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

Abstract

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.

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

“…Meanwhile, open surgical treatment and debridement may be necessary and inevitable, especially in cases of widespread abscesses and patients in septic states. 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].…”

“…However, during an emergent CT scan conducted following an episode of anal bleeding, a progressed extraperitoneal abscess was identified, located anteriorly to the bladder. It was also reported that after the primary incision, early recurrence was seen as a major risk factor for abscess expansion, leading to worse outcomes [5]. Accordingly, secondary intervention should involve more thorough and adequate strategies.…”

“…Deep-spreading perianal abscesses, particularly those with extraperitoneal invasion, puzzle physicians with diagnostic challenges due to their rarity and indolent clinical manifestations. Abdominal pain is indicative of an extraperitoneal spreading abscess in a large portion of patients (86%) with that presentation [5]. Associated medical illnesses, such as diabetes mellitus, alcoholism, end-stage renal disease, and immunocompromization, could predispose patients to higher complication rates, with pneumonia and respiratory failure being common [9].…”

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

“…The infectious etiology primarily involves an obstructed anal crypt gland providing a nest for bacterial growth and subsequent inflammation [ 1 ]. The consequent inflammatory debris and pus collect within the subcutaneous tissues and intersphincteric planes, forming abscesses, tunneling fistulae, or the habitat for chronic infections [ 2 ].…”

“…A physical examination will frequently reveal a patch of erythematous or indurated skin overlying the abscess collection, demarcated with an area of tender fluctuance as a consequence of accumulated pus and infectious debris. On occasion, drainage of pus from the abscess can also be visualized [ 2 , 3 ].…”