Fistula in Ano

Definition

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.

Causes

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. Other fistulae develop secondary to trauma, Crohn disease, anal fissures, carcinoma, radiation therapy, actinomycoses, tuberculosis, and chlamydial infections. Patients often provide a reliable history of previous pain, swelling, and spontaneous or planned surgical drainage of an anorectal abscess.

Signs and symptoms (in order of prevalence)

  • Perianal discharge
  • Pain
  • Swelling
  • Bleeding
  • Diarrhea
  • Skin excoriation
  • External opening

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

Treatment

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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