirectal Abscess
Abenezer S Tedla, Harsh R Parikh, Savni Satoskar, Jigyasha Pradhan, Shailja Kataria, Vinayak S Gowda
Cureus.2024;[Epub] CrossRef

A Rare Case of Posterior Horseshoe Abscess Extending to Anterolateral Extraperitoneal Compartment: Anatomical and Technical Considerations: Christianna Oikonomou, Periklis Alepas, Stelios Gavriil, Dimitrios Kalliouris, Konstantinos Manesis, Petros Bouboulis, Dimitrios Filippou, Panagiotis Skandalakis; Ann Coloproctol. 2019;35(4):216-220. Published online May 31, 2019; DOI: https://doi.org/10.3393/ac.2018.03.05

13,100 View
184 Download
6 Web of Science
10 Citations

Abstract PDF

Perianal abscess and fistula are 2 distinct entities that share a common pathology. A horseshoe fistulous abscess, a complex type of these conditions, occurs when the suppurative inflammation spreads through the deep anal space to the bilateral ischiorectal fossae. Following the intersphincteric plane, this infection may extend to the pararectal space, forming a supralevator abscess. We present a very rare case involving a 52-year-old male patient who was admitted to our surgical department with an extraperitoneal purulent inflammation as a complication following multiple drainage procedures for a posterior horseshoe abscess. Emphasis is given to the anatomical and technical considerations of eradication of anorectal sepsis and the management of complex fistula-in-ano along with a concise review of the literature.

Citations

Citations to this article as recorded by

Acquired Ano-Rectal Sinuses and Fistulas Involving Genito-Urinary Structures in Men: A Case Series
Abhraneel Das, Devesh Malik, Saurav S Bhadoria, Asmita Asmita
Cureus.2025;[Epub] CrossRef
Fused Ischiorectal Phlegmon with Pre- and Retroperitoneal Extension: Case Report and Narrative Literature Review
Laurențiu Augustus Barbu, Liviu Vasile, Liliana Cercelaru, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Stefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Tiberiu Stefăniță Țenea Cojan, Nicolae-Dragoș Mărgăritescu
Journal of Clinical Medicine.2025; 14(14): 4959. CrossRef
Ischiorectal abscess with retroperitoneal extension: masquerading as an appendicular abscess
Kalyani Dnyaneshwar Aher, Minakshi Gadhire, Naman Jain, Prafulla Salunkhe
International Surgery Journal.2025; 12(10): 1886. CrossRef
Innovative dual-access surgical strategy for advanced pelvic Fournier’s gangrene: a retrospective study assessing combined suprapubic and transsacral debridement
Zhi-Min Liu, Guo-Zhong Xiao, Jie Huang, Xin Jin, Neng-Sheng Lai, Xing-Yang Wan, Hong-Cheng Lin
BMC Gastroenterology.2025;[Epub] CrossRef
Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report
Hsiang Teng, Po-Hsien Wu
Medicina.2024; 60(2): 293. CrossRef
Complex Tunneling Perirectal Abscess: Intra-abdominal and Extraperitoneal Extension of a Persistent Perirectal Abscess
Abenezer S Tedla, Harsh R Parikh, Savni Satoskar, Jigyasha Pradhan, Shailja Kataria, Vinayak S Gowda
Cureus.2024;[Epub] CrossRef
Practical application of the wound healing agent in the treatment of patients with acute paraproctitis
L. A. Lichman, S. E. Katorkin, P. S. Andreev, O. E. Davydova
Ambulatornaya khirurgiya = Ambulatory Surgery (Russia).2024; 21(2): 120. CrossRef
Autologous Platelet-Rich Plasma Injection and Platelet-Rich Fibrin Glue Insertion for the Treatment of Extensive Supralevator Anorectal Fistula: A Case Report
Amin Dalili, Daryoush Hamidi Alamdari, Alimohamad Dalili, Maryam Sarkardeh, Alireza Rezapanah, Nooshin Tafazoli
WORLD JOURNAL OF PLASTIC SURGERY.2023; 12(1): 58. CrossRef
Adölesanda vajene spontan drene olan anorektal apse: Olgu sunumu
Ali Ekber Hakalmaz, Ayşe Kalyoncu Uçar, Gonca Topuzlu Tekant, Yunus Söylet, Sinan Celayir
Turkish Journal of Pediatric Surgery.2023; 37(3): 119. CrossRef
Extraperitoneal Spread of Anorectal Abscess: A Case Report and Literature Review
Papadopoulos S. Konstantinos, Dimopoulos Andreas, Kordeni Kleoniki, Filis Dimitrios
Annals of Coloproctology.2021; 37(Suppl 1): S11. CrossRef

Original Article

Diagnosis and Management of a Cryptoglandular Actinomycotic Fistula-in-Ano: An Update on 7 New Cases and a Review of the Literature: Axel Egal, Isabelle Etienney, Heym Beate, Jean Francois Fléjou, Charles André Cuenod, Patrick Atienza, Pierre Bauer; Ann Coloproctol. 2018;34(3):152-156. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.07.23

