tailieunhanh - Anal and rectal diseases explained - part 5

Vật lý kiểm tra cho thấy một lỗ nhỏ bên ngoài có hoặc không có hệ thống thoát nước (xem hình 1). Điều này có thể trông giống như một tổn thương da nhỏ. Theo nguyên tắc Goodsall, một đường ngang tưởng tượng được rút ra qua hậu môn, và tổn thương bên ngoài nhìn thấy trước dòng này sẽ mở ra trực tiếp từ các ống hậu môn (xem hình 2 và 3). | Chapter 3 Diagnosis Physical examination reveals a small external opening with or without drainage see Figure 1 . This may look like a tiny skin lesion. According to Goodsall s rule an imaginary transverse line should be drawn across the anus and an external lesion seen anterior to this line opens directly from the anal canal see Figures 2 and 3 . If the external opening is detected posterior to this line the fistula is more complex and tracks laterally around the anus prior to a midline posterior opening. Bidigital palpation with the index finger within the anal canal and thumb exterior to the anal canal may enable identification of the entire fistulous track. The internal opening of the fistula may be detectable using a proctoscope or flexible sigmoidoscope. Magnetic resonance imaging MRI and anorectal ultrasound are helpful in identifying the full extent of fistulous tracks. Some patients will require an examination under anesthesia. Figure 2. Goodsall s rule for finding the internal opening of an anal fistula based on the location of the external opening. When an imaginary line is drawn through the center of the anus external openings anterior to this line follow a radial straight path towards the anal canal. If the external opening is posterior to the line the fistulous tract will curve and leave the anal canal in the posterior midline. This is trial version 84 Perianal fistula Figure 3. Classification of perianal fistulas. Treatment Management of perianal fistulas is generally surgical. For low fistulas internal opening below the puborectalis muscle fistulotomy or opening of the fistula track following the insertion of a probe into the external opening is utilized. High fistulas internal opening above the puborectalis muscle often require closure of the internal opening and performance of an advancement flap. Drainage using a seton may also be performed. Some patients will require a diverting stoma following the repair of a high complex .