Fistula In Ano Case Study

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Introduction: A fistula is defined as a pathologic tract connecting two hollow organs, or one hollow organ and the skin. Fistula in Ano is a benign condition but may causing considerable distress to the patient and difficulty for surgeons. Fistula in Ano effects approximately ten individuals in 100,000, with male predominance, higher abundance of anal glands is thought to be the partial reason. The infected gland leads to fistula formation after some time, which starts as an abscess. There are, of course, other causes include chronic ulcerative colitis, Crohn's disease, tuberculosis, carcinoma of the rectum or anal canal, benign rectal strictures, foreign bodies or diverticulitis.
Parks at el explicate the primary tracts as following four
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is based on the location of its tract in relation to anal sphincter muscle: intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric.[2] Idiopathic fistula-in-ano most commonly occurs in healthy subjects, with cryptoglandular infection being the most widely accepted etiologic factor. The anal crypt gland penetrates the anal sphincter to varying degrees. Once obstructed, infection will ensue and suppuration will follow the least resistant path, which accordingly determines the location of the abscess (perianal, ischiorectal, inter-sphincteric) and the type of fistula [3]. Other common causes of anal fistula include chronic ulcerative colitis, Crohn's disease, tuberculosis, carcinoma of the rectum or anal canal, benign rectal strictures, foreign bodies or diverticulitis. Preoperative assessment and planning is very important. Medical history and physical examination are most important in the assessment phase. Management of fistula-in-ano demands accurate diagnosis followed by removal of tracts with preservation of continence function of anal sphincter. Magnetic resonance imaging (MRI) has become an integral part of the assessment of fistula as it can distinguish between sepsis and granulation tissue from sphincter muscles [4]. Properly performed MRI can be regarded as the “investigation of choice” for preoperative assessment, replacing surgical examination under anesthetic (EUA) in this regard. Although, endoanal ultrasonography is used by many surgeons in the preoperative workup of anal fistulas, MRI is generally superior to endoanal ultrasonograhy [5]. MRI helps not only to accurately demonstrate disease extension but also to predict prognosis, make therapy decisions, and monitor therapy.[6] we found MRI very informative and useful in accurately diagnosing different types of

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