A perirectal abcess is a bacterial infection arising in an anal gland. They typically produce symptoms of progressively worsening pain, swelling and sometimes drainage in the anal area. Once the infection drains either spontaneously or surgically, a persistent opening from the external drainage site to the internal gland is called an anal fistula. Abcesses are best treated with surgical drainage since antibiotic therapy alone is not effective. If an anal fistula develops, there are a number of options for treatment.
Complex Fistula Repair
Anal fistulas may be a simple straight tract or be complex with multiple openings and deeper tracts. Varying amounts of anal sphincter muscle may be involved with the fistula making repair more complex. Although simple opening of the fistula is often the best treatment option, patients with the more complex fistulas will benefit from the expertise of a colorectal surgeon. Detailed below are some of the options for these more complex or recurrent fistulas.
Fibrin Glue Closure
Injection of a specially made biologic glue into a fistula can result in healing without the risk of surgical division of the anal muscle. Because this procedure has a significant rate of unhealed or recurrent fistulas, it is used primarily when more traditional surgical treatment is felt to be too risky.
Rectal Flap Closure
Healing of more complex anal fistulas can be accomplished with the insertion of a special plug of biologic material which allows healing of the tract. This plug is inserted in the operating room and is absorbed by the body during the healing process.