Does HIV status influence the anatomy of anal fistulas?
- 28 Downloads
PURPOSE: Although anorectal disease is common in human immunodeficiency virus-positive patients, little is known about the type and anatomic distribution of anal fistulas in this patient group. The aim of this study was to compare anatomic characteristics of anal fistulas in human immunodeficiency virus-positive patients with those in human immunodeficiency virus-negative patients by use of a retrospective chart review. METHODS: The charts of 146 male patients younger than 50 years with an anal fistula were reviewed. Incomplete fistulas referred to those tracts arising from an internal opening into either a blind sinus or an undrained abscess cavity. RESULTS: There were 60 human immunodeficiency virus-positive patients and 86 human immunodeficiency virus-negative patients. Mean age of the human immunodeficiency virus-positive patient group was 37 yearsvs. 40 years for the human immunodeficiency virus-negative patient group. Thirty-one human immunodeficiency virus-positive patients (52 percent) were classified as having AIDS, and the remaining 29 patients (48 percent) were asymptomatic. Mean T helper cell count in the human immunodeficiency virus-positive patient group was 277 cells per microliter. Fistulous tracts were intersphincteric (n=56), transsphincteric (n=41), suprasphincteric (n=2), and incomplete (n=47). Incomplete fistulas were identified in 33 (55 percent) human immunodeficiency virus-positive patientsvs. 14 (16 percent) human immunodeficiency virus-negative patients (P<0.001). Of the 47 incomplete fistulas, 37 (79 percent) were found in association with an abscess cavity. All ten patients with an incomplete fistula into a blind sinus were human immunodeficiency virus-positive. The incidence of an incomplete fistula without an abscess was significantly higher in the human immunodeficiency virus-positive patient group (17 percent) compared with the human immunodeficiency virus-negative patient group (0 percent;P<0.001). CONCLUSIONS: Anal fistulas in HIV-positive patients arise from the dentate line in similar locations to human immunodeficiency virusnegative patients. However, human immunodeficiency virus-positive patients were more likely to have incomplete anal fistulas than human immunodeficiency virus-negative patients. Furthermore, human immunodeficiency virus-positive patients are predisposed to incomplete fistulas leading into a blind sinus.
Key wordsAnal fistula HIV Anal abscess
Unable to display preview. Download preview PDF.
- 1.Wexner SD, Smithy WB, Milsom JW, Dailey TH. The surgical management of anorectal diseases in AIDS and pre-AIDS patients. Dis Colon Rectum 1986;29:719–23.Google Scholar
- 2.Carr ND, Mercey D, Slack WW. Non-condylomatous perianal disease in homosexual men. Br J Surg 1989;76:1064–6.Google Scholar
- 3.Beck DE, Jaso RG, Zajac RA. Proctologic management of the HIV-positive patient. South Med J 1990;83:900–3.Google Scholar
- 4.Puy-Montbrun T, Denis J, Ganansia R, Mathoniere F, Lemarchand N, Arnow-Dubois N. Anorectal lesions in human immunodeficiency virus-infected patients. Int J Colorect Dis 1992;7:26–30.Google Scholar
- 5.Orkin BA, Smith LE. Perineal manifestations of HIV infection. Dis Colon Rectum 1992;35:310–4.Google Scholar
- 6.Parks AG, Gordon PH, Hardcastle JE. A classification of fistula in ano. Br J Surg 1976;63:1–12.Google Scholar
- 7.Seow-Choen F, Nicholls R. Anal fistula. Br J Surg 1992;79:197–205.Google Scholar
- 8.Centers for Disease Control and Prevention. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep 1992;41(No. RR-17):1–35.Google Scholar
- 9.Gottlieb MS, Schanker HM, Fan PT, Saxon A, Weisman JD, Pozalski I. Pneumocystis pneumonia—Los Angeles. MMWR Morb Mortal Wkly Rep 1981;30:250–1.Google Scholar
- 10.Safavi A, Gottesman L, Dailey TH. Anorectal surgery in the HIV+ patient: update. Dis Colon Rectum 1991;34:299–304.Google Scholar
- 11.Burke EC, Orloff SL, Freise CE, Macho JR, Schecter WP. Wound healing after anorectal surgery in human immunodeficiency virus-infected patients. Arch Surg 1991;126:1267–71.Google Scholar
- 12.Goodsall DH. Anorectal fistula. In: Goodsall DH, Miles WE, eds. Diseases of anus and rectum, part I. London: Longmans, Green & Co, 1990:92.Google Scholar
- 13.Seow-Choen F, Hay AJ, Heard S, Phillips RK. Bacteriology of anal fistulae. Br J Surg 1992;79:27–8.Google Scholar
- 14.Goldberg GS, Orkin BA, Smith LE. Microbiology of human immunodeficiency virus anorectal disease. Dis Colon Rectum 1994;37:439–43.Google Scholar
- 15.McCullough JB, Batman PA, Miller AR, Sedgwick PM, Griffin GE. Depletion of neuroendocrine cells in rectal biopsy specimens from HIV positive patients. J Clin Pathol 1992;45:524–7.Google Scholar
- 16.Barbul A, Breslin RJ, Woodyard JP, Wasserkrug HL, Efron G. The effect ofin vivo T helper and T suppressor lymphocyte depletion on wound healing. Ann Surg 1989;209:479–83.Google Scholar