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| CASE REPORT |
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| Year : 2019 | Volume
: 14
| Issue : 3 | Page : 256-257 |
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Traumatic low fistula-in-ano
Suresh Chandak, S Niveditha, Sandip Shinde
Department of General Surgery, DMIMS, Wardha, Maharashtra, India
| Date of Submission | 20-Apr-2019 |
| Date of Decision | 01-May-2019 |
| Date of Acceptance | 22-Jun-2019 |
| Date of Web Publication | 2-May-2020 |
Correspondence Address:
Dr. S Niveditha
Department of General Surgery, DMIMS, Sawangi, Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_76_19
Trauma is a rare cause of fistula-in-ano. Moreover, treatment option varies as per the patient presentation. A 23-year-old male patient presented with a complaint of fistula-in-ano after penetrating injury with iron rod a month back. The diagnosis of fistula was confirmed after probing under anesthesia. As this was a simple superficial fistula, the patient was treated with fistulectomy with healing by secondary intention.
Keywords: Fistula-in-ano, fistulectomy, perianal fistula, trauma, traumatic
How to cite this article:
Chandak S, Niveditha S, Shinde S. Traumatic low fistula-in-ano. J Datta Meghe Inst Med Sci Univ 2019;14:256-7 |
| Introduction | |  |
Perianal fistula is a commonly seen disease in the general population. Its rate varies from 5.6 to 12.3/100,000.[1],[2],[3] This disease arises from an infectious process of the intersphincteric glands.[1],[3]
In general, fistulectomy is an adequate surgical procedure for the treatment of a simple or low transsphincteric fistula.[4]
| Case Report | | |
A 23-year-old male patient presented with a discharging sinus in the perianal region for 1 month.
He gave a history of penetrating injury at the same site by falling on an iron rod a month back. With a doubtful diagnosis of burst abscess, perianal sinus, and fistula-in–ano, the patient was examined on the operating table under anesthesia. An opening with pus discharge was present at 1 o'clock position. On probing, diagnosis of fistula-in-ano was confirmed with an inner opening at the distal anal canal.
Fistulectomy was done and the raw area was packed to allow healing by secondary intention [Figure 1], [Figure 2], [Figure 3], [Figure 4]. | Figure 1: A 23-year-old male presented with a discharging sinus in the perianal region for 1 month
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 | Figure 2: On probing, diagnosis of fistula-in-ano was confirmed with an inner opening at the distal anal canal
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| Discussion | | |
Fistula-in-ano secondary to trauma is a relatively rare etiological factor for fistula formation in the perianal region. In a study conducted by Sainio,[1] he observed that out of 458 anal fistulae, traumatic fistula accounted for 3.3% of the total. Trauma subsequently leads to the development of perianal sepsis and fistula formation.[5]
Ultrasound, fistulography, computed tomography, and magnetic resonance imaging are not routinely indicated in the initial evaluation of fistula.[6]
Although a number of surgical techniques are available to treat this condition, no one is ideal for the treatment of this disease.
In this case, the fistula was treated like a simple fistula and fistulectomy was done.
However, for a traumatic fistula, a 3–6-month waiting period after injury is generally useful to promote fibrosis of the injured muscle. A fistulotomy is not generally used if it results in undue amounts of sphincter division.[6]
| Conclusion | | |
Traumatic fistula-in-ano is a rare cause of fistula-in-ano. All cases of fistula-in-ano secondary to trauma cannot be treated in the same way and symptoms at the time of presentation guide the steps for investigations and type of surgery for the treatment of fistula.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 1984;73:219-24.  |
| 2. | Marks CG, Ritchie JK. Anal fistulas at St Mark's Hospital. Br J Surg 1977;64:84-91. |
| 3. | van Koperen PJ, Bemelman WA, Bossuyt PM, Gerhards MF, Eijsbouts QA, van Tets WF, et al. The anal fistula plug versus the mucosal advancement flap for the treatment of anorectal fistula (PLUG trial). BMC Surg 2008;8:11. |
| 4. | Rajput VV, Warad BS, Kale DV, Tated SP, Nagoba BS. Fistula in ano treated by ligation of intersphinteric fistula tract: A case report. WIMJOURNAL 2015;2:42-5. |
| 5. | Kocierz L, Leung E, Thumbe V. An unusual cause of perianal fistula. J Surg Case Rep 2011;2011:4. |
| 6. | Practice parameters for treatment of fistula-in-ano. The standards practice task force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 1996;39:1361-2. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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