Fistula-in-ano.This term is given to fistulae or sinuses lying between the perianal skin and the anorectal mucosa. Fistula and sinus formation may result from subcutaneous or submucosal abscesses from infected anal glands. Fistulae-in-ano are usually ideopathic but they may complicate perianal Crohn's disease or tuberculosis. Occasionally they are a presenting feature of rectal carcinoma. Fistulae usually present with pain or recurrent discharge of pus or sero-sanguineous material. Operative exploration and laying open of the fistula may be necessary. Patients with Crohn's disease and fistula-in-ano should be managed conservatively with metronidazole and operative drainage of any perianal abscesses. Plastic strands (setons) are often used to maintain track openings to allow chronic drainage of pus and enable healing in the longer term.
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