講演情報
[INTS4-4]A Thrombosed Perianal Tubular Lesion Presenting as an Abscess: A Diagnostic and Surgical Dilemma
*Aynur Kamal Safiyeva1,2 (1. Central Customs Hospital, Baku , Azerbaijan, General Surgery Department, Azerbaijan, 2. Department of General Surgery of ASATID , Baku Azerbaijan)
Background:
Perianal pain is most frequently associated with anal fissures, thrombosed hemorrhoids, or perianal abscesses. However, rare thrombosed tubular structures located in the perianal or rectovaginal space may clinically and radiologically mimic abscesses, posing significant diagnostic and surgical challenges. In atypical cases, advanced imaging—particularly magnetic resonance imaging (MRI)—is essential to avoid misdiagnosis and unnecessary surgical intervention.
Case presentation:
A 37-year-old woman presented with acute perianal pain radiating to the anal canal for 2–3 days. Physical examination revealed marked tenderness without evidence of anal fissure, thrombosed hemorrhoid, or perianal skin changes. Laboratory inflammatory markers were within normal limits. Perianal ultrasonography demonstrated a 40 × 30 mm horseshoe-shaped infiltrative lesion without cutaneous communication, initially interpreted as a perianal abscess. Surgical exploration revealed no purulent material. Subsequent contrast-enhanced pelvic MRI demonstrated a 51 mm U-shaped, non-enhancing tubular structure in the rectovaginal space, consistent with a thrombosed tubular lesion rather than an abscess.
Conclusion:
This case highlights a rare diagnostic pitfall in which a thrombosed perianal tubular structure mimicked an abscess both clinically and on ultrasonography. MRI plays a critical role in atypical presentations and should be considered when clinical and laboratory findings are incongruent, in order to prevent unnecessary surgical procedures.
Perianal pain is most frequently associated with anal fissures, thrombosed hemorrhoids, or perianal abscesses. However, rare thrombosed tubular structures located in the perianal or rectovaginal space may clinically and radiologically mimic abscesses, posing significant diagnostic and surgical challenges. In atypical cases, advanced imaging—particularly magnetic resonance imaging (MRI)—is essential to avoid misdiagnosis and unnecessary surgical intervention.
Case presentation:
A 37-year-old woman presented with acute perianal pain radiating to the anal canal for 2–3 days. Physical examination revealed marked tenderness without evidence of anal fissure, thrombosed hemorrhoid, or perianal skin changes. Laboratory inflammatory markers were within normal limits. Perianal ultrasonography demonstrated a 40 × 30 mm horseshoe-shaped infiltrative lesion without cutaneous communication, initially interpreted as a perianal abscess. Surgical exploration revealed no purulent material. Subsequent contrast-enhanced pelvic MRI demonstrated a 51 mm U-shaped, non-enhancing tubular structure in the rectovaginal space, consistent with a thrombosed tubular lesion rather than an abscess.
Conclusion:
This case highlights a rare diagnostic pitfall in which a thrombosed perianal tubular structure mimicked an abscess both clinically and on ultrasonography. MRI plays a critical role in atypical presentations and should be considered when clinical and laboratory findings are incongruent, in order to prevent unnecessary surgical procedures.