Abstract
Anorectal abscess and perianal fistulas are considered two phases of the same disease. It is still unclear why some patients completely heal after incision and drainage of the anorectal abscess and others go on to develop a perianal fistula. This chapter evaluates the incidence and risk factors for the development of cryptoglandular perianal fistulas.
Similar content being viewed by others
References
Eisenhammer S (1954) Advance of ano-rectal surgery with special reference to ambulatory treatment. S Afr Med J 28(13):264–266
Eisenhammer S (1978) The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular (intersphincteric) fistulous abscess and fistula. Dis Colon Rectum 21(4):237–254
Eykyn SJ, Grace RH (1986) The relevance of microbiology in the management of anorectal sepsis. Ann R Coll Surg Engl 68(5):237–239
Fritsch H, Aigner F, Ludwikowski B, Reinstadler-Zankl S, Illig R, Urbas D, Schwarzer C, Longato S (2007) Epithelial and muscular regionalization of the human developing anorectum. Anat Rec (Hoboken) 290(11):1449–1458
Fritsch H, Zehm S, Illig R, Moser P, Aigner F (2010) New insights into the development and differentiation of the human anorectal epithelia. Are there clinical consequences? Int J Color Dis 25(10):1231–1242
Galanis I, Chatzimavroudis G, Christopoulos P, Makris J (2016) Prospective randomized trial of simple drainage vs. drainage and initial fistula management for perianal abscesses. J Gastrointest Dig Syst 6:382. https://doi.org/10.4172/2161-069X.1000382
Garcia-Arranz M, Garcia-Olmo D, Herreros MD, Gracia-Solana J, Guadalajara H, de la Portilla F, Baixauli J, Garcia-Garcia J, Ramirez JM, Sanchez-Guijo F, Prosper F, FISPAC Collaborative Group (2020) Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: a randomized clinical trial with long-term follow-up. Stem Cells Transl Med 9(3):295–301
Ghahramani L, Minaie MR, Arasteh P, Hosseini SV, Izadpanah A, Bananzadeh AM, Ahmadbeigi M, Hooshanginejad Z (2017) Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: a randomized single blind clinical trial. Surgery 162(5):1017–1025
Gokce FS, Gokce AH (2020) Can the risk of anal fistula development after perianal abscess drainage be reduced? Rev Assoc Med Bras (1992) 66(8):1082–1086
Hamadani A, Haigh PI, Liu IL, Abbas MA (2009) Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess? Dis Colon Rectum 52(2):217–221
Hämäläinen KP, Sainio AP (1998) Incidence of fistulas after drainage of acute anorectal abscesses. Dis Colon Rectum 41(11):1357–1361
Hasan RM (2016) Incidence of fistula after management of perianal abscess. J Coloproctol (Rio J) 36:216–219
He Z, Du J, Wu K, Chen J, Wu B, Yang J, Xu Z, Fu Z, Pan L, Wen K, Wang X (2020) Formation rate of secondary anal fistula after incision and drainage of perianal sepsis and analysis of risk factors. BMC Surg 20(1):94
Hebjørn M, Olsen O, Haakansson T, Andersen B (1987) A randomized trial of fistulotomy in perianal abscess. Scand J Gastroenterol 22(2):174–176
Herfs M, Hubert P, Moutschen M, Delvenne P (2011) Mucosal junctions: open doors to HPV and HIV infections? Trends Microbiol 19(3):114–120
Ho YH, Tan M, Chui CH, Leong A, Eu KW, Seow-Choen F (1997) Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon Rectum 40(12):1435–1438
Knoefel WT, Hosch SB, Hoyer B, Izbicki JR (2000) The initial approach to anorectal abscesses: fistulotomy is safe and reduces the chance of recurrences. Dig Surg 17(3):274–278
Lai CK, Wong J, Ong GB (1983) Anorectal suppuration: a review of 606 patients. Southeast Asian J Surg 6:22–26
Lee JM, Kim NK (2018) Essential anatomy of the anorectum for colorectal surgeons focused on the gross anatomy and histologic findings. Ann Coloproctol 34(2):59–71
Li D, Yu B (1997) Primary curative incision in the treatment of perianorectal abscess. Zhonghua Wai Ke Za Zhi 35(9):539–540
Lu D, Lu L, Cao B, Li Y, Cao Y, Li Z, Wang Z, Lu J (2019) Relationship between body mass index and recurrence/anal fistula formation following initial operation for anorectal abscess. Med Sci Monit 25:7942–7950
Malik AI, Nelson RL, Tou S (2010) Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev (7):CD006827
McElwain JW, MacLean MD, Alexander RM, Hoexter B, Guthrie JF (1975) Anorectal problems: experience with primary fistulectomy for anorectal abscess, a report of 1,000 cases. Dis Colon Rectum 18(8):646–649
