WordNet

holding office; "the in party"
to or toward the inside of; "come in"; "smash in the door" (同)inwards, inward
currently fashionable; "the in thing to do"; "large shoulder pads are in"
directed or bound inward; "took the in bus"; "the in basket"
an abnormal passage leading from a suppurating cavity to the body surface (同)sinus

PrepTutorEJDIC

《具体的な場所,位置》 / …『の中に』(『で』) / …『において』,…で / 《intoの代りに移動を表す動詞と共に》…『の中へ』 / (乗り物)『に乗って』 / …『の状熊に』(『で』) / …『に従事して』,に属して / …『を身につけて』,に覆われて / 《『in』do『ing』の形で》…『するときに』,する際に(when) / 《時間》 / …『して』,…『が経過したあと』 / …『の間に』 / …『については』,…の点では / 《方法・手段・材料》…『で』 / 《人を目的語にして,性質・能力があることを示して》…の中に / …の目的で,のつもりで,として / 《比率割合》…のうちで,につき / 《過去分詞に伴って》…に[…されて] / 『中へ』(に) / 『在宅して』,帰って / (乗り物などが)『到着して』,(時期・季節が)来て / 出回って,流行して / 《俗》流行の,当世風の / 《話》特定の人々にのみ理解される
(次にくる語の発音が母音で始まるときに用いる) / (子音[h]で始まり第1音節に強勢のない語の場合はanを用いることがある.ただし,この場合は[h]を発音しない)
瘻(ろう)菅(長い菅状になった潰瘍)
indiumの化学記号
Indiana

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/07 11:57:48」(JST)

wiki en

Anal fistula, or fistula-in-ano, is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin.

Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It then points to the surface again, and the process repeats.

Anal fistulas per se do not generally harm, but can be very painful, and can be irritating because of the pus-drain (it is also possible for formed stools to be passed through the fistula); additionally, recurrent abscesses may lead to significant short term morbidity from pain, and create a nidus for systemic spread of infection.

Surgery is considered essential in the decompression of acute abscesses; repair of the fistula itself is considered an elective procedure which many patients elect to undertake due to the discomfort and inconvenience associated with a draining tract.

Symptoms

Anal fistulae can present with many different symptoms:

Pain
Discharge — either bloody or purulent
Pruritus ani — itching
Systemic symptoms if abscess becomes infected

Diagnosis

Diagnosis is by examination, either in an outpatient setting or under anaesthesia (referred to as EUA — Examination Under Anaesthesia). The examination can be an anoscopy.

Possible findings:

The opening of the fistula onto the skin may be seen
The area may be painful on examination
There may be redness
An area of induration may be felt — thickening due to chronic infection
A discharge may be seen
It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula

Pilonidal cysts/sinuses are another condition in which infected perianal "holes" or openings may appear

Treatment

There are several stages to treating an anal fistula:

Definitive treatment of a fistula aims to stop it recurring. Treatment depends on where the fistula lies, and which parts of the anal sphincter it crosses.

There are several options:

Doing nothing — a drainage seton can be left in place long-term to prevent problems. This is the safest option although it does not definitively cure the fistula.

