After fistulectomy if recurrence takes place, is it always due to infection?
If a recurrence took place it is due to incomplete fistulectomy procedure or to underlined specific disease like Crohn' or tuberculosis, or something of the sort. What kind of microorganisms do you think are causative for the vulgar fistula to recur?
In 24 cases of recurrent fistulae, pus culture was +ve in all cases.Either of Proteus Miribilous or E. coli were reported in 22 cases while in one case both were reported.Only in one case St. aureus was reported.
Surely it was! However, was the microbes causative indeed?
As far as I know, there is no quite positive and sharp theories highlighted the rectal fistula pathogenesis, so that is would be exellent field for further investigation (and Nobel prizes :)).
However, it has been believed from the times almost beyond memory that the central point in the acute paraproctitis and chronic one (which is presented by the anal fistula) development plays one of the perianal glands due to bacterial contamination and colonization (Chiari concept, 1879, if I remember correctly).
One could ask a question as to why just the singular mucous gland becomes infected? There is no data jugeing by the literature, but we could make a conclusion based by analogy with other glands acute and chronic pathology: sebaceous, sialic; mamma and pancreas, etc. Each of the acute disease developed due to inappropriate drainage of a gland, and infection appeares secondarily. For example, the acute mastitis occurs due to the lactostasis and is sterile at the beginning. And so on.
So, one could suggest, that the acute paraproctitis occurs due to the causative gland mechanical obturation (you might see, for example, Principles and Practice of Surgery for the Colon, Rectum, and Anus, 3d ed, P.H.Gordon & S.Navatvongs / NY, London, Informa Healthcare, 2007, 1354 P.).
Why does the single anal gland become obturated? The question that worths $1.000.000!
Thank you for the reply and good luck!
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