A CLINICO.PATHOLOGICAL STUDY OF ANAL FISTULAE

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ABSTRACT The abscess-fistula sequence is the accepted hypothesis for pathogerresis ofanal fistulae' Anal fistulae may be either simple or complex Anal fistulae'sulgery isnotoriousfor omplications of recurence and ittcontinence ' Both of these complications may be either related to iatlogenic mishaps or incomplete ssessment of the nature and extent of pathological involvement . The aim of this work is to assess the role of specific infection especially cytomegalovirus in he pathogenesis of anal fistulae' The literature on t'he subject is scanty and little has been written about the relationship rctrreeru cytomegalovinrs dise$e and anorectll fistrrla€' This wor.k was done on Zg patients presenting with anal fistulae in Kasr-El-Aini hospital' A pathological study of excised specimens was done to discover prcsence of paftogens rsing A Hx. and Eosin staining B. ftnmuno histochemical staining to detect cytomegalovirus altigens' The patients were grouped according to Park's (1976) classificatioD into iroup A: lntersphincteric fistrrlae Group B: Transsphincteric fistulae 24 cases fufiher subdivided into 5 Cases 6 cases offissure fistulae 7 case simple low anal fistulae l1 cases of comPlek fistulae There was no cases of supra sphincteric or exfta sphincteric fistulae Routine histopathological examination using Hx and eosin was negative for detection of pecific pathogens . , However itnmuno histopathological arrerrm"ni using monoclonal antibOdy for ;ytornegalovirus antigens has revealed the prcsence of positive'staining in 7 cases. The positive *ained cclls were within the squamous epiftelium surrounding the internal opening of the :xcised fistulae All positive oases were mainly in the patients presenting wiftr intenphincteric fistulae' ' St+$stical analysis revealed statistically significant association of positive cytomegelovirus mtigen in patients with low intersphinoteric fistulae especially those with fissure fistulsF. This result could be a preliminary report which need firrther verification and reusing severf,l ;pecrrlations.
Page 1: 9ttV A CLINICO.PATHOLOGICAL STUDY O
Page 5 and 6: ACKNOWLEDGMENT I ,a f This work was
Page 7 and 8: List of Tables Table Table (l): Cli
Page 9 and 10: Fig. (12): Typei of Intersphincteri
Page 11 and 12: Anal Fhtula Inlroduction & Ain of W
Page 13 and 14: AnalFbtula Review of Literature Fb.
Page 15 and 16: Anal Fhtula Review of Literature I
Page 17 and 18: AnalFbtula Review oJ Literature rt
Page 19 and 20: Anal Fbtula Review of Literature Pu
Page 21 and 22: Anal Flrula Review af Llterature It
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Page 25 and 26: Anal Fhtula Reviev, of Literatwe LY
Page 27 and 28: Anal Flstula R*iew of Literature DE
Page 29 and 30: Anal Fbtula Review of Literature Ac
Page 31 and 32: Anal Fkula Revlew ofLiterature + *
Page 33 and 34: AnalFhtula . Review of Literature T
Page 35 and 36: Anaf Fbtula Review ofLiteralure In
Page 37 and 38: Anal Fhtula Revlew ofLilerature * m
Page 39 and 40: Anal Fbtula Review o! Literature (s
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Page 51 and 52: Anal Fbtula Review ofLiterature PAT
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AnalFbtula Revlew of Literature Cir
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Anal Fbtula Revlew ofLiterature SUB
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Anal Fbtula Review of Literature Fi
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Anal Fbtula . Rlitw of Literature T
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Anal Flstula Review afLiterature il
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Anal Fhtula Materials & Methods MAT
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Anal Fbtula Matefials & Methods H-
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AnalFbula Materials &, Methods 3- L
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Anal fbtula Materlals & Methods * 5
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AnalFbtula Materials & Methods * Sa
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Anal Flstula Materials & Methods t
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Anal Fhtula Materials & Methods t n
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Anal Flstula rte,nr/rs A* preoperat
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Re.fl/fts B- Endoanal sonography wa
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Analtktula Re.flrlts 4- At operatio
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.Resu//s I + Fig 22: High power of
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tesz/rl I I t Fig 24: An immuno$tai
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Resrlts # Fig 28: An immunostaining
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Anal Fbtula .Rcsulrs The disfributi
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Anal Fbtula DJscussion DISCUSSION s
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Anal Fl$tula Dr'scusslon t Serum Cy
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Anal Fhtula Disczsslon * Further ve
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Anal Fbtula Summary SUMMARY The aim
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Anal Fbtula Summary t Further verif
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AnalFlrtula Relervnws Balthezar, 8,
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Anal Ftoh References Culpepper-Morg
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AnalFbtula References infection in
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AnalFbtuh Relerences Goldberg, S.M.
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AnalFlstula References Jackman, R.J
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Anal Flstula Refercnces Mercusen, D
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Anal Fbtuh References in patients w
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Anal'Flstula References Rubin, R.H.
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Anal Flstula , References Vasilevsk
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A CLINICO.PATHOLOGICAL STUDY OF ANAL FISTULAE

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