By Andrea Bondurri, Piergiorgio Danelli, Matteo Marone (auth.), Massimo Tonolini, Giovanni Maconi (eds.)
This sensible quantity is meant for all radiologists, gastroenterologists, and surgeons who're chargeable for, or attracted to, the prognosis and care of sufferers with illnesses of the anal and perianal area. After an introductory part targeting surgical, MRI, and US anatomy, updated scientific and healing info is supplied at the complete variety of perianal inflammatory stipulations, with distinct consciousness to Crohn’s illness, ulcerative colitis, and sexually transmitted illnesses. actual and surgical exam is punctiliously mentioned, with attention of barriers, effects, scientific wishes, and the questions prone to be posed of imaging. the next 3 sections supply specific details at the various imaging modalities: transanal and transperineal ultrasound, contrast-enhanced MRI, and CT. options, diagnostic accuracy, universal and strange sickness styles, artifacts, and pitfalls are sincerely presented.
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Drugs with definite or potential efficacy for treating perianal CD include antibiotics (metronidazole and ciprofloxacin), immunosuppressants (azathioprine and 6-mercaptopurine), calcineurin inhibitors (cyclosporine and tacrolimus), and biologic agents (infliximab, adalimumab, and certolizumab) [17]. In the ECCO consensus statement, antibiotics and azathioprine or 6-mercaptopurine are considered the first-line therapy in complex perianal disease, and infliximab or adalimumab is reserved as second-line treatment in case of failure [18].
It is based on the principle that removal of the chronic epithelialized tract will allow healing by secondary intention of healthier tissue. The dissection is carried out from the external orifice while the internal orifice is closed directly. This is a difficult procedure that can result in significant patient morbidity due to the large amounts of tissue and sphincter damage. Success rates are similar to those of fistulotomy, even if subsequent incontinence rates are 15% higher [3, 4, 8]. 3 Seton The use of a seton has the same purpose as using a wire to cut a block of ice.
Caudal fibers from the outer layer of the EAS extend anteriorly and posteriorly to connect with the bulbocavernosus and the anococcygeal body. • The plane of the lower pubic symphysis is the axial puborectalis plane. It includes the urethra, lower rectum, upper anal canal, and, in men, the prostate. • The upper and lower margins of the puborectalis include the inner and outer ISS and the vertical portion of the levator ani. G. Pompili et al. Fig. 12 Mid-sagittal anal section. Sagittal T2-weighted image.