14 September 2025
: Case report 
Management of Complex Anal Fistula in Recurrent Perianal Abscess: A Case Report
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents
Mingzi Zhang BEF 1, Wei Wang B 2, Yijun Xia BC 1, Huaqing Zhang CD 3, Yue Du CD 4, Zhi Wang AD 1*, Xiao Long AD 1DOI: 10.12659/AJCR.948682
Am J Case Rep 2025; 26:e948682
Table 1 Timeline of clinical events of this patient.
| Date | Event |
|---|---|
| 2023.06.15 | Initial symptoms: swelling and pain in the right buttock and thigh |
| 2023.06.27 | Patient was diagnosed with septic shock and transferred to our hospital’s emergency department |
| 2023.07.07 | Patient underwent CT-guided percutaneous drainage |
| 2023.07.14 | The drainage tube was removed |
| 2023.07.17 | Patient experienced recurrent fever and chills |
| 2023.07.19 | CT imaging revealed abscess formation in the right thigh. Surgical incision and drainage were performed: intraoperative exploration revealed no annal fistula |
| 2023.08.24 | Patient recovered well and was discharged |
| 2023.10.15 | Ultrasound revealed heterogeneous hypoechoic areas in the right buttock (2.2×1.8 cm) and right gluteal-subcutaneous region (4.6×0.8 cm). No other discomfort was reported |
| 2023.11.30 | The incision site became raised and ulcerated, with purulent discharge and a malodor. The incision was extended to facilitate drainage |
| 2023.12.16 | Patient was admitted for surgical wound repair: intraoperative exploration revealed no annal fistula |
| 2024.01.22 | Patient recovered well and was discharged |
| 2024.02.21 | The mid-portion of the incision ruptured again, prompting patient referral to a specialized colorectal hospital for further evaluation |
| 2024.03.21 | The patient was diagnosed with high complex-type anal fistula according to rectal MRI |
| 2024.03.29 | The patient underwent first-stage of high anal fistulectomy and seton treatment |
| 2024.05.15 | The patient underwent second-stage of high anal fistulectomy and seton treatment |
| 2025.04.21 | One-year follow-up showed no recurrence and preserved anal function, with no incontinence |