علاج خراج الشرج والمستقيم على شكل حدوة الحصان العابر للخط الأوسط

References

DOI: 10.1097/DCR.0000000000002473

• Abscesses that cross the midline (ie, horseshoe) can be challenging to manage.
• These abscesses most often involve the deep postanal space and extend laterally into the ischiorectal spaces.
• Under these circumstances, primary lay-open fistulotomy should typically be avoided because these fistulas tend to be transsphincteric.
• The Hanley procedure, a technique that drains the deep postanal space and uses counter incisions to address the ischiorectal spaces, is effective in the setting of a horseshoe abscess, although it may negatively impact anal sphincter function.
• A modified Hanley technique using a posterior midline partial sphincterotomy to unroof the postanal space plus seton placement has a high rate of abscess resolution and has been reported to better preserve anorectal function compared to other operative interventions.