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Article ; Online: [No title information]

Dyrved, Liv / Perregaard, Helene

2023 Volume 185, Issue 43

Abstract: This case report describes a uterine rupture initially misinterpreted as acute appendicitis. Uterine rupture is a rare but serious obstetric complication, whereas acute appendicitis is one of the most common causes of abdominal pain. The patient gave ... ...

Title translation	Uterine rupture during vaginal birth misinterpreted as acute appendicitis postpartum.
Abstract	This case report describes a uterine rupture initially misinterpreted as acute appendicitis. Uterine rupture is a rare but serious obstetric complication, whereas acute appendicitis is one of the most common causes of abdominal pain. The patient gave vaginal birth after previously having had a caesarean delivery. The following days she experienced persistent abdominal pain which was interpreted as acute appendicitis. Diagnostic laparoscopy found a normal appendix but a complete uterine rupture. The lesson to be learned from this case report is not to let the most common diagnoses overshadow the rare ones.
MeSH term(s)	Pregnancy ; Female ; Humans ; Appendicitis/diagnosis ; Appendicitis/surgery ; Uterine Rupture/diagnosis ; Uterine Rupture/etiology ; Uterine Rupture/surgery ; Appendix ; Abdominal Pain/diagnosis ; Abdominal Pain/etiology ; Postpartum Period
Language	Danish
Publishing date	2023-11-02
Publishing country	Denmark
Document type	Case Reports ; English Abstract ; Journal Article
ZDB-ID	124102-3
ISSN	1603-6824 ; 0041-5782
ISSN (online)	1603-6824
ISSN	0041-5782
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Article ; Online: Fistula development after anal abscess drainage-a multicentre retrospective cohort study.

Skovgaards, Daniel Mark / Perregaard, Helene / Dibbern, Christian Bakholdt / Nordholm-Carstensen, Andreas

International journal of colorectal disease

2023 Volume 39, Issue 1, Page(s) 4

Abstract: Purpose: Anal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the development of anal fistulas are sparse. This study aimed to identify the risk ... ...

Abstract	Purpose: Anal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the development of anal fistulas are sparse. This study aimed to identify the risk factors for anal fistulas after anal abscess surgery. Methods: This was a multicentre, retrospective cohort study of patients undergoing acute surgery for anal abscesses in the Capital Region of Denmark between 2018 and 2019. The patients were identified using ICD-10 codes for anal abscesses. Predefined clinicopathological factors and postoperative courses were extracted from patient records. Results: A total of 475 patients were included. At a median follow-up time of 1108 days (IQR 946-1320 days) following surgery, 164 (33.7%) patients were diagnosed with an anal fistula. Risk factors for developing fistulas were low intersphincteric (OR 2.77, 95CI 1.50-5.06) and ischioanal (OR 2.48, 95CI 1.36-4.47) abscesses, Crohn's disease (OR 5.96, 95CI 2.33-17.2), a history of recurrent anal abscesses (OR 4.14, 95CI 2.47-7.01) or repeat surgery (OR 5.96, 95CI 2.33-17.2), E. coli-positive pus cultures (OR 4.06, 1.56-11.4) or preoperative C-reactive protein (CRP) of more than 100 mg/L (OR 3.21, 95CI 1.57-6.71). Conclusion: Several significant clinical risk factors were associated with fistula development following anal abscess surgery. These findings are clinically relevant and could influence the selection of patients for specialised follow-up, facilitate expedited diagnosis, and potentially prevent unnecessarily long treatment courses.
MeSH term(s)	Humans ; Abscess/complications ; Abscess/diagnosis ; Retrospective Studies ; Escherichia coli ; Anus Diseases/complications ; Anus Diseases/surgery ; Rectal Fistula/complications ; Rectal Fistula/surgery ; Drainage/adverse effects ; Treatment Outcome
Language	English
Publishing date	2023-12-13
Publishing country	Germany
Document type	Multicenter Study ; Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-023-04576-6
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Article ; Online: [Treatment of perianal fistulas with mesenchymal stem cells].

Dalby, Helene Rask / Perregaard, Helene / Dige, Anders / Hagen, Kikke Bartholin / Nordholm-Carstensen, Andreas / Lundby, Lilli

Ugeskrift for laeger

2022 Volume 184, Issue 14

Abstract: Treatment of perianal fistulas are challenged by insufficient healing and a high rate of relapse. Existing sphincter-sparing procedures have healing rates of around 50%. Treatment with mesenchymal stem cells of both autologous and allogenic origin and ... ...

