Clinical Presentation: A 40-year-old male presents with recurrent perianal pain, swelling, and purulent discharge. He reports a history of perianal abscess drainage several months ago, but symptoms have persisted despite antibiotic therapy. On examination, a small external opening with surrounding induration is noted at the anal verge. What is the likely diagnosis, and what is the appropriate management approach? Answer: The likely diagnosis is an anal fistula. Management involves surgical intervention for definitive fistula closure. Surgical options include fistulotomy, fistulectomy, seton placement, or advancement flap repair, depending on the fistula complexity and location. Preoperative evaluation should include assessment of the fistula tract and associated comorbidities to determine the optimal surgical approach. Explanation: Anal fistulae are abnormal tracts that connect the anal canal or rectum to the perianal skin. They commonly develop as a consequence of cryptoglandular infection and perianal abscess formation. Management aims to achieve complete fistula closure while preserving anal continence. Surgical intervention is typically required for definitive treatment, with various surgical techniques available depending on the fistula characteristics and patient factors. In this scenario, the patient's symptoms and examination findings are consistent with an anal fistula, necessitating surgical evaluation and intervention for resolution.
