A 30-year-old male patient was electively admitted to our general surgery clinic in June 2009 with a diagnosis of fistula in ano. His past medical history revealed a serious fall during a football game which resulted in a left acetabular fracture in 1993. Open reposition and internal fixation procedures had been performed two months after this accident. Postoperatively, he had developed abscesses on the upper medial aspect of his left thigh in the second month and on the lateral aspect of the left gluteal region in the third month. All these abscesses had been treated by surgical drainage and with antibiotics. Three years after the hip operation, he had developed a perianal abscess which was also drained. However, the intermittent spontaneous purulent discharge in the perianal region continued for 13 years since the patient did not seek any medical care during this period. His past medical history was not conclusive for any inflammatory bowel disease. Pelvic magnetic resonance imaging (MRI) performed in a different medical center eight months prior to his admission demonstrated an abscess cavity, measuring 2 cm in diameter, located superior to the levator ani muscle and its tract of 10 cm coursing from its internal opening in the rectum down to the perianal region (Figure 1). The laboratory analysis including complete blood count, blood biochemistry, and erythrocyte sedimentation rate were within normal limits. Physical examination revealed the presence of two external openings 7 cm and 3 cm from the anal verge at the 3 o'clock and 2 o'clock positions, respectively. The results of digital rectal examination and colonoscopy were normal and the internal opening of the tract was not visualized. Based on these clinical findings, surgical intervention for the complex fistula in ano was planned. After bowel preparation, the patient was taken to the operation room. Under general anesthesia, the patient was placed in a jack-knife position and the buttocks were taped apart. The fistula tracts were laid open to the level of the anal sphincters. At this level, digital examination was performed towards the upper part of the tract and a foreign body located above the levator ani muscle was felt. A nonabsorbable braided thread of 5 cm in length and 6 mm in thickness was extracted (Figure 2). After partial excision and curretage of the tract, a penrose drain was placed and the wound was closed with interrupted simple absorbable sutures (Figure 3). Following the discovery of this object, a plain pelvic radiography was performed, this demonstrated advanced left acetabular degeneration with no other foreign body visible. Following an uneventful postoperative recovery, the patient was discharged home on the third postoperative day. On follow-up visits, complete resolution of the perianal fistula was observed after a month. The patient remained symptom-free during the 7-month follow-up period.