Abstract	Treatment of perianal fistulas are challenged by insufficient healing and a high rate of relapse. Existing sphincter-sparing procedures have healing rates of around 50%. Treatment with mesenchymal stem cells of both autologous and allogenic origin and freshly collected autologous adipose tissue show both promising healing rates and few complications and may be offered to patients with complicated fistulas not suited for other treatment modalities.
MeSH term(s)	Anal Canal ; Cutaneous Fistula ; Humans ; Mesenchymal Stem Cell Transplantation/adverse effects ; Mesenchymal Stem Cell Transplantation/methods ; Mesenchymal Stem Cells ; Organ Sparing Treatments/adverse effects ; Rectal Fistula/etiology ; Rectal Fistula/surgery ; Treatment Outcome
Language	Danish
Publishing date	2022-04-12
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	124102-3
ISSN	1603-6824 ; 0041-5782
ISSN (online)	1603-6824
ISSN	0041-5782
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Article ; Online: Lateral internal sphincterotomy (LIS) using endoanal ultrasound - a video vignette.

Perregaard, Helene / Hagen, Kikke B / Krarup, Peter-Martin / Nordholm-Carstensen, Andreas

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2021 Volume 23, Issue 11, Page(s) 3038–3039

MeSH term(s)	Anal Canal/diagnostic imaging ; Anal Canal/surgery ; Chronic Disease ; Fissure in Ano ; Humans ; Lateral Internal Sphincterotomy ; Treatment Outcome ; Ultrasonography
Language	English
Publishing date	2021-09-14
Publishing country	England
Document type	Letter ; Video-Audio Media
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15900
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Article ; Online: [Cryptoglandular anal fistulas].

Perregaard, Helene / Dalby, Helene Rask / Hagen, Kikke Bartholin / Dige, Anders / Lundby, Lilli / Nordholm-Carstensen, Andreas

Ugeskrift for laeger

2021 Volume 183, Issue 36

Abstract: Cryptoglandular anal fistulas (AF) cause recurrent anal abscesses and patients risk multiple surgeries due to low healing rates of sphincter-saving procedures. Knowledge of anal anatomy and imaging with MRI or endoanal sonography is crucial to classify ... ...

Abstract	Cryptoglandular anal fistulas (AF) cause recurrent anal abscesses and patients risk multiple surgeries due to low healing rates of sphincter-saving procedures. Knowledge of anal anatomy and imaging with MRI or endoanal sonography is crucial to classify AF as simple or complex depending on risk of anal incontinence after fistulotomy as summarised in this review. Fistulotomy has healing rates of > 90%, risks incontinence, and the procedure is reserved for simple fistulas. Complex AF are treated with a draining seton and then with sphincter-saving procedures which have long-term healing rates of about 50%.
MeSH term(s)	Anal Canal/diagnostic imaging ; Anal Canal/surgery ; Fecal Incontinence/etiology ; Humans ; Magnetic Resonance Imaging ; Rectal Fistula/diagnostic imaging ; Rectal Fistula/surgery ; Treatment Outcome
Language	Danish
Publishing date	2021-09-09
Publishing country	Denmark
Document type	Journal Article ; Review
ZDB-ID	124102-3
ISSN	1603-6824 ; 0041-5782
ISSN (online)	1603-6824
ISSN	0041-5782
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Article ; Online: Fistula Laser Closure (FiLaC™) for fistula-in-ano-yet another technique with 50% healing rates?

Nordholm-Carstensen, Andreas / Perregaard, Helene / Hagen, Kikke Bartholin / Krarup, Peter-Martin

International journal of colorectal disease

2021 Volume 36, Issue 9, Page(s) 1831–1837

Abstract: Purpose: Treatment of ano-cutaneous fistulas remains a therapeutic challenge. Fistula Laser Closure (FiLaC™) is a relatively new technique for the treatment of ano-cutaneous fistulas. This study aimed to determine the success rate of fistula closure ... ...

