Treatment of Chronic Anal Fissure with an Associated Anorectal Abscess or Fistula

Clinical Scenario

Anorectal fistula / abscess

This protocol addresses patients with a chronic anal fissure in whom an anal abscess or anorectal fistula is also present. The co-occurrence of these conditions defines a distinct clinical situation that requires a coordinated surgical approach.

Specific Condition

When a chronic anal fissure is identified alongside a concurrent abscess or fistula, the presence of sepsis and the fistula tract must both be addressed — not managed in isolation from the fissure.

If other aetiologies are ruled out, the abscess and fistula are managed in direct association with treatment of the fissure itself.

Treatment Approach

Management involves a combined surgical strategy addressing both the fistula/abscess and the fissure concurrently — including laying open and drainage procedures alongside an anorectal sphincter-related intervention.

The complete sequence, specific procedural combination, and any additional steps are detailed in the full structured regimen →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/codi.167

If a fissure is associated with an abscess or fistula, laying open/drainage associated with posterior sphincterotomy may be considered.

If other aetiology is ruled out, abscesses should be drained, and fistulae laid open in the same way as if they presented in the absence of a fissure, in association with a fissurectomy (as per Recommendation 12).

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