High anal fistula case treatment by kshar sutra

High anal fistula case treatment by kshar sutra with healing images

Fistula in ano treatment by kshar sutra in high anal fistula

Fistula in ano treatment by kshar sutra in high anal fistula with kshar sutra

Fistula in Ano Symptoms Diagnosis and Treatment

Fistula in Ano Symptoms Diagnosis and Treatment

A fistula-in-ano is a hollow tract lined with granulation tissue, connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Secondary tracts may be multiple and can extend from the same primary opening

Anal fistula, or fistula-in-ano, is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin.

Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into theanal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It then points to the surface again, and the process repeats.

A fistula is an abnormal communication between two epithelial surfaces. 
An epithelial surface is any part of the body that is covered by a special type of 
cells called “the epithelium”. Examples of such surfaces are the skin, the mucosa 
of the mouth, the mucosa of the bowel, the mucosa of the anal canal, the vagina 
etc.

A fistula in ano is an abnormal sinus track (or a fine tube), between the skin 
(external orifice of the fistula) and either an abscess or the anus / rectum 
(internal orifice of the fistula).

There is a relation between a perianal abscess and a fistula in ano: almost 
always a fistula develops as a result of an abscess.

As we describe in the chapter of “perianal abscess” any abscess tries to drain 
itself automatically to the nearest exit point. This could be the interior of the 
anus/rectum or the skin.

Once it is formed, a fistula will stay in place for as long as there is pus that 
requires drainage through its track. Therefore a chronic infection that drags 
on also perpetuates the related fistula.

Gallery Images of Fistula In Ano --

Fistula in Ano

Symptoms

Anal fistulae can present with many different symptoms:

• Pain
• Discharge — either bloody or purulent
• Pruritus ani — itching
• Systemic symptoms if abscess becomes infected

[edit]Diagnosis

Diagnosis is by examination, either in an outpatient setting or under anaesthesia (referred to as EUA — Examination Under Anaesthesia). The examination can be an anoscopy.

Possible findings:

• The opening of the fistula onto the skin may be seen
• The area may be painful on examination
• There may be redness
• An area of induration may be felt — thickening due to chronic infection
• A discharge may be seen
• It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula

Pilonidal cysts/sinuses are another condition in which infected perianal "holes" or openings may appear

Diagnosis of Fistula in Ano
Most fistulas have an easily identifiable external orifice which discharges pus or 
bloody fluid. However this orifice may close from time to time and on first 
examination may be missed. A lump of the skin around the anus often hides an 
underlying fistula orifice.

The methods to diagnose and image the fistula are:

• Examination under Anaesthetic (EUA)
  
• MRI Scan of the perineum
  
• Endorectal Ultrasound
  

Surgical Treatment of Fistula in Ano

• Fistulotomy: laying open of the fistula track.
  
• Fistulectomy: excision of the fistula track
  
• Advancement flap repair: this is a complex form of surgery, performed only by specialist colorectal surgeons and it consists of creation of a “flap” of rectal tissue which is used to cover the internal orifice of the fistula. It is performed only for persistent high fistulas and it carries a high risk of incontinence.
  

After either fistulotomy or fistulectomy there is an open wound left which is 
packed for a few days. Nursing care is required for a varied period of time which 
depends on the size of the wound and the degree of associated infection.
At some point dressings stop being necessary and the patient can continue 
treatment with salt baths.

There are two main complications after any surgery for fistula in ano:a.        Recurrence: in many cases a fistula will recur despite surgery. This is 
because, as explained above, infections in this area are difficult to eradicate and 
surgery is limited by the risk of incontinence.

Recurrence is common and can sometimes be very frustrating for both patient 
and surgeon. It is not unusual for some unfortunate patients to have to undergo 
many repeat examinations under anaesthetic (EUA) and fistulotomies. The 
placement of seton helps with keeping the local infection under control without 
having to do many repeat surgical drainages.
b.        Incontinence: Any type of surgery in the anal area can result in 
incontinence. This can be mild incontinence (for flatus only) or more severe 
(incontinence for stools). Incontinence is the result of either surgical damage or 
severe infection which destroys the sphincter.

The risk of incontinence has to be discussed with all patients prior to surgery. 
This risk is usually quite low (around 2-5%) but in case of complex high fistulas 
can be higher. Also the “flap advancement” operation may have a much higher 
risk of incontinence (around 20%).
Colostomy is sometimes necessary as a temporary measure if the infection 
does not settle. A colostomy for a few months diverts the flow of the faeces from 
the anus and allows for the sepsis to be treated. It can then be closed. Very few 
patients with fistula will need a colostomy.
Fibrin glue is a new treatment that has been useful in some cases. A biological 
glue is prepared either from the patient’s blood or from bovine blood (the latter is 
commercially available). Fibrin glue contains natural blood clotting products and 
when applied it forms a plug that seals off the fistula. Although some satisfactory 
results have been reported, its usefulness is limited by infection. In the presence 
of infection the glue fails to close the fistula.

Factors predisposing to fistula in ano are Crohn’s disease, radiotherapy, cancer etc., however in most cases no specific cause is found.

The life with a fistula can be normal if sepsis/infection is avoided. A patient can 
wear the seton for many months or a year or two without severe symptoms apart 
from occasional small discharge. Hot salt baths help to soothen and irrigate the 
area.

Although surgery is absolutely necessary at some point for every fistula, multiple 
operations without a specific aim, such as draining sepsis or laying open the 
complete fistula, do no always help and can lead to incontinence.

An MRI of the perineum-anus should be performed whenever new symptoms 
or serious flare-ups occur in order to identify new abscess cavities.
Most fistulas eventually settle, however they may take a long time until 
they do so! Only Kshar-Sutra is only process with 99.96% accuracy without any recurrence ,

Kshar-Sutra Is an Ayurvedic surgical process done by kshar-sutra ligation of fistula witch remove it completely