Gary Monique A, Wu Jacqueline, Bradway Marcella
Department of Surgery, Berkshire Medical Center/University of Massachusetts Medical School, Pittsfield, MA, USA
Department of Surgery, Berkshire Medical Center/University of Massachusetts Medical School, Pittsfield, MA, USA.
J Surg Case Rep. 2013 Jun 26;2013(6):rjt041. doi: 10.1093/jscr/rjt041.
Supralevator abscesses are the rarest manifestation of anorectal suppurative disease. We report a supralevator abscess in a 60-year-old male whose earliest presentation included poorly localized abdominal and pelvic pain, tenesmus, urinary retention and weight loss, initially treated as diverticular disease based upon imaging and presentation. Progressive symptoms led to the discovery of a pelvic abscess with subsequent percutaneous drainage, later followed by emergent laparotomy, where a single perforated diverticulum was revealed to be the source fistulization. He underwent a Hartmann procedure with concomitant drainage of supralevator and ischiorectal collections. Perirectal pain with neurological involvement is part of a constellation of signs and symptoms that should invoke a high index of clinical suspicion for supralevator abscess formation. Percutaneous attempts at drainage are often inadequate; definitive surgical therapy is the best approach to prevent recurrence and associated morbidity.
肛提肌上脓肿是肛肠化脓性疾病最罕见的表现形式。我们报告一例60岁男性的肛提肌上脓肿，其最初表现为定位不清的腹部和盆腔疼痛、里急后重、尿潴留和体重减轻，根据影像学检查和临床表现最初被诊断为憩室病。症状进展导致发现盆腔脓肿，随后进行经皮引流，之后紧急行剖腹探查术，发现一个单一的穿孔憩室是瘘管形成的源头。他接受了哈特曼手术，同时引流肛提肌上间隙和坐骨直肠间隙的积脓。伴有神经受累的直肠周围疼痛是一系列体征和症状的一部分，应引起对肛提肌上脓肿形成的高度临床怀疑。经皮引流尝试往往不充分；确定性手术治疗是预防复发和相关并发症的最佳方法。
