fistula.pptx

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.

4. TYPES Ano rectal Fistula Recto vaginal or Ano vaginal Fistula Colo vaginal Fistula

5. 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.

6. 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.

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

8. 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

9. 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.

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

11. 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.

12. 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.

13. 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.

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

15. 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.

16. 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.

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