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Anal fistula is a chronic abnormal communication between the anal canal and the perianal skin. [1] An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. [2] Anal fistulae commonly occur in people with a history of anal abscesses. They can form when ...
Anorectal Abscess and Fistula: Painful swelling, [5] Redness, Pain, [10] Bloody diarrhea, [11] an opening can point to a fistula, with or without drainage [5] with itchiness. [12] Visual Exam, Digital Rectal Exam, Anoscopy, Imaging (CT, MRI) of the fistula tract, endoanal ultrasound, Labs, [11] exam under anesthesia. [11]
Goodsall's rule relates the external opening (in the perianal skin) of an anal fistula to its internal opening (in the anal canal). It states that if the perianal skin opening is posterior to the transverse anal line, the fistulous tract will open into the anal canal in the midline posteriorly, sometimes taking a curvilinear course.
There are several forms of imperforate anus and anorectal malformations. The new classification is in relation of the type of associated fistula. [7] The Wingspread classification was in low and high anomalies: [citation needed] A low lesion, in which the colon remains close to the skin.
Anorectal abscess (also known as an anal/rectal abscess or perianal/perirectal abscess) is an abscess adjacent to the anus. [1] Most cases of perianal abscesses are sporadic, though there are certain situations which elevate the risk for developing the disease, such as diabetes mellitus, Crohn's disease, chronic corticosteroid treatment and others.
Anal glands are the most common cause of anal fistula.Large fistulae present a surgical challenge as resection of larger sections of the anal sphincter may result in anal incontinence. [4]
The diagnosis can be made clinically with tests like ultrasound, X-rays, voiding cystourethrogram (VCUG) and cloacagram. MRI of the spine and pelvis and endoscopic examinations may also be performed. [6] Failure to identify a cloaca as being present in a newborn may be dangerous, as more than 90% have associated urological problems.
Colorectal surgeons instead define the anal canal as the zone from the anal verge to the anorectal ring (palpable structure formed by the external anal sphincter and the puborectalis muscle). [1] Several distinctions can be made based upon the location of a structure relative to the pectinate line: