Anal fistula pathophysiology

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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

Anal fistula develops from infection of anal crypts gland.

Pathophysiology

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

There are following steps in the formation of anal fistula:

Associated Conditions

Anal fistulas are associated with following conditions:[5]

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]

References

  1. 1.0 1.1 "Anatomy and Embryology - Springer".
  2. 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.
  3. PARKS AG (1961). "Pathogenesis and treatment of fistuila-in-ano". Br Med J. 1 (5224): 463–9. PMC 1953161. PMID 13732880.
  4. 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.
  5. "Management of anal fistula | The BMJ".
  6. "anal fistula - Humpath.com - Human pathology".

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