Abstract	Purpose: Treatment of ano-cutaneous fistulas remains a therapeutic challenge. Fistula Laser Closure (FiLaC™) is a relatively new technique for the treatment of ano-cutaneous fistulas. This study aimed to determine the success rate of fistula closure using FiLaC™. Secondary endpoints included adverse events and patient characteristics associated with treatment success. Methods: This was a retrospective cohort study of consecutive patients subjected to FiLaC™ at Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, between March 2017 and July 2019. All patients had a one-track fistula not suitable for fistulotomy. All were treated with a draining seton for at least 8 weeks prior to laser closure. Fistulas were ablated with a 360-degree emitting 12-watt 1470 nm laser probe. The inner fistula opening was closed with absorbable suture. All patients were followed with clinical examination including MRI or EAUS 1 year after the procedure. Results: In total, 66 patients with 68 fistulas were included. Two patients had a high intersphincteric, 20 had low transsphincteric, 41 high transsphincteric and 5 had suprasphincteric fistulas. Fistula aetiology was cryptoglandular in 83.8%, whereas the rest were due to Crohn's disease. Thirty-one (45.6%) were subjected to a second FiLaC™ procedure. Follow-up was median 19 months (12-26 months). Ultimately, 30 of 68 (44.1%) of the fistulas healed. No cases of incontinence following FiLaC™ were observed, but a single patient developed an abscess. Conclusion: Fistula closure with FiLaC™ had success rates comparable to that of other sphincter-sparing techniques. The technique seems safe with respect to adverse events and risk of incontinence.
MeSH term(s)	Anal Canal ; Humans ; Lasers ; Organ Sparing Treatments ; Rectal Fistula/etiology ; Rectal Fistula/surgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-04-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-021-03932-8
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Article ; Online: [Perianal abscess after anal intercourse should raise suspicion of rectal gonorrhoeae infection].

Kanstrup, Charlotte / Perregaard, Helene / Bertelsen, Claus Anders

Ugeskrift for laeger

2019 Volume 181, Issue 9

Abstract: Neisseria gonorrhoeae infection is a sexually transmitted disease. Rectal gonorrhoea is often asymptomatic, the most common symptoms are anal pain, bleeding and purulent discharge. This case report describes a younger man, who experienced increasing anal ...

Abstract	Neisseria gonorrhoeae infection is a sexually transmitted disease. Rectal gonorrhoea is often asymptomatic, the most common symptoms are anal pain, bleeding and purulent discharge. This case report describes a younger man, who experienced increasing anal pain and later fever after anal intercourse. N. gonorrhoeae infection was verified, before a clinical examination revealed a perianal abscess. During incision of the abscess an anal fistula was suspected, and six weeks after primary surgery and treatment with relevant antibiotics, transanal ultrasonography showed perianal scarring and no signs of anocutaneous fistula.
MeSH term(s)	Abscess/etiology ; Abscess/microbiology ; Abscess/surgery ; Anus Diseases/etiology ; Anus Diseases/microbiology ; Anus Diseases/surgery ; Fever/etiology ; Fever/microbiology ; Gonorrhea/etiology ; Gonorrhea/microbiology ; Gonorrhea/surgery ; Humans ; Male ; Pain/etiology ; Pain/microbiology ; Rectal Fistula/etiology ; Rectal Fistula/microbiology ; Rectal Fistula/surgery ; Sexual Behavior
Language	Danish
Publishing date	2019-02-25
Publishing country	Denmark
Document type	Case Reports ; Journal Article
ZDB-ID	124102-3
ISSN	1603-6824 ; 0041-5782
ISSN (online)	1603-6824
ISSN	0041-5782
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Article ; Online: Mortality after abdominal emergency surgery in nonagenarians.

Perregaard, Helene / Tenma, Jutaka / Antonsen, Jacob / Mynster, Tommie

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2019 Volume 47, Issue 2, Page(s) 485–492

Abstract: Purpose: To search the pattern of diagnoses in nonagenarians undergoing emergency abdominal surgery between January 2009 and December 2013 in two hospitals. To test the hypothesis that pre-hospital functional status is an effective criterion for ... ...

Abstract	Purpose: To search the pattern of diagnoses in nonagenarians undergoing emergency abdominal surgery between January 2009 and December 2013 in two hospitals. To test the hypothesis that pre-hospital functional status is an effective criterion for predicting postoperative mortality in nonagenarians after emergency abdominal surgery. Methods: The study is an observational study on 157 patients. Patients were identified from the operation database and perioperative data were extracted as prospectively information supplied by retrospective data from patient electronic files. The primary endpoints were short, middle and long-term mortality and the secondary endpoint was to identify preoperative factors associated with postoperative mortality. Results: The most frequent reason for operation was intestinal obstruction. Overall mortality in the cohort was 34% (n = 54) after 30 days and 54% (n = 84) after 1 year. Amongst patients developing a serious complication (classified as Clavien Dindo class III or greater) after surgery (n = 45) the mortality was 80% (n = 36) after 30 days and 89% (n = 40) after 1 year. In multivariate analysis, a high American Association of Anesthesiologists class (ASA) and a high Performance Status (PS) class (low performance) were significant predictors of post-operative mortality. Conclusion: Our data support pre-admission functional status for predicting postoperative mortality after emergency abdominal surgery in nonagenarians.
MeSH term(s)	Abdomen/surgery ; Aged, 80 and over ; Humans ; Intestinal Obstruction ; Postoperative Complications ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2019-10-29
Publishing country	Germany
Document type	Journal Article ; Observational Study
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-019-01247-6
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Article ; Online: [Treatment of anal abscesses].

