Our Summary

This research paper discusses a unique medical case of a 36-year old man who was initially believed to have an anal fistula, a common condition often caused by an abscess. Upon surgery, it was discovered that the patient actually had a rarer condition called pilonidal disease, which was acting like an anal fistula. The patient also had a second anal fistula at the back.

The surgical team decided to perform two surgeries to treat the patient. First, they removed the front fistula and drained the abscess, while also placing a seton (a piece of surgical thread) for the back fistula. After a month, once the seton had fallen out, indicating that the back fistula had healed, they removed the remaining pilonidal sinus.

The team learned from this case that pilonidal disease can sometimes be misdiagnosed as an anal fistula, which presents a challenge in treatment. They concluded that a two-step surgical approach worked well in this case, as it not only helped remove the disease but also facilitated healing without any major complications or recurrences.

FAQs

  1. What was the unique condition the patient was found to have during surgery?
  2. What two-step surgical approach did the team use to treat the patient’s conditions?
  3. How did the surgical team determine when the back fistula had healed?

Doctor’s Tip

A helpful tip a doctor might give a patient about anal fistula surgery is to follow post-operative care instructions carefully to ensure proper healing and reduce the risk of complications. This may include keeping the surgical area clean and dry, taking prescribed medications as directed, avoiding strenuous activities that could strain the area, and attending follow-up appointments with the healthcare provider. It is also important to report any unusual symptoms or signs of infection to the healthcare provider promptly.

Suitable For

Anal fistula surgery is typically recommended for patients who have persistent symptoms such as pain, swelling, discharge, and recurrent infections associated with an anal fistula. Patients with complex or recurrent fistulas, as well as those with multiple fistulas or fistulas that are close to important structures such as the sphincter muscles, may also be recommended for surgery.

In cases where conservative treatments such as antibiotics, drainage, and seton placement have not been successful in resolving the symptoms, surgery may be considered as a treatment option. The goal of surgery for anal fistulas is to remove the fistula tract, prevent recurrence, and preserve continence.

It is important for patients to undergo a thorough evaluation by a colorectal surgeon to determine the appropriate treatment plan for their specific condition. The type of surgery recommended will depend on the location, complexity, and characteristics of the anal fistula, as well as the overall health and preferences of the patient.

In conclusion, patients who experience persistent symptoms associated with an anal fistula may be recommended for surgery to effectively treat the condition and prevent complications. A multidisciplinary approach involving colorectal surgeons, gastroenterologists, and other specialists may be necessary to provide comprehensive care for patients with anal fistulas.

Timeline

  • Patient experiences symptoms of anal fistula, such as pain, swelling, and discharge
  • Patient seeks medical advice and is diagnosed with anal fistula
  • Patient undergoes surgery to remove the front fistula and drain the abscess
  • A seton is placed for the back fistula to aid in healing
  • After a month, the seton falls out, indicating healing of the back fistula
  • The remaining pilonidal sinus is removed in a second surgery
  • Patient recovers from surgery with no major complications or recurrences.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery include:

  1. What is the specific type of anal fistula or condition I have, and how does it differ from other similar conditions like pilonidal disease?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the success rate of this type of surgery for treating anal fistulas?
  4. What is the expected recovery time and post-operative care plan?
  5. Will I need any additional procedures or treatments after the surgery?
  6. How long do you recommend I take off work or avoid certain activities following the surgery?
  7. Are there any dietary or lifestyle changes I should make to promote healing and prevent recurrence?
  8. How often will I need follow-up appointments after the surgery?
  9. What signs or symptoms should I watch for that may indicate a complication or recurrence of the fistula?
  10. Are there any alternative treatment options or medications that may be beneficial in my case?

Reference

Authors: Eberspacher C, Mascagni D, Fralleone L, Grimaldi G, Antypas P, Mascagni P, Maturo A, Di Matteo FM, Pontone S, Pironi D. Journal: G Chir. 2017 Nov-Dec;38(6):313-317. doi: 10.11138/gchir/2017.38.6.313. PMID: 29442064