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Fistula in Ano |
| Defination
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| A fistula in ano is a hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the peri anal skin. Secondary tract may be multiple and from the same primary opening inside.
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| Causes:
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| Nearly always caused by a previous ano-rectal abscess. Anal canal glands situated at the dentate line afford a path for infecting organisms to reach the intramuscular spaces.
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| Other fistulae develop secondary to trauma, Crohn disease, anal fissures, carcinoma, radiation therapy, actinomycoses, tuberculosis, and chlamydial infections.
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| Patients often provide a reliable history of previous pain, swelling, and spontaneous or planned surgical drainage of an anorectal abscess.
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| Signs and symptoms (in order of prevalence)
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- Perianal discharge
- Pain
- Swelling
- Bleeding
- Diarrhea
- Skin excoriation
- External opening
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| Past medical history
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Important points in the history that may suggest a complex fistula include the following:
- Inflammatory bowel disease
- Diverticulitis
- Previous radiation therapy for prostate or rectal cancer
- Tuberculosis
- Steroid therapy
- HIV infection
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| Treatment
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| Treatment depends upon the type of fistula whether it is low, high or complex. Generally we are doing core-fistulectomy for high grad and complex fistula and patient is discharge on the same day and he may go to office on the next day.
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