25
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Anorectal emergencies: WSES-AAST guidelines

      review-article
      1 , , 1 , 2 , 3 , 4 , 5 , 1 , 6 , 7 , 1 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 10 , 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 1 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40
      World Journal of Emergency Surgery : WJES
      BioMed Central
      Diagnosis, Non-operative management, Surgery, Antibiotics, Hemorrhoids, Fournier’s gangrene, Anorectal bleeding, Anorectal sepsis, Anorectal foreign bodies , Anorectal Varices, Technique, Timing, Angiography, Embolization, Guidelines

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.

          The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

          Related collections

          Most cited references302

          • Record: found
          • Abstract: not found
          • Article: not found

          GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Transfusion strategies for acute upper gastrointestinal bleeding.

              The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy. We enrolled 921 patients with severe acute upper gastrointestinal bleeding and randomly assigned 461 of them to a restrictive strategy (transfusion when the hemoglobin level fell below 7 g per deciliter) and 460 to a liberal strategy (transfusion when the hemoglobin fell below 9 g per deciliter). Randomization was stratified according to the presence or absence of liver cirrhosis. A total of 225 patients assigned to the restrictive strategy (51%), as compared with 61 assigned to the liberal strategy (14%), did not receive transfusions (P<0.001) [corrected].The probability of survival at 6 weeks was higher in the restrictive-strategy group than in the liberal-strategy group (95% vs. 91%; hazard ratio for death with restrictive strategy, 0.55; 95% confidence interval [CI], 0.33 to 0.92; P=0.02). Further bleeding occurred in 10% of the patients in the restrictive-strategy group as compared with 16% of the patients in the liberal-strategy group (P=0.01), and adverse events occurred in 40% as compared with 48% (P=0.02). The probability of survival was slightly higher with the restrictive strategy than with the liberal strategy in the subgroup of patients who had bleeding associated with a peptic ulcer (hazard ratio, 0.70; 95% CI, 0.26 to 1.25) and was significantly higher in the subgroup of patients with cirrhosis and Child-Pugh class A or B disease (hazard ratio, 0.30; 95% CI, 0.11 to 0.85), but not in those with cirrhosis and Child-Pugh class C disease (hazard ratio, 1.04; 95% CI, 0.45 to 2.37). Within the first 5 days, the portal-pressure gradient increased significantly in patients assigned to the liberal strategy (P=0.03) but not in those assigned to the restrictive strategy. As compared with a liberal transfusion strategy, a restrictive strategy significantly improved outcomes in patients with acute upper gastrointestinal bleeding. (Funded by Fundació Investigació Sant Pau; ClinicalTrials.gov number, NCT00414713.).
                Bookmark