Skovgaards, Daniel Mark / Perregaard, Helene / Hagen, Kikke Bartholin / Nordholm-Carstensen, Andreas

Ugeskrift for laeger

2020 Volume 182, Issue 51

Abstract: Anal abscesses are well-known conditions worldwide. The golden standard of acute treatment is incision and drainage. Knowledge of the anatomy of the anal area and the abscess involvement of perianal spaces is crucial in order to perform safe and correct ... ...

Abstract	Anal abscesses are well-known conditions worldwide. The golden standard of acute treatment is incision and drainage. Knowledge of the anatomy of the anal area and the abscess involvement of perianal spaces is crucial in order to perform safe and correct surgical treatment as summarised in this review. Pre- and perioperative imaging with magnetic resonance imaging, endoanal ultrasonography or CT facilitates correct incision and drainage, while antibiotics as conservative approach have no place in the treatment of abscesses. One third of the patients have an underlying fistula, and if suspected referral to a fistula centre is warranted.
MeSH term(s)	Abscess/diagnostic imaging ; Abscess/drug therapy ; Abscess/surgery ; Anal Canal ; Anus Diseases/diagnostic imaging ; Anus Diseases/surgery ; Drainage ; Humans ; Rectal Fistula/diagnostic imaging ; Rectal Fistula/surgery
Language	Danish
Publishing date	2020-12-09
Publishing country	Denmark
Document type	Journal Article ; Review
ZDB-ID	124102-3
ISSN	1603-6824 ; 0041-5782
ISSN (online)	1603-6824
ISSN	0041-5782
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Article ; Online: Treatment of chronic anal fissure: a feasibility study on Levorag® Emulgel versus Diltiazem gel 2.

Nordholm-Carstensen, Andreas / Perregaard, Helene / Wahlstrøm, Kirsten Lykke / Hagen, Kikke Bartholin / Hougaard, Helene Tarri / Krarup, Peter-Martin

International journal of colorectal disease

2020 Volume 35, Issue 4, Page(s) 615–621

Abstract: Purpose: To compare the standard treatment, diltiazem gel 2%, with Levorag® Emulgel for chronic anal fissures.: Methods: This was a single-blinded, randomised, controlled, clinical trial with a non-inferiority design. Patients with a chronic anal ... ...

Abstract	Purpose: To compare the standard treatment, diltiazem gel 2%, with Levorag® Emulgel for chronic anal fissures. Methods: This was a single-blinded, randomised, controlled, clinical trial with a non-inferiority design. Patients with a chronic anal fissure were randomised to treatment with diltiazem or Levorag® Emulgel twice daily for 8 weeks. Primary endpoint was complete healing of the anal fissure after 12 weeks. Secondary endpoints included incidence of adverse events and efficacy on pain relief. Results: In total, 55 patients were included. Inclusion was terminated prematurely due to a slow inclusion rate. Complete fissure healing at 12 weeks follow-up was overall achieved in 31 of 55 (56%) patients, 18 of 29 (62%) in the diltiazem group compared with 13 of 26 (50%) in the Levorag® Emulgel group (P = 0.424). Pain relief was significantly better at day seven in patients treated with diltiazem (P = 0.040) compared with Levorag® Emulgel, whereas there were no differences in early (3 days) or late (12 weeks) pain relief. Three patients (10.3%) developed severe perianal exanthema during diltiazem treatment, whereas no side effects were observed in the Levorag® Emulgel group. Conclusion: The study demonstrated statistical non-inferiority of Levorag® Emulgel compared with diltiazem in the treatment of chronic anal fissure. Diltiazem resulted in a more prompt pain relief and also in a substantial number of local allergic reactions. Levorag® Emulgel may therefore be an alternative in these patients. Trial registration: Clinicaltrials.gov no. NCT02158013.
MeSH term(s)	Adult ; Chronic Disease ; Diltiazem/adverse effects ; Diltiazem/therapeutic use ; Drug Combinations ; Feasibility Studies ; Female ; Fissure in Ano/complications ; Fissure in Ano/drug therapy ; Humans ; Male ; Pain/drug therapy ; Pain/etiology ; Plant Extracts/adverse effects ; Plant Extracts/therapeutic use ; Wound Healing ; Young Adult ; beta-Glucans/adverse effects ; beta-Glucans/therapeutic use
Chemical Substances	Drug Combinations ; Levorag ; Plant Extracts ; beta-Glucans ; Diltiazem (EE92BBP03H)
Language	English
Publishing date	2020-01-24
Publishing country	Germany
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-020-03515-z
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