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- Title
The direction of the trans-sphincteric fistula track through the sphincter complex: its potential clinical significance.
- Authors
Buchanan, G.N.; Williams, A.B.; Bartram, C.I.; Halligan, S.; Nicholls, R.J.; Cohen, C.R.G.
- Abstract
Aims: The longitudinal direction of the trans-sphincteric fistula track through the anal sphincter complex may have implications regarding fistulotomy. Methods: The angle of the track of trans-sphincteric fistulae relative to the longitudinal axis of the anal canal was measured preoperatively using magnetic resonance imaging (MRI) in 46 patients. This was compared to the findings at operation. Results: Of the 46 patients, the track passed cranially as well as laterally at an acute angle (<90°) in 23 while it passed either transversely or caudally at an obtuse angle (≥ 90°) in 23. The internal opening was significantly higher in relation to the dentate line (above (n = 8), at (n = 14), below (n = 1)) when the track was acute than when it was obtuse (above (n = 1), at (n = 17), below (n = 5)) (P = 0·004). The fistula track crossed the sphincter at a median angle of 35°, 95° and 131·5° from internal openings sited above, at, and below dentate line level respectively (P = 0·0016). Conclusions: The fistula track passed cranially and laterally through the sphincter complex in half of the patients. It was most acutely angled when the internal opening was situated above the dentate line. This may lead to a more extensive fistulotomy than would be anticipated when judged from the level of the internal opening.
- Subjects
ANAL fistula; SPHINCTERS; SYMPTOMS; MAGNETIC resonance imaging
- Publication
British Journal of Surgery, 2003, Vol 90, p135
- ISSN
0007-1323
- Publication type
Article