Anorectal Abscess and Fistula



  • Anorectal abscess and fistula-in-ano represent different stages of anorectal suppuration.

  • The abscess is the acute inflammatory event.

  • Ducts from anal glands empty into the anal crypts at the level of the dentate line.

  • Anal glands penetrate into deeper tissue: 80 % submucosal, 8 % internal sphincter, 8 % conjoined longitudinal muscle, 2 % intersphincteric space, and 1 % penetrate the internal sphincter.

  • Understanding the potential anorectal spaces (Table 13.1) is essential for successful treatment of anorectal suppuration.

  • Table 13.2 lists the etiologies of anorectal abscesses. 90 % are from nonspecific cryptoglandular suppuration.

  • Abscesses result from obstruction of the anal glands (Park’s cryptoglandular theory published in 1961).


Catheter Tuberculosis Diarrhea Methotrexate Pseudomonas 


  1. Parks AG. Pathogenesis and treatment of fistula-in-ano. Br Med J. 1961;1(1):763–769.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Colorectal SurgeryJewish General HospitalMontrealCanada

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