[Differential diagnosis of rectal hemorrhage and painful anus diseases].
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Patients with trisomy 21 have a higher incidence of several gastrointestinal anomalies. However, the coexistence of imperforate anus, Hirschsprung's disease, and trisomy 21 had not been reported previously. This report describes the case of an infant girl born with trisomy 21 and imperforate anus, without a fistula, who presented with bowel obstruction 3 months after anoplasty. The obstruction was attributable to Hirschsprung's disease. This was managed by a leveling colostomy in the descending colon, followed by an endorectal pull-through after 4 weeks. She has a normal stooling pattern 11 months after colostomy closure. Hirschsprung's disease should be suspected in infants with trisomy 21 who have constipation after repair of imperforate anus. The authors believe that the endorectal pull-through is the safest technique to use for Hirschsprung's disease after a previous anoplasty.
Bowen's disease of the anus is usually treated by wide local excision including macroscopic normal areas if random biopsies show dysplasia. Skin grafting will often be necessary, since areas of microscopic dysplasia may be found at a considerable distance from the gross affected site. In this study of 11 patients with Bowen's disease of the anus we report the results of a more conservative approach. All patients were treated by local excision of the gross affected areas only, and none of the patients required skin grafting. Seven patients were followed for a median of 34 months without macroscopic recurrence, including 3 patients with histologically proven dysplasia in the resection margins. Two patients, one with and one without dysplasia in the resection margins, developed recurrence within a year. One patient with an area of invasive carcinoma was first treated by local excision, but required an abdominoperineal excision 3 months later. One patient lost to follow-up had invasive carcinoma after 3 years. It is concluded that a conservative surgical approach in Bowen's disease of the anus is justified, provided the patients are followed closely.
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Sexually transmitted diseases, despite vigorous efforts in prevention, are still existing and may provide portal of entry for human immunodeficiency virus transmission. Syphilis and gonococcal infection are decreasing but remain a problem in developing countries and their return cannot be excluded, despite active therapy. In industrial countries, viral infections are expanding. Herpes genitalis is the most common cause of genito-anal ulceration and anogenital warts have been steadily rising in the past decades. Some human papillomavirus genotypes are oncogenic. No treatment is able to eradicate them.
Bowen's disease of the anus and the perineum is undoubtedly a rare pathology. This is demonstrated by the fact that, while described by M. Bowen in 1912, only 112 cases have been reported in 1979. The differential diagnosis is more difficult than that of Bowen-like papulosis and Queyrat's erythroplasia. Ano-perineal Bowen's disease is, or may be, in a large number of cases, seen concomitantly with a primary ano-rectal or vaginal carcinoma, even if they were diagnosed after Bowen's disease.
Bowen's disease is a type of squamous carcinoma in situ with peculiar characteristics. It has a high incidence of associated internal malignancies and its progression to an invasive carcinoma has been described. We present seven patients with Bowen's disease of the perianal skin which have been treated conservatively with local excision and minimal margins of resection. No recurrences have been observed in this series up to the present time. Two patients had other associated malignancies; three patients had hypothyroidism. Local excision of the disease with minimal margins is advocated.
Endoluminal MRI of the rectum and anus was introduced in the first half of this decade to overcome the limitations of endoluminal sonography and body coil MRI. Endoluminal MRI is the imaging method of choice for fecal incontinence and anal tumors, whereas it is a competitive imaging method to phased array coil MRI in patients with perianal fistulas or rectal tumor. The purpose of this article is to describe the technique and major indications of endoluminal MR imaging of the anus and rectum.
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