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Tuesday, July 21, 2009


Posted by Prahallad Panda on 9:02 PM Comments

Cassia fistula flower - פרח כסית האבוב
                           This is a very nasty disease to me.Somehow I am not comfortable to treat this one.Patient comes with a painful swelling near to anus,fever and prostration .On examination a painful swelling will be found near the anal opening.Once drained a large amount of foul swelling pus will  come out and relief the patient to a considerable extent. And this cycle goes on unless the patient is not  throughly investigated for possibility of Fistula-In-Ano.
It is a condition where there is build up of a   tunnelled connection ,of course small in caliber between interior of lower gut and the exterior i.e. skin.This occurs from an infection of anal glands located inside the anus and rectum and gradually enlarge to burst to the out side.With  passing of time the inside of the fistula or tunnel matures and continuously discharges pus.That is why I call a nasty disease.
Fistula may also manifestation of some diseases like TB,Ulcerative Colitis,Chron's Disease ,A rectal cancer and some other diseases.These are of various types and classified in various manner.
                                                                         Most accepted being superficiel,deep,intershincteric,transphencteric and high etc.which is required for the treating doctors.Treatment of more complex fistulas are not very much satisfactioy.A fistulogram gives good idea of it's extension to help in operation.Besides trans rectal ultrasonogram is helpful.Tuberculosis if suspected should be searched for the primary site of infection .A simple per rectal examination is helpful to supect a cancer inside.
Surgery is the option for most of fistulas except TB and some other diseases.Here the whole tract is excised leaving a raw area to heal from the depth. And if dressing done properly and wound heals fromthe depth probably the surgeon should be able to sleep cmfortably.The excised specimen is to be subjected to histopathological study to exclude associated cancer and TB in the  tract.And in that case furhter treatment for the specific disease to be taken up.

Most common complication of surgery is inardverent injury to the anal sphincture making the patient incompetent to hold faecal matter.And the next is recurrance.
So this surgey many times brings down the ranking of the surgeon's popualrity.People taking non-veg diet and suffering fron constipation are prone for this disease.

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