Fistula-in-ano
- Fistula = abnormal communication between two epithelial surfaces (...-in-ano)
Causes
Goodsall's rule
- 'if the external opening lies anterioly then track passes radially towards
internal opening, if the external opening lies posteriorly then track is
horseshoe-shaped and opens in midline posteriorly
Symptoms and signs
- History of abscess
- Persistent drainage of mucus, blood, pus, faecal matter
- Peri-anal irritation and discomfort
- Single opening near anus
- PR reveal indurated track, pressure causes to discharge
- Proctoscopy or sigmoidoscopy to define internal opening
Differential diagnosis
- Pilonidal sinus
- Hidradenitis suppurativa
- incontinence
- Crohn's disease
- trauma
Treatment
- Track opened under GA (danger of incontinence with high and pelvirectal
fistulae)
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