Multiple Sinus Tracts Research Articles

Aneurysms of Aortic Sinus of Valsalva Dissecting through the Interventricular Septum With Rupture into the Left Ventricle: Case Series and Literature Review.

Aneurysm of Aortic sinus of Valsalva (ASOV) dissecting into the interventricular septum (IVS) and rupturing into the left ventricle (LV) is a rare clinical diagnosis. Systemic inflammatory diseases like tuberculosis can aggravate this condition. We describe three cases of ASOV dissecting into the IVS and rupturing into the LV. All three patients underwent surgical intervention; two had a successful outcome. A literature review was conducted and19 previously reported cases were studied. The extent and direction of septal dissection determined the associated cardiac valvular and rhythm problems. Patch closure of the mouth of the aneurysm is the surgical method of choice. In the presence of multiple sinus tracts or if there is recurrence after surgical closure, aortic sinus or root replacement techniques have better outcomes.

Gluteal and Presacral Abscess Due to Crohn’s Disease with Multiple Fistulas

The abscess is a common complication of Crohn's disease (CD), with the perianal form more frequent than gluteal or presacral which is relatively rare. There are few case reports of gluteal abscess combined with presacral abscess caused by CD and the treatment has not been established. A 21-year-old male was admitted with right buttock and lower back pain with a duration of 3 months. He had a history of CD in the small intestine diagnosed 10 months previously. He had poor compliance and had not returned for follow-up care during the previous 6 months. Abdominopelvic CT indicated newly developed multiple abscess pockets in right gluteal region, including piriformis muscle and presacral space. Additionally, fistula tracts between small bowel loops and presacral space were observed. Patient's CD was moderate activity (273.12 on the Crohn's Disease Activity Index [CDAI]). Treatment was started with piperacillin/ tazobactam antibiotic but patient developed a fever and abscess extent was aggravated. Therefore, surgical incision and drainage was performed and 4 Penrose drains were inserted. Patient's pain and fever were resolved following surgery. Infliximab was then administered for the remaining fistulas. After the induction regimen, multiple fistula tracts improved and patient went into remission (CDAI was -0.12).

Hair in the Wrong Place

Introduction: The preauricular sinus is a congenital abnormality which was initially identified by Van Heusinger in 1864. Preauricular sinus development is strongly related to the development of auricle in the sixth week of pregnancy. Preauricular sinus can be inherited or are sporadic. Most cases are sporadic and over half of all cases are unilateral. Bilateral cases are more frequent in inherited cases. Case Report: A 10 year old boy was brought with complaints of discharge from left pre auricular region on and off since birth. History of frequent episodes of discharge from left pre auricular region about 2-3 episodes per year. Local examination showed preauricular sinus tract at the root of helix on both sides. There was no discharge, no warmth, no tenderness. The child underwent necessary investigations and pre aneasthetic fitness was obtained. Pre auricular sinus tract excision on left side under general anasthesia was done. Multiple sinus tracts were excised and sent for histopathological examination which showed evidence of pilonidal sinus. There was presence of sinus tract line by epidermis, lumen filled with keratin and hair shafts. The child was brought for follow up on postoperative day 10, the sutured site was found to be healthy. Suture removal was done and the wound was healing well. The child is on regular follow up and has shown no signs of any recurrence. Discussion: The only definite treatment of recurrent infective sinuses is complete excision of the sinus tract. In our case, supra aural elliptical incision was placed and all visible sinus tracts were cleared and sent for histopathological analysis. When these sinuses get infected, most frequent cause being with gram-positive bacteria, the exudates should be sent for culture, and the appropriate antibiotics should be administered. The temporalis fascia, the cartilage of the helix, and the auditory canal are identified using the supra-auricular approach. An en bloc excision of the sinus is then carried out. Pilonidal sinus is a difficult condition that causes suffering and embarrassment to its victims. Despite it being rare and atypical, pilonidal sinus could also occur in the auricular region. Although pilonidal sinus has been reported in a number of uncommon areas of the body besides the sacrococcygeal region, this is the second case of pilonidal sinus that we are aware of in the preauricular region that is reported in literature. Conclusion: Thus we present a very rare case of pilonidal sinus in pre auricular region. Only two cases have been reported till date in literature and our case is the second one to be reported in the pre auricular region.

