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Published on : Mar 14, 2014
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Slide 1 - ANORECTAL ABSCESSES AND FISTULA-IN-ANO
Slide 2 - INTRODUCTION Both abscess and fistula-in-ano can be considered simultaneously. The abscess is an acute manifestation, and the fistula is a chronic condition.
Slide 3 - ETIOLOGY Nonspecific : Cryptoglandular in origin. Specific : Crohn’s Ulcerative colitis TB Actinomycosis Carcinoma Trauma Radiation Foreign body Lymphoma Pelvic inflammation Leukemia
Slide 4 - PATHOGENESIS The cryptoglandular hypothesis states that infection of the anal glands associated with the anal crypts is the primary cause of anal fistula and abscess.
Slide 5 - ppt slide no 5 content not found
Slide 6 - CLASSIFICATION
Slide 7 - TREATMENT Incision and drainage. Determine the most tender point, a 2 cm area of skin is injected with local freezing. Eliptical or cruciate incision. Drainage of pus. Destroy all loculations.
Slide 8 - ANTIBIOTICS Immunosuppression. Valvular disease. Diabetics. Extensive disease Systemic manifestation.
Slide 9 - CLASSIFICATION
Slide 10 - Intersphincteric fistula
Slide 11 - Transsphincteric fistula
Slide 12 - Suprasphincteric fistula
Slide 13 - Extrasphincteric fistula
Slide 14 - Evaluation of Anal Fistula An accurate preoperative assessment of the anatomy of an anal fistula is very important. Five essential points of a clinical examination of an anal fistula : (1) location of the internal opening. (2) location of the external opening. (3) location of the primary track . (4) location of any secondary track. (5) determination of the presence or absence of underlying disease .
Slide 15 - Goodsall’s rule
Slide 16 - TREATMENT The objective is to cure with lowest possible recurrence rate and minimal, if any, alteration in continence, shortest period. The principles are: 1- Identification of the primary opening. 2- Relationship to puborectalis 3- Least amount of muscles should be divided. 4- Side tracts should be sought, 5- Presence of underlying disease.
Slide 17 - Fistulotomy/fistulectomy The laying-open technique (fistulotomy) is useful for 85-95% of primary fistulae . Curettage is performed to remove granulation tissue. Marsupialization of the edges to improve healing times.
Slide 18 - Setons in the Management of Difficult Fistulas
Slide 19 - ppt slide no 19 content not found