Rectal Fistulas

Question 1

What are Rectal Fistulas ?

Answer 1

-results of acute anal abscess
They are characterised by internal orrifice in the rectum, sinus tract which is situated in the pararectal space and end with external orrifice in the skin of the perineum

Question 2

Clinical picture of Renal Fistulas

Answer 2

Acute condition of the disease changes into remission
In acute conditions there are pains in the fistula, temperature rise ,malaise, purulent and mucous discharge from the fistula, secretion of feces and gases

Question 3

Classification of Rectal Fistulas

Answer 3

• intrasphincteric
• transsphincteric
• extrasphincteric

Question 4

Diagnosis of Rectal Fistulas

Answer 4

From patients complaints
Examination, Palpation of the perianal area
-Digital rectal examination
-Proctosigmoidoscopy
-Probing of the fistula
-Fistulography in patients with extrasphincter Fistulas
-Sphincterometry is used to determine tonic contraction of the sphincter

Question 5

Treatment of Rectal Fistulas

Answer 5

Surgical treatment is done
The aim of the operation is fistulectomy and removal of internships orrifice of the fistula
It’s done under general anesthesia
Inter spincter rectal fistulas- radical operation is done (Gabriel’s operation )
Incase of trans spincter fistulas - Gabriel’s operation is also done

For complicated or extrasphincter Fistulas;

• fistulectomy with closure of stump of the sphincter in the perineal wound and dosed posterior sphincterotomy
• fistulectomy with closure of the sphincter
• plastic operations in which fistula is cut off from the rectum , internal orrifice is closed by separated displaced mucosa
• fistulectomy with ligation

In result patients with inter spincter fistulas there are relapses in 1% cases, 1,3 % have anal incompetence
4% of patients with extrasphincter Fistulas have relapses and 4% have anal incompetence