Cutaneous Myiasis in a Neglected Case of Pemphigus Vulgaris: A Case Report

Introduction: Myiasis is an infestation of the tissues and organs of living vertebrates and humans by fly larvae, usually those belonging to the Calliphoridae family. The larvae feed on the host’s necrotic or living tissue. Here, we report a 58-year-old woman with a 1-year history of biopsy-proven pemphigus vulgaris presented with an acute flare-up. Case presentation: On mucocutaneous examination, the patient had multiple sinus tracts covered with purulent necrotic slough, and cylindrical maggots were crawling out of and around the areas of slough. The patient was diagnosed with wound myiasis caused by Cochliomyia hominivorax. Turpentine oil flushes and oral ivermectin were prescribed. Discussion: Cutaneous myiasis can be papular, pustular, furuncular, and nodular. It is more common in people who have poor hygiene and intimate contact with domestic animals, such as people living in rural areas and tropical/ subtropical countries. The chief aim of management is to remove the maggots as soon as possible, kill them to prevent maturation, promote wound healing, and prevent development of secondary complications. Conclusion: In the current case, the patient’s poor nursing and personal care and low socioeconomic condition predisposed her to secondary wound infection and maggot infestation. Such cases require prompt care to prevent secondary infection and septicemia.

Outcomes of Definitive Draining Seton Placement for Complex Anal Fistula in Crohn's Disease.

Definitive draining seton (DDS) alone is an accepted treatment for complex refractory anal fistulas in Crohn's disease (CD). We evaluated the long-term success of DDS in CD patients. DDS was defined as draining seton placed definitively for at least 12months. Primary end point was clinical response (CR) defined as a lack of induration, pain, swelling, abscess recurrence, or unintended dislodgement. The study cohort of 23 patients had a median age of 29 (range; 9-61) years and included 14 males (61%). Reasons for DDS included anal stenosis (n = 9; 39%), active proctitis (n = 9; 39%), and/or anal canal ulceration (n = 9; 39%). Median number of setons was 2 (range; 1-6) and 65% had multiple fistula tracts. Almost all patients (n = 22; 96%) were on a biologic postoperatively. At 12-month follow-up, only 39% (n = 9) had a CR. The remaining 14 patients failed due to new abscess formation (n = 6; 26%), new fistula formation (n = 6; 26%), and seton dislodgement (n = 2; 9%). Six (26%) patients required fecal diversion. No patients required proctectomy. DDS for complex CD fistula results in a mediocre CR with many patients developing recurrent abscess/fistula or requiring diversion despite biologic therapy.

Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment.

Purpose According to recent studies, magnetic resonance imaging (MRI) assessment of complex fistulas provides a significant benefit compared to fistulography, computed tomography, and ultrasonography. The aim of this study was to describe the accuracy of MRI and the importance of identifying puborectalis muscle involvement on MRI in patients with complex fistula.Methods All patients who were clinically diagnosed with ‘complex’ or showed multiple fistula tracts underwent fistula MRI. Eligible patients were consecutive patients who underwent fistula MRI between September 2018 and September 2019 at our hospital.Results A total of 83 patients (74 males, 9 females; 116 tracts) were included in this study. The sensitivity and specificity of MRI in diagnosing fistula tracts were 94.8% and 98.2%, respectively. The sensitivity and specificity in identifying internal opening were 93.9% and 97.3%, respectively. Of the 35 patients with puborectalis muscle involvement in the MRI, 31 images of suprasphincteric-type patients on the Park’s classification were classified. The patients of puborectalis involvement were divided into 2 groups according to the surgical procedure that was performed. There were 12 sphincter-saving procedures and 19 sphincter division procedures performed. Recurrence was seen in 2 patients in the sphincter-saving procedure group, while no case was seen in the sphincter division procedure group. Five complications were found in the sphincter division procedure group, of which 2 reported incontinence.Conclusion Fistula MRI is a highly accurate examination for evaluating complex fistulas, and the puborectalis muscle involvement findings are very important for diagnosis and treatment.

