Anorectal emergencies: WSES-AAST guidelines

Tarasconi, Antonio; Perrone, Gennaro; Davies, Justin; Coimbra, Raúl; Moore, Ernest E.; Azzaroli, Francesco; Abongwa, Hariscine K.; Simone, Belinda De; Gallo, Gaetano; Rossi, G.; Abu‐Zidan, Fikri M.; Agnoletti, Vanni; de’Angelis, G.L.; de’Angelis, Nicola; Ansaloni, Luca; Baiocchi, Gian Luca; Carcoforo, Paolo; Ceresoli, Marco; Chichom-Mefire, Alain; Saverio, Salomone Di; Gaiani, Federica; Giuffrida, Mario; Hecker, Andreas; Inaba, Kenji; Kelly, Michael D.; Kirkpatrick, Andrew W.; Kluger, Yoram; Leppäniemi, Ari; Litvin, Andrey; Ordóñez, Carlos A.; Pattonieri, Vittoria; Peitzman, Andrew B.; Pikoulis, Manos; Sakakushev, Boris; Sartelli, Massimo; Shelat, Vishal G; Tan, Edward; Testini, Mario; Velmahos, George C.; Wani, Imtiaz; Weber, Dieter; Biffl, Walter L.; Coccolini, Federico; Catena, Fausto

doi:10.1186/s13017-021-00384-x

Cited by 37 publications

(40 citation statements)

References 311 publications

(359 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Physical examination of patients with EHT often reveals internal anal sphincter hypertonia, which seems to play a causal role in pain. In fact, according to the World Society of Emergency Surgery (WSES) and of the American Association for the Surgery of Trauma (AAST) guidelines on anorectal emergencies, topic muscle relaxant are suggested ( 21 ). Currently there is no evidence of benefit and no indication to the subcutaneous administration of low molecular weight heparin ( 22 ).…”

Section: Conservative Management and Outcomesmentioning

confidence: 99%

Management and Treatment of External Hemorrhoidal Thrombosis

et al. 2022

Self Cite

View full text Add to dashboard Cite

BackgroundExternal hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades.MethodsThis mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered.ResultsTraditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48–72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique.ConclusionThe management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.

show abstract

Section: Conservative Management and Outcomesmentioning

confidence: 99%

Management and Treatment of External Hemorrhoidal Thrombosis

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…An anal fissure is a longitudinal, oval, ulcer-like tear in the anal canal that can extend from the dentate line to the anal verge [59][60][61][62][63]. In almost 90% of cases, the anal fissures are observed in the posterior midline and cause pain during defecation and/or bleeding due to hypertonia of the internal anal sphincter, which results in ischemia.…”

Section: Anal Fissurementioning

confidence: 99%

Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends

Hwang

2022

J Anus Rectum Colon

View full text Add to dashboard Cite

Recent trends in benign anal disease treatment are minimizing surgery to preserve normal anorectal anatomical unit and its functions. However, some surgeons still prefer and are confident with the use of conventional solid surgical methods. In this report, we will investigate the recent trends in the treatment for hemorrhoids, fistula, and anal fissure. The practice guidelines of advanced countries, including UK, Italy, France, USA, Japan, and ESCP, are referred to in this review. Opinions suggested in international meetings were also added. In the management of hemorrhoids, surgical treatments and office procedures were recommended according to a patient's status and preference. For the management of complex anal fistula, novel sphincter-preserving surgical techniques are more widely accepted than a sphincter-dividing procedure of immediate repair following fistulectomy. The treatment of anal fissures is well covered in the guidelines of the ASCRS.

show abstract

“…If bowel perforation is suspected and the patient is haemodynamically stable, a CT abdomen with contrast should be performed to further assess prior to operating. However, if the patient is haemodynamically compromised, it is not recommended to delay surgical intervention for further imaging [16].…”

Section: Investigationsmentioning

confidence: 99%

Rectal Foreign Bodies: Surgical Management and the Impact of Psychiatric Illness

O’Farrell¹,

Chowdhury²,

Havelka³

et al. 2022

Cureus

View full text Add to dashboard Cite

BackgroundEntrapped rectal foreign bodies can be a challenge to manage and are being encountered by acute surgical teams with increasing frequency. The aims of our study were to (a) ascertain the population demographics of patients presenting with this problem in our local area of East Kent, (b) see if an association could be drawn between this presentation and proposed risk factors such as a psychiatric illness or socioeconomic deprivation, and (c) to review how foreign bodies are being removed in the East Kent Hospital University Foundation NHS Trust, United Kingdom and to highlight best practice with regards to this in line with the latest guidelines. MethodologyBetween 2017 and 2021, 32 cases of entrapped rectal foreign bodies were diagnosed and managed at our NHS Trust. Retrospective data taken from the theatre directory and electronic patient records were used to audit patient demographics, co-morbidities, the type of foreign body, and the extraction technique. ResultsThe majority of patients (90%) were male (n = 29). The patients' age ranged from 15 to 95 years, with a median age of 48 years. In total, 12 (37.5%) patients had a medical history of a psychiatric illness. The most common foreign bodies removed were sex toys or vibrators (n = 8) and roll-on deodorant bottles (n = 7). Kent Area B (n = 10) and Kent Area A (n = 9) were the areas with the highest number of cases. Twenty-two (68.8%) patients underwent examination under a general anaesthetic for removal, seven (21.8%) patients had the object manually removed without sedation, and three (9.4%) required a laparotomy with or without bowel resection. ConclusionsCases of an entrapped rectal foreign body in this local region typically involved male patients between 40 and 50 years old. A high proportion of this group had a history of a psychiatric illness supporting an association between this presentation and mental health. We have proposed some explanations for this association including the anal canal nervous system interplay with the "brain-gut axis." Lower socioeconomic status and unemployment may also be risk factors for this surgical problem. A trans-anal approach for management is successful in the majority of cases; however, almost 10% of patients required emergency surgical management. We have highlighted best practice guidelines for the investigation and management of the entrapped rectal foreign body as part of our discussion.

show abstract

Anorectal emergencies: WSES-AAST guidelines

Cited by 37 publications

References 311 publications

Management and Treatment of External Hemorrhoidal Thrombosis

Management and Treatment of External Hemorrhoidal Thrombosis

Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends

Rectal Foreign Bodies: Surgical Management and the Impact of Psychiatric Illness

Contact Info

Product

Resources

About