Gastrointestinal tuberculosis (TB) is an uncommon form of extrapulmonary TB, with anorectal involvement representing an exceedingly rare subset. We report a fatal case of disseminated anorectal TB in a 28-year-old male immigrant from Kenya with a history of alcohol use disorder, a recognized risk factor for TB reactivation and spread. The patient initially presented with rectal pain and perirectal purulent discharge. On evaluation, he was found to have a left perirectal abscess, a right ischioanal abscess, and multiple fistulas. Acid-fast bacillus staining of debrided anorectal abscess fluid revealed Mycobacterium tuberculosis complex, with additional evidence of pulmonary involvement on chest imaging and bronchoalveolar lavage, consistent with disseminated TB. The patient was initiated on anti-TB treatment with rifampin, isoniazid, pyrazinamide, and ethambutol. However, his condition rapidly deteriorated as he developed acute respiratory distress syndrome and septic shock, ultimately resulting in his death. This case highlights the rarity and potential severity of anorectal TB in disseminated disease. We also emphasize the importance of considering TB in patients with persistent or atypical anorectal infections, particularly those with epidemiologic risk factors such as prior residence in TB-endemic regions and alcohol use disorder.

Primary colonic squamous cell carcinoma (SCC) represents a small minority of all colorectal cancer cases. Common clinical presentations include abdominal pain, weight loss, anorexia, dyschezia, and hematochezia. While adjuvant chemotherapy/radiation may be considered, treatment of colonic SCC is primarily surgical. We report a case of primary colonic SCC. A 66-year-old man with multiple comorbidities and a 42-pack-year smoking history presented with abdominal pain, constipation, and rectal bleeding. Colonoscopy findings included an anorectal ulcer and an ulcerated rectal mass, diagnosed as poorly differentiated, HPV-related SCC. Surgical treatment consisted of a low anterior resection with ileostomy and adjuvant chemoradiation, complicated by leukopenia/neutropenia. The ileostomy was reversed six months later with no gross malignancy. However, circulating tumor DNA (ctDNA) remained positive with a follow-up positron emission tomography scan and biopsy confirming recurrent SCC. The patient is currently receiving combination chemotherapy with carboplatin and paclitaxel, with considerations being made for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. This case demonstrates the role of ctDNA as an early marker of recurrence and an association with HPV infection. However, the risk factors for primary colonic SCC remain unclear, and adjuvant chemoradiation lacks consensus. Further evaluation of primary colonic SCC cases is necessary to determine standardized management guidelines.

Introduction Anorectal malformations (ARMs) are congenital conditions requiring surgical correction. Despite surgical intervention, patients often experience persistent fecal and urinary dysfunction, significantly impacting their quality of life (QoL). This multicenter retrospective study aimed to assess QoL in ARM patients, identify factors influencing QoL deterioration, and propose improved management strategies. Methods We retrospectively analyzed data from 39 ARM patients who underwent surgery between 1999 and 2019 at two Belgian hospitals. Patients completed the Hirschsprung's Disease Anorectal Malformation Quality of Life Questionnaire (HAQL). We also reviewed their medical records. Descriptive statistical analysis was performed. Results At a median follow-up of 106 months, functional outcomes showed high rates of constipation (87%), fecal incontinence (54%), and fecal soiling (87%). Fecal incontinence was more prevalent in patients with bulbar rectourethral and recto-vesical fistulas. Postoperative complications occurred in 72% of patients, primarily in those with high ARMs, and correlated with increased constipation and abdominal pain. Management gaps were observed: only 47% of constipated patients and 56% of incontinent patients underwent anorectal manometry, and only 50% of constipated patients utilized physiotherapy. QoL assessment revealed persistent digestive functional disorders and physical symptoms across age groups, which improved with age. However, emotional and body image issues persisted into adulthood. Conclusion Patients with ARMs frequently experience significant functional digestive disorders and impaired QoL. Suboptimal management, particularly regarding the use of anorectal manometry and physiotherapy, contributes to these challenges. A long-term, multidisciplinary follow-up is crucial. This follow-up should include systematic dietary support, perineal rehabilitation, and targeted interventions guided by anorectal manometry to improve QoL in this population.

