1991 Volume 44 Issue 8 Pages 1140-1149
The causes of intractability in anal fistulas were analysed as the following 4 factors : 1. combined systemic diseases, 2. local situations, 3. intraoperative factors and 4. postoperative factors. In this paper, 3 peculiar pathological statuses were found : 1. anal fistula combined with other anal diseases. 2. combined with intestinal Crohn's disease, and 3. massive necrotizing cellulitis.
1. Anal fistulas combined with other anal diseases
By our statistics, the most frequently combined other anal disease is hemorrhoids followed by anal fissure and stenosis. The frequency of the combination is higher as the fistula is more shallow and simple. When the fistula is combined with other anal diseases, they have to be treated simultaneously at the time of the operation. Special consideration must be taken when treating the combined lesions.
2. Anal fistula combined with intestinal Crohn's disease
In our hospital, among 93 cases of intestinal Crohn's disease, 72 cases (77.4%) was combined with anal fistulas, of which 15 cases (26.8%) belonged to deep, complicated fistulas. They have the characteristics of intractability and recurrence. In our hospital, they are treated surgically after improvement of the systemic status with good results in 40 cases (73%).
3. Seven cases of massive necrotizing cellulitis were experienced in our hospital. It is massive suppuration of subcutaneous tissues, which starts as perianal abscess rapidly spreading from the perineum through scrotum and inguinal areas to abdominal wall and lower extremities. It is a serious condition caused by a mixed virulent infection. The tceatment consists of instantaneous opening of the infected areas combined with administra-tion of broad spectrum antibiotics and systemic supportive treatments. The results of our cases were all favorable.