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104 Download
3 Web of Science
3 Citations

Abstract PDF

Purpose
Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001.
Methods
This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris.
Results
From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study. The main symptom was an acute painful ischioanal abscess. One patient exhibited macroscopic small yellow granules (“sulfur granules”), another “watery pus” and a third subcutaneous gluteal septic metastasis. All patients were overweight (body mass index ≥ 25 kg/m²). Histological study of surgically excised tissue established the diagnosis. All the patients were managed with a combination of classical surgical treatment and prolonged antibiotic therapy. No recurrence was observed during follow-up, the median follow-up being 3 years.
Conclusion
Actinomycosis should be suspected particularly when sulfur granules are present in the pus, patients have undergone multiple surgeries or suppuration has an unusual aspect. Careful histological examination and appropriate cultures of pus are needed to achieve complete eradication of this rare, but easily curable, disease.

Citations

Citations to this article as recorded by

Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Development of a new patient-reported outcome measure for complex cryptoglandular fistulas (20-Item complex cryptoglandular fistula questionnaire™): a qualitative study
Jeffrey D. McCurdy, Patrick Crooks, Chad Gwaltney, Robert Krupnick, Kathy-Ann Cadogan, Chitra Karki
Journal of Patient-Reported Outcomes.2024;[Epub] CrossRef
Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature
Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith
Annals of Coloproctology.2021; 37(5): 269. CrossRef

Case Report

Pilonidal Abscess Associated With Primary Actinomycosis: Han Boon Oh, Mohamad Hashir Abdul Malik, Chris Hang Liang Keh; Ann Coloproctol. 2015;31(6):243-245. Published online December 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.6.243

8,767 View
37 Download
6 Web of Science
6 Citations

Abstract PDF

Pilonidal disease in the sacrococcygeal region usually presents as abscesses, recurrent inflammation, cellulitis or fistula tracks. However, few reports on actinomycosis affecting pilonidal sinuses have been published. We report a case of a 25-year-old woman who presented with a pilonidal abscess who underwent surgical drainage and debridement. Pus from the pilonidal abscess was sent for microbiology, which grew actinomyces turicensis associated with prevotella bivia and peptostreptococci. She was treated with oral amoxicillin-clavulanate after surgical drainage for one week and recovered well. Actinomycosis associated with pilonidal abscesses, though uncommon, should be recognized and can be satisfactorily treated with a combination of surgical drainage and antibiotics.

Citations

Citations to this article as recorded by

Brain abscess caused by Actinomyces turicensis in a non-immunocompromised adult patient: a case report and systematic review of the literature
Alessandra Imeneo, Lorenzo Vittorio Rindi, Andrea Di Lorenzo, Rosario Alessandro Cavasio, Pietro Vitale, Ilaria Spalliera, Mario Dauri, Daniele Guerino Biasucci, Ilaria Giuliano, Cartesio D’Agostini, Silvia Minelli, Maria Cristina Bossa, Anna Altieri, Mas
BMC Infectious Diseases.2024;[Epub] CrossRef
Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Cutaneous Actinomycosis of the Perineum in an Immunocompetent Man
Jeffrey A. Sanford, Walter L. Rush, Mary K. Klassen-Fischer, Jill I. Allbritton
The American Journal of Dermatopathology.2022; 44(4): 272. CrossRef
Pleural empyema caused by Actinomyces turicensis
Apostolos C. Agrafiotis, Ines Lardinois
New Microbes and New Infections.2021; 41: 100892. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
Actinomyces turicensis parapharyngeal space infection in an immunocompetent host: first case report and review of literature
Ayla Tabaksert, Ravi Kumar, Veena Raviprakash, Rajeev Srinivasan
Access Microbiology .2021;[Epub] CrossRef

Original Articles

Managing Deep Postanal Space Sepsis via an Intersphincteric Approach: Our Early Experience: Ker-Kan Tan, Dean C. Koh, Charles B. Tsang; Ann Coloproctol. 2013;29(2):55-59. Published online April 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.2.55

4,946 View
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15 Citations

Abstract PDF

Purpose

Managing deep postanal (DPA) sepsis often involves multiple procedures over a long time. An intersphincteric approach allows adequate drainage to be performed while tackling the primary pathology at the same sitting. The aim of our study was to evaluate this novel technique in managing DPA sepsis.

Methods

A retrospective review of all patients who underwent this intersphincteric technique in managing DPA sepsis from February 2008 to October 2010 was performed. All surgeries were performed by the same surgeon.

Results

Seventeen patients with a median age of 43 years (range, 32 to 71 years) and comprised of 94.1% (n = 16) males formed the study group. In all patients, an internal opening in the posterior midline with a tract leading to the deep postanal space was identified. This intersphincteric approach operation was adopted as the primary procedure in 12 patients (70.6%) and was successful in 11 (91.7%). In the only failure, the sepsis recurred, and a successful advancement flap procedure was eventually performed. Five other patients (29.4%) underwent this same procedure as a secondary procedure after an initial drainage operation. Only one was successful. In the remaining four patients, one had a recurrent abscess that required drainage while the other three patients had a tract between the internal opening and the intersphincteric incision. They subsequently underwent a drainage procedure with seton insertion and advancement flap procedures.

