Fistulas are abnormal connections between organs or tissues. An anal fistula is a small tunnel connecting the anus to the skin around the anus. About 50% are caused by anorectal abscesses. There are several types including anorectal, rectovaginal, and colovaginal fistulas. Diagnosis involves a physical exam, imaging like MRI, and procedures like anoscopy. Treatment depends on location and severity, and may include antibiotics, surgery like fistulotomy or LIFT procedure to remove the fistula.

1. FISTULAS
T.Haripriya
Tutor
AACON

2. Fistulas
• Definition:
• It is an abnormal connection between an organ, vessel, or
intestine and another structure.
• An anal fistula is a small tunnel that connects an infected gland inside
the anus to an opening on the skin around the anus.
• An anal fistula is an abnormal connection leading from the anus or
rectum.

3. INCIDENCE
• About 50% of anal fistulas are due to anorectal abscess.
• Anal fistulas extend to the outside of the skin, vagina, or buttocks
and often precedes an abscess.

5. TYPES
• Ano rectal Fistula
• Recto vaginal or Ano vaginal Fistula
• Colo vaginal Fistula

6. TYPES
• Anorectal Fistula: It occurs between the anal canal and the skin around
the anal opening.
• Rectovaginal or Anovaginal Fistula: Is a hole develops between the rectum
or anus and the vagina.
• Colovaginal Fistula: It occurs between the colon and the vagina.

7. Causes
• Crohn’s disease (an inflammatory disease of the intestine)
• Radiation (treatment for cancer)
• Trauma
• Sexually transmitted diseases
• Diverticulitis (a disease in small pouches form in the large intestine and
become inflamed)
• Rectal Cancers.

8. Pathophysiology
Due to etiological factors
Obstruction of the anal canal
Stasis and bacterial growth of anal gland
Abscess formation
Chronic phase develop
Anal fistula

9. Signs & symptoms
• Skin irritation around the anus area
• Skin redness around the anus
• Pain in the anal region which might worsen during walking, sitting or
coughing
• Fatigue
• Fever with chills
• Foul smell
• Pain during bowel movement
• Bleeding from rectum

10. Diagnostic evaluation
• History collection
• Physical examination: Rectal Examination
• An anoscopy is an instrument used to visualize the the anus and rectum.
• Ultrasound or MRI of the anal area to get a better view of the fistula
tract.
• A colonoscopy is a flexible, lighted instrument is inserted into the colon
via the anus to visualize the internal organs of the colon.
• It is performed under conscious sedation, a type of light anesthetic.

11. Medical Management
• Treatment vary depending on their location and severity of symptoms
• Antibiotics
• Immunosuppressant's like 6-Mercaptopurine

12. Surgical Management
Fistulotomy
• The most common type of surgery for anal fistulas is a fistulotomy,
involves cutting along the whole length of the fistula to open it up so
it heals as a flat scar.

14. Surgical Management
• Advancement flap procedure
• This involves cutting or scraping out the fistula and covering the hole
it entered the bowel with a flap of tissue taken from inside the
rectum, which is the final part of the bowel.

15. Surgical Management
LIFT procedure
• The Ligation of the Intersphincteric Fistula Tract (LIFT) procedure is a
treatment for fistulas that pass through the anal sphincter muscles.
• Is based on secure closure of the internal opening and removal of
infected cryptoglandular tissue through the intersphincteric approach.
• During the treatment, a cut is made in the skin above the fistula and
the sphincter muscles are moved apart.

16. (a) High ligation of the anal fistula tract by the
lateral approach (b). The arrows indicate the
direction of the dissection.

17. Surgical Management
• Advancement flap procedure
• This involves cutting or scraping out the fistula and covering the hole
it entered the bowel with a flap of tissue taken from inside the
rectum, is the final part of the bowel.

18. Surgical Management
• LIFT procedure
The ligation of the inter sphincteric fistula tract (LIFT) procedure is a
treatment for fistulas that pass through the anal sphincter muscles.
• During the treatment, a cut is made in the skin above the fistula and
the sphincter muscles are moved apart.

19. Prevention
• Consuming a fiber-rich diet
• Maintain clean and dryness in the anal region.
• Avoid straining while stool passing
• Regular exercises