Such an abscess may drain per rectum or spontaneously drain through an opening in the skin of the buttocks. Surgical treatment involves prompt incision and drainage. The probe is passed through both the external opening at the skin level and the internal opening at the pectinate line. Patients present with complaints of scant to moderate drainage through the skin opening. Pain is not usually a presenting symptom.
Surgical management involves opening the fistula tract overlying the probe as shown.
The wound is allowed to heal by secondary intention. In patients with multiple or recurrent fistulas Crohn's disease should be considered as this may be an initial presentation of this disease process. The illustration from Corman's textbook demonstrates the normal anatomic position of the venous cushions in the anal canal. These cushions are located on the right posteriorly, right anteriorly and left anteriorly. This anatomic arrangement explains the common presentation of both internal and external hemorrhoid disease in these anatomic positions.