Related articles: Anal Fistula
Definition
An anal fistula is a tubuliform lesion that has an orifice in the anal canal and the other (usually) on the surface of the perianal skin. This channel can form spontaneously or represent the complication of various pathological affections that can involve the anorectal region.
In most cases, the formation of an anal fistula is the consequence of the drainage of recurrent abscesses due to an acute purulent infection. Other predisposing conditions are diverticulitis or chronic inflammatory diseases of the intestine (including Crohn's disease).
An anal fistula can also derive from tuberculosis, cancer, trauma and neoplasms of the anal or rectal tract. Sometimes this lesion is congenital.
Most fistulas originate in anorectal crypts and connect the interior of the anal canal with the perineum.
Most common symptoms and signs *
- Asthenia
- Anal burning
- Anal pain
- Pelvic pain
- Temperature
- Pus formation
- Swelling in the anal area
- Anal itching
- Blood from the anno
- Blood in the stool
Further indications
An anal fistula typically causes irritation around the anus, itching, burning and sometimes pain.
These symptoms tend to be accentuated during defecation and are accompanied by intermittent or constant pus or serous secretion from a small hole near the anus.
The anal fistula can also involve blood loss and fouling of the laundry (sometimes the secreted material is mixed with faeces). The cutaneous orifice can spontaneously close for a variable period, then reopen, returning to secrete pus. In some cases, fatigue, fever and pelvic pain may also occur.
If the pathological process of canalization progresses and becomes chronic, involving the perianal surface in different points, it can favor serious damage to the sphincter. Furthermore, long-standing fistulas may predispose to the formation of neoplasms.
Diagnosis is based on physical examination and sigmoidoscopy to rule out Crohn's disease. On inspection, the proctologist may encounter one or more secondary orifices, while palpation may result in a cord-like lesion. To define the course of the anal fistula and identify any secondary extensions, the physician may use an intra-ultrasound scan with a probe.
Anal fistula often requires surgical treatment. If diarrhea or Crohn's disease is present, fistulotomy is not recommended due to delayed wound healing. In these patients, medical therapy can be used with appropriate antibiotics and immunosuppressive drugs.
