Recurrent Perineal Abscesses Arising from a Congenital Isolated Perineal Canal Mimicking Crohn’s Disease: A 22‑Year Diagnostic Odyssey

Abstract

A 40‑year‑old man presented with recurrent perineal abscesses originating from a congenital isolated perineal canal extending from the anterior aspect of the anal canal to the base of the scrotum. Since the age of 18, he experienced 3‑4 episodes of painful perineal swelling requiring incision and drainage. The chronicity and midline perineal involvement raised repeated concerns for underlying Crohn’s disease. However, serial MRI pelvis studies, colonoscopic evaluations, and histology from the mucosa‑lined tract consistently showed no evidence of inflammatory bowel disease. This case highlights a rare congenital anomaly that can closely simulate perianal Crohn’s disease, leading to diagnostic uncertainty and repeated interventions over decades.

Keywords: Congenital Perineal Canal; Isolated Perineal Canal; Midline Perineal Tract; Recurrent Perineal Abscess; Perineal Infections; Anal Canal Anomaly; Perineal Fistula Mimic; Crohn’s Disease Mimic; Non‑IBD Perianal Disease; MRI Pelvis Fistula Assessment; Mucosa‑Lined Perineal Tract; Congenital Anorectal Malformation; Adult Presentation of Congenital Anomaly; Perineal Sinus Tract; Surgical Excision of Perineal Canal

Citation

Govani DR, Swamy KB, Mehta AR, Midha PK, Govani ND, Panchasara NG, et al. Recurrent Perineal Abscesses Arising from a Congenital Isolated Perineal Canal Mimicking Crohn’s Disease: A 22-Year Diagnostic Odyssey. WebLog J Med Sci. wjms.2026.b1908. https://doi.org/10.5281/zenodo.18823822