A Rare Case of Posterior Horseshoe Abscess Extending to Anterolateral Extraperitoneal Compartment: Anatomical and Technical Considerations

Oikonomou, Christianna; Alepas, P.; Gavriil, Stelios; Kalliouris, Dimitrios; Manesis, Konstantinos; Bouboulis, Petros; Filippou, Dimitrios; Skandalakis, Panagiotis

doi:10.3393/ac.2018.03.05

Cited by 7 publications

(11 citation statements)

References 12 publications

(15 reference statements)

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“…The reported cases have demonstrated several managements [5]. The optimal treatments include extraperitoneal drainage with a lower midline abdominal incision [6] and additional fistulectomy and diverting loop sigmoidostomy [7]. The wound can be closed primarily with drains or vacuum-assisted devices [8].…”

Section: Discussionmentioning

confidence: 99%

Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report

Teng,

2024

Medicina

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Introduction—This report illuminates the distinctive features of a successfully managed Retzius space infection arising from a complex perirectal abscess. It adds novel insights to the scientific literature by addressing the rarity of such occurrences, highlighting the diagnostic complexities associated with extraperitoneal spread, and underscoring the crucial role of a nuanced understanding of anatomy in navigating clinical scenarios involving anorectal abscesses. Patient’s Main Concerns and Important Clinical Findings—A 68-year-old male presented with dizziness and diffuse lower abdominal pain, accompanied by intermittent perianal pain for one month. Regardless of an initial misdiagnosis as hemorrhoids, the patient presented sepsis status with fever, hypotension, and tachycardia upon admission. Clinical examinations, including a digital rectal examination, laboratory findings, and imaging studies, revealed a substantial perianal abscess extending into the space of Retzius. Primary Diagnoses, Interventions, and Outcomes—The primary diagnosis involved a heterogeneous fluid-filled perianal abscess extending into the Retzius space, confirmed by abdominal contrast-enhanced computed tomography (CT). Immediate initiation of broad-spectrum antibiotics and subsequent incision and drainage in the 8 o’clock region was performed. Post-operatively, the patient experienced rectal bleeding, necessitating suturing ligation. A follow-up CT scan revealed an extraperitoneal abscess around the bladder, leading to CT-guided drainage and identification of microbial pathogens. Antibiotic treatment with piperacillin-tazobactam was administered. With two weeks of antibiotics and post-operative care, the patient’s symptoms improved, and he was discharged with no signs of recurrence or complications. Conclusions—This case report emphasizes the importance of early consideration and identification of extraperitoneal abscesses for timely intervention. The complexity of anatomical planes in extraperitoneal spaces poses diagnostic challenges, necessitating a strategic treatment. The successful management of this case underscores the significance of a multidisciplinary approach, including prompt diagnosis, appropriate antibiotic therapy, and timely surgical interventions, ultimately contributing to improved outcomes in cases involving complex anorectal abscesses.

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Section: Discussionmentioning

confidence: 99%

Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report

Teng,

2024

Medicina

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“…The supralevator abscess is the most complicated variant of deep anorectal abscesses. Its symptoms are not specific, resulting in delayed diagnosis and treatment 4 , 9 . NF is an uncommon soft-tissue infection.…”

Section: Discussionmentioning

confidence: 99%

“…Retroperitoneal NF should be considered in any patient with symptoms of sepsis 3 . The rapid worsening of the patient also provides a clue towards the diagnosis 4 .…”

Section: Introductionmentioning

confidence: 99%

Autologous Platelet-Rich Plasma Injection and Platelet-Rich Fibrin Glue Insertion for the Treatment of Extensive Supralevator Anorectal Fistula: A Case Report

Dalili

Alamdari

Dalili

et al. 2023

WJPS

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Supralevator fistula stays a challenge in general surgery. We present a case with supralevator anorectal fistula and subsequent retroperitoneal necrotizing fasciitis in which autologous platelet-rich plasma and platelet-rich fibrin glue were used for fistula closure. A 59-year-old man was admitted with pelvic pain and fever. Abdominopelvic sonography and CT scan reported a deep horseshoe-shaped anorectal abscess with extension to the pelvic floor, supralevator, psoas, retroperitoneal muscles, and kidneys. He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy. After 30 days, he was discharged, but he returned to the office with the complaint of purulent discharge from the hypogastric region and a diagnosis of fistula formation. Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract. At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection. Autologous platelet-rich plasma injection and platelet-rich fibrin glue insertion suggest a secure and effective approach for treating supralevator anorectal fistula.

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“…The wound can be closed primarily with drains or with vacuum assistance devices [ 10 , 11 ]. Among the literature, a case of ischiorectal horseshoe abscess with anterolateral extraperitoneal spread was treated with open drainage, canalization through the ischioanal fossa through an abdominal incision, and diversion loop colostomy while performing fistulotomy, all in the same operation [ 12 ]. On the contrary, a complicated case of expanding abscess causing ileus was treated successfully with simple drainage after a rather difficult diagnosis [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Extraperitoneal Spread of Anorectal Abscess: A Case Report and Literature Review

et al. 2021

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Background Supralevator abscess is a rare form of anorectal disease responsible for very rare but morbid manifestations, one of which is superior spread through fascial planes. Case presentation We present a rare case of a spreading anorectal abscess in a patient who presented with only diffuse abdominal pain, and we review similar cases in the literature according to anatomical considerations, presentation, diagnostic procedures, and treatment options. Discussion We identified seven previously reported cases of spreading anorectal abscesses. Most abscesses had a horseshoe morphology, and all patients presented or developed abdominal pain. All patients had perianal swelling and pain. Five out of seven patients were previously mistreated. Only two abscesses spread through both the pre-and retroperitoneal planes. Conclusion Abdominal pain is a dominant feature of extraperitoneal inflammation originating from anorectal abscesses. The absence of perianal signs is rare, and proper inspection of the patient along with the medical history can lead to quicker diagnosis and decisive treatment.

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A Rare Case of Posterior Horseshoe Abscess Extending to Anterolateral Extraperitoneal Compartment: Anatomical and Technical Considerations

Cited by 7 publications

References 12 publications

Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report

Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report

Autologous Platelet-Rich Plasma Injection and Platelet-Rich Fibrin Glue Insertion for the Treatment of Extensive Supralevator Anorectal Fistula: A Case Report

Extraperitoneal Spread of Anorectal Abscess: A Case Report and Literature Review

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