Conclusion

Managing DPA space sepsis via an intersphincteric approach is successful in 70.6% of patients. This single-staged technique allows for effective drainage of the sepsis and removal of the primary pathology in the intersphincteric space.

Citations

Citations to this article as recorded by

Deep Postanal Abscess With Sacrococcygeal Osteomyelitis: A Case Report
Javid Ahmadov, Mustafa Anil Turhan, Ender Erguder, Sezai Leventoğlu, Bulent Mentes
Cureus.2025;[Epub] CrossRef
Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients
Pankaj Garg, Gabriele Naldini, Vincent De Parades, Petr Tsarkov, Vipul Yagnik, Kaushik Bhattacharya, Baljit Kaur, G Mahak
Clinical and Experimental Gastroenterology.2025; Volume 18: 121. CrossRef
Process to determine the level of the primary internal opening of anal fistula on magnetic resonance imaging
Pankaj Garg, Baljit Kaur, G. Mahak
Annals of Coloproctology.2025; 41(3): 253. CrossRef
Anorectal Abscess
Anna Kata, Jonathan S. Abelson
Clinics in Colon and Rectal Surgery.2024; 37(06): 368. CrossRef
Research Progress on Diagnosis and Surgical Treatment of Perianal Deep Space Abscess
永罡秦
Advances in Clinical Medicine.2023; 13(01): 180. CrossRef
A Rare Case of Posterior Horseshoe Abscess Extending to Anterolateral Extraperitoneal Compartment: Anatomical and Technical Considerations
Christianna Oikonomou, Periklis Alepas, Stelios Gavriil, Dimitrios Kalliouris, Konstantinos Manesis, Petros Bouboulis, Dimitrios Filippou, Panagiotis Skandalakis
Annals of Coloproctology.2019; 35(4): 216. CrossRef
Klinische Anatomie der Anorektalregion in Bezug auf das Analfistelleiden
S. Stelzner, T. Wedel
coloproctology.2019; 41(6): 390. CrossRef
Understanding and Treating Supralevator Fistula-in-Ano: MRI Analysis of 51 Cases and a Review of Literature
Pankaj Garg
Diseases of the Colon & Rectum.2018; 61(5): 612. CrossRef
The treatment of anal fistula: secondACPGBIPosition Statement – 2018
G. Williams, A. Williams, P. Tozer, R. Phillips, A. Ahmad, D. Jayne, C. Maxwell‐Armstrong
Colorectal Disease.2018; 20(S3): 5. CrossRef
Transanal opening of intersphincteric space (TROPIS) - A new procedure to treat high complex anal fistula
Pankaj Garg
International Journal of Surgery.2017; 40: 130. CrossRef
Clinical Significance of 2 Deep Posterior Perianal Spaces to Complex Cryptoglandular Fistulas
Heng Zhang, Zhi-yang Zhou, Bang Hu, De-chao Liu, Hui Peng, Shang-kui Xie, Dan Su, Dong-lin Ren
Diseases of the Colon & Rectum.2016; 59(8): 766. CrossRef
Complex Fistula-In-Ano
J. Graham Williams
Diseases of the Colon & Rectum.2016; 59(8): 707. CrossRef
S3-Leitlinie: Analabszess
A. Ommer, A. Herold, E. Berg, St. Farke, A. Fürst, F. Hetzer, A. Köhler, S. Post, R. Ruppert, M. Sailer, T. Schiedeck, O. Schwandner, B. Strittmatter, B. H. Lenhard, W. Bader, S. Krege, H. Krammer, E. Stange
coloproctology.2016; 38(6): 378. CrossRef
Behandlung kryptoglandulärer, supralevatorischer Abszesse im MRT-Zeitalter: eine Fallserie
A. Furtwängler
coloproctology.2015; 37(3): 214. CrossRef
Modern management of deep post-anal space abscess and horseshoe fistulas
Reuben D. Shin, Jason F. Hall
Seminars in Colon and Rectal Surgery.2014; 25(4): 210. CrossRef

The Use of a Staged Drainage Seton for the Treatment of Anal Fistulae or Fistulous Abscesses: Cheong Ho Lim, Hyeon Keun Shin, Wook Ho Kang, Chan Ho Park, Sa Min Hong, Seung Kyu Jeong, June Young Kim, Hyung Kyu Yang; J Korean Soc Coloproctol. 2012;28(6):309-314. Published online December 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.6.309

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Abstract PDF

Purpose

The aim of this retrospective study was to evaluate the rate of recurrence and incontinence after the treatment of fistulae or fistulous abscesses by using the staged drainage seton method.

