An Unusual Case of Complex Transphincteric Fistula-In-Ano

Abstract

Fistula in ano is a common benign perianal condition that affects predominantly male patients due to various etiological factors like repeated perianal infections, tuberculosis, Crohns disease of perineum, Hidradenitis suppurativa, HIV infection, etc. Complex variety is encountered in very few patients, which requires special treatment for its cure. Extrasphincteric fistulae occur in only 5% of total fistula in ano patients. We would like to report such an unusual case of fistula in ano where its one tract reached almost to the popliteal fossa in the posterior compartment of the thigh. CASE HISTORY A 32-year-old Hindu male patient, caterer by occupation, came with complaints of persistent foul smelling discharge from his perianal wound for one month. The patient underwent anal fistulectomy under spinal anesthesia at a charitable hospital in the city in 2006. The histopathology report showed a fistula tract with chronic inflammation. In 2007, he again took treatment from another tertiary care hospital in the city for 6 months, but the wound did not heal. Finally, he came to our institute 6 months back for further treatment. He presented with painful defecation, mucus discharge in stools and foul smelling discharge from the wound. There was no associated history of any fever, bleeding per-rectally or constipation. He did not give any history of major medical illnesses or other surgery done in the past.