An anal fistula is an abnormal tract that connects the anal canal with the skin and is lined with epithelium and granulation tissue. A fistula in ano most commonly results from a perianal or ischiorectal abscess (Fig 78-4). It may, however, be associated with ulcerative colitis, Crohn's disease, or tuberculosis. Although anterior-opening fistulas tend to follow a simple, direct course to the anal canal (Goodsall rule), posterior-opening fistulas may follow a devious, curving path, including some that are horseshoe-shaped.
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