ABSTRACT
According to Hippocrates, anal fistulas were the result of local trauma sustained, for example, during horse riding and rowing. When the resulting contusion, associated with the accumulation of blood, becomes putrid, it spreads to the soft parts and finally bursts through the perianal skin. When this happens, a fistula is formed. In 50 percent of the individuals, some branches penetrate the internal anal sphincter, ending in the intersphincteric space. Parks also examined fistulous track specimens obtained from 30 patients. According to the cryptoglandular hypothesis, infection of an anal gland is the initial event in causation of an anorectal abscess. It has been suggested that obstruction of the main duct near the anal crypt may result in stasis and subsequent bacterial overgrowth. Population-based studies have shown that the lifetime risk of developing an anal fistula is 30 percent amongst patients with Crohn’s disease. Anal fistulas may also have a tuberculous origin.
