Abstract
Usually an anal fistula has an internal (primary) opening, an external (secondary) opening, and a tract connecting the two. Uncommonly the external openings are more than one but lead to a single internal opening. Rarely more than one internal opening is present, and, along with its corresponding external opening(s), it should be considered as a separate fistula. Injection of a dye to identify the internal opening may be considered when may external openings are present.
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References
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Chulani, H.L., Kulkarni, M.S. Quadruple anal fistula:. Dis Colon Rectum 25, 143–144 (1982). https://doi.org/10.1007/BF02553260
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DOI: https://doi.org/10.1007/BF02553260