Fistula surgery

Exploration of the abscess, eradication and excision of the fistula and fistula opening

An abscess is a cavity, which developed during an inflammation, and it is filled with pus. Many times, its content empties in a few days through the spontaneously formed fistula opening. A fistula connects the abscess with the opening; this can be several centimeters long and multidirectional.

What are the causes of an abscess?

An abscess most commonly develops as the consequence of a bacterial infection. It is part of the natural protective processes that the immune system gets activated, and it closes off the infected, inflamed tissues, then secretion (pus) is created from the demised bacteria, tissue fragments, and immune cells.

What are the symptoms of an abscess?

Abscesses, which form in the skin tissue and in the tissues underneath the skin, are usually detected early as visible and palpable abnormalities, and they are accompanied by the typical signs of inflammation: skin redness, pain, swelling, loss of function/disturbed function. “Internal” abscesses (e.g., in the abdominal cavity or in the chest, etc.) may produce numerous symptoms, but a symptom free period may also occur temporarily.

How is an abscess diagnosed?

Abscesses which developed on the body surface can be diagnosed by physical examination, but an ultrasound scan or a CT scan might be necessary to accurately determine the location of the expansion. An imaging study must always be performed in case of internal abscesses.

How is an abscess treated?

Abscesses are treated surgically. The exploration can be performed as an outpatient procedure, or in an operating room, and in certain cases, the ultrasound guided or CT guided insertion of a tube (drainage) can provide a solution.

During the surgery, which is performed in local or general anesthesia, the abscess has to be opened, the demised pieces need to be removed, it needs to be rinsed thoroughly, then it has to be left open, and a drain has to be inserted. Recovery is always prolonged, so it may occur that several explorations are necessary. In one part of the cases, the treatment has to be complemented by the oral or intravenous administration of antibiotics. Certain conditions, such as diabetes mellitus, prolonged steroid intake, autoimmune diseases, using immunosuppressants, arterial or venous circulatory insufficiency, significantly increase the chance of complications to develop.

Can you prevent an abscess?

In one part of the cases, an abscess can be prevented by preventing the inflammation, or detecting and treating it in time. If an untreated internal medicine disease is revealed as the cause of the abscess (e.g., Chron’s disease, diabetes, etc.), internal medical care has to be commenced.

What kind of surgical complications may occur?

The potential complications depend on the location of the abscess, and the type of the surgery. In case of an intraabdominal abscess, these are the injury of the intraabdominal organs or vessels, the development of an incisional hernia in the abdominal wall; in case of a thoracic abscess, these are the injuries of the thoracic organs; in case of a rectal abscess, these are the injuries of the sphincter muscles, and nerve injuries; in case of an abscess on the limbs, these are vascular, nerve, and muscle injuries, the opening of the joint capsule; in case of head and neck abscesses, these are vascular, nerve, and salivary gland injuries.

What happens if the justified surgical treatment is not performed?

Inflammation can spread to quite a large area very quickly. The velocity of condition deterioration depends on the inducing pathogen, and the patient’s general condition too. The body defends itself from the infection by isolating the inflamed area. Following this, secretion starts if the abscess spontaneously gets opened, “bursts”, and a fistula develops. Once the abscess is emptied, the fistula opening closes and the produced secretion leads to pain, swelling, or secretion again. Usually, this condition persists as long as the fistula is not eradicated surgically. Sepsis may develop from an untreated inflammatory condition, which is a severe condition that often requires treatment at an intensive care unit. An untreated abscess on the limb may lead to the partial or complete loss of the limb. In extreme cases, an inflammation in the perineal area may lead to the development of abscess complexes affecting the whole perineum, genitals, and the lesser pelvis, and extensive tissue death (Fournier gangrene). Intraabdominal and thoracic abscesses may lead to extensive peritonitis and pleuritis, the involvement, inflammation, and death of abdominal and thoracic organs.