Bengaluru: A team of medical professionals from Ramakrishna Super Speciality Hospital at Jayanagar has successfully treated chronic multiple fistulae-in-ano of a 39-year-old person from Somaliland, Africa. Ahmed (name changed), the patient who is a health inspector, was referred to the hospital for treatment by the Head of the Department of a reputed medical college.
Ahmed’s was a complex case involving multiple fistulae-in-ano (six fistulae, comprising high and low types), which led to recurrent pus discharge, pain, and compromised quality of life over a prolonged period. The patient had a history of diabetes and suffered from recurring perianal abscesses over the past year. He had been operated on at his hometown by surgeons with no permanent relief in sight.
Soon after Ahmed was brought to and admitted at the Ramakrishna Hospital, a team of doctors and the Minimally Invasive Proctology department conducted a thorough diagnosis, which involved performing a Transrectal ultrasound and MRI fistulogram to assess the extent of the fistulae. A limited colonoscopy was also carried out to eliminate the possibility of inflammatory bowel disease and tuberculosis.
Dr Rajeev Premnath, General Laparoscopic Surgeon and Endoscopist, Minimally Invasive Proctology Department at Ramakrishna Hospital, elaborating on the procedures, said, “Considering the intricate nature of the fistulae and the presence of multiple tracts, a two-stage surgery was planned to safeguard the anal sphincter. A fistula is characterized by an abnormal connection between the skin and mucosal surface, causing a recurrent discharge of pus and discomfort. As for the anal region, it specifically denotes an anomalous link between the anal canal and the surrounding skin, leading to persistent pain and discharge.”
During the initial surgery, fistulectomies were performed using a laser for the low fistulae, along with the protection of the anal sphincter complex. For the high fistula, a Seton application was employed. Seton is a thread-like material used to maintain openings in the body, facilitating drainage and promoting healing in conditions like abscesses or fistulae, explained Dr Premnath.
Following a smooth post-operative period of two months, Ahmed underwent a second surgery for the high fistula, involving the removal of the Seton. Subsequently, post-procedure observation for three months revealed successful healing and the patient recovered well, returning to his home country hale and hearty.
“When ignored, a fistula can increasingly complicate over time, affecting the individual and quality of life. The more intricate the fistula, the more complex the surgical procedure, heightening the risk of harm to the anal sphincter. Consequently, early diagnosis and treatment are crucial for effectively managing a fistula. This case illustrates a staged approach to complex fistulae, emphasizing the significance of protecting the anal sphincter,” summed up Dr Premnath.
“I express my profound gratitude to the doctors and the entire team at Ramakrishna Super Speciality Hospital for their unwavering support and utmost care during my treatment,” beamed Ahmed, adding, “I endured a challenging period of suffering before seeking medical attention. Dr Premnath and his team offered me a beacon of hope, and with their dedicated support, I have achieved a complete and robust recovery, returning home with a sense of relief. Words truly fall short in conveying the depth of my appreciation for them.”