Exceptional dissemination of perineal tuberculosis up to the right flank: a tribute to J.P. Nesselrod’s study on the anatomy of pelvic lymphatics published in 1936 in the Annals of Surgery

Excerpt

A 56-year-old cachectic male in poor general and hygienic condition collapsed and was subsequently admitted to hospital in a severe sepsis. The personal history was negative for preexisting intraabdominal and cardiorespiratory ailments. Recent journeys to tropical countries were denied. However, a lengthy stay at a psychiatric clinic due to alcohol abuse several years ago was noteworthy. The patient had been suffering from perineal fistula for years without any medical treatment. At admission, we found a complex of perianal and gluteal abscesses with involvement of the skin of the right lower back. The abdomen was clinically unsuspicious. The laboratory studies revealed a severe inflammatory syndrome measuring a white cell count of 30 × 109/L, CRP value of 226 mg/L, and slightly elevated procalcitonine with 0.47 μg/L. …