Anal fistula pathophysiology: Difference between revisions
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==Anatomy== | ==Anatomy== | ||
*The anal canal is a 2 to 4cm in length, starts at the anorectal junction to the end of anal verge.<ref name="urlAnatomy and Embryology - Springer">{{cite web |url=http://link.springer.com/chapter/10.1007%2F978-1-4419-1584-9_1 |title=Anatomy and Embryology - Springer |format= |work= |accessdate=}}</ref> | *The [[anal canal]] is a 2 to 4cm in length, starts at the [[anorectal]] junction to the end of [[anal]] verge.<ref name="urlAnatomy and Embryology - Springer">{{cite web |url=http://link.springer.com/chapter/10.1007%2F978-1-4419-1584-9_1 |title=Anatomy and Embryology - Springer |format= |work= |accessdate=}}</ref> | ||
*It is divided into an upper and a lower part by transition zone that is seen at the dentate line or pectinate line which is surrounded by longitudinal mucosal folds, called columns of Morgagni.<ref name="urlAnatomy and Embryology - Springer">{{cite web |url=http://link.springer.com/chapter/10.1007%2F978-1-4419-1584-9_1 |title=Anatomy and Embryology - Springer |format= |work= |accessdate=}}</ref> | *It is divided into an upper and a lower part by transition zone that is seen at the dentate line or pectinate line which is surrounded by longitudinal mucosal folds, called columns of Morgagni.<ref name="urlAnatomy and Embryology - Springer">{{cite web |url=http://link.springer.com/chapter/10.1007%2F978-1-4419-1584-9_1 |title=Anatomy and Embryology - Springer |format= |work= |accessdate=}}</ref> | ||
*Each of this fold contains anal crypts, each of which contains 3 to 12 anal glands, the distribution of these glands is not uniform with most of the glands present anterior to the position of the anal canal and fewer in the posterior position. | *Each of this fold contains anal crypts, each of which contains 3 to 12 [[anal glands]], the distribution of these [[glands]] is not uniform with most of the [[glands]] present anterior to the position of the [[anal canal]] and fewer in the [[posterior]] position. | ||
==Pathogenesis== | ==Pathogenesis== | ||
*Anal fistula develops from infection of anal crypts gland. | *[[Anal fistula]] develops from [[infection]] of [[anal]] crypts [[gland]]. | ||
There are following steps in the formation of anal fistula: | There are following steps in the formation of [[anal fistula]]: | ||
*The initial infection occurs in the [[ducts]] of the anal glands and the spread of infection results in the formation of the [[abscess]], .<ref name="pmid15740520">{{cite journal| author=Rickard MJ| title=Anal abscesses and fistulas. | journal=ANZ J Surg | year= 2005 | volume= 75 | issue= 1-2 | pages= 64-72 | pmid=15740520 | doi=10.1111/j.1445-2197.2005.03280.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15740520 }} </ref> | *The initial [[infection]] occurs in the [[ducts]] of the [[anal glands]] and the spread of infection results in the formation of the [[abscess]], .<ref name="pmid15740520">{{cite journal| author=Rickard MJ| title=Anal abscesses and fistulas. | journal=ANZ J Surg | year= 2005 | volume= 75 | issue= 1-2 | pages= 64-72 | pmid=15740520 | doi=10.1111/j.1445-2197.2005.03280.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15740520 }} </ref> | ||
