Perianal Fistula Presenting as Scrotal Abscess in a Resource-Limited Setting

Perianal fistula-in-ano is a common anorectal condition; however, extension into the scrotum is rare and may obscure the underlying anorectal source, particularly in resource-limited settings. A 47-year-old man presented with progressive scrotal swelling, perineal pain, and a purulent discharge. Physical examination revealed extensive perineal infection with scrotal abscess formation and laboratory studies showed marked leukocytosis. However, advanced imaging is not possible. Emergency surgical exploration revealed a complex transsphincteric perianal fistula extending along perineal fascial planes into the scrotum, forming a communicating scrotal abscess. A complete fistulectomy, wide debridement, and abscess drainage were performed. Histopathological examination revealed acute suppurative inflammation without evidence of malignancy. The postoperative course was uncomplicated with progressive wound healing during follow-up. This case highlights scrotal abscess as an uncommon presentation of advanced perianal fistula, and underscores the importance of timely surgical exploration when diagnostic imaging is unavailable.