Long anterior anal fistula with an external opening in the medial raphe of the scrotum is likely to open radially inside the anal canal: an addition to the Goodsall’s rule

Muralidhar, Venkiteswaran; Santhaseelan, R.G.; Krishnamurthy, Ashwini

doi:10.1136/bcr-2018-227560

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…The Goodsall's rule states that if the external opening is anterior to the transverse anal line, the stula will penetrate radially and open into the anterior wall of the anal canal provided it is less than 3 cm from the anal verge, or else it will open in the midline posteriorly. When lying more than 3 cm from the anal verge, anterior stulas may have a curved track, which is similar to posterior stulas [4,19] (Fig. 5).…”

Section: Discussionmentioning

confidence: 99%

Preoperative magnetic resonance imaging of anal fistulas with scrotal extension

Nguyen

et al. 2023

Preprint

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The aim of this study was to elucidate the magnetic resonance (MR) characteristics of anal fistulas extending to the scrotum, the rules applicable to them, and to correlate MR features with surgical findings. We conducted a retrospective study in 150 consecutive patients with anal fistulas extending into the scrotum, who were diagnosed and underwent surgery at University Medical Center Ho Chi Minh City between January 2017 and April 2022. MR findings were evaluated and compared with surgical findings using the Cohen’s kappa coefficient (k) with a 95% confidence interval. 150 patients (mean age 37.6 ± 10.9 years) with 166 fistulas, including 150 anal fistulas with scrotal extension. Most fistulas were low transsphincteric (80.0%, 120/150 patients). There was strong agreement for primary tract classification and detecting the location of internal openings between MRI and surgical findings with k = 0.83 (0.78–0.87) and k = 0.89 (0.85 – 0.93) (p<0.001), respectively. There is a significant correlation between the location of internal openings and the type of fistula (p<0.05). Low transsphincteric fistulas were predominant in the anterior group (103/122 patients vs. 10/19 patients), while in the posterior group it was more common in the high transsphincteric fistulas (7/19 patients vs. 14/122 patients), and the intersphincteric fistulas (1/19 patients vs. 5/122 patients); and the suprasphincteric fistulas were only seen in posterior group (1 patient). Anal fistulas with scrotal extension are exceptions to Goodsall’s rule. Albeit being long-tract fistulas, most of them are low transsphincteric and have anterior internal openings.

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Section: Discussionmentioning

confidence: 99%

Preoperative magnetic resonance imaging of anal fistulas with scrotal extension

Nguyen

et al. 2023

Preprint

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Preoperative magnetic resonance imaging of anal fistulas with scrotal extension: a retrospective study

Nguyen

et al. 2023

Front. Surg.

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IntroductionThis study aimed to elucidate the magnetic resonance (MR) characteristics of anal fistulas extending to the scrotum, and the applicable rules, and to correlate MR features with surgical findings.MethodsWe conducted a retrospective study in 150 consecutive patients with anal fistulas extending into the scrotum, who were diagnosed and underwent surgery at University Medical Center Ho Chi Minh City between January 2017 and April 2022. MR findings were evaluated and compared with surgical findings using Cohens kappa coefficient (k) with a 95% confidence interval.Results150 patients (mean age 37.6 ± 10.9 years) with 166 fistulas, including 150 anal fistulas with scrotal extension. Most fistulas were low transsphincteric (80.0%, 120/150 patients). There was a strong agreement for primary tract classification and detecting the location of internal openings between MRI and surgical findings with k = 0.83 (0.780.87) and k = 0.89 (0.85 0.93) (p<0.001), respectively. There is a significant correlation between the location of internal openings and the type of fistula (p<0.05). Low transsphincteric fistulas were predominant in the anterior group (103/122 patients vs. 10/19 patients), while in the posterior group, it was more common in the high transsphincteric fistulas (7/19 patients vs. 14/122 patients), and the intersphincteric fistulas (1/19 patients vs. 5/122 patients); and the suprasphincteric fistulas were only seen in the posterior group (1 patient).ConclusionAnal fistulas with scrotal extension are exceptions to Goodsalls rule. Albeit long-tract fistulas, most are low transsphincteric and have anterior internal openings.

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Long anterior anal fistula with an external opening in the medial raphe of the scrotum is likely to open radially inside the anal canal: an addition to the Goodsall’s rule

Cited by 2 publications

References 3 publications

Preoperative magnetic resonance imaging of anal fistulas with scrotal extension

Preoperative magnetic resonance imaging of anal fistulas with scrotal extension

Preoperative magnetic resonance imaging of anal fistulas with scrotal extension: a retrospective study

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