Sloft in ischio rectal abscess

SLOFT IN THE MANAGEMENT OFISCHIO-RECTAL ABSCESS

Dr D.U.PathakMS FACRSI

Shalby Hospital Jabalpur India

59 yrs Non diabetic male with clinically and on MRI detected as a case of acute Ischio-rectal abscess.

Treatment choices

I&D with de-roofing of the abscess cavity

Leaving internal opening with chances of Fistula formation later on in 50% of cases

Dealing with internal opening

Lay open Put in a Seton Ayurvedic kshar

sutra

Do nothing – with 50% chances of Fistula formation later on

LIFT not possible

Where LIFT is not possible ...

I&D and dealing internal opening with SLOFT effectively prevents fistula formation.

SLOFT is possible because the inherent anal duct, is transacted, near to the internal opening at dentate line .

With this breach in communication, de-roofing of the abscess cavity and wide excision of skin is un-necessary

Ischio-rectal abscess Abscess drained

near anal verge. Incision is cruciate

and small No de-roofing done Curettage done Pus sent for culture

sensitivity

Probing

Every Ischio-rectal abscess has an internal opening at dentate line

SLOFT (Sub Mucous Ligation Of Fistula Tract)

Incision is given close to the dentate line

Anal duct dissected around the indwelling probe

Aneurism needle passed around the probe and the duct tied and transacted after withdrawing the probe

Communication breach

Confirmed by probe coming out from inter sphincteric plane

Post operative care

No dressings or packing of the wound

Only regular sitz bath and hygiene

Weekly follow ups

Conclusion

The SLOFT is an easy way to deal with the internal opening rather than to leave is and accepting the risk of 50% chances of Fistula formation

Normally the wound heals in 15-20 days

Post operative result after 48 hours

The cavity is collapsed.

Patient has no pain. Incision is almost

invisible. It is obvious that

there is no need of any post op care or follow up.

ThanksDr D.U.Pathak

(Cell and WhatsappNo - 94251-52747)