Perianal Abscesses and Fistulae Condition Notes| OSCEstop

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Causes of a fistula-in-ano include:

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Explanation of Correct Answer

Perianal haematoma: Not typically associated with the formation of a fistula-in-ano. It is usually a result of ruptured blood vessels near the anus.
Gastroenteritis: This condition affects the gastrointestinal tract and does not commonly lead to fistula-in-ano.
Rectal prolapse: This involves the protrusion of the rectal wall through the anus and is not a common cause of fistula-in-ano.
Haemorrhoids: These are swollen blood vessels in the rectum or anus and do not usually cause fistula-in-ano.
Crohn’s disease: Correct option. Crohn’s disease is a chronic inflammatory bowel disease that can cause inflammation and abscesses in the perianal region, leading to the formation of fistulas.

Overview of Fistula-in-Ano

A fistula-in-ano is an abnormal connection between the epithelialized surface of the anal canal and the perianal skin.
It often results from an anorectal abscess that has drained spontaneously or has been surgically drained but fails to heal completely.

Causes

Crohn’s disease: Chronic inflammation can lead to abscess formation and subsequent fistula development.
Anal abscess: Infection in the anal glands can lead to abscess formation and subsequent fistula.
Trauma: Injury to the anal region can result in fistula formation.
Radiation therapy: Can cause tissue damage and lead to fistula formation.
Infections: Tuberculosis and sexually transmitted infections can also lead to fistula-in-ano.

Symptoms

Persistent drainage: Pus or blood from an opening near the anus.
Recurrent abscesses: Frequent abscess formation in the perianal area.
Pain and swelling: Discomfort and swelling around the anus.
Fever: May occur if there is an ongoing infection.

Diagnosis

Clinical examination: Inspection and palpation of the perianal area.
Imaging: MRI or endoanal ultrasound to visualize the fistula tract.
Proctoscopy: To examine the anal canal and rectum.

Treatment

Surgical intervention: Fistulotomy or seton placement to open or drain the fistula tract.
Medical management: Antibiotics for infection and medications for underlying conditions like Crohn’s disease.
Fibrin glue or plugs: Minimally invasive options to close the fistula tract.

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Factors preventing spontaneous healing of a post-operative fistula include:

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