Delayed vasocutaneous fistula following vasectomy associated with retained silk ligature: a case report with clinicopathological correlation

Abstract

Abstract Background Vasectomy is a safe and highly effective method of permanent male contraception. Delayed vasocutaneous fistula is an exceptionally uncommon complication, and its diagnosis requires careful correlation of clinical, laboratory, operative and pathological findings. We report a delayed vasocutaneous fistula associated with retained silk ligature at the previous vasectomy site and discuss the diagnostic approach and probable mechanism. Case presentation A 43-year-old man presented with a two-month history of persistent whitish discharge from the root of the left hemiscrotum, three years after bilateral no-scalpel vasectomy. Clinical examination demonstrated a sinus opening with an underlying thickened vas deferens, Microscopic examination of the discharge revealed occasional spermatozoa. Preoperative ultrasonography demonstrated a hypoechoic tract extending towards the previous vasectomy site with adjacent inflammatory changes. During surgical exploration, a tract terminating at the previously silk-ligated proximal vasal stump was identified. The tract together with the involved vasal segment was excised en bloc. Histopathological examination demonstrated a squamous epithelium-lined sinus tract containing retained suture material, surrounded by chronic inflammatory infiltrates, composed predominantly of lymphocytes and plasma cells together with an adjacent fragment of vas deferens. These findings supported chronic inflammation associated with retained suture material. The patient remained asymptomatic without recurrence during follow-up. Conclusion This case demonstrates that the diagnosis of delayed vasocutaneous fistula should be established through correlation of clinical findings, microscopic identification of spermatozoa, operative findings and histopathological examination rather than histopathology alone. Retained non-absorbable suture material, consistent with the previously documented silk ligature, may contribute to persistent chronic inflammation and delayed fistula formation following vasectomy.