Vaginocutaneous fistula secondary to gluteal abscess: a case report

Abstract

A fistula is an abnormal connection between two epithelialized surfaces that are normally separated, most commonly occurring secondary to infectious, inflammatory, or traumatic processes. Vagino-cutaneous fistulas are exceedingly rare, as the most frequent fistulas in this anatomical region are vesicovaginal or rectovaginal, due to the close proximity of these structures. We present the clinical case of a 36-year-old woman with a history of obesity and sedentary lifestyle who initially presented to her primary healthcare unit with pain in the gluteal and perianal region, accompanied by urinary symptoms. She was treated empirically with antibiotics for a presumed urinary tract infection and analgesics, without clinical improvement. On day 15, she attended the emergency department due to purulent vaginal discharge. Physical examination revealed a necrotic lesion measuring 5 × 5 cm in the perianal region of the left buttock, and surgical debridement confirmed a vagino-cutaneous fistula. Initial management included debridement, eschar excision, and sterile dressing coverage, followed by a second procedure for partial closure. The patient remains hospitalized under multidisciplinary management, awaiting further evaluation for additional intervention. This case highlights the importance of timely medical diagnosis and thorough physical examination during the initial consultation, and documents the rarity and complexity of vagino-cutaneous fistulas.