Prevalencia de fístulas anorectales en pacientes que son atendidos por el servicio de coloproctología del Hospital Guayaquil. Estudios realizados en el Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón desde el mes de julio 2016 a junio 2017
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
Resumen
Se define como Fístula Perianal o Anorectal (FA) al trayecto inflamatorio con abertura externa cutánea, en la región perianal y una abertura interna o primaria en el canal anal. Por lo general se origina a partir de una infección criptoglandular o primaria que deriva en un absceso en el espacio interesfinteriano del canal anal. Generalmente todas las fístulas son de origen criptoglandular; los traumatismos, la enfermedad de Crohn, una afección maligna, la radiación o infecciones poco comunes como tuberculosis, actinomicosis y clamidosis también pueden producir fístulas. Un 80% de las Fístulas Anorectales es provocado por la infección criptoglandular y desarrollo de un absceso interesfinteriano, para lo cual un tacto rectal confirmaría su presencia. Hay otras causas, dentro de las cuales están la enfermedad de Crohn, tuberculosis, procesos inflamatorios pelvianos, traumas. Gran parte también se dan en pacientes que han recibido quimioterapia. Las Fístulas Anorectales son más frecuentes en hombres que en mujeres y la frecuencia de edad es entre los 30 a 50 años de edad. Pacientes con el antecedente de un absceso perianal están en riesgo en un 30% a 50% de las ocasiones. El cuadro común es la persistencia de abscesos frecuentes, seguidos de secreción intermitente o constante
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habituales. El material que drena es purulento o serosanguíneo. Y a su vez, puede Síntomas: Supuración perianal, prurito, ardor al defecar, dolor, sangrado. Este sangrado suele manchar la ropa interior, humedad perianal. Inspección: Uno o más orificios, por lo general en los márgenes del ano. Palpación: Necesariamente el trayecto de la fístula, consistencia y disposición recuerda la de un cordón resistente. Y también un área de infiltración próxima al orificio secundario. Tacto rectal: Corresponde a una induración en el sitio que corresponde al orificio primario, en la línea pectínea. Dentro de las Técnicas quirúrgicas se encuentran la Fistulotomía, que corresponde a la apertura longitudinal de todo el trayecto fistuloso. Que suele estar relacionado con una marsupialización de los bordes de la fístula, evitando el cierre en falso de la herida. Drenando el absceso se disminuye el riesgo de recurrencias y continuidad de una fístula, y la necesidad de una cirugía próxima. En las Fístulas Anorectales Complejas (afectan a más de la mitad del esfínter externo o tienen varios trayectos). La relación entre todas estas técnicas es la ausencia de sección del esfínter. La manera más sencilla se basa en el relleno del trayecto fistuloso, queriendo dejar cicatriz en el daño.
It is defined as Perianal or Anorectal Fistula (AF) to the inflammatory pathway with external cutaneous opening, in the perianal region and an internal or primary opening in the anal canal. Usually, it originates from a cryptoglandular or primary infection that leads to an abscess in the intersphincter space of the anal canal. Generally all fistulas are of cryptoglandular origin; Trauma, Crohn's disease, a malignant condition, radiation, or rare infections such as tuberculosis, actinomycosis, and chlamydia can also cause fistulas. 80% of Anorectal Fistulas are caused by cryptoglandular infection and the development of an interfunctional abscess, for which a digital rectal examination confirms their presence. There are other causes, among which are Crohn’s diseases, tuberculosis, pelvic inflammatory processes, and traumas. A large part also occurs in patients who have received chemotherapy. Anorectal Fistulas are more frequent in men than in women and the frequency of age is between 30 to 50 years of age. Patients with a history of perianal abscess are at risk in 30% to 50% of cases. The common picture is the persistence of frequent abscesses, followed by habitual intermittent or constant discharge. The material that drains is purulent or serosanguineous. And in turn, pain may occur in case of infection or if the orifice is closed. Symptoms: Perianal suppuration, pruritus, burning XVIII during defecation, pain, bleeding. This bleeding usually stains underwear, perianal moisture. Inspection: One or more holes, usually on the margins of the anus. Palpation: Necessarily the trajectory of the fistula, consistency and disposition, reminds that of a resistant cord. And also an infiltration area next to the secondary orifice. Rectal examination: Corresponds to an induration at the site corresponding to the primary orifice, on the pectineal line. Within the surgical techniques are the Fistulotomy, which corresponds to the longitudinal opening of the entire fistulous tract. Which is usually related to a marsupialization of the edges of the fistula, avoiding the false closing of the wound. Draining the abscess reduces the risk of recurrence and continuity of a fistula, and the need for a nearby surgery. In Complex Anorectable Fistulas (they affect more than half of the external sphincter or have several paths). The relationship between all these techniques is the absence of sphincter section. The simplest way is based on filling the fistulous tract, wanting to leave a scar on the damage.
It is defined as Perianal or Anorectal Fistula (AF) to the inflammatory pathway with external cutaneous opening, in the perianal region and an internal or primary opening in the anal canal. Usually, it originates from a cryptoglandular or primary infection that leads to an abscess in the intersphincter space of the anal canal. Generally all fistulas are of cryptoglandular origin; Trauma, Crohn's disease, a malignant condition, radiation, or rare infections such as tuberculosis, actinomycosis, and chlamydia can also cause fistulas. 80% of Anorectal Fistulas are caused by cryptoglandular infection and the development of an interfunctional abscess, for which a digital rectal examination confirms their presence. There are other causes, among which are Crohn’s diseases, tuberculosis, pelvic inflammatory processes, and traumas. A large part also occurs in patients who have received chemotherapy. Anorectal Fistulas are more frequent in men than in women and the frequency of age is between 30 to 50 years of age. Patients with a history of perianal abscess are at risk in 30% to 50% of cases. The common picture is the persistence of frequent abscesses, followed by habitual intermittent or constant discharge. The material that drains is purulent or serosanguineous. And in turn, pain may occur in case of infection or if the orifice is closed. Symptoms: Perianal suppuration, pruritus, burning XVIII during defecation, pain, bleeding. This bleeding usually stains underwear, perianal moisture. Inspection: One or more holes, usually on the margins of the anus. Palpation: Necessarily the trajectory of the fistula, consistency and disposition, reminds that of a resistant cord. And also an infiltration area next to the secondary orifice. Rectal examination: Corresponds to an induration at the site corresponding to the primary orifice, on the pectineal line. Within the surgical techniques are the Fistulotomy, which corresponds to the longitudinal opening of the entire fistulous tract. Which is usually related to a marsupialization of the edges of the fistula, avoiding the false closing of the wound. Draining the abscess reduces the risk of recurrence and continuity of a fistula, and the need for a nearby surgery. In Complex Anorectable Fistulas (they affect more than half of the external sphincter or have several paths). The relationship between all these techniques is the absence of sphincter section. The simplest way is based on filling the fistulous tract, wanting to leave a scar on the damage.
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FISTULAS RECTAL, PREVALENCIA, COLOPROCTOLOGIA, CANAL ANAL, HOSPITAL DE ESPECIALIDADES GUAYAQUIL DR. ABEL GILBERT PONTON, CANTON GUAYAQUIL, ECUADOR