PMC9133505_01
Sagittal T2-weighted perineum MRI shows a 25- mm anal fistula (arrow).
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F1
Magnetic resonance imaging of the perineum showed an anal fistula between 1 and 3 o'clock in the lithotomy position (Figure 1).
Fistulography reveals a 25-mm-long tubular structure of about 1-3 mm in width without any connection with the rectum.
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F2
Fistulography revealed a 25-mm-long tubular structure of about 1-3 mm in width without connection with the rectum (Figure 2).
Perineal approach (prone position): the fistula had communication with the secondary anus, and this fact was checked with a metal catheter after intraoperative fistulography.
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F3
Intraoperative fistulography under pressure showed that there was connection between the fistula and the secondary anus and was checked with a metal catheter (Figure 3).
The resected specimen shows that the distal portion is a 40-mm-long duct.
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F4
ACD had a narrow fistula, measuring approximately 2 mm in diameter and 40 mm in length (Figure 4). A hemovac drain was inserted, and the muscles were approximated with absorbable sutures (Figure 5).
A hemovac drain is inserted, and the muscles are approximated with absorbable sutures.
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F5
ACD had a narrow fistula, measuring approximately 2 mm in diameter and 40 mm in length (Figure 4). A hemovac drain was inserted, and the muscles were approximated with absorbable sutures (Figure 5).
Histological findings (H&E). The duct is predominantly lined by squamous epithelium (white arrow) and smooth-muscle (black arrow).
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F6
Squamous epithelium in the distal end and smooth-muscle cells lined the wall were demonstrated on pathology (Figure 6).
One month after surgery, the wound healed completely.
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F7
One month after surgery, the wound healed completely (Figure 7).