Mpox (monkeypox) is an emerging viral infection with a broad and evolving clinical spectrum that increasingly spans beyond its characteristic cutaneous manifestations. Anorectal manifestations are well recognized in patients with Mpox in recent outbreaks. However, the gastrointestinal (GI) or anorectal symptoms may precede the typical rash, creating significant diagnostic challenges and delaying appropriate infection control measures. We describe a quinquagenarian man with poorly controlled diabetes mellitus who presented with fever, diarrhea, tenesmus, and severe perianal pain. Cross-sectional imaging demonstrated diffuse rectosigmoid inflammation, while endoscopy revealed severe ulcerative proctitis. Initial evaluation favored acute infectious proctitis, and treatment was directed accordingly. However, the subsequent development of disseminated pustular skin lesions prompted consideration of Mpox, which was ultimately confirmed by polymerase chain reaction testing of the lesions. Extensive testing excluded concurrent human immunodeficiency virus (HIV) infection and other common sexually transmitted infections, and rectal biopsy demonstrated nonspecific acute colitis. The patient recovered with supportive management and had complete endoscopic resolution on follow-up colonoscopy. This case illustrates the relevance of considering Mpox in the differential diagnosis of acute proctitis and lower GI symptoms, even before characteristic skin lesions appear. It also underscores the diagnostic value of maintaining a high index of suspicion in patients presenting with severe anorectal disease and points out that diabetes-associated immune dysfunction may play a role in such cases. Early recognition of atypical GI manifestations is essential for timely diagnosis, appropriate patient isolation, avoidance of unnecessary interventions, and optimal clinical outcomes.

Background Hemorrhoidal disease is one of the most common benign anorectal disorders encountered in surgical practice. Although various surgical modalities are available for grade III and IV hemorrhoids, Milligan-Morgan hemorrhoidectomy remains the gold standard treatment. However, postoperative pain is a major complication associated with this procedure. Therefore, hemorrhoidectomy using the harmonic scalpel (HS) has gained attention because of its potential to reduce tissue injury and postoperative pain. Methods This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids who underwent hemorrhoidectomy using the conventional technique (n = 59) or the harmonic scalpel (n = 53) at a tertiary teaching hospital between December 2024 and May 2026. Approval was obtained from the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research (approval number: CSP-MED/24/OCT/110/327), and written informed consent was obtained from all the participants. The study aimed to compare the efficacy of hemorrhoidectomy using the harmonic scalpel with the conventional technique in terms of perioperative outcomes. The primary outcomes included intraoperative bleeding, operating time, and postoperative pain, whereas secondary outcomes included the duration of hospital stay and postoperative urinary retention. Statistical analysis was performed, and a p-value of <0.05 was considered statistically significant. Results A significant reduction in operating time (<0.001), intraoperative blood loss (<0.001), postoperative pain (<0.001), postoperative urinary catheterization (0.018), and hospital stay (<0.001) was noted in the group undergoing hemorrhoidectomy using the harmonic scalpel compared with the conventional group. Conclusion Patients undergoing hemorrhoidectomy using the harmonic scalpel demonstrated a significant reduction in intra- and postoperative complications compared with the conventional group, suggesting greater efficacy in the management of grade III and IV hemorrhoids.

Most ingested foreign bodies (FBs) commonly pass through the gastrointestinal tract without complications. However, sharp objects, such as bones, may cause mucosal injury, perforation, and abscess formation. Rectal impaction is rare, but can pose a diagnostic challenge, especially in nonspecific presentations, such as anal pain. We report a case of a 40-year-old male patient who first presented with severe acute anal pain. He was later found to have complex anorectal abscesses and a rectal perforation secondary to the manual removal of an ingested meat bone FB. Surgical exploration revealed a full-thickness rectal perforation and anorectal abscesses, which were subsequently drained, and the perforation was repaired. This case highlights the importance of considering FB related complications in patients presenting with anal pain, especially following manipulation. Prompt imaging and surgical intervention are key to preventing severe outcomes.

