Septic Arthritis of the Hip Joint Secondary to an Anal Fistula

Abstract

report an unusual presentation of an anal fistula involving the hip joint causing septic arthritis A 66-year-old woman presented with a two-week history of erythema and painful swelling in the right hip. Septic arthritis was diagnosed at the emergency department and she received antibiotic therapy initially. However, her symptoms did not alleviate and right hip arthrotomy, synovectomy and surgical debridement were performed three days later. During the operation, fecal material was found in the wound at the right gluteal region and this had contaminated the hip joint. An anal fistula was disclosed by digital rectal examination and a probe. Subsequent computed tomography and fistulography confirmed a fistula between the anus and the right hip joint. She underwent fistulotomy, diverting colostomy and four debridements. The patient's recovery was uneventful. This was an unusual and life-threatening complication of a common disease. The case emphasizes the important role of a complete physical examination and adequate investigation for patients presenting with symptoms of a septic hip. An anal fistula should be taken into consideration among the various causes of a septic hip.