7335 - Ano, fistula in, including anorectal fistula, anorectal abscess
DBQ: Link to Index of DBQ/Exams by Disability for DC 7335
Definition
The anus is the rectal outlet situated in the fold between the buttocks. Ano, fisula in relates to an abnormal, tube-like passageway from the anal canal to a hole in the skin somewhere around the anal opening.
Etiology
Anal fistulas may occur spontaneously or may be the result of an anorectal abscess that has eroded a new pathway to the skin. Some predisposing causes may include diverticulitis, Crohn's disease, tumors, or trauma.
Signs & Symptoms
Manifestations usually include an occasional or constant discharge. The site reveals one or more fistulous openings, and a tract that may be palpated. Use of a probe can determine the direction and depth of the tract. Itching and odor may be present due to this condition.
Tests
Diagnostic measurements include a digital examination to locate the internal and external fistula openings. An anoscope and a probe will be used to determine the fistula path, then endoanal ultrasonography is utilized to determine the fistula's proximity to the anal sphincter.
Treatment
Surgery is the most effective treatment. A "ditch" is created by laying open the entire tract and allowing healing by secondary intention to take place.
Residuals
Because of the open wound and delayed healing, antibiotics may be necessary.
Special Considerations
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May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See 38 CFR 3.350(i)(1) – Total plus 60% – Special Monthly Compensation (SMC).
Notes
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Rate as for impairment of sphincter control.