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Affiliations
1 Indus International Hospital, Mohali, Punjab, India. drgargpankaj@yahoo.com.
2 Garg Fistula Research Institute, 1042, Sector-15, Panchkula, Haryana, 134113, India. drgargpankaj@yahoo.com.
3 SSRD MRI Centre, Chandigarh, India.
Pankaj Garg et al. Abdom Radiol (NY). 2021 Aug.
Affiliations
1 Indus International Hospital, Mohali, Punjab, India. drgargpankaj@yahoo.com.
2 Garg Fistula Research Institute, 1042, Sector-15, Panchkula, Haryana, 134113, India. drgargpankaj@yahoo.com.
3 SSRD MRI Centre, Chandigarh, India.
Conventionally, in the pathophysiology of anal fistulas, there is only one space considered significant for the spread of pus in the sphincter complex: the intersphincteric space. However, with increasing experience in the high-resolution MRI, and more focus being given on managing fistulas through the intersphincteric space, two additional pathways of fistula spread have been identified. First is a newly described space labelled as the outer-sphincteric space. Second is a known anatomical space (inner intersphincteric space), but this space was considered as irrelevant from the point of view of fistula spread. The conventional intersphincteric space is present in between these two spaces and is referred as 'middle intersphincteric space' in this paper. These three distinct spaces have significant clinical implications as the pattern of spread of pus is quite different in each space, and the management also differs for fistula tract in each of these spaces.
Keywords: Abscess; Anal fistula; Anal sphincter; MRI; Pathway.
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Jimenez M, Mandava N. Jimenez M, et al. 2021 Jul 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. 2021 Jul 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32809492 Free Books & Documents. Review.
Wanitsuwan W, Junmitsakul K, Jearanai S, Lohsiriwat V. Wanitsuwan W, et al. Dis Colon Rectum. 2020 Nov;63(11):1534-1540. doi: 10.1097/DCR.0000000000001691. Dis Colon Rectum. 2020. PMID: 33044294
Celayir MF, Bozkurt E, Aygun N, Mihmanli M. Celayir MF, et al. Sisli Etfal Hastan Tip Bul. 2020 Aug 24;54(3):297-301. doi: 10.14744/SEMB.2020.89106. eCollection 2020. Sisli Etfal Hastan Tip Bul. 2020. PMID: 33312026 Free PMC article.
Kang WH, Yang HK, Chang HJ, Ko YT, Yoo BE, Lim CH, Hwang JK, Lee YC, Shin HK, Son HJ. Kang WH, et al. Int J Surg. 2018 Dec;60:9-14. doi: 10.1016/j.ijsu.2018.08.008. Epub 2018 Oct 19. Int J Surg. 2018. PMID: 30343130
Ommer A, Herold A, Berg E, Fürst A, Post S, Ruppert R, Schiedeck T, Schwandner O, Strittmatter B. Ommer A, et al. Langenbecks Arch Surg. 2017 Mar;402(2):191-201. doi: 10.1007/s00423-017-1563-z. Epub 2017 Mar 1. Langenbecks Arch Surg. 2017. PMID: 28251361 Review.
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