Ischio‐anal abscess as a first presentation of complicated diverticular disease

Fistulating diverticular disease masquerading as a peri-anal abscess: a laparoscopic approach to management

“…These occur most often on a background of previous interventional drainage of diverticular abscess, or previous bowel resection [ 2 ]. Peri-anal colocutaneous fistulae are an even rarer subset, with only isolated cases reported in the literature [ 1 , 3–7 ]. Anal fistulous disease has traditionally been described using the Parks classification [ 8 ].…”

“…In our case, lack of abdominal pain at presentation masked the contribution of underlying active diverticulitis. This patient also lacked previous risk factors of colocutaneous fistulating disease [ 3 ]. Colocutaneous fistulae are unlikely to heal spontaneously and require operative intervention [ 3 ] after initial sepsis control with abscess drainage and antibiotics.…”

“…This patient also lacked previous risk factors of colocutaneous fistulating disease [ 3 ]. Colocutaneous fistulae are unlikely to heal spontaneously and require operative intervention [ 3 ] after initial sepsis control with abscess drainage and antibiotics. Definitive management requires bowel resection.…”

“…Definitive management requires bowel resection. Open procedures are traditionally preferred in these cases due to intra-abdominal adhesions, subsequent difficulties identifying dissection planes and the associated difficulties with abdominal access [ 1 , 3 , 5 ]. An open approach with high anterior resection and defunctioning loop ileosteomy, with excision and packing of the external fistulae opening has been successful in the management of peri-anal fistula from diverticulitis [ 3 ].…”

“…Open procedures are traditionally preferred in these cases due to intra-abdominal adhesions, subsequent difficulties identifying dissection planes and the associated difficulties with abdominal access [ 1 , 3 , 5 ]. An open approach with high anterior resection and defunctioning loop ileosteomy, with excision and packing of the external fistulae opening has been successful in the management of peri-anal fistula from diverticulitis [ 3 ]. Ayoubi et al described an uncomplicated post-op course, healing of the external opening and no residual fistula or anastamotic leak on follow-up gastrograffin studies [ 3 ].…”