Anal fistula: Difference between revisions
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***If external opening is posterior to this line fistula curves to post midline of canal | ***If external opening is posterior to this line fistula curves to post midline of canal | ||
*Causes: | *Causes: | ||
**[[perianal | **[[perianal Abscess|Perianal]]/ischiorectal abscess, [[Crohn's]], [[ulcerative colitis]], malignancies, [[STI]], [[anal fissures]], [[rectal foreign body|foreign bodies]], [[TB]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Fistulous tract open: Persistent, painless, blood-stained, mucous, malodorous discharge | *Fistulous tract open: Persistent, painless, blood-stained, mucous, malodorous discharge | ||
*Fistulous tract blocked: Bouts of inflammation that are relieved by spontaneous rupture | *Fistulous tract blocked: Bouts of inflammation that are relieved by spontaneous rupture | ||
*[[perianal | *[[perianal Abscess|Abscess]] | ||
**Throbbing pain that is constant and worse with sitting, moving, defecation | **Throbbing pain that is constant and worse with sitting, moving, defecation | ||
**May be only sign of fistula | **May be only sign of fistula | ||
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[[Category:GI]] | [[Category:GI]] | ||
[[Category:Surgery]] | |||
Revision as of 19:00, 29 September 2019
Background
- Inflammatory tract originating from infected anal gland connecting anal canal with skin
- May be intersphincteric, suprasphincteric, transsphincteric, or extrasphincteric
- Goodsall's Rule
- Draw imaginary line horizontally through the anal canal
- If external opening is anterior to this line fistula runs directly into the canal
- If external opening is posterior to this line fistula curves to post midline of canal
- Draw imaginary line horizontally through the anal canal
- Causes:
- Perianal/ischiorectal abscess, Crohn's, ulcerative colitis, malignancies, STI, anal fissures, foreign bodies, TB
Clinical Features
- Fistulous tract open: Persistent, painless, blood-stained, mucous, malodorous discharge
- Fistulous tract blocked: Bouts of inflammation that are relieved by spontaneous rupture
- Abscess
- Throbbing pain that is constant and worse with sitting, moving, defecation
- May be only sign of fistula
- Fistulous opening
- Adjacent to anal margin suggests superficial connection (e.g. intersphincteric region)
- Distant from anal margin suggests deeper, more superior abscess
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Evaluation
- Endocavitary ultrasound with 3% hydrogen peroxide for definitive diagnosis
Management
- Ill-appearing
- Analgesia
- IVF
- Antibiotics
- Urgent surgical consultation
- Well-appearing
- Antibiotics
- Ciprofloxacin 750mg PO BID AND metronidazole 500mg QID x7d
- Outpatient surgery referral
- Improperly excised fistulas may result in permanent fecal incontinence
- Spasm treatment
- Nitroglycerin, Lidocaine
- Sitz baths
- Antibiotics