Methods

According to the condition, a drainage seton alone or a drainage seton combined with internal opening (IO) closure and relocation of the seton was used. After a period of time, the seton was changed with 3-0 nylon; then, after another period of time, the authors terminated the treatment by removing the 3-0 nylon. Telephone interviews were used for follow-up. The following were evaluated: the relationship between the type of fistula and recurrence; the relationship between the type of fistula and the period of treatment; the relationship between the recurrence and presence of abscess; the relationship between IO closure and recurrence; the relationship between the period of seton change and recurrence; reported continence for flatus, liquid stool, and solid stool.

Results

The recurrence rate of fistulae or suppuration was 6.5%, but for cases of horseshoe extension, the recurrence rate was 57.1%. The rate of recurrence was related to the type of fistula (P = 0.001). Incontinence developed in 3.8% of the cases. No statistically significant relationship was found between the rate of recurrence and the presence of an abscess or between the closure of the IO and the period of seton change or removal.

Conclusion

In the treatment of anal fistulae or fistulous abscesses, the use of a staged drainage seton can reduce the rate of recurrence and incontinence.

Citations

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Chunqiang WANG, Tianye HUANG, Xuebing WANG
Minerva Gastroenterology.2024;[Epub] CrossRef
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A. G. Khitaryan, A. Z. Alibekov, A. A. Golovina, S. A. Adizov, X. S. Oplimakh
Koloproktologia.2024; 23(4): 94. CrossRef
A Large Study on Lifestyle Factors Increasing Probability of Fistula and Factors Responsible for Recurrent Fistula
Hitender Suri, Deepika Suri, Kamalpreet Bansal, Sauvik Suri, Virendera Ghodke
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Nisar A. Chowdri
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Verónica Gamelas, Guilherme Simões, Sara Santos, Rafaela Loureiro, Isabel Seves, João Costa Simões, Maria João Bettencourt
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Ana Laura Sanches Lima, Beatriz Schorro Gianini, Bruna Miranda Santana, Carlos Henrique Marques dos Santos, Doroty Mesquita Dourado, Juliano Seger Falcão, Lucas Bannwart, Sara Jéssica Falcão Câmara
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Cureus.2020;[Epub] CrossRef
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Hasan Calis
Acta Medica Alanya.2019; 3(1): 67. CrossRef
Ligature method for the treatment of anal fistula: a modern view on the old approach (literature review)
A. I. Musin, E. V. Antipova, A. A. Ulyanov, D. E. Kuznetsov
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Drainage Seton Versus External Anal Sphincter–Sparing Seton After Rerouting of the Fistula Tract in the Treatment of Complex Anal Fistula: A Randomized Controlled Trial
Waleed Omar, Abdallah Alqasaby, Mahmoud Abdelnaby, Mohamed Youssef, Mostafa Shalaby, Mohamed Anwar Abdel-Razik, Sameh Hany Emile
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Oluwatomilayo O. Daodu, Julia O’Keefe, John A. Heine
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Sameh Hany Emile, Hesham Elgendy, Ahmad Sakr, Mohamed Youssef, Waleed Thabet, Waleed Omar, Wael Khafagy, Mohamed Farid
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High ligation of the anal fistula tract by lateral approach: A prospective cohort study on a modification of the ligation of the intersphincteric fistula tract (LIFT) technique
Wook Ho Kang, Hyung Kyu Yang, Han Jeong Chang, Yong Taek Ko, Byung Eun Yoo, Cheong Ho Lim, Jae Kwan Hwang, Young Chan Lee, Hyeon Keun Shin, Hae Jung Son
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A. Lauretta, N. Falco, E. Stocco, R. Bellomo, A. Infantino
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Hui-hong Jiang, Hai-long Liu, Zhen Li, Yi-hua Xiao, A-jian Li, Yi Chang, Yong Zhang, Liang Lv, Mou-bin Lin
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Sameh Hany Emile, Hossam Elfeki, Waleed Thabet, Ahmed Sakr, Alaa Magdy, Tito M Abd El-Hamed, Waleed Omar, Wael Khafagy
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Isaac José Felippe Corrêa Neto, Janaína Wercka, Diego Palmeira Rangel, Eduardo Augusto Lopes, Hugo Henriques Watté, Rogério Freitas Lino Souza, Alexander Sá Rolim, Laercio Robles
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Evaluation of the inflammatory response induced by different materials in the treatment of perianal fistulas: experimental study in rats
Mariana Ocampos Galvão, Carlos Henrique Marques dos Santos, Gustavo Ribeiro Falcão
Journal of Coloproctology.2016; 36(01): 016. CrossRef
Pulling Seton: Combination of mechanisms
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Advanced Biomedical Research.2016;[Epub] CrossRef
The role of loose seton in the management of anal fistula: a multicenter study of 200 patients
M. E. Kelly, H. M. Heneghan, F. D. McDermott, G. J. Nason, C. Freeman, S. T. Martin, D. C. Winter
Techniques in Coloproctology.2014; 18(10): 915. CrossRef
Management of Fistula-in-Ano—The Current Evidence
Parvez Sheikh, Atef Baakza
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Management of Appendicitis Presenting with Abscess or Mass: Jeong-Ki Kim, Seungbum Ryoo, Heung-Kwon Oh, Ji Sun Kim, Rumi Shin, Eun Kyung Choe, Seung-Yong Jeong, Kyu Joo Park; J Korean Soc Coloproctol. 2010;26(6):413-419. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.413

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Abstract PDF

Purpose

Management strategy in acute appendicitis patients initially presenting with abscess or mass is surrounded with controversy. This study was performed to identify the outcomes of management for this condition.

