History taking
1. Most patients have a history of perianal rectal abscess. Meng Yong, Department of Anorectology, Jinan Hospital of Traditional Chinese Medicine
2. Repeated perianal pus flow and bleeding.
3. Local itching is often present.
Physical examination
1. 1 or more fistulae are seen around the anus, and a small amount of purulent or yellow water-like secretion overflows when squeezed, and a cord-like material can often be found entering the anal canal.
2. Most of the rectal finger examinations can be done in the anal canal or lower rectum to palpate the inner mouth, and the finger can feel the fistula when probing from the outer mouth with a probe.
Auxiliary examination
1. X-ray examination, chest fluoroscopy or photographs to exclude the presence of tuberculosis, if there is tuberculosis should be examined whether the local tuberculous anal fistula, fistulography can help to diagnose.
2. Proctoscopy, pay attention to the presence or absence of an internal opening and the distance of the internal opening from the anal verge.
Diagnosis and differential diagnosis
The diagnosis and differential diagnosis can be easily made based on the above history, physical examination or auxiliary examination.
Treatment principles
If there is inflammation in the external orifice of the fistula, a potassium permanganate bath can be used once a night and once after defecation, and surgery should be performed after the inflammation disappears.
The fistula should be found at the inner mouth of the fistula and the entire fistula should be removed or cut open in order to cure it.
(1) Fistulotomy: for fistulas below the levator muscle and the rectal ring of the anal canal and through the lower 1/3 of the ring.
(2) Threaded treatment: for fistulas above the anorectal ring or through the upper 2/3 of the ring.
(3) Fistulotomy: for low-level simple fistulas, all fistulas are removed.
(3) Tuberculous fistula: cure tuberculosis first, and then perform the treatment of anal fistula, otherwise it is easy to recur after surgery.
The efficacy criteria
1) Cure: removal of the lesion and disappearance of symptoms and signs. The incision is well healed.
2. improvement: the cause of the disease is clear and the symptoms improve after treatment.
Discharge criteria
Achieve the standard of clinical cure and improvement, incision healing, can be discharged.