Anorectal Infection: Abscess-Fistula

Abstract

Anorectal abscess and fistula are among the most common diseases encountered in adults. Abscess and fistula should be considered the acute and chronic phase of the same anorectal infection. Abscesses are thought to begin as an infection in the anal glands spreading into adjacent spaces and resulting in fistulas in 40% of cases. The treatment of an anorectal abscess is early, adequate, dependent drainage. The treatment of a fistula, although surgical in all cases, is more complex due to the possibility of fecal incontinence as a result of sphincterotomy. Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula. So even though the aim of a surgical procedure is to cure a fistula, conservative management short of major sphincterotomy is warranted to preserve fecal incontinence. However, trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure all result in more recurrence/persistence requiring repeated operations in many cases. A surgeon dealing with fistulas on a regular basis must tailor various operations to the needs of the patient depending on the complexity of the fistula encountered. KEYWORDS: Fistula, abscess, anorectal infection, sphincterotomy, fecal incontinenceObjectives: At the completion of this article, the reader is expected to understand the etiology and pathogenesis of an anal abscessfistula, the classification of anal fistulas, and alternative surgical procedures.Anorectal abscess-fistula is one of our most common afflictions. Because of the close association of abscess and fistula in etiology, anatomy, pathophysiology, therapy and morbidity, it is appropriate to consider both entities as one, i.e., abscess-fistula or a fistulous abscess. It is also appropriate to consider an abscess as the acute and a fistula as the chronic state of anorectal suppuration. EPIDEMIOLOGY IncidenceMost publications on the subject reflect authors' experience from a single institution; this does not address the incidence of the disease due to lack of a proper denominator. Also, it is difficult if not impossible to accurately access the incidence of anorectal abscesses because they

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