SURGICAL TREATMENT OF COMPLETE ANAL STENOSIS DUE TO MONKEYPOX INFECTION

Case Presentation A 24-year-old male patient, HIV-positive, presented with a case of Monkeypox infection manifesting perianally, initially as a painful anal ulcer. The lesion progressed, leading to anal stenosis and severe proctalgia, necessitating hospitalization for pain management. The patient underwent transverse loop colostomy and started specific therapy with Tecovirimat after a positive PCR result for the Monkeypox virus from a lesion biopsy. Following medical treatment and lesion healing, the patient developed complete anal stenosis. Initial treatment involved topical application of betamethasone and hyaluronidase for three weeks without improvement. Subsequently, surgical intervention was performed. The anal opening was created using puncture with intraoperative colonoscopy guidance (via the colostomy). After opening the anal orifice, a guidewire was passed, and anal dilation was performed with Savary dilators. During the same surgical procedure, intestinal transit was reconstructed by closing the loop colostomy. In the postoperative period, the patient showed good clinical progress and was discharged on the eighth day with an anal dilator for home use and topical diltiazem 2% ointment for anal muscle relaxation. Weekly sessions of anal dilation using Hegar dilators were performed until the sixth postoperative week, followed by biweekly sessions and three local applications of triamcinolone. The patient remains under outpatient follow-up without complaints of fecal incontinence.

Discussion Perianal manifestations of Monkeypox infection, such as vesicles, pustules, and ulcers, can cause proctalgia that is often refractory to simple analgesia. To our knowledge, there are no reports in the literature of perianal manifestations of Monkeypox infection resulting in complete anal stenosis. Surgical treatment of complete anal stenosis is challenging due to the risk of sphincter injury and fecal incontinence.

Conclusion Anal stenosis is a potential complication of Monkeypox infection with perianal manifestations, and its treatment may involve ostomy procedures. Surgical correction of complete anal stenosis carries significant risks, with fecal incontinence being the most feared due to its considerable impact on patients' quality of life. Adequate treatment of complete anal stenosis is highly complex, requiring a team of specialists and long-term follow-up.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025