An 8 Years experience in surgical treatment of anal fistula

Aim: To review our experience with patients who had been operated for perianal fistula based on cryptoglandular etiological basis and to reveal risk factors affecting postoperative results.Material and Methods: A total of 65 perianal fistula patients, who underwent surgical treatment, were screened for this retrospective study.Results: The mean age was 45.4 ± 10.6 years, with a predominance rate of male patients. The previous surgery rate for anal sepsis was 44.6%. The median (min-max) follow up time was 19 (15–103) weeks, and the duration of symptoms was 18 (6-250) weeks. The most common fistula type was intersphincteric (36.9%), and fistulotomy was the most preferred surgery (50.8%). New postoperative incontinence was found in 6 (8.2%) of patients, 5 (83.3%) of them had gas incontinence. The healing rate in the follow-up period was unsatisfactory for 12 (18.5%) patients. The significant risk factors for failure were BMI≥30 kg/m2 (p0.001), complex fistula with multiple fistula tracts (p=0.001), duration of symptoms ≥12wk (p=0.012), a history of previous surgery for anal sepsis (p=0.001), the presence of baseline incontinence (p=0.003), procedures except for fistulotomy (p=0.009).Conclusion: The risk factors most associated with failure were obesity (BMI≥30 kg/m2) and multiple fistula tracts. Other significant risk factors leading to failure were duration of symptoms ≥12wk, a history of previous surgery for anal sepsis, the presence of baseline incontinence, complex fistula type, and non-fistulotomy procedures. This study suggests the need for comparative, randomized controlled studies that investigate methods and their outcomes, particularly in complex fistulas.

Complete natal cleft removal with kite incision in the treatment of extensive sacrococcygeal pilonidal sinus.

Pilonidal sinus (PS) is a benign disease for which different treatment modalities are used, varying from non-surgical treatments to surgical treatments with flap use for big defects. High recurrence is the main problem in complicated cases. We presented complete natal cleft excision with kite incision and fasciocutaneous flap (CNCEF with kite incision) in extensive sacrococcygeal PS. Seventy-six patients who underwent CNCEF with kite incision because of extensive PS extending through intergluteal sulcus to the anus, with multiple sinus tracts and recurrent PS were retrospectively analysed. A special incision involving natal cleft and all sinus tracts completely and fasciocutaneous flap, lateralizing median line, was used in all cases. Post-operative complications and recurrence was recorded. Sixteen (21.1%) patients were operated because of recurrence. The mean age and body mass index were 33.04 ± 6.78 and 29.86 ± 5.46, respectively. The mean hospital stay period and mean operation time was 2.95 ± 0.76 days and 64.33 ± 8.64 min, respectively. The mean drain removal time was 2.78 ± 0.7 days and mean follow-up was 13.46 ± 4.31 months. There were flap oedema and seroma in one (1.3%) and four (5.3%) of the patients, respectively. Surgical site infection necessitating antibiotic treatment developed in three (3.9%) patients. The overall post-operative complication rate was 10.5% and there was recurrence in one patient on follow-up period (1.3%). CNCEF with kite incision method, which shifts midline, is a safe and reliable method with acceptable post-operative complication and recurrence rates in extensive sacrococcygeal PS patients.

Multifocale osteomyelitis en abdominale abcesvorming bij een warmbloedveulen

Volgens de auteurs is dit de eerste casuïstiek waarin het simultane voorkomen wordt beschreven van multifocale osteomyelitis en abdominale abcesvorming veroorzaakt door Salmonella bij een veulen met gewichtsverlies, diarree en koorts. Er was geen falen van het passieve immuunsysteem na de geboorte van het veulen. Radiografisch onderzoek toonde multifocale osteomyelitis (type P). In de bacteriële cultuur van het gewrichtsvocht werd Salmonella-species geïdentificeerd. De antibioticatherapie werd afgestemd op de resultaten van het antibiogram, echter zonder klinische verbetering. Abcessen ontwikkelden zich verder in de linkerdij en een Salter-Harrisfractuur type I van de linkerfemur werd vastgesteld. Er werd beslist om over te gaan tot euthanasie van het veulen. Postmortaal computertomografisch onderzoek toonde een grote massa in het caudale abdomen, die uitliep tot in de regio van het linkerbekken en achterbeen. Er werden eveneens multifocale osteomyelitis aangetoond. Middels het pathologisch onderzoek werd de massa als een abces met verschillende fistelgangen geïdentificeerd. Postmortem bacteriologisch onderzoek toonde eveneens Salmonella-species aan.

