Anal fistula K60.30

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Fistula in the anal region.

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  • A distinction is made between:
    • Incomplete external or internal fistula: Only one fistula opening present.
    • Complete fistula: Continuous fistula passage, fistula opening in the skin and rectal mucosa.
  • Classification by parks:
    • Subcutaneous Fistula
    • Submucous fistula
    • Intersphincteric fistula
    • Transpinct Fistula
    • Suprasphinous fistula
    • Extrasphincteric fistula
    • Recto-organic fistula.

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Consequence of periproctitic abscesses.

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Endosonography, CT, MRT

Differential diagnosis
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Tuberculous fistula, osteomyelitic fistula, rectovaginal and rectourethral fistula, fistula in Crohn's disease, ulcerative colitis, diverticulitis

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  • Treatment scheme see also Table 1: Inpatient procedure under general or spinal anaesthesia, exception: subcutaneous fistulas.
  • Complete surgical splitting of all accessible fistula ducts under antibiotic protection with a broad spectrum of action, e.g. doxycycline (e.g. Doxy-Wolff) 200 mg/day p.o. or i.v. Alternatively, in case of suspected anaerobic infection: Clindamycin (e.g. Sobelin Kps. 150 mg) 3 times/day 2 Kps. or Metronidazol (e.g. Clont 400) 2-3 times/day 1 tbl. p.o.
  • Procedure: probing of the fistula duct by means of a button probe, visualisation with methylene blue, cleavage by means of a channel probe, fistulaography, removal of the granulation tissue lining the fistula by curettage or excision in triangular form with removal of the involved glands (proctodermal glands).

Notice! Exclusion of M. Crohn (colon contrast enema), because in this case no fistula splitting but scraping is performed!

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Treatment scheme for anal fistulas

Fistula type


Incomplete fistulas

Outer or inner fistula

Perforation of the fistula towards the mucosa, probing of the inner fistula opening with a hook probe

Complete fistulas

Inter- and transsphincteric fistulas

Procedure according to Parks: excision of the fistula on both sides of the ostia while preserving the puborectalis and levator anii muscles, open wound treatment and secondary wound healing

Supra- and extrasphincter fistulas

Drainage through insertion of a thread

Subcutaneous and submucous fistulas

Oval excision and primary wound closure, insertion of strips containing antibiotics, e.g. sofa tulle


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020