II. Causes

  1. Perirectal Abscess
    1. Fistula forms in 50% of cases
    2. Sequelae of rupture or surgery
  2. Anal Fissure
  3. Crohn's Disease
  4. Anorectal cancer
  5. Tuberculosis
  6. Local Radiation Therapy
  7. Lymphogranuloma venereum
  8. Obstetric Trauma (e.g. fourth degree peroneal Laceration)

III. Types

  1. Simple Rectal Fistula
  2. Complex Rectal Fistula criteria
    1. Anterior tract or
    2. Multiple tracts or
    3. Cross more than 50% of external anal sphincter or
    4. Recurrent

IV. Symptoms

  1. Chronic yellow, pustular (seropurulent) or mucus drainage from fistula
  2. Pain may be present at fistula tract

V. Signs

  1. Communicating tract between perianal skin and anus
  2. One or several external openings tracking toward anus
  3. Drainage may be spontaneous or with applying pressure with a finger from inside the anus

VI. Imaging

  1. MRI Pelvis (indicated in complicated Anal Fistulas)

VII. Associated Conditions

VIII. Management: Conservative Therapy

  1. Sitz baths
  2. High fiber diet
  3. Topical Analgesics

IX. Management: Surgery

  1. Indications
    1. Non-healing fistula
    2. Complex Anal Fistulas
    3. Increased risk factors for complications
  2. Adverse effects
    1. Fecal Incontinence risk with complex Anal Fistula surgical repair
  3. Protocol
    1. Surgical repair requires precise mapping of the fistula tract
    2. Fistula tracts are mapped with exam under Anesthesia, as well as MRI and Ultrasound

X. References

  1. Goroll (2000) Primary Care Medicine, Lippincott, p. 426
  2. Fargo (2012) Am Fam Physician 85(6): 624-30 [PubMed]

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Related Studies

Ontology: Rectal Fistula (C0034884)

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
German Rektalfistel, Rektumfistel
Czech Píštěl rekta, rektum - píštěl, rektální píštěl, rektální fistula
Korean 직장 샛길(누공)
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