Article Information

Corresponding author: Uzzam Ahmed Khawaja

Article Type : Case Report

Volume : 1

Issue : 4

Received Date : 22 Sep ,2020


Accepted Date : 07 Oct ,2020

Published Date : 13 Oct ,2020


DOI : https://doi.org/10.38207/jmcrcs20201036

Citation: Waleed MS, Ramzan S, Sadiq W, Khawaja UA (2020) Perineal Fistula, A Rare Case Presentation. J Med Case Rep Case Series 1(4): https://doi.org/10.38207/jmcrcs20201036

Copyright: © © 2020 Waleed MS. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
  Perineal Fistula: A Rare Case Presentation

Madeeha Subhan Waleed1, Summera Ramzan2, Waleed Sadiq3 and Uzzam Ahmed Khawaja4, *

1Ayub Medical College, Abbottabad, Pakistan

2Al Nafees Medical College and Hospital, Islamabad, Pakistan

3Staten Island University Hospital, New York, USA

4Jinnah Medical and Dental College, Karachi, Pakistan

*Corresponding Author: Khawaja UA, Jinnah Medical and Dental College, Karachi, Pakistan

Abstract
Common cause of perineal pain is fistula in the anal region. Fistula cause by impaction of foreign body is rare. We present to you a case of a 48- year-old man of Asian descent presented to the emergency department with pain and discharge from the anal region in the last three years. He had an impaction of a foreign body that was removed surgically.

Keywords: perineal fistula, foreign Body, bleeding per rectum

Introduction
Common cause of perineal pain is fistula in the anal region. Fistula cause by impaction of foreign body is rare [1]. The anal canal is a very rare site of impaction of a foreign body [2]. Most of the foreign body pass out of the anus once they are ingested [3]. The sites of impaction of the ingested foreign body include appendix, caecum, and terminal ileum [2].

Case Presentation
A 48-year-old man of Asian descent presented to the emergency department with pain and discharge from the anal region for three years. He gave no history of bleeding per rectum. He had no medical co-morbidities. His previous surgical history was unremarkable. On local examination, he had a fistula in ano with an external opening seen at 7 O’clock, position and internal opening could not be visualized. Purulent discharge from the external opening was there. Digital rectal examination was normal. His sonofistulogram showed a complex fistula in ano with evidence of a foreign body (3.2 cm) in the fistulous tract. The rest of his blood investigations were normal. Based on these findings, surgical intervention was planned, and he was taken to the operation theatre. His foreign body removal was done under general anesthesia. The fistula tract was laid open and a bone piece of 3 cm was extracted in piece as shown in Figure 1a. Setons were placed in the fistulous tract. The foreign body was sent for histopathological report and it turned out to be. The patient recovered fine.

Figure 1a. Foreign body removed from the patient.

Figure 1b. Foreign body removing from the patient.

Discussion
Ingested foreign body can cause a rare complication of a fistula in ano. Only few cases have been reported in the literature so far 1-4. Fish bones 5, chicken bones 5, suture material1, filshie clips1, etc. have been various unusual contents removed from the fistula in ano. Risk factors predisposing to impacted foreign body by ingestion include the presence of dentures, previous anal surgery complicated by anal stenosis and alcohol intoxication [6].

Conclusion
Presence of pain and purulent discharge should raise the suspicion of a foreign body in the anal tract although this is very rare but should be kept in mind to decrease morbidity as well as mortality for the patient. The ultimate treatment would be removing it under general anesthesia.

References

  1. Paksoy M, Ozben V, Ayan F, Simsek A, Ayan F (2010) An atypical etiology of suprasphincteric fistula: a forgotten surgical material. Case Reports in Medicine. Apr:1–3.
  2. Doublali M, Chouaib A, Elfassi MJ, Farih MH, Benjelloun B, et al (2010) Perianal abscesses due to ingested foreign bodies. J Emerg Trauma Shock 3(4): 395–397.
  3. Cockerill FR 3rd, Wilson WR, Scoy RE V (1984) Travelling toothpicks. Mayo Clin Proc 58(9): 613–616.
  4. Seow C, Leong AF, Goh HS (1991) Acute anal pain due to ingested bone. Int J Colorectal Dis 6(4): 212–213.
  5. Choi DH (2008) Acute anal pain due to ingested bone fragments. J Korean Soc Coloproctol 24(1): 51–57.
  6. Lai AT, Chow TL, Lee DT, Kwok SP (2003) Risk factors predicting the development of complication after foreign body ingestion. Br J Surg  90(12): 1531–1535.