Abstract
A non-healing sinus manifesting in an episiotomy scar after it has healed is rare. We report one such woman. There were no underlying risk factors like third- or fourth-degree tear or inflammatory bowel disease. In spite of previous attempted exploration the problem had persisted. Examination of the case under anaesthesia revealed it to be a low fistula-in-ano. The methodical evaluation and management of the case is detailed. Fistulectomy completely cured the patient. Most of these patients present to obstetricians and gynaecologists. Awareness and a high index of suspicion of communication with the anorectal canal are important. A team approach with the colorectal surgeon would help in better preoperative counselling, planned evaluation and definitive procedure to completely cure the patient.
References
Howard D, DeLancey JO, Burney RE (1999) Fistula-in-ano after episiotomy. Obstet Gynecol 93(5 Pt 2):800–802
Barranger E, Haddad B, Paniel BJ (2000) Fistula in ano as a rare complication of mediolateral episiotomy: report of three cases. Am J Obstet Gynecol 182(3):733–734
Robinson AM Jr, DeNobile JW (1988) Anorectal abscess and fistula-in-ano. J Natl Med Assoc 80(11):1209–1213
Sygut A, Mik M, Trzcinski R, Dziki A (2010) How the location of the internal opening of anal fistulas affect the treatment results of primary transsphincteric fistulas. Langenbecks Arch Surg 395(8):1055–1059. doi:10.1007/s00423-009-0562-0
Tasci I, Erturk S, Alver O (2013) Coring-out fistulectomy with a newly designed ‘fistulectome’ for complicated perianal fistulae: a retrospective clinical analysis. Colorectal Dis 15(7):e396–e401. doi:10.1111/codi.12163
Consent
Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dorairajan, G., N, H. Chronic non-healing sinus manifesting in episiotomy scar: hidden fistula-in-ano. Int Urogynecol J 25, 1441–1443 (2014). https://doi.org/10.1007/s00192-014-2377-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-014-2377-y