Name
ANORECTAL FISTULA
DESCRIPTION
DETAIL
CAUSES β’ Erosion of anal canal β’ Extension from infection from a tear in lining in anal canal β’ Infecting organism is commonly Escherichia coli -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Pilonidal sinus β’ Perianal abscess β’ Urethroperineal fistulas β’ Ischiorectal abscess β’ Submucous or high muscular abscess β’ Pelvirectal abscess (rare) β’ Rule out: Crohn disease; carcinoma; retrorectal tumorsβ’ Proctoscopy β’ Sigmoidoscopy β’ Probe inserted into tract to determine its course (be careful not to create an artificial opening) β’ Injection of dilute methylene blue into abscess cavity may be helpful in demonstrating fi stula
TYPENOTES
GENERAL MEASURES: * Sitz baths 3-4 times per day until defi nitive surgery DRUG(S) OF CHOICE: . Broad spectrum antibiotic if active infection . Cephalexin (Kefl ex) . Cefadroxil (Duricef) . Ampicillin-sulbactam (Unasyn) . Amoxicillin-clavulanate (Augmentin) . Stool-softening laxative SURGICAL MEASURES β’ Fistulotomy - surgical incision of entire length of fistula (unroofing). Mucosal tract may be cauterized or curetted. Sphincterotomy. β’ Fistulectomy - complete excision of tract (rarely indicated due to extensive tissue loss). Sphincterotomy. β’ General anesthesia or regional anesthesia usually required β’ Postoperative - hot sitz baths β’ Avoid constipation POSSIBLE COMPLICATIONS β’ Constipation (urge to defecate may be suppressed due to pain) β’ Rectovaginal fistula β’ Partial incontinence of fecal material if sphincter is divided β’ Delayed wound healing β’ Low grade carcinoma may develop in long-standing fistulas β’ Recurrent anorectal fi stula if fi stula is incompletely opened or excised β’ Chronic intermittent infections β’ Sepsis (rarely) EXPECTED COURSE/PROGNOSIS β’ Surgical results usually excellent β’ Postoperative healing requires 4-5 weeks for perianal fistulas; 12-16 weeks for deeper fi stulas β’ Postoperative healing may occur within 2-3 weeks in children
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
MONTOUX TEST, COMPLETE BLOOD COUNT