What is Horseshoe Fistula?

What is Horseshoe Fistula?

Horseshoe fistula is one of the most complicated and problematic conditions of anal abscess-fistula disease. The disease usually originates from a deep anal abscess and extends to both sides of the anus. There is a fistula opening on both sides of the anus. Bloody-pus discharge develops from these fistula openings. Its treatment is specific and requires experience.

Symptoms of Horseshoe Fistula

Initially, there is fever and anal pain, which are symptoms of anal abscess. Later, anal discharge complaint develops. The discharge is bloody and pus. There may be a feeling of wetness, pain and itching in the anal area.

Horseshoe Fistula Examination

The examination should be performed in an environment that ensures patient privacy and sensitivity. In ideal conditions, it should be performed on a proctological table and using lighting to ensure a good view of the anal area. Fistula openings must be present. The experience of the surgeon is important for recognition of the disease and differential diagnosis at this stage.

 

Diagnosis of Horseshoe Fistula

As in every complicated proctological disease, the experience of the surgeon is very important in the diagnosis of the disease. It is important. Diagnosis is usually made by proctological examination. Pelvic MRI examination can be used to confirm and map it.

 

What are the Imaging Methods for Horseshoe Fistula?

The most commonly used examinations for imaging proctological cases are rectoscopy, colonoscopy, anal ultrasonography and MRI imaging. The most common method we use in the evaluation of anal fistula and horseshoe fistula is pelvic MRI.

 

Is Medical Treatment of Horseshoe Fistula Possible?

What is the unfortunate nature of anal fistulas and horseshoe fistula? which cannot be treated medically. Treatment is only possible with surgery.

 

Surgical Treatment of Horseshoe Fistula

Surgery of horseshoe fistula is special. Finding and draining a deep postal abscess is the basic principle of surgical treatment. Fistula tracts must be identified and drained.

 

Is Horseshoe Fistula Treatment Problematic? Why?

Surgical treatments are problematic in all anal fistula surgeries. The complexity of the disease, the extent to which the anal muscles (sphincters) are affected by the disease, Previous surgery and recurrence are factors that increase existing problems.

 Horseshoe Fistula Surgery

This surgery is one of the most difficult operations in anal fistula surgery. After reaching a deep anal abscess (deep postanal abscess), it must be drained. Generally, this abscess opens into the anal canal posteriorly. This drainage is provided with seton. Then, drainage should be provided with a seton placed through the fistula openings on both sides.

 

What is a seton?

Seton can be made using different materials; penrous drain, surgical glove edge, elastic vascular hanger and setons specially produced for this task. The purpose of the seton is to ensure that the abscess drains and to avoid damaging the anal muscles (sphincters) as much as possible.

Fistula Treatment in Crohn's Disease

Crohn's disease is a disease of the digestive system. It is an inflammatory bowel disease. Although microbes come to mind when inflammation is mentioned, the cause of this disease is autoimmunity. Crohn's sometimes affects the anal area and causes anal fistula and fissure. Treatment of fistulas that develop in Crohn's disease is not like standard fistula surgery. Since there is a healing problem, seton is often used for drainage purposes. Another inflammatory bowel disease is ulcerative colitis. Anal fistula is rare in ulcerative colitis.

 

Recovery After Horseshoe Fistula Surgery

After horseshoe fistula surgery, the patient is usually discharged on the 1st day. Anal discharge continues for a while. There should be no expectation of recovery in a short time in these patients. It should not be forgotten that the patient should be followed closely by the surgeon. The placed setons are removed at regular intervals. Revision surgery is performed when necessary.

 

Recurrence Horseshoe Fistula

The most important factors affecting healing/recurrence in horseshoe fistula are early diagnosis of the disease and the first surgery performed by qualified hands. Even if everything goes well, it should not be forgotten that unfortunately there is a certain possibility of recurrence in this disease.

 

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