3. Patient complaints of :
• dull perianal discomfort and pruritus
• exacerbated by movement and increased perineal
pressure from sitting or defecation
• present with swelling around the rectum
• perirectal drainage that may be bloody, purulent, or
mucoid
( note: ischiorectal abscess often present with systemic
fevers, chills, and severe perirectal pain)
4. On examination:
• normal vital signs on initial evaluation
• Physical examination: a small, erythematous,
well-defined, fluctuant, subcutaneous mass
near the anal orifice
• DRE: a fluctuant, indurated mass may be
encountered
5.
6. Workup/Investigations :
• CBC with differential : may show leukocytosis
• Pus cultures
• Blood cultures
• confirmation by means of anal
ultrasonography, CT or MRI
• Plain x-rays little clinical significance
8. Types /classification
1. Perianal (60%) :of suppuration in an anal
gland
2. Ischorectal (30%): extension laterally through
the external sphincter
3. Submucous
4. Pelvirectal : situated between the upper
surface of the levator ani and the pelvic
penitoneum
5. Fissure abscess
10. Etiology
• Non specific :Cryptoglandular in origin.
• Specific :
1. Infection : E.coli , Staph. , strep. , Bacteroids
2. Irritation : Crohn’s disease, ulcerative colitis
Immune compromised state : DM,AIDS,malignancy
3. Others : TB, STDs, Radiation therapy,
11. 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
12. Epidemology
• May resolve itself
• third and fourth decades of life
• quite common in infants too
• Men are affected more frequently than
women 2:1 – 3:1
• relation between the formation of ano-rectal
abscesses and bowel habits
13. Management
• Early surgical drainage of the purulent
collection
• Primary antibiotic therapy alone is ineffective
• Any delay : augments tissue damage, may
impair sphincter continence function,
promote stricture and/or fistula formation
• Ability to drain an anorectal abscess depends
on patient comfort and on the location and
accessibility of abscess.
14. Drainage of perianal or superficial
abscesses
The gauze is removed after 24 hours, and the patient is instructed
to take sitz baths 3 times a day and after bowel movements.
Pus is collected and sent for culture. Hemostasis is achieved with
manual pressure, and the wound is packed with gauze.
A small cruciate incision is made over the area of fluctuancy in
close proximity to the anal verge.
15.
16. Post operative
• analgesics and stool softeners are prescribed
to relieve pain and prevent constipation.
• Antibiotic therapy when indicated– to cover
aerobes and anaerobes e.g. ciprofloxacin 500
mg PO 2x daily for 5 days
• follow up: 2-3 weeks for wound evaluation
and inspection for possible fistula-in-ano.
19. Thank you !!!
• Refrences
Bailey & Love's Short Practice of Surgery 25th
edition
Manipal manual of surgery 3rd edition
SRB’s manual of surgery 4th edition