title: Endoanal ultrasonography-assisted percutaneous transperineal management of anorectal sepsis.
abstract: OBJECTIVE
  We aimed to analyze the feasibility and efficacy of a new transperineal access to treat anorectal sepsis (fistulae and abscesses) under endoanal ultrasonography guidance.
  
  
  METHODS
  Twenty-five patients (80% Crohn disease) were included retrospectively. Twenty-one patients had fistulae (perianal, urethroanal, and anovaginal) treated by injection of heterologous fibrin glue and cyanoacrylate. Four patients with abscesses were treated by irrigation-injection of normal saline solution and an aminoglycoside antibiotic.
  
  
  RESULTS
  Twenty-five patients underwent 32 treatment sessions. At 4 weeks' evaluation, 19 patients (90.5%) with anal fistulae ultimately achieved a 4-week short-term success. Of these, 5 patients (26%) showed resolution of symptoms and persistent occlusion of the fistula track at long-term follow-up (>6 mo). At 4-week follow-up, the treatment of abscesses was successful in 3 of 4 cases. However, a relapse was observed in 2 cases after a mean period of 3 months. No serious adverse events were observed.
  
  
  CONCLUSIONS
  Endoanal ultrasonography-assisted percutaneous transperineal injection represents a sphincter-sparing alternative to the surgical route, with interesting outcomes and excellent tolerability for the treatment of anorectal sepsis.
authors.affiliation: Department of Gastroenterology, Nord Hôspital, Marseille, France. vittonv@yahoo.com
authors.forename: Veronique
authors.initials: V
authors.lastname: Vitton
authors.forename: Geraldine
authors.initials: G
authors.lastname: Gascou
authors.forename: Salah S
authors.initials: SS
authors.lastname: Ezzedine
authors.forename: Mohamed
authors.initials: M
authors.lastname: Gasmi
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Grimaud
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods; D001004:Anus Diseases / Q000601:surgery*; D002648:Child; D003424:Crohn Disease / Q000601:surgery; D003487:Cyanoacrylates / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D018805:Sepsis / Q000601:surgery; D018084:Ultrasonography, Interventional / Q000379:methods; D014522:Urethral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D003487:Cyanoacrylates; D015718:Fibrin Tissue Adhesive