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Retained silk may underlie late postvasectomy fistula
Surgery and histopathology identified retained silk ligature with chronic inflammation at the site of a rare fistula presenting 3 years following vasectomy.
To investigate a case of vasocutaneous fistula occurring 3 years after vasectomy, potentially related to retained silk ligature and chronic inflammation.
Approach:
Patient Presentation: A 43-year-old male presented with a 2-month history of persistent whitish discharge from the left hemiscrotum following a bilateral no-scalpel vasectomy.
Diagnostic Assessment: Clinical examination, microscopy of discharge, ultrasonography, surgical exploration, and histopathologic examination were performed to assess the sinus and its communication with the vas deferens.
Surgical Intervention: Surgical excision of the fistulous tract and involved vasal segment was performed, with the remaining vas religated using absorbable suture.
Key Findings:
A 2-mm sinus opening was found at the root of the left hemiscrotum, with a thickened left vas deferens beneath it.
Microscopy revealed occasional spermatozoa and inflammatory cells in the discharge.
Ultrasonography showed a hypoechoic tract consistent with chronic inflammation.
Surgical exploration confirmed a fistulous tract extending to the previously ligated vasal stump, with retained silk suture embedded in fibrotic tissue.
Histopathology demonstrated chronic inflammatory infiltrates and an adjacent fragment of vas deferens.
Interpretation:
The findings suggest that retained suture material and associated inflammation may contribute to the development of a vasocutaneous fistula post-vasectomy.
Limitations:
The study was limited by its single-case design.
Original ultrasound images were unavailable for independent review.
No contemporaneous photomicrograph of sperm microscopy was available.
Conclusion:
Delayed vasocutaneous fistula should be considered in patients with persistent scrotal sinus discharge after vasectomy, especially when spermatozoa are present in the discharge.
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