Fistula of the rectum is a stroke that is located under the skin in the anal region. It connects the affected anal gland and the skin near the anus. The causes of the development of a chronic inflammatory process, which leads to the formation of a fistula, can be surgery, resection of the rectum, trauma, fissure in this area, and in 95% of cases - acute paraproctitis.
Not every patient with acute paraproctitis develops a fistula of the rectum. But if the abscess is opened, drained, but the external gates are not completely removed to infect, this will lead to the purulent contents constantly entering the lumen of the fistula. All this will lead to the formation of infiltrates and cavities with pus, the outer walls of the fistulous course begin to sclerosize, and the inner walls are covered with granulation tissue.
Initially, the inflamed gland swells, the resulting pus looks for a way out through the loose fiber into the rectum and through the skin outward in the anus. This forms the inner and outer fistulous opening. Clinically distinguish:
- a complete (external) fistula is accompanied by a constant burning sensation, a sacrum and pus during an exacerbation period and a feeling of discomfort, inconvenience during bowel movements due to thickening of the skin during remission;
- incomplete (internal) fistula of the rectum, the symptoms of which are such that during the period of remission it does not cause discomfort and almost does not manifest itself, but with an exacerbation, the patient's condition deteriorates sharply.
The disease proceeds undulating. An exacerbation is observed with blockage of the passages, when the patient is concerned about pain in the anus, aggravated by bowel movements. The patient has a fever, a headache, sleep disturbance and potency suffers, the mother of pond and periodic purulent discharge are disturbing. Severe skin irritation, burning and itching appear, so the patient requires frequent washing and changing pads.
After opening the cavities, the well-being improves significantly, inflammation decreases, discharge becomes rare, and performance is restored. Prolonged inflammatory processes in pararectal fiber lead to complications of the fistula. Deformation of the anal canal may occur and a scar of sphincter muscles may form, which interfere with normal functioning and lead to incontinence of the anal sphincter. In the most complex and severe cases, malignant degeneration of the fistula can occur.
The diagnosis of “ rectal fistula ” is made by a proctologist - a specialist who conducts a rectal digital examination of the patient on a chair on an outpatient basis. After a certain preparation of the patient, an endoscopic examination of the large intestine , a sigmoidoscopy, is performed to clarify the diagnosis. In this case, you can visually see the mucous membrane, take a tissue for a biopsy, and make a differential diagnosis if a tumor is suspected.
If necessary, an external fistula is probed, and ultrasonography is performed to determine the location of the site of the fistulous course. To determine the direction of moves, the localization of internal fistulas, fistulography is mandatory. These studies help confirm that the patient has a fistula of the rectum, or to exclude this diagnosis.
Conservative treatment is ineffective and is used as a prophylaxis of relapse in the postoperative period. Surgery is performed by specialists in a hospital, under general anesthesia or under epidural anesthesia. The type of operation depends on the location of the fistula in relation to the sphincter, on the degree of scarring of the tissue, on the presence and amount of purulent cavities in the fiber. But in any case, when a fistula of the rectum is found in the patient, surgery is inevitable.
The most favorable postoperative period occurs with intrasphincter fistula. The most difficult to technically carry out the operation with transfinkter and extrasphincter cases. It is especially difficult with complex branching of the passages when it is necessary to completely excise the tissues that are involved in the formation of the fistula and maximize the sphincter function.
In the postoperative period, the patient needs to do dressings with levomikol, baths with potassium permanganate, later with chamomile or calendula. The complete healing process lasts about a month.