Medical School, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
Medical School, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
BMJ Case Rep. 2024 Jul 30;17(7):e261266. doi: 10.1136/bcr-2024-261266.
This is a case of a woman in her 50s with HIV and uncontrolled diabetes who presented to the emergency department with urinary retention and a painful gluteal cleft lesion, admitted for cellulitis. Since initial CT and soft tissue ultrasound (US) were negative for fluid collection, the care team was surprised to find her symptoms continued to progress despite intravenous antibiotics. Finally, MRI 9 days into her admission demonstrated a 12-cm perirectal horseshoe abscess. The patient was ultimately treated with incision and drainage with Penrose drain placement. This case demonstrates the importance of maintaining a high suspicion for horseshoe abscess, a complex form of ischiorectal fossa abscess which can be missed on CT and US imaging, and which may expand rapidly in immunosuppressed patients.
这是一位 50 多岁的女性 HIV 感染者和未控制的糖尿病患者，因尿潴留和臀部疼痛性裂沟病变就诊于急诊科，收入院治疗蜂窝织炎。由于最初的 CT 和软组织超声（US）均未发现积液，因此当医护团队发现尽管使用了静脉抗生素，她的症状仍在继续恶化时感到非常惊讶。最终，入院 9 天后的 MRI 显示直肠后马蹄形脓肿 12cm 长。患者最终接受了切开引流和放置彭罗斯引流管的治疗。本病例表明，对于马蹄形脓肿这种复杂的坐骨直肠窝脓肿，保持高度怀疑非常重要，CT 和 US 影像学检查可能会漏诊，而且在免疫抑制患者中，脓肿可能会迅速扩大。
