46/M came with c/o pus discharge from perineal area

 THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED


46 years old male farmer by occupation came to OPD with C/C of swelling and pus discharge seen since 1year

HOPI:pt was apparently asymptomatic 16years back then he developed multiple swelling around perianal region and discharge is seen which is insidious in onset and gradually in progression whitish yellow type discharge releived on medication no aggrevating factors which is associated with pain, itching while defecation,for which he went to RMP doctor and he was treated by medication,slowly symptoms get subsided but after 2months again he developed the abscess discharge in the same region for which he went to hospital and undergoes surgery (drainage of abscess) after the surgery he was good and he taken mediation for 5 years continuously then he stopped to take medication again he developed swelling beside perianal region and both gluteal region,on pressing discharge is seen,he was again treated conservatively later 6months back,he went to hospital for the same problem and he was advised for MRI(MR FISTULOGRAM)
in which he found to have fistula seen in both side of Anal canal

Past history: no history of HTN,DM, Thyroid abnormality,asthma, epilepsy
Personel history:
He wakes up at 5AM,has bedi and than go to bathroom,he ate breakfast at 7o clock,he went to agriculture land,he usually do sowing, plucking of weeds, spraying insecticide and pesticides,he came to home at 2o clock had lunch,he taken rest for 30min after that he again goes to agriculture land he came to home at 7oclock he had dinner at 8oclock, before sleeping he used to take 2bedi and slept at 10oclock
Family history:


General examination:
Pt is conscious,coherent,cooperative and well orientated with time, place, person
Pallor: present

Icterus: absent
Cyanosis: absent
Clubbing:absent
Lymphadenopathy: absent
Pedal edema: absent 



Previous MRI SCAN(found to have perianal fistula)

VITALS:
Temp: Afebrile
RR:18cpm
PR:65bpm
BP:
SYSTEMIC EXAMINATION:
CVS: S1 and S2 sounds heard 
          No murmur are seen
CNS :NO focal neurological deficit
RS:NVBS heard 
P/A of abdomen:soft and no organomegaly
Gluteal region examination:
On inspection:
erythema is seen,medial aspect of both buttocks multiple sinus is seen,pus discharging and foul smelling 
On palpation:
Local raise of temperature,mild tenderness is seen,on palpating the swelling white colour pus discharge is seen
 VITALS:
Temp: Afebrile
RR:18cpm
PR:65bpm
BP:
SYSTEMIC EXAMINATION:
CVS: S1 and S2 sounds heard 
          No murmur are seen
CNS :NO focal neurological deficit
RS:NVBS heard 
P/A of abdomen:soft and no organomegaly
Gluteal region examination:
On inspection:
erythema is seen,medial aspect of both buttocks multiple sinus is seen,pus discharging and foul smelling 
On palpation:
Local raise of temperature,mild tenderness is seen,on palpating the swelling white colour pus discharge is seen
INVESTIGATION:
1)USG SCAN:
2)
3)ECG


4) X-RAY


5)MRI FISTULOGRAM:

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