Anal fistula - Citizendia

Anal fistula Classification and external resources
ICD-10	K 60.3
ICD-9	565.1

An anal fistula is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. In medicine a fistula (pl fistulas or fistulae is an abnormal connection or passageway between two Epithelium -lined organs or vessels that normally do not connect In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body The anal canal is the terminal part of the Large intestine. It is situated between the Rectum and Anus, below the level of the Pelvic diaphragm

Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. The anal glands or anal sacs are small paired sacs located on either side of the anus between the external and internal sphincter muscles. The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. The anal canal is the terminal part of the Large intestine. It is situated between the Rectum and Anus, below the level of the Pelvic diaphragm If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process The tract formed by this process is the fistula.

Abscesses can recur if the fistula seals over, allowing the accumulation of pus. Pus is a whitish-yellow yellow or yellow-brown substance produced during Inflammatory responses of the body that can be found in regions of Pyogenic bacterial It then points to the surface again, and the process repeats.

Anal fistulas per se do not generally harm and they often do not hurt, but they can be irritating because of the pus-drain (and, it is not unknown for formed stools to be passed through the fistula); additionally, recurrent abscesses may lead to significant short term morbidity from pain, and create a nidus for systemic spread of infection.

Surgery is considered essential in the decompression of acute abscesses; repair of the fistula itself is considered an elective procedure which many patients elect to undertake due to the discomfort and inconvenience associated with a draining tract.

1 Symptoms
2 Diagnosis
3 Treatment
- 3.1 Treating active infection
- 3.2 Definitive Treatment
4 External links

Symptoms

Anal fistulae can present with many different symptoms:

Pain
Discharge - either bloody or purulent
Pruritus ani - itching
Systemic symptoms if abscess becomes infected

Diagnosis

Diagnosis is by examination, either in an outpatient setting or under anaesthesia (referred to as EUA - Examination Under Anaesthesia). Pus is a whitish-yellow yellow or yellow-brown substance produced during Inflammatory responses of the body that can be found in regions of Pyogenic bacterial Pruritus ani is the irritation of the skin at the exit of the Rectum, known as the Anus, causing the desire to scratch A patient is any person who receives medical attention care or treatment. Anesthesia, or anaesthesia (see spelling differences; from Greek grc αν- an-, "without" and grc αἲσθησις The examination can be an anoscopy. An anoscopy is an examination using a small rigid Speculum (anoscope inserted a few inches into to the Anus in order to evaluate problems of the anal canal

Possible findings:

The opening of the fistula onto the skin may be seen
The area may be painful on examination
There may be redness
An area of induration may be felt - thickening due to chronic infection
A discharge may be seen
It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula

Treatment

There are several stages to treating an anal fistula:

Treating active infection

Some patients will have active infection when they present with a fistula, and this requires clearing up before definitive treatment can be decided. Induration (in'doo rā'shən -dyoo- a noun means in terms of Pathology, (a hardening of an area of the body as a reaction to inflammation hyperemia or neoplastic infiltration An infection is the detrimental Colonization of a host Organism by a foreign Species.

Antibiotics can be used as with other infections, but the best way of healing infection is to prevent the buildup of pus in the fistula, which leads to abscess formation. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa This can be done with a seton - a length of suture material looped through the fistula which keeps it open and allows pus to drain out. A seton or seton stitch is a medical term for a procedure used to aid the healing of fistulae. Pus is a whitish-yellow yellow or yellow-brown substance produced during Inflammatory responses of the body that can be found in regions of Pyogenic bacterial In this situation, the seton is referred to as a draining seton. A seton or seton stitch is a medical term for a procedure used to aid the healing of fistulae.

Definitive Treatment

Definitive treatment of a fistula aims to stop it recurring. Treatment depends on where the fistula lies, and which parts of the anal sphincter it crosses. The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth.

There are several options:

Doing nothing - a drainage seton can be left in place long-term to prevent problems. This is the safest option although it does not definitively cure the fistula.
Conversion to a cutting seton - this involves a similar process to a draining seton but the suture is tied tightly. This gradually cuts through the muscle and skin involved, leaving behind a small area of scarring. Scars (also called cicatrices) are areas of fibrous tissue that replace normal Skin (or other tissue after injury This cures the fistula in most cases, but can cause incontinence in a small number of cases, mainly of flatus (wind). Fecal incontinence is the loss of regular control of the Bowels. Flatulence is the production of a mixture of gases in the digestive tract of Mammals that are byproducts of the digestion process Wind is the flow of Air or other Gases that compose an Atmosphere (including but not limited to the Earth's)
Lay-open of fistula-in-ano - this option involves an operation to cut the fistula open and let it heal naturally. This cures the fistula but leaves behind a scar, and can cause problems with incontinence. Fecal incontinence is the loss of regular control of the Bowels. This option is not suitable for complex fistulae, or those that cross the entire anal sphincter. The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth.
Fibrin glue injection is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally. This method is perhaps best tried before all others since, if successful, it avoids the risk of incontinence, and creates minimal stress for the patient.
Fistula plug is an "advanced" version of the fibrin glue method. It involves "plugging" the fistula with a "plug" made of porcine small intestine submucosa (sterile, biodegradable), fixing the plug from the inside of the anus with suture, and, again, letting the fistula heal "naturally" from the inside out. According to some sources, the success rate with this method is as high as 80%.
Endorectal advancement flap is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. The flap is lifted to expose the fistula, which is then cleaned and the internal opening is sewn shut. After cutting the end of the flap on which the internal opening was, the flap is pulled down over the sewn internal opening and sutured in place. The external opening is cleaned and sutured. Success rates are variable and high recurrence rates are directly related to previous attempts to correct the fistula.
Anal Fistula Plug is a recently developed method known as AFP. This treatment requires placement and fixing of a plug in the anal fistula by a special technique. The plug is made of highly sophisticated absorbent material; it provides a scaffold over which body’s collagen gets deposited and closes the fistula. Comparative studies have shown this method to be very effective. One advantage of this method is that it involves no cutting, so there is no post operative wound and pain. AFP plugs can sometimes be inserted under local anesthesia. This method can be used successfully to treat high fistula without colostomy. It does not carry any risk of bowel incontinence. As opposed to the staged operations, which may require multiple hospitalizations, AFP requires hospitalization for only about 24 hours. The success rate of AFP is better than the other procedures. AFP was approved for clinical use by the FDA in May 2005 and hundreds of procedures have been done since then.

External links

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