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Forum Name: Surgery Topics

Question: Supralevator abscess


 dave55 - Thu Nov 12, 2009 11:28 am

Good morning.

I am one month post-op I&D of the reoccuring horse shoe abscess, that sits high in the Levator ani. This was my 6th I&D. have used dry packs Q12 hours to heal the fistula in a downward fashion. There has been no successful Seton placement.

My question is two-fold;

1) I have found no real data to suggest the morbidity /mortality rates with this cronic condition. Is there any?

2) Being a non-insulin dependent diabetic with A1C's running in the 5.8-6.1 range (on Metformin) I am curious if my chances are equal to an otherwise healthy individual if it would come to diversion, colostomy and re-attachment in the future.
IE; healing time etc...

Thank you.
 Dr.M.Aroon kamath - Tue Nov 24, 2009 10:53 am

User avatar Hi,
Supra-levator anorectal abscesses are a challenge to any surgeon, especially if they are horse-shoe shaped (a challenge in diabetics and non-diabetics as well).

The crux of the problem lies in preserving the ano-rectal sling, damage to which has the potential to cause incontinenceof feces.

As it is just over a month ago that a Supra-levator anorectal abscesses had been drained, the priorities in your case are

- fairly tight control of your glycemic status under medical supervision, and
- to continue with local wound management as needed
until the wound heals, or ends up as a fistula.

Seton placement would not have been feasible in the acute phase (abscess). Seton placement may be considered if by chance, a fistula should form.

Control of glycemic status in this kind of a situation often warrents insulin therapy, rather than oral hypoglcemics.

I hope this information may be of use to you.
Best wishes!
 dave55 - Tue Dec 08, 2009 6:48 am

Short update; Now approching four months out, had a whitecount drawn (normal) and a repeat CT with contrast, looks like it has resolved. The only real difference this time around was using packing twice per day in the surgical fistula leading to the abscess instead of slowly pulling out the Malecot drain over time.
Yes, my Doctors hammered me over my sugars and so I have been eating a diet of really only fish and veggies which I suppose I should eat in any event as I diabetic, but my lastes A1C was 5.4 to which made my Physician pretty happy, and I have lost weight.
Day by day now, I will be taking Colace for a while I guess, and hoping for this not to re-occur, but I feel great and that is a good thing.

Although I trust my Family Doctor and Surgeon it is helpful to have a place to get some additional insight, I appeciate this site.

Thanks again,

Dave
 Dr.M.Aroon kamath - Tue Dec 08, 2009 10:13 am

User avatar Hi Dave,
Thank you so much for your appreciation.We wish that you get better soon. Good luck!

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