Life for Ahmed (name changed), a 39-year-old health inspector from Somaliland in Africa was full of pain and suffering. He had multiple fistulae-in-ano (six high and low fistulae) that resulted in recurrent health issues and compromised quality of life over a prolonged period.
The patient had a history of diabetes and suffered from recurring perianal abscesses over the past year. Although he had been operated on in his hometown by surgeons, there was no permanent relief. He was referred to Ramakrishna Super Speciality Hospital at Jayanagar where a team of medical professionals successfully treated his chronic multiple fistulae-in-ano.
Following diagnosis, which involved performing a Transrectal ultrasound and MRI fistulogram to assess the extent of the fistulae, a limited colonoscopy was also carried out to eliminate the possibility of inflammatory bowel disease and tuberculosis.
Two-stage surgery
Rajeev Premnath, General Laparoscopic Surgeon and Endoscopist at the hospital’s Minimally Invasive Proctology Department, said considering the intricate nature of the fistulae and the presence of multiple tracts, a two-stage surgery was conducted to safeguard the anal sphincter.
A fistula is characterised by an abnormal connection between the skin and mucosal surface, causing a recurrent discharge of pus and discomfort. As for the anal region, it specifically denotes an anomalous link between the anal canal and the surrounding skin, leading to persistent pain and discharge, he said.
“During the initial surgery, fistulectomies were performed using a laser for the low fistulae, along with the protection of the anal sphincter complex. For the high fistula, a Seton application was employed. Seton is a thread-like material used to maintain openings in the body, facilitating drainage and promoting healing in conditions like abscesses or fistulae,” he explained.
Sucessful healing
Following a smooth post-operative period of two months, Mr. Ahmed underwent a second surgery for the high fistula, involving the removal of the Seton. Subsequently, post-procedure observation for three months revealed successful healing and the patient recovered well, returning to his home country hale and hearty.
“When ignored, a fistula can increasingly complicate over time, affecting the individual and quality of life. The more intricate the fistula, the more complex the surgical procedure, heightening the risk of harm to the anal sphincter. Consequently, early diagnosis and treatment are crucial for effectively managing a fistula. This case illustrates a staged approach to complex fistulae, emphasizing the significance of protecting the anal sphincter,” the doctor added.
