Study Of Clinical Presentation And Management Of Patients Presenting With Fistula- In –Ano
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 1
Abstract
Introduction: Fistula in ano is the common surgical problem prevalent worldwide and is also considered one of the commonest cause for a persistent sero-purulent discharge that irritates the skin in the neighborhood and causes discomfort. It forms a good majority of treatable benign lesions of rectum and anal canal. 90% or so of these cases are end result of cryptoglandular infection. Diagnosis of fistula in ano is made on the basis of complaints of the patients, physical examination and investigations. The only accepted treatment for fistula in ano today is surgery. Complications of fistula surgery are myriad and include faecal soilage, mucous discharge, varying degree of incontinence, recurrent abscess and fistula. Aims and ojectives: In this dissertation, a prospective study will be conducted to elicit the clinical presentation of fistula in ano, various modes of treatment and the complications associated with it. 50 cases of fistula-in-ano admitted to the surgery department, Guru Nanak Dev Hospital, Amritsar will be included in the study. Summary and conclusions: The incidence of fistula was observed more in males than females with a ratio of 9:1 occurring in middle age group, most commonly in the 3rd and 4th decade of life. The most common clinical presentation was perianal discharge in 100% of cases followed by pain, swelling and pruritus with incidence of 62%, 58% and 52% respectively. The average duration of disease was found to be 6.7 months approximately. Fistulogram does not provide any additional information other than identification of internal opening. The external opening was clinically seen in all the cases with internal opening palpated in 84% of cases and seen only in 50% of cases. The external opening was most commonly located posteriorly (66% cases) in relation to the anal verge. The most common histopathological finding is of non-specific chronic inflammation with very less incidence of tuberculosis. The most common treatment modality undertaken for low anal fistulas is fistulectomy with few cases of fistulotomy and anal advancement flaps. The treatment modality undertaken for high type of fistuals is fistulectomy with seton placement. Other advanced surgical methods could not be done because of lack of adequate resources and high equipment cost. The average duration of hospital stay was approximately 4 days in most cases due to early ambulation and very few complications. Proper antibiotic coverage, regular daily sitz bath and proper local care of wound, the average healing time by granulation was found to be 40.3 days with 52% of cases have their wound healed in 15-30 days .The incidence of mild pain was reported in almost all the cases. Transient incontinence (10%), wound infection (10%) and constipation (30%) were the complications reported in the early post-operative period. Minor stenosis (2%) and recurrence (2%) were among the delayed postoperative complications found in the 2nd and 3rd month of the post-operative period.
Authors and Affiliations
Dr. Sudershan Kapoor, Dr. Ashwani Kumar, Dr. Sahil Rally, Dr. Venita Kapoor, Dr. Amarbir Singh Sandhu
Keywords
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