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[Lumbosacral pain revealing intramural rectal abscess. Apropos of 2 cases]
J L Bussière1, M Soubrier, P Cauhapé
1Service de Rhumatologie, CHRU, Clermont-Ferrand.
Abstract:
Intramural abscess of the rectum is an uncommon (7%) form of perianal abscess in which the suppuration moves upwards within the rectal wall. Diagnosis is usually readily established on the presence of prominent anorectal symptoms and on rectal examination findings. However, atypical cases occur occasionally. Two cases of intramural abscess with misleading presenting symptoms suggestive of rheumatologic disease are reported herein. Both patients had subacute lumbosacral pain suggestive of an inflammatory condition. In one patient, the correct diagnosis was established two years after onset of symptoms when the patient passed pus per rectum. In the other, endoscopic ultrasonography readily evidenced the abscess. Modern imaging techniques including endorectal ultrasonography, CT scan with enhancement and MRI are very helpful for the diagnosis of such difficult cases. Intramural rectal abscess should be added to the list of possible nonspinal visceral etiologies routinely looked for during the evaluation of patients with atypical lumbosacral pain.
Insights
Intramural rectal abscess, a rare condition, can present with atypical symptoms like back pain, delaying diagnosis. Advanced imaging is crucial for identifying these difficult cases.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Intramural abscess of the rectum is an uncommon (7%) variant of perianal abscess, characterized by pus collection within the rectal wall.
- Diagnosis is typically straightforward with characteristic anorectal symptoms and examination findings.
Observation:
- This report details two atypical cases of intramural rectal abscess presenting with subacute lumbosacral pain, mimicking rheumatologic conditions.
- One patient experienced a two-year diagnostic delay until passing pus rectally; the other benefited from prompt endoscopic ultrasonography.
Findings:
- Atypical presentations of intramural rectal abscess can mislead clinicians, suggesting non-visceral inflammatory conditions.
- Modern imaging modalities such as endorectal ultrasonography, contrast-enhanced CT, and MRI are invaluable for diagnosing challenging cases.
Implications:
- Intramural rectal abscess should be considered in the differential diagnosis for patients presenting with unexplained lumbosacral pain.
- Early recognition and utilization of advanced imaging can prevent delayed diagnosis and improve patient outcomes.