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A D V E R T I S E M E N T
A D V E R T I S E M E N T
This patient presents with a fistula in ano. The external opening is visible at the 4:00 position with the patient in lithotomy position.
A D V E R T I S E M E N T
Most fistulas in ano are the residual tract left when an abscess originating in an anal crypt expands through a portion of the sphincter muscles and drains through the perianal skin. At least a fourth of patients with crypt abscesses will develop fistulas-in-ano. There presence should be suspected whenever there are multiple recurrences of an abscess. Most fistulas track between the internal and external sphincter, or through the external sphincter alone, to exit laterally on the buttocks.
Notes:
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A D V E R T I S E M E N T
According to Goodsall's rule, when the external opening lies anterior to the midtransverse plane, the internal opening is located radially. When the external opening lies posterior to the midtransverse plan, as is the case here, the internal opening should be found in the posterior midline. This rule does not apply to openings greater than 3cm from the anal verge.
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This page was last modified on 1/24/2000.
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