Anal Fistula

Question 1

Definition of anal fistula

Answer 1

• Is a chronic abnormal
  communication between the epithelialized surface of the anal canal and usually the perianal skin.
  #An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus

Question 2

Presenting complaints

Answer 2

*Intermittent perianal discharge *Perianal itching
*Pain
*Swelling
*fever

Question 3

Causes/ risk factors of fistula

Answer 3

*HIV/AIDS
*Colorectal c a n c e r
*Other causes of immunosuppression
*Tuberculosis
*Lymphogranulomavenereum *Ulcerative colitis
*Crohn’s disease
*Trauma, foreign body *Hydradenitissuperativa

Question 4

Examination of anal fistula

Answer 4

*Rectal examination (inspection) DRE
*Proctoscopy/ sigmoidoscopy

Question 5

What is Goodsall’s Rule

Answer 5

*When an imaginary transverse line is drawn through the center of the anus in lithotomy position

Question 6

Goodsall’s Rule locations of anal fistula

Answer 6

*Fistula located anteriorly within 3cm radius from the anus run a direct radial course into the anal canal
*Fistula located posteriorly and those <3cm radius anteriorly run a curvilinear course to open at the middle of the anal canal
posteriorly

Question 7

Where is anal fistula mostly located

Answer 7

*Majority of fistula are posterior.

Question 8

In women where is the fistula located

Answer 8

*Anterior fistula are common in women.

Question 9

Investigations of fistula

Answer 9

*Investigation Discharge for m/c/s *Fistulogram Colonoscopy
*Barium enema
*Chest X-ray, ESR, Mantoux test MRI
Endoanal/ endorectal USS

Question 10

Treatment of fistula

Answer 10

*Fistulotomy
*Fistulectomy
*Seton application
* Advance flap
*Fibrin glue injection
*Fistula plug
*LIFT: ligation of intersphinteric tract