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Anal fistula, or fistula-in-ano, is a chronic abnormal communication between the epithelialised surface of the anal canal and (usually) the perianal skin.
Anal fistulae originate from the anal glands, which are located between the internal and external anal sphincter and drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.
Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It then points to the surface again, and the process repeats.
Anal fistulas per se do not generally harm, but can be very painful, and can be irritating because of the pus-drain (it is also possible 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.
Anal fistulae can present with many different symptoms:
Diagnosis is by examination, either in an outpatient setting or under anaesthesia (referred to as EUA — Examination Under Anaesthesia). The examination can be an anoscopy.
Possible findings:
Pilonidal cysts/sinuses are another condition in which infected perianal "holes" or openings may appear
Low level fistulae:
High level fistulae:
Park's classification:
There are several stages to treating an anal fistula:
Definitive treatment of a fistula aims to stop it recurring. Treatment depends on where the fistula lies, and which parts of the internal and external anal sphincters it crosses.
There are several options:
Some people will have active infection when they present with a fistula, and this requires clearing up before definitive treatment can be decided.
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. This can be done with a seton.
Latin literature, Romance languages, Ancient Rome, Rome, Ecclesiastical Latin
Egypt, Near East, Egyptian hieroglyphs, Roman Empire, Ancient Egyptian religion
Medicine, Surgery, Psychiatry, Stomach, Liver
Rectum, Anus, Pectinate line, Latin, Medical Subject Headings
Rectum, Anal canal, Latin, Feces, Perineum
Fever, Crohn's disease, Antibiotics, Gastroenterology, International Statistical Classification of Diseases and Related Health Problems
Rectum, Anus, Colitis, Toxic liver disease, Abscess
Endoscopy, Vomiting, Biopsy, Constipation, Gallbladder
Anus, Magnetic resonance imaging, Digestion, Liver, ATC code A
Fistula, Anal fistula, Fistulectomy