ObjectiveThe aim of this study was to determine the accuracy of three-dimensional endoanal ultrasound scan (3D-EAUS) in the pre-operative assessment of fistula-in-ano in identifying the fistula tract and comparing with findings at surgery in a South Asian cohort. A retrospective analysis of 87 patients with suspected fistula-in-ano who underwent pre-operative 3D-EAUS between January 2009 and January 2016 was carried out. All patients subsequently had surgical exploration under anaesthesia (EUA), irrespective of 3D-EAUS findings. The 3D-EAUS results were compared with the surgical findings to determine the accuracy of 3D-EAUS.ResultsA total of 86 (98.9%) patients (male = 75) were subsequently shown to have a fistula at surgical exploration and of them, 3D-EAUS detected a fistula in 79 (92%) patients. In this cohort, 3D-EAUS correctly predicted the surgical findings in (n = 61, 70.9%) patients with the highest accuracy being for transphincteric fistulae (87.1%). However, the overall concordance in our study was low with a kappa coefficient of 0.318. Additional findings such as sphincter defects were detected by the 3D-EAUS in 37 patients (internal sphincter defects-21, external sphincter defects-7, both-9) which were not evident at EUA. Therefore, 3D-EAUS had a good accuracy in selected types of fistulae and particularly useful in identifying sphincter defects before surgery.Electronic supplementary materialThe online version of this article (10.1186/s13104-019-4098-2) contains supplementary material, which is available to authorized users.

ObjectivesSurgery for fistula in ano is associated with anal incontinence. The biologic anal fistula plug (AFP) can minimize this. This is a retrospective analysis of patients with cryptoglandular anorectal fistulae, who underwent a surgical procedure using AFP. Patient’s demographics and characteristics of the fistulae were obtained from a prospective database. Each primary opening was occluded by using an AFP. Success was defined by the closure of the external opening and absent drainage.ResultsFifty-one patients were treated with AFP (male:female: 37:14), mean age 42 years (SD ± 14.86, range 26–70). Ten patients defaulted follow-up. Forty-seven procedures were analysed. Twenty-three (56.1%) patients had complete healing while 18 (43.9%) patients failed the fistula plug procedure during the follow up period of 12 months. Logistical regression failed to identify any statistical significant association with demographic or disease factors and healing. Healing was 1.5 times less likely for every failed procedure prior to AFP insertion. Contrary to other published studies, placement of fistula plug was associated with much lower overall rates of fistula healing. Highest success rates were seen in simple fistulae when compared to the complex type. Repeat plug placement may be successful in selected patients.

BackgroundSurgical management of complex perianal fistula associated with pararectal cavities can be challenging. We hypothesised that healing of the pararectal cavities prior to healing of the fistula leads to a better outcome. We aimed to assess the efficacy of irrigation catheters in the healing of pararectal cavities associated with fistula-in-ano.MethodsThis study design was consistent with IDEAL stage 2a (development) and was conducted at the Professorial Surgical Unit, National Hospital of Sri Lanka, Colombo. Thirty-two patients with complex fistulae with a pararectal cavity (detected by 2D-Endoanal ultrasounography-EAUS) were included. All patients underwent examination under anaesthesia (EUA), during which insertion of an irrigation catheter to the pararectal cavity and tagging of the primary fistula tract with a drainage seton was done. Patients were advised to irrigate with antiseptic solution and were followed-up at three weekly intervals to assess cavity reduction.ResultsThe majority were males (96.8%, n = 31). The primary fistula tract in 26 patients (81.2%) was trans-sphincteric and was inter-sphincteric in 6 patients (18.7%). Mean time of cavity contraction was 34.78 (range, 21–112) days. Complete healing was seen in 87.5% (n = 28), with 3 patients (9.37%) being lost to follow-up and 1 patient (3.12%) having a persistent perianal fistula after 6 months of follow-up. Those who had complete healing were followed up for a median duration of 6 (range, 3–20) months and there were no recurrences.ConclusionsIrrigation in the management of pararectal cavities yielded satisfactory results. A case control trial with larger numbers and assessment of cavity size pre and post procedure by 3D-EAUS/MRI evaluation would be necessary for more objective evaluation of the efficacy of this novel intervention.

Objective Fistulae-in-ano with a specific aetiology such as TB and Crohn’s are usually complex and challenging to treat. This study was aimed to determine the yield of routine histological analysis in fistula-in-ano, in detecting specific aetiology. Histopathology reports of all patients without a previous diagnosis, who underwent surgery for fistulae-in-ano were retrospectively analysed. Results A total of 215 patients [median age:40 years(range:14–73), males = 178(82.8%)] were analysed. The majority(75%,n = 161) were simple fistulae and recurrent(67%,n = 145). Histological evaluation revealed inflamed granulation tissue in 94.9%(n = 204) of patients. Five(2.3%) patients had conclusive evidence of Crohn’s disease and three(1.4%) had tuberculosis. One patient(0.5%) had evidence of adenocarcinoma with mucinous differentiation. Significant proportion of fistula with a specific aetiology were complex fistulae (82%vs.22%,p < 0.001) and associated with abscess/collections (45.5%vs.11.8%, p < 0.001). Age, type of fistula, level of internal opening, recurrence and presence of haemorrhoids were comparable in those with and without a specific aetiology. One patient with Crohn’s and those with TB did not have any associated symptoms to suggest the diagnosis. Routine histopathological analysis in patients presenting with fistula in-ano should be performed as clinical prediction based on the nature of fistula may not be always accurate.

