A 26-year-old female patient presents to the clinic with a painful perianal swelling that has been present for the last three days. On examination under anesthesia, she is found to have a low fistula in ano.
The treatment of choice for this patient is:
A. Incision and drainage
B. Incision, drainage, and fistulotomy
C. Incision, drainage, and seton insertion
D. Incision and drainage followed by MRI
The Correct Answer is: B. Incision, drainage, and fistulotomy
Explanation:
Incision, drainage, and fistulotomy:
The treatment of choice for a low fistula in ano, as described in the scenario, is typically incision, drainage, and fistulotomy. This procedure involves opening the fistula tract to allow it to heal from the inside out. The fistulotomy provides definitive treatment by removing the fistulous tract and allowing the area to heal, reducing the likelihood of recurrence. For a low fistula, this approach is usually effective and can be done with minimal risk of incontinence.
Explanation of Incorrect Options:
A. Incision and drainage:
While incision and drainage are necessary to manage the acute abscess associated with a fistula, it is not definitive treatment for a fistula in ano. This approach alone would not address the fistula tract and could lead to recurrence of the abscess.
C. Incision, drainage, and seton insertion:
Seton insertion is typically used for higher or more complex fistulas where there is a concern about preserving continence or where a staged approach to fistula treatment is necessary. In the case of a low fistula, a fistulotomy is usually sufficient.
D. Incision and drainage followed by MRI:
MRI can be useful in complex cases or when the extent of the fistula tract is unclear. However, in the case of a low fistula in ano, MRI is not typically required for initial management. Definitive treatment with fistulotomy can be performed based on the findings during examination under anesthesia.
Given these considerations, incision, drainage, and fistulotomy (Option B) is the treatment of choice for a low fistula in ano as described in the scenario.