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Anal Fistula

Fistula is an abnormal tunnel shaped communication between two tubular structures or a tubular structure and skin; anal fistula is tubular communication between end of bowel (anus) and the skin near the anus. Fistula results mainly from infection of the surrounding tissue of anus causing puss (abscess) formation when pus drains away a small channel leaves behind resulting in discomfort, skin irritation, throbbing pain, smelly purulent or bloody discharge near anus, swelling redness fever and if gets complicated can lead to bowel incontinence. Surgery is recommended in most cases. Diagnosis is based on history and clinical examination including: • Digital rectal examination: insertion of finger inside to check for the sign of fistula often involving dye injection to mark the location or inner opening of fistula • Proctoscopy : a telescopic examination with proper illumination • Other investigation: includes Ultarsonography, MRI (magnetic resonance imaging) ,CT –scan (computed tomography scan). Now the question is what causes such channel formation as mentioned above most fistula develop from anal abscess. They occur if the abscess does not heal properly ater puss drains away. Approximately one out of every two to four patient with anal abscess estimated to develop anal fistula. Other less common causes includes • Chrons disese: long term condition in which digestive system becomes inflamed (inflammatory bowl diseases).fistula in such conditions requires treatment of the underlying cause. Studies have identified a role in Crohn disease for fistula therapy with infliximab, with 50-60% response rates for perianal fistulas Adipose-derived stem-cell therapy is currently being studied for use in the treatment of Crohn fistula and other complex fistulas • Diverticulitis: in fectio of the small pouches that stick out of the side of the large intestine (colon) • Hidradenitis suppurative: a long term skin condition that causes abscesses and scarring • Inection with tuberculosis or HIV. • Complication resulting after surgery around anus.