Outcomes of mono-lateral limb reconstruction system in infected non-union of long bones

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">We planned to evaluate functional and radiological outcomes of mono-lateral limb reconstruction system for infected non-union of long bones and to analyse its complications occurring.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">It was a prospective study, conducted during period of September 2015 to August 2017 and consisted of 73 cases of these 60 cases were available for final assessment. This infected non-union were classified by AO classification and were treated with mono lateral limb reconstruction system. All the cases were evaluated by ASAMI criteria for bony and functional outcomes. Our mean follow up period was 16.8 months</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 60 cases of infected non-union with mono-lateral external fixator were followed for mean 16.8 months. According to these ASAMI criteria in our study 26.6% had excellent; 46.6% had good; 16.6% fair; and 10% poor bony outcome. And the functional outcomes were 13.3%, 60%, 16.6%, 10% were excellent, good, fair and poor respectively. <span lang="EN-IN">Among the cases 50% had pin tract infections and loosening. Two cases pin revision was done. Sinus tract got cleared in all cases except 6 where multiple sinus tracts were present and healing did not occur. There were no infections at the corticotomy site. Delay in the consolidation phase was present in all cases. There was no difficulty in transportation of bone. Post-operatively wound dehiscence in eight cases was managed with split skin graft cover. Limb length discrepancy upto 2.5 cms in lower limb was managed with modified footwear with heel and sole raise. Non-healing fractures united in mean 5.9 months after start of treatment. Non-union site united in 90% cases. </span><strong>Conclusions:</strong> <span lang="EN-IN">Mono-lateral limb reconstruction system is efficient method for treatment of infected non-union of long bones. It has an additional advantage of correcting limb length discrepancies which sometimes occur during the course of treatment.</span></p><p class="keywords"><strong>Keywords: </strong>Non-union, Infection, Long bones, Limb reconstruction system, External fixator</p>

Endoscopic Repair of Tracheoesophageal Fistula Using an Amplatzer Septal Occluder Device: 2017 Presidential Poster Award

Benign tracheoesophageal fistulas (TEF) are usually caused by direct trauma, caustic ingestion, radiation and infection. Symptoms are mainly respiratory infections due to recurrent aspirations, excessive secretions and cough. The Amplatzer device has been used extensively to treat septal defects with the goal of inducing an endothelial response and closure of the defect. We present our experience using a cardiac septal occluder for an endoscopic TEF repair. A 49-year-old female presented with failure to thrive, dysphagia, and 40lb weight loss in 6 months. She had endoscopic PEG-J placement and noted to have a large esophageal diverticulum. One day later she had severe abdominal pain. A barium swallow noted a ruptured distal esophageal diverticulum with multiple fistula tracts communicating with the right lower lobe bronchial tree. A metal esophageal stent was subsequently placed. Three weeks later the esophageal stent was removed but a 15mm circular defect was found at 35cm from incisors on the anterior lateral wall of esophagus. This defect was approximated with 2 over the scope (OTS) clips and a 23mm x 10cm EndoMax covered metal stent was deployed across the esophageal defect. Two months later during stent removal, a tiny residual defect was noted near the previous OTS clip. Over the course of 3 months, she was admitted for respratory failure due to recurrent pneumonia necessitating antibiotics caused by reformation of TEF despite multiple endoscopic interventions of either stent placement or OTS clips. Eventually, it was decided to perform endoscopic repair of TEF using a septal occluder device. The distal esophageal fistula was cannulated using a 7Fr Wilson-Cook Omni cannula over a glidewire. A 8 mm fistula tract between the right lower bronchus and esophageal diverticulum was noted. The guide wire was manipulated up the trachea, grasped and pulled out the ETT using a snare. A 7 mm septal occluder device was advanced inside 6 Fr introducer sheath to the distal esophagus. The distal (esophageal) disc and the proximal (bronchial) disc was released inside the fistula tract. A postprocedure esophageal occlusion fistulogram showed no extravasation of contrast medium into the trachea or mainstem bronchi. We demonstrate the technical feasibility and efficacy of the cardiac septal occluder to close a TEF. This novel technique is an alternative to surgical repair, although the long term efficacy and potential for epithelialization or migration are unknown.Figure: Tracheoesophageal Fistula.Figure: Guidewire through Tracheoesophageal Fistula.Figure: Occlusion of Tracheoesophageal Fistula using Septal Occluder Device.

