Simple cutaneous advancement flap anoplasty should be considered as a first-line surgical treatment of chronic anal fissure, irrespective of patient gender and anal tone.
HighlightsPatients with a recent history of anti-reflux surgery, who present with a tension pneumothorax could be presenting with a gastrothorax.They should always be treated with an intercostal catheter if they are in respiratory distress.Follow up imaging with a CT scan is needed to confirm diagnosis.Gastrothorax should be urgently managed with the insertion of a nasogastric tube and surgical decompression.Good control of post- operative nausea and vomiting is essential in avoiding wrap failure and ensuing complications.
We present a rare case of complicated sigmoid diverticulitis presenting as a peri-anal abscess from an extra-sphincteric fistulous tract. This presentation of a colocutaneous peri-anal abscess is extremely rare, with only a handful of cases described in the literature. Most are managed with an open sigmoid colectomy, however, this case was successfully managed laparoscopically. It highlights the need to consider extra-levator causes of peri-anal abscess, such as pelvic sepsis causing fistulating disease, and to consider early magnetic resonance imaging if there is clinical suspicion of underlying pathology. It also demonstrates that a safe and potentially less morbid outcome is possible via laparoscopic approach when compared to traditional open surgical approach.
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