Korean J Gastroenterol.  2022 Dec;80(6):267-272. 10.4166/kjg.2022.088.

Gluteal and Presacral Abscess Due to Crohn’s Disease with Multiple Fistulas

• Jwa HJ
• Song HJ
• Jun H
• Kim ST
• Boo SJ
• Kim HU
• Lee D

• KMID: 2537098
• DOI: http://doi.org/10.4166/kjg.2022.088

Abstract

The abscess is a common complication of Crohn’s disease (CD), with the perianal form more frequent than gluteal or presacral which is relatively rare. There are few case reports of gluteal abscess combined with presacral abscess caused by CD and the treatment has not been established. A 21-year-old male was admitted with right buttock and lower back pain with a duration of 3 months. He had a history of CD in the small intestine diagnosed 10 months previously. He had poor compliance and had not returned for follow-up care during the previous 6 months. Abdominopelvic CT indicated newly developed multiple abscess pockets in right gluteal region, including piriformis muscle and presacral space. Additionally, fistula tracts between small bowel loops and presacral space were observed. Patient’s CD was moderate activity (273.12 on the Crohn’s Disease Activity Index [CDAI]). Treatment was started with piperacillin/tazobactam antibiotic but patient developed a fever and abscess extent was aggravated. Therefore, surgical incision and drainage was performed and 4 Penrose drains were inserted. Patient’s pain and fever were resolved following surgery. Infliximab was then administered for the remaining fistulas. After the induction regimen, multiple fistula tracts improved and patient went into remission (CDAI was -0.12).

Keyword

Crohn disease; Abscess; Infliximab

Figure

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  Fig. 1 Abdominopelvic CT. (A, B) Axial view showing newly developed multiple abscess pockets (arrow) with wall enhancement in right gluteal muscles and presacral space. (C) Coronal view showing several linear enhancing structures (arrow) between small bowel loops and presacral space, probably fistula tracts.

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  Fig. 2 Operation findings. A total of 4 Penrose drains at 2 gluteal and 2 presacral lesions were inserted.

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  Fig. 3 Laboratory findings. After the surgery, white blood cell (WBC) levels decreased to normal range, and Hb levels increased gradually. POD, post operative day.

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  Fig. 4 Laboratory findings. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels dropped steadily after surgery. Albumin levels recovered to normal range after surgery. POD, post operative day.

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  Fig. 5 Abdominopelvic CT after 3 months. (A, B) Axial view showing decreased in extent of multiple abscess pockets in right gluteal muscles and presacral space. (C) Coronal view showing multiple fistula tracts are decreased.

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