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Anorectal Fistula


Presentation

  • An unusual case of an anorectal fistula presenting with hip pain and extensive lower limb muscle wasting in a patient with Crohn's disease is reported.[ncbi.nlm.nih.gov]
  • He presented to us for anal pain, anorectal stricture, and perianal induration. Abdominoperineal resection was performed for proper management. On gross no visible mucosal lesion of anal canal and rectosigmoid colon was revealed.[ncbi.nlm.nih.gov]
  • In addition, irritation of the perianal skin or drainage from an external opening may also be present. Most fistula-in-ano are diagnosed and managed on the basis of clinical findings.[suncoastsurgicalassociates.com]
  • Abstract One hundred and sixty-five patients presented in a 4-year period: 68 (41.2 per cent) had had previous anorectal sepsis and in 56 of these patients (82.3 per cent) the presenting sepsis was at the site of the previous abscess.[ncbi.nlm.nih.gov]
  • METHOD: Patients (N 30) with anal fistula presenting to 10 European academic surgical units were treated with a sphincter-preserving technique using Permacol paste.[ncbi.nlm.nih.gov]
Wound Infection
  • Results: In the control group, only one case (5%) of wound infection and dehiscence was seen, whereas in the one-stage study group, six cases (30%) of wound infection and dehiscence were seen ( P value 0.046).[afrjpaedsurg.org]
  • Postoperative wound infection was reported twice in both ASARP and PSARP groups and all were treated conservatively without sequelae.[dovepress.com]
Foul Smelling Discharge
  • Fistula symptoms include pain, tenderness, itching, redness, fever and a bloody and a foul-smelling discharge where the fistula opens to the skin. Sometimes, feces escapes through the fistula opening. Sometimes the fistula can open into the vagina.[listentoyourgut.com]
Perineal Pain
  • A patient with diabetes mellitus or alcoholism who also has perineal pain, sepsis, crepitus, bullae, and induration may have Fournier gangrene, a medical emergency requiring immediate antibiotics and debridement. 19 Anorectal Masses Condyloma, abscess[aafp.org]
Weight Gain
  • It might be an easier surgical technique because of the delay in definite repair and weight gain by the infant.[afrjpaedsurg.org]
Abdominal Pain
  • Symptoms include blood on or mixed in with the stool, a change in normal bowel habits, narrowing of the stool, abdominal pain, weight loss, or constant tiredness.[my.clevelandclinic.org]
  • This is associated with other symptoms such as: Abdominal pain Diarrhea Loss of appetite Weight loss Nausea Vomiting Symptoms for Diagnosis The presenting symptoms are a significant factor in the diagnosis of anal fistula and it is important that the[news-medical.net]
  • Many are painless, but others can cause bleeding, abnormal discharge or abdominal pain. Many polyps are found during colonoscopies . Some are linked to cancer. Once a polyp is discovered, removal is recommended.[nhcharlottecolonandrectalsurgery.org]
  • A colonoscopy looks for signs of colon or rectal cancer and evaluates symptoms such as abdominal pain, diarrhea, rectal bleeding and unexplained weight loss.[rush.edu]
  • Steamed, baked or boiled vegetables and fruits may be easier to digest if eating raw foods causes gas, indigestion, bloating or abdominal pain. Some nutritious foods can increase your risk of a foodborne illness when eaten raw.[livestrong.com]
Rectal Pain
  • Perianal pain, pruritus, purulent (often malodorous) perianal drainage, and perirectal skin lesions Intermittent rectal pain worse with defecation/sitting Fever most common with abscess... Surgical treatment is definitive ( 1 )[ A ].[5minuteconsult.com]
  • If you are suffering from severe rectal pain, it may be time to seek what patients are calling the most effective anal fistula surgery Los Angeles has to offer.[lacolonrectalsurgeon.com]
  • Patients experience intermittent rectal pain, particularly during defecation, but also while sitting and active. Patients may also experience intermittent and malodorous perianal drainage and pruritus.[aischannel.com]
  • However, while most abscesses are visible on the outside of the skin around the anus, it is important to recognize that there may be no external manifestation of an abscess, other than a complaint of rectal pain.[fascrs.org]
  • Pain, and Rectal Bleeding.[emedicine.com]
Anal or Rectal Pain
Dyschezia
  • In addition, the long-term non-healing anal fistula can also cause anorectal stenosis, dyschezia, anemia, weight loss, listlessness, neurasthenia and other symptoms.[english.zryhyy.com.cn]
Neglect
  • Neglected fistulas can result in repeated abscesses, multiple openings and complications. Symptoms of Anorectal Abscess and Fistula-in-Ano Pain and swelling in the anal region with wetness and soiling, often on a background of Crohn’s disease .[myvmc.com]
  • Neglected fistulas can result in repeated abscesses, multiple openings and complications. Symptoms of Anorectal Abscess and Fistula-in-Ano Pain and swelling in the anal region with wetness and soiling, often on a background of Crohn’s disease.[healthengine.com.au]
Salpingitis
  • Risk Factors Crohn disease Pelvic radiation Perianal trauma; previous anorectal abscess Pelvic carcinoma or lymphoma Ruptured anal hematoma Abscess formation due to acute appendicitis, salpingitis, or diverticulitis Tuberculosis (rare); syphilis; lymphogranuloma[unboundmedicine.com]

Workup

Thrombocytosis
  • Nonspecific laboratory findings such as leukocytosis, anemia, decreased albumin level, and thrombocytosis may be considered as supportive indicators.[ncbi.nlm.nih.gov]

