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Clinical Assessment of Anal Cryptoglandular Abscess and Fistula

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Anal Fistula and Abscess

Part of the book series: Coloproctology ((COLOPROCT))

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Abstract

There has long been a consensus for a number of points concerning the clinical assessment of cryptoglandular fistulae. This assessment is extremely useful for the following purposes: (1) the diagnosis of anal cryptoglandular fistulae and differential diagnosis; (2) topographic evaluation of the tract of the principal fistula and possible purulent collection and secondary extensions; (3) evaluation of the anatomy of the anal canal and of the sphincter apparatus. These diverse elements are essential to ensure correct management of this disease, which is challenging to treat due to the need to dry out the suppuration without exposing the patient to a risk of subsequent anal incontinence. However, this assessment is sometimes difficult and, given the potentially major consequences for the patient, doctors should not hesitate to seek the support of a more experienced specialist.

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References

  • Abeysuriya V, Salgado LS, Samarasekera DN (2010) The distribution of the anal glands and the variable regional occurrence of fistula-in-ano: is there a relationship? Tech Coloproctol 14:317–321

    Article  PubMed  CAS  Google Scholar 

  • Abou-Zeid AA (2011) Anal fistula: intraoperative difficulties and unexpected findings. World J Gastroenterol 17:3272–3276

    Article  PubMed  PubMed Central  Google Scholar 

  • Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A, Piloni V (2020) Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol 24:127–143

    Article  PubMed  CAS  Google Scholar 

  • Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RK (2011) For many high anal fistulas, lay open is still a good option. Tech Coloproctol 15:143–150

    Article  PubMed  CAS  Google Scholar 

  • Barwood N, Clarke G, Levitt S, Levitt M (1997) Fistula-in-ano: a prospective study of 107 patients. Aust N Z J Surg 67:98–102

    Article  PubMed  CAS  Google Scholar 

  • Becker A, Koltun L, Sayfan J (2006) Simple clinical examination predicts complexity of perianal fistula. Color Dis 8:601–604

    Article  CAS  Google Scholar 

  • Choen S, Burnett S, Bartram CI, Nicholls RJ (1991) Comparison between anal endosonography and digital examination in the evaluation of anal fistulae. Br J Surg 78:445–447

    Article  PubMed  CAS  Google Scholar 

  • Cirocco WC, Reilly JC (1992) Challenging the predictive accuracy of Goodsall’s rule for anal fistulas. Dis Colon Rectum 35:537–542

    Article  PubMed  CAS  Google Scholar 

  • Cirocco WC, Reilly JC (2020) It is time to retire Goodsall’s Rule: the Midline Rule is a more accurate predictor of the true and natural course of anal fistulas. Tech Coloproctol 24:317–321

    Article  PubMed  CAS  Google Scholar 

  • Coremans G, Dockx S, Wyndaele J, Hendrickx A (2003) Do anal fistulas in Crohn’s disease behave differently and defy Goodsall’s rule more frequently than fistulas that are cryptoglandular in origin? Am J Gastroenterol 98:2732–2735

    Article  PubMed  CAS  Google Scholar 

  • Cripps NP, Northover JM (1998) Anovestibular fistula to Bartholin’s gland. Br J Surg 85:659–661

    Article  PubMed  CAS  Google Scholar 

  • Davies M, Harris D, Lohana P, Chandra Sekaran TV, Morgan AR, Beynon J, Carr ND (2008) The surgical management of fistula-in-ano in a specialist colorectal unit. Int J Color Dis 23:833–838

    Article  CAS  Google Scholar 

  • de Parades V, Zeitoun JD, Atienza P (2010) Cryptoglandular anal fistula. J Visc Surg 147:265–277

    Article  Google Scholar 

  • de Parades V, Fathallah N, Blanchard P, Zeitoun JD, Bennadji B, Atienza P (2012) Horseshoe tract of anal fistulas: bad luck or an avoidable extension? Lessons from 82 cases. Color Dis 14:1512–1515

    Article  Google Scholar 

  • Dudukgian H, Abcarian H (2011) Why do we have so much trouble treating anal fistula ? World J Gastroenterol 17:3292–3296

    Article  PubMed  PubMed Central  Google Scholar 

  • Duinslaeger M (2000) Difficult fistulae. Acta Chir Belg 100:118–122

    Article  PubMed  CAS  Google Scholar 

  • 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 21:237–254

    Article  PubMed  CAS  Google Scholar 

  • Fucini C, Giani I (2011) Why do we have to review our experience in managing cases with idiopathic fistula-in-ano regularly ? World J Gastroenterol 17:3297–3299

    Article  PubMed  PubMed Central  Google Scholar 

  • Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD (1996) Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729

    Article  PubMed  CAS  Google Scholar 

  • Garcia-Granero A, Granero-Castro P, Frasson M, Flor-Lorente B, Carreño O, Espí A, Puchades I, Garcia-Granero E (2014) Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series. Int J Color Dis 29:1557–1564