Methods

We retrospectively analyzed prospectively registered 76 patients (male:female = 39:37; mean age, 50.8 years) with appendicitis presenting with abscess or mass over a 9-year period at the Seoul National University Hospital. Patients were divided into three groups (emergency operation group, delayed operation group, and follow-up group), and clinical characteristics and outcomes of treatment were investigated.

Results

Twenty-eight patients (36.8%) underwent an emergency operation. Of the remaining 48 patients, 20 (41.7%) were initially treated with conservative management through the use of antibiotics only; the other 28 (58.3%) with and additional ultrasound-guided percutaneous drainage of the abscess. Twenty-six (54.2%) patients underwent planned operations after conservative management, and 22 (45.8%) were followed without surgery (median duration, 37.8 month), of which 3 (13%) underwent an appendectomy due to recurrent appendicitis (mean of 56.7 days after initial attack). There were no statistical differences in types of operation performed (appendectomy or ileocecectomy), postoperative complications, and postoperative hospital stay among the patients who underwent emergency operations, delayed operations and operations for recurrence during follow-up.

Conclusion

Although the recurrence rate was relatively low after conservative management for appendicitis patients presenting with abscess or mass, there was no difference in surgical outcome between the emergent, elective, or recurrent groups. Our results indicate that proper management of appendicitis with abscess or mass can be selected according to surgeon's preference.

Citations

Citations to this article as recorded by

Primary Non-Surgical Treatment in Pediatric Complicated Appendicitis: Does Abscess Size Matter?
Merle Koerner, Safiullah Najem, Nariman Mokhaberi, Vasileios Vasileiadis, Annette Aigner, Julia Elrod, Konrad Reinshagen, Ingo Koenigs
Journal of Pediatric Surgery Open.2026; : 100262. CrossRef
High Diagnostic Accuracy but Persistent Risk of Complicated Appendicitis: A Retrospective Analysis from Hail Province, Saudi Arabia
Alfatih Mohamed Ahmed Aljanib, Faisal Fawaz Alshammari, Fahad Maiyah Alshammari, Ali Ahmed Alqahtani, Bandar Alsaif, Jerold C. Alcantara, Abdulaziz Bin Ali Alshammari, Talal Alharazi
International Journal of Applied & Basic Medical Research.2025; 15(2): 85. CrossRef
A Case of Appendiceal Pinworms in an Adolescent Patient
Zachary S Kauffman, David L Stuart
Cureus.2025;[Epub] CrossRef
From Bedside to Bot-Side: Artificial Intelligence in Emergency Appendicitis Management
Koray Ersahin, Sebastian Sanduleanu, Sithin Thulasi Seetha, Johannes Bremm, Cavid Abbasli, Chantal Zimmer, Tim Damer, Jonathan Kottlors, Lukas Goertz, Christiane Bruns, David Maintz, Nuran Abdullayev
Life.2025; 15(9): 1387. CrossRef
Comparison of outcomes of nonoperative management with versus without interval appendectomy for periappendiceal abscess in Korea: a retrospective cohort study
Jae Gil Lee, Chang Sung Park, Im Kyung Kim
Journal of Acute Care Surgery.2025; 15(3): 108. CrossRef
Study on the Curative Effect of Different Treatment Methods on 122 Cases of Periappendiceal Abscess
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Advances in Clinical Medicine.2024; 14(03): 85. CrossRef
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Jahangir Sarwar, Abul Shamsuddin, Sirajam Munira
Clinical Medicine Research.2024; 13(3): 33. CrossRef
Failure to Significantly Reduce Radiation Exposure in Children with Suspected Appendicitis in the United States
Charbel Chidiac, Oussama Issa, Alejandro V. Garcia, Daniel S. Rhee, Mark B. Slidell
Journal of Pediatric Surgery.2024; 59(12): 161701. CrossRef
Intra-abdominal abscesses: Microbiological epidemiology and empirical antibiotherapy
F. Méchaï, A. Kolakowska, E. Carbonnelle, O. Bouchaud, C. Tresallet, F. Jaureguy
Infectious Diseases Now.2023; 53(1): 104604. CrossRef
Upfront appendectomy vs interval appendectomy in acute appendicitis with mass formation in pediatric age group: Little difference in major outcome
Hussam Widatella, Ahmed Abdulmanan, Ibraheem Abdelraheem, Fadi Atwan, Sri Paran
Journal of Pediatrics & Neonatal Care.2023; 13(2): 137. CrossRef
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Pedro Osácar, Darío Ramallo, Luisina Elizalde
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Akinfemi A. Akingboye, Fahad Mahmood, Shafquat Zaman, Jenny Wright, Fatima Mannan, Ali Yasen Y. Mohamedahmed
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Masaaki Miyo, Shoichiro Urabe, Satoshi Hyuga, Tomo Nakagawa, Toshiya Michiura, Nobuyasu Hayashi, Kazuo Yamabe
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Comparison of treatment methods of appendiceal mass and abscess: A prospective Cohort Study
Zaza Demetrashvili, George Kenchadze, Irakli Pipia, Kakhi Khutsishvili, David Loladze, Eka Ekaladze, Giorgi Merabishvili, George Kamkamidze
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Ishfaq Ahmad Gilkar, Umer Mushtaq, Javid Ahmad Peer, Bilal Ahmed Mir, Yaqoob Hassan, Waseem Ahmad Dar
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Ramon R. Gorter, Hasan H. Eker, Marguerite A. W. Gorter-Stam, Gabor S. A. Abis, Amish Acharya, Marjolein Ankersmit, Stavros A. Antoniou, Simone Arolfo, Benjamin Babic, Luigi Boni, Marlieke Bruntink, Dieuwertje A. van Dam, Barbara Defoort, Charlotte L. Dei
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2013 WSES guidelines for management of intra-abdominal infections
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The Necessity of a Routine Interval Appendectomy Necessary in Adults?: Initial Experience.: Park, Jong Deok , Lee, Chang Ho , Kim, Jong Hun , Kim, Yong Kon , Lee, Min Ro; J Korean Soc Coloproctol. 2010;26(1):12-16.; DOI: https://doi.org/10.3393/jksc.2010.26.1.12

