Anal fistula: Difference between revisions
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==Background== | ==Background== | ||
*Inflammatory tract originating from infected anal gland connecting anal canal | *Inflammatory tract originating from infected anal gland connecting anal canal with skin | ||
**May be intersphincteric, suprasphincteric, transsphincteric, or extrasphincteric | **May be intersphincteric, suprasphincteric, transsphincteric, or extrasphincteric | ||
*Goodsall's Rule | *Goodsall's Rule | ||
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*Fistulous tract blocked: Bouts of inflammation that are relieved by spontaneous rupture | *Fistulous tract blocked: Bouts of inflammation that are relieved by spontaneous rupture | ||
*Abscess | *Abscess | ||
**Throbbing pain that is constant and worse | **Throbbing pain that is constant and worse with sitting, moving, defecation | ||
**May be only sign of fistula | **May be only sign of fistula | ||
*Fistulous opening | *Fistulous opening | ||
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==Diagnosis== | ==Diagnosis== | ||
*Endocavitary US | *Endocavitary US with 3% hydrogen peroxide for definitive diagnosis | ||
==Management== | ==Management== | ||
#Ill-appearing | #Ill-appearing | ||
Revision as of 02:10, 12 July 2016
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, UC, malignancies, STI, fissures, FBs, 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
Diagnosis
- Endocavitary US with 3% hydrogen peroxide for definitive diagnosis
Management
- Ill-appearing
- Analgesia
- IVF
- Anbx
- Urgent surgical consultation
- Well-appearing
- Abx
- Ciprofloxacin 750mg PO BID AND metronidazole 500mg QID x7d
- Outpt sx referral
- Improperly excised fistulas may result in permanent fecal incontinence
- Spasm treatment
- Nitroglycerin, Lidocaine
- Sitz baths
- Abx