Patient will present as → a 47-year-old man with severe rectal pain when he defecates. He has a fever of 102.2 F (39 C). On exam there is perianal swelling, redness and tenderness. A palpable mass is felt at the anal verge as seen here.
Anorectal abscess is a result of infection, whereas fistula is a chronic complication of an abscess.
- Abscesses produce painful swelling at the anus as well as painful defecation. Examination reveals localized tenderness, erythema, swelling, and fluctuance; fever is uncommon.
- Deeper abscesses may produce buttock or coccyx pain and rectal fullness; fever is more likely.
Anorectal fistula is an open tract between two epithelium-lined areas and is associated with deeper anorectal abscesses
- Communication between rectum and perianal skin
- Generally located within 3 cm of the anal margin
- Fistulae will produce anal discharge and pain when the tract becomes occluded.
- Clinical - perirectal tender swollen mass
- CT scan of pelvis only if recurrent
Fistula in Ano (Perianal Fistula)
Treatment of abscess requires surgical drainage, followed by warm-water cleansing, analgesics, stool softeners and a high-fiber diet are prescribed for all patients
- Prompt incision and adequate drainage are required and should not wait until the abscess points. Many abscesses can be drained as an in-office procedure; deeper abscesses may require drainage in the operating room.
- Antibiotics are needed for high-risk patients
Fistula must be treated surgically.
|A fistula is a connection or passageway formed abnormally between two epithelium-lined vessels or organs. Causes of enterocutaneous fistulas can be summarized by the mnemonic "FRIEND." The "FRIENDs" of a fistula include Foreign body, Radiation, Infection, Epithelialization, Neoplasm, and Distal obstruction.|