Anorectal barotrauma from compressed air is a rare but potentially life-threatening injury, and most published cases involve frank colorectal perforation, whereas extensive extraluminal air dissemination without a demonstrable full-thickness defect is poorly characterized. We report a previously healthy 21-year-old man who presented with acute anal pain after a coworker directed a high-pressure air jet toward his perineum through two layers of clothing. He was hemodynamically stable, with preserved anal sphincter tone and no rectal bleeding, but had widespread subcutaneous crepitus over the chest and abdominal wall and a tense, distended scrotum. Computed tomography (CT) revealed extensive air within the retroperitoneum, perirenal spaces, abdominopelvic fascial planes, and subcutaneous tissues of the chest, abdomen, perineum, and scrotum, together with intraspinal air consistent with pneumorrhachis; no discrete persistent rectal wall defect, large fluid collection, or fecal contamination was identified. No water-soluble rectal contrast leak study was performed; therefore, an occult sealed luminal communication could not be entirely excluded. Endoscopy at a tertiary referral center showed only superficial mucosal abrasion without a visible perforation, and the patient was managed conservatively with bowel rest, rectal lavage, and broad-spectrum antibiotics, recovering uneventfully. These findings suggest that extensive air dissection may occur through a sub-endoscopic mucosal breach or transiently sealed microperforation. CT was essential for mapping the air distribution and excluding high-risk features; in a stable patient without peritonitis, fecal contamination, or clinical deterioration, this supported cautious conservative management.

BackgroundPostoperative pain remains a major concern after anorectal surgery, contributing to delayed discharge and increased opioid use. Although perioperative gabapentin has been evaluated in multiple surgical settings, its clinical value in anorectal surgery remains uncertain.MethodsA systematic search of PubMed, Scopus, and the Cochrane Central Register of Controlled Trials identified studies published through May 2025. Randomized clinical trials and observational cohorts comparing preoperative gabapentin with placebo or standard analgesia in patients undergoing anorectal surgery were included. The primary outcome was 24-hour postoperative pain measured on the Visual Analogue Scale (VAS). Mean differences (MDs) were pooled using a random-effects model with 95% confidence intervals (CIs), and heterogeneity was quantified using the I[2] statistic. To assess robustness and clinical probability, a complementary Bayesian random-effects meta-analysis was performed. Analyses were conducted in R (version 4.4.2).Results6 studies, including 504 patients (242 gabapentin and 262 control), were included. Among these, postoperative pain at 24 hours (VAS) was available in four studies comprising 415 patients. Pooled results demonstrated significantly lower 24-hour VAS scores with gabapentin (MD = -2.10 cm; 95% CI -3.98 to -0.22; P = 0.029; I[2] = 99.2%). The Bayesian model favored gabapentin, with a posterior probability of benefit of 99.8%.ConclusionGabapentin shows a statistically detectable reduction in postoperative pain after anorectal surgery, but the effect is heterogeneous and supported by very low certainty evidence, making its clinical relevance uncertain and limiting its role in routine practice.

Background/Objective: Anorectal disorders are a common yet underdiagnosed component of pelvic floor dysfunction, particularly among postpartum women. These conditions, including hemorrhoids, anal fissures, and fecal incontinence, are associated with physical discomfort and may negatively affect psychological well-being. Self-esteem has been identified as a potential mediator linking somatic symptoms to mental health outcomes, including depression. We aimed to assess the relationship between anorectal symptoms, self-esteem and the severity of depressive symptoms in a Polish population of postpartum women. Methods: A cross-sectional questionnaire-based study was conducted between June and December 2025, including 120 women aged >18 years, at least 3 months postpartum. Data were collected using online and paper questionnaires. The assessment tools included the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20), Rosenberg Self-Esteem Scale (RSES), and Beck Depression Inventory (BDI). Statistical analyses included the multiple regression model, logistic regression and Spearman's rank correlation. Results: The most frequently reported anorectal symptoms included pain (45.83%), bleeding (42.5%), and pruritus (41.7%). The mean PFDI-20 score was 41.15 (SD 31.13). High self-esteem was observed in 55% of participants, whereas depressive symptoms were present in varying degrees of severity, ranging from no depressive symptoms (55.83%), mild (30%) to severe (0.83%). Significant positive correlations were found between pelvic floor dysfunction severity (particularly CRADI-8 and UDI-6 subscales) and depressive symptoms (BDI), while their correlation with self-esteem (RSES) was negative. The strongest positive correlation was observed between the overall PFDI-20 score and depression (r = 0.389). Multiple regression analyses identified anorectal symptoms, parity, hypothyroidism, and pre-pregnancy depression or anxiety as significant predictors of self-esteem. Anorectal symptoms and hormonal contraceptive use were significant predictors of depressive symptom severity. Among women who delivered vaginally, perineal tear was independently associated with greater depressive symptom severity (OR = 1.07, 95% CI: 1.01-1.14, p = 0.019). Conclusions: Postpartum anorectal and pelvic floor dysfunction symptoms are significantly associated with poorer psychological outcomes, including higher depressive symptoms and lower self-esteem. These findings highlight the importance of a multidisciplinary approach with routine psychological screening in postpartum care.

