Anal Fistula

Anal Fistula

An anal fistula is a small tunnel that connects an abscess, an infected cavity in the anus, to an opening on the skin around the anus.

The anus is the external opening through which feces are expelled from the body. A number of small glands that produce mucus are located just inside the anus. These glands can become clogged and infected, leading to an abscess. In about half of these abscesses, a fistula can form.

Symptoms of an anal fistula include:

• Frequent anal abscesses
• Pain and swelling around the anus
• Bloody or foul-smelling drainage (pus) from an opening around the anus. The pain may subside once the fistula drains.
• Irritation of the skin around the anus from drainage
• Pain with bowel movements
• Bleeding
• Fever, chills and a general feeling of fatigue Tests and Treatment

Diagnosis

To help identify the fistula tunnel, one or more of the following imaging tests may be used:

• MRI
• Endoscopic ultrasound
• Fistulography
• Examination under anesthesia.
• Fistula probe.
• Anoscope.
• Flexible sigmoidoscopy or colonoscopy. Treatments

Surgical options include:

• Fistulotomy: The surgeon cuts the internal opening of the fistula, scrapes and flushes out the infected tissue, flattens the tunnel, and stitches it in place. The surgeon may need to remove some of the tunnel to treat a more complicated fistula.
• Endorectal advancement flap: Before removing the internal opening of the fistula, the surgeon makes a flap from the rectal wall. After that, the flap is used to conceal the repair. This procedure has the potential to reduce the amount of sphincter muscle that is cut.
• Ligation of the intersphincteric fistula tract (LIFT): LIFT is a two-stage procedure for treating more complex or deep fistulas. LIFT enables the surgeon to access the fistula between the sphincter muscles without having to cut them. Initially, a silk or latex string (seton) is inserted into the fistula tunnel, forcing it to widen over time. The surgeon removes infected tissue and closes the internal fistula opening several weeks later.

Nonsurgical options include:

• Seton placement.
• Fibrin glue and collagen plug.
• Medication.

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