II. Causes
-
Perirectal Abscess
- Fistula forms in 50% of cases
- Sequelae of rupture or surgery
- Anal Fissure
- Crohn's Disease
- Anorectal cancer
- Tuberculosis
- Local Radiation Therapy
- Lymphogranuloma venereum
- Obstetric Trauma (e.g. fourth degree peroneal Laceration)
III. Types
- Simple Rectal Fistula
- Complex Rectal Fistula criteria
- Anterior tract or
- Multiple tracts or
- Cross more than 50% of external anal sphincter or
- Recurrent
IV. Symptoms
- Chronic yellow, pustular (seropurulent) or mucus drainage from fistula
- Pain may be present at fistula tract
V. Signs
- Communicating tract between perianal skin and anus
- One or several external openings tracking toward anus
- Drainage may be spontaneous or with applying pressure with a finger from inside the anus
VI. Imaging
- MRI Pelvis (indicated in complicated Anal Fistulas)
VII. Associated Conditions
VIII. Management: Conservative Therapy
- Sitz baths
- High fiber diet
- Topical Analgesics
IX. Management: Surgery (Fistulotomy)
- Indications
- Non-healing fistula
- Complex Anal Fistulas
- Increased risk factors for complications (e.g. Horseshoe Ischiorectal Abscess)
- Adverse effects
- Fecal Incontinence risk with complex Anal Fistula surgical repair
- Protocol
- Fistulotomy is typically delayed until after Perirectal Abscess heals
- Surgical repair requires precise mapping of the fistula tract
- Fistula tracts are mapped with exam under Anesthesia, as well as MRI and Ultrasound
X. References
- Goroll (2000) Primary Care Medicine, Lippincott, p. 426
- Fargo (2012) Am Fam Physician 85(6): 624-30 [PubMed]
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Related Studies
Definition (NCI_CTCAE) | A disorder characterized by an abnormal communication between the rectum and another organ or anatomic site. |
Definition (NCI) | An abnormal communication between the rectum and another organ or cavity. |
Definition (MSH) | An abnormal anatomical passage connecting the RECTUM to the outside, with an orifice at the site of drainage. |
Concepts | Anatomical Abnormality (T190) |
MSH | D012003 |
ICD10 | K60.4 |
SnomedCT | 80736008 |
English | Fistula, Rectal, rectal fistula, rectal fistula (physical finding), Rectal Fistula [Disease/Finding], fistula rectal, Fistula;rectal, fistulas rectal, rectal fistula (diagnosis), Rectal fistula, Rectal fistula (disorder), fistula; rectum, rectum; fistula, Rectal Fistula |
Dutch | rectale fistel, fistel; rectum, rectum; fistel, Fistel, anaal, Fistel, rectale, Rectale fistel |
Italian | Fistola del retto, Fistola rettale |
Portuguese | Fístula rectal, Fístula Retal |
Spanish | Fístula rectal, fístula rectal (trastorno), fístula rectal, Fístula Rectal |
Japanese | 直腸瘻, チョクチョウロウ |
Swedish | Ändtarmsfistel |
Finnish | Peräsuolifisteli |
Russian | ANAL'NYI SVISHCH, ANUSA SVISHCH, PRIAMOI KISHKI SVISHCH, АНАЛЬНЫЙ СВИЩ, АНУСА СВИЩ, ПРЯМОЙ КИШКИ СВИЩ |
German | Rektalfistel, Rektumfistel |
Czech | Píštěl rekta, rektum - píštěl, rektální píštěl, rektální fistula |
Korean | 직장 샛길(누공) |
Croatian | REKTALNA FISTULA |
Polish | Przetoka odbytnicza |
Hungarian | Rectalis fistula |
Norwegian | Rektal fistel, Rektumfistel, Endetarmsfistel |
French | Fistule rectale, Fistule du rectum |
Ontology: Anorectal fistula (C0149889)
Definition (NCI_CTCAE) | A disorder characterized by an abnormal communication between the opening in the anal canal to the perianal skin. |
Definition (NCI) | A pathologic tract that connects an opening in the anal canal to the perianal skin. In the vast majority of cases there is a history of perianal abscess. |
Concepts | Pathologic Function (T046) |
ICD10 | K60.5 |
SnomedCT | 197153005, 72779005 |
Dutch | anorectale fistel, anorectaal; fistel, fistel; anorectaal, Anorectale fistel |
French | Fistule anorectale |
German | anorektale Fistel, Anorektalfistel |
Italian | Fistola anorettale |
Portuguese | Fístula anorrectal |
Spanish | Fístula anorrectal, fístula anorrectal (trastorno), fístula anorrectal |
Japanese | 肛門直腸瘻, コウモンチョクチョウロウ |
English | Anorectal Fistula, anorectal fistula, Anal Fistula, Anorectal fistula, anorectal fistulas, fistula anorectal, Anal fistula, Anorectal fistula (disorder), fistula; anorectal, anorectal; fistula |
Czech | Anorektální píštěl |
Korean | 항문직장 샛길(누공) |
Hungarian | Anorectalis sipoly |