{"id":2429,"date":"2023-01-24T13:46:53","date_gmt":"2023-01-24T12:46:53","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-douleur-anale-pas-si-banale\/"},"modified":"2023-01-24T13:46:53","modified_gmt":"2023-01-24T12:46:53","slug":"une-douleur-anale-pas-si-banale","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-douleur-anale-pas-si-banale\/","title":{"rendered":"Une douleur anale pas si banale !"},"content":{"rendered":"<p><strong>2022<\/strong><\/p>\n<p><em>Simon WEISS (1), Isabelle ETIENNEY (1), Christiane STRAUSS (2), Sarah TA\u00cfEB (4)<br \/>\nH\u00f4pital de la Croix Saint Simon, PARIS.<br \/>\n1 Service de Proctologie m\u00e9dico-interventionnelle<br \/>\n2 Service de Radiologie<\/em><\/p>\n<p><strong>Gastroent\u00e9rologie <\/strong>&#8211; \u00a02022-05-07 &#8211;\u00a0CC &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Une patiente de 36 ans consulte aux urgences proctologiques pour des douleurs anales \u00e9voluant depuis 2 mois.<br \/>\nElle pr\u00e9sente comme seul ant\u00e9c\u00e9dent notable quatre accouchements dont trois par c\u00e9sariennes. Il est \u00e0 noter que la derni\u00e8re c\u00e9sarienne a \u00e9t\u00e9 compliqu\u00e9e d\u2019une h\u00e9morragie de la d\u00e9livrance n\u00e9cessitant une hyst\u00e9rectomie d\u2019h\u00e9mostase.<br \/>\nElle rapporte avec elle une IRM pelvienne faite en externe dont la conclusion est un abc\u00e8s de la fosse ischio-anale gauche avec prolongement en fer \u00e0 cheval ant\u00e9rieur.<br \/>\nCliniquement, elle se plaint de douleur anale sans fi\u00e8vre, non rythm\u00e9es par les selles.<br \/>\nL \u2019inspection de la marge anale r\u00e9v\u00e8le une induration de la fosse ischio-anale sans trajet \u00e9vident au toucher rectal. L\u2019anuscopie ne met pas en \u00e9vidence d\u2019orifice interne.<br \/>\nDevant l\u2019induration et les r\u00e9sultats \u00e9crits de l\u2019IRM, il est tent\u00e9 une incision de l\u2019induration apr\u00e8s anesth\u00e9sie locale \u00e0 la xyloca\u00efne qui se r\u00e9v\u00e8le infructueuse.<br \/>\nIl est d\u00e9cid\u00e9 un traitement par antalgiques et une \u00e9valuation dans les 10 jours par \u00e9chographie endo-anale.<br \/>\nL\u2019\u00e9chographie retrouve un sphincter anal intact et une absence de trajet fistuleux.<br \/>\nDevant cette discordance, l\u2019IRM fait l\u2019objet d\u2019une relecture dans notre centre o\u00f9 il est d\u00e9crit un tr\u00e8s fin trajet fistuleux \u00e0 partir de la ligne ant\u00e9ro-m\u00e9diane qui part du sphincter interne, au tiers inf\u00e9rieur du canal anal, traverse l\u2019espace inter-sphinct\u00e9rien puis se dirige vers la gauche dans la fosse ischio anale o\u00f9 l\u2019on retrouve une masse, h\u00e9t\u00e9rog\u00e8ne, mal limit\u00e9e, d\u2019aspect mixte en T2 (hyper et hyposignal) sans v\u00e9ritable abc\u00e8s constitu\u00e9.<br \/>\nIl est alors d\u00e9cid\u00e9 d\u2019attendre un \u00e9pisode aigu.<br \/>\nA la r\u00e9\u00e9valuation en consultation deux mois plus tard, l\u2019examen clinique est inchang\u00e9 sans trajet cliniquement palp\u00e9 et une patiente relevant moins de douleurs.<br \/>\nNouvelle \u00e9valuation 4 mois apr\u00e8s o\u00f9 la patiente d\u00e9crit des crises douloureuses intermittentes avec une persistance de l\u2019induration de la fosse ischio-anale gauche.<br \/>\nIl est finalement d\u00e9cid\u00e9 d\u2019une exploration au bloc op\u00e9ratoire de proctologie. Lors de l\u2019intervention, aucun trajet fistuleux n\u2019est retrouv\u00e9 et il est d\u00e9cid\u00e9 d\u2019une ex\u00e9r\u00e8se monobloc de la masse palp\u00e9e.<br \/>\nQuel diagnostic finalement ? La r\u00e9ponse \u00e0 Aix en Provence !<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2022 Simon WEISS (1), Isabelle ETIENNEY (1), Christiane STRAUSS (2), Sarah TA\u00cfEB (4) H\u00f4pital de la Croix Saint Simon, PARIS. 1 Service de Proctologie m\u00e9dico-interventionnelle 2 Service de Radiologie Gastroent\u00e9rologie &#8211; \u00a02022-05-07 &#8211;\u00a0CC &#8211; ________________________________ Une patiente de 36 ans consulte aux urgences proctologiques pour des douleurs anales \u00e9voluant depuis 2 mois. Elle pr\u00e9sente comme [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[35],"class_list":["post-2429","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-35"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Une douleur anale pas si banale ! - Abstracts des congr\u00e8s de l&#039;ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/une-douleur-anale-pas-si-banale\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Une douleur anale pas si banale ! 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