भगंदर म्हणजे काय?

भगंदर हा एक लहान बोगदा आहे जो कोलन आणि गुदाद्वाराच्या त्वचेच्या दरम्यान तयार होतो. हे सामान्यतः गुदाशयातील ग्रंथीमध्ये पस निघून झालेल्या संक्रमणामुळे होते.

याची मुख्य चिन्हे आणि लक्षणे

• गुदाशयाच्या तोंडाभोवती वेदना आणि जळजळ

• पस किंवा शौचात रक्त जाणे

• गुदाशयाच्या त्वचेजवळ खराब घाणवास येतो

• ताप, थंडी आणि थकवा

कारणं आणि निदान

भगंदर मुख्यतः पस  झालेल्या संक्रमणानंतर होतात. निदानासाठी गुदाशयाची शारीरिक तपासणी, एमआरआय, किंवा सीटी स्कॅन वापरले जातात.

उपचार

शस्त्रक्रिया हा मुख्य उपचार आहे, ज्यामध्ये फिस्ट्युलोटोमी,फिस्टुलेक्टोमी, सेटन प्रक्रिया, किंवा लेसर वापरून उपचार केला जातो.

Understanding Anal Fistulas

Anal fistulas are abnormal connections or channels that form between the end of the bowel and the skin near the anus. They are often the result of an infection in an anal gland that leads to an abscess. When the abscess drains or is surgically opened, it can leave a tract behind, which becomes a fistula.

Types of Anal Fistulas

Anal fistulas can be classified into different types based on their openings and location:

• Blind Fistula: Has only an internal opening.

• Complete Fistula: Has both external and internal openings.

• Incomplete Fistula: Has an external opening without an internal one.

Classification by Location

• Anal Fistulas: Located below the anorectal ring.

• Anorectal Fistulas: Located above the anorectal ring.

• Pelvirectal: Inflammation extends beyond the infra-levator space.

• Ischiorectal: Inflammation is limited to the ischiorectal region.

Park's Classification

• Intersphincteric: Extends up to the intersphincteric plane.

• Trans-sphincteric: Extends beyond the external sphincter into the ischiorectal space.

• Suprasphincteric: Penetrates through the intersphincteric plane above the puborectalis.

• Extrasphincteric: Passes outside the sphincter complex into the perianal skin from the rectum.

Differential Diagnosis

When diagnosing a fistula, it's important to consider other conditions that might present similarly:

• Infected Bartholin’s cyst

• Subcutaneous abscess

• Infected anal fissure

• Hidradenitis suppurativa

• Various infections (actinomycosis, tuberculosis, etc.)

• Crohn’s disease

• Other pathologies (prostatic abscess, lymphoma, etc.)

Classification System

The St James's University Hospital classification system grades perianal fistulas based on their complexity:

• Grade 1: Simple linear intersphincteric fistula

• Grade 2: Intersphincteric fistula with abscess or secondary tract

• Grade 3: Transsphincteric fistula

• Grade 4: Transsphincteric fistula with abscess or secondary tract within the ischiorectal fossa

• Grade 5: Supralevator and translevator extension

Grades 3 and 4 are considered complex due to the potential risk of affecting continence post-surgery.

Surgical Treatment Options

Surgery is often necessary, as fistulas rarely heal on their own. Surgical options include:

• Fistulectomy/Fistulotomy: Removal or opening of the fistula tract.

• LIFT (Ligation of Intersphincteric Fistula Tract): A procedure that involves locating and ligating the fistula tract.

• Seton Placement: Involves placing a surgical thread in the fistula tract to help drain and form scar tissue.