Could This Be an Anal Fistula? Symptoms and Diagnosis - Surgery

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Based on your description, it sounds like you may be dealing with a complex situation that could potentially involve an anal fistula, but there are several factors to consider. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It often arises after an anal abscess, which is a collection of pus that can occur due to infection in the anal glands.
In your case, the initial hard lump on your inner thigh that eventually ruptured and produced pus suggests that there may have been an infection, possibly originating from a hair follicle or an anal gland. The fact that the wound has been slow to heal and has required repeated interventions, including the insertion of a probe and the potential need for surgical excision, raises the suspicion of a fistula.
The distance from the site of the wound to the anus (7-8 cm) is noteworthy. While anal fistulas typically originate near the anus, they can sometimes extend deeper into the surrounding tissues. The depth of the wound (5-6 cm) that your doctor mentioned is also significant. If the probe could not reach the bottom of the wound, it may indicate a complex or branched fistula, which can complicate treatment.

Symptoms of an anal fistula can include:
- Persistent drainage of pus or blood from the opening near the anus.

- Pain or discomfort, especially during bowel movements.

- Swelling and redness around the area.

- Itching or irritation near the anus.

Given that your doctor has suggested a referral for further evaluation, it is essential to follow through with that recommendation. A specialist, such as a colorectal surgeon, can perform a more thorough examination, possibly including imaging studies like an MRI or an endoanal ultrasound, to determine the exact nature of the condition.
In terms of treatment, if it is confirmed to be an anal fistula, surgical intervention is often necessary. The goal of surgery is to remove the fistula tract while preserving the surrounding sphincter muscles to maintain anal function. Depending on the complexity of the fistula, different surgical techniques may be employed, including fistulotomy, seton placement, or advancement flap procedures.

It is also important to consider other potential diagnoses. For example, if the initial lump was not related to the anal area, it could be a separate issue entirely, such as a sebaceous cyst or a different type of abscess. Therefore, a comprehensive evaluation by a specialist is crucial for accurate diagnosis and appropriate management.

In summary, while your symptoms and history raise the possibility of an anal fistula, a definitive diagnosis can only be made through further examination and possibly imaging studies. It is important to consult with a colorectal surgeon who can provide a detailed assessment and discuss the best treatment options for your situation. Please ensure you follow up with your healthcare provider promptly to address these concerns.