Chronic Anal Fissure from Suspected Adult Sexual Abuse in a Traumatic Anal Sex Practice Patient

peer reviewedThe aetiopathogenesis of chronic anal fissure (CAF) is unclear and is probably multifactorial. CAF represents 10-15% of proctological consultations. This case report identifies adulthood sexual abuse as a significant risk and a potential aetiopathogenic factor of CAF. This case history was discovered while carrying out administrated interviews during, authors' clinical retrospective study on CAF. The clinical presentation of this 49-year-old woman is predominated by chronic anal lesions (anal tears in the anoderm, anal sphincter hypertrophy), associated medical history as a high consumer of healthcare with very poor mental health, chronic traumatic anal sex practice history, and especially persistent recurrences of gastro-intestinal symptoms after surgery. Surgical history is summarized as : 7x spontaneous abortion; 5x fistulectomy and 3x anal abscess 4x Bartholin's gland; 4 x hypertrophy papilla ablation; 2x anal manometry, 2x fissurectomy and I x sphincterotomy 2x haemorrhoid; and I x hysterectomy. These symptoms initially started and the operations in particular took place after she was married. After 26 years of sexual abuse within her marriage, the clinical diagnosis was made and was consented by this patient. A referral to a psychiatrist was evident and a long course of multidisciplinary therapy (medical, surgical, physiological and psychological approaches) seemed to be of benefit, in terms of improving the clinical symptoms. Authors suggest that physicians should suspect sexual abuse in any patient with a medical history as a high consumer of healthcare and especially when there is persistent recurrence after the lateral subcutaneous internal sphincterotomy. We recognise that the link or causality is difficult to prove and further study is probably needed to shed light on the link between sexual abuse and CAF : although in the United Kingdom, over 20.83% of the population are subject to sexual abuse. 83%

Chronic anal fissure from suspected adult sexual abuse in a traumatic anal sex practice patient

The aetiopathogenesis of chronic anal fissure (CAF) is unclear and is probably multifactorial. CAF represents 10-15% of proctological consultations. This case report identifies adulthood sexual abuse as a significant risk and a potential aetiopathogenic factor of CAF. This case history was discovered while carrying out administrated interviews during, authors' clinical retrospective study on CAF. The clinical presentation of this 49-year-old woman is predominated by chronic anal lesions (anal tears in the anoderm, anal sphincter hypertrophy), associated medical history as a high consumer of healthcare with very poor mental health, chronic traumatic anal sex practice history, and especially persistent recurrences of gastro-intestinal symptoms after surgery. Surgical history is summarized as : 7x spontaneous abortion; 5x fistulectomy and 3x anal abscess 4x Bartholin's gland; 4 x hypertrophy papilla ablation; 2x anal manometry, 2x fissurectomy and I x sphincterotomy 2x haemorrhoid; and I x hysterectomy. These symptoms initially started and the operations in particular took place after she was married. After 26 years of sexual abuse within her marriage, the clinical diagnosis was made and was consented by this patient. A referral to a psychiatrist was evident and a long course of multidisciplinary therapy (medical, surgical, physiological and psychological approaches) seemed to be of benefit, in terms of improving the clinical symptoms. Authors suggest that physicians should suspect sexual abuse in any patient with a medical history as a high consumer of healthcare and especially when there is persistent recurrence after the lateral subcutaneous internal sphincterotomy. We recognise that the link or causality is difficult to prove and further study is probably needed to shed light on the link between sexual abuse and CAF : although in the United Kingdom, over 20.83% of the population are subject to sexual abuse. 83%

Hoestgeïnduceerde ribfracturen met diafragmaruptuur rechts en intercostale hernia

A cough-induced diaphragmatic rupture is rare, even more on the right side. In this manuscript, the medical history of a 49-year-old patient with chronic obstructive pulmonary disease (COPD) and the rare combination of a coughinduced rib fracture as well as a right diaphragm rupture with herniation of the great omentum in the thoracic cavity associated with an intercostal hernia is presented. The hernia was surgically repaired and closed with a mesh.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Selection criteria for surgical treatment of pudendal neuralgia

