The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Adriana Corina Andrei

Adriana Corina Andrei

Late Malignancy after 26 Years of Evolution on an Untreated Perianal Fistula

Squamous cell carcinoma and basal cell carcinoma are two types of neoplasms that rarely affect the perianal region, and their etiology is still a matter for debate. We present the case of a 75 year old patient with a 26 year history of perianal fistula, who presents with purulent and fecal perianal discharge and swelling at this level. Physical examination and anoscopy detected low transsphincteric fistula. The biopsy revealed the diagnosis of squamous cell carcinoma, for which a local excision was performed followed by adjuvant radiotherapy. Two years after this event, the patient presented with another perianal lession, which according to the histopathological

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Rare Case of Perianal Endometriosis Complicated with Perianal Fistula: Case Report

Perianal endometriosis is a rare pathology which occurs mainly in patients with history of vaginal birth associated with an episiotomy scar. We present the case of a 42 year old patient with history of multiple interventions for right perianal fistula, accusing pain, purulent secretions and bleeding at the site of the interventions. Biopsies collected were specific for endometriosis. In the context of the sphincter involvement, which brings a high risk of incontinence, and the hormone-dependent evolution of this pathology, which tends to regress once menopause is reached, a fistulotomy was made, with subsequent remission of the purulent secretions, but with the persistence of the bleeding from the region during the menstrual cycle.

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Innovative Techniques for the Endoscopic Diagnosis in Inflammatory Bowel Diseases

Inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions in which idiopathic inflammation of the gastrointestinal tract wall is the characteristic feature.
The etiology of these disorders is not fully elucidated, proposed causes including environmental, immunological and genetic factors. A consensus hypothesis is that in genetically susceptible individuals, both exogenous factors (eg. Intestinal flora) and factors related to the host (barrier function of epithelial cells, innate and acquired immune response function) produce a chronic immune dysfunction in the intestinal mucosa which is further modified by the action of environmental factors (eg. smoking).

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Upper Digestive Tract Lesions in Inflammatory Bowel Diseases

Inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), are chronic, idiopathic diseases characterized by the inflamation of the wall tube (1). Ulcerative colitis was first described in the mid-1800s (2), whereas Crohn's disease was first reported later, in 1932, as "regional ileitis" (3). Because Crohn's disease can involve the colon and shares clinical manifestations with ulcerative colitis, these entities have often been conflated and diagnosed as inflammatory bowel disease, although they are clearly distinct physiopathological entities. Ulcerative colitis is the most common form of inflammatory bowel disease worldwide. In contrast to Crohn's disease that can extend in the entire intestinal wall, ulcerative colitis is a disease of the mucosa that is less prone to complications and can be cured by means of colectomy, and in many patients, its course is mild (4).
Until recently, it was considered that, unlike Crohn's disease (whose location can be at any level of the digestive tract), ulcerative colitis is strictly localized in the colon. However, in the recent years, increasingly more studies reveal the existence of a moderate, chronic, diffuse gastroduodenitis in pacient with ulcerative colitis, which normally causes no macroscopical lesions being highlighted only based on histopathologic examination (5). Most of these studies invoke the presence in the duodenum of a diffuse inflamation with neutrophilic infiltration in the glandular crypts, with redness and swelling during an acute exacerbation. In the stomach the predominant lesions are chronic focal gastritis (5,6,7).

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