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Introduction Dyspepsia is a common symptom that is encountered in clinical practice and upper gastrointestinal endoscopy (UGIE) has gained wide acceptance in the evaluation of dyspepsia. This study was aimed to determine the yield of UGIE in patients presenting with dyspepsia to a tertiary care centre. Methods A retrospective analysis of patients followed up at a single unit in a tertiary care hospital from 2007 to 2016 was carried out. Patients who underwent UGIE for evaluation of dyspepsia were included in the study. Those with additional symptoms like dysphagia, loss of weight, loss of appetite and pancreato-biliary pathology were not included. The yield of UGIE in patients with dyspepsia (i.e.peptic ulcer, gastritis, polyp, cancer) in relation to two age groups (≤40years and >40 years) was determined and compared. Results A total of 491 patients were analysed (males=259, 52.7% ; mean age=46.65±SD21.93 years). Among them, 31.97 %(n=157) were aged 40 years or less. Abnormalities were detected in 301(61.3%) patients (peptic ulcer-2.44%, gastritis-20.4%, polyp-3.9%, endoscopically malignant lesions-3.2%). In the ≤40 age group, 58.6%(n=93) had positive endoscopic findings (i.e.peptic ulcer-1.2%, gastritis-25.5%, polyp-1.2%, endoscopically malignant lesions-1.9%) while in the >40 year group, 62.6% had positive endoscopic findings (i.e.peptic ulcer-3.0%, gastritis-18.8%, polyp-5.1%, endoscopically malignant lesions-4.0%). Only two endoscopically malignant lesions were histologically malignant and both were detected in those who were aged more than 40 years. Conclusions In this study, the diagnostic yield of UGIE in detecting peptic ulcers, inflammatory and neoplastic lesions were considerably high in both age groups. Therefore, the age threshold for endoscopy may be lowered to avoid missing a significant lesion.

Introduction Fistulae-in-ano with a specific aetiology such as TB and Crohn's are usually complex and challenging to treat. This study was aimed to determine the yield of routine histological analysis in fistula-in-ano, in detecting specific aetiology. Methods A descriptive study was conducted at the Professorial Surgical Unit, National Hospital of Sri Lanka, Colombo from 2001-2016. Histopathology reports of all patients without a histological diagnosis and who underwent surgery for fistulae-in-ano were analysed. Results A total of 215 patients [median age:40 years (range:14-73), males=179(82.8%)] were analysed. The majority (75%, n=161) were simple fistulae. Histological evaluation revealed inflamed granulation tissue in 94.9% (n=204) of patients. Five (2.3%) patients had conclusive evidence of Crohn's disease and three (1.4%) had tuberculosis. One patient (0.5%) had evidence of adenocarcinoma with mucinous differentiation. Significant proportion of fistula with underlying specific aetiology were complex fistulae (82% vs. 22%, p<0.001) and associated with abscess/collections (45.5% vs. 11.8%, p<0.001). Age, type of fistula, level of internal opening, recurrence and presence of haemorrhoids were comparable in those with and without a specific aetiology. Conclusions Complex fistula and the presence of abscess/ collection were associated with a specific aetiology. Routine histopathological analysis in patients presenting with fistula in-ano should be performed as a clinical prediction based on the nature of fistula may not be always accurate.

Introduction The COVID-19 pandemic has resulted in substantial changes in social interactions, work schedules, and socioeconomic factors that may negatively impact sleep onset, maintenance, and quality. The ongoing stress of the pandemic also may exacerbate existing racial/ethnic disparities in sleep health. In this study, we examined the effects of COVID-19 related distress on sleep-related impairment and sleep disturbances among trauma-exposed South Asian adults. Since a health advantage among foreign-born individuals has been previously noted in the literature (the “immigrant paradox”), we also assessed whether generational status (i.e., being born in the U.S. or not) moderated associations between COVID-19 related distress and sleep outcomes. Methods Participants were recruited through Amazon’s Mechanical Turk and completed online surveys on demographic information, the COVID-19 Stress Scale, The Life Events Checklist for DSM-5 (LEC-5), and PROMIS™ Sleep-Related Impairment and Sleep Disturbances Scale. The final sample included 316 South Asian adults residing in the U.S, who had been exposed to a traumatic event at some point in their lifetime. Most participants were male (55%) and U.S.-born citizens (64%), with an average age of 35.32 (SD = 9.52) years. Results Examination of t-scores for PROMIS™ sleep-related and sleep disturbances revealed that our sample endorsed slightly higher values than the general U.S. population. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.09, p &lt; .001, sr2 = .04) and sleep-related impairment (b = 0.20, p &lt; .001, sr2 = .12). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep. Conclusion In our sample, we found that psychological distress triggered by the pandemic (e.g., fear of contamination, fear of the dangerousness of the virus, socioeconomic worries) was associated with greater sleep difficulties. Our findings highlight the importance of developing targeted interventions to cope with stress and sleep disturbances during the pandemic, particularly among vulnerable populations, such as those exposed to trauma. Our results did not support the immigration paradox: stress and sleep associations were similar regardless of generational status. Future studies are needed to better understand the role of generational status on sleep across different immigrant subgroups. Support (If Any)