Prospective study on development of Perianal Fistula following incision and drainage for Perianal Abscess

Jayakumar, P (2017) Prospective study on development of Perianal Fistula following incision and drainage for Perianal Abscess. Masters thesis, Madurai Medical College, Madurai.


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BACKGROUND AND OBJECTIVES: Perianal Fistula formation following incision and drainage of the perianal abscess is not an uncommon problem.Several factors influences the fistula formation. Younger Age, Antibiotic use following abscess drainage, Fecal organism in abscess and Antiseptic solution mixed sitz bath are associated with increased risk of fistula formation. Immunocompromized states, Skin organism in abscess and Plain tap water for sitz bath are associated with decreased risk of fistula formation. In this study we try evaluate the factors influencing fistula formation, particularly plain tap water for sitz bath vs antiseptic solution mixed sitz bath. METHODOLOGY: 45 cases of perianal abscess visited to Out Patient Department of Govt. Rajaji hospital, Madurai were included into the study. All were underwent Incision and Drainage for the abscess and followed till the wound healing or for 3 months. Patients excluded from the study are Chrons disease, known fistula, multiple abscesspatients and If the wound not healed for 3 months after drainage. Randomly plain tap water sitz bath and antiseptic mixed tap water sitz bath was recommended. Clinical and laboratory parameters were collected on the first visit. Wound evaluated on need basis till the wound heals. RESULTS: Total of 45 patients were included in the study, among them 13 patients were females and 32 were males.Among the 45 patients drained for perianal abscess 14 developed perianal fistula and the remaining 31 wound healed without fistula formation. Abscess cavity depth of >3cm after drainage associated with fistula formation 42.9%(12) compared to 11.8%(2) in patients with<3cm cavity with significant p value of 0.03. When >15m1 of pus drained associated with fistula formation 52.9%(9) compared to 17.9%(5) in <15 ml pus drained patients with significant p value of 0.01. Fecal organism in culture associated with 56.5%(13) of fistula formation compared with 4.5%(1) in skin organisms in culture with significant p value of < 0.001. CONCLUSION: We conclude that Depth of abscess cavity, amount of pus drained and Fecal organism in culture increases the chance of fistula formation. Where as Plain tap water for sitz bath redues the chance for fistula formation.

Item Type: Thesis (Masters)
Additional Information: Reg.No.221411108
Uncontrolled Keywords: Perianal Fistula, incision and drainage, Perianal Abscess, Prospective study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 02 Mar 2020 01:06
Last Modified: 02 Mar 2020 01:11

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