Fistulizing ano-perineal lesions occur in more than 20% of patients with Crohn's disease (CD). Although many medical and surgical treatments are now available, the relapse rate of such lesions remains high at nearly 30%. The objective of this study was to identify factors predictive of a new episode of anal suppuration in patients with fistulizing ano-perineal CD initially put into remission. This was a retrospective single-center study that included between 2018 and 2022 all patients with CD complicated by ano-perineal fistula put into remission. Achievement of remission was defined by the absence of new suppuration within 3 months of the last drainage surgery. Fifty-seven patients (57% female; median age at drainage 31 years) with multiple episodes of suppuration were included consecutively during the period. The rate of new ano-perineal suppuration was 22%, which occurred within a median of 1.8 years. Actuarially, survival without new suppuration was 96.7% at 1 year, 78.4% at 3 years, and 74.4% at 5 years. In the 38 (66.6%) patients receiving anti-TNF therapy after drainage, colonic (OR 1.25, p = 0.015) or ileocolic (OR 5.16, p = 0.015) location of CD, stenosing luminal phenotype (OR 5. 32, p = 0.013) and discontinuation of anti-TNF therapy during follow-up (OR 3.37, p = 0.049) were associated with an increased risk of a new suppurative episode in multivariate analysis. Conversely, discontinuation of conventional immunosuppressive therapy was associated with a reduced risk of a new episode of suppuration (OR 0.22, p = 0.29).
Introduction: Irritable bowel syndrome (IBS) represents a real public health problem. It is a very common gastrointestinal disorder which has significant impact on the quality of life of patients. The aim of this study is to determine the frequency of irritable bowel syndrome according to the criteria of Rome III and to identify the determining factors. Methods: We carried out a prospective cross-sectional observational study with a descriptive aim among students of the Faculty of Medicine and Pharmacy of Marrakech. Forty eight students were collected in our study. Results: The prevalence of IBS is estimated at 23.07%. The average age was 22.5 years with ages ranging from 19 to 26 years. A clear predominance of females was noted with a sex ratio of 0.5 (32 females / 16 males). According to the criteria of Rome III, the subtype with predominant constipation presents 60% (N = 21), the subtype with predominant diarrhea presents 54.28% (N = 19), and the mixed form presents 14.25% (N = 5). The most common association was abdominal pain with constipation. Most of the students had intermittent minimal chronic pain, mostly epigastric, accentuated by stress and calmed by stool emission. In association with digestive signs, asthenia was present in 97.14% of patients. The majority of cases had an incorrect lifestyle: 62.5% had an unbalanced diet, and 87.5% did not practice regular physical activity. Conclusion: Irritable bowel syndrome is relatively frequent in the active population. Our study objectified that IBS represents a significant percentage within our target population. They are determined principally by stress especially during exams, gender, genetic profile and unhealthy lifestyle.
Ulcerative colitis (CU) is an inflammatory disease predisposing to colorectal cancer. Colorectal cancer in ulcerative colitis is more often metachronous or synchronous. In this case report we present a patient with multifocal colorectal cancer in the course of CU and operative treatment that was implemented. Additionally primary sclerosing cholangitis was diagnosed in this patient post-operatively.
Juvenile polyposis syndrome is a rare autosomal dominant hereditary disease characterized by the presence of several juvenile polyps in the gastrointestinal tract. This disease predisposes to colorectal cancer, hence the importance of an early detection and a rigorous endoscopic screening [1]. We report the case of a juvenile colorectal polyposis in a 16 years old child revealed by a chronic rectal bleeding.
Spontaneous rupture rupture in cirrhotic patients with portal hypertension is a rare complication; however, the incidence, etiology and risk of rupture have not been established. The diagnosis is confirmed by abdominal imaging or exploratory laparotomy and treatment is essentially surgical. We report a case of atraumatic splenic rupture in a 30-year- old woman with hepatic cirrhosis associated with splenomegaly.
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