| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Hospital of the University of Pennsylvania Philadelphia, PA 19104
Hidradenitis suppurativa is an uncommon chronic suppurative inflammatory disease affecting the apocrine glands of the axillary and anogenital regions. Chronic recurrences of the disease can result in painful abscesses, sinus track and fistula formation, and disabling scarring in the affected areas. To our knowledge, hidradenitis suppurativa has not been reported previously in the radiology literature as a cause of perirectal disease. We therefore present a patient with hidradenitis suppurativa in whom a double-contrast barium enema examination revealed multiple perirectal sinus tracks and fistulas.
A 44-year-old woman presented with abdominal and perineal pain. She had a long history of biopsy-proven hidradenitis suppurativa involving both axillae and the perineum. During a 7-year period, she had been treated with numerous surgical excision and drainage procedures, including bilateral axillectomies and a vulvectomy for severe recurrent disease. Her hidradenitis suppurativa had been relatively quiescent for nearly 12 years. A physical examination performed before the barium enema showed the skin of the posterior perineal wall to be puckered and erythematous with several draining sinus tracks. The barium examination revealed multiple sinus tracks and fistulas arising from the posterior wall of the distal rectum (Fig. 5). There was no other evidence of inflammatory bowel disease involving the colon or terminal ileum. These fistulas were therefore attributed to perineal involvement by hidradenitis suppurativa.
|
The early stage of hidradenitis suppurativa is characterized by hyperkeratosis of sebaceous follicles in the skin followed by retention of follicular elements and subsequent bacterial infection. Extensive disease results when these follicles rupture and spill exudative material into the surrounding connective tissue and sweat glands, leading to cellulitis, abscesses, and eventual fibrosis and scarring [1]. Hidradenitis suppurativa can range in severity from a very mild to a chronic and progressively debilitating disease [2]. Although treatment with antibiotics, steroids, and isotretinoin may provide temporary control of hidradenitis suppurativa, some form of surgery (incision and drainage of abscesses, wide local excision of sinus tracks, and, possibly, skin grafting) usually is required for cure. Complications include iron-deficiency anemia, hypoproteinemia, arthritis, development of squamous cell carcinoma, and psychosocial problems associated with persistent malodorous drainage [1, 2].
Radiologists should be aware of the anorectal manifestations of hidradenitis suppurativa because the sinus tracks and fistulas involving the distal rectum can mimic the radiologic appearance of Crohn's disease or actinomycosis infection. Crohn's disease usually is associated with other findings such as ulceration, skip lesions, and strictures in other portions of the colon or terminal ileum. Perirectal actinomycosis may occur as a result of a penetrating trauma, abdominal surgery, or long-standing use of intrauterine devices. In a patient with a history of hidradenitis suppurativa, however, the presence of perirectal sinus tracks and fistulas should suggest rectal involvement by this disease.
References
This article has been cited by other articles:
|
|
 |
|
  A. M. Kelly and P. Cronin MRI Features of Hidradenitis Suppurativa and Review of the Literature Am. J. Roentgenol., November 1, 2005; 185(5): 1201 - 1204. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
