Article: A CHALLENGING DIAGNOSIS OF POSTERIOR VAGINAL WALL DERMOID CYST ALONG WITH ANTERIOR FISTULA-IN-ANO: A CASE REPORT

Article Category: Case Reports

DOI: 10.7897/2277-4343.155147

Pages: 21-24

Author: Krishna R Chandran *, Pashmina B Joshi, TS Dudhamal

Abstract: A dermoid cyst is a cystic swelling due to the entrapment of ectodermal tissue that occurs in the line of embryonic fusion. In which vaginal dermoid cyst is a sporadic condition, documented less than ten in literature. Fistula-in-ano is a well-known clinical entity with variable aetiology, an extension of the blind tract, and a variation of treatment in the protocol. A 42-year-old female presented with complaints of pain in the perianal region aggravated during defecation, along with dropwise bleeding in the last 2 days. On examination, late second-degree pile mass at 11 ‘O’clock, induration between 12 to 1 ‘O’ clock with hard swelling in the vaginal wall and internal opening at 12 ‘O’clock. As there was no abnormality detected in PV except a hard mass at the posterior vaginal wall. Diagnostic findings revealed the collection of abscesses in the perineum and cystic enlargement in the posterior vaginal wall, possibly due to an infected Bartholin cyst. The patient was operated on for fistula-in-ano and a biopsy of the cystic swelling at the vaginal wall. The swelling was surgically removed during the operation, and cheesy white stuff emerged. After the sac was sent for a biopsy, the benign squamous epithelium in the histopathology report confirmed the dermoid cyst diagnosis. The patient got complete relief from pain in the perianal region within six weeks of treatment. Vaginal dermoid cysts though rarest of rare, must be kept for differential diagnosis of vaginal cysts, which is a common occurrence in anterior fistula-in-ano.

Keyword: Bartholin cyst, Dermoid cyst, Fistula-in-ano, Rectovaginal fistula