Treatment of Acute Cryptogenic Abscesses

Abstract

Detroit, Michigan THE anal crypts were first described by Winslow in 1732 [13], and confirmed by Astruc in 1738 [1]. One hundred and fifty years later, this concept was recognized in America. Bodenhamer, in 1888 [2], reviewed previous work, and advanced the idea that these structures were the origin of certain anorectal diseases. Johnson, in 1914 [7], illustrated and made models of anal crypts, ducts and glands, and laid the foundation for our present understanding of these structures. Tucker and Hellwig, in 1934 [10], confirmed these glands as constant anatomical structures; while Gordon-Watson and Dodd, in 1935 [5], showed that when the ducts are patent, they may lead infection from the anus into the glands.So, cryptogenic abscesses are those abscesses developing in the anorectum from pyogenic infection in the anal glands. These abscesses communicate with the anal canal, and are thus infected by the bacterial flora of the bowel, and when drained, either by spontaneous rupture or by surgical incision, will result in a fistula-inano, or occasionally in a chronic abscess.Abscesses occasionally develop in the anal perineum from structures other than the anal glands. Infections arising in hair follicles, sweat glands, apocrine glands and retention cysts, when they occur in the anal perineum, may be confused with cryptogenic abscess. However, such infections do not communicate with the bowel, and when drained, do not result in fistulae.The anal glands, through their ducts, communicate with the bowel in or near the crypts at the muco-cutaneous junction. These glands may be found within the various tissue planes and spaces about the anorectum. The location of