Anoplasty for Fused Anus Following Fournier’s Gangrene Debridement: a Case Report

Anal stenosis is a rare debilitating surgical condition that secondary to functional and anatomical causes. Excisional hemorrhoidectomy is the leading anatomical cause of anal stenosis, affecting up to 87.7% of cases. The severity and level of the impacted region determines the management options considered. Numerous tension-free anoplasty techniques and their varying success rates have been reported in the literature. A patient-tailored anoplasty approach highly depends on the level of severity, location, and extent of anal stenosis. We present herein the management of a case of fused anus three years following extensive surgical debridement for Fournier’s Gangrene. A colonoscopy illumination guided neo-anal creation was performed, which resulted in low severe anal stenosis six weeks later. Subsequently, V-Y anoplasty, lateral internal sphincterotomy, and colostomy closure were performed, which demonstrated good initial recovery. However, six months later, the anal stenosis recurred. Diamond-shaped anoplasty was offered, but the patient refused any further surgical intervention. This case report aims to highlight the rare complication of fused anal stenosis and its management. The clinical management challenge and learning experience are reported. Additionally, it is recommended that such rare complications be managed in a tertiary center, using a multidisciplinary approach led by an experienced colorectal surgery sub-specialty unit.