Autologous Platelet-Rich Plasma Injection and Platelet-Rich Fibrin Glue Insertion for the Treatment of Extensive Supralevator Anorectal Fistula: A Case Report.

IF 0.9 Q3 SURGERY
Amin Dalili, Daryoush Hamidi Alamdari, Alimohamad Dalili, Maryam Sarkardeh, Alireza Rezapanah, Nooshin Tafazoli
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Abstract

Supralevator fistula stays a challenge in general surgery. We present a case with supralevator anorectal fistula and subsequent retroperitoneal necrotizing fasciitis in which autologous platelet-rich plasma and platelet-rich fibrin glue were used for fistula closure. A 59-year-old man was admitted with pelvic pain and fever. Abdominopelvic sonography and CT scan reported a deep horseshoe-shaped anorectal abscess with extension to the pelvic floor, supralevator, psoas, retroperitoneal muscles, and kidneys. He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy. After 30 days, he was discharged, but he returned to the office with the complaint of purulent discharge from the hypogastric region and a diagnosis of fistula formation. Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract. At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection. Autologous platelet-rich plasma injection and platelet-rich fibrin glue insertion suggest a secure and effective approach for treating supralevator anorectal fistula.

Abstract Image

Abstract Image

自体富血小板血浆注射加富血小板纤维蛋白胶插入治疗广泛肛直肠上提瘘1例。
提上睑瘘是普外科的一个难题。我们报告一例肛直肠上瘘和腹膜后坏死性筋膜炎,其中自体富血小板血浆和富血小板纤维蛋白胶用于瘘闭合。一名59岁男性因骨盆疼痛和发热入院。腹部盆腔超声和CT扫描报告深马蹄形肛门直肠脓肿,并延伸至盆底、提上肌、腰肌、腹膜后肌肉和肾脏。他接受抗生素治疗,脓肿引流,反复根治性手术清创和坏死切除术。30天后,他出院了,但他回到办公室抱怨从胃下区域脓性分泌物和诊断瘘管形成。将富血小板血浆注入瘘管周围组织,将富血小板纤维蛋白胶注入瘘管道。在11个月的随访中,患者未出现排尿功能障碍、便秘、腹泻或瘘管道感染。自体富血小板血浆注射和富血小板纤维蛋白胶插入是治疗提上肛直肠瘘的一种安全有效的方法。
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