Complicated Anorectal Abscess Leading to Pelvic Sepsis and Colostomy: The Importance of Infection Control
Year: 2017
Type: article
Study design: Case Report
Abstract: Background: Anorectal abscesses are a common condition in surgical emergencies. Their presentation can be challenging in elderly patients with dementia who are incapable of describing symptoms and duration. Pelvic abscess or other complications should be suspected when general symptoms do not improve after drainage. In these cases exhaustive source control (including defunctioning colostomy in some cases) and targeted antibiotic therapy are the correct management. Case Presentation: A 76-year-old female with Alzheimer dementia (memory loss and verbal incapability), fecal incontinence, and who was dependent for all activities presented to the emergency department on several occasions with fever of unknown origin and abdominal pain. On this occasion after a thorough physical examination she was diagnosed with an ischiorectal abscess. It was treated with drainage, empirical antibiotic therapy, and pus was sent for culture. Despite this theoretically adequate management, the condition progressed to a pelvic abscess. Culture results informed of mixed flora including Clostridium sp., Escherichia coli, Enterococcus faecium, Enterococcus faecalis, and Bacteroides fragilis. The infection was controlled with a targeted antibiotic therapy and a colostomy as a defunctioning technique. The patient recovered completely and the colostomy was well accepted by her caregivers. Conclusion This case illustrates the importance of an adequate initial diagnosis and infection control because even conditions considered easy to manage can progress to a life-threatening infection. In aging populations diseases usually have atypical presentations and unspecific symptoms. This case also illustrates how important it is to monitor patients post-operatively, because despite a theoretically adequate management they can present negative outcomes.
Source: Surgical Infections Case Reports
Institution: Hospital Universitario La Paz
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W2776819152