(Fistula in ano)
Under an anorectal fistula is defined as a tubular passage whose one opening in the anal canal opens, the other mostly in the skin around the anus. The symptoms consist of vaginal discharge and sometimes pain. The diagnosis is made in the investigation of the anus or a sigmoidoscopy. Therapeutically, a surgical procedure is often required.
(See also Clarification of Anorektalkrankheiten)
Under an anorectal fistula is defined as a tubular passage whose one opening in the anal canal opens, the other mostly in the skin around the anus. The symptoms consist of vaginal discharge and sometimes pain. The diagnosis is made in the investigation of the anus or a sigmoidoscopy. Therapeutically, a surgical procedure is often required. (See also the clarification of Anorektalkrankheiten) fistulas arise spontaneously or as a result of a drainage of a perirectal abscess. Predisposing causes represent the Crohn’s disease and tuberculosis Most fistulas originate in the anorectal crypts. others result from diverticulitis, tumors or injuries. Fistulas in children are usually congenital and are more common in boys. Rektovaginalfisteln usually arise in Crohn’s disease, obstetrical injuries, radiation therapy or cancer. Symptoms and complaints in the history are usually found recurrent abscesses with intermittent or continuous discharge. The discharge is purulent, bloody-serous or both. In addition, if there is an infection that fistulas are painful. In investigating one or more openings are usually found. Often a string-like transition is sampled. With a probe, one can examine the depth direction and often the primary opening of the passage. Diagnosis Clinical evaluation sigmoidoscopy The diagnosis of anorectal fistula is made clinically. A sigmoidoscopy should be followed when a suspected Crohn’s disease is (See diagnosis of Crohn’s disease). The hidradenitis suppurativa, the Pilonidalsinus, purulent skin and sinus fistulas urethroperineale must be differentiated from cryptogenic fistulas. Various surgical therapy methods Medical treatment if caused by Crohn’s disease In the past, the only effective therapy, surgery, wherein the primary opening and the entire transition exposed and be transformed into a “trench”. Partial cleavage of the sphincter may be necessary. If a significant portion of the sphincter must be severed, continence may be impaired. Alternatives to conventional surgery are promoting secretion tabs biological grafting and instillations of fibrin glue into the sinus tracts. More recently, the LIFT-operation (ligation of intersphincteric fistula tract procedure), in which the fistula is shared between the sphincter muscles, gained acceptance as an alternative to the preservation of continence. Due to delayed wound healing Fistelotomie is not advisable resulting from a Diarrh- or Crohn’s disease. In patients with Crohn’s disease is metronidazole and other appropriate antibiotics and immunosuppressive therapies have proven partially (s. Treatment of Crohn’s disease). Infliximab is effective in closing fistulas caused by Crohn’s disease.