# Complex Tunneling Perirectal Abscess: Intra-abdominal and Extraperitoneal Extension of a Persistent Perirectal Abscess

## TL;DR

A 24-year-old woman with a persistent perirectal abscess developed a complex infection extending into the abdomen, requiring emergency surgery.

## Contribution

This case report highlights the rare intra-abdominal and extraperitoneal extension of a perirectal abscess and its management.

## Key findings

- The patient's abscess extended into intra-abdominal and extraperitoneal compartments.
- Surgical irrigation, drainage, and debridement were necessary for treatment.
- CT imaging revealed extraluminal air pockets in multiple compartments.

## Abstract

Deep-tissue extension of perianal and perirectal abscesses, while rare, requires timely diagnosis and emergent surgical intervention to prevent serious secondary complications. This report evaluates a case of intra-abdominal and extraperitoneal extension of a persistent perirectal abscess that required comprehensive irrigation, drainage, and debridement of multiple abscess-associated cavities. This report follows the case of a 24-year-old African-American female presenting to the ED with mild fevers, nausea, abdominal distension, and lower abdominal pain following a persistent perirectal abscess that had not resolved following conservative outpatient antibiotic management one week prior. Clinical examination revealed abdominal guarding with CT imaging demonstrating extraluminal air pockets in multiple intra-abdominal and extraperitoneal compartments. The patient underwent emergent surgical irrigation, drainage, and debridement of multiple abscess cavities extending from the original perirectal abscess. This report provides a comprehensive overview of the diagnosis, surgical approach, and postoperative management in a patient presenting with a complex tunneling perirectal abscess forming intra-abdominal and extraperitoneal abscesses.