DOI: http://dx.doi.org/10.18203/2349-2902.isj20203073

Clinical and diagnostic profile of patients with anal fistula: a cross sectional study from Vilasrao Deshmukh Government Institute of Medical Sciences, Latur, Maharashtra

Praffula V. Mahakalkar, Ganesh Swami, Halnikar Chandrashekhar S., Anant A. Takalkar

Abstract


Background: Anal fistulas are one of the commonest causes for a persistent discharge seropurulent in nature that irritates the skin in the neighbourhood and leads to discomfort. Fistula-in-ano is seen quite frequently in perirectal perianal suppuration. The objective of this study to study the clinical profile and diagnosis of anal fistula at surgical OPD of VDGIMS.

Methods: The present cross-sectional observational study was carried out in patients with fistula-in-ano admitted at surgical department of VDGIMS, Latur during the period of 2017-19 in 50 diagnosed patients. Data was analysed by using SPSS 24.0 version IBM USA.

Results: Majority of the patients with anal fistula were from 41-50 years age group i.e. 15 (30%) and males were predominantly affected 40 (80%) compared to females i.e. 10 (20%). Male to female ratio was 4:1. Perianal discomfort was the commonest symptom in all patients i.e. 100%. It is followed by perianal discharge complained by 54% and perianal itching in 38% cases. The anterior position of external opening is found to be significant (p<0.05). Fistulogram showed external opening in all patients i.e. 50 cases whereas internal opening in 46 (92%) cases. Findings of MRI revealed that anal fistula was intra sphincteric in 28 cases i.e. 56%, extra sphincteric in 2 cases i.e. 4% and trans sphincteric in 20 cases i.e. 40%.

Conclusions: Commonest age group affected in our study was 40-50 years with male predominance. Perianal discomfort and discharge were the commonest symptom. E. coli was the predominant organism isolated. Fistulogram and MRI is useful in detecting the aetiology of fistula in ano.


Keywords


Fistula in ano, Clinical presentation, Diagnosis

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References


Goligher JC, Duthie HL, Nixon HH. Fistula-in-ano. Chapter-7, Surgery of the anus, rectum and colon. 4th edn., London: Bailliere Tindall; 1980: 163-199.

Satyaprakash, Lakshmiratan V, Gajendran V. Fistula-in-ano treatment by fistulectomy, primary closure and reconstitution. Aust NZJ Surg. 1985;55:23-7.

Schuster MM, Ratych RE. Ano rectal disease. Chapter-94, Bockus gastroenterology. 5th edn., Vol.2, Williams S. Hanbrich, Fenton Schaffner, Philadelphia: W.B. Saunders Company; 1995: 1773-1789.

Choen SF, Williams NS. The anus and anal canal. Chapter-72, Bailey and Love’s short practice of surgery. 24th end., RCG Russel, Norman S. Williams, Christoper JK. Bustrode. London: Hodder Arnold; 2004: 1265-1268.

Nicholls RJ. Anal fistula. Br J Surg. 1992;79:197-205.

Russel TR. Anorectum Chapter-32, Current surgical diagnosis and treatment. 10th edn., Lawrence W. Way, A lange medical book. London: Prentice - Hall International Inc; 1994: 693-711.

Agarwal A, Bhat SK, Kumar V, Sodhi BS. Clinical Presentation and Management of Anorectal Abscess and Fistula-in-ano. Int J Scientific Study. 2017;5(5):54-5.

Bhargava, Sharma R, Kataria D, Malviya S, Ajay. Retrospective and prospective study of clinical profile of fistula in ano. Int J Surg Sci. 2020;4:7-9.

Gordon PH. Principles and Practice of Surgery for the Colon, Rectum and Anus. Informa Health Care. 2002: 245.

Akhtar M. Fistula in Ano-An Overview. JIMSA. 2012;25(1):53-5.

Corman ML, Fistula A. Colon and Rectal Surgery. 5th ed. Philadelphia, Pa: Lippincott Williams and Wilkins, Chapter 11; 2005.

Hancock BD. ABC of colorectal diseases. Anal fissures and fistulas. BMJ. 1992;304(6831):904-7.

Memon AA, Murtaza G, Azami R, Zafar H, Chawla T, Laghari AA. Treatment of complex fistula in ano with cable-tie seton: a prospective case series. ISRN Surg. 2011;2011:636952.

Choen S, Burnett S, Bartram CI, Nicholls RJ. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae. Br J Surg. 1991;78:445-7.

Buchanan G, Halligan S, Williams A, Richard C, Cohen G, Tarroni D, et al. Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet. 2002;360:1661-2.

Javitt FMC, Lovecchio JL, Javors B, Naidich JB, McKinley M, Stein HL. The value of MRI in evaluating perirectal and pelvic disease. Magn Reson Imaging. 1987;5:371-80.

McCourtney JS, Finlay IG. Setons in the surgical management of fistula in ano. Br J Surg. 1995;82(4):448-52.

Ramanujam PS, Prasad ML, Abcarian H. The role of seton in fistulotomy of the anus. Surg Gynecol Obstet. 1983;157(5):419-22.