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Introduction Les objectifs de ce travail ont ete d’evaluer la prevalence des hypermetabolismes anaux de decouverte fortuite, leurs etiologies et l’existence d’une eventuelle correlation entre les parametres metaboliques et la prise en charge proctologique. Materiels et methodes Les donnees cliniques (âge, sexe, principaux antecedents, motif de realisation de la TEP au 18F-FDG, realisation ou non d’un examen proctologique, presence ou non d’un diagnostic proctologique et proposition ou non d’un traitement proctologique) des patients ayant un hypermetabolisme anal de decouverte fortuite ont ete analysees retrospectivement. Les TEP au 18F-FDG ont ete relues en aveugle des donnees de l’examen proctologique pour confirmer l’hypermetabolisme anal et extraire la SUVmax, SUVmean et plusieurs volumes metaboliques (MV50, MV41 et MV30). Les parametres cliniques et metaboliques des patients ayant ete explores ont ete compares a ceux ne l’ayant pas ete, et de ceux ayant eu une proposition therapeutique a l’issue de cet examen ont ete compares aux autres. Resultats Parmi les 43 020 compte-rendus de TEP au 18F-FDG realisees entre janvier 2005 et decembre 2018, un hypermetabolisme anal de decouverte fortuite a ete retenu chez 134 patients. Quarante-huit patients (36 %) ont eu un examen proctologique, parmi lesquels 33 (69 %) ont eu un diagnostic proctologique pose au decours. Les diagnostics etaient les suivants : une maladie hemorroidaire (n = 22), une fissure anale (n = 5), une recidive d’adenocarcinome sur anastomose colo-anale (n = 1), des condylomes (n = 3), un fecalome (n = 1), une suppuration (n = 2) et un syndrome de l’ulcere solitaire du rectum (n = 1). Aucun parametre metabolique n’etait associe significativement au fait qu’un diagnostic ait ete pose. Un traitement a ete propose pour 18 (38 %) patients dont 5 (28 %) un traitement chirurgical. Le SUVmax, le SUVmoyen, le MV41 et le MV30 differaient significativement entre les patients ayant une pathologie accessible a un traitement et ceux sans. Conclusion L’hypermetabolisme anal de decouverte fortuite est peu explore. Toutefois, lorsqu’un examen proctologique est realise, un diagnostic est pose dans plus de deux tiers des cas et un traitement est propose dans plus d’un tiers des cas. Les parametres metaboliques sont associes a l’existence de pathologies anorectales accessibles a un traitement. Ces donnees devraient encourager les praticiens a explorer systematiquement un hypermetabolisme anal de decouverte fortuite.

International audience; Background - There are no studies on incidental anal F-fluorodeoxyglucose (FDG) uptake. Aim - To assess the rate and aetiologies of incidental anal FDG uptake and to evaluate the correlation between FDG positron-emission tomography/computed tomography (PET/CT) parameters and the diagnosis of an anorectal disease. Methods - The data from patients with incidental anal FDG uptake were retrospectively analysed. Patients who underwent anorectal examinations were identified and compared to those who did not undergo examinations. Patients who were offered treatment were then identified and compared to those who did not receive treatment. Results - Among the 43020 FDG PET/CT scans performed, 197 FDG PET/CT scans of 146 patients (0.45%) reported incidental anal uptake. Among the 134 patients included, 48 (35.8%) patients underwent anorectal examinations, and anorectal diseases were diagnosed in 33 (69.0%) of these patients and treated in 18/48 (37.5%) patients. Among the examined patients, those with a pathology requiring treatment had significantly smaller metabolic volumes (MV) 30 and MV41 values and higher maximal and mean standardized uptake value measurements than those who did not require treatment. Conclusion - Incidental anal FDG uptake is rare, but a reliable anorectal diagnosis is commonly obtained when an anorectal examination is performed. The diagnosis of an anorectal disease induces treatment in more than one-third of the patients. These data should encourage practitioners to explore incidental anal FDG uptake systematically.

