Goodsall's rule

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Goodsall's rule relates the external opening of an anal fistula to its internal opening.

Goodsall's Rule states that the external opening situated behind the transverse anal line will open into the anal canal in the midline posteriorly. An anterior opening is usually associated with a radial tract.

Fistulas can be described as anterior or posterior relating to a line drawn in the coronal plane across the anus, the so called transverse anal line. Anterior fistulas will have a direct track into the anal canal. Posterior fistulas will have a curved track with their internal opening lying in the posterior midline of the anal canal. An exception to the rule are anterior fistulas lying more than 3 cm. from the anus, which may open in the anterior midline of the anal canal.

The investigation of choice for anal fistulas is magnetic resonance imaging (MRI).

References

• Perianal sepsis at Surgical Tutor
• Goodsall's rule at GP Notebook