FISTULA 2

Any boil or abscess at perianal area which bursts with 
discharge or  surgically  drained is initially a Fistula.
 The fistula can be recovered fully or become a chronic
 condition with intermittent or continuously  discharging
 pus or foul smelling materials. Patient usually complaints
of pus, blood or discharges soiling the under clothes.

Causes :-

1. Boil or abscess at perianal region which bursts
 with discharge.

2. Cryptoglandular anal infection leading to anal 
abscess formation  which  bust which discharge
leading to Anal Fistula.

3. Erosion and ulceration in anal canal provide
 the route for bacterial  infection in anal canal.
 The infection spreads to pararectal spaces
 leading to abscess formation and development 
of anal Fistula.

4. Anal Fissure is the most common cause of Anal abscess.

5. Blood born infection of pararectal spaces during malaria, 

Typhoid, Prolong illness, Tuberculosis, lower resistance and diabetes may cause anal abscess
 formation.

Clinical feature :-

Initially an abscess or boil at perianal region either to burst with discharge or in adequately 
drained leads to fistula formation. Intermittent or persistent discharge of pus or blood with 
pain or without pain is the prominent feature of Anal fistula.

Types of the Fistula :-

1. Law Anal

2. High Anal

3. Anorectal

4. High Inter-muscular

5. Pelvi-rectal

Treatment of Fistula :-

Treatment of fistula is surgical.

The operative treatment of Anal fistula consists of fistulectomy or fistulostomy.

Fistulectomy :-

Complete tubular tract of Fistula is dissected from adjacent tissues and excised. Daily dressing is done.

Fistulastomy :-

A probe is passed into fistulous tract which is laid open completely and dressing is done.

Operative results of anal fistula :-

An average recurrence rate of Anal fistula after adequate surgery is about 50%. The results of 
high Anal and horse shoe shape fistula are not satisfactory. Recurrence and incontinence for
faces and flatus are common complications of surgery for Anal fistula. Really in anorectal and
multiple horse shoe shape anal fistula excision of the rectum and colostomy is the choice of 
operation for complete eradication of disease.