© 2012 Hellenic Society of Gastroenterology www.annalsgastro.gr Imperforate anus and perianal fistula in Ancient Greek medical writings

Anorectal malformations remain one of the challeng-ing topics in pediatric surgery. Despite developments in assessing and approaching patients with these anomalies in the past decades, there exist, however, tangible descriptions of imperforate anus and perianal fistulas at least since the Middle Ages [1,2]. Tracing the earlier origins of the relevant practice, by browsing through the works of ancient Greek and Byzantine medical writers, we encounter interesting, pioneering observations in Gastroenterology. As derived from his writings, Hippocrates (ca. 460-370 BC), was aware of anorectal fistulas and tried to interpret their mechanism of origin. He attempted to treat them, either conservatively, using laxatives and purgative medications, or surgically, via an anoscope (εδροσκόπιο) [3,4]. He had very well understood the importance of the surgical option which is now a routine choice. In fact, a variety of operations exist mainly aiming to decrease recurrence and incontinence rates [5]. In Aristotle’s (384-322 BC) works, we run into references on imperforate anus (he states it as σύμφυση του πρωκτού), and rectourethral or anorectal fistulas, mainly in animals. He also recorded a failed attempt to restore an anorectal ring atresia. In particular, he stated: “Some animals have already been diagnosed with anal symphysis. Someone even pointed out, in the village of Per-inthos, the excretion of fine food with the urine in a cow, due to its infiltration from the intestine to the bladder, and whe