Goodsall's rule relates the external opening of an anal fistula to its internal opening. It 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 have a curved track (similar to posterior fistulas) that opens into the posterior midline of the anal canal.
The investigation of choice for anal fistulas is magnetic resonance imaging (MRI).
Goodsall's rule is named after David Henry Goodsall who described it in 1900.
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