Misdiagnosed case of an ano-scrotal fistula treated with partial excision of tract and Ksharasutra - A case report

Anal fistula can sometimes extend to the scrotum, resulting in varied presentations that can lead to misdiagnoses such as scrotal infection, abscess, or sinus, particularly when minimal or no symptoms are present in the anus. This case report presents a 50-year-old male patient initially diagnosed with a scrotal sinus who underwent excision one year ago. He presented with persistent pus discharge from the scrotum without anal complaints. So the case was initially diagnosed as a scrotal sinus based on clinical examination and ultrasonography findings, the true pathology of an ano-scrotal fistula was only revealed during surgery. This unexpected finding was effectively managed by partial fistulectomy and Ksharasutra therapy. This case underscores the importance of thorough preoperative assessment and intraoperative vigilance. The successful outcome demonstrates the necessity for flexibility in surgical planning and the potential benefits of integrative approaches in complex fistula-in ano.