Anal Fistula

ANAL FISTULA 1. CHIEF COMPLAINT •Anal fistula 2. HPI 3. ROS 4. SYMPTOMS •Pain •Discharge - either bloody or purulent •Pruritus ani - itching 5. HISTORY •FAMILY HISTORY •SOCIAL HISTORY •PASTMEDICAL HISTORY •SURGICAL HISTORY •CHRONIC CONDITIONS 6. ALLERGIES 7. PHYSICAL EXAMINATION •The area painful on examination 8. SPECIFIC DATA LIKE GRADING ETC 9. TESTS TO BE ORDERED •CBP •USG •Anoscopy 10.ASSESSMENT /PLAN 11.EDUCATION •Doing nothing - drainage section can be left in place long-term to prevent problems. This is the safest option although it does not definitively cure the fistula. •Lay-open of fistula-in-ano - this option involves an operation to cut the fistula open. Once the fistula has been layed open it will be packed on a daily basis for a short period of time to ensure that the wound heals from the inside out. This option leaves behind a scar,

and depending on the position of the fistula in relation to the sphincter muscle, can cause problems with incontinence. •Cutting seton - if the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting section may be used. This involves inserting a thin tube through the fistula tract and tying the ends together outside of the body. The seton is tightened over time, gradually cutting through the sphincter muscle and healing as it goes. This option minimizes scarring but can cause incontinence in a small number of cases, mainly of flatus (wind). Once the fistula tract is in a low enough position it may be layed open to speed up the process, or the seton can remain in place until the fistula is completely cured. •Fibrin glue injection •Endorectal advancement flap 12.MEDICATION •Amikacin •Gentamicin •Kanamycin •Cefixime •Cefdinir •Naproxen •Ibuprofen •Cefditoren •Aspirin 13. FOLLOW-UP