[Anorectal abscess and fistula]

Abstract

Anal glands which lie in the intersphincteric space at the dentate line play an important role in the development of abscesses and fistulas. Secondary causes are inflammatory colorectal diseases and skin infections. For the classification of anorectal abscesses and fistulas a simple and practible nomenclature is proposed. Clinical presentation and diagnostic are described with regard to new means of diagnostic. The opening of the abscess without a fistulotomy appears to be the treatment of choice in patients with a perianal abscess whereas patients with an intersphincteric abscess are treated by fistulotomy. Perianal fistulas can be detected in 50% of the cases after drainage of a perianal abscess. The therapy of the perianal fistula below the dentate line consists in the fistulotomy. In contrast intersphincteric fistulas and fistulas above the dentate line are more often treated with a mucosa flap where by the sphincteric musculature is spared.