An anorectal abscess is an infection that originates from an obstructed anal gland, causing pus to collect in surrounding tissue. It is most commonly caused by a cryptoglandular infection due to obstruction of the anal gland duct. Abscesses are classified based on their location as simple perianal, intersphincteric, ischiorectal, or supralevator. Clinical diagnosis involves examination for tenderness and swelling, while imaging studies can confirm deep abscesses. Treatment depends on the classification but generally involves incision and drainage along with antibiotics.

1. Anoretcal abscess
Mohammed AlHinai

2. anorectal abscess :
infection originates most often from an obstructed anal crypt gland, with the
resultant pus collecting in the subcutaneous tissue, intersphincteric plane or where
various types of anorectal abscesses form.
Primary :
- Anal gland infection
( most common)
secondary :
- Crohn disease
- Anorectal carcinoma
- Iatrogenic causes
- Lymphogranuloma venereum
- Rectal foreign bodies
- Actinomycosis
- Tuberculosis
Causes

3. Obstruction of anal canal duct
Stasis and bacteria growth of anal gland (cryptoglandular
infection)
Abscess formation initially in intersphincteric space
Then spread along adjacent spaces
pathogenesis
Chronic phase
develop
Anal fistula

4. Classification of perianal and perirectal abscess :
• Its important as affect the surgical management
Simple Complex
Perianal abscess
( superficial ):
• Tender swelling in
perianal skin.
• Fluctuance or
redness,
indurated skin in
perianal skin.

5. Classification of perianal and perirectal abscess :
• Its important as affect the surgical management
Complex
Intersphinteric
abscess :
• Pain during
defecation.
• Tender swelling or
fluctuant mass
protruding into
lumen of rectal
canal.
• No perianal skin
change.
• Diagnosed by DRE
or imaging.
Ischiorectal abscess :
• Pain usually during
sitting.
• Systemic symptoms
like fever and
malaise.
• Diffuse, tender,
indurated and
fluctuant area
within the buttocks.
• US diagnosed
Supralevator abscess :
• Usually caused by
secondary causes like
crohn disease or
pelvic infection.
• Severe perianal pain.
• Systemic symptoms
like fever, malaise and
urinary retention.
• On DRE, tender
induration or
fluctuation area felt
above the level of
anorectal ring.
• CT or MRI diagnosed

7. Differential diagnosis:
• Anal abscess
• Anal fissure
• Anal ulcer or sores.
• Pilonidal sinuses
• Thrombosed external hemorrhoids
Diagnosis
Clinical diagnosis Imaging studies :
• Including CT, MRI,
transperitoneal or
endorectal ultrasound.
• To confirm diagnosis of
deep anorectal abscess.

8. Management
Perianal abscess
( superficial ):
• Incision and
drainage (I&D).
Intersphinteric
abscess:
• Transrectal
drainage
Ischiorectal
abscess:
• US guidance
drainage.
supralevator abscess:
• CT scan guidance
percutaneous drainage
• Antibiotic (ciprofluxin
or augmentin)