Diagnostyka przetok odbytu – o czym każdy chirurg wiedzieć powinien?

Aneta Obcowska¹, Małgorzata Kołodziejczak², *Iwona Sudoł-Szopińska^{3, 4}

Summary
For many years anal fistula has been a well-known inflammatory disease, whose etiopathogenesis has also been well discovered. Its most common cause is anal crypt infection, while the others include: Leśniowski-Crohn disease, radiotherapy, alien body, actinomycosis, tuberculosis, anal cancers, conditions with decreased immunity and iatrogenic lesions. The fact of fistula-in-ano having been diagnosed provides too little information to successfully conduct an operation, simultaneously reducing complication risk (fistula recur, strait in complicated fistula transformation, incontinence). The right operative method is chosen on the basis of all the preoperatively collected information. The necessary anatomical information is usually obtained from ultrasonography. The whole test includes EAUS 2D, 3D (if possible) and transperineal ultrasound. If it is difficult to differentiate between anal fistulas and postoperative scars, it is possible to use hydrogen peroxide solution. In the case of difficult, branched and recurrent fistulas and in suspicion of Leśniowski - Crohn disease, MRI should be done. It is also essential in case of postoperative complications to examine the sphincters efficiency. To do that, special continence scales (Wexner, Miller) are used. In the case of operation on patients with high risk of incontinence (anterior, supralevator, recurrent fistulas), anorectomanometry should be done. All this information needs to be recorded in medical documentation for both medical and legal reasons.

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