                Author and article information

                Contributors
                atarasconi@gmail.com
                Journal
                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central (London )
                1749-7922
                16 September 2021
                16 September 2021
                2021
                : 16
                : 48
                Affiliations
                [1 ]GRID grid.411482.a, Emergency Surgery Department, , Parma University Hospital, ; Parma, Italy
                [2 ]GRID grid.24029.3d, ISNI 0000 0004 0383 8386, Cambridge Colorectal Unit, Addenbrooke’s Hospital, , Cambridge University Hospitals NHS Foundation Trust, ; Cambridge, UK
                [3 ]GRID grid.43582.38, ISNI 0000 0000 9852 649X, Riverside University Health System Medical Center, , Loma Linda University School of Medicine, ; Riverside, CA USA
                [4 ]GRID grid.239638.5, ISNI 0000 0001 0369 638X, Ernest E. Moore Shock Trauma Center at Denver Health, ; Denver, CO USA
                [5 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), , University of Bologna, ; Bologna, Italy
                [6 ]GRID grid.418056.e, ISNI 0000 0004 1765 2558, Department of Metabolic, Digestive and Emergency Surgery, , Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, ; Poissy, France
                [7 ]GRID grid.411489.1, ISNI 0000 0001 2168 2547, Department of Medical and Surgical Sciences, , University of Catanzaro, ; Catanzaro, Italy
                [8 ]GRID grid.43519.3a, ISNI 0000 0001 2193 6666, Department of Surgery, College of Medicine and Health Sciences, , UAE University, ; Al-Ain, United Arab Emirates
                [9 ]GRID grid.414682.d, ISNI 0000 0004 1758 8744, Anesthesia and Intensive Care Unit, AUSL Romagna, , M.Bufalini Hospital, ; Cesena, Italy
                [10 ]GRID grid.10383.39, ISNI 0000 0004 1758 0937, Department of Medicine and Surgery, , University of Parma, ; Parma, Italy
                [11 ]GRID grid.411482.a, Gastroenterology and Endoscopy Unit, , Hospital of Parma, ; Parma, Italy
                [12 ]GRID grid.410511.0, ISNI 0000 0001 2149 7878, Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC, ; Creteil, France
                [13 ]GRID grid.8982.b, ISNI 0000 0004 1762 5736, Department of Emergency and general Surgery, , Pavia University Hospital, ; Pavia, Italy
                [14 ]GRID grid.7637.5, ISNI 0000000417571846, Department of Clinical and Experimental Sciences, , University of Brescia, ; Brescia, Italy
                [15 ]GRID grid.8484.0, ISNI 0000 0004 1757 2064, Department of Morphology, Surgery and Experimental Medicine, , University of Ferrara, ; Ferrara, Italy
                [16 ]GRID grid.18887.3e, ISNI 0000000417581884, General Surgery, , Monza University Hospital, ; Monza, Italy
                [17 ]GRID grid.29273.3d, ISNI 0000 0001 2288 3199, Faculty of Health Sciences, Department of Surgery, , University of Buea, ; Buea, Cameroon
                [18 ]GRID grid.18147.3b, ISNI 0000000121724807, General surgery 1st unit, Department of General Surgery, University of Insubria, ; Varese, Italy
                [19 ]GRID grid.411482.a, Department of Medicine and Surgery, General Surgery Unit, , University Hospital of Parma, ; Parma, Italy
                [20 ]GRID grid.411067.5, ISNI 0000 0000 8584 9230, Department of General & Thoracic Surgery, , University Hospital of Giessen, ; Giessen, Germany
                [21 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Division of Acute Care Surgery, , University of Southern California, ; Los Angeles, CA USA
                [22 ]Department of General Surgery, Albury Hospital, Albury, Australia
                [23 ]GRID grid.414959.4, ISNI 0000 0004 0469 2139, General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, ; Calgary, Alberta Canada
                [24 ]GRID grid.413731.3, ISNI 0000 0000 9950 8111, Division of General Surgery, , Rambam Health Care Campus, ; Haifa, Israel
                [25 ]GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Helsinki University Hospital, ; Helsinki, Finland
                [26 ]GRID grid.410686.d, ISNI 0000 0001 1018 9204, Department of Surgical Disciplines, Regional Clinical Hospital, , Immanuel Kant Baltic Federal University, ; Kaliningrad, Russia
                [27 ]GRID grid.8271.c, ISNI 0000 0001 2295 7397, Department of Surgery, , Fundacion Valle del Lili - Universidad del Valle, ; Cali, Colombia
                [28 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, University of Pittsburgh School of Medicine, UPMC-Presbyterian, ; Pittsburgh, PA USA
                [29 ]GRID grid.5216.0, ISNI 0000 0001 2155 0800, 3rd Department of Surgery, , National & Kapodistrian University of Athens, ; Athens, Greece
                [30 ]General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
                [31 ]Department of Surgery, Macerata Hospital, Macerata, Italy
                [32 ]GRID grid.240988.f, Department of Surgery, , Tan Tock Seng Hospital, ; Singapore, Singapore
                [33 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Department of Surgery, Department of Emergency Medicine, , Radboud University Medical Center, ; Nijmegen, the Netherlands
                [34 ]GRID grid.7644.1, ISNI 0000 0001 0120 3326, Academic Unit of General Surgery “V. Bonomo” Department of Biomedical Sciences and Human Oncology, , University of Bari, ; Bari, Italy
                [35 ]GRID grid.32224.35, ISNI 0000 0004 0386 9924, Division of Trauma, Emergency Surgery, and Surgical Critical Care, , Massachusetts General Hospital, ; Boston, MA USA
                [36 ]Government Gousia Hospital, Srinagar, Kashmir India
                [37 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, Department of General Surgery, Royal Perth Hospital, , University of Western Australia, ; Perth, Australia
                [38 ]GRID grid.415402.6, ISNI 0000 0004 0449 3295, Department of Trauma and Acute Care Surgery, , Scripps Memorial Hospital La Jolla, ; La Jolla, San Diego, CA USA
                [39 ]GRID grid.144189.1, ISNI 0000 0004 1756 8209, General, Emergency and Trauma Surgery Department, , Pisa University Hospital, ; Pisa, Italy
                [40 ]GRID grid.414682.d, ISNI 0000 0004 1758 8744, General, Emergency and Trauma Surgery Dept., Bufalini Hospital, ; Cesena, Italy
                Author information
                http://orcid.org/0000-0001-6588-2268
                Article
                384
                10.1186/s13017-021-00384-x
                8447593
                34530908
                f6bb247a-b40c-4602-a47d-4ec41b9716a3
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 21 April 2021
                : 16 July 2021
                Categories
                Review
                Custom metadata
                © The Author(s) 2021

                Surgery
                diagnosis,non-operative management,surgery,antibiotics,hemorrhoids,fournier’s gangrene,anorectal bleeding,anorectal sepsis,anorectal foreign bodies ,anorectal varices,technique,timing,angiography,embolization,guidelines

                Comments

                Comment on this article