Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Central General Hospital, Bandung, Indonesia.
PT Perkebunan Nusantara VIII Subang General Hospital, Subang, West Java, Indonesia.
Wounds. 2022 Aug;34(8):E57-E62. doi: 10.25270/wnds/21100.
Perianal abscess is defined as a local collection of pus in the perianal tissues. It is among the most common anorectal problems encountered by surgeons. Further extension of this infection into the unilateral or bilateral ischiorectal fossa leads to a horseshoe abscess. Morbid obesity is a risk factor for horseshoe perianal abscess with the potential to disrupt the normal healing process.
A 35-year-old male with morbid obesity presented to the surgery outpatient clinic in a hospital in Subang, West Java, Indonesia, with continuous severe pain and swelling around the anus of approximately 7 days' duration. Local examination of the anogenital area revealed a horseshoe perianal abscess extending to the ischiorectal fossa, approximately 1 cm from the anal verge and measuring 7.5 cm × 4.5 cm × 10 cm. Physical examination findings included tenderness to palpation; the presence of blood, pus, and necrotic tissue; and fluctuance. Incision and drainage were performed in the operating room under general anesthesia. In lieu of colostomy, the patient chose wound healing by secondary intention. Postoperative open wound care consisted of wet-to-moist gauze dressings during the first 2 postoperative days, followed by hydrocolloid dressing after the pus and blood were adequately drained, and finally, alginate dressing after granulation tissue formed. Aluminum silicate (microporous ceramic) was used as the external (secondary) wound dressing. Time to healing was 8 weeks.
Horseshoe abscesses are challenging to manage. Thorough and careful diagnosis, prompt fluid resuscitation to overcome fluid and electrolyte imbalance and to ensure proper antibiotic administration, nutrition intake, and a planned surgical approach as well as individualized postoperative care are necessary to achieve healing.
肛周脓肿是指发生在肛门周围组织的局部脓肿。它是外科医生最常遇到的肛肠问题之一。如果这种感染进一步向单侧或双侧坐骨直肠窝扩展，就会导致马蹄形脓肿。病态肥胖是马蹄形肛周脓肿的一个危险因素，它可能会破坏正常的愈合过程。
一名 35 岁的男性，患有病态肥胖症，因肛门周围持续剧烈疼痛和肿胀约 7 天，来到印度尼西亚西爪哇省苏邦的一家医院外科门诊就诊。会阴部的局部检查显示，马蹄形肛周脓肿向坐骨直肠窝延伸，距离肛门边缘约 1 厘米，大小为 7.5cm×4.5cm×10cm。体格检查发现压痛，存在血液、脓液和坏死组织，并有波动感。在全身麻醉下，在手术室进行了切开引流术。由于患者选择二期愈合而非结肠造口术，因此未行结肠造口术。术后开放伤口护理包括在术后头 2 天使用湿性至湿润的纱布敷料，然后在脓液和血液充分引流后使用水胶体敷料，最后在肉芽组织形成后使用藻酸盐敷料。使用硅酸铝（微孔陶瓷）作为外部（二级）伤口敷料。愈合时间为 8 周。
马蹄形脓肿的治疗具有挑战性。彻底和仔细的诊断、及时的液体复苏以纠正液体和电解质失衡、确保适当的抗生素使用、营养摄入、以及计划好的手术方法和个体化的术后护理，对于实现愈合是必要的。
