Unusual presentation of ischiorectal (horseshoe type) abscess
Ischiorectal abscess is the second most common of anorectal abscess. The most common cause of a peri-anal abscess formation is secondary to anal gland sepsis(1). A third of perianal abscesses may manifest a fistula-in-ano which will increases the risk of abscess recurrence and requiring repeated...
| Main Authors: | , , , , |
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| Format: | Conference or Workshop Item |
| Language: | English English |
| Published: |
2014
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/58472/ http://irep.iium.edu.my/58472/ http://irep.iium.edu.my/58472/13/58472-abstract%20book.pdf http://irep.iium.edu.my/58472/2/poster%20abscess.pdf |
| Summary: | Ischiorectal abscess is the second most common of anorectal abscess. The most
common cause of a peri-anal abscess formation is secondary to anal gland sepsis(1). A
third of perianal abscesses may manifest a fistula-in-ano which will increases the risk
of abscess recurrence and requiring repeated surgical drainage(2). If it spread further
to the right and left ischiorectal space, it will forms a horseshoe’s shape.
Case Summary:
This is a 21 years old Chinese gentleman with 4 days history of colicky lower abdominal
pain and low grade fever. No significant past medical history. Clinically, tenderness
felt over left iliac fossa, palpable bladder with bogginess felt per rectal and rectal
tenderness at 9 o’clock position. Perianal skin examination looks normal.
Blood investigation showed leucocytosis with predominantly neutrophils. Urine examination
and abdominal X-ray was unremarkable. Ultrasound abdomen initially was
unremarkable but repeated ultrasound on day 3 of admission showed an ill-defined hypoechoic
lesion seem to be arising from the rectal wall. Endoanal ultrasound showed
horseshoe ischiorectal abscess up to the level of prostate.
Subsequently, we proceed with examination under anaesthesia and drainage of abscess
on the 7th of January 2014. No perianal fistula seen. Proctoscopy examination was
normal. Intraoperatively, we made 2 separate incisions deep into both right and left ischiorectal
space with a communicating penrose drain. Culture come back as Escherichia
Coli. Antibiotic was completed for 1 week’s course. Postoperative course was uneventful
and wound healed well. |
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