ANAL FISTULA
Abnormal tube like passage from skin near anus into anal canal.
Causes
Ill-treated or neglected perianal abscess. Complication of Crohn's disease, ulcerative colitis or diverticular disease of the colon.
Clinical Manifestations
Pus or stool leak constantly from the cutaneous opening, itching and pain. (There is usually no pain until the opening becomes blocked and an abscess form in the track behind).
Medical Management
Fistulectomy (excision of the fistulous tract)
(The patient is usually placed in the lithotomy position, and the sinus tract is identified by inserting a probe into it or by injecting the tract with methylene blue solution. The fistula is dissected out or laid open by an incision from its rectal opening to its outlet. The wound is packed with gauze.)
Bowel rest to allow fistula to heal, possible faecal diversion temporarily.
Nursing Management
3-4 hours before the surgery, the perineum is shaved and the lower bowel evacuated thoroughly with several prescribed enemas. The last enema should return clear and should be evacuated entirely.
Assess the wound and administer medication as prescribed
