1. Personalhistory
Adham ,male patient,11years old,lives in cairo , studies in
prepschool,no smoking
Complain
Anorectal pain 3 days ago
Presenthistory
The patient came to hospital complaing of aneorectal pain 3daus
ago , this pain is throobing in criteria ,increases with movement,cough ,sneezing
,and decreases with defecation and sometimes relieved by analgesic
This complain is recurrentfor severaltimes and the patient wentto hospital and
received treatment in formof antibiotic and analgesics,butno improvement
This complain is associated with discharge yellow in color, purulent small in
amount,no odor
There is constitual symptoms as boneache ,feeling tired
+++ve history of homosexual relation after attempt of sexual abuse
No history of other symptoms
__ve history of systemic diseases
According to vaccination schedule all immuinizations are taken at time
Pasthistory +histoy of circumicision
_ve history of systemic diseas
_ve history of allergies

2. Family history
+ve family history of his father is diabetic and hypertensivefor
severalyears
……………………….
Examination
General .. the child is alert ,conscious,oriented to time ,place,and
persons ,heis irritable,shy,afraid,speak difficulty
He is underweight
He has backlash
Local…by inspection hot ,tender,red swelling not totally seen
because ofexamination can not be completly done well due to patient backlash
and pain ,tenderness
Palpation and PR may need to be done under anasethia to complete examination
Investigation :
Culture and sensitivity for discharge
Intra-analultrasound may be needed
Diagnosis : anorectal swelling suspicioned to be anorectal abcess
Treatment:
Surgicaldrainage + antibiotic according to culture and sensitivity
Close follow up to avoid fistula
Physicologicland behavioraltreatment