Calero-Lillo A, Caubet E. Lesion mimicking perianal abscess in an immunocompromised patient: Report of a case.
Int J Surg Case Rep 2014;
5:893-5. [PMID:
25460429 PMCID:
PMC4275965 DOI:
10.1016/j.ijscr.2014.10.054]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/12/2014] [Accepted: 10/13/2014] [Indexed: 11/23/2022] Open
Abstract
Infectious and bleeding disorders are common in leukemia.
Intramuscular injections often cause haematomas.
Sciatic notch connects gluteal to perianal region.
INTRODUCTION
Ischiorrectal tumoral masses mimicking perianal abscess and abscess from uncommon microbiological origins have previously been reported.
PRESENTATION OF CASE
Unusual perianal abscess arising from an hematoma in an elderly woman with myelodysplastic syndrome: the patient presented on the emergency with gluteal pain and fever after intramuscular injection of analgesic drug. Physical examination revealed subcutaneous thickening on gluteus and perianal region, without skin changes. Magnetic resonance reported an heterogeneous mass sized 5 cm × 12 cm × 20 cm from gluteus maximus to ischioanal fat under levator ani muscle, through sciatic notch. Debridement of an staphylococceal infected hematoma through a single left lateral gluteus incision, and primary closure was performed. Proctologic examination was normal, so any perianal incision was done. The site infection progressed, so the patient required new surgery with wet cure. The patient contracted nosocomial pneumonia and died due to sepsis.
DISCUSSION
Hematological diseases can yield infectious and bleeding disorders. Intramuscular injections often cause haematomas that can lead to pyomyositis. Pyomyositis requires early debridement and continue cure.
CONCLUSION
Intramuscular administration of drugs should be avoided in patients with thrombocytopenia. Gluteal region is connected to perianal area through the sciatic notch. Usually perianal abscess in immunocompromised patients arise from proctologic origin, but other causes may be taken into account.
Collapse