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. 2019:59:128-131.
doi: 10.1016/j.ijscr.2019.05.016. Epub 2019 May 13.

Supralevator abscess: New treatment for an uncommon aetiology: Case report

David João Aparício  1 , Carlos Leichsenring  2 , Cisaltina Sobrinho  2 , Nuno Pignatelli  2 , Vasco Geraldes  2 , Vítor Nunes  2
Affiliations

Supralevator abscess: New treatment for an uncommon aetiology: Case report

David João Aparício et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Supralevator abscess is the least common type of anorectal abscess. Its diagnosis can be hard and treatment difficult.

Presentation of the case: A 48-year-old men was diagnosed in the emergency department with a supralevantor abscess. Under general anaesthesia, the abscess drainage was accomplished after removal of a fish bone, who was perforating the rectum. Due to persistent rectal purulent discharge, a pelvic Magnetic Resonance (MRI) was performed: a supralevator abscess adjacent to the internal obturator muscle and an inter-sphincteric fistulae from the inferior margin of this collection were identified. A Pezzer® drain was placed through the fistula tract. After radiological resolution, under general anaesthesia, the patient was submitted to extraction of the drain and marsupialization of the path left using an ENDO GIA®. At two year follow up he remained asymptomatic.

Discussion: Despite of the abscess aetiology, the principles of treatment are the same: good radiological characterization and proper drainage. An adequate radiological characterization is important to avoid iatrogenic creation of a complex fistulae.

Conclusion: If a supralevator abscess diagnosis is made, fistulae trajectory should be studied. If no clear internal opening is evident, a pelvic MRI should be done followed by drainage of the abscess. After resolution the drain should be taken off and marsupialization with ENDO GIA® should be performed.

Keywords: Case report; Mechanic fistulae tract marsupialization; Supralevantor abscess.

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Figures

Fig. 1
Fig. 1
Pelvic computerized tomography (CT) revealed a sharp radiopaque image on the rectum.
Fig. 2
Fig. 2
Pelvic computerized tomography revealed a left perianal heterogeneous hypodense collection with 36 × 12 mm.
Fig. 3
Fig. 3
a)Pelvic nuclear magnetic resonance revealed a 6 × 2 × 3 cm supralevator abscess with one major inter-sphincteric fistulae from the inferior margin of this collection; b) illustration of supralevantor abscess (green).
Fig. 4
Fig. 4
a) Pezzer® (P0) drain through the fistula tract; b) illustration of the supralevantor abscess (green) with the drain (red) trough inter-sphincteric fistulae.
Fig. 5
Fig. 5
a) Illustration of the marsupialization of the path left by the drain (3 cm) using a ENDO GIA® 30 - 3.5 mm cartridge (blue); b) final result after marsupialization; illustration of the final result.
See this image and copyright information in PMC

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