OPERATION FOR RECTAL FISTULA 339 



Operation for Rectal Fistula. 



INDICATIONS. — When the rectum becomes injured by 

 rough handling, by harsh or dry feces, by impactions, or by 

 irritant enemata, abscesses often form in the wall at the in- 

 jured point. These abscesses may point in -the rectum and 

 thereby establish a communication between it and the 

 abscess cavity, constituting at once the simplest form of 

 rectal fistula. Sometimes in addition to the tract into the 

 rectum another one is formed from the abscess cavity to the 

 surface of the body at the side of the anus, by the accumu- 

 lation of pus, flatus and fecal matter in the peri-proctal space. 

 At other times the pus of the abscess cavity gravitates over 

 the ischial arch through the obturator foramen, around the 

 brim of the pubis, or over the shaft of the ischium and then, 

 after finding its way between the internal femoral group of 

 muscles, points at the surface in the internal femoral 

 region, generally just inside and slightly above the stifle, or 

 at the bottom of the groove between the sheath and the 

 thigh. 



Proctal 'and periproctal abscesses of this character do not 

 always develop into chronic fistulas ; in fact, they usually 

 cicatrize promptly after discharging their contents either in 

 the rectum, perineum or femoral region. Occasionally, how- 

 ever, the tract becomes chronic and continues to discharge a 

 limited amount of pus from the surface orifice month after 

 month, showing no tendency whatever toward spontaneous 

 recovery. This is the rectal fistula of animals. 



Successful intervention is not always possible. When 

 the tract extends only to the side of the anus or over the 

 ischial arch, there is always a chance to submit it to treat- 

 ment that will encourage cicatrization, but when the tract 

 directs its course from the thigh through the obturator fora- 

 men or sciatic notch, or around the brim of the pubis, meddle- 

 some interference may end in fatal abdominal complications. 

 Furthermore, as long as they are compatible with health 

 there is little excuse for the performance of a dangerous op- 

 eration against them. The following simple procedure is 

 preferable for all of them : 



TECHNIQUE. — The patient is secured in the standing 

 position with sideline or stock when the orifice is at the anus, 

 and with the casting harness if it extends below the pubis 

 into the femoral region. 



The rectum is emptied manually and an attempt is made 



