Fistula-In-Ano + Abscess, Ulcer

Question 1

What is a fistula-in-ano

Answer 1

A track which communicates between the skin and anal canal / rectum

Question 2

How does blockage of the deep intramuscular gland ducts relate to fistulas

Answer 2

This can predispose to abscess formation which can then discharge and form a fistula

Question 3

History

Answer 3

Pruritis ani
Loss of faecal material and pus
Possible bleed

Question 4

How to tell Site

Answer 4

If anterior - tract is in straight line

If posterior - internal opening is at 6 o’clock

Question 5

Causes

Answer 5

Perianal sepsis
TB
Crohn's
Abscesses
Diverticular disease
Rectal carcinoma

Question 6

Tests

Answer 6

MRI

Endoanal USS

Question 7

What are the principles of surgery with fistulas

Answer 7

To drain the fistula and to lay open or cut out the tracts

• this stops them spreading and causing more fistulae

Question 8

Surgery for low fistulae

Answer 8

Fistulotomy + excision

• laid open to heal by secondary intervention

Question 9

Surgery for high fistulae involving anal continence muscles

Answer 9

Seton suture tightened over time to maintain continence

Question 10

Complications of fistula

Answer 10

Incontinence

Question 11

What are anal abscesses associated with

Answer 11

Crohn’s
Fistulae
Malignancy

Question 12

Treatment of abscesses

Answer 12

Drain under GA

Question 13

Causes of Ulcers

Answer 13

Crohn’s disease
Malignancy
TB
Syphilis