Anal fistula: Difference between revisions
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==Background== | ==Background== <!--T:1--> | ||
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[[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]] | [[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]] | ||
[[File:Fistula diag 01.png|thumb|Different types of anal fistulas.]] | [[File:Fistula diag 01.png|thumb|Different types of anal fistulas.]] | ||
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===Causes=== | ===Causes=== <!--T:3--> | ||
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*[[Special:MyLanguage/perianal Abscess|Perianal]]/ischiorectal abscess | *[[Special:MyLanguage/perianal Abscess|Perianal]]/ischiorectal abscess | ||
*[[Special:MyLanguage/Crohn's|Crohn's]] | *[[Special:MyLanguage/Crohn's|Crohn's]] | ||
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==Clinical Features== | ==Clinical Features== <!--T:5--> | ||
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*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 | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:7--> | ||
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==Evaluation== | ==Evaluation== <!--T:8--> | ||
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*Endocavitary [[Special:MyLanguage/ultrasound|ultrasound]] with 3% hydrogen peroxide for definitive diagnosis | *Endocavitary [[Special:MyLanguage/ultrasound|ultrasound]] with 3% hydrogen peroxide for definitive diagnosis | ||
==Management== | ==Management== <!--T:10--> | ||
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#Ill-appearing | #Ill-appearing | ||
##[[Special:MyLanguage/Analgesia|Analgesia]] | ##[[Special:MyLanguage/Analgesia|Analgesia]] | ||
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==See Also== | ==See Also== <!--T:12--> | ||
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*[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]] | *[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]] | ||
==References== | ==References== <!--T:14--> | ||
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<references/> | <references/> | ||
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[[Category:GI]] | [[Category:GI]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
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Latest revision as of 20:29, 6 January 2026
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
- Malignancy
- STI
- Anal fissure
- 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
See Also