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Abstract PDF: PURPOSE
The traditional management of a periappendiceal abscess or a perforated appendicitis has been initial conservative treatment, followed by an interval appendectomy (IA). However, the necessity of the interval appendectomy has been questioned by an increasing number of studies recently. The purpose of this study was to clarify the role of conservative treatment, instead of IA, in managing a perforated appendicitis or a periappendiceal abscess after successful initial conservative treatment.
METHODS
We prospectively studied 26 out of 80 patients who had been admitted for a perforated appendicitis or a periappendiceal abscess to Chonbuk National University Hospital from March 2005 to December 2007. These 26 patients were initially treated by using conservative treatment instead of surgery. We analyzed these 26 patients' progression and prognosis after treatment. The IAs were conducted at intervals of 6 to 12 wk after colonoscopy when the patient wanted an operation.
RESULTS
Twenty-three out of 26 (88.5%, 23/26) patients were improved after initial conservative treatment. Only 3 patients who were not improved were managed surgically. Four out of 23 patients who were relieved by conservative treatment underwent an IA voluntarily at intervals of 6 to 12 wk. Of the remaining 19 patients without IA, 1 patient (5%, 1/19) suffered a recurrence after 6 mo, and an appendectomy was performed. Eighteen (78%, 18/23) patients without an IA have shown no recurrence for 15 mo, and they are still being followed up.
CONCLUSION
We conclude that a routine IA after successful initial conservative treatment for a perforated appendicitis or a periappendiceal abscess seems unnecessary. Those patients should undergo colonoscopy to detect any underlying diseases and to rule out coexistent colorectal cancer.

Case Report

A Case of Successful Percutaneous Drainage of a Pelvic Abscess Complicating Colonoscopy.: Si, Youn , Kim, Shin Young , Choi, Seung Bong , Kim, Hyung Jin , Lee, Yoon Suk , Cho, Hyun Min , Kim, Jun Gi , Oh, Seung Tack , Lee, In Kyu; J Korean Soc Coloproctol. 2009;25(5):347-351.; DOI: https://doi.org/10.3393/jksc.2009.25.5.347

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Abstract PDF

Perforations that occur during colonoscopy are usually managed by surgical repair. When the patient's symptoms are mild and laboratory findings show minor abnormalities, a conservative treatment can be considered. Although an operation is the treatment of choice in patients with generalized peritonitis, in some selected patients, percutaneous abscess drainage can be an alternative to surgical intervention for drainage of deep-infected fluid collections or can act as a temporary measure until the patient becomes sufficiently stable for surgery. We report here on a 53-yr-old male patient who developed signs of localized peritonitis and had a pelvic abscess due to a colonic perforation after colonoscopy and was treated successfully by using percutaneous abscess drainage.

