Chronic non-healing sinus manifesting in episiotomy scar: hidden fistula-in-ano.
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.
Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, gowridorai@hotmail.com.
Gowri
G
Dorairajan
HimaBindu
H
N
D000328:Adult; D002908:Chronic Disease; D002921:Cicatrix / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D012003:Rectal Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*