Abstract
Introduction: Anal fistula is an abnormal pathway that connects the anorectal tract to the perianal skin. The Park’s classification describes four different types of anal fistulas depending on their links with the sphincter apparatus. In this paper, we report an interesting case of post-traumatic complex trans-sphincteric fistula treated with VAAFT procedure. Case Presentation: A 60-year-old-male patient, from an accidental fall, developed a gluteal abscess with a high trans-sphincteric anal fistula and a secondary tract leading to a large second abscess located in the right ischiorectal fossa. An abscess incision was done, and a draining seton was placed in another Institution. The patient came to our Hospital and underwent surgery using Video Assisted Anal Fistula Treatment (VAAFT) procedure. Conclusions: VAAFT is an effective and safe procedure for complex anal fistula, even when they have a post-traumatic origin.
Highlights
Anal fistula is an abnormal pathway that connects the anorectal tract to the perianal skin
We report an interesting case of post-traumatic complex trans-sphincteric fistula treated with Video Assisted Anal Fistula Treatment (VAAFT) procedure
Based on the relationships that the fistula acquires with the anal sphincter apparatus, anal fistulas are classified as inter-sphincteric, transsphincteric, supra-sphincteric, and extra-sphincteric
Summary
An anal fistula is an abnormal tract between the anorectal area and the perianal skin It represents the chronic manifestation of an acute infection, such as an abscess. Based on the relationships that the fistula acquires with the anal sphincter apparatus, anal fistulas are classified as inter-sphincteric, transsphincteric, supra-sphincteric, and extra-sphincteric They can be classified as simple or complex. 90% success in uncomplicated inter-sphincteric fistulas with a few postoperative complications, but the risk of faecal incontinence is higher if the fistulotomy is performed in the case of medium or high transsphincteric fistulas. We are reporting an interesting case of posttraumatic complex trans-sphincteric fistula treated with VAAFT procedure. The MR investigation showed a right gluteal abscess and a high trans-sphincteric fistula with two internal orifices, respectively, located at 6 and 9 o’clock close to the dentate line. The one, three, six months and two-year followup does not show any fistula recurrence
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