Aim To compare the rate of failure of radiofrequency thermocoagulation for anal fistula with that of rectal advancement flap in a case-matched study. Method Patients who underwent radiofrequency treatment were compared with age- and sex-matched patients with Crohn's disease (CD) who underwent a rectal flap procedure. Fistula features, general characteristics and the main clinical events were recorded in a prospective database. Failure was defined by at least one of following: abscess, purulent discharge, visible external opening or further drainage procedure. Results A total of 62 patients [median age 45 (range 36.8-57.5) years; 22 women, 40 men; 22 with CD] were analysed. The failure rate of radiofrequency treatment was higher than that of rectal flap treatment (74.2% vs 32.2%; P = 0.004). The cumulative probabilities of failure of the radiofrequency treatment were 53.8% (38.8-68.3), 71.8% (55.3-84.0) and 87.4% (70.6-95.3) at 3, 6 and 12 months, respectively. Three patients in the radiofrequency group required drainage for an abscess and one had severe thermal ulceration. The Cox proportional hazards regression model (surgical procedure, obesity, CD) showed rectal flap treatment [3.48 (1.60-8.07); P = 0.001] and CD [2.60 (1.16-6.41); P = 0.02] to be the main independent predictors of healing. Conclusion Radiofrequency thermocoagulation is a less satisfactory sphincter-sparing treatment for the management of anal fistula than a rectal flap procedure.

International audience; Background - Quality of life is increasingly seen as important, but remains difficult to assess in patients with functional anorectal complaints. Objective - We aimed to quantify quality of life and to analyse the symptomatic descriptors associated with a poor outcome in patients with faecal incontinence (FI) and/or constipation. Methods - The characteristics of the patients, data from self-administered questionnaires and from physical examinations were evaluated prospectively for all cases of functional anorectal disease over a period of thirteen years. Functional anorectal disease included faecal incontinence (FI) and/or constipation. Patients with scores in the lowest quartile of the Gastrointestinal Quality of Life Index (GIQLI) were considered to have suffered severe alterations to their quality of life, and were compared with the other patients. Results - In total, 1870 patients with functional anorectal disease were included (470 with a severely altered quality of life (GIQLI

International audience; Background & aims - The European Crohn's and Colitis Organization recommends magnetic resonance imaging (MRI) of anal fistulas to decide on the drug/surgery strategy. No evidence is available on the long-term impact of MRI features on fistula healing. The aim of this study was to evaluate the benefit of combined drug/surgery strategies for the treatment of perianal Crohn's fistulas based on MRI factors at referral.Methods - The clinical event (anal abscess, new fistula tract, cellulitis), therapeutic intervention (introduction/optimization of immunosuppressant/biologics, anal surgery, intestinal resection, stoma), and MRI data were prospectively recorded for patients with Crohn's disease (CD) and anal fistulas. Healing was defined by fulfilment of all the following conditions: no discharge or pain, closure of the external opening of the fistula, no visible internal opening, no abscess, and no subsequent draining seton or drainage procedure performed during at least 1 year of follow-up.Results - Seventy CD patients with anal fistulas and MRI evaluations were followed for 70 months. The cumulative rates of fistula healing were 25%, 40%, 50%, and 70% at 12, 24, 36, and 72 months, respectively. Severe, complex, branched, and high fistulas were associated with a less favorable outcome. Surgical closure of the tract improved the healing rates better than treatment with biologics or thiopurines. Male sex, A1 luminal phenotype, and anal ulceration at referral were independently associated with a higher healing rate.Conclusions - Therapeutic strategies for perianal fistulizing CD require robust anatomical and healing evaluations. Combined strategies using biologics to improve both drainage and secondary closure of the fistula tracts merit further study.

AIM Rectal flap advancement is still a part of therapeutic management of anal fistulas. Data on the outcome of rectal flap advancement in patients with Crohn's disease (CD) is scarce. Our objective was to ascertain rates of failure of rectal flap advancement and to determine predictive factors for failure, with a special focus on CD METHOD: The patients' details, the characteristics of the fistula and the main clinical and therapeutic events were prospectively assessed among patients who underwent rectal flap advancement. All patients had a partial-thickness rectal flap advancement. Failure of primary rectal flap advancement was defined as the occurrence of at least one of the following: abscess, discharge, visible external opening, further drainage procedure. The rates of failure of rectal flap and the predictive factors of failure were assessed. RESULTS Eighty-seven patients (34 patients with CD) were included. The median (interquartile range) follow-up was 13.3 (3.8-38.1) months. The cumulative failure rates were 15.9% (10.3-23.6), 23.0% (16.0-31.8), 31.6% (22.9-41.8) and 41.3% (30.5-53.0) at 3, 6, 12 and 24 months respectively. These data were comparable in Crohn's patients. Those with a supralevator fistula [hazard ratio 2.53 (1.01-7.71), P = 0.0476] and patients who had fewer than two fistula drainages before rectal flap [hazard ratio 3.19 (1.40-8.23), P = 0.005] were associated with higher rectal flap failure rates. In CD patients, the absence of biological therapy at referral was predictive of failure. CONCLUSION Rectal flap advancement is a satisfactory option for the therapeutic management of anal fistula, including CD populations. Fistula drainage is needed before performing this surgical technique.