Anorectal Fistula

Nihal K. Patel, MD and David A. Greenwald, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • An open communication between anal canal and perirectal skin

  • Anorectal fistulas typically form from an abscess of the anal crypt glands.

  • In patients with perianal Crohn disease, perire...

DIAGNOSIS

HISTORY

  • Perianal pain, pruritus, purulent (often malodorous) perianal drainage, and perirectal skin lesions

  • Intermittent rectal pain worse with defecation/sitting

  • Fever most common with abscess...

TREATMENT

GENERAL MEASURES

  • Surgical treatment is definitive (1)[A].

  • Optimal surgical treatment is based on fistula classification.

  • Goals of treatment are to eliminate the inflammatory process, maintain c...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Resumption of activity as tolerated after surgery 

Patient Monitoring

Anoscopy at 3 and 6 months following procedure; frequent follow-up to ensure complete healing ...

REFERENCES

Whiteford MH, Kilkenny JIII, Hyman N, et al; for Standards Practice Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of perianal abscess and...

ADDITIONAL READING

  • Cirocchi R, Farinella E, La Mura F, et al. Fibrin glue in the treatment of anal fistula: a systematic review. Ann Surg Innov Res.  2009;3:12.

  • Jacob TJ, Perakath B, Keighley MR. ...

SEE ALSO

Anorectal Abscess; Crohn Disease 

CODES

ICD10

  • K60.5 Anorectal fistula

  • K60.3 Anal fistula

  • K60.4 Rectal fistula

ICD9

565.1 Anal fistula 

SNOMED

  • 72779005 Anorectal fistula

  • 197155003 intersphincteric fistula (disorder)

  • 261827001 high anal fistula ...

CLINICAL PEARLS

  • Suspect anorectal fistula in patients with perianal pain, pruritus, purulent drainage, and perirectal skin lesions.

  • Surgery is the traditional mainstay of treatment for patients who do ...

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