Chapters authored
Segmental Colitis Associated with Diverticulosis
Segmental colitis associated with diverticulosis is a pathology of recent knowledge, whose pathogenesis is still poorly defined. Diagnosis is mainly based on colonoscopy and histopathological study. Clinical features are chronic diarrhea, abdominal cramps in the lower right quadrant, and intermittent hematochezia. The diagnosis is evidenced by colonoscopy showing inflammation in the colic mucosa between the diverticula, sparing the diverticular orifice associated with an anatomopathological condition showing chronic inflammation. The involvement is preferably sigmoid and may involve a descending colon, sparing the rectum. The treatment is similar to that of inflammatory bowel diseases in mild forms, but recent studies have presented new alternatives with good results. The treatment is not yet well defined, and antibiotics, mesalamine, and corticoid therapy can be used, and surgery can even be performed for refractory cases.
Part of the book: Diverticular Disease of the Colon
Hidradenitis Suppurativa Perineal and Perianal
Hidradenitis suppurativa (HS) is a chronic inflammatory, recurrent, and a debilitating skin disorder that affects the follicular epithelium, specifically of apocrine-gland-bearing regions (such as axillae, inframammary folds, groin, perineal, and/or perigenital). HS prevalence is around 1–4%, and the perineal disease is more common in males. HS is initially characterized by perifollicular lymphocytic infiltrate, which causes glands’ duct occlusion, dilation, rupture of the follicle, and increased inflammation. The result is the formation of tunnels (fistulas) connecting the glands to the skin’s surface. Secondary bacterial infections may occur. The etiological factors are obesity, smoking, and hormones, with a genetic predisposition of up to 40% of patients. HS usually occurs in early adulthood, with inflamed skin nodules, abscesses, pus discharge tunnels, and scarring developed in axillary, inguinal, gluteal, and perineal body sites. The diagnosis is made clinically based on typical lesions, affected regions, and progression (chronicity, persistent lesions, and recurrence). The therapy for HS must be individualized and guided by severity. They range from topical and systemic antibiotics, retinoids, immunosuppressive drugs, local therapies such as laser, phototherapy, hyperbaric, and even regulated and extensive surgical resections, which may be associated with skin grafts.
Part of the book: Benign Anorectal Disorders