Predictive accuracy of Goodsall’s rule for fistula-in-ano

Jayarajah, Umesh; Samarasekera, Dharmabandhu Nandadeva

doi:10.4038/cmj.v62i2.8474

Cited by 18 publications

(14 citation statements)

References 7 publications

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“…It is commonly encountered in colorectal surgical practice with a reported incidence of 8.6 per 100 000 population [2]. The majority are simple fistulae which can be delineated fairly accurately and treated easily without significantly affecting the quality of life [3,4]. However, complex fistulae are challenging to treat and can have frequent recurrences requiring multiple surgeries [5].…”

Section: Introductionmentioning

confidence: 99%

The yield of routine histopathology in fistula-in-ano

2020

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Introduction Fistulae-in-ano with a specific aetiology such as TB and Crohn's are usually complex and challenging to treat. This study was aimed to determine the yield of routine histological analysis in fistula-in-ano, in detecting specific aetiology. Methods A descriptive study was conducted at the Professorial Surgical Unit, National Hospital of Sri Lanka, Colombo from 2001-2016. Histopathology reports of all patients without a histological diagnosis and who underwent surgery for fistulae-in-ano were analysed. Results A total of 215 patients [median age:40 years (range:14-73), males=179(82.8%)] were analysed. The majority (75%, n=161) were simple fistulae. Histological evaluation revealed inflamed granulation tissue in 94.9% (n=204) of patients. Five (2.3%) patients had conclusive evidence of Crohn's disease and three (1.4%) had tuberculosis. One patient (0.5%) had evidence of adenocarcinoma with mucinous differentiation. Significant proportion of fistula with underlying specific aetiology were complex fistulae (82% vs. 22%, p<0.001) and associated with abscess/collections (45.5% vs. 11.8%, p<0.001). Age, type of fistula, level of internal opening, recurrence and presence of haemorrhoids were comparable in those with and without a specific aetiology. Conclusions Complex fistula and the presence of abscess/ collection were associated with a specific aetiology. Routine histopathological analysis in patients presenting with fistula in-ano should be performed as a clinical prediction based on the nature of fistula may not be always accurate.

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Section: Introductionmentioning

confidence: 99%

The yield of routine histopathology in fistula-in-ano

2020

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“…Crohn's disease and ulcerative colitis), diverticulitis, tuberculosis and cancer may be present [1]. Accurately determining the anatomy of the fistula and any underlying condition prior to treatment helps to achieve cure and minimises recurrences [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

The role of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano: an observational study

2020

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Objective: Flexible sigmoidoscopy is useful to look for an underlying aetiology in fistula-in-ano. This study was aimed to assess the yield of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano. A retrospective analysis of 159 consecutive patients with fistula-in-ano who underwent routine flexible sigmoidoscopy was performed. Sigmoidoscopy findings were recorded on a standard uniform format using a computer database. Those with a known aetiology were excluded. Results: The median age was 39 (range: 14-74) years and the majority were males (n = 128, 80.5%). Forty-nine patients (30.8%) presented with a recurrent fistula-in-ano. On flexible sigmoidoscopy, internal opening was seen in only 23 patients (14.4%). Furthermore, incidental findings of haemorrhoids (n = 5, 3.1%) and polyps (n = 7, 4.4%) were found. One patient (0.6%) had a healed anal fissure, 5 patients (3.1%) had inflamed mucosa and 2 patients (1.3%) had ulcers. Only two patients with inflamed mucosa were diagnosed to have Crohn's disease on histology. Therefore, flexible sigmoidoscopy was not helpful in the majority to locate the internal opening. Only two patients had evidence of an underlying aetiology, which was Crohn's disease. However, they had recurrent complex fistulae and other associated symptoms. Therefore, flexible sigmoidoscopy may be reserved for selected group of patients with symptoms of an underlying aetiology.

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“…It is commonly encountered in colorectal surgical practice with a reported incidence of 8.6 per 100 000 population [2]. The majority are simple fistulae which can be delineated fairly accurately and treated easily without significantly affecting the quality of life [3,4]. However, complex recurrent fistulae are challenging to treat and can have frequent recurrences requiring multiple surgeries [5].…”

Section: Introductionmentioning

confidence: 99%

The yield of routine histopathology in fistula-in-ano: a retrospective analysis

Samarasekera

Jayarajah

Almeida

2020

Preprint

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Objective Fistulae-in-ano with a specific aetiology such as TB and Crohn’s are usually complex and challenging to treat. This study was aimed to determine the yield of routine histological analysis in fistula-in-ano, in detecting specific aetiology. Histopathology reports of all patients without a previous diagnosis, who underwent surgery for fistulae-in-ano were retrospectively analysed. Results A total of 215 patients [median age:40 years(range:14–73), males = 178(82.8%)] were analysed. The majority(75%,n = 161) were simple fistulae and recurrent(67%,n = 145). Histological evaluation revealed inflamed granulation tissue in 94.9%(n = 204) of patients. Five(2.3%) patients had conclusive evidence of Crohn’s disease and three(1.4%) had tuberculosis. One patient(0.5%) had evidence of adenocarcinoma with mucinous differentiation. Significant proportion of fistula with a specific aetiology were complex fistulae (82%vs.22%,p < 0.001) and associated with abscess/collections (45.5%vs.11.8%, p < 0.001). Age, type of fistula, level of internal opening, recurrence and presence of haemorrhoids were comparable in those with and without a specific aetiology. One patient with Crohn’s and those with TB did not have any associated symptoms to suggest the diagnosis. Routine histopathological analysis in patients presenting with fistula in-ano should be performed as clinical prediction based on the nature of fistula may not be always accurate.

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Predictive accuracy of Goodsall’s rule for fistula-in-ano

Cited by 18 publications

References 7 publications

The yield of routine histopathology in fistula-in-ano

The yield of routine histopathology in fistula-in-ano

The role of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano: an observational study

The yield of routine histopathology in fistula-in-ano: a retrospective analysis

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