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Fistula-in-ano: an uncommon cause of chronic vulvar symptoms
Cherie LeFevre1, Elisabeth A Erekson, Susan Hoffstetter
1From the Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St. Louis, Missouri; and Department of Obstetrics and Gynecology, Alpert Medical School at Brown University, Providence, Rhode Island.
Background:
Rectal and anal fistulae are frequently missed diagnoses. Symptoms of fistula-in-ano may mimic other chronic vulvar conditions.
Cases:
Three patients presented with chronic symptoms including nonhealing ulcer, pruritus, dyspareunia, and discharge for 6-18 months. High clinical suspicion and rectal examination with concomitant perineal probing was useful in making a diagnosis. Once the diagnosis of fistula-in-ano was made, surgical correction was successful.
Conclusion:
When evaluating persistent vulvar problems, the clinician's differential diagnoses should include less common causes. The goals of treatment for fistula-in-ano should be to eliminate the nidus of infection and to preserve the anal sphincter during the repair.
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