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Secondary healing of horseshoe perianal abscess in a patient with morbid obesity: experience at a rural hospital.
Wounds. 2022 08; 34(8):E57-E62.W

Abstract

INTRODUCTION

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.

CASE REPORT

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.

CONCLUSION

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.

Authors+Show Affiliations

Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Central General Hospital, Bandung, Indonesia.PT Perkebunan Nusantara VIII Subang General Hospital, Subang, West Java, Indonesia.Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Central General Hospital, Bandung, Indonesia.Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Central General Hospital, Bandung, Indonesia.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

36108243

Citation

Allisha, Fidkya, et al. "Secondary Healing of Horseshoe Perianal Abscess in a Patient With Morbid Obesity: Experience at a Rural Hospital." Wounds : a Compendium of Clinical Research and Practice, vol. 34, no. 8, 2022, pp. E57-E62.
Allisha F, Setiawan G, Rudiman R, et al. Secondary healing of horseshoe perianal abscess in a patient with morbid obesity: experience at a rural hospital. Wounds. 2022;34(8):E57-E62.
Allisha, F., Setiawan, G., Rudiman, R., & Indriasari, V. (2022). Secondary healing of horseshoe perianal abscess in a patient with morbid obesity: experience at a rural hospital. Wounds : a Compendium of Clinical Research and Practice, 34(8), E57-E62. https://doi.org/10.25270/wnds/21100
Allisha F, et al. Secondary Healing of Horseshoe Perianal Abscess in a Patient With Morbid Obesity: Experience at a Rural Hospital. Wounds. 2022;34(8):E57-E62. PubMed PMID: 36108243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Secondary healing of horseshoe perianal abscess in a patient with morbid obesity: experience at a rural hospital. AU - Allisha,Fidkya, AU - Setiawan,Gideon, AU - Rudiman,Reno, AU - Indriasari,Vita, PY - 2022/9/15/entrez PY - 2022/9/16/pubmed PY - 2022/9/20/medline SP - E57 EP - E62 JF - Wounds : a compendium of clinical research and practice JO - Wounds VL - 34 IS - 8 N2 - INTRODUCTION: 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. CASE REPORT: 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. CONCLUSION: 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. SN - 1943-2704 UR - https://www.unboundmedicine.com/medline/citation/36108243/Secondary_healing_of_horseshoe_perianal_abscess_in_a_patient_with_morbid_obesity:_experience_at_a_rural_hospital_ L2 - https://www.diseaseinfosearch.org/result/9028 DB - PRIME DP - Unbound Medicine ER -