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Dear Sir,
We are truly thankful for the correspondence sent by Zinicola and Cracco [1] and we want to emphasize the importance of Parks’ principles regarding supraelevator abscess (SLA) of intersphincteric origin [2]. Moreover, we think knowledge of these proctologic disorders is essential to perform correct drainage avoiding iatrogenic fistulae.
There is still a need for prospective studies with a long follow-up. We found the theory of “skeletal muscle” rule very interesting and accurate and completely agree that when deciding on the drainage route is crucial to determine whether or not the infection has crossed the external anal sphincter.
We would like to add that in the posterior anal area, if the infection propagates through the external anal sphincter a deep postanal space abscess could be created. This abscess has the particularity that is does not show external signs of sepsis, which delays the diagnosis and treatment. This therapeutic delay can produce a SLA of extrasphincteric origin [3].
References
Zinicola R, Cracco N (2021) Direction drainage of supralevator abscess. Tech Coloproctol. https://doi.org/10.1007/s10151-021-02522-8
Jeri-McFarlane S, García-Granero Á, Gil-Catalan A, Craus-Miguel A, Coll-Sastre M, Gamundi-Cuesta M et al (2021) Surgical strategy for supralevator abscess in Perianal Crohn’s disease: emergency surgery and residual complex fistula. Tech Coloproctol 25(10):1163–1164
Sancho-Muriel J, Garcia-Granero A, Fletcher-Sanfeliu D, Alvarez-Sarrado E, Sánchez-Guillén L, Pellino G et al (2018) Surgical anatomy of the deep postanal space and the re-modified Hanley procedure: a video vignette. Color Dis 20(7):645–646
Garcia-Granero A, Granero-Castro P, Frasson M, Flor-Lorente B, Carreño O, Espí A et al (2014) Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series. Int J Colorectal Dis 29(12):1557–1564
Sahnan K, Adegbola SO, Tozer PJ, Gupta A, Baldwin-Cleland R, Yassin N et al (2018) Improving the understanding of perianal Crohn fistula through 3D modeling. Ann Surg 267(6):e105–e107
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Jeri-McFarlane, S., García-Granero, A. & González-Argenté, F.X. Response to “Direction of drainage of supralevator abscess”. Tech Coloproctol 26, 235 (2022). https://doi.org/10.1007/s10151-021-02547-z
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DOI: https://doi.org/10.1007/s10151-021-02547-z