Biography
Biography: Manasa Anand
Abstract
Fistula in ano, one of the common conditions, which usually arise as a complication of incompletely drained perianal abscess. Our first case is a 73 year old male with complaints of purulent discharge in the perianal region for duration of five years. Operated twice for perianal abscess 5 and 3 years ago. On examination, external openings noted at 6, 8 and 10 ‘o’ clock position. Rectal examination revealed a growth arising from anorectal junction, extending for 5 centimetres upwards, confirmed by computed tomography abdomen. Colonoscopy guided biopsy revealed infiltrating adenocarcinoma which was congruent with the wedge biopsy taken from the fistulous tract. Our second case is a 60 year old male patient with complaints of purulent discharge from the perianal region since seven years, with history of surgery for perianal abscess seven years ago. Examination revealed external openings at 1, 2, 3 and 5’o’ clock position with mucous discharge. Rectal and colonoscopic examinations were normal. Wedge biopsy revealed it to be mucinous adenocarcinoma. Following tumour board consensus, both of them were sent for neoadjuvant chemotherapy. Systemic conditions like tuberculosis and Crohn’s disease are commonly associated with chronic multiple fistulae. Colorectal malignancy with implantation in a fistula and a primary malignancy arising in a fistula are extremely rare presentations, with less than 50 cases being reported. They act as a guide for an underlying solid tumour. With a high index of suspicion, mandatory colonoscopies and guided biopsies for patients with chronic fistulae is of utmost importance.