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[Classification and diagnosis of anal fistulas].

Parks' classification of the anal fistulas is based on the knowledge of the pathogenesis of the disease. It relates fistula tracks to the anatomy of the anorectal musculature. Four main types are described, with some variations in each group: inter-, trans-, supra- and extrasphincteric fistulas. A circumferential spread occurs in the horseshoe fistulas. Positive diagnosis of fistula is difficult when the secondary opening lies distant from the anus. Aetiological factors, topography of the tracks, and clinical form (benign or necrotizing fasciitis) are systematically established. Anal fistulas must be differentiated from other suppurations of the anorectal area: intestinal (tumours, actinomycosis, piles,...) and extravisceral diseases (pilonidal cyst, hidradenitis suppurativa, bartholinitis...).

Crohn Disease↗

[Sacrococcygeal ependymoma. Review of the literature apropos of a personal case].

The authors report a personal case of sacro-coccygeal ependymona, the 11th known at the present day after a review of the literature. They describe the anatomical and clinical aspects of these tumors. The pre-operative diagnosis being most often one of common and benign lesion, like a pilonidal cyst, they emphasize the necessity of an histologic examination of every resected lesion of the sacro-coccygeal region.

Adult↗

Anorectal disorders.

Common anorectal disorders can produce one or more of the following symptoms: pain, protrusion, pruritus, bleeding or discharge. The cause may be cryptitis, anal fissure, hemorrhoids, anorectal abscess, fistula in ano, neoplasm, condylomata acuminata, pilonidal cyst or inflammatory bowel disease. Each disorder is suggested by its characteristic history. Adequate examination by proctosigmoidoscopy will usually confirm the presence of the suspected disease.

Abscess↗

Subcutaneous sacrococcygeal myxopapillary ependymoma. A case report.

A case of myxopapillary ependymoma presenting as a primary tumor of the subcutaneous tissue of the sacrococcygeal area is reported. The tumor usually presents as an asymptomatic mass at the base of the spine in young individuals and may therefore be mistaken for a pilonidal cyst. The clinical and pathological features of this tumor are discussed.

Adult↗

Surgical management of advanced squamous cell skin cancers.

Squamous cell cancer of the skin usually follows prolonged exposure to known carcinogens including ultraviolet light, ionizing radiation, chronic infection or irritation, chemicals, and immunologic suppression. The majority of squamous cell skin cancers metastasize infrequently and can be cured with aggressive wide local excision. However, on occasion they can be quite aggressive locally, with or without associated distant metastasis, and may require a radical surgical approach. We report a series of four male patients covering the spectrum of this disease with the following distribution: lower pole of the right ear, right posterior thigh below gluteal fold with positive inguinal nodes, lateral aspect of the foot with bone involvement, and as an incidental finding in a pilonidal cyst. We conclude that one should not hesitate to proceed with aggressive surgical resection as it may provide the only chance for cure. Finally, one should always look for lymph node metastasis, particularly with large (> 5 cm) lesions adjacent to a regional lymph node drainage basin.

Aged↗

Benign retrorectal tumors in adults: the choice of operative approach.

Six adult patients were treated for tumors of the retrorectal space from 1975 to 1990 at the University of Mississippi Medical Center. All were female; ages ranged from 19 to 64 (mean, 37.8) years. Two asymptomatic tumors were discovered in the peripartum period, and two patients had symptoms of local fullness or pain. One patient presented with a pelvic abscess, and one patient had had recurrent pilonidal cyst abscesses drained. All lesions were completely excised (one by a transsacral route, two by a transanal route, and three by a combined abdominosacral approach). All were histologically benign (four tailgut cysts and two epidermoid cysts). One tailgut cyst recurred after transanal excision and was removed by a transsacral route without further recurrence. Adequate excision may be achieved by any of several approaches. Transanal excision, although convenient for small low-lying dermoid tumors, resulted in the only recurrence in our series.

Adult↗

[Faun tail and sacral hemangioma associated with occult spinal dysraphism].

INTRODUCTION: Hemangiomas are the most frequent skin tumor of childhood. Usually, a "wait and see" policy is adopted. However, a sacral hemangioma may reveal occult neurodysraphism. CASE REPORT: MRI discovered lipomyelomeningocele and a tethered spinal chord in an asymptomatic 4-month-old boy with sacral hemangioma and faun tail. Because of absence of neurological defect only surgery of the caudal appendage was performed for the moment. DISCUSSION: Midline lombosacral lesions, as well as lipomas, hirsutism or pilonidal cyst, may be associated with occult spinal defect; the most severe is tethered chord. Renal or ano-genital anomalies can be also associated. CONCLUSION: MRI is necessary in case of midline sacral hemangioma to detect underlying anomalies.

Hemangioma↗

Tailgut cyst associated with a pilonidal sinus: an unusual case and a review.

Tailgut cysts are rare congenital abnormalities in the retrocaecal/presacral region. Clinical diagnosis is difficult and delayed and they can present in childhood and adult life with a variety of clinical symptoms and complications. Differential diagnoses include, rectal duplication cysts, cystic teratoma, epidermal cyst, anal gland cyst and anal gland carcinoma. Magnetic resonance imaging has recently become the modality of choice to image these cysts. Although Tailgut cysts rarely undergo malignant transformation, early surgical resection is presently considered the treatment of choice. Here we report the case of a 34 year old gentleman with a Tailgut cyst associated with a Pilonidal sinus, and review of the literature. We believe that the high incidence of complications associated with operations in the presacral region should be weighed against the generally benign course of these lesions, especially with the quality of modern imaging technology.

Journal Article↗