*The crytoglandular theory states that [[obstruction]] of anal gland [[duct]] results in a [[infection]] and due to the presence of these glands deep in relation to the [[anal canal]] and sphincter, the infection follows the path of least resistance resulting in [[abscess]] formation at the termination of the gland.<ref name="pmid13732880">{{cite journal| author=PARKS AG| title=Pathogenesis and treatment of fistuila-in-ano. | journal=Br Med J | year= 1961 | volume= 1 | issue= 5224 | pages= 463-9 | pmid=13732880 | doi= | pmc=1953161 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13732880 }} </ref><ref name="pmid14687825">{{cite journal| author=Coremans G, Dockx S, Wyndaele J, Hendrickx A| title=Do anal fistulas in Crohn's disease behave differently and defy Goodsall's rule more frequently than fistulas that are cryptoglandular in origin? | journal=Am J Gastroenterol | year= 2003 | volume= 98 | issue= 12 | pages= 2732-5 | pmid=14687825 | doi=10.1111/j.1572-0241.2003.08716.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14687825 }} </ref> | *The crytoglandular theory states that [[obstruction]] of anal gland [[duct]] results in a [[infection]] and due to the presence of these [[Gland|glands]] deep in relation to the [[anal canal]] and [[sphincter]], the [[infection]] follows the path of least resistance resulting in [[abscess]] formation at the termination of the [[gland]].<ref name="pmid13732880">{{cite journal| author=PARKS AG| title=Pathogenesis and treatment of fistuila-in-ano. | journal=Br Med J | year= 1961 | volume= 1 | issue= 5224 | pages= 463-9 | pmid=13732880 | doi= | pmc=1953161 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13732880 }} </ref><ref name="pmid14687825">{{cite journal| author=Coremans G, Dockx S, Wyndaele J, Hendrickx A| title=Do anal fistulas in Crohn's disease behave differently and defy Goodsall's rule more frequently than fistulas that are cryptoglandular in origin? | journal=Am J Gastroenterol | year= 2003 | volume= 98 | issue= 12 | pages= 2732-5 | pmid=14687825 | doi=10.1111/j.1572-0241.2003.08716.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14687825 }} </ref> | ||
* If the abscess is ruptured, a fistula is formed. | * If the [[abscess]] is ruptured, a [[fistula]] is formed. | ||
==Associated Conditions== | ==Associated Conditions== | ||
Anal fistulas are associated with following conditions:<ref name="urlManagement of anal fistula | The BMJ">{{cite web |url=http://www.bmj.com/content/345/bmj.e6705 |title=Management of anal fistula | The BMJ |format= |work= |accessdate=}}</ref> | Anal fistulas are associated with following conditions:<ref name="urlManagement of anal fistula | The BMJ">{{cite web |url=http://www.bmj.com/content/345/bmj.e6705 |title=Management of anal fistula | The BMJ |format= |work= |accessdate=}}</ref> | ||
*Diverticulitis | *[[Diverticulitis]] | ||
*Foreign-body reactions | *Foreign-body reactions | ||
*Actinomycosis | *[[Actinomycosis]] | ||
*Chlamydia | *[[Chlamydia]] | ||
* | *[[Lymphogranuloma venereum]] (LGV) | ||
*Syphilis | *[[Syphilis]] | ||
*Tuberculosis | *[[Tuberculosis]] | ||
*Radiation exposure | *[[Radiation exposure]] | ||
*HIV disease | *[[HIV AIDS|HIV disease]] | ||
*Crohn’s disease | *[[Crohn's disease|Crohn’s disease]] | ||
*Pilonidal disease | *[[Pilonidal abscess|Pilonidal]] disease | ||
*Hidradenitis suppurativa | *[[Hidradenitis suppurativa]] | ||
*Trauma | *[[Trauma]] | ||
*Previous surgery (including ileoanal pouch surgery) | *Previous [[surgery]] (including ileoanal pouch surgery) | ||
*Presacral dermoid cysts | *Presacral [[Dermoid cyst|dermoid cysts]] | ||
*Sacrococcygeal teratoma | *[[Sacrococcygeal teratoma]] | ||
*Rectal duplication | *[[Rectal]] duplication | ||
==Gross Pathology== | ==Gross Pathology== | ||
| Line 43: | Line 43: | ||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
On microscopic histopathological analysis, following features are found:<ref name="urlanal fistula - Humpath.com - Human pathology">{{cite web |url=https://www.humpath.com/spip.php?article18351 |title=anal fistula - Humpath.com - Human pathology |format= |work= |accessdate=}}</ref> | On microscopic histopathological analysis, following features are found:<ref name="urlanal fistula - Humpath.com - Human pathology">{{cite web |url=https://www.humpath.com/spip.php?article18351 |title=anal fistula - Humpath.com - Human pathology |format= |work= |accessdate=}}</ref> | ||
