Under usual conditions, anal fistulas have an internal (primary) opening, an external (secondary) opening, and a tract connecting the two. Uncommonly, there are more than one external opening, although they still usually lead to a single internal
opening. In rare cases, the multiple external openings lead to more than one internal opening. Anal sepsis originated in the anal ducts which open into crypts and which allow a ready path for infection to spread from the anal canal into the
perianorectal tissue, forming abscesses and fistulas. Therefore each different internal opening is considered as a different (independent) fistula. In this rare case, two internal openings are connected by one branched tract and lead to a single
external opening, and these were not considered as different independent fistula. Because this patient had received fistula operations two-times previously, this fistula did not seem to be the result of the natural pathological process. However
this
case study may be helpful in improving in the treatment of fistulas.
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