ANO-RECTAL FISTULA

Roll no. – 649-654

Surgical Anatomy

Commences from where the rectum passes through pelvic diaphragm and ends
at the anal verge

The Anorectal Ring-

• Junction between rectum and anal canal
• Formed by joining of puborectalis muscle, deep external sphincter, conjoined
muscle and highest part of internal sphincter

Puborectalis Muscle-
• Maintains angle between rectum and anal canal
• Important component in continence mechanism
External sphincter-

- Single muscle – divided by lateral extensions from longitudinal muscle layer into-
. - Deep
- Superficial
- Subcutaneous
- Somatic voluntary muscle
- Innervated by Pudendal nerve

Intersphinteric plane-
-Contains intersphinteric anal glands

Longitudinal Muscle Layer-

- Continuation of smooth muscle of outer muscle coat of rectum
- Provides supportive mesh for anal canal
- Provides potential pathways for spread of infection
Internal Sphincter-

-Continuation of circular muscle coat of rectum

-Pearly white in colour
-Involuntary muscle
-Innervated by non- adrenergic non-cholinergic fibres(NANC)

release of neurotransmitter (Nitric oxide)

relaxation
Blood Supply-

Arterial Supply- by superior rectal artery

Middle rectal artery
Inferior rectal artery

Venous Drainage-
Upper half - Superior rectal vein
Middle rectal vein Internal iliac veins
Lower half - Inferior rectal vein

Lymphatic Drainage-Superficial and deep inguinal lymph nodes