Fistula of the rectum

Fistula of the rectum is a stroke, which is located under the skin in the anal area. He connects the affected anal gland and the skin near the anus. The causes of the development of a chronic inflammatory process that leads to fistula formation can be surgical intervention, rectal resection, trauma, cracks in this area and in 95% of cases - acute paraproctitis.

Not every patient with acute paraproctitis develops a fistula of the rectum. But if the abscess is opened, drained, but not completely removed by the outer gate to infect the infection, this will result in the purulent contents constantly flowing into the lumen of the fistula. All this will lead to the formation of infiltrates and cavities with pus, the outer walls of the fistulous course begin to sclerosis, and the inner walls are covered with a granulation tissue.

Initially, the inflamed gland swells, the pus formed looks for an exit through the loose fiber into the rectum and through the skin outward in the area of the anal opening. Thus, the inner and outer foramen of the fistula are formed. Clinically distinguish:

• Complete (external) fistula is accompanied by constant burning, suturing and pus during an exacerbation and a feeling of discomfort, inconveniences during defecation due to thickening of the skin during remission;
• Incomplete (internal) fistula of the rectum, the symptoms of which are such that during the period of remission it does not cause discomfort and almost does not manifest itself, but when the condition worsens, the patient's condition deteriorates sharply.

The disease proceeds undulating. An exacerbation is observed when the passages are blocked, when the patient is concerned about the pain in the anus, which is aggravated by defecation. The patient's fever, headache, sleep and potency suffer, the syphilis and periodic purulent discharge disturb. There is a strong irritation of the skin, burning and itching, so the patient needs frequent washing and a change of gaskets.

After opening the cavities, the well-being improves significantly, the inflammation decreases, the discharge becomes rare, the working capacity is restored. Long-term inflammatory processes in the pararectal tissue lead to complications of the fistula. There may come a deformation of the anal canal and a scar of sphincter muscles that disrupt normal functioning and lead to incontinence of the anal sphincter. In the most difficult and severe cases, malignant degeneration of the fistula can occur.

The diagnosis "fistula of the rectum" is made by a proctologist - a specialist who conducts a rectal finger examination on an armchair in an outpatient setting. After a certain preparation of the patient, the endoscopic examination of the large intestine is carried out to rectify the diagnosis - sigmoidoscopy. In this case, you can visually see the mucosa, take the tissue on a biopsy, make a differential diagnosis if you suspect a tumor.

If necessary, the external fistula is probed, and ultrasound examination - ultrasonography - is performed to determine the location of the fistulous site. To determine the direction of the strokes, localization of internal fistulas necessarily carry out fistulography. These studies help to confirm that the patient has a fistula of the rectum, or to exclude this diagnosis.

Conservative treatment is ineffective and is used as a prophylaxis for relapse in the postoperative period. Operative intervention is performed by specialists in a hospital, under general anesthesia or under epidural anesthesia. The type of operation depends on the location of the fistula in relation to the sphincter, the degree of scar tissue, the presence and quantity of purulent cavities in the cellulose. But in any case, when a patient has a fistula of the rectum, the operation is inevitable.

The most favorable is the postoperative period with intrasfincter fistulas. It is most difficult to technically carry out the operation for transfinctorial and extra-inflexional cases. It is especially difficult for complex branching of the passages, when it is necessary to completely excise the tissues that participate in fistula formation and maximize the function of the sphincter.

In the postoperative period, the patient must make bandages with levomycol, baths with manganese, later with chamomile or calendula. The process of complete healing lasts about a month.