Hemorrhoidal artery embolization (HAE) is an increasingly utilized minimally invasive treatment for symptomatic internal hemorrhoids with a favorable safety profile. As adoption expands, rare delayed complications may emerge. We report a case of delayed asymptomatic endorectal coil migration identified 11 months following HAE. The procedure was performed via common femoral arterial access using selective microcatheterization of distal branches of the superior rectal artery. Embolization was achieved using 600-µm microspheres and multiple pushable microcoils deployed distally to the hemorrhoidal plexus. The patient experienced partial symptom recurrence requiring subsequent rubber band ligation (RBL). Surveillance colonoscopy later demonstrated partial extrusion of a metallic coil through the rectal mucosa without associated pain, bleeding, infection, or ischemia. The patient was managed conservatively with no intervention. Potential mechanisms for delayed coil migration include mucosal thinning following devascularization, chronic inflammatory remodeling, and mechanical factors related to subsequent anorectal interventions such as RBL; however, causality cannot be definitively established. This case highlights the importance of long-term follow-up and awareness of delayed device-related findings as HAE continues to evolve in clinical practice.

The pelvic floor is a unique anatomical location where the balance of the different pressures, either visceral, muscular, or liquid play a fundamental role in the physiological functioning of all the structures contained therein. The pelvis is bounded superiorly by the imaginary line between the pubis and sacral promontory and inferiorly as the line between the ischial tuberosity and the apex of the coccyx, which separates the pelvis from the perineum below.  From an anatomical standpoint, the pelvic floor can be divided into 4 compartments: Anterior or urinary (bladder, bladder neck, and urethra). Medium or genital (vagina and uterus in women, prostate in men). Posterior or anterior (anus, anal canal, sigmoid, and rectum). Peritoneal (endopelvic fascia and perineal membrane). The functional classification of the pelvis is as follows: Diaphragm or pelvic floor (ischiococcygial muscle and levator ani muscles), closed above by the endopelvic fascia. The urogenital diaphragm (triangular ligament/fascia of Carcassonne) is located caudally between the ischium and the pubic symphysis and crossed by the urethra and the vagina. The perineum or perineal membrane is the continuation of the Carcassonne fascia, connecting the deep layer of the pelvic floor musculature, the coccyx, and the anal sphincter.

Chronic anal fissure (CAF) is a common anorectal disorder associated with severe pain and impaired quality of life. Botulinum toxin A (BTA) injection has emerged as a minimally invasive alternative to lateral internal sphincterotomy; however, data regarding high-dose Dysport® protocols and the clinical relevance of booster injections remain limited. This retrospective single-center observational study was conducted at the General Surgery Clinic of Mersin City Training and Research Hospital. Patients treated for CAF between January 1, 2025, and December 1, 2025, were identified through institutional medical records. Sixty consecutive patients were screened; 10 were excluded because they did not attend follow-up visits, and 50 patients with complete follow-up data were included in the final analysis. All patients received a standardized 75 IU Dysport® injection targeting the internal anal sphincter. At the first follow-up reassessment, a booster injection was considered when either <50% reduction in visual analog scale (VAS) pain score or incomplete fissure healing was present. Pain severity was assessed using the VAS, and fissure healing was evaluated clinically and anoscopically. Outcomes were analyzed. The mean age was 45.8 ± 12.3 years, and 28 patients (56%) were men. The mean VAS pain score decreased from 7.80 ± 0.99 (95% confidence interval [CI]: 7.52-8.08) at baseline to 3.18 ± 0.85 (95% CI: 2.94-3.42) at 1 month and 1.00 ± 0.67 (95% CI: 0.81-1.19) at 3 months. Repeated-measures analysis of variance demonstrated a statistically significant reduction in pain over time (F[2, 98] = 1512.68, P < .001, partial η2 = 0.969). Healing was observed in 34/50 patients (68.0%, 95% CI: 54.2-79.2) at 1 month and 45/50 patients (90.0%, 95% CI: 78.6-95.7) at 3 months. Booster injections were required in 30/50 patients (60.0%, 95% CI: 46.2-72.4). Recurrence was observed in 5/50 patients (10.0%, 95% CI: 4.3-21.4) during follow-up; these patients subsequently underwent lateral internal sphincterotomy. Transient mild incontinence occurred in 3/50 patients (6.0%, 95% CI: 2.1-16.2) and resolved with conservative management. High-dose Dysport® injection appears to be a safe and effective minimally invasive option for the short-term treatment of CAF. A booster-based stepwise strategy may improve outcomes in selected patients before escalation to surgery.