A rare case of non-tuberculous mastitis

A 15-year-old girl presented with left breast lump with purulent discharge. During the last three months she lost 4 kg weight. There was evening rise of temperature which was not associated with joint pains or chills. She had received three courses of antibiotics earlier in the other healthcare center, with no response. Ultrasound scan showed multiple cutaneous sinuses and FNA report findings were suggestive of chronic granulomatous mastitis. As the patient was not responding to multiple antibiotics courses, HRZE (Anti Tubercular Treatment, ATT) was started. But after three months of ATT she developed multiple sinus tracts filled with fluid and with superficial ulcerations, which was aspirated, sent for analysis and oral Moxifloxacin 400 mg was added. DNA based line probe assay detected Non Tuberculous mycobacterium (NTM) and was referred for NTM species identification. Molecular genetics assay identified Mycobacterium chelonae/ Mycobacterium immunogenum species and HRZE regimen was stopped. Patient was started on oral clarithromycin, linezolid according to sensitivity report. She responded well and repeat ultrasound scan showed significant resolution of the sinus and there was no discharge. NTM should be considered for breast infections that recur despite standard antibiotic therapy or ATT. Keywords: nontuberculous mastitis; anti tubercular therapy; antibiotics; young female

Mycetoma of the Upper Extremity: A Case Report

Case Report: A 32 year-old woman was referred to our outpatient clinic with a diagnosis of chronic swelling on the whole right forearm. Her past history included an accidental injury to the right wrist as he was working in a farm in Sudan 10 years before. At the beginning of the illness, she developed a single firm, painless nodule on the wrist which increased in size over months and on the surface of which vesicles gradually appeared. Then, the vesicles burst and multiple sinus tracts were formed which began discharging fluid containing small granules. The sinus tracts healed and re-occurred intermittently, discharging a sero-purulent yellowish-gray fluid. Within 6 years, there was extensive involvement of the volar and the dorsal surface of the forearm. Most of her wrist movements were restricted with deformations. She has been treated surgically and medically for the past five years in different centers in Sudan. Physical examinations revealed an extensively swollen right forearm with multiple discharging sinuses and foul smelling (Figure 1). Laboratory investigations revealed a normal leukocyte count, anemia (Hb 8.9 g/dl), a high ESR (120 mm/h) and high C-reactive protein (CRP: 13.3). Radiologic examination of the forearm showed osteolytic lesions, periosteal reaction and bone destruction in the forearm bones with massive soft tissue swelling. Fine needle aspiration confirmed the diagnosis of mycetoma. The patient underwent above elobow amputation. In advanced and neglected cases of mycetoma, amputation seems to be inevitable [1,2]. Therefore, we encourage clinicians to maintain a high index of suspicion in cases of chronic, granulomatous infection of the upper limb. We recommend a multidisciplinary approach to the chronic granulomatous infection of the upper extremity.

Pilonidal sinus – challenges and solutions

Although it is clinically asymptomatic in some cases, pilonidal sinus disease may also present as a complicated disease, characterized by multiple sinus tracts, leading to severe impairment of patient quality of life. Although clinical studies of pilonidal sinus have been conducted for approximately a century, the gold standard for treatment is undefined. The ideal treatment requires a shorter hospital stay, requires less wound care, results in rapid recovery, maintains quality of life, and has low recurrence rates. In this review, we aim to discuss the challenges and possible solutions for the management of pilonidal sinus disease.

A penile torsion with a fistula due to previous hypospadias surgery: A case report

We presented a case of penile torsion due to previous hypospadias surgery. A patient applied to our clinic for treatment of hypospadias fistula and accompanying penile torsion. Patient's urethral fistula was repaired first and penile torsion was corrected in the second stage due to multiple fistula tracts. Proximal based flip flap technique was used for closure of the fistula and simple degloving with release of fibrous tissue and pedicle of the previous preputial island flap was used for correction of the penile torsion. Post hypospadias surgery torsion deformity as in our case may corrected with simple degloving and dissection at the level of the buck fascia.

