CHAPTER 9 ANAL FURUNCULOSIS/PERIANAL FISTULA 163
Bacterial culture and sensitivity from sinus tracts: samples should be obtained from
within the tract and not from surface debris (wipe skin surface with alcohol prior to
sampling to remove fecal contamination, if possible).Fine-needle aspirate and cytology from thickened anal sacs (if present).
Colonoscopy with biopsy may reveal associated colitis.
THERAPEUTICS
Basic Care
Clip hair from the affected area.
Daily antiseptic lavage.
Systemic and topical antibiotics.
Hydrotherapy.
Elevation of the tail.
Analgesics.
Dietary modification: fiber-enhanced diet or stool softeners if pain/tenesmus.
Restricted-ingredient diet trial if associated with colitis.
Surgical Options
Surgery: no longer considered as primary treatment.
High recurrence rate (70%) in cases treated with surgery alone.
Adjunctive to medical management for cases with incomplete resolution.
Primary objective of surgery is complete removal or destruction of diseased tissue
while preserving normal tissue and function.
Surgical options:
Electrocautery of fistulae
Cryosurgery
Surgical debridement with fulguration by chemical cautery
Exteriorization and fulguration by electrocautery
En blocsurgical resection
Radical excision of the rectal ring
Tail setting or amputation
Laser surgery.
Anal sacculectomy should be performed.
Postoperative complications include anal stenosis and fecal incontinence.
Multiple procedures may be necessary for complete resolution.
Medical Options
Cyclosporine A (5 mg/kg/day):
Success rate 5–96% of cases (Figure 9.7)
Surgery may be required due to inadequate healing or anal stricture