HWN Suggests

Anorectal Infection: Abscess–Fistula

The treatment of an anorectal abscess is early, adequate, dependent drainage. The treatment of a fistula, although surgical in all cases, is more complex due to the possibility of fecal incontinence as a result of sphincterotomy. Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula. So even though the aim of a surgical procedure is to cure a fistula, conservative management short of major sphincterotomy is warranted to preserve fecal incontinence. However, trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap,…

read full article

Articles of Interest

Abscess and Fistula Expanded Information

Currently, there is no medical treatment available for this problem and surgery is almost always necessary to cure an anal fistula. If the fistula is straightforward (involving minimal sphincter muscle), a fistulotomy may be performed.

Anal Abscess & Fistula

Unfortunately, up to 50% of abscesses may re-present as another abscess or as a frank fistula at some point in one's lifetime. Despite proper treatment and apparent complete healing, fistulas can potentially recur, with recurrence rates dependent upon the particular surgical technique utilized.

Anal abscess & anal fistula

An anal fistula usually develops after an anal abscess (a collection of pus) bursts, or when an abscess has not been completely treated. After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin. If this occurs, persistent drainage from the outside opening may indicate the persistence of this tunnel. If the outside opening of the tunnel heals, recurrent abscess may develop. A fistula can also be caused by conditions that affect the intestines, such as Crohn's disease or ulcerative colitis. As many as 50% of people with Crohn’s disease get an anal fistula. Up to 30% of people with HIV (a virus that attacks the body's immune system) will also develop an anal fistula.

Anal Fistulotomy

An anal fistula (anorectal fistula) is one of the most common colorectal issues in the U.S. An anal or anorectal fistula is an inflammatory tract or connection between the anal canal and the perianal skin. Classic anal fistulas are the result of a perineal infection and abscess formation. These infections arise from the anal glands, which form a cryptoglandular abscess at the dentate line and then communicate outward to the perianal skin

Under pressure: Anorectal abscesses… to drain or not to drain?

A word on fistulas - Fistulas are a connection between two epithelium-lined surfaces, characterized by persistent or recurrent anal drainage. They are seen in Crohn’s, TB, cancer, FB reactions, and as a complication of anorectal abscesses. Treatment is surgical. ~50% of anorectal abscesses form a fistula overtime. Suggest surgical consultation after drainage of perianal abscess as fistula formation is common. Fistulas may be missed on CT scan; MRI is more sensitive for diagnosis.

Resources

StatPearls

Fistula-in-ano often occurs following anorectal abscess. An anorectal abscess occurs when an anal gland becomes obstructed, resulting in infection and abscess formation. The infection is located near the sphincter complex, and therefore the fistula can traverse the sphincters

Teachme Surgery

There are multiple surgical management options available, depending on the tract anatomy.