title: Unusual sonographic finding in a patient with late recurrence of a perianal fistula.
abstract: 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.
authors.affiliation: Colon and Rectal Surgical Associates of San Antonio, Medical Center Tower I, 7950 Floyd Curl Drive, Suite 101, San Antonio, Texas 78229-3916, USA.
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Mayoral
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Rubal
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012007:Rectum / Q000473:pathology; D012008:Recurrence; D014463:Ultrasonography