Evaluation of Recurrent and/or Persistent Complex Ano-Perianal Abscess after Surgery: The Unique Value of Magnetic Resonance (MR) Imaging

Abstract

Introduction: Despite proper treatment and apparent healing after surgery, a recurrent ano-perianal abscess may develop in up to 10% of patients, especially if the opening on the skin heals. Factors reported to be associated with recurrence include complex type of fistula, horseshoe extension, lack of identification or lateral location of the internal opening, previous fistula surgery, and the surgeon performing the procedure [1]. Findings on pelvic MRI have been shown to have accuracy up to 90% for mapping the fistula tracts and 80-90% concordance with operative findings. We report the unusual case of an unknown persistent deep perirectal abscess occurring in an asymptomatic man two years after surgery. Case Blog: A forty-year-old male with remote history of surgical incision of his perirectal abscess dating back to the age of four, and two more recent operations aimed at draining a perianal abscess 5 years before, was admitted at the Coloproctology Unit of Parioli Clinic, Rome, Italy in November 2013 because of painful supralevator abscess, which was successfully treated via intersphincteric route (MP). Worthy of notice, just prior the onset of symptoms and the patient had experienced a stressful period of time during troublesome separation from his wife. As known, this psychological event is capable to adversely affect the immune