Anorectal Abscess is pus collection in perianal region, this presentation is about its causes, types, investigations and management.

1. Anorectal Abscess

2. • Anorectal abscess represents infection of the soft tissues surrounding
the anal canal and rectum with formation of discrete abscess cavity
• Many anorectal abscesses coincide with or lead to the formation of
fistula in ano

3. Aetiology
• Cryptoglandular theory
• Following haemorrhoidal sclerotherapy - submucosal abscess
• Infected haematoma – mucocutaneous or marginal abscess
• Foreign body, trauma, deep skin-related infection – ischiorectal
abscess
• Pelvic disease – pelvirectal supralevator sepsis
• Underlying rectal disease, such as neoplasm and particularly Crohn’s
disease, may be the cause
• Immunosuppressed patients, diabetics, AIDS

4. 1, Levator ani muscle;
2, superfcial perineal fascia;
3, superfcial perianal space;
4, ischiorectal space;
5, supralevator space.
A, Intersphincteric;
B, ischiorectal;
C, superfcial perianal;
D, supralevator;
E, submucosal.

5. Cryptoglandular Theory
• The cryptoglandular theory of intersphincteric anal gland infection
(Parks) holds that pus, which travels along the path of least
resistance, may spread caudally to present as a perianal abscess,
laterally across the external sphincter to form an ischiorectal abscess
or, rarely, superiorly above the anorectal junction to form a
supralevator intermuscular or pararectal abscess (depending on its
relation to the longitudinal muscle) (Figure 80.27), as well as
circumferentially in any of the three planes:
intersphincteric/intermuscular, ischiorectal or pararectal supralevator

10. Presentation

11. Presentation

12. Diagnosis

15. Cruciate incision &
Deroofing

16. Thank You