Supuración extraperitoneal como complicación de un absceso perianal profundo. Reporte de caso

Abstract

Los abscesos perianales profundos pueden tener presentaciones poco frecuentes, con diseminación del proceso infeccioso a lugares atípicos, como el espacio extraperitoneal. En estos casos, la clínica es inespecífica y poco orientadora y el retraso diagnóstico puede llevar a cuadros sépticos graves. Presentamos el caso de un paciente que se presentó en la urgencia con una supuración extraperitoneal secundaria a un absceso perianal profundo.

A Clinical-Anatomical-Radiological Study of Extraperitoneal Spaces: A Case Series

“…Among the patients diagnosed with ischiorectal abscesses, pain in the abdomen indicates extraperitoneal inflammation [10]. Given the diffuse nature of the suppuration rather than a distinct collection, extraperitoneal surgical drainage is considered the gold standard treatment [3], which is the treatment provided to the patients in our case series. In abscesses with extensive pre-or retroperitoneal extensions, access to the peritoneal cavity must be avoided due to the high risk of contamination and secondary peritonitis [10].…”

“…One of the frequent surgical emergency conditions encountered in the emergency department is anorectal abscesses, which are typically treated with antibiotics, incision, drainage and a rare complication of an anorectal abscess is the upward spread of infection into the supralevator and extraperitoneal spaces. These abscesses tend to develop below the puborectalis muscle, which acts as a barrier limiting the cephalad extension [3]. Supralevator abscesses are the least common, occurring in only 1% to 9% of patients, and their spread across specific anatomic spaces is a very rare complication that could potentially result in sepsis and death [10].…”

“…Supralevator abscesses are the least common, occurring in only 1% to 9% of patients, and their spread across specific anatomic spaces is a very rare complication that could potentially result in sepsis and death [10]. The spread of infection into the perianal region highlights the complexity of the anatomic planes and the connections of the retroperitoneal and extraperitoneal spaces [3]. It is crucial to understand the symptomatology in these individuals; in our study, three patients diagnosed with an ischiorectal abscess who later underwent incision and drainage experienced pain in the abdomen and persistent discharge from the operation site.…”

“…Diagnostic delay and inadequate drainage are common, resulting in prolonged sepsis and associated high morbidity and mortality [1]. An extraperitoneal abscess may not present with features of peritonism [2], and also, these patients are paucisymptomatic due to the deep location of the infection and the fact that the inflammatory response of the retroperitoneum is more limited than that of the peritoneum to infection [3]. In these settings, that is, in patients with ongoing sepsis, there should be a high index of suspicion of the extraperitoneal spread of infection, and imaging modalities like CT of the abdomen and pelvis should be obtained for early recognition to determine the extent of spread of extraperitoneal abscess.…”