Citations

Citations to this article as recorded by

A Case of Buried Bumper Syndrome Complicated by Abdominal Wall Abscess in an Elderly Patient
Chul Young Kim, Min Seong Kim, Do Young Kim, Young Bae Lim, Dong Yoon Kang, Tack Su Yun, Sang Seok Yoon, Jung Hyun Lee, Woo Young Kim, Yong Kyu Lee
Journal of the Korean Geriatrics Society.2010; 14(4): 265. CrossRef

Original Articles

Anal Diseases among Patients with Leukemia.: Kang, Won Kyung , Jeon, Hyo Sin , Kim, Hyung Jin , Lee, In Kyu , Jeon, Hae Myung , Lee, Myung Ah , Chang, Suk Kyun , Oh, Seong Taek; J Korean Soc Coloproctol. 2006;22(2):86-90.

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Abstract PDF: PURPOSE
Anal diseases are a common complication among patients with leukemia, and the perianal abscess may prove to be the most fatal among anal diseases. We report here the prevalence, the treatment methods, and the prognosis for anal diseases among patients with leukemia.
METHODS
Among the 310 patients who were diagnosed with and treated for leukemia between October 1999 and September 2000, we investigated the medical records of 53 patients with complications due to anal diseases.
RESULTS
Among the 310 patients with leukemia, 53 (17.1%) reported anal diseases. There were 30 patients with hemorrhoids, 15 patients with a perianal abscess, 3 patients with an anal fistula, 3 patients with a fissure and 2 patients with hemorrhoids and fistulas. Anal pain was the most common complaint. Conservative treatment improved the symptoms in 42 patients (79.2%) while surgery was necessary in the remaining 11 patients (20.8%). A hemorrhoidectomy was undertaken in 4 patients, a drainage procedure in 4 paients, and a fistulotomy in 3 patients. Throughout the study period, 6 patients died (11.3%), 3 of them with perianal abscesses. Among the 15 patients with a perianal abscess, 13 showed fever (87%), and 9 patients underwent drainage (4 surgical drainages and 5 natural drainages). E. coli was the most commonly cultured organism.
CONCLUSIONS
The incidence of anal diseases in patients with leukemia was high. Nonsurgical methods were sufficient for hemorrhoids and fistulas. For a perianal abscess, drainage should be undertaken when abscess formation is evident. When abscess formation is not evident, medical treatment is the primary modality, and surgery should be considered only when medical treatment fails to improve or worsens the patient's condition, but the prognosis is poor.

Clinical Analysis of 42 Cases Who Underwent Colectomy for Suspected Acute Appendicitis.: Yoon, Ho Young , Kim, Byung Chun; J Korean Soc Coloproctol. 2005;21(6):357-361.

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Abstract PDF: PURPOSE
When patients underwent emergency surgery for suspected appendicitis, colon resection could be performed at the time of the initial operation. The aim of this study was to evaluate 42 cases underwent colectomy for suspected acute appendicitis.
METHODS
A retrospective analysis of 42 patients underwent colectomy for suspected acute appendicitis was performed over the period from January 1997 to December 2003 at the department of surgery, Kangnam Sacred Heart hospital, Hallym university.
RESULTS
The sex ratio were 1.2:1. The mean age was 37.7 years. Right lower quadrant pain was present in all patients. Nausea and vomiting occurred in 18 cases (42.8%). Preoperative fever was 11 cases (26.1%). Abdominal ultrasound was most commonly performed preoperatively. The operative findings showed cecal mass with pericecal abscess was 20 cases (47.5%) and cecal mass with inflammation, 11 cases (26.1%), etc. The pathologic findings showed cecal diverticular abscess was 18 cases (42.8%) and pericecal abscess, 9 cases (21.4%), periappendiceal abscess, 5 cases (11.9%), etc. Type of operation was ileocecectomy, 29 cases (69.04%), and right hemicolectomy, 12 cases (28.57%), and extended right hemicolectomy, 1 case. Postoperative complications developed in 12 cases (28.57%), but those were uneventful.
CONCLUSIONS
When an unexpected and suspicious cecal mass was found at operation for suspected appendicitis, the resection of all clinically apparent disease including colectomy could be considered. So, the surgeon must be aware of the possibility of these condition and choose the appropriate treatment.

Proper Selection of Antibiotic According to the Bacterial Culture of Anorectal.: Kang, Hae Sung , Shim, Kang Sup , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 1997;13(2):247-254.

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Abstract PDF: The aim of this study was to determine the guideline of usage of antibiotics for anonectal suppurative disease. This study was conducted in consecutive 96 patients, who were taken surgical treatments for the anorectal abscess at the department of general surgery of Ewha Womans University Hospital, from January 1990 to December 1994. All subjects were classified in terms of age, gender, duration, history, associated disease, classification, location, and isolation of organism. The incidence of the anorectal abscess was highest in the 3rd and 4th decade of age and male in terms of gender. 80.3% of all patients were admitted within 10 days after onset. The most common past history of anorectal disease was the anorectal abscess(15 cases, 15.6%) and the associated systemic disease was tuberculosis(9 cases, 9.4%). The main type of anoreclal abscess was the perianal abscess(87.5%) and the most frequent location was posterior area(39.6%). In the pus culture and isolation test, 90.6% of all patients had colony formation and the most frequently cultured organism was E.coli(55 cases,57.3%), followed by Klebsiella species(15 cases,15.6%) and anaerobic Bacteroid species(14 cases,14.6%). In antibiotic sensitivity test, the 3rd generation of aminoglycoside was sensitive in 89 cases and resistant in 3 cases, and the 3rd generation of cephalosporin was sensitive in 87 cases and resistant in 5 cases. These results suggest that the 3rd generation of aminoglycoside or the 3rd generation of cephalosporin could be selected to treat the anorectal suppurative disease.

