Hiding Intersphincteric and Transphincteric Sepsis in a Novel Pathological Approach to Chronic Anal Fissure

Abstract

The authors assume that chronic fissures may persist because of hiding sepsis in the anal canal and that chronic anal fissure might be the clinical and pathological expression of a coexisting intersphincteric or low transphincteric fistula, and the ultrasonographic findings strongly support this theory.

The treatment of anal fistula: secondACPGBIPosition Statement – 2018

“…Naldini et al . performed endoanal ultrasound scans on 175 patients with a chronic anal fissure. They demonstrated an intersphincteric fistula in 91 (53%) patients and a transsphincteric fistula in 21 (12%) patients.…”

“…Whereas there has not been any recent publication confirming this theory, equally there has not been a publication proposing a more plausible explanation. Naldini et al [6] performed endoanal ultrasound scans on 175 patients with a chronic anal fissure. They demonstrated an intersphincteric fistula in 91 (53%) patients and a transsphincteric fistula in 21 (12%) patients.…”

The cryptoglandular theory revisited

“…Probably, some of these fistulae originate from a dorsal anal fissure. Naldine et al performed endoanal ultrasound in 117 patients with a chronic anal fissure [12]. Ultrasound revealed an associated intersphincteric abscess in 65 percent and a low perianal fistula in 12 percent of patients.…”

Maintenance Therapy with Partially Hydrolyzed Guar Gum in the Conservative Treatment of Chronic Anal Fissure: Results of a Prospective, Randomized Study

“…Particularly, the insufficient anal sphincter stretchability, the associated perianal sepsis and the coexistent sentinel pile have been advocated as additional pathogenetic factors and could explain both recurrences after conservative treatment and differences between surgical and pharmacological sphincterotomy outcome [5, 25, 26]. …”