Background: Large language models (LLMs) are increasingly used by patients for obtaining medical information; however, concerns remain regarding their clinical safety, reliability, and appropriateness of patient guidance. Evidence evaluating LLM performance in hemorrhoid-related patient questions remains limited. Objective: To compare the clinical accuracy, safety, and overall clinical adequacy of responses generated by ChatGPT, Gemini, and DeepSeek to hemorrhoid-related patient questions. Methods: In this cross-sectional comparative study, 25 hemorrhoid-related patient questions were developed and categorized into three predefined subgroups: basic informational questions, clinically significant scenarios, and misleading/risky patient statements. Responses generated by ChatGPT (GPT-5.3), Gemini (3.1), and DeepSeek (R1) were evaluated by two experienced surgeons using a consensus-based expert assessment approach and a structured 5-point scoring system assessing clinical accuracy, safety, appropriateness of patient guidance, and overall clinical adequacy. Critical errors and qualitative communication characteristics were also analyzed. Friedman and post hoc Conover tests with Bonferroni correction were used for statistical comparisons. Results: Overall response quality differed significantly among models (χ[2](2) = 29.119, p < 0.001, Kendall's W = 0.582). ChatGPT achieved the highest overall scores (5.00 ± 0.00), followed by Gemini (4.80 ± 0.41) and DeepSeek (4.12 ± 0.67). Significant differences were primarily observed between DeepSeek and the other models, whereas ChatGPT and Gemini showed comparable performance. Model divergence became more pronounced in clinically significant scenarios involving alarm symptoms, rectal bleeding, persistent symptoms, and acute anorectal pain. No model generated directly harmful medical recommendations or explicit guidance likely to result in substantial diagnostic delay. However, qualitative assessment demonstrated differences in communication style and risk communication. ChatGPT generally produced more balanced and context-appropriate responses, Gemini generated more explanatory responses, whereas DeepSeek showed a tendency toward disproportionately urgent or alarmist language in some higher-risk scenarios. Conclusions: Large language models demonstrated generally high clinical accuracy in answering hemorrhoid-related patient questions; however, notable model-specific differences were observed in clinical guidance, communication style, and risk communication, particularly in high-risk clinical scenarios. These findings suggest that LLMs may serve as useful supportive tools for patient education and health information delivery, although they should currently be regarded as systems that support rather than replace human clinical judgment.

Rome V represents a major conceptual and clinical evolution in the field of disorders of gut-brain interaction (DGBI). Its most important contribution is the deliberate move away from the term "functional", a label that has often implied that symptoms are less real, less biological, or merely psychological. By emphasizing DGBI, Rome V reframes these conditions as positive diagnoses arising from altered gut-brain regulation, visceral sensitivity, motility, mucosal and immune mechanisms, microbiota, autonomic function, and central processing. Beyond terminology, Rome V introduces greater diagnostic precision. In esophageal disorders, the exclusion of gastroesophageal reflux disease and major motor disorders is aligned with Lyon Consensus 2.0 and Chicago Classification v4.0, while globus and functional chest pain are refined to avoid unnecessary interventions. In gastroduodenal disorders, functional dyspepsia is better phenotyped according to meal-related symptoms, with clearer distinctions from chronic nausea and vomiting syndrome, gastroparesis, cyclic vomiting syndrome, cannabinoid hyperemesis syndrome, rumination, and inability to belch. In bowel disorders, Rome V reintroduces abdominal discomfort into IBS criteria, changes the symptom frequency threshold, renames functional constipation as chronic constipation, and redefines abdominal bloating/distension. The anorectal section is particularly relevant because it operationalizes fecal incontinence, defines dyssynergic defecation using objective testing, and formally recognizes rectal hypo- and hypersensitivity, which may guide biofeedback therapy. Rome V also raises future challenges: implementation in clinical practice, patient-centered communication, avoidance of reductionism, development of mechanism-based research, and interpretation of forthcoming epidemiological data. Overall, Rome V promotes precision, reduces stigma, and supports more rational, mechanism-based care.