the Management of Perianal Abscess, Fistula and Recto-Vaginal Fistula

- Introduction

A generally accepted explanation for the cause of anorectal abscess and fistula-in-ano is that an abscess results from obstruction of an anal gland and that a fistula is caused by chronic infection and epithelialization of the abscess drainage tract.^(1–3) Anorectal abscesses are described by the anatomic space in which they develop; ischiorectal (also called ischioanal) abscesses are the most common followed by intersphincteric, supralevator, and submucosal locations.^{(4, 5)} Anorectal abscess occurs more often in males than females. In general, an abscess is treated with prompt incision and drainage. ^{(3, 4)}.

Fistula-in-ano is an epithelialized tract that connects the perianal skin with the anal canal. In patients with an anorectal abscess, 30% to 70% present with a concomitant fistula-in-ano, and, of those who do not, approximately 30% to 50% will ultimately be diagnosed with a fistula in the months to years after abscess drainage. ^{(2, 6-9)}. Although an anorectal abscess is described by the anatomic space in which it forms, a fistula-in-ano is classified in terms of its relationship with the internal and external anal sphincters. ⁽⁹⁾.