PMC4701749_01
Initial computed tomography of the pelvis revealing mild inflammation of the perianal skin and tissue surrounding the rectum.
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Computed tomography (CT) of the pelvis ruled out deep abscess or collection, but was remarkable for mild inflammation of the perianal skin and tissue surrounding the rectum (Fig. 1).
(A) Initial clinical manifestation consisting of bilateral perianal ecchymoses and perianal edema, which developed on postoperative day 7; (B) computed tomography of the pelvis repeated on postoperative day 7 revealing increased circumferential perianal inflammation and edema without abscess formation.
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By the fourth hospital day, on clinical exam the patient had developed significant bilateral perianal ecchymoses and perianal edema with increased tenderness to palpation (Fig. 2A). CT of the pelvis was repeated and only remarkable for increased circumferential perianal inflammation and edema without any appreciable underlying abscess (Fig. 2B).
Intraoperative photograph after superficial debridement and tissue biopsy.
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Only superficial epidermal debridement was necessary to encounter viable tissue (Fig. 3).
Early development of ecchymoses and bullae formation on postoperative day one and two after debridement and biopsy.
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Over the following two postoperative days, his clinical exam again worsened with development of ecchymoses and bullae formation where he had previously been debrided (Fig. 4).
Significant clinical improvement of affected area after 4 days (A) and 11 days (B) of intravenous steroid therapy.
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He remained afebrile, his white blood cell count normalized, and the bullae formation and inflammatory process regressed (Fig. 5).