Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Perirectal Abscesses and Fistulas Peritoneal Tumors 1159

■Recurrent abscesses at the same site suggest a fistula

■Consider inflammatory bowel disease or malignancy in patients with

unusual or recurrent abscesses or fistulae

■Don’t forget colon cancer screening!

complications and prognosis

■Neglected abscesses may result in extensive necrosis and can result

in incontinence, considerable tissue loss, even death

■25–50% of abscesses will go on to produce a fistula in spite of (not

because of ) appropriate drainage of the fistula

■Fecal incontinence is a risk of fistulae treatment by any technique;

the risk is greater the more of the sphincter that is involved and more

likely in women than in men, especially women with prior vaginal

deliveries

■Most fistulae respond well to surgical treatment

■Fistula recurrence much greater in Crohn’s patients

■Anti-TNF antibodies may allow Crohn’s fistulae to close

PERITONEAL TUMORS

MINDIE H. NGUYEN, MD

history & physical

History

■primary peritoneal tumors in general rare

➣mesotheliomas: most are malignant; found 35–40 years after

exposure to asbestos

➣pelvic lipomatosis: nonmalignant growth of adipose tissue with

or without fibrosis in the perirectal and perivesical spaces; pre-

dominantly in black males (male:female ratio 18:1) between 20–

60 yr of age; may cause proliferative cystitis, urinary tract obstruc-

tion, hypertension, and occasionally gastrointestinal symptoms

■benign peritoneal cysts: rare condition

➣benign cystic mesothelioma: usually in adult women who

present with pain; usually recurs after resection

➣benign cystic lymphangioma: usually in young men who pre-

sent with abdominal mass; seldom recurs after resection

■metastatic peritoneal tumors (peritoneal carcinomatosis): by far the

most common peritoneal tumors

➣tissues of origin: