Anterior and posterior horseshoe abscess – drainage with multiple radial incisions. A case report

Abstract

We present a case of a 30-year-old male treated for massive anterior and posterior horseshoe abscess posing a threat of Fournier’s gangrene. The patient presented at the hospital with fever and anal pain. He reported in his medical history that he had been treated for sciatica for 7 days. Rectal examination revealed anal and perineal phlegmon. The patient was qualified for urgent surgical intervention. Under general anesthesia, multiple radial incisions were made around the anus, exposing the deep postanal space. A massive anterior and posterior horseshoe abscess was diagnosed intraoperatively. No fistula was found intraoperatively. Broad-spectrum antibiotic therapy was initiated. Setons were used for the wounds, with anesthesiologist-assisted seton replacement under short-term sedation. Septic shock was successfully managed. In the days that followed, the wounds haled properly. The patient was discharged for further outpatient follow-up. After 2 months, the patient reported a slight incision leakage at 1 o’clock in the lithotomy position. He was referred for transrectal ultrasound due to suspected fistula. Conclusions: 1. A horseshoe abscess is an extensive anorectal infection requiring rapid surgical intervention. 2. Radial incisions of horseshoe abscesses are an effective method of abscesses drainage. 3. Postoperative seton replacement is a safe and proper wound healing method, but often requires analgosedation.