Many times we come across the multiple external openings of Fistula in Ano ( may be a Horse shoe shaped FIA), in which many surgical procedures like Fistulectomy / Lift / VAAFT etc are difficult to perform. Is their any applied surgical anatomy of different Peri anal spaces in reference to these cases ?
Dr.Dwiwedi,
Good question it is.
Suppose that either acute or chronic paraproctitis are consequences of one of the perianal mucous glands' obturation. In this case, it would be just take these very glands as an important scientific challenge to explore carefully. However, I did my best to find out anything of the glands anatomy and found absulutely nothing nor in periodics, neither in monographs on Proctology. No one seemingly ever dissect them to make up their anatomy and topography.
So, a development of perianal fistulae remains obscure still waiting for pioneers to discover and discribe them.
Good luck!
Posterior Anal Space or other Peri Anal/rectal spaces in reference with the surgical management of anal Complex Fistula are very important for the possibility of an intersfinteric fistula that you can discover only by means on transanal US and also RM to see all fistulas.
If fistulas are posterior you can make a Fistulectomy.
If fistulas are anterior I suggest to do pancolonscopy with biosy to be sure that your patient doesn't suffers a Crohn or a RU desise. In this case avoid surgery and go on with conservative therapy.
Best regards
Dear Dr. Dwivedi, the best way to think about this is to remember that anal fistula starts from an infection in the anal glands. These are circumferential. when the infection starts posteriorly, there is a lot of potential space in the posterior half (consists only of fat etc in the ischiorectal fossae), for the infection, and its abscess to grow, and track laterally, and eventually, but not always, drain as an external opening anywhere in the posterior half, and sometimes also in the anterior half particularly if the opening is more than one inch from the verge - hence Goodsalls rule is not infallible, but usually correct. An anteriorly placed infection has "less room to manouevre" due to anatomical constraints from the muscles etc above the anterior half, so tend to open directly out and radially. Hope this answers your question.....
Thanks a lot Dr Borodach, Dr Massimo Chiaretti , n Dr Gurpreet Singh-Ranger for your contribution. Kindly do make inputs about -in multiple openings fistulae mostly in Ant & post too, Is it Post. Deep Anal Space involved ? and drain into other spaces ?
Hello Dr. Dwivedi, I have seen some anterior fistulae that look like they open directly into the anal canal on clinical exam, and eventually turn out to be a complex posterior fistula with an anterior opening, i.e. a posterior fistula can fistulate all the way round and open out into the anterior half, and even into the vagina. Also, I suspect, but have no evidence for this, that there must be instances where multiple anal glands might become infected, extend outwards, and perhaps connect with other infected glands elsewhere in the anal canal. My advice would probably be that unless it is extremely obvious there is an anterior fistula with an obvious radial internal opening, always be suspicious there might be complex fistulation. MRI is very helpful, but I have found the usefulness of these depends a lot on the experience of the radiologist in interpretation. I hope that helps.
Good Morning
I suggest to the Colleague Andrey Borodach to have a look about Hermann glands for example on
www.proctos.net
www.proctos.net/anatomia_anale_ghiandole_anali.htm Ghiandole anali. Individuate da Hermann e Desfosses nel 1880..
Best Regards Massimo Chiaretti
Dr.Chiaretti,
Thank you for the link! However, there is no any reference on anatomic literature there. That site is for patients only.
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