Anal Fistula

Persistent, purulent drainage from the perirectal region for 3 months prompted a 60-year-old man to seek medical evaluation. He also complained of minimal bleeding from the anus and perianal itching. The patient reported that he recently obtained some relief after a boil in the same area spontaneously burst.

Virendra Parikh, MD, of Fort Wayne, Ind, noted an external opening near the anus (A). An indurated cord-like structure (or tract) from the external opening toward the internal anal canal was revealed on palpation. Based on the clinical presentation, anal fistula was diagnosed.

Anal fistula, which results from a perianal abscess, connects the anal gland (from which the abscess arose) to the skin of the perianal region. Anal fistulotomy is necessary for cure. Because a fistula may result from bacterial infection, ulcerative colitis, diverticulitis, tuberculosis, and a number of other diseases, it is important to identify and treat the cause.

In this patient, a normal colonoscopy ruled out other diseases. During surgery, a metal probe was passed through the external opening and connected to the internal opening at the dentate line (B). The patient recovered uneventfully.