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. 2011 Mar;24(1):14-21.
doi: 10.1055/s-0031-1272819.

Anorectal infection: abscess-fistula

Herand Abcarian

Anorectal infection: abscess-fistula

Herand Abcarian. Clin Colon Rectal Surg. 2011 Mar.

Abstract

Anorectal abscess and fistula are among the most common diseases encountered in adults. Abscess and fistula should be considered the acute and chronic phase of the same anorectal infection. Abscesses are thought to begin as an infection in the anal glands spreading into adjacent spaces and resulting in fistulas in ~40% of cases. The treatment of an anorectal abscess is early, adequate, dependent drainage. The treatment of a fistula, although surgical in all cases, is more complex due to the possibility of fecal incontinence as a result of sphincterotomy. Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula. So even though the aim of a surgical procedure is to cure a fistula, conservative management short of major sphincterotomy is warranted to preserve fecal incontinence. However, trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure all result in more recurrence/persistence requiring repeated operations in many cases. A surgeon dealing with fistulas on a regular basis must tailor various operations to the needs of the patient depending on the complexity of the fistula encountered.

Keywords: Fistula; abscess; anorectal infection; fecal incontinence; sphincterotomy.

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Figures

Figure 1
Figure 1
(Left) Anal glands opening in anal crypts. (Right) Extension of abscess to adjacent spaces. 1, submucosal; 2, high intermuscular; 3, supralevator; 4, ischiorectal; 5, perianal. (Illustration provided by Russell K. Pearl, M.D., Department of Surgery, University of Illinois at Chicago.)
Figure 2
Figure 2
High abscesses. 1, supralevator; 2, submucosal/intermuscular. Low abscesses. 3, intersphincteric; 4, ischiorectal; 5, perianal. (Illustration provided by Russell K. Pearl, M.D., Department of Surgery, University of Illinois at Chicago.)
Figure 3
Figure 3
Classification of fistulas after Parks, Gordon, Hardcastle. (A) Intersphincteric. (B) Transsphincteric. (C) Suprasphincteric. (D) Extrasphincteric. (Illustration provided by Russell K. Pearl, M.D., Department of Surgery, University of Illinois at Chicago.)
See this image and copyright information in PMC

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