Year 2023 / Volume 115 / Number 3
Letter
Resection of an anal fistula with endoscopic submucosal dissection

142-143

DOI: 10.17235/reed.2022.9002/2022

Hong-yan Wang, Qin-qin Min, Shi-xiang Xiong, Chuan-bin Zheng, Chang-yin Lu, Mu-min Shao, Shao-ju Guo,

Abstract
A 34-year-old man presented with paroxysmal hypogastralgia during defecation for 2 weeks. Physical and laboratory examination findings were unremarkable, other than a depression located 1 cm above the dentate line, accompanied by mild tenderness and a clubbed induration extending to the rectum. Colonoscopy showed a 2.0×0.8 cm longitudinal, protruding mass in the posterior wall of the lower rectum. Endosonography revealed a mixed echogenic mass originating from the rectal submucosa, with no sign of muscular wall disruption. There was no evidence of Crohn’s or other diseases. Following anorectal consultation, we suspected a submucosal or internal blind fistula since the patient was symptomatic with a superficial mass which communicated to the rectum. The location and depth of the mass indicated that endoscopic resection might allow for removal of the lesion without impairment of the anorectal anatomy and function. After obtaining the patient’s consent, endoscopic submucosal dissection (ESD) was performed. En bloc resection was achieved using a disposable, high-frequency knife (Micro-Tech, China). No adverse events occurred. Histopathological examination revealed a benign fistula composed of local submucous granulomatous tissue proliferation and a focal mucous epithelial defect. The patient’s symptoms were relieved postoperatively, and no recurrence was evident after 6 months.
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References
1. Pescatori M. Surgery for anal fistulae: state of the art. Int J Colorectal Dis 2021;36:2071-9.
2. Włodarczyk M, Włodarczyk J, Sobolewska-Włodarczyk A, et al. Current concepts in the pathogenesis of cryptoglandular perianal fistula. J Int Med Res 2021;49: 300060520986669.
3. Iqbal N, Tozer PJ, Fletcher J, et al. Getting the most out of MRI in perianal fistula: update on surgical techniques and radiological features that define surgical options. Clin Radiol 2021;76:784.e17-25.
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Wang H, Min Q, Xiong S, Zheng C, Lu C, Shao M, et all. Resection of an anal fistula with endoscopic submucosal dissection . 9002/2022


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Publication history

Received: 11/06/2022

Accepted: 27/06/2022

Online First: 30/06/2022

Published: 07/03/2023

Article revision time: 8 days

Article Online First time: 19 days

Article editing time: 269 days


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