Anal fistula: Difference between revisions
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#Ill-appearing | #Ill-appearing | ||
##Analgesia | ##Analgesia | ||
##IVF | ##[[IVF]] | ||
## | ##Antibiotics | ||
##Urgent surgical consultation | ##Urgent surgical consultation | ||
#Well-appearing | #Well-appearing | ||
## | ##Antibiotics | ||
###Ciprofloxacin 750mg PO BID AND metronidazole 500mg QID x7d | ###[[Ciprofloxacin]] 750mg PO BID AND [[metronidazole]] 500mg QID x7d | ||
## | ##Outpatient surgery referral | ||
###Improperly excised fistulas may result in permanent fecal incontinence | ###Improperly excised fistulas may result in permanent fecal incontinence | ||
##Spasm treatment | ##Spasm treatment | ||
###Nitroglycerin, Lidocaine | ###[[Nitroglycerin]], [[Lidocaine]] | ||
###Sitz baths | ###Sitz baths | ||
Revision as of 00:14, 14 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'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
Diagnosis
- Endocavitary US 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