Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of recurrent perianal abscesses, persistent purulent discharge, and intermittent pain. Symptoms are exacerbated by defecation. History significant for [multiple prior I&D procedures / Crohnโs disease / radiation therapy]. No systemic symptoms of fever or chills.
Clinical Examination Findings
Perianal examination reveals [single/multiple] external openings located at [clock position] cm from the anal verge. Digital rectal examination (DRE) and anoscopy demonstrate [induration / palpable tract / internal opening at clock position]. Goodsallโs rule assessment indicates [simple/complex] trajectory. No evidence of acute abscess or cellulitis.
Treatment Protocol
Plan: Surgical intervention for complex anal fistula. Options discussed: [Seton placement / Advancement Flap / LIFT procedure / VAAFT]. Pre-operative MRI Pelvis/Fistulogram ordered to delineate tract anatomy and rule out secondary extensions. Patient counseled on risks of incontinence and recurrence.