Abscess and Anal Fistula
Abscess and anal fistula are one of the most treated pathologies in General Surgery.
Abscess and Anal Fistula
An anorectal fistula is the chronic manifestation of an acute process; anorectal abscess. The abscess is a pocket of pus formed by infection of the glands located in the mucosa of the anus.
When the abscess ruptures spontaneously or is surgically drained, a kind of tunnel or epithelial pathway may form, connecting the abscess in the anus or rectum to the perianal skin.
Fistula may also have other less frequent causes such as Crohn’s disease, birth injuries, previous radiotherapy, various infectious diseases, injuries caused by trauma or malignant pathology.
Anal fistula can manifest as a perianal abscess that does not heal, or as a hole in the perianal region or buttocks that drains pus intermittently. It may be a cause of anal pain or discomfort, especially during defecation.
Diagnosis
The diagnosis of an anal fistula is based on a clinical history and physical examination ideally performed by an experienced proctologist.
In the case of simple fistulas, no further diagnostic testing may be necessary.
In more complex fistulas, it is usually necessary to perform some imaging test such as endoanal ultrasound or nuclear magnetic resonance before considering the treatment of the fistula.
There are many different classifications describing anal fistulas, but in general they all describe the relationship of the fistula to the sphincters of the anus and to what degree these are affected by the path of the fistula.
One of the most widely used is Parks’ classification, which divides them into:
– Superficial or submucosal fistulas. It does not affect the sphincters.
– Intersphincteric fistulas. It affects only the internal anal sphincter.
– Transsphincteric fistulas. It affects both sphincters to a greater or lesser extent.
– Extrasphincteric fistulas. It affects the entire sphincteric apparatus.
– Suprasphincteric fistulas. It affects the entire sphincteric apparatus and usually originates in the pelvic process.
Another way to classify them is in simple or complex fistulas.
Fistula should be differentiated from other anorectal processes such as anal fissure, rectal ulcer, perianal hidradenitis suppurativa or pilonidal sinus.
The treatment of symptomatic anal fistulas is almost always surgical, except for some caused by Crohn’s disease.
The goal of treatment is to cure the fistula while preserving the patient’s anal continence. The type of intervention depends on many factors, mainly the complexity of the fistula and may sometimes require more than one intervention.
Frequently Asked Questions
about Pilonidal Sinus
- Reddening of the skin
- Pain
- Presence of pus or blood in an opening of the skin.
- Unpleasant odor of oozing pus.
This pathology should be treated by a specialist in coloproctology, which is responsible for the diagnosis and treatment of diseases of the colon, rectum and anus.
As we know, the pilonidal cyst is located in the region above the intergluteal fold, an area of treatment for this specialist.
