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Unusual sonographic finding in a patient with late recurrence of a perianal fistula

✍ Scribed by Jaime L. Mayoral; Bernard J. Rubal

Publisher
John Wiley and Sons
Year
2002
Tongue
English
Weight
259 KB
Volume
30
Category
Article
ISSN
0091-2751

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✦ Synopsis

We describe a case of late recurrence of a perianal fistula in a 51-year-old man with a 4.5-year history of recurrent perianal fistulas and abscesses. This was the fourth recurrence he had experienced; at each occurrence, he had undergone various examinations, including sigmoidoscopy, anoscopy, barium enema, fistulography, probe exploration, instillation of hydrogen peroxide, and/or sonography, and he had also undergone surgery. At our examination, transperineal sonography with a portable ultrasound scanner revealed an echogenic linear structure within the fistulous tract. Under endoanal sonographic guidance, surgery was performed, and a tan solid cylindrical structure longer than 2 cm was removed. Histopathologic examination revealed stratified squamous epithelium and soft tissue with substantial fibrosis and mild chronic inflammation, findings consistent with the characteristics of a remnant cast from a previous fistulous tract. Our findings suggest that some patients may benefit from relatively inexpensive sonographic examination with appropriate transducers.

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