Case of Anal fistula

A 60 year old male presented to OPD with complaints of non resolving anal fistula with constant pus discharge and report is attached Management Advised for a surgeon opinion in this case Just thought to discuss with you all here, as option of Abs are very limited here in this case Kindly guide

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Pure case of anal fistula Mri Fistulactomy Tract maybe tuberculous or malignant HP must

Perianal fistula indicate that tract is well established There is a path for pus to come out Such fistula remain typically stable for long time What do you mean by stable? - Stable means that they do not give rise to severe spreading infection, they do not form new tracts, they do not cause aggressive disease The reason behind stability is that whether pus forms there is a opening through which it can come out, therefore it do not have chance to spread to new area. Besides there is a strong fibrosis present in the tract which is caused by our bodies immune reaction, the fibrosis acts as barrier for spread of infection Therefore, My approach to treatment is 1) Do not treat pus discharge with antibiotic, the pus discharge is benign and harmless 2) Use antibiotic only if there is pain and fever, which usually is absent in these cases 3) Treat them with surgical excision of fistula tract - Fistulectomy which give rise to lasting and permanent relief from symptoms

Valuable opinion

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Full track of fistula needs to be checked and excised. Antibiotics as per report

Treat with Amikacin & Imipenam. Tab Metronidazole 400 mg TDS Tab Ciprofloxacin 500 mg BD Tab Chymotrypsin + Trypsin TDS Ointment Anovate for LA Ointment Diltiazem 2% for LA Sitz Bath with Betadine ointment Do MR Fistulogram & MRI Pelvis. Advice Fistulectomy. Ayurvedic - Kshar Shutra Surgery is also effective.

Antibiotics are an unnecessary addition to routine incision and drainage of an uncomplicated abscess. They have not been shown to improve healing times or reduce recurrence rate. Antibiotics should be considered for patients with high-risk conditions such as immunosuppression, diabetes, extensive cellulitis, prosthetic devices, and high-risk cardiac, valvular, and anatomic conditions

Advice fistulogram According to fistulogram treatment

TT PT with. Imepenim AMIKACIN Metrogyl Hot dietz bath Decide fistulac tomy

Likely MDR species. Start sensitive antibiotics for 2 to 3weeks.

in ayurved, Kshar sutra procedure

FISTULA-ANAL kshar sutra treatment is successful

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