Recurrent gluteal abscess: an atypical presentation of colon neoplasm

Resumen Caso clínico: Mujer de 74 años que consulta a Urgencias por absceso glúteo derecho recidivante y que tras hacerle body-TAC, por el hallazgo incidental preoperatorio de nódulos pulmonares bilaterales, se diagnóstica de neoplasia de ciego perforada de manera contenida en forma de colección retroperitoneal que fistuliza a tejido cutáneo. Discusión: El cáncer de colo-rectal es el de mayor incidencia en España. Los signos y síntomas de presentación más comunes incluyen rectorragia, dolor abdominal, anemia inexplicable y / o un cambio en el hábito intestinal. Una parte importante de los pacientes puede presentar características clínicas sugestivas de enfermedad metastásica debido a diseminación linfática y hematógena y en raras ocasiones se puede manifestar como absceso en regiones adyacentes por perforación del propio tumor. Conclusiones: El carcinoma de colon perforado siempre debe considerarse como un diagnóstico diferencial para los abscesos de los miembros inferiores recidivantes y con mal control con manejo habitual.

Video Assisted Anal Fistula Treatment (VAAFT) for Treating a Complex Posttraumatic Anal Fistula: Case Report

Introduction: Anal fistula is an abnormal pathway that connects the anorectal tract to the perianal skin. The Park’s classification describes four different types of anal fistulas depending on their links with the sphincter apparatus. In this paper, we report an interesting case of post-traumatic complex trans-sphincteric fistula treated with VAAFT procedure. Case Presentation: A 60-year-old-male patient, from an accidental fall, developed a gluteal abscess with a high trans-sphincteric anal fistula and a secondary tract leading to a large second abscess located in the right ischiorectal fossa. An abscess incision was done, and a draining seton was placed in another Institution. The patient came to our Hospital and underwent surgery using Video Assisted Anal Fistula Treatment (VAAFT) procedure. Conclusions: VAAFT is an effective and safe procedure for complex anal fistula, even when they have a post-traumatic origin.

Radiation-induced sarcoma presenting as a gluteal abscess: a diagnostic and therapeutic challenge

Sarcomas are a rare and fatal treatment complication following radiotherapy. Radiation-induced sarcomas (RISs) presenting as a gluteal abscess is a rarity, accounting for its varied presentation. We present a case of a middle-aged woman, post-chemo-radiation for carcinoma cervix 5 years ago, who presented with gluteal abscess. Achieving haemostasis post incision and drainage under anaesthesia was a challenge. On further evaluation, she was diagnosed with radiation-induced gluteal soft tissue sarcoma. Haemostasis was achieved after radiation following failed attempts of surgical and radiological interventions. She is currently planned for chemotherapy. Cancer survivors have an increased risk of developing a second malignancy following radiation treatment. RISs are highly aggressive, exhibit a varied clinical presentation and pose a challenge in early diagnosis; thus, have a poor outcome. RISs pose a diagnostic challenge; any dubious lesion in the previously irradiated field should raise suspicion and prompt aggressive management.