Abstract

A typical fistula usually consists of a tract with a primary (internal) opening in the anus or rectum and a secondary (external) opening on the perirectal skin. There have been very few case reports where a fistula in ano has traversed an unusual course and caused a diagnostic dilemma. In this report we presented a case of perianal fistula presented with osteomyelitis on the lateral side of right. The patient was previously admitted to another center where she was diagnosed with deep soft tissue infection on thigh associated with osteomyelitis and underwent three consecutive operations within 6 months for drainage and debridement. However healing was not achieved. A pelvic magnetic resonance imaging showed suprasphincteric anal fistula that extended to the lateral side of the right thigh. Crohn’s disease was excluded. The patient was referred to our center and fistula tract was irrigated with a 1% silver nitrate solution. After long follow up, the patient showed complete cessation of the discharge with complete healing of external orifices of the fistula. This report described an unusual perianal fistula extending to the thigh. Previously this case was diagnosed as osteomyelitis. It is important to consider perianal fistulas as a differential diagnosis for this type of wounds and the application of silver nitrate solution often produces a favorable outcome in such cases.

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