A fistula is an abnormal connection between an organ and another structure. Fistulas develop when an organ becomes inflamed or injured. The most common location for a fistula is around the anus. Over half of fistulas form in this location. The second most common location is between 2 loops of intestine. Fistulas can also form between the:. Perianal fistulas are subclassified by their location and complexity Figure 1. These are the internal and external sphincters. Fistulas can form across 1 or both sphincters Figure 2. Some fistulas start high up in the rectum and do not cross the sphincters at all.
Who's at risk
Anorectal complaints are not uncommon in pediatric care, but the etiology and management can differ significantly from adults. Age is an important factor when considering etiology and management, distinguishing between infants, children, and adolescents. For all ages, malignancy is rarely a consideration, but a thorough examination of infants and children typically requires deep sedation or general anesthesia. Very little primary literature or evidence exists to guide care; so there are many opportunities for careful study to enhance our understanding beyond personal experience and historical practice patterns. Hemorrhoid is the most common purported anorectal diagnosis for pediatric patients referred for evaluation by a surgeon. However, the incidence of hemorrhoids in the pediatric population is exceedingly low and an alternative explanation is often identified. A general concern in the evaluation of reported pediatric hemorrhoids is the identification of alternate soft tissue growths, which may have been misinterpreted as hemorrhoids, particularly rectal polyps, skin tags, and anal condylomata.
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Perianal fistula surgery can damage the anal sphincters which may cause faecal incontinence. By measuring regional pressures, 3D-HRAM potentially provides better guidance for surgical strategy in patients with perianal fistulas. A group of 30 patients without fistulas served as controls. Data regarding demographics, complaints, previous perianal surgical procedures and obstetric history were collected. Fistula tract areas detected with 3D-EUS were analysed with 3D-HRAM by visual coding and the regional pressures of the corresponding and surrounding area of the fistula tract areas were measured. Forty patients 21 males, mean age 47 were included. The mean resting pressure of the fistula tract area was significantly lower compared to the surrounding area 47 vs.
The anal canal is the end part of the intestinal tract. It includes the rectum and anus. Sometimes an abnormal passage forms from the anal canal to the skin near the anus. This is called an anal fistula. Anal fistulas can also form from the anal canal to other organs, such as the vagina or urinary tract. An anal fistula most often happens from an anal gland that has developed a pus-filled infection abscess. Or it may happen after radiation therapy for cancer. Injury to the anal canal and surgery can also cause anal fistulas.