A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation

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Abstract
The central abscess is a new clinicopathologic entity which plays an important role in the pathogenesis of anorectal abscess and fistula. Eight cases are presented. The abscess occupies the central space, which lies between the longitudinal muscle and the base loop of the external sphincter. The anatomic pattern and the clinical manifestations of the abscess are discussed. The abscess extended, in some cases, to the s.c. space and perianal skin, to the anal canal proper, or to the intersphincteric spaces. This is due to the fact that the central space communicates with all of the other perianal spaces along the central septa. A new theory in the pathogenesis of anorectal suppuration and fistula is put forward. All anorectal abscesses or fistulas originate as central space infection which spreads to the other perianal spaces. Proper diagnosis and early drainage of the central abscess prevent further spread of suppuration to other spaces.