Delayed diagnosis of perirectal horseshoe abscess and patient’s perspective

• Published in: BMJ case reports Vol. 17; no. 7; p. e261266
• Main Authors: Khazi-Syed, Afeefah Fatimah, Hoffer, Emily, Imphean, Darren, Felde, Lanna
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 30.07.2024; BMJ Publishing Group LTD
• Subjects: Abdomen; Abscess - diagnosis; Abscess - diagnostic imaging; Abscesses; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Bladder; Blood; Buttocks - diagnostic imaging; Catheters; Cellulitis; Constipation; Delayed Diagnosis; Diabetes; Drainage - methods; Edema; Female; Fistula; General practice / family medicine; Heart rate; Hemoglobin; Hemorrhoids; HIV / AIDS; HIV Infections - complications; Hospitals; Humans; Hydronephrosis; Infection (gastroenterology); Infections; Infectious Diseases; Magnetic Resonance Imaging; Medical diagnosis; Medical management; Middle Aged; Pain; Patients; Pelvis; Rectal Diseases - diagnosis; Rectal Diseases - diagnostic imaging; Sepsis; Surgery; Tomography, X-Ray Computed; Ultrasonic imaging; Urinary retention; Urinary Retention - etiology; Medical management; General practice / family medicine; Infection (gastroenterology); HIV / AIDS
• ISSN: 1757-790X; 1757-790X
• 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.