    Article  Google Scholar 

  • Gerrard-Gough B, Kovalcik PJ, Cross GH (1978) High intramuscular anorectal abscess. Arch Surg 113:891–892

    Article  PubMed  CAS  Google Scholar 

  • Gonzalez-Ruiz C, Kaiser AM, Vukasin P, Beart RW Jr, Ortega AE (2006) Intraoperative physical diagnosis in the management of anal fistula. Am Surg 72:11–15

    Article  PubMed  Google Scholar 

  • Goodsall DH, Miles WE (1982) Anorectal fistula. Dis Colon Rectum 25:262–278

    Article  Google Scholar 

  • Grewal H, Guillem JG, Quan SH, Enker WE, Cohen AM (1994) Anorectal disease in neutropenic leukemic patients. Operative vs. nonoperative management. Dis Colon Rectum 37:1095–1099

    Article  PubMed  CAS  Google Scholar 

  • Gunawardhana PA, Deen KI (2001) Comparison of hydrogen peroxide instillation with Goodsall’s rule for fistula-in-ano. ANZ J Surg 71:472–474

    Article  PubMed  CAS  Google Scholar 

  • Halligan S, Stoker J (2006) Imaging of fistula in ano. Radiology 239:18–33

    Article  PubMed  Google Scholar 

  • Holzheimer RG, Siebeck M (2006) Treatment procedures for anal fistulous cryptoglandular abscess-how to get the best results. Eur J Med Res 11:501–515

    PubMed  CAS  Google Scholar 

  • Hughes F, Mehta S (2002) Anorectal sepsis. Hosp Med 63:166–169

    Article  PubMed  CAS  Google Scholar 

  • Jain BK (2020) Pre-surgery assessment of anal fistula. Tech Coloproctol 24:775–776

    Article  PubMed  CAS  Google Scholar 

  • Jayarajah U, Samarasekera DN (2017) Predictive accuracy of Goodsall’s rule for fistula-in-ano. Ceylon Med J 62:97–99

    Article  PubMed  CAS  Google Scholar 

  • Kondylis PD, Shalabi A, Kondylis LA, Reilly JC (2009) Male cryptoglandular fistula surgery outcomes: a retrospective analysis. Am J Surg 197:325–330

    Article  PubMed  Google Scholar 

  • Marcus RH, Stine RJ, Cohen MA (1995) Perirectal abscess. Ann Emerg Med 2:597–603

    Article  Google Scholar 

  • Millan M, Garcia-Granero E, Esclápez P, Flor-Lorente B, Espí A, Lledó S (2006) Management of intersphincteric abscesses. Color Dis 8:777–780

    Article  CAS  Google Scholar 

  • Nwaejike N, Gilliland R (2007) Surgery for fistula-in-ano : an audit of practise of colorectal and general surgeons. Color Dis 9:749–753

    Article  CAS  Google Scholar 

  • Ommer A, Herold A, Berg E, Fürst A, Post S, Ruppert R, Schiedeck T, Schwandner O, Strittmatter B (2017) German S3 guidelines: anal abscess and fistula (second revised version). Langenbeck’s Arch Surg 402:191–201

    Article  Google Scholar 

  • Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12

    Article  PubMed  CAS  Google Scholar 

  • Rosa G, Lolli P, Piccinelli D, Mazzola F, Bonomo S (2006) Fistula in ano: anatomoclinical aspects, surgical therapy and results in 844 patients. Tech Coloproctol 10:215–221

    Article  PubMed  CAS  Google Scholar 

  • Rosen SA, Colquhoun P, Efron J, Vernava AM 3rd, Nogueras JJ, Wexner SD, Weiss EG (2006) Horseshoe abscesses and fistulas: how are we doing? Surg Innov 13:17–21

    Article  PubMed  Google Scholar 

  • Sygut A, Mik M, Trzcinski R, Dziki A (2010) How the location of the internal opening of anal fistulas affect the treatment results of primary transsphincteric fistulas. Langenbeck’s Arch Surg 395:1055–1059

    Article  Google Scholar 

  • Téoule P, Seyfried S, Joos A, Bussen D, Herold A (2018) Management of retrorectal supralevator abscess-results of a large cohort. Int J Color Dis 33:1589–1594

    Article  Google Scholar 

  • Vogel JD, Johnson EK, Morris AM, Paquette IM, Saclarides TJ, Feingold DL, Steele SR (2016) Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum 59:1117–1133

    Article  Google Scholar 

  • Williams G, Williams A, Tozer P, Phillips R, Ahmad A, Jayne D, Maxwell-Armstrong C (2018) The treatment of anal fistula: second ACPGBI Position Statement – 2018. Color Dis 20(Suppl 3):5–31

    Article  Google Scholar 

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Correspondence to Vincent de Parades .

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de Parades, V. et al. (2021). Clinical Assessment of Anal Cryptoglandular Abscess and 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_9-1

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  • DOI: https://doi.org/10.1007/978-3-030-30902-2_9-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-30902-2

  • Online ISBN: 978-3-030-30902-2

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