Persistent Cyst Near Anus: Is It Infected or a Fistula?

Cyst near the anus, not healing after surgery?

Hello Dr.
Ke: In March 2017, I developed a round lump near my anus that caused discomfort when sitting.
I visited a hospital, and the doctor diagnosed it as a sebaceous cyst.
After surgery, there were no stitches, and the wound depth was about 2.5 cm.
Postoperatively, I mainly applied medication and soaked in warm water.
During follow-up visits, the doctors indicated that everything was fine.
However, two years have passed, and the wound has not fully healed.
Occasionally, after using the restroom, I notice a bit of blood or a light yellow fluid when wiping.
When I touch the wound, it feels hard and slightly painful, but I generally do not touch it and it hasn't caused me any significant issues in daily life.
I have not paid much attention to it.
Does this situation indicate that the wound has been in a state of inflammation all along? Could it have developed into an anal fistula? If I seek medical attention, would this condition require another surgery?

Danxin de nǚzǐ, 20~29 year old female. Ask Date: 2019/05/02

Dr. Ke Fangxu reply Surgery

Generally, an epidermoid cyst should not take two years to heal after surgery.
If the wound continues to remain unhealed, it is important to consult a physician for further evaluation.
It is possible that the initial surgery did not completely excise an anal fistula.
If this is the case, a repeat surgery may be necessary.

Reply Date: 2019/05/02

More Info

Persistent cysts near the anus, particularly those that have not healed properly after a surgical procedure, can indeed raise concerns about infection or the development of a fistula. In your case, the history of a sebaceous cyst that was surgically removed but has not fully healed over two years is significant. The presence of blood or yellowish fluid upon wiping, along with hardness and occasional pain, suggests that there may be ongoing inflammation or infection.

A fistula is an abnormal connection between two epithelial surfaces, often occurring when an abscess or cyst becomes infected and creates a channel to the skin or another organ. In the context of your situation, if the cyst has been persistently draining fluid and has not healed, it is possible that a fistula could have developed. The symptoms you describe, such as the discharge and discomfort, are consistent with this possibility.

When you visit a healthcare provider, they will likely perform a thorough examination, which may include imaging studies such as an ultrasound or MRI to assess the area more clearly. If a fistula is confirmed, surgical intervention may be necessary to properly address the issue. This could involve excising the fistula tract and ensuring that the area is clean and free from infection.
It is important to note that while some cysts can resolve on their own, persistent symptoms, especially those involving pain and discharge, warrant further investigation. The risk of complications, such as recurrent infections or the development of more complex fistulas, increases if the condition is left untreated.

In summary, your symptoms suggest that there may be ongoing inflammation or infection related to the original cyst. It is advisable to consult with a healthcare provider who specializes in colorectal or general surgery for a comprehensive evaluation. They can provide guidance on the best course of action, which may include further diagnostic testing and potential surgical intervention if necessary. Early intervention can help prevent complications and promote healing.

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