A 9 years old male presented with fever and a dull aching pain in perineum of 1 week duration. The patient’s mother stated he has pain on defecation. He has also painful digital rectal examination without a palpable mass.
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Axial contrast enhanced CT demonstrates a multi-loculated thick-walled cystic lesion in the pre-sacral space of the extra-peritoneal pelvis and in the right ischiorectal fossa without evidence of invasion to adjacent organs. The inflammatory nature of the lesion is underlined by peripheral enhancement, stranding of the adjacent fat and thickening of the mesorectal fascia.
The findings are consistent with a pelvic abscess. He was placed on appropriate antibiotics and his symptoms resolved after 2 weeks.