SUPRALEVATOR ABSCESS WITH METRONIDAZOLE RESISTANT ANAEROBIC INFECTION: A CASE REPORT

Background- Supralevator abscesses are uncommon and may result from extension of an intersphincteric or ischiorectal abscess upward or extension of an intraperitoneal abscess downward. These are difcult to diagnose. Because of its proximity to the peritoneal cavity, supralevator abscesses can mimic intra-abdominal conditions. To identify the origin of a supralevator abscess prior to treatment is essential(1). Case Summary- We are presenting a case of Supralevator abscess which presented as acute pain abdomen. It was a diagnostic and therapeutic challenge due to metronidazole resistant anaerobic infection as well as uncontrolled diabetes mellitus. A 48 years old female presented with right sided abdominal pain for 2 weeks. After clinical evaluation provisional diagnosis of acute calculous cholecystitis with burst perianal abscess was made. Radiological evaluation revealed the diagnosis of a supralevator abscess with an intraperitoneal extension. Routine blood investigations revealed that the patient was also diabetic. The patient was optimized pre-operatively and drainage by laparotomy was done. Pus samples were sent for aerobic and anaerobic culture sensitivity and the patient was put on empirical antibiotics and abdominal drains were put in the abscess cavity. As per the reports of culture sensitivity the antibiotics were changed, importantly Piperacillin and tazobactam started for anaerobic organism resistant to metronidazole which led to clinical improvement of the patient. This case report gives us idea about the Conclusiondiagnostic and therapeutic challenges encountered during management of the rare Supralevator abscess; about the emerging resistance against metronidazole among anaerobic organisms and the need of anaerobic culture sensitivity in clinically progressive disease as well as the need of proper management of co-morbidities.