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Fistula in Ano: Causes, Diagnosis, and Treatment

Fistula in ano is defined as a track lined by granulation tissue that connects the anorectal lumen to the skin around the anus. Risk factors include recurrent perianal abscesses, diabetes, and immunocompromised states, while treatment options range from fistulotomy to laser closure techniques. Clinical assessment involves a thorough history, physical examination, and imaging studies to determine the appropriate management strategy.

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Farah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Topics covered

  • FiLaC,
  • Chronic Conditions,
  • Anal Canal Anatomy,
  • Purulent Discharge,
  • Fistula Tract,
  • Acute Anorectal Sepsis,
  • Fistula Classification,
  • Internal Sphincter,
  • Immunocompromised,
  • Investigations
132 views20 pages

Fistula in Ano: Causes, Diagnosis, and Treatment

Fistula in ano is defined as a track lined by granulation tissue that connects the anorectal lumen to the skin around the anus. Risk factors include recurrent perianal abscesses, diabetes, and immunocompromised states, while treatment options range from fistulotomy to laser closure techniques. Clinical assessment involves a thorough history, physical examination, and imaging studies to determine the appropriate management strategy.

Uploaded by

Farah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Topics covered

  • FiLaC,
  • Chronic Conditions,
  • Anal Canal Anatomy,
  • Purulent Discharge,
  • Fistula Tract,
  • Acute Anorectal Sepsis,
  • Fistula Classification,
  • Internal Sphincter,
  • Immunocompromised,
  • Investigations

FISTULA IN ANO

Presenter: Saranyia
Supervisor: Mr Tan
CONTENTS
 Definition
 Anatomy
 Risk factors
 Classifications
 Clinical features
 Investigations
 Treatment
FISTULA IN ANO
 Track lined by granulation tissues, which runs outwards from the anorectal
lumen (internal opening) to the external opening on the skin around the
anus
ANATOMY OF ANAL CANAL
The External sphincter
 Somatic voluntary muscle
 Innervated by pudendal nerve
 3 components : subcutaneous, superficial, deep

The Internal sphincter


 Smooth muscle
 Autonomic control
RISK FACTORS
 Recurrent perianal abscess
 Diabetes Mellitus
 Chrons disease
 Tuberculosis
 Immunocompromised (HIV)
 Radiotherapy
 Trauma
PARKS CLASSIFICATION
A- Superficial
B- Inter-sphincteric
C- Trans-sphincteric
D- Supra-sphincteric
E- Extra-sphincteric
CILICAL PRESENTATION
 Intermittent purulent discharge
 Pain
 Previous episode of acute anorectal sepsis
 Swelling/lump in the perianal area
 Fever
CLINICAL ASSESSMENT
 Complete history to find out the underlying cause
 General examination- to look for any signs of sepsis
 Perianal examination
 Look for the external opening (usually appears as an open sinus/ elevation of
granulation tissue)
 Look for spontaneous discharge via the external opening
 Fibrous tract may be felt underneath the skin
 Bogginess on per rectal examination
 Goodsall’s rule to help indicate the likely position of the internal opening
GOODSALL’S RULE
GOODSALL’S RULE
With patient in lithotomy position
 If external opening anterior to the imaginary line drawn through the anal
canal, the fistula usually runs directly into the anal canal
 If the external opening is posterior to the line, it usually curves to the
midline
IMAGING
 Endoanal ultrasound
 To help define muscular anatomy differentiating intersphincteric from trans-
sphincteric
 Determine sphincter integrity
 Colonoscopy
 MRI – gold standard
 Able to demonstrate secondary extensions
TREATMENT
 Fistulectomy
 Fistulotomy
 Seton insertion
 LIFT- Ligation of intersphincteric fistula tract
 FiLaC- fistula tract laser closure
 Advancement Flaps
FISTULOTOMY
 Primary fistulotomy in simple fistula in ano is associated with high patient
satisfaction and fistula resolution rates (more than 90%)
 Fistulotomy for high-lying or otherwise complex f istulas may result in
significant postoperative incon tinence in 10% to 40% of patients.
 Risk factors for postop anal sphincter dysfunction : recurrent fistula, pre-
operative fecal incontinence, complex fistula, sphincter damage from prev
birthing trauma
FISTULECTOMY
 Excision of the entire fistula track
 No advantage in both recurrence and incontinence rate compared to
fistulotomy
LIFT
 Ligation of Intersphincteric Fistula Tract
 Sphincter sparring procedure
 For complex trans-sphincteric fistulas
 Better healing rate
SETON
 Achieve drainage of the fistula track
 Allow secondary track to heal if any
FILAC
 Fistula Lase Closure
 Uses a radially emitting laser probe that, when passed along the tract,
traumatizes the epithelium and, in theory, obliterates the fistula tract.
 Sphincter preserving technique

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