1Dermatology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
2Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
3Anatomopathology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
*Corresponding Author : El Arabi Yasmina
Dermatology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Email: [email protected]
Received : May 20, 2022
Accepted : Jun 10, 2022
Published : Jun 17, 2022
Archived : www.jcimcr.org
Copyright : © El Arabi Y (2022).
Keywords: Anal fistula; Cutaneous nodule; Pyogenic abscess.
A 32-year-old female patient, primiparous, with no particular pathological history, presented a painful cutaneous nodule located at the perianal level of the left buttock evolving since her delivery 3 years ago, and through which seropurulent fluid flows intermittently. The symptomatology evolved in a context of apyrexia and conservation of the general state. It was treated many times as an abscess by oral antibiotherapy with no total remission. She has no digestive symptoms. Clinical examination found an erythematousdermo-epidermal nodule of renitant consistency measuring 1 cm, with a whitish satellite swelling measuring 0.5 cm. The perilesional skin was flesh-colored and retractile. Examination of the lymph node areas didn’t find palpable lymphadenopathy. Skin biopsy showed non-specific fibrous dermatitis. The soft tissue ultrasound revealed an anal fistula unclogging to the skin. The patient was referred to the gastroenterology department for specialized care of her anal fistula which was cryptoglandular. A fistulectomy was planned.
The originality of our observation lies in the fact that the diagnosis of anal fistula remained unknown for a long time despite its evidence. Our patient was treated for 3 years by general practitioners as a pyogenic abscess without doing further explorations, until we discovered the presence of an underlying anal fistula. It is therefore essential to make practitioners aware of this entity. Any cutaneous nodule in the gluteal region should raise suspicion of an underlying digestive tract damage . The positive diagnosis requires radiological investigations mainly Magnetic resonance imaging . The etiology of anal fistulas can be cryptoglandular as the case of our patient, Crohn’s disease, tuberculosis, trauma, or rectal cancer . The differential diagnoses are pyogenic abscesses, pilonidal sinus, hidradenitis suppurativa, or suppurating skin cyst . The treatment is interventional with a high risk of recurrence .