*There is the central core of active and chronic inflammation with granulation tissue, foreign body giant cells, and surrounded by scar. | *There is the central core of active and chronic [[inflammation]] with [[granulation tissue]], foreign body [[Macrophage|giant cells]], and surrounded by [[scar]]. | ||
*Granulomas are seen occasionally. | *[[Granulomas]] are seen occasionally. | ||
*There is squamous cell extend into the fistula track which is partially epithelialized. | *There is [[squamous cell]] extend into the [[fistula]] track which is partially epithelialized. | ||
==References== | ==References== | ||
Revision as of 00:41, 2 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Anatomy
- The anal canal is a 2 to 4cm in length, starts at the anorectal junction to the end of anal verge.[1]
- It is divided into an upper and a lower part by transition zone that is seen at the dentate line or pectinate line which is surrounded by longitudinal mucosal folds, called columns of Morgagni.[1]
- Each of this fold contains anal crypts, each of which contains 3 to 12 anal glands, the distribution of these glands is not uniform with most of the glands present anterior to the position of the anal canal and fewer in the posterior position.
Pathogenesis
- Anal fistula develops from infection of anal crypts gland.
There are following steps in the formation of anal fistula:
- The initial infection occurs in the ducts of the anal glands and the spread of infection results in the formation of the abscess, .[2]
- The crytoglandular theory states that obstruction of anal gland duct results in a infection and due to the presence of these glands deep in relation to the anal canal and sphincter, the infection follows the path of least resistance resulting in abscess formation at the termination of the gland.[3][4]
Associated Conditions
Anal fistulas are associated with following conditions:[5]
- Diverticulitis
- Foreign-body reactions
- Actinomycosis
- Chlamydia
- Lymphogranuloma venereum (LGV)
- Syphilis
- Tuberculosis
- Radiation exposure
- HIV disease
- Crohn’s disease
- Pilonidal disease
- Hidradenitis suppurativa
- Trauma
- Previous surgery (including ileoanal pouch surgery)
- Presacral dermoid cysts
- Sacrococcygeal teratoma
- Rectal duplication
Gross Pathology
On gross pathology:
- They are seen linear or completely maloriented and have the epithelial lining at one of its edges
Microscopic Pathology
On microscopic histopathological analysis, following features are found:[6]
- There is the central core of active and chronic inflammation with granulation tissue, foreign body giant cells, and surrounded by scar.
- Granulomas are seen occasionally.
- There is squamous cell extend into the fistula track which is partially epithelialized.
References
- ↑ 1.0 1.1 "Anatomy and Embryology - Springer".
- ↑ Rickard MJ (2005). "Anal abscesses and fistulas". ANZ J Surg. 75 (1–2): 64–72. doi:10.1111/j.1445-2197.2005.03280.x. PMID 15740520.
- ↑ PARKS AG (1961). "Pathogenesis and treatment of fistuila-in-ano". Br Med J. 1 (5224): 463–9. PMC 1953161. PMID 13732880.
- ↑ Coremans G, Dockx S, Wyndaele J, Hendrickx A (2003). "Do anal fistulas in Crohn's disease behave differently and defy Goodsall's rule more frequently than fistulas that are cryptoglandular in origin?". Am J Gastroenterol. 98 (12): 2732–5. doi:10.1111/j.1572-0241.2003.08716.x. PMID 14687825.
- ↑ "Management of anal fistula | The BMJ".
- ↑ "anal fistula - Humpath.com - Human pathology".