A 35-year-old male presents to the surgical clinic with a history of persistent pain and discharge near the anal region. He reports that the symptoms began after an episode of a painful swelling near his anus, which eventually burst spontaneously, releasing pus. On examination, there is an external opening near the anal verge with purulent discharge. Digital rectal examination (DRE) reveals a firm area consistent with an internal opening. The clinical team suspects a fistula in ano.
Which of the following statements about fistula in ano is correct?
A. The internal opening is felt as a firm area on digital rectal examination (DRE).
B. It results from an anorectal abscess that bursts spontaneously.
C. It is defined as a tract between the anal canal and the perineal skin.
D. Treatment involves laying open the tract.
E. All are correct.
The Correct Answer is: E. All are correct
Explanation:
– Internal Opening on DRE (A): In a fistula in ano, the internal opening can often be felt as a firm or indurated area during a digital rectal examination (DRE). It may feel like a small nodule or area of induration, which corresponds to the internal communication of the fistulous tract.
– Result from Anorectal Abscess (B): Fistula in ano typically results from an anorectal abscess that has either burst spontaneously or been drained surgically. The abscess leads to the formation of a tract between the anal canal and the perineal skin.
– Defined as a Tract (C): A fistula in ano is indeed defined as an abnormal tract or connection between the epithelialized surface of the anal canal and the perineal skin. This definition accurately describes the pathology.
– Treatment (D): The standard treatment for a simple fistula in ano often involves a surgical procedure called a fistulotomy, where the tract is laid open. This allows the tract to heal from the inside out and prevents recurrence.
Given that all the statements are accurate descriptions of fistula in ano, the correct answer is E. All are correct.