Fecalith in Fistula-in-Ano

Abstract

Perianal fistula is a chronic inflammatory condition that involves anorectum and has a significant effect on quality of life of the patients. Treating a complex fistula may be a difficult task for surgeons due to high risk of complication like recurrence of the disease and fecal incontinence. Fecaliths (fecal stones) are fecal impaction in the intestinal lumen that are not passed spontaneously. It has been well described in colorectal unit and most often affects the elderly people with underlying neuro-psychiatric disease. Fecal impaction in fistula-in-ano is an extremely rare condition that has not been described in literature. Until the complete excision is achieved, the cure is not achieved. Herein, a 55-year-old male presented with complaints of recurrent pus discharge from perianal region for 1 year. On perineal examination, external opening was noticed at 11 o’clock, 1 cm from anal verge and internal opening was noted 1 cm inside the anal verge at 11 o’clock. A 3 × 3 cm hard, mobile swelling was noted in the fistulous tract with overlying skin and mucosa was free. Complete excision of lump was done with fistulectomy. A 2 × 2 cm hard, calcified stone and a seed were found in the fistulous tract. Wound was left open for secondary healing and complete healing was achieved at 6 weeks. Patient did not develop any perineal complication following surgery. Histopathological examination revealed calcification with inspissated fecal material and fistulous tract negative for malignancy. A final diagnosis of fecalith in anal fistula was made.