A Case of Extrasphincteric Enterocutaneous Fistula After Scrotal Reconstruction for Fournier Gangrene: Use of a Novel Salvage Technique.

Abstract

Anocutaneous and rectocutaneous fistulas are associated with high morbidity and mortality, and complex fistulas often pose challenges to surgical repair. Here, the authors report a case of a rare 7-cm extrasphincteric fistula that extended from the base of the phallus to the external anal canal in a patient with a history of scrotal reconstruction after Fournier gangrene. Despite the anterior location of the cutaneous sinus tract and initial concern for penile urethral involvement, intraoperative instillation of methylene blue revealed a long extrasphincteric anocutaneous fistula. With colorectal surgery co-involvement, the mature tract was dissected free from the urethra, base of the penis, and scrotum, and redirected inferiorly and diverted to a new position anterior to the anal sphincter complex. This technique created a significantly shorter tract that salvaged the scrotal reconstruction, preserved the sphincter complex, and minimized risk of infection to the scrotal reconstruction. This novel technique can be used as either a temporary or permanent solution to complex mature fistulas in high-risk patients.