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What Causes Pus Discharge From An Yellow Anal Abscess Post VAAFT Procedure?

Posted on Mon, 4 Jul 2016

Question: Hi Doctor,

I had a fistula in ano surgery done by VAAFT method, and fistula tract was closed by Filac process. It was done ten days back. I have noticed pus and discharge since yesterday. The pus is observed coming from a yellow colored abscess around 2 cm from the anal hole. However, at the same time, it is also noted that there is less burning, itching and pain post surgery even after the bowel movements. I am regularly dressing the wound two to three times daily and also doing sitz bath. Is it normal to have this ? Please advise

I have also uploaded the photo of the fluid which was observed last night. The fluid was watery in nature and yellowish in color. I also spoke to the surgeon who had conducted the operation after sending the photos one hour back and according to him, it is not pus. It is a natural phenomenon after surgery. I am confused

Answered by Dr. Ajit Naniksingh Kukreja (3 hours later)

Brief Answer:
Need to wait

Detailed Answer:
Hi

Thanks for writing in, I've reviewed the reports..

In a combination of VAAFT and FiLaC the internal opening of the fistula is scrapped and closed and the tack ablated with laser

The external opening is kept open to allow secretions drain

It usually is concerning if the discharge persists after three weeks, and is associated with redness and pain in the external opening site

Having seen your pictures I feel you can very well wait for another week or so and see if the discharge continues

In that case you need to get a culture of the discharge and see your operating surgeon who will prescribe antibiotics accordingly

Hope this helps
Do write back in case of concern

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ajit Naniksingh Kukreja (47 hours later)

Thanks a lot doctor for your reply which has helped to reduce my stress. I want to know the following:-

1) The area near the external opening seems to be tender, and there is still hardness in the whole tract which was there before surgery. Is it normal?

2) There is another opening 2 cm near the anus which is shown in the attached picture. What is this opening ? When I pass gas, I feel uncomfortable, and it seems gas is going to the opening. I am getting more discomfort like fluid discharge from this opening.

At the same time, I would like to state that I am not having any pain, burning or itching in the area now.

Answered by Dr. Ajit Naniksingh Kukreja (18 minutes later)

Brief Answer:
Clinical examination will help

Detailed Answer:
Hi

Thanks for writing in again

Here is my response:

1] It should not be tender, firm and hard area in the route of tract is probably postoperative inflammation and would subside, try some antiinflammatory analgesic for few days and see the response

2] Needs clinical examination as this could be another tract which might have gone unidentified during primary surgery

DO not hesitate to write back in case of concern

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ajit Naniksingh Kukreja (44 hours later)

Dear Doctor,

Yesterday evening I had pain from the external opening, and I was even not able to walk properly. After some time, fluid started oozing, and the pain became less. The similar thing happened this morning also. I have taken a photograph of the area of the external opening which I am sending to you. There are two openings seen, one very near the anus which becomes uncomfortable when I pass the wind etc. I am seeking your advice since I plan to travel to XXXXXXX for further check-up.

Answered by Dr. Ajit Naniksingh Kukreja (3 hours later)

Brief Answer:
Needs Evaluation

Detailed Answer:
Hi

Thanks for writing in again

Fluid discharge at this stage is Ok but the pain making it difficult to walk is not acceptable

Another concern will be discomfort while passing flatus ?

I have seen the latest pic but it is difficult to evaluate a fistula from a picture, it either needs clinical evaluation and/or transanal ultrasound

If you are travelling to XXXXXXX I have a good friend who is equally experienced in fistula surgery

Hope I am of some help in advising you

Regards
Wishing you a healthy life ahead

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ajit Naniksingh Kukreja (1 hour later)

Dear doctor,

Thanks for your reply. Please suggest the name of the doctor so that I can seek his advice at the soonest

Answered by Dr. Ajit Naniksingh Kukreja (16 hours later)

Brief Answer:
Dr Parvez Sheikh

Detailed Answer:
Hi

He is Dr Parvez Sheikh and available at Saifee Hospital XXXXXXX

Unfortunately due to privacy statement I cannot share his XXXXXXX number, you can seek an appointment for his OPD at the Saifee hospital helpdesk

When you meet him you may share with him that you got the reference from me

Regards
Dr Kukreja

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Prasad