A rare case of acute presentation of a chronic massive extraperitoneal abscess: a case report

Abstract

Extra-peritoneal abscesses are uncommon entities encountered during general surgical practice. They occur in a plane present between the peritoneum and the deep fascia anteriorly, posteriorly or in the pelvis. These abscesses commonly occur as a result of supra-levator and pre-peritoneal extension of an ischiorectal abscess. Treatment includes antibiotics and drainage. Here we have described a case of an abscess in the anterior extra-peritoneal plane extending from perirectal and pararectal space, drained surgically through a midline incision.

Complex Tunneling Perirectal Abscess: Intra-abdominal and Extraperitoneal Extension of a Persistent Perirectal Abscess

“…In contrast, perirectal abscesses are more complex, with the involvement of deeper tissues [ 1 ]. A perirectal abscess can be classified as either ischiorectal, intersphincteric, supralevator, or horseshoe abscess, dependent on the involvement of the relevant deeper planes of the anorectal tissue [ 1 , 3 , 5 ]. However, perirectal abscesses also present the opportunity for cephalad abscess extension into the various intra-abdominal and extraperitoneal compartments, introducing anatomical complexity and complicating the surgical approach in definitive I&D treatment [ 5 , 6 ].…”

“…The primary treatment strategy for either perianal or perirectal abscess involves surgical I&D [ 1 , 3 , 5 , 6 ]. The procedure is traditionally performed at the bedside, with a follow-up short course of empiric antibiotics to prevent systemic infectious spread [ 2 , 5 , 6 ].…”

“…The primary treatment strategy for either perianal or perirectal abscess involves surgical I&D [ 1 , 3 , 5 , 6 ]. The procedure is traditionally performed at the bedside, with a follow-up short course of empiric antibiotics to prevent systemic infectious spread [ 2 , 5 , 6 ]. In scenarios involving either intra-abdominal or extraperitoneal extension of perianal/perirectal abscesses, the gold standard involves open irrigation, drainage, and debridement of abscess cavities with follow-up cultures and targeted pathogen-specific antibiotics in the postoperative period [ 2 , 5 , 6 ].…”

“…The procedure is traditionally performed at the bedside, with a follow-up short course of empiric antibiotics to prevent systemic infectious spread [ 2 , 5 , 6 ]. In scenarios involving either intra-abdominal or extraperitoneal extension of perianal/perirectal abscesses, the gold standard involves open irrigation, drainage, and debridement of abscess cavities with follow-up cultures and targeted pathogen-specific antibiotics in the postoperative period [ 2 , 5 , 6 ]. On occasion, fistulotomy may also be indicated for excision of abscess-associated chronic fistulae and prevention of recurrent abscess formation [ 2 , 6 ].…”

“…A perirectal abscess can be classified as either ischiorectal, intersphincteric, supralevator, or horseshoe abscess, dependent on the involvement of the relevant deeper planes of the anorectal tissue [1,3,5]. However, perirectal abscesses also present the opportunity for cephalad abscess extension into the various intra-abdominal and extraperitoneal compartments, introducing anatomical complexity and complicating the surgical approach in definitive I&D treatment [5,6]. Furthermore, perirectal abscess extension into the deeper tissue also introduces the potential for seeding and compromise of nearby organ structures, increasing the potential for severe complications: bowel or bladder rupture, intra-abdominal tunneling and chronic fistulae formation, and infectious seeding of adjacent tissue with consequent sepsis [1,[5][6][7].…”