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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 50  |  Issue : 3  |  Page : 107-109

Traumatic scrotal anal fistula


Department of Urology, Taipei City Hospital, Taipei, Taiwan

Date of Submission03-Aug-2016
Date of Decision12-Oct-2016
Date of Acceptance25-Oct-2016
Date of Web Publication29-May-2017

Correspondence Address:
Shao-Ming Chen
Department of Urology, Heping Campus, Taipei City Hospital, 33, Section 2, Chung Hwa Road, Taipei 10065
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_36_17

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  Abstract 

Scrotal wounds are most often related to infection or allergy and are generally identified in urology clinics. Topical medications, which are generally applied initially to the wound, can assist with spontaneous healing without any sequelae. However, further workup is sometimes required if the wound does not heal properly. Herein, we present two cases which were finally diagnosed as traumatic scrotal anal fistulae, for which surgical excision was clearly indicated.

Keywords: Anus, fistula, scrotum, trauma


How to cite this article:
Chen SM. Traumatic scrotal anal fistula. Formos J Surg 2017;50:107-9

How to cite this URL:
Chen SM. Traumatic scrotal anal fistula. Formos J Surg [serial online] 2017 [cited 2019 Apr 22];50:107-9. Available from: http://www.e-fjs.org/text.asp?2017/50/3/107/207182


  Introduction Top


Urogenital fistula occurs specifically in the urogenital organs connected to other organ in the body. It is defined as a tunnel between two epithelium-lined surfaces. It might be due to infection, trauma, and congenital or acquired anomalies. Fistulae are generally a disease condition, but they might be surgically created for therapeutic reasons, such as vesicocutaneous fistula for cystostomy. The most common type of urinary fistula is vesicovaginal fistula.[1] Surgical repair is relatively indicated with fair success rate.[2] The symptoms/signs of the fistula depend on the whereabouts. The diagnosis can be made using different kinds of imaging studies, such as barium enema, intravenous urography, and fistulography. We are going to report two interesting case reports of traumatic scrotal anal fistula. The patients are completely cured with surgical treatment.


  Case Reports Top


The informed consents have been signed by the patients for this case report. Both are the young man with the ages of 37-year-old (Case 1) and 43-year-old (Case 2), respectively. Those two patients suffered from a contusion impact by a sharp hard object against the scrotal area. At the time of injury, the same side of the testis was intact. Initially, both visited the local medical doctor. The topical medications were applied to the wound for months. The wounds still left unhealed [Figure 1] and [Figure 2]. Finally, they visited my urology clinic. On examination, the wounds are well defined with a dimple. Induration was physically found underlied the wound area. They denied any systemic disease. All laboratory tests were unremarkable, wound culture inclusive. Then, fistulography was performed for both patients. The contrast medium was injected from the scrotal wound and found remained in the rectum [Figure 3]. The scrotal anal fistulae were finally diagnosed. For the first younger patient, the fistula was completely excised [Figure 4] under spinal anesthesia, and the wound was closed layer by layer. However, some sequelae were found in the younger patient 2 months later. Multiple recurrent scrotal anal fistulae were found. Clinically, there was no connection between the bladder and the scrotal wound. Hydrogen peroxide solution was injected to denote the multiple exits [Figure 5]. Ten percent of tetracycline solution was instilled into the wound for an attempt to get the secondary healing but in vain. We had to debride the wound second time. The wound was loosely approached with penrose drain inserted. Finally, the wound was completely healed. As we had the first experience, the fistula of the second patient [Figure 6] was surgically treated smoothly without any complication.
Figure 1: The scrotal wound (↖) was found at the younger patient (case 1) and the guide wire was passed through the wound (↗↗) to anus (↖)

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Figure 2: The scrotal wound was found at the older patient (case 2) and the probe was introduced to the scrotal wound

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Figure 3: The contrast medium was injected from the scrotal wound and seen remained in the rectum in the younger patient (case 1)

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Figure 4: The double-J stent passed through the guide wire and made the landmark of the fistula for excision for one of the younger patients (case 1)

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Figure 5: The hydrogen peroxide was injected to denote the recurrent multiple exits for the younger patient

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Figure 6: The fistulae of the two patients

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  Discussion Top


The scrotal wounds are always found at outpatient department. We assume that the mechanism of the injury might be due to the impact on pubic bone through the scrotum. The wound is deep enough to make a fistula's tract. A lot of confounding variables at the time of injury should be considered, such as constipation, hemorrhoid, and anal fistula.

We must be very careful to evaluate the unhealed wound left for long time. The younger patient suffered the sequelae in which the wound was initially closed layer by layer. It is too tight to have good drainage during sitz bath, which could not completely clean up the wound. Secondary infection was unavoidably ensured. From the references, the vesicle-rectal fistula might be due to rectal cancer, incarceration inguinal hernia, and imperforate anus.[3],[4],[5] Those cases are not associated with any trauma. Our cases have not been reported to date. We suggested that any traumatic scrotal wound should be meticulously evaluated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sachdev PS, Hassan N, Abbasi RM, Das CM. Genito-urinary fistula: A major morbidity in developing countries. J Ayub Med Coll Abbottabad 2009;21:8-11.  Back to cited text no. 1
    
2.
Husain A, Johnson K, Glowacki CA, Osias J, Wheeless CR Jr., Asrat K, et al. Surgical management of complex obstetric fistula in Eritrea. J Womens Health (Larchmt) 2005;14:839-44.  Back to cited text no. 2
    
3.
Nakajima K, Sugito M, Nishizawa Y, Ito M, Kobayashi A, Nishizawa Y, et al. Rectoseminal vesicle fistula as a rare complication after low anterior resection: A report of three cases. Surg Today 2013;43:574-9.  Back to cited text no. 3
    
4.
Kasat LS, Waingankar VS, Kamat T, Anilkumar, Bahety G, Meisheri IV. Spontaneous scrotal faecal fistula in an infant. Pediatr Surg Int 2000;16:443-4.  Back to cited text no. 4
    
5.
Currarino G. Imperforate anus associated with a recto-bulbar-cutaneous fistula. J Pediatr Surg 1994;29:102-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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