Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management
Objectives: Extreme horseshoe anal fistulas are rare, and there are little data on the diagnosis and management of these fistulas. Materials and Methods: Patients with horseshoe anal fistula, in which the fistula tract encircled more than 75% of the anal circumference were included in the study. All...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Tzu-Chi Medical Journal |
| Subjects: | |
| Online Access: | http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2021;volume=33;issue=4;spage=374;epage=379;aulast=Garg |
| _version_ | 1819117569741684736 |
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| author | Pankaj Garg Baljit Kaur Vipul D Yagnik Geetha R Menon |
| author_facet | Pankaj Garg Baljit Kaur Vipul D Yagnik Geetha R Menon |
| author_sort | Pankaj Garg |
| collection | DOAJ |
| description | Objectives: Extreme horseshoe anal fistulas are rare, and there are little data on the diagnosis and management of these fistulas. Materials and Methods: Patients with horseshoe anal fistula, in which the fistula tract encircled more than 75% of the anal circumference were included in the study. All patients were assessed by a preoperative magnetic resonance imaging (MRI). The patients were managed by a sphincter-sparing procedure. The continence was evaluated by an objective continence scoring system (Vaizey's scores). Results: 1059 anal fistula patients were operated on over 7-years with a median follow-up of 36 months (range: 5–79 months). There were 47/1059 (4.4%) patients with extreme horseshoe anal fistulas. In 4/47 patients, the fistulas were complete circumanal (encircling anal canal completely). The mean age was 39.5 ± 10.9 years, M/F-41/6. The fistula was supralevator in 12/47 (25.5%), had an associated abscess in 28/47 (59.6%), and was recurrent in 33/47 (70.2%) patients. The tracts were intersphincteric in 27/47, transsphincteric in 2/47, and both (intersphincteric and transsphincteric) in 18/47 patients. All patients (n = 47) were managed by a sphincter-sparing procedure. Four patients were lost to follow-up. The fistula healed completely in 34/43 (79%) patients. There was no significant difference between preoperative and postoperative Vaizey's continence scores 0.031 ± 0.17 and 0.033 ± 0.18 respectively (P=0.90, Mann–Whitney U-test). Conclusion: Extreme horseshoe fistulas are rare, with an incidence of about 4% (in a referral practice). The missed diagnosis of circumferential tracts could lead to a recurrence. MRI was pivotal to confirm the diagnosis. Proper identification and management of internal opening and adequate drainage of all tracts were crucial for successfully treating extreme horseshoe fistulas. |
| first_indexed | 2024-12-22T05:35:04Z |
| format | Article |
| id | doaj.art-0c057ea41ca4427d8be9c43bb395f2e7 |
| institution | Directory Open Access Journal |
| issn | 1016-3190 2223-8956 |
| language | English |
| last_indexed | 2024-12-22T05:35:04Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Tzu-Chi Medical Journal |
| spelling | doaj.art-0c057ea41ca4427d8be9c43bb395f2e72022-12-21T18:37:20ZengWolters Kluwer Medknow PublicationsTzu-Chi Medical Journal1016-31902223-89562021-01-0133437437910.4103/tcmj.tcmj_287_20Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and managementPankaj GargBaljit KaurVipul D YagnikGeetha R MenonObjectives: Extreme horseshoe anal fistulas are rare, and there are little data on the diagnosis and management of these fistulas. Materials and Methods: Patients with horseshoe anal fistula, in which the fistula tract encircled more than 75% of the anal circumference were included in the study. All patients were assessed by a preoperative magnetic resonance imaging (MRI). The patients were managed by a sphincter-sparing procedure. The continence was evaluated by an objective continence scoring system (Vaizey's scores). Results: 1059 anal fistula patients were operated on over 7-years with a median follow-up of 36 months (range: 5–79 months). There were 47/1059 (4.4%) patients with extreme horseshoe anal fistulas. In 4/47 patients, the fistulas were complete circumanal (encircling anal canal completely). The mean age was 39.5 ± 10.9 years, M/F-41/6. The fistula was supralevator in 12/47 (25.5%), had an associated abscess in 28/47 (59.6%), and was recurrent in 33/47 (70.2%) patients. The tracts were intersphincteric in 27/47, transsphincteric in 2/47, and both (intersphincteric and transsphincteric) in 18/47 patients. All patients (n = 47) were managed by a sphincter-sparing procedure. Four patients were lost to follow-up. The fistula healed completely in 34/43 (79%) patients. There was no significant difference between preoperative and postoperative Vaizey's continence scores 0.031 ± 0.17 and 0.033 ± 0.18 respectively (P=0.90, Mann–Whitney U-test). Conclusion: Extreme horseshoe fistulas are rare, with an incidence of about 4% (in a referral practice). The missed diagnosis of circumferential tracts could lead to a recurrence. MRI was pivotal to confirm the diagnosis. Proper identification and management of internal opening and adequate drainage of all tracts were crucial for successfully treating extreme horseshoe fistulas.http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2021;volume=33;issue=4;spage=374;epage=379;aulast=Garganal fistulacircumferentialextremehorseshoeincontinencemagnetic resonance imaging |
| spellingShingle | Pankaj Garg Baljit Kaur Vipul D Yagnik Geetha R Menon Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management Tzu-Chi Medical Journal anal fistula circumferential extreme horseshoe incontinence magnetic resonance imaging |
| title | Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management |
| title_full | Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management |
| title_fullStr | Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management |
| title_full_unstemmed | Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management |
| title_short | Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management |
| title_sort | extreme horseshoe and circumanal anal fistulas challenges in diagnosis and management |
| topic | anal fistula circumferential extreme horseshoe incontinence magnetic resonance imaging |
| url | http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2021;volume=33;issue=4;spage=374;epage=379;aulast=Garg |
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