Posterior Horseshoe Fistula with Horse-Shoe Ishiorectal Abscess with Bilateral Supralevator Abscess Tract (Extending upto S1)

Abstract

Ano-rectal sepsis is a benign perianal disease. Fistula in ano develops as a sequel to an abscess that does not heal, bursts or is drained inadequately. We are reporting an unusual case of bilateral Ischiorectal abscess/fistula (Horse-shoe) with high supralevator abscess tract (extending upto S1 vertebrae), with a common internal opening posteriorly in the midline and external openings at laterally at both sides. Such atypical abscess/fistula is uncommon and complex. Adequate pre-operative knowledge about the extension of the tract is a must. Surgical drainage of the abscess and debridement with complete excision of the tract, antibiotic coverage with adequate post-operative wound care forms the main stay of treatment.

Keywords: perianal abscess, posterior Horseshoe fistula, Horseshoe Ischiorectal Abscess, Supralevator abscess, Fistula in ano.