Name of the Condition

• Rectal fistula
• Also known as anal fistula or fistula-in-ano.

Summary

A rectal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. This condition often occurs following an infection of an anal gland, leading to a collection of pus (abscess). Once the abscess is drained, a fistula may form.

Causes

• Previous anal abscesses or infections.
• Crohn's disease, which involves chronic inflammation of the gastrointestinal tract.
• Infections like tuberculosis or sexually transmitted infections.
• Trauma or surgery in the anal region.

Risk Factors

• Crohn's disease.
• A history of anal abscesses.
• Men are more commonly affected than women.
• Lifestyle factors that lead to poor anal hygiene or increased risk of infection.

Symptoms

• Pain and swelling around the anus.
• Discharge of pus or blood from a small opening near the anus.
• Irritation or redness of the skin around the anus.
• Fever or feeling unwell, in some cases.

Diagnosis

• Physical examination by a healthcare provider.
• Anoscopy to inspect the anal canal.
• Imaging tests like MRI or CT scan to identify the path of the fistula.
• Fistulography, using contrast dye to map the fistula.

Treatment Options

• Surgical intervention (fistulotomy) is usually necessary to repair the fistula.
• Seton placement: a surgical thread is used to keep the fistula open and allow it to drain.
• Fibrin glue or plugs: less invasive options that promote healing.
• Antibiotics or medications may be used to manage infection or inflammation.

Prognosis and Follow-Up

• With proper surgical treatment, the outlook is generally positive.
• Some cases may recur and require further surgery.
• Regular follow-up is important to monitor healing and prevent complications.

Complications

• Persistent or recurrent infections.
• Abscess formation.
• Bowel incontinence or scarring if not properly treated.

Lifestyle & Prevention

• Good anal hygiene to prevent infection.
• Managing underlying conditions like Crohn's disease.
• Timely medical attention for anorectal abscesses.

When to Seek Professional Help

• Persistent pain or swelling near the anus.
• Unexplained fever or feeling of being unwell.
• Recurrent anal abscesses.

Additional Resources

• American Society of Colon and Rectal Surgeons (ASCRS) www.fascrs.org
• Crohn's & Colitis Foundation www.crohnscolitisfoundation.org

Tips for Medical Coders

• Ensure the documentation specifies the type and location of the fistula.
• Be aware of potential related conditions like Crohn’s disease that may need coding.
• Avoid confusion with similar conditions such as perianal abscesses (K61.0) which have distinct ICD codes.