Beware of Anal Fissure Surgery During Menstruation: Endometrium Inoculation

We here present a lady patient of perianal firm and tender lump with pre-menstrual exacerbation of pain that occurred after surgery for anal fissure during active menstruation which we believe is on account of endometrium implantation resulting into endometriosis. A 32-year-old woman presented with pain and mass in the anus 3 months after surgery for anal fissure. On examination, a firm swelling of 2 × 2 cm was felt extending from 7 to 10 o’clock position in the perianal area which was extremely tender. Detailed clinical history revealed exacerbation of pain before and after each menstrual cycle for the last 2 months. An incisional biopsy confirmed the diagnosis of endometrioma and following complete excision cured the condition. This is the first case report of such an incidence where surgical wound inoculation of menstrual endometrial tissue is in the perineal region. In our research with PubMed, we realized that there are no cases other than ours in the literature. We think that if surgeons abstain from perianal intervention to patients having identified endometrioma when the patient is in menstruation, the risk of occurrence of perianal endometrioma is decreased. Similar content being viewed by others

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