Anal and Rectal Lesions - Anorectal Fistulas Flashcards
What is a fistula?
Abnormal connection between two epithelial surfaces.
What conditions predispose/generate the most fistulae? (2)
- Diverticular Disease.
2. Crohn’s Disease.
What is the general prognosis of fistulae?
Resolve spontaneously as long as there is no distal obstruction - particularly true of intestinal fistulae.
What are the four types of fistulae?
- Enterocutaneous.
- Enteroenteric/Enterocolic.
- Enterovaginal.
- Enterovesicular.
What are the types of enterocutaneous fistulae?
- Duodenal/Jejenual Fistulae (High-Volume, Electrolyte-Rich Secretions) : Severe Excoriation of the Skin.
- Colocutaneous Fistulae (Faeculent Material).
What do enter-cutaneous fistulae result from?
Spontaneous rupture of an abscess cavity onto the skin (e.g. following perianal abscess drainage) or result of iatrogenic input.
What is the main complication of enteroenteric/enterocolic and enterovaginal fistulae?
Bacterial overgrowth can precipitate malabsorption syndromes - especially serious in IBD.
Give 2 complications of enterovesicular fistulae.
- Frequent UTIs.
2. Passage of Gas during Urination.
Management of Fistulae.
Conservative Management :
- Skin Involvement - Well-fitted stoma bag to protect overlying skin.
- High-Output : Octreotide to reduce volume of pancreatic secretions.
- High-Output : TPN to provide nutritional support (nutritional complications).
- Avoid probing perianal fistulae if acute inflammation is present.
- Drain acute sepsis and maintain drainage using setons in perianal fistulae, secondary to Crohn’s.
Aetiology of Anal Fistulae.
Previous Anorectal Abscesses.
Types of Anal Fistulae.
- Intersphincteric.
- Transsphincteric.
- Suprasphincteric.
- Extrasphincteric.
Which rule determines the location of anal fistulae?
Goodsalls Rule.
