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Anorectal emergencies: WSES-AAST guidelines

  • Tarasconi, Antonio1
  • Perrone, Gennaro1
  • Davies, Justin2
  • Coimbra, Raul3
  • Moore, Ernest4
  • Azzaroli, Francesco5
  • Abongwa, Hariscine1
  • De Simone, Belinda6
  • Gallo, Gaetano7
  • Rossi, Giorgio1
  • Abu-Zidan, Fikri8
  • Agnoletti, Vanni9
  • de’Angelis, Gianluigi10, 11
  • de’Angelis, Nicola12
  • Ansaloni, Luca13
  • Baiocchi, Gian Luca14
  • Carcoforo, Paolo15
  • Ceresoli, Marco16
  • Chichom-Mefire, Alain17
  • Di Saverio, Salomone18
  • And 24 more
  • 1 Parma University Hospital,
  • 2 Cambridge University Hospitals NHS Foundation Trust,
  • 3 Loma Linda University School of Medicine,
  • 4 Ernest E. Moore Shock Trauma Center at Denver Health,
  • 5 University of Bologna,
  • 6 Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye,
  • 7 University of Catanzaro,
  • 8 UAE University,
  • 9 M.Bufalini Hospital,
  • 10 University of Parma,
  • 11 Hospital of Parma,
  • 12 Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC,
  • 13 Pavia University Hospital,
  • 14 University of Brescia,
  • 15 University of Ferrara,
  • 16 Monza University Hospital,
  • 17 University of Buea,
  • 18 General surgery 1st unit, Department of General Surgery, University of Insubria,
  • 19 University Hospital of Parma,
  • 20 University Hospital of Giessen,
  • 21 University of Southern California,
  • 22 Department of General Surgery, Albury Hospital, Albury, Australia
  • 23 General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre,
  • 24 Rambam Health Care Campus,
  • 25 Helsinki University Hospital,
  • 26 Immanuel Kant Baltic Federal University,
  • 27 Fundacion Valle del Lili - Universidad del Valle,
  • 28 University of Pittsburgh School of Medicine, UPMC-Presbyterian,
  • 29 National & Kapodistrian University of Athens,
  • 30 General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
  • 31 Department of Surgery, Macerata Hospital, Macerata, Italy
  • 32 Tan Tock Seng Hospital,
  • 33 Radboud University Medical Center,
  • 34 University of Bari,
  • 35 Massachusetts General Hospital,
  • 36 Government Gousia Hospital, Srinagar, Kashmir India
  • 37 University of Western Australia,
  • 38 Scripps Memorial Hospital La Jolla,
  • 39 Pisa University Hospital,
  • 40 General, Emergency and Trauma Surgery Dept., Bufalini Hospital,
Published Article
World Journal of Emergency Surgery
Springer (Biomed Central Ltd.)
Publication Date
Sep 16, 2021
DOI: 10.1186/s13017-021-00384-x
PMID: 34530908
PMCID: PMC8447593
PubMed Central
  • Review


Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies. The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

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