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Trans-Scrotal Complex Fistula-in-Ano: Tricks for Safe Single Stage Surgery
Rajvilas Anil Narkhede, Gunjan S Desai* and Hitesh Mehta
Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, India
*Corresponding author: Gunjan S Desai, Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, 400050, India
Published: 29 Nov, 2017
Cite this article as: Narkhede RA, Desai GS, Mehta H.
Trans-Scrotal Complex Fistula-in-Ano:
Tricks for Safe Single Stage Surgery.
Clin Surg. 2017; 2: 1774.
Keywords
Complex fistula; Trans-scrotal fistula; Trans-sphincteric fistula
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Complex fistula-in-ano with tract extending trans-scrotally to the root of penis and secondary opening at base of scrotum is very rare. Fistula-in-ano with scrotal extension is known to present as inter-sphincteric or low trans-sphincteric fistula running through the Colles’ fascia, which is the path of least resistance over a tough deep perineal Gallaudet’s fascia and often stands out as exception to Goodsall’s rule [1,2]. Present images show surgical technique for managing one such case. Digital examination under anesthesia revealed a palpable thickening at 12 O’clock; 2 cm proximal to anal verge which on probing identified a long fistulous tract with trans-scrotal extension to root of penis and a secondary opening at the base of scrotum (Figure 1-3). A careful sharp fistulectomy was performed, starting from root of penis, dissecting tract in the scrotal septum without violating the testes with its tunica and was brought out infra-scrotally. The secondary tract opening at base of scrotum was watchfully dissected, palpating the ‘cord like feel’ of foley’s catheter, thus preventing any iatrogenic injury to urethra. After complete fistulectomy, internal opening was closed with absorbable sutures and partial primary wound closure was performed. Recovery was uneventful (Figure 4-6). In conclusion, single stage surgery is feasible option and safe dissection in correct tissue planes holds the key to successful outcome for complex trans-scrotal fistula-in-ano.
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Figure 1