Anal Fistula Flashcards
Definition of anal fistula
- 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
Presenting complaints
*Intermittent perianal discharge *Perianal itching
*Pain
*Swelling
*fever
Causes/ risk factors of fistula
*HIV/AIDS
*Colorectal c a n c e r
*Other causes of immunosuppression
*Tuberculosis
*Lymphogranulomavenereum *Ulcerative colitis
*Crohn’s disease
*Trauma, foreign body *Hydradenitissuperativa
Examination of anal fistula
*Rectal examination (inspection) DRE
*Proctoscopy/ sigmoidoscopy
What is Goodsall’s Rule
*When an imaginary transverse line is drawn through the center of the anus in lithotomy position
Goodsall’s Rule locations of anal fistula
*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
Where is anal fistula mostly located
*Majority of fistula are posterior.
In women where is the fistula located
*Anterior fistula are common in women.
Investigations of fistula
*Investigation Discharge for m/c/s *Fistulogram Colonoscopy
*Barium enema
*Chest X-ray, ESR, Mantoux test MRI
Endoanal/ endorectal USS
Treatment of fistula
*Fistulotomy
*Fistulectomy
*Seton application
* Advance flap
*Fibrin glue injection
*Fistula plug
*LIFT: ligation of intersphinteric tract