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Introduction: The pathogenesis of hidradenitis suppurativa (HS) is not fully understood. There exist several theories, in which mechanical factors, genetic factors, as well as immunological dysfunction of lymphocytes are suspected. Clinically, this entity is frequently mistaken for anal fistula with consequently wrong treatment. We aim to determine the utility of transperineal ultrasound (TPUS) and anal ultrasound (AUS) in the diagnosis of HS and its differentiation from an anal fistula. Material/Methods: Retrospective analysis was performed on 51 patients (5 females, 46 males) aged 20-71 years (mean age 47.5), who were operated on in the years 2006-2011 for HS in the area of the anus and perineum, and pre-operatively had been imaged with TPUS and AUS. Sixty-seven operations were analyzed, as 11 patients were operated on more than once due to HS recurrence. Results: In 66 out of 67 cases (98.5%), the pre-operative TPUS and AUS were in accordance with the intraoperative findings. Only in 1 patient was a pilonidal cyst diagnosed intraoperatively. In all 67 patients, the TPUS showed typical fluid-solid changes localized in the subcutaneous adipose tissue. In 6 out of 67 cases of HS (8.9%) AUS showed an anal fistula coexisting with the HS. In 2 cases (2.9%) a skin malignancy coexisting with HS was found. Discussion: TPUS is an accessible imaging method, which confirms the typical localization of changes of HS, and together with AUS it allows for the proper differentiation of HS from an anal fistula or an abscess. [ABSTRACT FROM AUTHOR]

In recent years there has been a significant progress in the diagnostics and therapy of diseases of anus and anal canal. The progress in diagnostics includes both advancement in imaging diagnostics, such as 2D and 3D ultrasonography or MRI, and improvement in functional examinations, such as non-invasive EMG. In the surgical treatment of proctological diseases, as in other fields of surgery, development of minimally invasive techniques is observed. On the other hand, however, many surgeons are going back to old treatment methods, changing only some technical details. It is not always possible to evaluate the efficacy of such methods explicitly, mainly because of a short period of observation and the fact that the groups of patients are not always homogeneous. This article discusses advancements in the treatment of such inflammatory diseases as anal fissure, haemorrhoids, abscesses, fistulas, condylomas and ano-rectal Crohn's disease. Major changes have been observed in the surgical treatment of anal fistules. Due to the large percentage of complications related to the surgical treatment of anal fistules, for a few years there have been attempts to use conservative methods of treatment of this disease. Such methods include tissue glue and so called "plugs", which are used to close the internal ostium of the fistula. Progress in the treatment of ano-rectal Crohn's disease mainly includes introduction of anti-inflammatory medicines of a newer generation, and the most recent novelty is biological treatment. In addition, current guidelines in the diagnostics and treatment of incontinence have been discussed, as well as contemporary trends in the management of patients with anal cancers. The article provides a review of the current literature on the treatment of proctological inflammatory diseases and anal cancers. [ABSTRACT FROM AUTHOR]