# A Clinical-Anatomical-Radiological Study of Extraperitoneal Spaces: A Case Series

## TL;DR

This study explores how infections from anorectal diseases can spread through extraperitoneal spaces, causing delayed diagnosis and complications, using a case series and cadaver dissections.

## Contribution

The study provides new clinical-anatomical insights into extraperitoneal abscess spread through case series and cadaver dissections, emphasizing the role of early CT scans.

## Key findings

- CT scans revealed extraperitoneal abscesses in six patients with persistent symptoms after initial treatment.
- Cadaver dissections confirmed anatomical pathways of infection spread in extraperitoneal spaces.
- Early CT imaging is critical for timely diagnosis and reducing complications.

## Abstract

Complications can arise secondary to anorectal suppurative diseases, with infections spreading along the extraperitoneal space, such as the peri-vesical, prevesical, pre-sacral, and pararectal spaces, resulting in abscesses at remote sites, which can make diagnosis more challenging. Due to the absence of peritonitis symptoms, there is a delay in presentation among such patients. Comprehending the intricacies of these areas and the way infection can spread within them is crucial for promptly identifying and effectively draining the extraperitoneal abscess.

We present a case series of six patients with a mean age of 45, all males. A total of three patients had undergone incision and drainage after being diagnosed with anorectal suppurative disease and remained symptomatic after the initial surgical intervention of incision and drainage. Two patients initially diagnosed with anterior abdominal abscesses patients, after being treated with incision and drainage, continued to have purulent discharge from the drainage site. Finally, the last patient continued to present with perianal pain after an open hemorrhoidectomy. CT scans of all six patients showed collections in the extraperitoneal spaces correlated with the observed complications.

To deepen our understanding of pelvic extraperitoneal spaces, cadaver dissections were conducted and compared with CT images. Through cadaver dissections and CT imaging, the study provides insights into the anatomy and interconnections of pelvic extraperitoneal spaces, emphasizing the importance of early CT scans for diagnosis. Understanding these intricate anatomical structures is essential for accurate diagnosis and efficient and effective treatment. Timely diagnosis is vital to prevent prolonged illness and reduce the risk of complications and mortality. The importance of early CT scans in suspected patients is underscored, which is highly important to expedite appropriate actions.