Absceso Anal y La Fistula

Un absceso anal es una cavidad infectada llena de pus cerca del ano o el recto. Hay varios tipos de abscesos dependiendo de donde se formen en relación al recto y al ano:

Supralevator abscess = absceso supraelevador

Ischiorectal abscess = absceso isquiorectal

Intersphincteric abscess = absceso interesfinteriano

Perianal abscess (subcutaneous abscess)  = absceso perianal (absceso subcutáneo)

Una fístula anal (también llamada fístula en el ano) es un pequeño túnel que se origina desde una abertura dentro del canal anal y termina en una abertura exterior cerca del ano. Una fístula anal es amenudo el resultado de un absceso anal anterior. Hasta el 50% de las personas con un absceso desarrollan una fístula. Sin embargo, una fístula también puede ocurrir sin un absceso. Lo mismo que ocurre con los abscesos, hay varios tipos de fístulas dependiendo de la porción del recto y del ano que afecten.

a. Superficial fistula = fístula superficial

b. Intersphincteric fistula = fístula interesfinteriana

c. transsphincteric fistula = fístula transesfintériana

d. suprasphinteric fistula = fístula supraesfinteriana

e. extrasphincteric fistula = fístula extraesfinteriana

f. external anal sphincter = esfínter anal externo

 

Causas

El canal anal tiene unas pequeñas glándulas que forman parte de la anatomía normal. Si las glándulas en el ano se obstruyen puede dar lugar a una infección. Cuando la infección es grave, es frecuente que se produzca un absceso. Las bacterias, las heces o materias extrañas también pueden obstruir las glándulas anales y causar un absceso.  La enfermedad de Crohn, el cáncer, el trauma y ​​la radiación pueden aumentar el riesgo de infecciones y fístulas.

Síntomas

Un paciente con un absceso puede tener dolor, enrojecimiento o hinchazón alrededor del ano o canal anal. Otros síntomas comunes incluyen sentirse enfermo o cansado, fiebre y escalofríos. Los pacientes con fístulas tienen síntomas similares, así como el drenaje de un orificio cerca del ano. Se sospecha de la existencia de una fístula si estos síntomas vuelven en la misma zona cada pocas semanas.

Diagnóstico

La mayoría de los abscesos o fístulas anales se diagnostican y se tratan de acuerdo con los hallazgos clínicos. De vez en cuando, los estudios de imagen como la ecografía, tomografía computarizada o resonancia magnética pueden ayudar en el diagnóstico y tratamiento de abscesos profundos y pueden ser utilizados para visualizar el túnel de la fístula.

Tratamiento

La mayoría de los abscesos requieren tratamiento quirúrgico. Es importante que el cirujano esté muy familiarizado con el tratamiento de abscesos y fístulas. Los cirujanos de colon y recto son expertos en esta área. Para la mayoría de los pacientes, un absceso puede ser drenado quirúrgicamente a través de un procedimiento simple. Se hace una incisión en la piel cerca del ano para drenar la infección. Esto puede hacerse en la consulta de su cirujano con anestesia local o en un quirófano bajo anestesia general. Algunos pacientes con enfermedad más severa pueden requerir varias cirugías para resolver el problema. Los pacientes con tendencia a contraer infecciones graves debido a la diabetes o problemas de inmunidad pueden necesitar ser hospitalizados.

La cirugía es casi siempre necesaria para el tratamiento de una fístula anal. En muchos pacientes, si la fístula no es demasiado profunda, se realiza una fistulotomía. Durante esta cirugía, se abrirá la vía de la fístula para permitir la cicatrización desde abajo hacia arriba. La cirugía puede requerir la división de una pequeña porción del músculo del esfínter. Sin embargo, dividir una porción mas grande del esfinter es arriesgado porque puede producir incontinencia fecal. Si el trayecto de la fístula afecta a una mayor parte del músculo del esfínter, será necesario realizar otras cirugías que intentaran cerrar la fistula sin cortar el músculo. Los casos más difíciles pueden requerir múltiples cirugías.

En general, los antibióticos sólos no son eficaces en el tratamiento de abscesos o fístulas. El uso de antibióticos puede ser necesario, además de la cirugía, en los supuestos de que el paciente tenga  problemas inmunológicos, tenga condiciones específicas de válvulas cardíacas o celulitis generalizada (una infección bacteriana de la piel y los tejidos debajo de la piel). El paciente deberá proporcionar a su médico su historia clínica detallada y someterse a un examen físico para que éste pueda determinar si se requiere el uso de antibióticos.

Pronóstico Postoperatorio

Su cirujano le proporcionará la pautas adecuadas para el cuidado post-quirúrgico.  Desafortunadamente, a pesar del tratamiento adecuado y la curación completa, un absceso o una fístula pueden volver. Si un absceso regresa, es posible que haya una fístula que necesita ser tratada. Si una fístula regresa, es probable que se requiera cirugía adicional para tratar el problema.

¿Qué es un cirujano de colon y recto?

Cirujanos de colon y recto son expertos en el tratamiento quirúrgico y no quirúrgico de las enfermedades del colon, recto y ano. Han completado el entrenamiento quirúrgico avanzado en el tratamiento de estas enfermedades, así como la formación en cirugía general completa. Los cirujanos certificados por la junta de colon y recto completan residencias en cirugía general y cirugía de colon y recto, y deben pasar los exámenes intensivos llevados a cabo por el Colegio Americano de Cirujanos (ACS) y la Asociación Americana de Cirujanos de Colon y Recto (ASCRS).  Estos cirujanos poseen los conocimientos para el tratamiento de enfermedades tanto benignas como malignas del colon, recto y ano, y tienen capacidad para realizar exámenes de detección rutinaria y tratar quirúrgicamente estas enfermedades si fuere necesario. ,

AVISO LEGAL

La Asociación Americana de Cirujanos de Colon y Recto está dedicada a asegurar la atención al paciente de alta calidad, al avance de la ciencia, la prevención y el tratamiento de los trastornos y enfermedades del colon, recto y ano.  El propósito de estos folletos es proporcionar información sobre los procesos de enfermedades, y no la de indicar una forma específica de tratamiento. Están diseñados para el uso de  los médicos, trabajadores sanitarios y pacientes que deseen información sobre la gestión de las condiciones tratadas. Estos folletos no incluyen o excluyen otros métodos apropiados de atención médica de estas enfermedades. La última palabra sobre el tratamiento a seguir le corresponde al médico basándose en las circunstancias  de cada paciente.



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