Anal fistula after surgical treatment

Lay-open of fistula-in-ano — this option involves an operation to cut the fistula open. Once the fistula has been laid open it will be packed on a daily basis for a short period of time to ensure that the wound heals from the inside out. This option leaves behind a scar, and depending on the position of the fistula in relation to the sphincter muscle, can cause problems with incontinence. This option is not suitable for fistulas that cross the entire anal sphincter.
Cutting seton — if the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting seton (from the Latin seta, "bristle") may be used. This involves inserting a thin tube through the fistula tract and tying the ends together outside of the body. The seton is tightened over time, gradually cutting through the sphincter muscle and healing as it goes. This option minimizes scarring but can cause incontinence in a small number of cases, mainly of flatus. Once the fistula tract is in a low enough position it may be laid open to speed up the process, or the seton can remain in place until the fistula is completely cured. This was the traditional modality used by physicians in Ancient Egypt and formally codified by Hippocrates,^[1] who used horsehair and linen. It was used in Europe until the 19th century, the traditional material for the seton being a copper "cheese wire" with its ends tied into a knot that was gradually tightened over several months.
Seton stitch — a length of suture material looped through the fistula which keeps it open and allows pus to drain out. In this situation, the seton is referred to as a draining seton. The stitch is placed close to the ano-rectal ring – which encourages healing and makes further surgery easy.
Fistulotomy — till anorectal ring
Colostomy — to allow healing
Fibrin glue injection is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally. This method is perhaps best tried before all others since, if successful, it avoids the risk of incontinence, and creates minimal stress for the patient.
Fistula plug involves plugging the fistula with a device made from small intestinal submucosa. The fistula plug is positioned from the inside of the anus with suture. According to some sources, the success rate with this method is as high as 80%. As opposed to the staged operations, which may require multiple hospitalizations, the fistula plug procedure requires hospitalization for only about 24 hours. Currently, there are two different anal fistula plugs cleared by the FDA for treating ano-rectal fistulas in the United States. This treatment option does not carry any risk of bowel incontinence. In the systematic review published by Dr Pankaj Garg, the success rate of the fistula plug is 65-75%.^[2]
Endorectal advancement flap is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. The flap is lifted to expose the fistula, which is then cleaned and the internal opening is sewn shut. After cutting the end of the flap on which the internal opening was, the flap is pulled down over the sewn internal opening and sutured in place. The external opening is cleaned and sutured. Success rates are variable and high recurrence rates are directly related to previous attempts to correct the fistula.
LIFT Technique is a novel modified approach through the intersphincteric plane for the treatment of fistula-in-ano, known as LIFT (ligation of inter sphincteric fistula tract) procedure. LIFT procedure is based on secure closure of the internal opening and removal of infected cryptoglandular tissue through the intersphincteric approach. Essential steps of the procedure include, incision at the intersphincteric groove, identification of the intersphincteric tract, ligation of intersphincteric tract close to the internal opening and removal of intersphincteric tract, scraping out all granulation tissue in the rest of the fistulous tract, and suturing of the defect at the external sphincter muscle.^[3] The procedure was developed by Thai colorectal surgeon, Arun Rojanasakul, The first reports of preliminary healing result from the procedure were 94% in 2007.^[4] Additional ligation of the intersphincteric fistula tract did not improve the outcome after endorectal advancement flap.^[5]

Infection

Some patients will have active infection when they present with a fistula, and this requires clearing up before definitive treatment can be decided.

Antibiotics can be used as with other infections, but the best way of healing infection is to prevent the buildup of pus in the fistula, which leads to abscess formation. This can be done with a seton.

History

Japan: A man suffering from anal fistula. From the Yamai no Soshi, late 12th century.

A traditional ayurvedic medicine treatment for fistulae and piles (inflamed hemorrhoids) consisting of herbs has been in use in India for about 5000 years. This treatment is mentioned in ancient medical texts.^{[citation needed]}

Famous personalities suffering from this disease

Pope Leo X^[6]
King Louis XIV of France

References

^ Hippocrates, "On Fistulae", translation by Francis Adams, Internet Classics Archive, Massachusetts Institute of Technology.
^ Garg P, Song J, Bhatia A, Kalia H, Menon GR (October 2010). "The efficacy of anal fistula plug in fistula-in-ano: a systematic review". Colorectal Dis 12 (10): 965–70. doi:10.1111/j.1463-1318.2009.01933.x. PMID 19438881.
^ Rojanasakul A (September 2009). "LIFT procedure: a simplified technique for fistula-in-ano". Tech Coloproctol 13 (3): 237–40. doi:10.1007/s10151-009-0522-2. PMID 19636496.
^ Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K (March 2007). "Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract". J Med Assoc Thai 90 (3): 581–6. PMID 17427539.
^ van Onkelen, RS; Gosselink, MP; Schouten, WR (2012 Feb). "Is it possible to improve the outcome of transanal advancement flap repair for high transsphincteric fistulas by additional ligation of the intersphincteric fistula tract?". Diseases of the colon and rectum 55 (2): 163–6. PMID 22228159.
^ The Medici: Godfathers of the Renaissance. Paul Strathern, Vintage Books 2007, p278.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 肛門直腸瘻：臨床症状、診断、およびマネージメントの原則 anorectal fistula clinical manifestations diagnosis and management principles
2. 肛門直腸瘻の外科的マネージメント operative management of anorectal fistulas
3. 肛門周囲膿瘍：臨床症状、診断、および治療 perianal abscess clinical manifestations diagnosis treatment
4. クローン病の肛門合併症 perianal complications of crohn disease
5. 肛門膿瘍および瘻孔の評価における画像検査の役割 the role of imaging tests in the evaluation of anal abscesses and fistulas

