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Updated: Apr 27, 2026

Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
The space between: a supralevator abscess caused by perforated diverticulitis
Monique A Gary1, Jacqueline Wu2, Marcella Bradway2
1Department of Surgery, Berkshire Medical Center/University of Massachusetts Medical School, Pittsfield, MA, USA mgary@bhs1.org.
Supralevator abscesses, a rare anorectal disease, can present with vague abdominal pain. Early suspicion and definitive surgical treatment are crucial for managing this condition.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Supralevator abscesses represent the rarest form of anorectal suppurative disease.
- Anorectal fistulas can lead to complex abscess formations.
Observation:
- A 60-year-old male presented with abdominal pain, tenesmus, and urinary retention, initially misdiagnosed as diverticular disease.
- Imaging revealed a pelvic abscess, leading to percutaneous drainage, followed by laparotomy confirming a perforated diverticulum as the fistula source.
Findings:
- The patient underwent a Hartmann procedure with drainage of supralevator and ischiorectal abscesses.
- Definitive surgical intervention is essential for treating supralevator abscesses.
Implications:
- Perirectal pain and neurological symptoms warrant high clinical suspicion for supralevator abscess.
- Percutaneous drainage is often insufficient; surgical management is key to preventing recurrence and morbidity.
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