Intraperitoneal Spread of Ischiorectal Abscesses: A Rare Sequel

Intraperitoneal Spread of Ischiorectal Abscesses

Abstract

Background: Ischiorectal abscess is a common presenting abscesses. Presentation is usually benign. We present a study of 84 Patients treated at our hospital for large ischiorectal abscesses, of which 2 presented with signs of peritonitis and intraperitoneal spread. All cases were treated with timely surgical and medical management. Methods: This is a prospective descriptive study of cases of ischiorectal abscesses which were diagnosed and treated medically and surgically in Department of Surgery, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, from October 2016 to October 2017. Cases were analysed in terms of their demographic variables, associated comorbidities and symptoms, previous interventions, associated systemic diseases and recurrence at follow up of upto 1year. Results: A total 84 patients of large ischiorectal abscess were included in the study. 58.33% were males. Median age of presentation was 55 years. 21.42% presented with extensive sepsis of the perineum while 2 patients presented with peritonitis. 32.14% had diabetes-mellitus, 28.57% had COPD. Median delay in presentation was 6 days. None had fistulous tract at presentation.  16 had negative microbial cultures, MRSA isolated in 4, MDR E.coli in 5, MDR-Klebseila in 4 and 19 had mixed growth. One patient with peritonitis expired. None had recurrence till 1year follow up. Ten patients of Fourniers Gangrene underwent second surgery to close the defect, rest healed by secondary intention. Conclusion: Peritonitis secondary to ischiorectal/ Perineal abscess is a rare sequlae. Both Peritoneal toileting with local debridement is required to save the patient. Suspicion of intraperitoneal spread should be kept when these patients present with peritonitis even in the absence of an enterocutaneous fistula.