Prevalence and types of coronary to pulmonary artery fistula in a Chinese population at dual-source CT coronary angiography

Coronary to pulmonary artery fistula (CPAF) is rare; reports on the prevalence and types of CPAF in a large cohort of patients are scarce. To analyze the prevalence and types of CPAF on computed tomography coronary angiography (CTCA) in a large Chinese population. CTCA data of 58,533 patients from five Chinese tertiary referral medical centers were retrospectively studied. The prevalence, origin, aneurysmal sac, fistula tracts, and extracardiac communication of CPAF were recorded. CTCA findings were compared with conventional coronary angiography when possible. Ninety-nine patients had CPAF (prevalence of 0.17%). Of the 99 CPAF cases, fistulas were found to originate from either both coronary arteries in 52 patients or from one coronary artery (33 cases from the left and 14 cases from the right coronary artery). Ten CPAF patients were complicated with the communication of extracardiac arteries. Fifteen (15.2%) CPAF patients had aneurysmal sac formation. Thirty (30.3%) patients had a single fistula tract, while 69 (69.7%) patients had multiple fistula tracts. CTCA findings in 16 patients were similar to those at DSA. Based on this large cohort, the prevalence of CPAF in the Chinese population is about 0.17%, with origin from either the left or right coronary artery or from both. CTCA can clearly visualize the types, abnormal vascular tracts, and aneurysmal sac formation of CPAF.

Complex fistulas and advanced soft tissue techniques

Perianal fistulas are categorized as “complex” under the following conditions: a high tract passing the upper two-thirds of the external sphincter, presence of multiple fistula tracts, rectovaginal fistulas, previous local irradiation, and association with the presence of an anorectal stricture or Crohn׳s disease. Treatment of complex fistulas can be challenging and carries a high risk of poor wound healing, recurrences, and incontinence. Therefore a detailed understanding of perianal anatomy, knowledge of the extent of the disease, and its relation to the various structures are required for proper management. This article describes the technical approach of various advanced soft tissue techniques for complex fistula repair (i.e., the endorectal mucosal advancement flap, the anocutaneous advancement flap, and the Martius flap) and discusses its indications, advantages, and associated complications. The reported success rates of endorectal advancement flaps in the literature are variable, but generally better for cryptoglandular (24–100%) compared to Crohn׳s (33–92%) fistulas. The success rate in patients with Crohn׳s disease appears to be slightly better under anti-TNF therapy. Sphincteroplasty following complete fistulotomy (episioproctotomy) can be an appropriate approach in a selected patient group. In conclusion, treatment of complex perianal fistulas is challenging, and the advanced soft tissue techniques are an important option within the armamentarium of techniques that can be applied to treat this condition in a patient-tailored treatment approach.

An unusual gross appearance of vulval tuberculosis masquerading as tumor.

Tuberculosis of the vulva is very rare. It is found in about 0.2% of the cases of genital tract tuberculosis. It usually presents as small shallow ulcers and multiple sinus tracts or rarely as elephantiasis of vulva. Except for very rare cases of primary tuberculosis in the vulva, it is usually associated with tuberculosis elsewhere in the body leading to secondary tuberculosis. Here, we report a case of secondary vulval tuberculosis which presented as a vulval mass in a 40-year-old female patient. The rarity of this presentation in the female genital tract is emphasized.

Retropharyngeal Abscess Due to Actinomyces Species in an Immunocompromised Patient: Case Report

Actinomyces are fastidious, obligate anaerobic grampositive bacilli that are non–acid fast and slow growing. These characteristics make the organism difficult to identify by routine specimen handling and routine culture techniques. Nineteenth-century investigators originally characterized the organism as a fungus because it forms large radiating colonies, hence its name. This organism is widely accepted to be part of the normal flora in the abdominopelvic and thoracic regions but is most commonly found in the cervicofacial area. Cervicofacial actinomycosis usually presents as a firm, non-painful, slowly progressive swelling, with multiple sinus tracts in the periodontal soft tissue areas, maxilla, mandible, tongue, submandibular gland, or neck. Because Actinomyces are present as commensal organisms in healthy humans, they are best thought of as opportunistic pathogens. The organism does not cross mucosal barriers except when there is tissue injury or in an immunocompromised condition. Actinomyces are exquisitely sensitive to penicillin. Retropharyngeal abscesses due to Actinomyces spp are rare and found only in isolated case reports.

PWE-067 MRI to distinguish hidradenitis suppurativa from perianal Crohn's disease

IntroductionHidradenitis suppurativa is a chronic inflammatory disease of apocrine gland-bearing skin. It has a predilection for the ano-genital skin and is characterised clinically by inflammatory abscesses and sinus tract formation....