Treatment

  • Healing after treatment with Permacol paste was similar for intersphincteric to transsphincteric fistulae and primary or recurrent fistulae. Only one patient exhibited an adverse event (perianal abscess) that was possibly related to the treatment.[ncbi.nlm.nih.gov]
  • The healing rate of anal fistula in treatment group was 100%. The ache time, healing time and anal deformation of treatment group were obviously superior to traditional surgical methods.[ncbi.nlm.nih.gov]
  • This reinforces the importance of biopsy of all perianal abscesses and fistulas for early detection and treatment.[ncbi.nlm.nih.gov]
  • The mucosal flap advancement is considered the gold standard for the treatment of high perianal fistula of cryptoglandular origin by most colorectal surgeons.[ncbi.nlm.nih.gov]
  • ADM should be considered a first line treatment for patients with complex anorectal fistula.[ncbi.nlm.nih.gov]

Prognosis

  • The diagnosis is difficult, due to lack of specificity of symptoms and signs, and is often delayed, resulting in a poor prognosis.[ncbi.nlm.nih.gov]
  • Despite new therapy protocols, the prognosis of mucinous adenocarcinoma is still poor, mostly due to its advanced nature at the time of diagnosis.[ncbi.nlm.nih.gov]
  • RESULTS: Two deaths in the four patients with squamous carcinoma and one in the two patients with adenocarcinoma with adequate follow-up suggest a poorer prognosis in both types of malignancy than when these lesions occur without Crohn's disease.[insights.ovid.com]

Etiology

  • […] ones require excision, which must follow 4 principles: find opening; find tract; unroof tract over its length; ensure that healing occurs from within outward. anorectal fistula Surgery An acutely inflammed 'tract' which connects the anus and the rectum Etiology[medical-dictionary.thefreedictionary.com]
  • These complications are thought to be associated with inadequate drainage, elevated bacterial load, or a noncryptoglandular etiology of disease.[snfge.org]
  • The etiology of the fistula was cryptoglandular in four patients, and perianal Crohn's disease in six patients (including one patient with an anovaginal fistula). The surgical procedure was technically successful in all patients.[ncbi.nlm.nih.gov]
  • Etiology and Pathophysiology Inspissated debris in an obstructed anal crypt gland results in suppuration and abscess formation. Tracking along the path of least resistance in the perianal and perirectal spaces leads to fistula formation.[unboundmedicine.com]
  • Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology 2002 ;224(1):9–23. Link, Google Scholar 20. Yu NC, Raman SS, Patel M, Barbaric Z. Fistulas of the genitourinary tract: a radiologic review.[pubs.rsna.org]

Epidemiology

  • System(s) affected: GI; skin/exocrine Synonym(s): fistula-in-ano; anal fistula Epidemiology True prevalence unknown Mean age of presentation for anal abscess and fistula is 40 years. Males are twice as likely to develop an abscess and/or fistula.[unboundmedicine.com]
  • Epidemiology References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified. Etiology Classification Anal abscesses and fistulae may be classified according to their variations in anatomical position and distribution.[amboss.com]
  • For the analysis of the epidemiological data the comparison between the male and the female was made.[clinicsinsurgery.com]
  • EPIDEMIOLOGY Incidence Most publications on the subject reflect authors' experience from a single institution; this does not address the incidence of the disease due to lack of a proper denominator.[ncbi.nlm.nih.gov]
  • Epidemiology The true prevalence of fistula-in-ano is unknown.[emedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • Etiology and Pathophysiology Inspissated debris in an obstructed anal crypt gland results in suppuration and abscess formation. Tracking along the path of least resistance in the perianal and perirectal spaces leads to fistula formation.[unboundmedicine.com]
  • In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. . Accessed March 17, 2017. Breen E, et al.[mayoclinic.org]
  • Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 28. Lentz GM, Krane M. Anal incontinence: diagnosis and management.[medlineplus.gov]
  • […] opening of the rectal ampulla ( above the dentate line ) through the levator ani muscles Opening: perianal skin Subcutaneous/subanodermal/submucosal Course: beneath the perianal/anal skin/rectal mucosa Opening: perianal skin (anoderm)/ anal canal / rectum Pathophysiology[amboss.com]
  • The most commonly accepted pathophysiology is the cryptoglandular hypothesis, which posits that obstruction of the deep submucosal glands results in infection and abscess formation in the intersphincteric space, which consequently drains inferiorly between[radiopaedia.org]

Prevention

  • Further randomized trials are needed to fully clarify the role, duration, and type of antibiotics best suited for postoperative prevention of fistula following drainage of anorectal abscesses.[snfge.org]
  • Prevention As mentioned earlier, the formation of the anal fistula is totally unpredictable. The only way to prevent the disease is to reduce the incidence of infection of the anal glands which is the precursor of anal fistula.[nuh.com.sg]
  • Quality of the trials were assessed and allowances made for subgroup analysis and prevention of publication bias, using funnel plots if needed. MAIN RESULTS: Ten randomised controlled trials were available for analysis.[ncbi.nlm.nih.gov]
  • This treatment method prevents a large scar and undesirable complications. During the surgery, the cutting seton is passed through the fistula tract.[surgeryabroad.eu]
  • Perianal hygiene Prevention or prompt treatment of anorectal abscess; management of commonly associated conditions or risk factors Commonly Associated Conditions Anorectal abscess Crohn disease Diabetes Chronic steroid treatment or immunosuppression[unboundmedicine.com]

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