A complex fistula-in-ano presenting as a soft tissue tumor

Area of Science:

• Proctology
• Surgical Gastroenterology

Background:

• Anorectal abscess and fistula-in-ano are common conditions representing acute and chronic manifestations of anal gland infections.
• Fistula formation occurs when infections spread into adjacent spaces, sometimes in complex patterns.
• These complex patterns pose significant challenges in mapping and treatment.

Purpose of the Study:

• To describe a case of complex perianal fistula presenting atypically.
• To highlight the importance of accurate diagnosis and mapping for complex perianal fistulas.

Main Methods:

• Case report detailing a complex perianal fistula.
• Initial presentation as a painless benign lump mistaken for soft tissue swelling.
• Diagnosis confirmed as a chronic abscess cavity with a complex fistulous tract.

Main Results:

• The fistula presented as a painless lump in the buttock.
• Initial misdiagnosis as a soft tissue swelling.
• Imaging was essential to reveal the underlying complex fistulous tract.

Conclusions:

• Complex perianal fistulas are challenging to treat and prone to recurrence.
• Accurate diagnosis and detailed mapping are essential for optimal treatment outcomes.
• Radiological investigations, such as MRI, are crucial when clinical examination is insufficient.