. Rectal and anal surgery : with description of the secret methods of the itinerant specialists. any patients have hadfistulc¥ for years and l)een conscious of no serious annoyance ofthe discharge issm>h that mostpersons are earn-estly desirous ofgetting rid of thetrouble, and arewilling to xmdergoan operation forits removal. Thediagnosis is onlydifficult in distin-guishing differentvarieties. Therecan be no mistaking the general nature of the troublewhen the parts are superficially examined. A urinaryfistula is not infrequently taken for fistula in ano, andoperated upon with, o
. Rectal and anal surgery : with description of the secret methods of the itinerant specialists. any patients have hadfistulc¥ for years and l)een conscious of no serious annoyance ofthe discharge issm>h that mostpersons are earn-estly desirous ofgetting rid of thetrouble, and arewilling to xmdergoan operation forits removal. Thediagnosis is onlydifficult in distin-guishing differentvarieties. Therecan be no mistaking the general nature of the troublewhen the parts are superficially examined. A urinaryfistula is not infrequently taken for fistula in ano, andoperated upon with, of course, no benefit to the care should be taken to exclude these cases, and alsothose of deep pelvic or lumbar abscess, which sometimespoint near the anus. The writer has frequently been calledupon to examine cases of urinary fistula which had beendivided, under the mistaken supposition that they were casesof fistula in ano. Urinary fistulse may sometimes breakinto the bowel as well as externally. The diagnosis becomesin such cases more difficult, but the antecedent history of. Fig. 28.—Section of^Horhe-Shoe Fistula withDiverticula. From Authors Observations. 62 RECTAL AND ANAL SURGERY. urethral stricture, or some uiiuary affection, will serve toclear up doubtful points. The examination of a fistula is best made with thepatient upon the side opposite the one affected, or in thelithotomy position. If a probe be passed into the sinus, andthe left forefinger into the rectum, the latter may sometimesfeel the point of the instrument projecting into the bowel ata point not far from the sphincter. More frequently, how-ever, some difficulty is exjierienced in finding the internalopening, on account of the irregular character of the fistulaand its numerous pouches (Fig. 2H). The opening is notusually at the highest point of the fistulous tract, but isfound most often between the two sphincters, within an inchof the orifice. If the probe be carried to the extremity of th
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Keywords: ., bookcentury1800, bookdecade1880, booksub, booksubjectanusdiseases