A Clinical Study of Periappendiceal Abscess.: Kim, Dong Hoan , Chung, Woo Shik , Ryu, Seong Ryul , Chang, Tae Soo; J Korean Soc Coloproctol. 1997;13(2):215-222.

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Abstract PDF: This is a clinical analysis and review of one-hundred ninety-four patients with periappendiceal abscesses who were treated at the Departmeat of Surgery, Masan Samsung Hospital over a ten year period from January 1985 to December 1994. The following results were obtained. The incidence of periappendiceal abscesses was 7.24% of the total cases of appendicitis operated on during the same period, and most of the patients(43.8%) were over fifty years old. The male to female ratio was 1:1.02. 41.2% of the patients had operations within four days after their symptoms occurred. On admission, the most common physical finding was tenderness on the right lower quadrant of the abdomen (92.9%) and leukocytosis(> OR = 10,000/mm3) was noted on CBC in 82% of the patients. Abdominal sonograms revealed periappendiceal abscesses in 88% of the patients, 83% were revealed with barium enema and 88% with abdominal CT scan. Many patients(75.5%) visited the local clinic and were treated under the diagnosis of gastritis or enteritis instead of appendicitis. One-hundred eighty-three patients(94.3%) had appendectomies with drainages(94.3%), two patients had drainages of abscesses without appendectomy, six patients had ileocecal resections and three patients had right hemicolectomies. Microbiologically, E. coli was the most frequently cultured species(63%) from abscess, and Klebsiella, Enterococcus and Proteus were isolated in some cases. Postoperative complication occurred in seventy-five patients(38.6%) and the most frequent complication was wound infection(28.8%). There was no mortality and the mean hospital stay was fifteen days.

Case Report

Two Cases of Unusual Abscesses in Right Colon Cancer.: Lee, Chae Young , Jeon, Hae Myung , Kim, Jeong Soo , Oh, Seung Taek , Kim, Won Woo , Kim, Kee Hwan , Chae, Hiun Suk , Ahn, Bo Young; J Korean Soc Coloproctol. 1999;15(5):450-456.

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Abstract PDF: Two unusual presentations of carcinoma of the right colon are described. One of the two patients presented with huge abdominal abscess with adhesed to surrounding small bowels and the other presented with anterior abdominal wall abscess. Colonic carcinoma very rarely presents as abdominal wall abscess, retropertoneal abscess, groin inflammatory mass, subcutaneous thigh abscess, and obstruction with diastatic rupture of cecum. The appearance of the abscess may antecede any gastrointestinal symptoms, thus lessening the surgeon's suspicion of carcinoma. The literature has been reviewed and the pathology that characterizes such lesions and this management is discussed. The bulky colonic tumors with extensive local invasion and negative mesenteric lymph nodes have a relatively good prognosis if adequate resection is performed.

Original Article

Comparison between an Interval Appendectomy and an Urgent Appendectomy for Patients of Periappendiceal Abscess.: Cho, Sung Wook , Kim, In Gyu , Lee, Bong Hwa; J Korean Soc Coloproctol. 2003;19(5):276-281.

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Abstract PDF: PURPOSE
Our goal was to compare the clinical course after an interval appendectomy with that after an urgent appendectomy in patients with localized periappendiceal abscesses confirmed by radiology.
METHODS
This study was a retrospective review of 57 consecutive patients who were treated between February 1999 and June 2003 for appendicitis complicated by periappendiceal abscess. For periappendiceal abscesses, 37 patients were treated with an urgent appendectomy, but 20 patients were treated initially non-operatively. Finally, 12 of those 20 patients underwent an interval appendectomy. Exclusion criteria were periappendiceal abscesses spreading to the whole abdomen diffusely, as confirmed by either abdominal CT or ultrasonography.
RESULTS
Interval appendectomies were performed in 12 (60%) of the patients in the 20 initial non-operative group. The complication rate for the 12 patients in the initial non-operative group who underwent an interval appendectomy was significantly lower than that for the 37 patients in the urgent appendectomy group (P<0.05). The duration of nothing by mouth (NPO) and the length of the hospital stay in the initial non-operative group with an interval appendectomy were also significantly lower than those in the urgent appendectomy group (P<0.05). The histopathologic finding for the interval appendectomy group was suppurative appendicitis in 9 of the 12 cases.
CONCLUSIONS
Initial non-operative treatment with an interval appendectomy has been relatively fewer postoperative problems than an urgent appendectomy in patients with localized periappendiceal abscesses in our study, and further study in more large series considered to be needed.

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