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Case 123: Buttock pain

3 weeks post treatment for chronic anal fissure

1. What is the diagnosis?

Ischiorectal abscess, which is now spontaneously draining on the operating table.

2. What operative treatment did this man most likely have 3 weeks ago?

He probably had a left lateral internal sphincterotomy. This operative site has become to source of the sepsis. Infection of an internal sphincterotomy is uncommon but with this case history it is still the likely cause. Patients seen with pain post sphincterotomy should be evaluated for possible perianal sepsis which can sometimes be difficult to demonstrate on clinical examination.

Examination under anaesthetic should be used liberally in all patients presenting with significant perianal pain to exclude sepsis in this area.

Basics of perianal sepsis
Essential Surgical Care - World Health Organization

American Society of Colon and Rectal Surgeons