ConclusionsThis report of seven deaths from fistula‐in‐ano with acute abscess in a seven‐year period between 1962 and 1969 at the Philadelphia General Hospital indicates the serious potential of this generally‐benign surgical lesion. Fistula‐in‐ano with acute abscess occurring in the obese or diabetic patient in association with local and systemic signs of invasive infection requires serious, considered management. Similarly, four deaths from the chronic form of fistula‐in‐ano during the same period indicate the debilitating nature of neglected fistula‐in‐ano, which can lead ultimately to death.