M. Grant Liska, BS¹; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES² ¹University of Central Florida College of Medicine ²Philippine Children’s Medical Center
Fistula-in-ano is a chronic abnormal communication between the anal canal and, usually, the perianal skin. It can be described as a hollow tract that is lined with granulation tissue and connects a primary opening inside the anal canal to a secondary opening in the perianal skin. It usually originates from the anal glands and is frequently the result of a previous anal abscess. Anal fistulae present with pain, swelling, pruritus, skin irritation, and purulent or bloody drainage. Most anal fistulae are diagnosed based on clinical findings, but complex and deep anal fistulae usually require imaging studies such as CT scan or MRI to delineate the tract.
Currently, there is no medical treatment available and surgery is almost always necessary. A simple intersphincteric fistula can often be treated with fistulotomy or fistulectomy, while trans-sphincteric and suprasphincteric fistulae are treated by placement of a seton to maintain drainage and induce fibrosis. Extrasphincteric fistula treatment depends on the anatomy and etiology of the fistula.
This article presents the case of a 1-year-old male with a history of recurrent perianal infection, which led to the development of an anal fistula. The anal fistula was noted to be superficial, and a fistulotomy was performed.
J. Corbin Norton, MD Department of Urology University of Arkansas for Medical Sciences
Stephen J. Canon, MD Department of Pediatric Urology Arkansas Children’s Hospital
Amrit Singh, MD Department of Pathology University of Arkansas for Medical Sciences / Arkansas Children’s Hospital
Laura L. Hollenbach, MD Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences
Georgia Gamble, MD Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences
Laura A. Gonzalez-Krellwitz, MD Department of Pathology University of Arkansas for Medical Sciences / Arkansas Children’s Hospital
The patient, in this case, is a 15-year-old female who presented with primary amenorrhea and who on work-up was found to have complete androgen insensitivity syndrome. Here, Dr. Canon at the University of Arkansas for Medical Sciences performs a prophylactic laparoscopic bilateral gonadectomy to reduce her future risk for intra-abdominal testicular malignancies. Final pathology results showed a rare case of bilateral germ cell neoplasia in situ and bilateral paratesticular leiomyomas and reinforced the decision to intervene early allowing for the removal of the gonads prior to their conversion to formal germ cell tumors.
Dr. Wiygul and colleagues take a multidisciplinary approach to treating a cloacal exstrophy, a rare congenital defect that is part of the OEIS complex: omphalocele, exstrophy of the cloaca, imperforate anus, and spine deformities.