Confusion Between Anal Fistula and Skin Tumor: Seeking Clarity for Proper Treatment

It is difficult to differentiate between an anal fistula and a skin tumor, making it challenging to provide the appropriate treatment?

Hello Doctor, my husband has had a hard lump near his anus since April, which has changed color, is painful when pressed, and even affects his walking.
After a few days, it ruptured on its own, bleeding and oozing pus.
We went to the emergency room and outpatient clinic, where they diagnosed it as an anal fistula.
Initially, we followed the first hospital's treatment instructions and completed a week of medication, but the condition fluctuated for several months.
We then visited another major hospital, where the doctor also diagnosed it as a fistula and provided a detailed explanation (including showing the family a tube-like structure under the skin) and informed us that surgery would be more challenging due to the location.
Following the doctor's advice, we have been using a cotton swab to clean the wound with hydrogen peroxide and apply medication daily.
The cotton swab is long, and the wound is deep enough that it can almost go in completely.
This doctor later transferred us to the hospital director due to time constraints.
After examining us, the director stated it was not a fistula but a skin tumor, and then referred us to another doctor.
The next doctor also said it was a skin tumor, but after prescribing a week of medication, we were not required to return for a follow-up.
Currently, we are unsure whether it is an anal fistula or a subcutaneous tumor, and we do not know which specialty to continue seeing (as it is evident that the condition has not improved).
The doctor stated it is not an anal fistula, but the cotton swab can indeed be inserted into the wound.
If it is not an anal fistula, why were the previous doctors' treatments for a fistula effective? I would like to ask which diagnosis is more accurate, anal fistula or skin tumor, as we are concerned about delaying treatment.
Thank you very much!

An Jiu, 20~29 year old female. Ask Date: 2023/11/08

Dr. Zhang Shuhao reply Surgery

Based on your description of wounds around the anus that are bleeding, discharging pus, and prone to recurrence, there is a high suspicion of an anal fistula.
The difference between an anal fistula and a skin tumor is that the fistula is connected to the anal glands, so both the glands and the fistula need to be excised to prevent recurrence.
An experienced colorectal surgeon has a very high accuracy rate in diagnosing fistulas through palpation.
If conservative treatment is not effective, you may discuss with the previously recommended surgeon whether to proceed with surgical treatment.

Reply Date: 2023/11/08

More Info

It sounds like you are dealing with a complex and frustrating medical situation involving a potential anal fistula and a skin tumor. Based on the information provided, I will clarify the differences between these two conditions and offer some guidance on how to proceed with your husband's treatment.

Understanding Anal Fistulas and Skin Tumors
Anal Fistula:
An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It often develops as a result of an infection in the anal glands, leading to the formation of an abscess. Symptoms typically include:
- A painful lump near the anus
- Discharge of pus or blood
- Irritation of the skin around the anus
- Pain during bowel movements
If left untreated, an anal fistula can lead to recurrent infections and complications. Treatment usually involves surgical intervention to properly drain the fistula and promote healing.

Skin Tumor:
On the other hand, a skin tumor can refer to a variety of growths on the skin, which may be benign (non-cancerous) or malignant (cancerous). Symptoms can vary widely depending on the type of tumor but may include:
- A lump or bump on the skin
- Changes in color or texture of the skin
- Pain or discomfort in the area
- Ulceration or bleeding if the tumor is aggressive

Diagnosis and Treatment
Given that multiple healthcare providers have offered differing opinions on your husband's condition, it is crucial to obtain a definitive diagnosis. Here are some steps you can take:
1. Seek a Specialist:
- Consider consulting a colorectal surgeon or a dermatologist who specializes in skin tumors. They can provide a more focused evaluation of the lump and the surrounding tissue.

2. Imaging Studies:
- Request imaging studies such as an MRI or ultrasound, which can help visualize the structures involved and clarify whether there is a fistula or a tumor.

3. Biopsy:
- If a skin tumor is suspected, a biopsy may be necessary to determine the nature of the growth. This involves taking a small sample of tissue for pathological examination.

4. Follow-Up Care:
- Ensure that your husband continues to follow up with healthcare providers until a clear diagnosis is established. If symptoms worsen or new symptoms arise, seek immediate medical attention.

Conclusion
The confusion between an anal fistula and a skin tumor is understandable, especially when symptoms overlap. It is essential to pursue a thorough evaluation to determine the correct diagnosis and appropriate treatment plan. Delaying treatment could lead to complications, so do not hesitate to advocate for your husband's health by seeking further opinions and diagnostic tests.
In summary, while the initial diagnosis of an anal fistula may have been accurate, the subsequent identification of a skin tumor suggests that further investigation is warranted. Engaging with specialists and utilizing imaging and biopsy techniques will be key to resolving this medical dilemma.

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