대한대장항문학회

Fistula in Ano in infants and early childhood has certain distinctive feature that differ<br>from those in adults. These include preponderance in the first year of life(more often in<br>the first six months), exclusive male predominance, simple superficial character and<br>straight course of the tracts. The external opening situates antero-laterally or laterally<br>in most infantile fistula. These unique characteristics lead to the need for etiological<br>explanation.<br>The purpose of this study is to find some clue -histologic evidence- that may play a<br>role in the causation of the fistula or that may explain the pathogenetic mechanism of<br>this disorder.<br>We carried out a complete clinical investigation on 21 cases of the infantile and early<br>childhood fistula including a monozygotic twin, and found almost similar clinical findings<br>in all cases. Histopathologic study on multiple sections of the wall of fistula tract was<br>Performed on 11 cases. Four of the eleven cates disclosed a few small crevices lined by<br>stratified columnar epithelium-a similar histologic structure seen in the lining of anal<br>gland and, in one case, we observed normal looking anal gland in the wall of the<br>fistulous tract.<br>Base on these findings, we presume that some environmental effect in utero causes<br>the formation of the abnormal anal glands which are vulnerable for gross infection after<br>birth, and these abnormal glands are inclined to distribute in the lateral or anterolateral<br>portion of anal canal. These findings support the congenital etiology.<br>