Anesthetic Management in a Patient with Complex Perianal Fistula Secondary to Suppurative Hidradenitis
Keywords:
suppurative hidradenitis, perianal fistula, spina bifidaAbstract
Introduction: Hidradenitis suppurativa is a chronic inflammatory skin disease that affects the apocrine sweat glands and causes inflammatory nodules, abscesses, and painful fistulas. Objective: To describe the perioperative anesthetic management in a patient proposed for surgery for complex perianal fistulas secondary to HS, with unknown anatomical alterations of the lumbosacral spine. Case Presentation: We present the case of a 44-year-old male patient with a history of HS who subsequently developed perineal lesions and complex perianal fistulas. Surgical planning for the correction of these conditions was unexpected due to the impossibility of performing subarachnoid neuraxial anesthesia, subsequently revealing significant anatomical alterations of the lumbosacral spine through imaging studies. General orotracheal anesthesia was opted for, also facing the anticipated difficulty in the definitive approach to the airway. Conclusions: The combination of HS, complex perianal fistulas, and unknown lumbosacral anatomical abnormalities represents a significant challenge in anesthetic management. Careful planning and the use of appropriate techniques are essential to ensure patient safety during the surgical procedure.
Downloads
References
1. Robert Sabat, Afsaneh Alavi, Kerstin Wolk PH, Worstman X, Barry McGrath, Amit Garg. Hidradenitis supurativa. The Lancet. American Journal of Orthod. 2025 [acceso 30/04/2025];405(10476);420-38. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39862870/
2. Fauconier M, Reguiai Z, Barbe C, Colosio A, Eschard JP, Salmon JH et al. Asociación entre hidradenitis supurativa y espondiloartritia. Joint Bone Spine. 2018;85(5):593-7. DOI: https://doi.org/10.1016/j.jbspin.2017.09.005
3. Fimmel S, Zouboulis CC. Comorbidities of hidradenitis suppurativa (acné inversa). Dermatoendocrinol. 2010;2(1);9-16. DOI: https://doi.org/10-4161/derm.2.1.12490
4. Patel V, Champaneria R, Dretzke J, Yeung J. Efecto de la anestesia regional frente a la general en el delirio posoperatorio en pacientes ancianos sometidos a cirugía por fractura de cadera: una revisión sistemática. BMJ. 2018;8(12):e020757. DOI: https://doi.org/10.1001/jama.2021.22647
5. Fettes P, Jansson JR, Wildmith J. Anestesia raquídea fallida: mecanismos, manejo y prevención. BJA. 2009;102(6):739-48. DOI: https://doi.org/10.1093/bja/aep096
6. Labat G. Anestesia regional: su técnica y aplicación clínica. WB Saunders; 1922. DOI: https://doi.www.scirp.org/reference/ReferencesPapers?ReferenceID=2242327
7. Demilie AE, Denu ZA, Bizuneh YB, Gebremedhn EG. Incidence and factors associated with failed spinal anaesthesia among patients undergoing Surgery: a multi-center prospective observational study. BMC Anaesthesiol. 2024;24(1):129. DOI: https://doi.org/10.1186/s12871-024-02484-y
8. Delgado Vega YM. Factores relacionados con la ocurrencia de punción lumbar traumática en pacientes pediátricos en Ciego de Ávila, 2020 [Tesis de especialidad]. Cuba: Universidad de Ciencias Médicas de Ciego de Ávila; 2020. 48 p. [acceso 12/05/2025]. Disponible en: file:///C:/Users/TEMP.DESKTOP-MUAJI7B.003/Downloads/00%20FINAL.%20Dra.%20Yailena%20del%20Mar%20Delgado%20Vega%2016-11-20.pdf
9. Yüksek A, Miniksar OH, Honca M, Öz H. Incidencia y causas del fracaso de la anestesia raquídea. Dubai Med J. 2020;3(2):50-4. DOI: https://doi.org/10.1159/000508837
10. Sievänen H, Kari J, Eskola V, Huurre A, Soukka H, Palmu S. Incidencia de punciones lumbares traumáticas en adultos: el impacto del primer procedimiento de un paciente. Enero 2023. ScienceDirect. Medicina Clínica. 23(1):31-7. DOI: https://doi.org/10.7861/clinmed.2022-0169
11. Ashagrie HE, Amed SA, Melesse DY. The incidence and factors associated with failed spinal anesthesia among parturients underwent cesarean section, 2019: A prospective observational study. Int J Surg Open. 2020;24:47-51. DOI: https://doi.org/10.1016/ j.ijso.2020.03.009
12. Crowe G, Drew T. Neuraxial anaesthesia in the parturient with pre-existing structural spinal pathology. BJA Education. Bjaed Org. 2024 [acceso 12/05/2025];24(10):361-70. Disponible en: https://www.bjaed.org/article/S2058-5349(24)00077-5/fulltext
13. Dornes Ramón R, Vázquez Mora Y, Martínez Castro Y, Flatts Segundo I, Alberna Cardoso A. Caracterización de las fístulas perianales mediante resonancia magnética por imágenes. Hospital Cubano de Qatar, 2017-2023. Medisur. [acceso 30/04/2025];22(3):496-501. Disponible en: https://medisur.sld.cu.medisur.sld.cu/index.php/medisur/article/view/45171
14. Richette P, Molto A, Viguier M, Dawidowicz K, Hayem G, Nassif A, et al. Hidradenitis suppurativa associated with spondyloarthritis – results from a multicenter national prospective study. J Rheumatol. 2014;41(3):490-4. DOI: https://doi.org/10.3899/jrheum.130977
15. Tzellos T, Zouboulis CC. Review of comorbidities of hidradenitis suppurativa: Implications for daily clinical practice. Dermatol Ther (Heidelb). 2020;10(1):63-71. DOI: https://doi.org/10. 1007/s13555-020-00354-2
16. Willman M. Espondilitis e hidradenitis supurativa. ¿Existe una conexión? 29 de agosto de 2022. Disponible en: https://www.myhsteam.com
17. Farran Ortega L, Fornons-Servent R, Miguel Nolla J, Juanola Roura X. Prevalencia de hidrosadenitis supurativa en paientes con espondiloartritis axial. Reumatología Clínica. 2025;21(2). DOI: https://doi.org/10.1016/j.reuma.2024.501808
18. Moreno M, Garbayo P. Una consulta multidisciplinar, pionera en España. 20 de octubre, 2023 por Ashendhi. Asociación de Enfermos de Hidrosadenitis. Disponible en: https://asendhi.org/parc-tauli-abre-consulta-multidisciplinar-para-hidradenitis-supurativa-asociada-a-espondiloartritis/
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Yanira Figueroa Veitia, Tamara Rodríguez Bonet, Mireidis Quintana Ruíz, Jiordano Samper Frías, Félix Tassé Veranes, Víctor José Vasallo Comendeiro
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Those authors who have publications with this journal accept the following terms:
- They will retain their copyright and guarantee the journal the right of the first publication of their work.
- All the content of the journal is under a license https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES
- It is recommended to the author to insert their articles in recognized preprints serves and introduce their database in server crated to this end.
Sociedad Cubana de Anestesiología y Reanimación (SCAR) 
