Chronic non-healing sinus manifesting in episiotomy scar: hidden fistula-in-ano

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.

Magnetic resonance imaging as a diagnostic tool for postpartum fistula-in-ano on episiotomy scar – A case report

“…Fistula-in-ano as a complication of episiotomy is uncommon and had only been documented in a few previous papers. [2][3][4][5] As the diagnosis of these fistulas is frequently missed or delayed, [6] this pathology should be suspected whenever a female patient with a previous episiotomy presents with persistent suppuration and perineal pain. [3] MRI is currently thought to be the golden standard in anal fistula and is considered equal or superior to examination under anesthesia, [1,7] as it provides accurate information about fistulous tract location, relationships to the anal sphincters, and detection of any secondary tracts or abscess.…”