FISTULA IN ANO

Abnormal communication between anal canal and rectum with exterior (perianal skin) is called as fistula in ano. Even though multiple openings are seen in the perianal skin, the internal opening is always single.

Aetiopathogenesis

1. They occur due to persistent anal gland infection, which results in anorectal abscesses, rupture inside as well as outside resulting in a fistula. Once a fistula occurs, it persists because of infection and absence of rest to the part. As there are many anal glands, often, problem persists inspite of initial treatment of one fistula.

2. In India, tuberculosis is common. Patients with pulmonary tuberculosis have 1 -2% chances of developing multiple anal fistulae. Whenever a patient presents with multiple anal fistulae, it is but natural to think of tubercular aetiology. Such fistulae are not indurated and there is watery discharge without pus.

3. In Western countries, ulcerative colitis and Crohn's disease are responsible for multiple anal fistulae.

 4. Colloid carcinoma of rectum can present as multiple fistulae in ano. This type of carcinoma has worst prognosis. Rectal examination should be done in every patient with anal fistula.

Other causes of anal fistula

SPECIAL TYPES OF FISTULA IN ANO

• Fistula carcinoma

• lleitis-Crohn's

• Schistosomiasis

• Tuberculosis

• Ulcerative colitis

• Lymphogranuloma venereum

• Anal fissure abscess

One can remember as FISTULA

Classification

1. Standard classification (low or high fistula)

1. Subcutaneous

2. Submucous

3. Low anal

4. High anal

5. Pelvirectal

II. Park's classification (the type of the fistula in relation to sphincter)

1. Intersphincteric

2. Trans-sphincteric

3. Supralevator (internal opening is situated above the anorectal bundle).

Clinical features

• Persistent seropurulent discharge, keeps the part always wet.

• Previous history of anal gland infection, with recurrent abscess.

• External opening can be single/multiple, with pouting granulation tissue, may discharge blood.

• Internal opening in carcinoma felt as a 'button hole' defect inside the rectum.

• Goodsall's rule: A fistula, with an external opening in the anterior half of anus within 3. 7 5 cm tends to be direct type and in the posterior half, indirect type or curved and sometimes horseshoe type. It may communicate with the opposite side.

Diagnosis

• External opening is found at the bottom of a depressed area or with granulation tissue or it is seen discharging pus.

• Internal opening may be felt on digital examination as indurated area or sometimes can be seen with proctoscopy or after sigmoidoscopy. The entire track may be palpable as indurated cord like structure.

• Endorectal ultrasonography and MRI seem to identify internal openings and fistula. However, they can be selectively used in deserving cases.

• Examination under general or regional anaesthesia.

 

 

 

TREATMENT AT DR. SOHAN LAL CLINIC

The integrated POLYCLINIC facility offers patients to select their treatment either from the Department of Homeopathy or from the Department of Medicine.

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