Aims: Pudendal neuralgia is the clinical expression of a chronic compression of the pudendal nerve. The diagnosis is based on a set of five criteria, called Nantes criteria. Four of the criteria are clinical and the last requires evaluation of the anesthetic response to CT-guided infiltration of the pudendal nerve. The aim of our study is to evaluate the relevance of anesthetic test response to select patients for surgery, and whether this criterion can be used to predict its success. Methods: Retrospective analysis of a cohort of 34 patients undergoing surgical treatment. In our cohort, we included six patients with negative CT-guided pudendal nerve infiltration test. Results: Of the 28 patients that met all five Nantes criteria, 64% (18 patients) responded well to surgery. In contrast, 100% of the six patients with a negative anesthetic test failed to show an amelioration of symptoms after surgical treatment (P = 0.006). In our analysis, there was no significant difference in surgery response when men were compared to women (P = 0.387), when procedure was unilateral or bilateral (P = 0.562), or when duration of symptoms was long (P = 0.412). We observed a difference in terms of age between the group of responders and non-responders, although this difference did not reach the threshold of significance (P = 0.216). Conclusions: The selection of candidates for surgery should always include a single diagnostic anesthetic injection of the pudendal nerve, as the fifth of the Nantes criteria is an effective predictor of the success of surgery. Neurourol. Urodynam. 36:663–666, 2017. © 2016 Wiley Periodicals, Inc.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A minimally invasive, endoscopic transgluteal procedure for pudendal nerve and inferior cluneal nerve neurolysis in case of entrapment: 3-and 6-month results. The ENTRAMI technique for neurolysis

Background: Pudendal and cluneal nerve entrapment can cause a neuropathic pain syndrome in the sensitive areas innervated by these nerves. Recently, a new endoscopic minimal invasive approach for pudendal and inferior cluneal nerve neurolysis has been published in a cadaver study. The aim of our study was to describe the feasibility of this new approach and to evaluate the clinical outcome. Methods: Fifteen patients underwent the ENTRAMI technique. The Numeric Pain Rating Scale (NPRS) and Patient Global Impression of Change (PGIC) were recorded at baseline and at 3 and 6 months after surgery. Result: The average duration of intervention (skin to skin) was 139 min (range 50–270 min) for bilateral pudendal neurolysis and/or cluneal neurolysis and 113 min (range 100–130 min) for unilateral pudendal and/or cluneal neurolysis. No perioperative blood loss occurred. At 3 months, 50% of patients declared a more than 30% improvement of their PGIC, increasing to 57% at 6 months; 31% reported more than 90% improvement of PGIC at 6 months. Overall reduction of the average maximal NPRS score was from 9 (range 7–10) to 6 at 3 months (range 0–10; p value < 0.05) and to 5 at 6 months (range 0–10; p value < 0.05). There were no postoperative complications. Conclusions: The ENTRAMI technique is feasibly in patients suffering from pudendal and/or cluneal neuralgia and preliminary results are promising. Clinical trial number: NCT03883178.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Endoscopic trans gluteal minimal-invasive approach for nerve liberation (ENTRAMI technique) in case of pudendal and/or cluneal neuralgia by entrapment: One-year follow-up

Background: Chronic neuropathic perineal pain syndrome is a collective term that encompasses several diagnoses. In patients where the neuropathic pain syndrome is caused by pudendal or cluneal nerve entrapment, surgical release can be proposed if other measures have failed. The aim of this study is to evaluate the clinical outcome of patients suffering from pudendal and/or cluneal nerve entrapment at 1 year after this minimal invasive surgery, which is based on the open trans gluteal approach who has proven its efficacy compared to medical treatment in a randomized control trial. Methods: Patients eligible for inclusion had chronic perineal neuropathic pain for at least 3 months in the area served by the pudendal and/or cluneal nerve, refractory to conservative measurements. Patients met all five of the Nantes criteria. Results: Fifteen patients underwent the ENTRAMI technique. At 1 year after surgery, overall reduction of the average maximal Numeric Pain rating Scale (NPRS-score) was from 9 (range, 7-10) at baseline to 5 (range, 0-10; P-value 30%) and optimal treatment response (PGIC ≥90%) was found in 40% (P-value <.05). No complications were recorded. Conclusion: This study clearly shows that the technique is feasible with promising long-term results in a difficult to manage patient group.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Diagnostic et gestion d'un cas particulier de constipation opiniâtre

Constipation is a very common pattern in childhood. There are multiple reasons for constipation including one very rare :chronic intestinal pseudo-obstruction syndrome. We report the case of a young patient monitored for multiple incidents of intestinal pseudo- obstruction with intractable constipation. The patient underwent several surgical interventions to relieve his symptoms because the non operative treatments, based on liquid diet and laxatives, didn't show great effectiveness. We will review the differential diagnosis of chronic constipation and we will discuss the particular diagnostic entity of this patient. We will also discuss the different treatments that allowed to provide tolerance to oral feeding.SCOPUS: ar.jinfo:eu-repo/semantics/publishe