Anal fistula with concomitant perianal cyst: A case report and literature review

Recurrent anal fistula remains a clinical challenge, especially when standard treatment fails to prevent relapse. Adjacent cystic infections may represent an underrecognized contributor to persistent or recurrent disease. A patient with a long-standing history of perianal discomfort and multiple anal fistula recurrences presented with ongoing discharge and pain despite previous surgical interventions. Clinical examination and intraoperative findings revealed a 2 × 2 cm infected cyst located adjacent to the recurrent anal fistula tract. The patient underwent complete surgical excision of both the anal fistula and the adjacent infected cyst. Postoperative recovery was uneventful. The patient achieved sustained remission with no signs of recurrence observed during a 3-month follow-up period. This case highlights a notable association between recurrent anal fistula and adjacent cystic infection. Cystic infection may serve as a hidden trigger for fistula reactivation and should be considered in patients with treatment-resistant perianal disease.