English Journal

Are there specific endosonographic features in Crohn's patients with perianal fistulae?

Zbar AP, Horesh N, Bucholtz V, Zmora O, Beer-Gabel M, Carter D.SourceDepartment of Surgery and Transplantation, Chaim Sheba Medical Center Ramat Gan Israel, Israel. Electronic address: apzbar1355@yahoo.com.
Journal of Crohn's & colitis.J Crohns Colitis.2013 Jul 1;7(6):490-6. doi: 10.1016/j.crohns.2012.07.024. Epub 2012 Aug 21.
Both 2-dimensional and 3-dimensional endoanal ultrasounds have been shown to be accurate in the definition of the anatomy of complex fistulae-in-ano in patients with perianal Crohn's disease. Recently, a Crohn's Ultrasound Fistula Sign (CUFS) has been suggested as a discriminating feature of periana
PMID 22921529

Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano.

Han JG, Yi BQ, Wang ZJ, Zheng Y, Cui JJ, Yu XQ, Zhao BC, Yang XQ.SourceDepartment of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.Colorectal Dis.2013 May;15(5):582-6. doi: 10.1111/codi.12062.
AIM: Ligation of the intersphincteric fistula tract and reinforcement with a bioprosthetic graft are two recently reported procedures that have shown promise in the treatment of anal fistula. This study was undertaken to validate combining ligation of the intersphincteric fistula tract plus bioprost
PMID 23067044

Tacrolimus salvage in anti-tumor necrosis factor antibody treatment-refractory Crohn's disease.

Gerich ME, Pardi DS, Bruining DH, Kammer PP, Becker BD, Tremaine WT.Source*Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, Colorado; and †Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Inflammatory bowel diseases.Inflamm Bowel Dis.2013 May;19(6):1107-11. doi: 10.1097/MIB.0b013e318280b154.
BACKGROUND: : Several small retrospective studies have reported encouraging response rates in patients with Crohn's disease (CD) treated with tacrolimus.METHODS: : We conducted a retrospective study of the use of oral tacrolimus for severe CD refractory to anti-tumor necrosis factor agents. Response
PMID 23518805

Japanese Journal

痔瘻癌の治療 (特集目で見てわかる肛門疾患治療) -- (腫瘍)

池内浩基,内野基,松岡宏樹
臨床外科 66(12), 1518-1522, 2011-11
NAID 40019058459

痔瘻 (特集必読セカンドオピニオン) -- (消化管)

鈴木健夫,村田宏,根津真司
外科 72(12), 1365-1368, 2010-11
NAID 40017406307

痔瘻 (特集小児の漢方療法--エキス剤を使いこなそう)

大谷俊樹
小児科診療 73(3), 492-494, 2010-03
NAID 40016995951

Related Pictures

GASTROINTESTINAL TRACT - ppt download Common Office Anorectal Problems - ppt video online download PPT - Common Office Anorectal Problems PowerPoint Presentation - ID:272362 Anorectal Disease. - ppt video online download Fistula in ano sloft technic by dr d.u.pathak Back to medical school -anorectal disorders - ppt video online download Fistula In Ano Symptoms Diagnosis and Treatment: Fistula in Ano Symptoms Diagnosis and