Mitalas LE, van Onkelen RS, Monkhorst K, Zimmerman DD, Gosselink MP, Schouten WR (2012) Identification of epithelialization in high transsphincteric fistulas. Tech Coloproctol 16(2):113–117
Muranaka F, Nakajima T, Iwaya M, Ishii K, Higuchi K, Ogiwara N, Miyagawa S, Ota H (2018) A comparative immunohistochemical study of anal canal epithelium in humans and swine, focusing on the anal transitional zone epithelium and the anal glands. Anat Rec (Hoboken) 301(5):796–805
Oliver I, Lacueva FJ, Pérez Vicente F, Arroyo A, Ferrer R, Cansado P, Candela F, Calpena R (2003) Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment. Int J Color Dis 18(2):107–110
Onkelen van RS, Gosselink MP, Schouten WR (2013a) Treatment of anal fistulas with high intersphincteric extension. Dis Colon Rectum 56(8):987–991
Onkelen van RS, Mitalas LE, Gosselink MP, van Belkum A, Laman JD, Schouten WR (2013b) Assessment of microbiota and peptidoglycan in perianal fistulas. Diagn Microbiol Infect Dis 75:50–54
Parks AG (1961) The pathogenesis and the treatment of fistula in ano. Br Med J 1:463–469
Ramanujam PS, Prasad ML, Abcarian H, Tan AB (1984) Perianal abscesses and fistulas: a study of 1 023 patients. Dis Colon Rectum 27:593–597
Read DR, Abcarian H (1979) A prospective survey of 474 patients with anorectal abscess. Dis Colon Rectum 22(8):566–568
Rojanasakul A, Booning N, Huimin L, Pongpirul K, Sahakitrungruang C (2021) Intersphincteric exploration with ligation of Intersphincteric fistula tract or attempted closure of internal opening for acute anorectal abscesses. Dis Colon Rectum 64(4):438–445
Saber A, Bayumi EK (2016) Perianal abscess; simple drainage versus drainage and fistulotomy. J Surg 4(3-1):10–13. https://doi.org/10.11648/j.js.s.2016040301.12
Sahnan K, Askari A, Adegbola SO, Tozer PJ, Phillips RKS, Hart A, Faiz OD (2017) Natural history of anorectal sepsis. Br J Surg 104(13):1857–1865
Sahnan K, Askari A, Adegbola SO, Warusavitarne J, Lung PFC, Hart A, Faiz O, Phillips RKS, Tozer P (2019) Persistent fistula after anorectal abscess drainage: local experience of 11 years. Dis Colon Rectum 62(3):327–332
Schouten WR, van Vroonhoven TJ (1991) Treatment of anorectal abscess with or without primary fistulectomy. Results of a prospective randomized trial. Dis Colon Rectum 34(1):60–63
Scoma JA, Salvati EP, Rubin RJ (1974) Incidence of fistulas subsequent to anal abscesses. Dis Colon Rectum 17(3):357–359
Sözener U, Gedik E, Kessaf Aslar A, Ergun H, Halil Elhan A, Memikoğlu O, Bulent Erkek A, Ayhan KM (2011) Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study. Dis Colon Rectum 54(8):923–929
Tang CL, Chew SP, Seow-Choen F (1996) Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscesses with proven internal opening. Dis Colon Rectum 39(12):1415–1417
Tozer PJ, Rayment N, Hart AL et al (2015) What role do bacteria play in persisting fistula formation in idiopathic and Crohn’s anal fistula? Color Dis 17:235–241
Vasilevsky CA, Gordon PH (1984) The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum 27(2):126–130
Waggener HU (1969) Immediate fistulotomy in the treatment of perianal abscess. Surg Clin North Am 49(6):1227–1233
Xu RW, Tan KK, Chong CS (2016) Bacteriological study in perianal abscess is not useful and not cost-effective. ANZ J Surg 86(10):782–784
Zhang H, Zhou ZY, Hu B, Liu DC, Peng H, Xie SK, Su D, Ren DL (2016) Clinical significance of 2 deep posterior perianal spaces to complex cryptoglandular fistulas. Dis Colon Rectum 59(8):766–774
Zhou C, Li M, Zhang Y, Ni M, Wang Y, Xu D, Shi Y, Zhang B, Chen Y, Huang Y, Zhang S, Shi H, Jiang B (2020) Autologous adipose-derived stem cells for the treatment of Crohn’s fistula-in-ano: an open-label, controlled trial. Stem Cell Res Ther 11(1):124
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this entry
Cite this entry
Gosselink, M.P., Baharlou, H. (2022). From Abscess to Fistula. In: Ratto, C., Parello, A., Litta, F., De Simone, V., Campennì, P. (eds) Anal Fistula and Abscess. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-030-30902-2_6-1
Download citation
DOI: https://doi.org/10.1007/978-3-030-30902-2_6-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-30902-2
Online ISBN: 978-3-030-30902-2
eBook Packages: Springer Reference MedicineReference Module Medicine