ANORECTAL FISTULA

Question 1

Pertinent Anatomy of a patient with Anorectal Fistula

Answer 1

(1) Anus
(a) Anal crypt gland
(2) Rectum

Question 2

normally, anal crypts do what

Answer 2

allow for secretion of excess mucus otherwise found in the rectum and anus

Question 3

chronic manifestation of the acute perirectal process that forms
an anal abscess. When the abscess ruptures or is drained, an epithelialized track can form
that connects the abscess in the anus or rectum with the perirectal skin

Answer 3

anorectal fistula

Question 4

Symptoms

Answer 4

(1) “nonhealing” anorectal abscess following drainage
(2) chronic purulent drainage and a pustule-like lesion in the perianal or buttock area
(3) intermittent rectal pain, particularly during defecation, but also with sitting
(4) intermittent and malodorous perianal drainage and pruritus

Question 5

Differential Diagnosis

Answer 5

(1) Perianal Abscess
(2) Hemorrhoid
(3) Anal Fissure
(4) Pilonidal Cyst
(5) Colorectal Cancer

Question 6

Treatment

Answer 6

(1) Patients presenting with anal fistula require higher echelon care due to proximity of
involved area.
(2) If patient is unstable, stabilize and prepare for MEDEVAC.
(3) MEDEVAC should be reserved for problematic patients.
(4) All others can be consulted for further assessment if otherwise stable.

Question 7

Initial Care

Answer 7

(1) Given location of area, initial care will be based on vital signs and patient stability.
(2) If patient presents in pain, consider MEDEVAC and treat pain with appropriate
medications.