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PERIANAL ABSCESS & ISCHIORECTAL ABSCESS

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PERIANAL & ISCHIORECTAL ABSCESSES COME UNDER ANORECTAL ABSCESSES.IN THIS PPT DISCUSS THE DIFFERENCE BETWEEN PERIANAL & ISCHIORECTAL ABSCESS

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PERIANAL ABSCESS & ISCHIORECTAL ABSCESS

  1. 1. -Dr.Navya Teja
  2. 2. ANORECTAL ABSCESS •MC organism – E.COLI •Commonly occurs due to infection of anal glands in relation to crypts-CRYPTOGLANDULAR DISEASE (95%) •Common in diabetics & immunocompromised •Other causes- o injury to anorectum o Cutaneous infection ( boil) o Blood born infections
  3. 3. PATHOPHYSIOLOGY Originates from an infection arising in the crypto glandular epithelium lining the anal canal The internal anal sphincter normally serves as a barrier to infection passing from the gut lumen to the deep perirectal tissues. This barrier can be breached through the crypts of Morgagni, which can penetrate through the internal sphincter into the intersphincteric space
  4. 4. PATHOPHYSIOLOGY Once infection gains access to the intersphincteric space, it has easy access to the adjacent perirectal spaces Extension of the infection can involve the intersphincteric space 2–5%, ischiorectal space 20-25% , or even the supralevator space 2.5%.
  5. 5. DIFFERENTIAL DIAGNOSIS FOR ANORECTAL ABSCESS •PERIURETHRAL ABSCESS •BARTHOLIN ABSCESS •TUBERCULOUS ABSCESS
  6. 6. WORKUP/INVESTIGATIONS • MRI – IOC • PERINEAL & ANAL USG- also useful • CBC may show leukocytosis • Pus cultures • Blood cultures
  7. 7. CLASSIFICATION OF ANORECTAL ABSCESS 1. Perianal (60%) 2. Ischorectal (30%) 3. Submucous 4. Pelvirectal 5. Fissure abscess
  8. 8. Classification
  9. 9. PERIANAL ABSCESS
  10. 10. PERIANAL ABSCESS (60%) •Lies in region of subcutaneous portion of EXTERNAL SPINCTER •Usually results from suppuration of anal gland or thrombosed ext pile or any infected perianal condition
  11. 11. PERIANAL ABSCESS-CLINICAL FEATURES •SEVERE PAIN in perianal region with difficulty to sit •O/E- tender,smooth,soft ,swelling in the region
  12. 12. PERIANAL ABSCESS-TREATMENT •I & D •SITZBATH +ANTIBIOTICS+ANALGESICS +L/A of ANAESTHETIC AGENTS+LAXATIVES
  13. 13. ISCHIORECTAL ABSCESS ( 30%)
  14. 14. ISCHIORECTAL FOSSA •PYRAMIDAL IN SHAPE •5CM DEPTH,2 CM WIDTH •Right & left communicate with each other through posterior spincteric space- HORSE SHOE abscess
  15. 15. ISCHIORECTAL FOSSA- BOUNDARIES •LATERALLY-fascia covering OBTURATOR INTERNUS •MEDIALLY- LEVATOR ANI & EXTERNAL SPINCTER •POSTERIORLY- SACROTUBEROUS LIGAMENT & GLUTEUS MAXIMUS •ANTERIORLY- UROGENITAL DIAPHRAGM •BELOW- BY SKIN
  16. 16. ETIOLOGY •Commonly it is due to extension of lower intermuscular anal abscess laterally through ext spincter •Fat in fossa is more prone to infection coz its LEAST VASCULARISED
  17. 17. CLINICAL FEATURES •Tender,indurated,brawny swelling in the skin over ischiorectal fossa with high fever •Swelling – not localised •Fluctuation - absent
  18. 18. TREATMENT •In LITHOTOMY position, CRUCIATE shaped incision, Followed by DE ROOFING & DRAINAGE of pus •Presence of any internal opening to rectum should be looked for
  19. 19. COMPLICATIONS Fistula-in-Ano Fournier’s Gangrene Death Fecal Incontinence
  20. 20. PROGNOSIS Drainage alone results in cure for 50%. 50% will have recurrences and develop an anal fistula.

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