A critique of anal glandular infection in the aetiology and treatment of idiopathic anorectal abscesses and fistulas
✍ Scribed by J. C. Goligher; M. Ellis; A. G. Pissidis
- Publisher
- John Wiley and Sons
- Year
- 1967
- Tongue
- English
- Weight
- 903 KB
- Volume
- 54
- Category
- Article
- ISSN
- 0007-1323
No coin nor oath required. For personal study only.
✦ Synopsis
UNIVERSITY DEPARTMENT OF SURGERY AND THE RECEIVING ROOM, GENERAL INFIRMARY, LEEDS
MUCH controversy has surrounded the mechanism of production of idiopathic anorectal abscesses and fistulas, but perhaps the most popular conception of their aetiology at the present time is the so-called anal glandular or cryptoglandular hypothesis. Some 6-8 epithelial-lined tracks, known as anal glands, are normally present in the wall of the anal canal, extending from the anal crypts into the submucosa and usually through the lower third or half of the internal sphincter to abut on the longicudinal intersphincteric muscle-fibres. According to the anal glandular theory, one of these glands provides the avenue along which contamination extends from the anal canal into the connective tissues of the anal region, leading to the development of an anorectal abscess and possibly ultimately of a fistula.
This hypothesis has long enjoyed wide acceptance in North America (Nesselrod, 194g), but it is only in recent years, following the work of Eisenhammer (1956, 1958, 1961) and Parks (1961), that it has secured substantial support in Britain. These two writers have laid stress on the occurrence of an intersphincteric abscess as an essential intermediate phase in the evolution of an ordinary anorectal abscess from infection along an anal gland. This intersphincteric loculus of pus is believed to form around the terminal ramifications of the gland in the intersphincteric space, internal to the longitudinal intersphincteric muscle-fibres (Fig. I). From this site it may extend in several different directions-downwards, still internal to the longitudinal muscle-fibres, to emerge at the anal verge as a perianal abscess; out- wards, through the longitudinal muscle and the external sphincter, to enter the ischiorectal space and form an ischiorectal abscess; upwards, in the intersphincteric plane between the internal sphincter (and, at a higher level, the circular muscle coat of the rectal wall) internally, and the longitudinal musclefibres of the anal canal and rectum externally, to form a high intermuscular abscess (Eisenhammer,