Formosan Journal of Surgery

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

Traumatic scrotal anal fistula


Shao-Ming Chen 
 Department of Urology, Taipei City Hospital, Taipei, Taiwan

Correspondence Address:
Shao-Ming Chen
Department of Urology, Heping Campus, Taipei City Hospital, 33, Section 2, Chung Hwa Road, Taipei 10065
Taiwan

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.



How to cite this article:
Chen SM. Traumatic scrotal anal fistula.Formos J Surg 2017;50:107-109


How to cite this URL:
Chen SM. Traumatic scrotal anal fistula. Formos J Surg [serial online] 2017 [cited 2021 May 7 ];50:107-109
Available from: https://www.e-fjs.org/text.asp?2017/50/3/107/207182


Full Text

 Introduction



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



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}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}

 Discussion



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

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